The Paradox of Metabolically Healthy Obesity

September 17, 2010 3:52 PM

From Obesity Panacea, a blog is written by two obesity researchers: a 5-part series delving into the fascinating and seemingly paradoxical research on people who remain metabolically-healthy despite being obese: 1) Introduction: An Oxymoron? 2) Prospective Risk of Disease 3) Lower Risk of Mortality? 4) Is Weight Loss Detrimental? 5) Is Weight Loss Beneficial?

A summary of the first four posts from Part 5:

So what have we learned thus far?

1. About a third of obese individuals fail to exhibit the metabolic complications commonly attributed to excess weight.

2. These same individuals also seem to be at the same relative risk of diabetes and cardiovascular disease as equally healthy, but lean individuals.

3. Nevertheless, despite being metabolically healthy, some evidence suggests that excess weight may put such obese individuals at risk for early mortality due to other, non-metabolic, factors.

4. This latter point would imply that all obese individuals should be encouraged to lose weight, despite their metabolic health. This, in fact, is in line with guidelines developed by leading health authorities which currently recommend weight reduction as the primary treatment strategy for all obese patients, regardless of metabolic health. However, as we learned yesterday, weight loss via caloric restriction among metabolically healthy obese may actually result in a deterioration in insulin sensitivity, thereby increasing risk of developing type-2 diabetes.

posted by ocherdraco (40 comments total)

"a blog written" rather. Please pardon the typo.
posted by ocherdraco at 3:53 PM on September 17, 2010

Given the numerous non-metabolic benefits of weight loss (mobility, joint problems, psychological status, sexual function, etc.), all obese individuals have something to gain from a modest 5-10% weight loss.

I thought it was interesting that they are calling for such moderate weight loss, rather than what I see more often which is some kind of call for everyone to move down into the "normal" BMI range. I'm not sure if they are just trying to be realistic (because weight loss is difficult at best and harder to sustain) or if the benefits are concentrated in small weight loss like that.

Regardless, I think it is only for the better to complicate the easy (and perhaps fictitious) stereotype that fatness equals immanent death. Our bodies are complex, and the interactions between an individual's body and the structures of our society (eg food, transportation, housing, etc) are even more complex. The easy answers don't seem to work so well, so maybe in complexity we can find some better options.
posted by Forktine at 4:43 PM on September 17, 2010

I thought it was interesting that they are calling for such moderate weight loss

And, yet, someone does not necessarily leave the set of "all obese individuals" when one loses 5-10%. So, maybe it is intended to be incremental and cumulative.
posted by found missing at 5:03 PM on September 17, 2010

Yes, yet again a little truth strives to the top. Folks, overweight does not equal unhealthy. Not even in the majority of cases. This is a good primer on the basics, from a good blogger and author on the wow-do-we-really-need-this topic of "fat acceptance."
posted by gilrain at 5:23 PM on September 17, 2010 [6 favorites]

This is a good primer on the basics, from a good blogger and author on the wow-do-we-really-need-this topic of "fat acceptance."

Wow that blog was hard to read. I don't think the writer is heavy because of fat, I think it's from the giant fucking chip on her shoulder. If her argument is valid (and that's debatable) she needs to learn how to express it better.
posted by rocket88 at 5:53 PM on September 17, 2010

I imagine that when you are frequently discriminated against based on genetics, a chip on your shoulder is the better defense than caving into undeserved shame.
posted by gilrain at 6:07 PM on September 17, 2010 [13 favorites]

If her argument is valid (and that's debatable) she needs to learn how to express it better.

Yeah, after my brother-in-law contracted type 2 diabetes I decided to cut out soda, candy, and junk food. I've lost 35 lbs in a year, and I still eat whatever I want to in restaurants, just no sugary stuff and I typically split a meal with my wife.

According to her, I'm going to magically gain the weight back sometime in the next four years... even though I can't eat sugary stuff any more, it's repulsive to me.

Although, I must admit, my brother-in-law also stopped eating the stuff and is as heavy as ever... so maybe she has some kind of point.
posted by Huck500 at 6:18 PM on September 17, 2010 [1 favorite]

rocket88: "This is a good primer on the basics, from a good blogger and author on the wow-do-we-really-need-this topic of "fat acceptance."

Wow that blog was hard to read. I don't think the writer is heavy because of fat, I think it's from the giant fucking chip on her shoulder. If her argument is valid (and that's debatable) she needs to learn how to express it better."

Ah, good 'ol "You've Lost Your Temper So I Don't Have To Listen To You Anymore". It's been a while.
posted by ShawnStruck at 6:21 PM on September 17, 2010 [11 favorites]

When faced with opposing viewpoints on a topic, I choose to believe the one that makes me feel better about myself.
posted by Mayor Curley at 6:22 PM on September 17, 2010 [4 favorites]

So in part 3, Dr. Kuk says, My study shows that individuals who are obese and do not have common diabetes and heart disease risk factors die at the same rate as those who do.

Wouldn't this be a huge result? Not just "la la, see all fat people should lose weight," this result is saying that all this stuff about diabetes, heart disease, and obesity means nothing in terms of overall mortality rates for obese people. Maybe Dr. Kuk was overstating things.

Anyway, some of these factors are probably indirectly influenced by environmental issues, ranging from subtle (cancer not spotted because doctors of obese patients laser-focus on diabetes risk issues and ignore everything else) to the extreme retardation of labeling someone as unhealthy because of "longer transport times due to their higher body weight, and difficulty assessing and treating the injuries due to their increased size."
posted by fleacircus at 6:23 PM on September 17, 2010

According to her, I'm going to magically gain the weight back sometime in the next four years

You might. It happens really often. It's happened to me by varying degrees a few times. But you get back up on the horse.

What you shouldn't do is then shop around for what you want to hear, and embrace that even if it flies in the face of the bulk of evidence. That's what Creationists do.
posted by Mayor Curley at 6:30 PM on September 17, 2010 [1 favorite]

Folks, overweight does not equal unhealthy. Not even in the majority of cases.

Read the rest part 5, particularly the results of their own study.

Bottom line?

Although a fair number of obese individuals may have a perfect metabolic profile, it appears they may still experience negative consequences of their excess weight. Furthermore, weight loss achieved via lifestyle intervention appears to still bring about some metabolic benefit among previously healthy obese individuals (it certainly doesn’t seem to harm health). Given the numerous non-metabolic benefits of weight loss (mobility, joint problems, psychological status, sexual function, etc.), all obese individuals have something to gain from a modest 5-10% weight loss.

It may not amount to 'unhealthy,' but the point remains that weight loss has substantial health benefits for all obese people.
posted by jedicus at 6:55 PM on September 17, 2010 [6 favorites]

I only started gaining weight when I got to my late 20s/early 30s and was working at a desk all day and eating in front of the TV in the evening. Last year I moved to the Caribbean and most days I hike in 90 degree heat or go scuba diving and I'm skinny again. My takeaway is that it feels much better to be not overweight, but if I was still spending my days on the computer instead of taking photos of insects, I would not have changed.

I don't think anyone really wants to be obese, and I don't think it is healthy or enjoyable to lug all that extra weight around. At the same time, living a totally unnatural lifestyle (food, activity, etc.) and having to do equally unnatural stuff to compensate for that (going to a gym and pretending to walk on a machine), is totally weird and hard to sustain. Obesity isn't an epidemic because a few people have some moral fault. It's the obvious end result of a modern developed-world lifestyle, with an epicenter in the US where the things people eat are particularly absurd and the demands of working are particularly onerous. At the same time, obesity isn't okay because it is the byproduct of our modern times, it is a symptom of how messed up things are.
posted by snofoam at 7:43 PM on September 17, 2010 [24 favorites]

Metabolically healthy "obese" people exist alongside unhealthy "skinny fats." Doctors possess affordable tests to tell people whether or not they are metabolically healthy. It's time for discussing appearances to be inappropriate and discussing metabolic goals to replace it. I've had too many "obese" clients tell me that health professionals were cruel to them even though they had made significant dietary changes with associated improvement in markers like insulin sensitivity. It's HARD for some people to lose weight. There are genetic factors, but also many other factors like epigenetics, gut bacteria, and even environmental contamination. It's not easy to control, but health professionals often just hand people the idiotic food pyramid and tell them to eat less and move more. Sorry, it doesn't work that way.
posted by melissam at 7:44 PM on September 17, 2010 [11 favorites]

I question the idea that "Although a fair number of obese individuals may have a perfect metabolic profile, it appears they may still experience negative consequences of their excess weight [italics mine]". I strongly suspect that the negative consequences are due at least in part not to the "excess" weight itself, but to the stress of living in a society that socially rejects fat people. Prolonged stress and lack of social support are not particularly good for the health.
posted by parrot_person at 7:53 PM on September 17, 2010 [3 favorites]

Re: "the point remains that weight loss has substantial health benefits for all obese people"

Yes, passing as a member of the dominant social group in a given society probably would have substantial health benefits for a member of a marginalized group.
posted by parrot_person at 7:55 PM on September 17, 2010 [7 favorites]

Just because you live doesn't mean it's a life you'd want. Most smokers and alcoholics live to the mean as well. Medicine is good that way, keeping you alive way past your sell-by date.
posted by docpops at 8:02 PM on September 17, 2010

Nice, I like when I'm compared to a can of botulism-infected beans.
posted by muddgirl at 8:20 PM on September 17, 2010 [2 favorites]

Medicine is good that way, keeping you alive way past your sell-by date.

Yeah! Fat people should die for being fat, it's the natural way of things, God is smiting them for being evil.
posted by Slap*Happy at 8:29 PM on September 17, 2010 [4 favorites]

The problems that excess weight lead to are all thing that are hard or impossible to treat, especially in aging patients. Arthritis, back pain, incontinence, infections of the skin, etc. It just adds another layer of difficulty to the stress of aging.
posted by docpops at 8:45 PM on September 17, 2010

There are some problems with saying that even if a person is healthy, they should still lose weight.

Is the process of weight loss itself healthy? A person with no metabolic problems might soon develop them after substantially reducing their caloric intake. And how many obese people have metabolic issues because of past dieting?

Another problem with offering weight loss as any kind of solution for unhealthy individuals or recommendation for healthy ones: the fact that the vast majority will regain the weight within 5 years. And as many of us know, they will regain the weight, PLUS more. 10 years ago I wasn't dieting and I was a hundred pounds lighter. I went on a low calorie diet, lost 15 pounds, gained thirty-five. Lost 10, gained 20. Lost 15, gained 25. Lost 50 (weight watchers), gained 70. And about three more diets until now I sit, 100 pounds heavier than I was and my metabolism is completely jacked up. Many many fat people could tell the same story.

So not only is substantial weight loss ineffective because it doesn't stick for most people, but I think it's actually a dangerous recommendation. Then there's the fact that for many obese people, losing 10% of body weight does not move them out of the obese category. It may not even come close.

I also strongly believe that unexplained weight gain and "excess weight" are often symptoms of a larger problem. Sometimes these show up with other symptoms which are then dismissed by the doctors who can only see the weight. There might be better solutions than the risky one of trying to lose weight and keep it off, solutions that go to the heart of the problem. But for the "ugliness" of fat, we might pay more attention to those solutions.
posted by Danila at 8:52 PM on September 17, 2010 [7 favorites]

Nutrition is a new, soft science, and the theories about weight loss and metabolism are newer and softer yet.
(Wow. Puns.)

In addition to obesity not being a good marker at all for overall health, hold on to your hats kids, because:

-Increasing the amount of an individual's dietary fat does not increase weight.

-Calories consumed have a *very* difficult-to-predict impact on weight, even when the individual's age, weight, and muscle mass are known.

-Dietary fats and dietary cholesterol have no conclusive link to cardiovascular events, excepting hemorrhagic stroke (which is caused by too LITTLE accumulation of cholesterol in the arteries).

-Your blood cholesterol and what the interior your blood vessels look like aren't really related very well at all.

I could keep going, but it's all too depressing. As far as public health is concerned, our government is so beholden to a few massive industries (agribusiness, food processing, pharmaceuticals, etc.) that they seriously don't even know what to tell people.

In pursuing my (all but useless) public health degree, I accumulated more nutrition hours than an M.D. Here's what all my professors told us:

Don't eat HFCS or hydrogenates in any quantities.

Try not to eat a ton of flour, especially white wheat flour, or a ton of sugar, especially processed white sugar.

Use sugar substitutes with caution.

If you keep track of your calories, roughly one third should come from carbohydrate, preferably complex carbohydrate, one third from fat, and one third from protein.

If you can get it, and you are going to drink milk, drink clean raw milk. Eat a lot of fruits and vegetables, the fresher the better. Get organics and take your vitamins if these are options for you. Enjoy food, have a moment of silence before eating, and eat sitting down.

Walk at least 10,000 steps per day, the more the better.

Drink lots and lots of water.

There's some more stuff, that applies pretty specifically to kidney patients, diabetics, and high level athletes, but this is the jist of several semesters of nutrition.




-
posted by Leta at 9:16 PM on September 17, 2010 [5 favorites]

>Medicine is good that way, keeping you alive way past your sell-by date.

Yeah! Fat people should die for being fat, it's the natural way of things, God is smiting them for being evil.

Yeah fuck you, doctor! You're not telling us what we want to hear! Of course that whole "God smiting" thing is pulled out from the smelly depths of my indignance, but it sounds sufficiently confrontational!
posted by Mayor Curley at 9:26 PM on September 17, 2010

I'm "obese" (based on the latest definition, which, keep in mind, changes periodically), yet, I do a vigorous workout for 1.5 hrs 3 days a week at the boxing gym, plus I ride my bike 1-3 times a week for somewhere between 40 minutes and a couple hours each time. (These are fairly low-key bike rides, but I am moving and getting my heart rate up.) I eat a really nutrious pescatarian diet of mostly home-made and mostly whole-grain food. I never drink soda or eat fast food and although I enjoy treats, I certainly don't have them every day. My blood pressure and insulin levels are fine.

There's no freaking way I'm going to waste one second of my life trying to lose weight. Growing, cooking, sharing, and eating food is one of the biggest sources of pleasure in my life, and I'm not interested in tainting the experience by constantly monitoring and restricting my intake. My body is fat and healthy and strong, and I'm happy with it the way it is.
posted by serazin at 9:27 PM on September 17, 2010 [5 favorites]

Leta - why the raw milk?
posted by docpops at 9:33 PM on September 17, 2010

Well, most adults don't produce lactase, which results in lactose intolerance. Pasteurized milk has had all its lactase destroyed, but it's present in raw milk. (Enzyme nomenclature: Suffix -ose is a sugar molecule, -ase is the enzyme that breaks it down.)

Lactase being an inducible enzyme, it's a whole lot easier to prompt your body into making it if there's already some to culture off of.

Many adults get the runs from milk and get bound up from cheese, and lactase addresses both these problems.

Plus, raw milk (CLEAN raw milk, which, among other things, means from cows fed 100% hay and grass, or goats fed ~10% grain, the rest forage/hay) is full of Vitamin C (which is killed by heat), from all that green stuff that the dairy animal ate. And milk is much lower in sugar, than, say fruit juice. Or even whole fruit for that matter. Vitamin K2 is also present in raw milk, and also made nonbioavailable in pasteurized milk. It's relatively easy for modern people to get Vitamin C from non milk sources year round now, but K2 is harder to get in a bioavailable form.

Not to mention the immunology benefits, but that is an issue that you can literally write an entire doctoral thesis on, so I won't go there right now.

Also, every one of my Human Nutrition profs was into eating as high quality as possible, and if you are producing raw milk, you have to have very healthy animals, very clean facilities, and very high quality feed. Pasteurized milk is almost always of lower quality because it can be, and because the economics of the market tend to demand it.
posted by Leta at 9:54 PM on September 17, 2010 [2 favorites]

Seems like some people tend to confuse "healthy" with "not unhealthy". There is a difference. Fat is never healthy, but it is sometimes not actively causing health problems at the moment, is the point being made here - and that if you can do so without fucking yourself up somewhere else, it's always a good idea if you're fat to cut down on being so fat.

There is also a difference between "not discriminated against" and "celebrated", and when it comes to obesity, only one of those is a sane expectation.
posted by kafziel at 12:08 AM on September 18, 2010 [1 favorite]

I imagine that when you are frequently discriminated against based on genetics, a chip on your shoulder is the better defense than caving into undeserved shame.

This is an obviously fallacious argument that gets put forward time and again in these sorts of discussions.

Travel to North Korea and count the number of obese people there. Look at some photos of people in the USA in the 1930s and again count the number of obese people. Is the gene pool of the modern US America really so different from that of North Korea? Has it radically changed from the gene pool of its grandparent generation?

No. What is radically different is the quality and quantity of our food intake and our lifestyles. Ignoring that, and pointing at genetics is ostrich behaviour.

Yes, there are people who lead sedentary lifestyles and eat bad food and who are still skinny. Are they lucky because they have magical "skinny genes"? No, they are not because they are not healthy either. And their skinniness will not last as they age. The fact that a lot of us are getting fat and obese is a big pointer to "how messed up things are" as snofoam commented above.
posted by Pranksome Quaine at 5:28 AM on September 18, 2010 [2 favorites]

The science doesn't bear out the lifestyle hypothesis. It doubled between 1980 and 2002 - The lifestyle from 1958 to 1980, in terms of diet and exercise, is not radically different enough to support lifestyle as primary cause, the way it is with indigenous cultures in the American Southwest and Polynesia. As a matter of fact, there are more healthy food options and opportunities for exercise, from gyms to jogging to cycling to kayaking, that are accessible to the suburban and urban middle class.

Serving sizes have changed, but it's more likely symptom than cause.
posted by Slap*Happy at 7:15 AM on September 18, 2010 [1 favorite]

(The obesity rate doubled from 1980 to 2002, that is.)
posted by Slap*Happy at 7:16 AM on September 18, 2010

Small world...I know Travis. I'll forward this thread to him. He'll be interested.
posted by jimmythefish at 7:20 AM on September 18, 2010

I've lost more than 50lbs in the past year and kept it off.

Here is what I learned:
My knees thank me everyday.
I can sleep better without a belly causing snoring and sleep apnea.
I have more energy and need less energy (I am not carrying that extra 50lbs around all day).
I feel much better.
I have been ill less.
My chronic headaches have gone away.
I am faster.


I counted calories and unlike what some people here are claiming here there was a stunningly deadly accuracy to the calories consumed/calories burned by exercise equation. As someone with a graduate level stats background in social sciences the relationship is the kind of strength that would blow away every other finding in the field.

My opinion is that the diet world is filled with all kinds of marketing FUD (other diets don't work but mine does!) mixed with motivated self-delusion and denial (I am not fat I am big boned! BMI is an inaccurate measure, I have a slow metabolism, It's my genes, etc..). This results in a cumulative impression that for some people dieting is difficult to impossible and that the weight return is inevitable

Yo-yo dieters get the results they do because they don't stick to their diets (dieting is for life - why would expect it to be otherwise?) or they choose unsustainable weightloss goals. (My goal was to drop 1.5lbs a week).

People really want villains like HFCS, red meat, McDonalds or fast metabolisms but that stuff just doesn't make any sense once you think about it. Even if HFCS is converted to weight faster or more efficiently than regular sugar or your metabolism is more efficient at storing fat think about how much that increase would have to be to explain your weight gain.

This isn't to say that there are not issues with certain types of food but the effects just are not great enough to explain obesity. People are obese because they eat to much and don't exercise enough.

It could be because they don't know the calorie content of all the food they eat (I certainly didn't - many foods I thought were reasonable were shockers and some food I thought was horrible turned out to not be so bad --mmmm cake). It could be because modern life is very energy efficient. Superstores, elevators, outsourced physical labor, cars, passive entertainment. But none of these explanations are reasons that you can't change the equation to introduce inefficiencies into your life but the important first step is to reject the use of causal explanations as excuses and instead see them as things you can alter if you choose. After that it is just math. Every single day.
posted by srboisvert at 7:38 AM on September 18, 2010 [3 favorites]

I counted calories and unlike what some people here are claiming here there was a stunningly deadly accuracy to the calories consumed/calories burned by exercise equation.

Yes, I also lost 30 lbs and have kept it off for several years now. I'm rather happy with it personally. I suspect both you have some things in common. I'm betting we both didn't have the worst diets, grew up normal weight, and are relatively young. We were chubby, not metabolically deranged.

And we both have a graduate level stats background in social sciences, which sounds fancy, but I'm going to trust obesity researchers who uniformly say that yes it is possible to have such a damaged metabolism that losing weight isn't just about subtracting calories.

For example binge eating can alter the ability to stay slim for years. Excess fructose can cause things like fatty liver syndrome, which among other things, can prevent weight loss. That's the tip of the iceberg there.

The best strategy is to try to eat as healthy as you can and watch your metabolic markers. It's easier to stay slim than it is to become slim...
posted by melissam at 7:54 AM on September 18, 2010 [1 favorite]

Travel to North Korea and count the number of obese people there.

Travel to a tribe that has never been introduced to alcohol. No alcoholics, right? Ok, now come back a couple years after it was introduced. Alcoholics.

That doesn't disprove the idea of a genetic vulnerability to addiction. It just means no one had the chance to experience it.
posted by furiousxgeorge at 9:03 AM on September 18, 2010 [2 favorites]

srboisvert, it's great that calorie counting worked for you, and that your weight loss was a simple matter of calories in/calories out. That's great. No, seriously. It's great that it worked... for you.

The allegedly simple calories in/calories out equation doesn't work for me, however. For me to lose weight, it takes an extreme diet (something like the first phase of Atkins or South Beach, with almost no carbs at all) and a workout schedule that has me in the gym for 2 hours a day, every day. And even then, weight loss is extremely slow. Every single pound lost is a vicious fight with my own body. And the moment I stop working out every single day and eating like a bird, I gain back whatever I've lost.

For me, the cause is pretty obvious: I started the thickening up phase of puberty at age 12, when my breasts and hips really began to make an appearance. My custodial parent, who had some serious self-loathing issues surrounding her own body (which mine was beginning to look like, oh noes), sent me to Jenny Craig. I'd like to point out, again, that I was 12, and also that my body was just doing what bodies do naturally when they're going through a massive hormonal shift. I wasn't a huge kid, I just had a parent who hated her own body and hated mine for not being willow-thin.

Anyway, Jenny Craig didn't have the affect my parent intended. I didn't become the willow-thin model she was hoping for. Instead of losing weight, my body freaked out at the calorie restrictions and went into starvation mode, holding onto every single bit of food I ate. So the crazy diet schemes just kept coming -- whatever my parent could find that was "guaranteed" to shed pounds, she'd make me do it. Fen-phen? Sure, sign my 17 year old kid up, it might cause heart damage but let's give it a whirl! Atkins? You like meat, right? Opti-Fast? Who doesn't love drinking all their meals? The blood type diet, the cabbage soup diet... name a fucked up diet scheme that has appeared in a ladies magazine and I'm sure I was on it before I was out of high school.

The end result is that my adult body still looks exactly like my parent's body did when she was my age. Not a damn thing changed, after all that effort, except that I gain weight really easily and it takes a hell of a lot of effort to lose anything at all. (I also have a couple of really fun eating disorders, a not-small amount of psychological damage, and a relationship with my parent that is so strained we're not even on speaking terms at the moment.) Other people in my family do not have this problem with weight loss. I believe that being put on insane diets at the onset of puberty permanently screwed my metabolism. Had I been left alone to go through puberty naturally, I bet things might be very different.

One good thing is that I've found the fat acceptance/Health At Every Size movement, so at least I don't have as much self-loathing going on as I did before. I'm coming to terms with the fact that my body is going to do what my body is going to do, and all I can do is give it the best food I can find and try to find an enjoyable, sustainable way to be active so that my joints and muscles stay lubricated and flexible. (Yoga is great for that, and has the added benefit of being awesome for my mental health, too.) I've also heard a lot of stories from people like me, for whom weight loss isn't this simple equation. I'm very grateful to know that there are other people out there like me, and that I'm not some horrible freak because that ever so simple equation doesn't work for me like it does for everyone else.

So, sroboisvert, while I'm very glad for you that you were able to lose weight and are now happy with the results, please remember that not everyone is built the same way.
posted by palomar at 9:04 AM on September 18, 2010 [9 favorites]

As usual tons of misinformation out there.

People, obesity may have many social effects which in turn impact health outcomes, but obesity by itself is not the key to health outcomes.

It is entirely possible to be obese and very healthy - so healthy that you'll outlive the average normal weight person.

But there is a secret to this trick, something that virtually nobody wants to accept - you have to cut calories without cutting nutrition. It's about calories. If you have genes that predispose you to obesity, go ahead and be obese - but cut calories (while maintaining complete nutrition). And that, nobody wants to do. But if you did, you could remain fat and as long as you consumed fewer calories (though nutritionally complete) than the normal weight individual, odds will favor your living longer.

Food for thought (yes, I did it, sorry). First, let me introduce you to ob/ob mice:

"The ob/ob or obese mouse is a mutant mouse that eats excessively and becomes profoundly obese. It is an animal model of type II diabetes. Identification of the gene mutated in ob led to the discovery of the hormone leptin, which is important in the control of appetite."

As can be seen, the ob/ob mouse is a genetic mess. A horror. A nightmare. They're fucked up.

Now let us see what happens when we CR (calorie restrict, while keeping nutrition complete). See PMID: 17909538 :

"Genetic links between diet and lifespan: shared mechanisms from yeast to humans.
Bishop NA, Guarente L.

Department of Biology, 77 Massachusetts Avenue, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA."

Unfortunately, I don't have a link to the full text, but I can cut and paste the relevant passage:

"Preliminary evidence suggests that the longevity effects of DR can be uncoupled from metabolic effects, because DR of genetically obese ob/ob mice resulted in a long lifespan, even though the diet-restricted ob/ob mice retained greater adiposity than the ad libidum wild-type96. Thus, DR might have effects on lifespan that are separate from low adiposity."

Preliminary evidence: fat (adiposity) can be disconnected from metabolic effects.

Confirmed effect: DR (dietary restriction - same as caloric restriction CR, except without additional compensation for nutrients) when applied to ob/ob mice results in these mice living longer than "normal" mice fed fully. The ob/ob remained chubby, but lived longer if under DR (CR). Otherwise, under normal feeding (AL), ob/ob mice live shorter lives.

Countless experiments in animals from lowly yeast all the way to mammals have confirmed that CR extends lifespan and healthspan (also the only intervention known to slow biological aging). What's interesting, is that CR even works in genetically fucked up obese mammals.

So again - you can remain fat. Go ahead. You'll still be healthy, as long as you cut your calories (but maintain complete nutrition).

Problem #1: you will not cut your calories.

Problem #2: you will not know if you are cutting your calories, because it takes too much work for the average person to truly keep track of ALL calories consumed.

Result: you will remain fat/obese but with variable health outcomes, depending on how many calories you consume.

Oh, as an afterthought - exercise is helpful, but not decisive when it comes to weight loss.

Bottom line: for a calorie restriction diet to work, you need to cut calories without cutting nutrition - weight loss is not the goal, though it is frequently a byproduct. And for it to work, it is not a one-time thing, it is a life long endeavor. Don't think of it as a "diet", but as a lifestyle.
posted by VikingSword at 11:04 AM on September 18, 2010 [1 favorite]

VikingSword, a lot of people in the paleo diet meetup I run are former CRON(calorie restriction with optimal nutrition)-ers including me. I guess you haven't had some of the side effects? Including complete loss of libido? Yes, I was using CRON-O-Meter to make sure I was getting absolutely everything. NYMAG did a great feature on it. Yes, you MIGHT live a very long healthy life, but many people have serious side effects.

Intermittent fasting has many of the potential benefits anyway. And you can live a normal life and not weigh your food all the time!

I do think that once you fix metabolic derangement you will desire to eat less. When I started trying to get healthy I was eating three times as much as I do now and I was hungry ALL the time. Now that my insulin sensitivity has recovered, among other things, I am rarely hungry and have to schedule meals or I forget about them while I'm working. It's no coincidence that most CRON-ers have been skinny most of their lives and many are quants.

It's pretty easy to control the food intake of lab animals without choices...but people...not so much.

"All this other stuff is wrong! Do this, it's magic! You'll live forever" become more like "you can try this, but your body will be very unhappy and you might be kind of miserable. But some experiments on ANIMALS show promising results, so try it!" I DID learn a lot from CRON though and still use CRON-O-meter occasionally. The takehome point that many people are malnourished despite looking over-nourished is very useful.
posted by melissam at 12:17 PM on September 18, 2010

I guess you haven't had some of the side effects? Including complete loss of libido? Yes, you MIGHT live a very long healthy life, but many people have serious side effects.

And? The question was: can you be obese and still very healthy. CR will deliver that. This wasn't a full discussion of the CR lifestyle, it was a truthful answer to a specific issue.

I am not promoting CR as such for people (I practice it, but am not an evangelist). What I am doing is contributing to the discussion by saying: here's where science stands - yes you *can*, be both obese and healthy, by using CR - and incidentally I could have stopped there, but I went on to imply strongly that it wasn't practical for practically anyone. But the facts are still there: CR works.

And CR also works for some people - though clearly few in number. This is a lifestyle in no danger of becoming popular.

Side effects - there are a ton of them, go to the CR Society website for a rundown. It was not my intention to hide them - it's the first thing I say when anyone asks me about the diet, right after explaining what CR stands for. I love elaborating in great detail about all the drawbacks. However, two key things to keep in mind: one, it's variable depending on the individual. Many but not all experience a loss of libido. Many, but not all experience a good bit of hunger. Two, even if you do experience a side effect, people react differently to it.

Example: libido. One very well known practitioner of CR experienced a loss of libido. He had to abandon CR - it was either that, or a divorce. Another experienced it, and was quite mournful about it. Yet another very well known guy liked it a great deal - his take was that now that he didn't have to deal with a sex drive, it calmed him down (became more zen-like), and actually improved his relationships and his ability to work without distraction (he's an engineer-reasercher-inventor). This "zen" effect is highly praised by many - glad to be rid of this nagging drive... a feature, not a bug. Obviously different strokes for different folks.

Even hunger - I happen to be one of the people who rarely experience hunger on CR (hunger actually kicks in for me if I go off CR, as if I awakened the dragon), but to react negatively to this lack of side effect. I in fact wish I experienced more hunger - I find *mild* hunger very useful and even pleasant. I had mild hunger in the beginning of my CR years ago. It makes food taste delicious. More importantly, it makes all your senses sharper, and your attention more acute (there's research backing this). I find myself "sharper" with mild hunger (in fact sometimes I do a targeted cut further on calories to evoke a bit of hunger, if there's a big challenge I have to meet, then go back to regular CR).

Other side effects are mild - you're cold a lot of the time (put on a sweater), or relative - CR'd people and animals are more heat resistant (I live in southern CA, so I like being resistant to heat).

By far the biggest drawbacks are practical and social. You can become unacceptably (unattractively) thin ("Does s/he have AIDS?") - though again, that's a minority of CRONies. You're screwed in restaurants with friends. It's hard to travel (I just go off CR for my traveling vacations). It can be very expensive. You can have problems with your spouse unless you are on the same wavelength.

And finally, it's incompatible with certain lifestyle choices - you cannot do certain kinds of heavy-duty sports that require a lot of calories.

Bottom line: CR is not for everyone - actually it's for very, very few. That does not make it utterly impossible and it certainly is a valid model in science and nutrition.

EOD feeding (and various intermittent fasting regimens) mostly works to the extent that your net calorie intake is lower than ad lib - there are many studies on this.

But hey, it's not my purpose to try to convert anyone to CR - rather to put in a word for scientific accuracy in nutritional advice, which is usually sorely missing in such discussions. Which is why I say: yes, there is a way, but you won't like it, and won't do it - but the truth requires that it be mentioned.
posted by VikingSword at 1:15 PM on September 18, 2010

I in fact wish I experienced more hunger - I find *mild* hunger very useful and even pleasant.

Yeah, me too. I wonder if we are just as broken as the people who are ravenous. I haven't been CRON for awhile, but I've done IF for two years.

I'm certainly not on normal meal hunger patterns, but maybe that's the original human pattern. For most of human evolution we didn't have breakfast, we ate when we could.

But there is some evidence that fasting can be addictive for some. I quit mainly because my blood pressure was too low, but I've had to be careful to get enough calories ever since.
posted by melissam at 2:11 PM on September 18, 2010

(dieting is for life - why would expect it to be otherwise?)

I'm just an anecdote of one, but I've begun to suspect that some may have the inverse problem that anorexics have, in that they need to consume far more calories to maintain their weight compared to people who've never been. If I eat enough calories to maintain my new weight, according to most metrics, I will pack on the pounds. I'm finding I have to stay slightly under in order to avoid putting the weight back on. So, yup this "diet" thing is for life.

The best strategy is to try to eat as healthy as you can and watch your metabolic markers.

Do people really wonder if their serotonin levels are low, ponder how much brown fat they have, or suspect the cause of their hunger is because their fat cells don't like being so small and, are screaming to get bigger and/or resistant to insulin? I think it flows more along the lines of, I'm hungry must eat without much consideration going into what it is they're eating, or the impact it has on them. The year before I was diagnosed with hyperglycaemia I never suspected that what I ate and, how it made me feel was indicative of prediabetes or, that when I get down in the dumps my cravings for a thick slice of bakery fresh bread with a slab of sharp old cheddar is really a sign my serotonin levels are low, that what I really need is more 5HTP. I dunno, the more I read about this the more I think the answer is exceedingly complex and, goes beyond merely eat less/exercise more.
posted by squeak at 9:50 AM on September 19, 2010 [2 favorites]