I suppose many of you will think I'm being inflammatory or provocative with what I'm about to say. You'll have to take my word for it when I say that I'm not.
"Fat Rights" advocates are, as a rule, barking up the wrong tree. What most fat people suffer from is not just a poor body image. The correlation between obesity and diabetes is firmly established, along with a host of related life-threatening conditions. It is very hard to be both fat and healthy--not impossible, but very difficult, especially over the long haul.
That said, here are a few startling points to ponder:
1) Medical research shows that, for obese subjects, barely 1% ever manage to maintain normalweight (non-overweight) status and keep it there for 5 years or more. Of the 1% or so who do manage it, the majority have been shown to subsist permanently on an abnormally low caloric intake--not just less than the average population, but less than most physicians recommend for healthy adults.
2) Most clinical weight loss programs involving diet and exercise for obese patients count as a "success" any patient who manages to keep 5-10 pounds off for two or more years--and 2/3rds of patients fail to maintain that minimal a loss.
3) Not one clinically controlled study has ever shown that "eat better and exercise more" is an effective long-term strategy for elminating obesity. Preventing weight increase, yes. Moderate weight loss, yes. But not one has ever shown that this treatment is a cure for the seriously overweight.
Not a single one.
4) There is, despite a century of research, no evidence that obese individuals eat more than non-obese individuals, are more lazy or less disciplined, or suffer from psychological abnormalities that cause their obesity.
5) A growing body of research indicates that losing weight through dieting (whether combind with exercise or not) may, in some individuals, either cause obesity or severely aggravate the condition. Some researchers even believe that dieting may be the primary cause of obesity in the Western world. Even if it's not, it appears to be a significant contributing factor in many individuals.
6) Research also in dicates that, over the past 20+ years, Americans have actually eaten fewer calories (and less fat) daily than they used to, while the national rates of obesity have skyrocketed.
Hard to believe? Would it surprise you to know that I used to run a mailing list full of dieticians, physical trainers, and physicians, from which I learned most of the above? That I've pored over tons of peer-reviewed scientific research, and found all of the above confirmed again and again and again in the medical literature?
In fact, the six things I said above are no longer even controversial among physicians who keep up on the current literature on obesity. It's not controversial in modern medical schools, either. There's controversy over what does cause obesity, or what the best strategies for dealing with it are. But the current state of medical research is virtually unanimous about the fact that there is no reliable treatment at this time.
If you are extremely overweight, you should ask your doctor about this--and immediately fire any doctor who brushes off these issues and assures you that you can get down to a normal weight if you just eat better and exercise more.
In fact, you may hear your physician espouse the conventional wisdom of 10+ years ago, which was "eat less and exercise more is the only thing that's ever been proven to fix obesity" and "almost no one is overweight because of glandular problems." Both such claims, while widespread among physicians who are unqualified to treat obesity, are demonstrably false-to-fact. Your average internist, especially one who's been out of medical school for a while, may not know that. But if you have a physician who says something like that, you should strongly consider firing him. Few internists are qualified to treat obesity. But, please believe me: What I told you above is the consensus opinion of the medical community that actually deals with these issues. It is something you will rarely find in popular magazine articles or diet books, but it is the unvarnished truth.
By the way, if you're into some serious technical reading, you may want to spend a couple of hours reading, contemplating, and digesting Chuck Forsberg's Adiposity 101. It's a tough, long read, but it's a pretty good compendium of the last 15-20 years of research on obesity--and you will find confirmation there of everything I've said here, and quite a bit more that may surprise you.
If you're seriously overweight, you should find a physician who specializes in weight issues, and who keeps up on the current literature in the field. Simply call around to different doctors' offices and ask the office staff about the doctor's experience in treating obesity, and whether the doctor keeps up on current obesity research. That will usually be your best bet.
If you're seriously overweight, I cannot emphasize strongly enough how important it is that you find a qualified, experienced physician who's up to date on the field. Don't kid yourself into thinking that convincing-sounding diet books and a little self-discipline will help you, either. Unless you're only looking to drop 5, 10, maybe 15-20 pounds, such approaches are all but worthless. You need medical advice and assistance from people who know what they're doing. You really do.
The "fat-rights" people, or whatever they call themselves, are barking up the right tree, in a way...Positive self-image is important if you want to help yourself. Society needs to change its views on obesity in order for the problem to really get seriously addressed.
The "fat rights" people need to wake up and realize that they have a lower quality of life and a shorter life span than people who are at an average weight and physically fit. A large part of the problem is to be blamed on the medical profession itself. A tiny portion of training for med students focuses on diet and weight maintenence. The training they usually get is outdated. Diet research is usually flawed for the most part. Food companies are also to blame for their false advertising on healthy low fat and low calorie products. Especially Subway restaurants, with the Jared diet.
If you want to lose weight and improve your overall health, I reccomend a high protein/low carbohydrate diet such as Protein Power by Drs. Michael & Mary Dan Eades or The Atkins Diet by the late Dr. Robert Atkins. The Protein Power is a really interesting book. The Eades provide a lot of historical and medical data in explaining why the high protein low carbohydrate diet works and critically bashes the medical, diet and food industries for their flawed research.
Read the books, go on their diet plan and don't forget to exercise!
All the barking I hear coming from the "fat rights" people has nothing to do with addressing obestity. Rather, they seek to convince us all that it's ok to be obese. I hate to be politically incorrect, but it's NOT ok. Being obese puts you at significantly higher risk of diabetes, heart disease, some forms of cancer, back problems, and various other unpleasantries.
When the fat rights people start demanding help instead of acceptance, I'll be right there with them.
Self-esteem is not going to change one's biology. I'd rather see society working on something slightly less improbable than the Sun rising in the West. The clinically obese deserve better than slogans and bumperstickers about how they're "people too".
I for one find it encouraging that the obesity research community seems to be coming to the realization that the human body is a complex mechanism, and that simple energy economics don't rule the means by which we take in and conserve caloric energy.
I had a need to lose at least 30 pounds (a recommendation I arrived at after consulting both a dietician and an obesity specialist), and have had moderate success with the South Beach diet (17 pounds in 4 weeks). I looked into Atkins, but did not find it sustainable over the course of my lifespan. The recommendations of Dr. Agatston have been incorporated into my lifestyle, and I fully expect to reach my goal weight within my goal timeframe.
The most important aspect of my weight loss has been the attitude that I'm not on a diet, I've changed my eating habits.
1) Medical research shows that, for obese subjects, barely 1% ever manage to maintain normalweight (non-overweight) status and keep it there for 5 years or more. Of the 1% or so who do manage it, the majority have been shown to subsist permanently on an abnormally low caloric intake--not just less than the average population, but less than most physicians recommend for healthy adults.
What does your research show about these persons' caloric intake vis-a-vis the rest of the citizens of the world? Comparing obese Americans' caloric intake to that of Americans in general is like comparing different levels of anti-Semitism in Nazi Germany. If the whole country is screwed up, it's not a valid basis of comparison.
3) Not one clinically controlled study has ever shown that "eat better and exercise more" is an effective long-term strategy for elminating obesity. Preventing weight increase, yes. Moderate weight loss, yes. But not one has ever shown that this treatment is a cure for the seriously overweight.
Not a single one.
And this indicts the concept or those trying to implement it? Have any studies ever actually confined the participants and physically constrained them from cheating on the program? I'm guessing not.
4) There is, despite a century of research, no evidence that obese individuals eat more than non-obese individuals, are more lazy or less disciplined, or suffer from psychological abnormalities that cause their obesity.
What we do know, without having to pass any kind of judgment, is that they are not exercising enough to offset their calorie consumption. You can call this "lazy," "undisciplined," "unfortunate" or whatever you prefer. I roomed with a formerly-obese woman during flight school who resolved to do extensive aerobic exercise (generally 6-mile runs to and from the Pensacola Bay Bridge) combined with a very low caloric intake. I used to run cross-country competitively and she could throw me by mile 4. I think it's fair to say that almost all of us are lazier than she was, myself included.
6) Research also in dicates that, over the past 20+ years, Americans have actually eaten fewer calories (and less fat) daily than they used to, while the national rates of obesity have skyrocketed.
My father (and his father) grew up on a farm, where mornings spent flipping hay bales to the cattle prepared him for, among other things, being the Kansas state champion in wrestling for his weight class. The "townies" had absolutely no base of athletic conditioning which could prepare them to wrestle against him. This is one reason old-time farmers are astounded by modern aerobic exercise programs, which they call "fake work." Comparisons between current and past caloric consumption in discussions about obesity are totally useless unless they include an accounting for different physical activity levels.
By comparison to almost any previous generation and any nation through history (though there are certain exceptions) we are a nation and generation of glutonous slackers. Does this play out differently for people with different metabolisms? Absolutely. But that doesn't excuse any of us.
"A growing body of research indicates that losing weight through dieting (whether combind with exercise or not) may, in some individuals, either cause obesity or severely aggravate the condition. Some researchers even believe that dieting may be the primary cause of obesity in the Western world. Even if it's not, it appears to be a significant contributing factor in many individuals"
Perhaps you can explain this... I would say that there's absolutely NO WAY someone can gain weight if they eat less. That is, if a person weighs 200 lbs and normally consumes 2500 calories a day (and burns, let's say, 2000), and they switch to eating 1700 calories a day, then it is quite literally impossible for them to gain weight.
Sure, someone dieting can still gain weight - if the hypothetical person above only cut to 2100 calories a day, for instance. But beyond the obvious fact that someone who takes in more than they use will gain weight, I don't understand this point. (Of course, this is also assuming that people choose a diet and stick with it - not that they diet for a week, binge for two, etc.)
You need medical advice and assistance from people who know what they're doing.
Hadn'd you just pointed out that nobody has been successful in treating obesity? Who are these people, and how, exactly, do they help?
Gosh, how does anybody actually starve to death?
How come there weren't a few obese people in the death camps, or in Somalia?
When I was in Infantry OCS, in 1969, we got, maybe, two meals a day, due to exigencies in scheduling, and worked like decathaletes in training. I was 205 when I graduated. I'm now considerably larger. I have eaten more and exercised less since then.
We graduated in mid-December. I had a three-week leave. I visited lots of old friends at their folks' homes--it being holidays. Invariably, the father would pour me another drink and the mother would say I was looking thin--damn right--and make me eat another piece of pie. Went up ten pounds in three weeks.
Coincidence?
The human body is a complex organism. I don't feel weight gain is a simple calories in calories out situation.
Some people may simply eat too much. Others, however, despite reasonable diet and exercise can not obtain, or maintain a significant weight loss
I believe there is something, or somethings, in the American food supply which is messing up the insulin balance in the bodies of many people. One theory is the use of high fructose corn syrup, rather than natural sugar, and it's presence in almost all processed foods. Could other additives be contributing as well? A recent study found children who were treated with anti-biotics at a young age had a higher incidence of asthma later in life. Are any of these chemicals a factor?
When some obese people have to resort to stomach stapling and a life of 1 ounce meals to approach a quasi-normal body weight, something is very wrong.
A nationwide pattern of continual dieting has merely trained many of our bodies to be more efficient fat storing organisms. This raises the question "how much of the nationwide obesity epidemic is really caused by dieting"?
I agree with other posters who are not happy saying "fat is OK". Rather we must focus resources to find out what we must really do to identify the actual causes of obesity and address them.
Larry, we don't need any help at being efficient fat-storing organisms. That's the way nature evolved us to be- it used to be a good thing. We like the way food tastes when it's high in sugar and fat because that used to mean the difference between survival and starvation. Now, we're killing ourselves because of it.
While I am pretty far from wanting to sue McDonalds, since I still believe in freedom of choice (and my kids like Happy Meals), our culture is to blame. People who move here from places where there are a lot fewer cheap calories to be had very quickly catch up to us Americans, maybe not the first generation, but definitely the second. There are lots of ethnic differences too- Native Americans seem to have much more trouble, and more problems from extra weight, too, like diabetes.
Although, knowing what kind of chemicals (antibiotics and growth hormone) goes into commercial meat has made me cut way back on that. So you may have a point there.
What I would suggest to some of you who are being so critical is that you actually read the article I linked to. The research is there, and you can go read it yourself.
Calories in/calories out is grade-school science. It really is. And frankly, snottily throwing that at someone who's seriously overweight is abusively condescending.
There are a ton of variables. Your body can, for example, simply refuse to burn its fat content. Furthermore, certain types of fat cells burn calories more quickly than others. The regulatory hormones that stimulate appetite can get out of whack. Metabolisms can speed up and slow down, irrespective of your diet or exercise patterns. There's research showing that, for some fat people, there is almost NO increase in metabolism no matter how much they exercise.
As for why you should seek a physician's assistance: because different approaches have been shown to work for some individuals but not others. Furthermore, you need to be monitored, because there is a huge amount of data suggesting that if you take 20 or 30 pounds off, and you don't keep it off, you'll trigger yourself into a spiral of greater and greater weight gain that could kill you. Once you lose 30 or more pounds, your health is in serious jeapardy if you put it back on, to a much greater degree than if you'd never lost it in the first place.
In other words, when you diet, and you're trying to lose more than a few pounds, you're doing something that's hazardous to your health. It's swerious business. You're treating a medical condition that's poorly understood, and you needt he assistance of someone who's up to speed on the latest research and has real experience in helping people. If you can't control your obesity with diet and exercise alone, you are a fool to just tell yourself, "well I lack discipline" and try to "psych yourself up for another try." 99% of people who try that fail, and most of them wind up fatter than ever.
Several people have tried to persuade me that some people "just get heavy" even though they don't eat more than they need to.
This has always seemed ridiculous to me, but some people in this forum seem to have read studies about it, so here's the question I've asked every time:
How can a person gain weight if they expend more energy than they consume?
(Answer: they can't. The reason people are heavy is because they retain water, or consume more energy than they expend.)
Hi Dean,
Our posts crossed paths. I didn't see yours when I wrote mine, and I haven't read the article.
The metabolism and appetite hormones arguments don't seem to conflict with "Calories-in, Calories-out" theory, they just show why it may be particularly hard for some people to consume fewer calories, or why their body gets better gas mileage.
But either way, the underlying scientific principle is still there: you can't grow unless you consume more than you expend. The research doesn't dispute that, does it?
I did some research into eating disorders in college for my thesis and I came up with one fact that may partially explain how diets can actually cause a person to gain weight: The body is trained to react to starvation by demanding lots of calories, and many an inexperienced dieter will start by trying to cut their intake by far too much. It's really, really hard to think clearly when you're hungry (as I sadly know) and diets that are too extreme force a hunger that is equally extreme. Result: diet broken, weight goes up.
The sad addendum to this fact is that many of the medical problems caused by obesity seem to be equally likely to have been caused by weight swings. Two or three dramatic weight swings are enough to cause serious lifelong health consequences.
(And, BTW, it bugs the heck out of me when people equate weight with willpower. If that were true, I'd be willpower supreme, when actually I'm not, and my "overweight" college roommate who could kick my butt physically in any test you'd care to name would be the "weak" one. While some portion of obesity can be laid at the feet of those who eat nothing but junkfood and teach their children to do the same, some of it truly IS glandular, and those who lump everyone into one "weak-willed" category are doing many people a vast disservice, and I can name names.)
I should point out that my feelings below are not directed at anyone personally, particularly you, Danielle. But I read Dean's point about getting a doctor who knows what he/she is doing, and I find myself in violent agreement.
I actually fear doctors to a degree, until I know them a little better. Because doctors can kill, and have.
My wife has a rare inherited syndrome that has life-threatening implications. For this condition, the most important treatment is knowledge. Those who know and plan for the problems they are likely to have can expect a normal lifespan with minimal to moderate quality-of-life issues and a few major surgeries, but those who don't usually die by their 40th birthday.
Because the condition is rare, few doctors in the world know much about it besides the quick overview they received in medical school. This does not prevent these doctors from making poor decisions in ignorance. In particular, doctors will argue with patients over treatment in ways that threatens the health and quality of life of patients. Too many times, the patients turn out to be the experts in the field, and the doctors only hinder them from reaching health.
This summer, we went to Chicago to a conference on this condition, and we met lots of wonderful people. One of them was a person who had worked to help people with this condition all his life. He sat on the board of the main charity that covers the condition, and even helped design and build its headquarters. He had access to world-renowned experts in the field to treat his own case, and was extremely conscientious in monitoring himself. His medical records had extensive commentaries and information about his condition from the aforementioned experts, and to the extent possible, he had informed everyone about his condition.
A few weeks after the conference, this person's heart essentially failed; the details are likely a bit technical, but I'll just say that the process ends in death without immediate treatment and surgical correction, but is very survivable with this treatment. However, when he was rushed to the emergency room, a cardiologist blocked the life-saving treatments because he felt the condition was not as severe as the patient and his family claimed.
The cardiologist was overruled, but the process took many crucial hours, during which the patient's condition deteriorated beyond the point of treatment. He died a few days after being admitted.
These exact circumstances could well play out with my wife. She is not on the board of this charity, and her access to world-renowned experts is much less. She has already had several cardiologists give her bad advice, one instance of which could have been life-threatening had she followed it.
Yet the day could come where she experiences what this man experienced, and we may be on the road to our own emergency room. If that day comes, will some know-it-all decide that his professional opinion is better than my layman's familiarity, or the instructions I relay from the experts I've seen? And if he does, will I be able to convince others of his stupidity - despite his M.D. - to save my wife's life?
So I applaud Dean and Rosemary for not accepting shoddy service, and for finding doctors that can really help. Doctors should work to earn your trust, and the good ones will. When a doctor doesn't, flee from his presence.
The best doctors are priceless gems. I have spoken with some of these experts, and they rank among the greatest examples of humanity this world can offer. But the worst suck the life out of us through the fear they induce by their very presence.
I apologize if this is off-topic, but you touched a raw nerve with me.
Grrrr.
Nick, your basic problem is that you're uninformed. Go read some of the sources, and check back, because basically everything you've got to say is (a) "common sense" and (b) contradicted by the actual studies. One particular study you might want to look into is the "Pima Indian" study, in which people from the Pima tribe not only were put under conditions under which their food intake was completely controlled, but their total bodily outputs were rigorously examined, including water metabolism and oxygen consumption. (Why from the Pima nation? Because they've had particularly extreme problems with obesity and consequent problems.)
But then how is it that people's metabolisms violate the "common sense" equation that calories in must exceed calories out to gain weight? Of course, the naive answer to that is "they can't".
To see why it's a naive answer, consider an exactly analgous question: why is it that even in very cold conditions, people's body temperature can stay the same? After all, calories out must equal calories in, and in cold conditions calories out clearly increase. Of course, we know that within wide limits of environmental temperature, the body is perfectly capable of keeping body temperature regulated to within a few tenths of a degree. It does so through a variety of homeostatic mechanisms: sweating, vasodialation and vasoconstriction, and so on, including (wait for it) regulation of metabolic rate.
What was discovered in the Pima studies was that Pimas -- and, in fact, most everyone -- down-regulate their metabolic rates when challenged by low calorie intake. When on a 1200 calorie diabetic diet, Pimas down-regulate their metabolisms to that they can do a day's work, including substantial exercise, on much fewer calories than we'd consider "normal", or even (until these studies) possible.
There's one other bit of information here, though: it's very clear that there are homeostatic mechanisms through which certain people don't gain weight -- there are people who are naturally skinny. There appear to be at least two mechanisms involved in this: changes in metabolism, and appetite regulation.
The studies on the Pimas, and others including the observation that obesity seems to be partially genetically regulated (eg, twin studies) got people looking for a mechanism. At least one such has been found in mice: a protein called "leptin", which is coded for by a particular gene, which is expressed in adipose tissue, and which is apparently involved in weight regulation. (See this site.)
Here's a money quote from that site:
On the issue of people who go on South Beach or Atkins: there's a good bit of evidence to suggest that there are a couple of different etiologies involved here. There are a number of people who are 10-20 pounds overweight who really are just short of exercise; small changes in diet or exercise can make the necessary changes. There's a second population -- anechdotally, it's people who are around 30 percent or more overweight -- who appear to suffer from some sort of "pre-diabetic sugar sensitivity", and who seem by recent studies to benefit from low-glycemic-index diets like Atkins and South Beach. I suspect that these same people are the ones who are likely to get Type II diabetes, which is characterized by insulin insensitivity. This is interesting, because insulin basically does two things: it directly regulates the use of glucose by the cells, and it (through a complicated metabolic regulatory pathway, see, eg, this presentation) regulates the uptake of lipids into adipose tissue -- that is, the storage of fats in fatty tissues. These two mechanisms are relatively distinct, and it means there's every good reason to suspect that fat gains in this pre-diabetic condition is a secondary side effect of the body trying to homeostatically regulate glucose metabolism.
Then there's a third group, who are profoundly obese -- those few sad folks you see who weigh three or four or five times more than normal weight. I'm not sure that I've ever seen any good explanation for this condition, but it seems anechdotally to happen in people of normal weight, come on suddenly, and be connected with major emotional trauma. (Note I'm saying "anechdotally" -- I don't have statistics to demonstrate it cleanly, just an impression from a number of examples I ran into in medical school.) I don't know that I've ever heard a good explanation for why it happens, or heard of a really effective treatment.
Matt: The problem with the calories in/calories out equation is that it's like saying, "if you put gas in the car, the car will go." What if your fuel line is clogged? What if your rings are shot? Your catalytic converted ruined? Your turbocharger frozen up? Your spark plugs fouled?
If the metabolism cannot kick into a high enough gear to burn calories normally, if the chemical processes which mobilize fat stores are retarded, if the temperature-regulating mechanisms don't work right, you're not going to burn calories like a normal person.
That's not even to bring up the issue of calorie conversion. If person A's metabolism converts fuel to fat more efficiently than person B's, then person A is going to put on weight much more quickly.
I'm only just getting started on the possible problems, even if the person's appetite control mechanisms are functioning completely normally. And if those aren't functioning properly....
There are countless factors at play here, in other words. Fuel may not be converted into calories as quickly by some as others, conversion and mobilization of fat stores as fuel may be retarded in some, storage rates may be higher, excretion of excess may be lower, metabolic processes which burn off calories as heat may not work right for some--the variables are tremendous.
The most damning indictment of the notion that obese people can lose their weight "if they really want to," to me, is the 99% failure rate of those who have been obese for any significant amount of time--and the fact that surveys of the 1% who do manage to attain full normalweight success over 5 or more years show that most of them eat abnormally low amounts of food for the rest of their lives, diets that would be considered starvation level by most people.
I've met people like this, and do you know what they admit to me? They're hungry when they go to bed, they're hungry when they wake up, they're hungry all day and all night, and they never leave a meal feeling satisfied. They have merely learned how to live with constant hunger, 24 hours a day, 7 days a week.
How long do you think you could put up with that?
Here's the real danger: everyone who gets obese is pretty much convinced that if he can just "psych himself up" he can take it all off. Odds of success are vanishingly small. Weight rebound is far more likely, which is a huge health hazard, and makes the next attempt to lose weight even harder because you've reset your body's set point.
Left-wingers. Right-wingers. Christians. Jews. Mormons. Raving Fire-and-Brimstone Baptists and Atheists. Democrats. Republicans. You find people going through this cycle in all walks of life, in every profession, and in every philosophical outlook. Can it really be that an entire third of the population, spread through all groups, is merely "undisiplined?"
Jeff: You're right. Doctors go through a hell of a lot to get through medical school, but it remains that we have a tendency to trust them excessively. Smart patients (who also know how not to be hypocondriacs) know that they are in charge and the doctor works for them. We are not just "patients," and we are not "partners." We are customers. We here at the Esmay abode own a Merck Manual, a Physician's Desk Reference, a couple of good medical dictionaries, and often spend time scanning Medline--not the consumer version, either, but the real one read by doctors. The doctors we work with tend to treasure this in us, because we are both rational and informed.
Jeff
Don't worry about offending me. No doctor knows everything, a good one knows when to get a patient to a specialist or subspecialist.
That is just terrible about your friend ( and your wife). I don't know the condition of which you speak, but this is a REALLY good example of the need for some kind of card with a microchip that contains ALL your medical history in a credit card. I do not know why this idea has not taken off, it probably has something to do with privacy laws.
In lieu of that, if you have a rare condition, keep a copy of a letter ON YOUR PERSON, written by your doctor, that outlines the problem and where he/she can be contacted. This has worked very well for my patients- I wouldn't say I treat really rare conditions very often, but even common problems can have treatments that have taken years to work out and it's easy for another doctor to come along and change everything around without knowing how hard it was to get to that point.
Doctors can be arrogant and we should be called on it. But that arrogance is an unfortunate byproduct of having self-confidence, an essential ingredient to surviving medical training and making difficult decisions from an almost overwhelming (and changing) amount of information, every day. It is really unbelievable how much you have to know and keep up on. For generalists, it's very hard. Even with the advent of the internet and palm pilots, we all still have to think on our feet.
Doctors can be arrogant and we should be called on it. But that arrogance is an unfortunate byproduct of having self-confidence, an essential ingredient to surviving medical training and making difficult decisions from an almost overwhelming (and changing) amount of information, every day.
And the CROWD GOES WILD!!!!
Will you be my new internet Doc?
(Just kidding. ;-)
To Nick's comments - It is entirely possible to gain weight while eating fewer calories - it's just a lot less likely to happen to someone in their 20's or 30's.
I am fat. Damn, I don't want to be. I eat very moderately, and walk whenever I can. The more diets I tried, the fatter I got. Oddly, my cholesterol levels are about perfect - which drives my doctor to distraction.
On the other hand, I am am a productive citizen, I rarely take a sick day (until I got shingles last year, I had not missed a day of work for illness for 3 years in a row). I pay my taxes, I vote, I contribute to society.
Why, then, must I put up with so much abuse from people who are 30 years younger than I am or who have been forever thin?
The way many people talk, I am downright immoral and most definitely lazy. But, at the same time I have earned rewards many times at work because I am such a hard worker, diligent, and generally very good at what I do.
So what's a fat woman to do?
My husband's grandma was fat until the day she died at 102 years of age. She had her 1/2 pound of bacon every day - go figure.
So try hard to be less cruel when you see us fatties around. People are kinder to drug addicts and alchoholics than they are to fat people. Give us a break.
Calories in/calories out is grade-school science. It really is. And frankly, snottily throwing that at someone who's seriously overweight is abusively condescending.
So are Newton's laws of motion, but it doesn't stop them from holding true, except in subatomic physics. If you want to prove something incorrect, then prove it incorrect. Name-calling is beneath you.
There are a ton of variables. Your body can, for example, simply refuse to burn its fat content. Furthermore, certain types of fat cells burn calories more quickly than others. The regulatory hormones that stimulate appetite can get out of whack. Metabolisms can speed up and slow down, irrespective of your diet or exercise patterns. There's research showing that, for some fat people, there is almost NO increase in metabolism no matter how much they exercise.
I understand your refusal to simply admit the scientific truth of the calories in vs. calories out reality, but it is reality. Period. To use your engine analogy: a gasoline engine may be more or less efficient than other engines, but it won't go anywhere without gasoline. A person's metabolism may be more or less efficient than another person's, but neither of them will gain weight unless their caloric intake exceeds their caloric expenditure.
Saying that there are "other variables" just restates what we already know about differences in the systems. It doesn't change the fundamental reality of the system. Saying otherwise is disingenuous at best.
One more thing . . .
If obesity is generally determined by genetics, why has the American incidence of obesity skyrocketed during the past fifty years?
We're still using the same gene pool (the same "natives" and the same sources of immigrants) to create new people. Why the sudden increases in obesity?
I grant that there may be a few people for whom metabolism causes more trouble at a given level of caloric intake than the rest of us. But there shouldn't be any more of these people as a percentage of the population than there used to be. Unless the obese are more likely to have children or their children are more likely to survive, we are working with the same genes as before.
Absent convincing evidence to the contrary, I will continue to believe we have behaved ourselves to where we are now, and if we're not satisfied we need to behave ourselves back to where we came from, health habit-wise
Jonathon, basically you need to read the research. The reason the "grade school" thermodynamics is wrong is because it is a model which is disproven by experiment. "If the bird book and the bird disagree, believe the bird."
Got that? Disproven by experiment.
Read the literature, learn the real science. You don't know it now. Your opinion is uninformed. You don't know what you're talking about. Hell, just reading the leptin link above -- note it's not some pop-diet site, it's part of a formal endocrinology course at a major university -- would inform you on the areas in which you are mistaken.
Ok, I've read through the Adipose 101 article.
Most importantly, it never denies the Calories-In, Calories-Out theory. What it does claim is that complex factors influence people's appetites and metabolism. It never says that people who eat less then they expend fail to lose weight.
Here's one quote:
"the public must first be weaned from its belief that the obese eat much more than other people, that this is the cause of their obesity, and that they could become lean and remain slender simply by eating normal amounts of food."
This might appear to contradict Calories-In, Calories Out, but it doesn't. It only says that some obese people gain weight even when they eat "normal amounts" of food, and don't eat "much more than other people". This merely challenges the idea that everyone's caloric needs are the same. But Calories-In, Calories-Out never said that obese people eat more than other people; it says they eat MORE THAN THEY NEED.
This theory is key to the article's argument:
"The SET POINT THEORY of body weight regulation postulates that a biological servo system affects energy expenditure, hormones, fat cell receptors, appetite, and other metabolic parameters to maintain a constant body weight (set point) resistant to changes in energy input or exertion."
This says that there's some regulator in my body that tries to reach a given weight. Note that it does not challenge the Calories-In, Calories-Out theory either, and only postulates that my appetite and other metabolic parameters will respond when my weight differs from my set point.
In summary, Adiposity 101 helps explain _why_ it's so hard for some people to limit their caloric intake to what they expend, or to expend the calories they consume: their bodies are programmed to resist weight change.
It does not show or claim that people who consume less than they expend fail to lose weight.
Gentlemen:
Matt, thanks for expressing my exact throughts.
Charlie: you're the one who has no idea what he (or she) is talking about. Organic creatures are a closed thermodynamic system. As calories are expended through normal metabolic funcions (keeping us alert, warm despite cold environment) and through physical activity, these calories must be replenished or the organism will eventually die. Not immediately (heck, bears can hibernate without ingesting new food for months) but eventually.
Show me the experiment in which the subjects were prevented from consuming more calories then they expended over the space of a year or so, and I will write to the chemistry book publishers and bring this to their attention. But that isn't going to happen because we're talking about mathematics and chemistry here--physical reality, not thoughts and feelings. It isn't up for subjective interpretation.
Is this to say that the chronically obese are able to lose weight without experiencing hunger pangs, and/or without a strange-to-our-modern-society commitment to hours of aerobic activity each day? Absolutely not. No one denies that maintaining one's medically appropriate weight can be a struggle. That's not what this conversation is about.
Some years ago, we had a local media fluster about a thousand-pound woman in a local hospital.
She was getting no better.
I happened to run into a meds tech who worked on her floor and posed the astonished question of how can she gain weight on 1100 calories a day.
It turns out that her friends brought her pizza and donuts.
The same thing happened last month, with a guy weighing 960 being ineligible for a stomach staple because the surgical table was only certified to eight hundred pounds. They threw him out after it was discovered he had his friends bringing him food.
Some of these people need psychiatric intervention, but they haven't invalidated the law of conservation of matter and energy.
A couple of quick comments:
The calories in = calories out is true...but it is overly simplistic since energy expenditure is not the only way calories leave the system...keep in mind that digestion is never 100% efficient, and can vary greatly from person to person and under different conditions.
Also, please be careful with the terms 'diet' and 'dieting'. Changing one's long-term diet IS effective at controlling weight, but as Dean points out, may require incredible self-control to maintain. (And I don't want to hear any crap about how you could do it if you had to...the number say it all...99% of people can't do it.) 'Dieting', or short-term changes in diet, are usually harmful over all.
Lastly, dave said "All the barking I hear coming from the "fat rights" people has nothing to do with addressing obestity." But this is not true. Many heavy people feel scorned and mistreated, and as a result tend to refrain from physical activities where they might be made fun of. For many, this is a substantial road-block to getting started on a excercise routine that can greatly improve their health and quality of life.