Fat: The Gift that Keeps On Giving
December 28, 2011 9:41 PM Subscribe

The Fat Trap (NYT pop review): Overweight individuals in Western nations (and, increasingly, beyond) face interpersonal and institutional stigma for their bodies*. Oftentimes, these stigmas are predicated on the belief that being overweight is a moral failure, that being overweight is usually a result of laziness, decadence, and/or characterlogical poor impulse control. However, an emerging consensus among obesity researchers points toward strong, common physiological and individual genetic factors as causative for heightened BMIs in the modern world and the general failure of dieting to produce BMI outcomes. A recent study in the New England Journal of Medicine (paywalled) adds to this body of evidence, suggesting that chemical messengers held to contribute to altered "efficient" metabolism and increased hunger in the wake of low-calorie dieting are (on average) significantly elevated up to a full year (if not longer) following a substantial drop in weight from dieting.

Caloric restriction as in dieting has been consistently shown both to decrease basal and activity-induced energy expenditure, leptin, and cholecystokinin and to increase levels of ghrelin and hunger, all of which likely contribute to weight regain. Reductions in energy expenditure have been displayed to persist for up to a year. This paper is the first to suggest that not only reduced energy expenditure but also deleterious hormonal changes persist far after initial weight loss has taken place. Subjects were originally overweight to obese, had participated in a liquid diet weight-loss plan under medical supervision over a ten-week period and were provided with weight-maintenance advice and nutritional counseling during a 1-year follow-up. On average, subjects did manage to keep some (though not all) of the weight off (avg. -7.9kg, though less when including intention-to-treat group of individuals who did not successfully complete the first weight-loss phase of the study).

These results may help to explain the common finding that most people who diet fail to maintain , regaining some, all, or more weight, (both paywalled) Some, however, keep their goals, frequently through sustained lifestyle changes including near-daily exercise, dietary changes (e.g. portion control, wholesale elimination of certain food-groups), and weekly-to-daily weight monitoring. (Though there is nothing approaching a consensus as to what extent the ability to effect these changes is independent of socioeconomic class, employment, daily time burden, personal history, and the biological factors in question.)

Some additional points and related articles (summarized well in the main link):
- Having lost at least 5kg through dieting in the past may be associated later in life with higher BMI above and beyond the influences of initial BMI and genetic interactions.
- On a population level, BMI may be anywhere from around 40% to 80% inheritable for modern humans, the latter being the same inheritability as height. Genetic factors appear to influence not just energy intake and reward from eating, but also to what extent caloric content is retained as fat and the efficiency of general metabolism. At least individual 32 genetic loci have been associated with risk for being overweight or obese, with some possibly operating in a linearly additive manner to explain variance in BMI. One of the most well-studied genetic polymorphisms (FTO: the fat mass and obesity-associated protein) predisposing to higher BMIs is present with at least one gene copy in roughly 65% of the Caucasian and African-American population, with less prevalence (27-44%) in Asian-American populations.
- Identical twins tend to either over-gain or under-gain weight relative to caloric intake at similar rates in response to controlled overfeeding. (They also tend toward similar body-weight distribution gain in response to said overfeeding.) Similarly, identical twins show large amounts of homogeneity within pairs in terms of weight loss and metabolic efficiency.

* (Such stigma, in fact, may be rather counteproductive if encouraging weight-loss is the goal of the stigmatizers.)

posted by Keter (173 comments total) 124 users marked this as a favorite

Evidence found for brain injury in diet-induced obesity

Consistent with these data in rodents, we found evidence of increased gliosis in the mediobasal hypothalamus of obese humans, as assessed by MRI. These findings collectively suggest that, in both humans and rodent models, obesity is associated with neuronal injury in a brain area crucial for body weight control.
posted by Blazecock Pileon at 9:52 PM on December 28, 2011 [2 favorites]

would appreciate if someone could translate this into simple english for me

Once you've gone fat you can't ever go back.
posted by twoleftfeet at 10:17 PM on December 28, 2011 [10 favorites]

This is 100 percent purely anecdotal, but I have seen friends and family fail repeatedly to lose weight long term by dieting. At the same time, I have seen people succeed at becoming healthier, and often, but by no means always, losing weight in the process. I have no idea how representative or not that is, but it has been enormously educational for me, as someone who has not struggled with his weight, to see what has worked and what has not for those I am close to.

I have a lot of discomfort with the "health at any size" movement, because it seems pretty obvious to me that some sizes are inherently less healthy. But I have come to the realization (in part through reading these threads on MeFi) that there is a core of insight there, because the path to health is not shaming and is not a focus on weight loss, but rather simply a focus on health.
posted by Forktine at 10:25 PM on December 28, 2011 [12 favorites]

Maybe the study participants mentioned in the first link should just stop eating altogether.
posted by talkingmuffin at 10:27 PM on December 28, 2011 [3 favorites]

Yes, there's some people who are genetically pre-disposed to have trouble expending the same level of energy, resisting that extra slice of cake, or processing the nutritional elements of certain foods. Everyone has one of those friends who can eat anything and everything in sight, and does so while maintaining a perfectly healthy body. Yes, they're bastards, but they've been around forever, and so have the people who have trouble.

The people who were successful in keeping the weight off made long-term lifestyle changes? You don't say. People who think they can just lose weight and then keep it off through magic are simply delusional. It takes effort and conscious choices to maintain a healthy lifestyle, especially if you're one of the people who is pre-disposed to having trouble.

So, the human body gets comfortable after years of being overweight or obese and takes maybe a year or more to start processing energy in a more "normal" way. Neat, from a scientific standpoint, but not surprising to anyone who has yo-yo dieted for years.

Once you've gone fat you can't ever go back.

Eh. About a year, maybe longer for some people. I bet we'll find out that it's related to one of those 32 markers, combined with how long the obesity lasted.

I'm not surprised at all about any of these findings. I'm also not going to let it discourage me from becoming healthier every day. Getting a lifetime of bad eating habits behind me, for good, is going to take longer than just the weight loss. I've been prepared for that from the beginning of my personal journey because this isn't about losing weight, it's about changing my life.

You can't become a non-smoker without giving up smoking. You can't stop drinking without stopping drinking. You can't get healthy without getting a healthy lifestyle.
posted by Revvy at 10:29 PM on December 28, 2011 [10 favorites]

Everyone has one of those friends who can eat anything and everything in sight, and does so while maintaining a perfectly healthy body.

I hate to be that guy, but: I am that guy. I wasn't always like that though. I cycle about 750-1000 miles a month.

I'm sure there are lots of biological factors that go into being able to maintain a healthy weight. The reality is that most people have almost completely sedentary lifestyles and have unrealistic expectations about what it would take to change that.
posted by bradbane at 10:44 PM on December 28, 2011 [4 favorites]

Being serious, but would appreciate if someone could translate this into simple english for me - I find that I am not understanding the key point - it seems to be that dieting changes the metabolism and thus increases the chance of being fat later, am I grasping this correctly?

Based on the reading I did a few weeks back when this first hit the news...

You have it exactly right.

Basically, what they've started to learn is that weight gain causes fundamental changes in metabolism which means that once you get fat and then lose weight, you can't easily go back to eating a "typical" amount of calories again, because when you up the calorie count above what you used to lose weight, your body will use those calories to put weight on again.

The article I heard on NPR (which may be linked in the FPP -- I haven't looked) said something to the effect of, if you're on an 800 calorie a day diet, you'll have to stay on that level of food intake forever to keep from regaining weight.

There appears to be a whole new batch of understanding about weight gain and how it works within the body as a system which is adding to our understanding of these things that goes beyond "eat less and exercise more", which has been the standard wisdom for a long time when it comes to weight loss.

Anyway, this is a pretty extensive FPP and I haven't read through the links, but what I see seems to be a pretty good round-up of the new discoveries.

Not saying that eating less and exercising more isn't a good idea for most people... Just that my cursory understanding of the topic from (as I said) a few weeks ago when I started hearing about all this suggests that it's a lot more complicated than that.
posted by hippybear at 10:44 PM on December 28, 2011 [2 favorites]

basically it works like this:

when you get fat you make more fat cells, say maybe going from 10 arbitrary units to 30 aribitrary units. However each fat cell also increases in size rapidly, from an average size of 1 to an average size of 10 (fat cells can get large, not surprising). So as you get fatter you increase the number and size of fat cells going from a fat number of 10 to 300. Again, arbitrary units.

The problem with losing weight is that it's quick to decrease the size of fat cells but slow to decrease the number. Therefore people going on rollercoaster diets are keeping their fat cell number constant at 30 but their fat cell size keeps bouncing between 2 and 10 and therefore they have trouble keeping it off by appearance. People need to understand that you need to prolong the diet past the point when you feel like it looks good if you want to keep it off long term

(writing a note to do sit ups in the morning to work off the holidays)
posted by slapshot57 at 10:45 PM on December 28, 2011 [5 favorites]

Random question about this article on the NYT website: this morning, when I went to read that article, I clicked the link on the NYT's homepage, and it brought me to the first page of the article. However, that odd fat-roll image was set to take up almost the entire above-the-fold space -- in other words, it was absolutely huge. And it was so jarring because I couldn't really tell what it was at first -- perhaps due to the odd cropping and the sudden screen-filling photo. It was like that image of the faces that are also vases...I thought it was two people's guts smashed together and then it looked like a butt and then the guts, and my brain was freezing and I couldn't see it any other way until I went back later to send someone the link and it was reduce to a little thumbnail on the left.

Did anyone else see the article in that format, and is it still available that way because I was trying to show someone what I was talking about but can't seem to pull it back up?
posted by This_Will_Be_Good at 10:47 PM on December 28, 2011

The focus on a temporary diet that will fix your weight issue is a huge problem in the modern approach to obesity. Eating and living healthily is a lifelong project and there's no temporary fix to the problem.

If you're overweight and have trained your body to consume and process an absurdly high number of calories over your lifetime, guess what? It's going to take the rest of your lifetime to fix that. You know what else? That's still better than the alternative: an earlier death and increased medical issues as you age.
posted by Aizkolari at 10:50 PM on December 28, 2011 [8 favorites]

Thank you for the clarifications hippybear, slapshot57 etc

For the first time in my life I'm looking at my diet - I was one of those mythical people who could eat whatever and not show a pound, I weighed teh same from age 16 to age 32 no matter what I did and then shifted up another 5 kg or so through the decade after. Now suddenly at this transitional age I'm heavier by far than I've ever been though its not 'obvious' and I know that I have to completely overhaul my eating style simply because the body and its metabolism have aged and changed. If I don't bring down the 5 kg now I'll never be able to and its meant actually thinking about what I eat, when and how in a manner I've never had to all my life.
posted by infini at 10:57 PM on December 28, 2011 [2 favorites]

The most difficult part is the whole web's information on calories is geared towards a western diet adn doesn't tell you that asam laksa may be far more fattening than simply nasi lemak ;p
posted by infini at 10:58 PM on December 28, 2011 [11 favorites]

I've always suspected that humans have genetic issues processing corn and processed corn products. Almost like an allergy.

Sugar: The Bitter Truth

And then there's that...
posted by neversummer at 10:59 PM on December 28, 2011 [10 favorites]

when you get fat you make more fat cells, say maybe going from 10 arbitrary units to 30 aribitrary units. However each fat cell also increases in size rapidly, from an average size of 1 to an average size of 10 (fat cells can get large, not surprising). So as you get fatter you increase the number and size of fat cells going from a fat number of 10 to 300. Again, arbitrary units.

The problem with losing weight is that it's quick to decrease the size of fat cells but slow to decrease the number. Therefore people going on rollercoaster diets are keeping their fat cell number constant at 30 but their fat cell size keeps bouncing between 2 and 10 and therefore they have trouble keeping it off by appearance. People need to understand that you need to prolong the diet past the point when you feel like it looks good if you want to keep it off long term

It's actually more complicated than that. It isn't just that your fat cells are growing and shrinking without going away, there's the whole leptin problem, where fat cells are actually releasing hormones which affect appetite and how your body processes calories and such.

Basically, until you actually lose fat cells, your body's metabolism is altered by the present of fat cells because of their ability to produce leptin and what that does to your system. Exactly when your individual body destroys fat cells (and how that actually happens) is much much longer than previously understood, and the mechanism about how it actually takes place is probably still really not understood clearly.

Back when leptin was first discovered, they thought that they had found the miracle cure for obesity. Simply release more leptin into the body through artificial means and the body will shed pounds. What they hadn't counted on (but which makes complete sense when you think about it) is that bodies which had a large number of fat cells had become accustomed to having that additional leptin being produced and released into the system already, and so there was a "numbing" of the effect of leptin on metabolism and caloric use within those bodies. Basically, you give a fat person leptin, and their body ignores it because of the leptin already being produced.

It's a really vicious cycle, and difficult to break, and made even more difficult to break because the body doesn't just rid itself of fat cells as you lose weight. If we could find a way to reliably flush fat cells from the body, we might have a medical solution to obesity which removes a lot of the problems encountered by diet-and-exercise weight loss programs. But as it stands, bodies hold on to cells they create as if they were part of them (as they indeed are), and as long as fat cells aren't gone, neither will be the effects of having them.
posted by hippybear at 10:59 PM on December 28, 2011 [6 favorites]

Man, it won't work for everybody but regular exercise keeps me from really hitting the booze (empty calories plus can't work out as hard) and I tend to eat healthily for most of the day when I do it.

Exercise has helped me keep my eating in better check even when I don't work out. But I enjoy getting the physical stress out of my body after sitting at a desk most days, so it's not just about weight but health to me.

That said, everyone's different. Near-daily exercise is great for me. Others will get more out of the diet aspect, but focusing on the happy and healthy part (including stress reduction and good sleep) makes weight management less of a task and more of a lifestyle.
posted by Unicorn on the cob at 11:04 PM on December 28, 2011 [4 favorites]

Ketogenesis is a fat burning process. It works quite well and is very well understood.
posted by Revvy at 11:06 PM on December 28, 2011 [1 favorite]

Huh. My 2011 dieting worked out quite well -- fruit for breakfast and lunch, and cutting dairy products out of my dinners.

That, and buying an exercise bicycle.

Getting older means you don't get to choose between diet and exercise -- you have to do both.
posted by bardic at 11:15 PM on December 28, 2011 [9 favorites]

While assembling the FPP, I had in my head that there was an article I had read in a class or scientific review that provided some limited data that "weight" gained more proximal (i.e. recently gained) to dieting is easier to lose than "weight" gained more distal (i.e. from years ago) to dieting. However, I wasn't able to find this article, which may in fact be a creation of my imagination and my own anecdotal experiences with friends and family. If this rings a bell to anyone and they know the reference, I'd love to read it again!
posted by Keter at 11:22 PM on December 28, 2011 [1 favorite]

The practical take-away for me: that individuals may a "set point" for weight determined largely by genetic factors and bodies may rebel strongly against movements in either direction away from this "set point." The body appears to do this in a surprisingly multifaceted attack (e.g. hunger, altering both resting and active [i.e. muscle] metabolism, gross hormonal shifts) that is difficult to overcome above and beyond other forms of regression. (Not a surprise for some, but the "most fat people are just lazy/ignorant/etc." trope is common enough that it's novel when the science complicates this picture.) When people fail diets, it is not always due to strictly "psychological" circumstances (however we may define that), but may plausibly be due to bona fide physiological challenges. Different people may experience the body's rebound to differing severities.

One thing I'd like to see more of would be to look at differences in these "set points"... what sets people who under-or-overgain weight in response to certain calories to people who don't have a particularly exceptional physiological challenge to gaining or losing at their leisure... what physiologically separates the people who gain a few pounds drop it by adopting a thrice-weekly running habit that they kick after thinning out and the people who gain a few pounds and never lose it despite a weekly gym regimen. To look at these subpopulations rather than overall trends (which seem to suggest that most people fall somewhere in-between these extremes).
posted by Keter at 11:38 PM on December 28, 2011 [2 favorites]

Eat better, exercise more, that is all.
posted by karmiolz at 11:41 PM on December 28, 2011 [1 favorite]

Everyone in my immediate family is/was somewhat to very overweight, except me. I feel I dodged a bullet in that I picked up some hobbies that are energy intensive (martial arts, weight lifting, cycling) and have always had food habits that are not conducive to gain -- I have almost always cooked my own food from scratch and I don't buy baked goods or sweets in the groceries. At one point a couple of years ago my weight had increased to a level I was really uncomfortable with, perhaps 8 kg over my ideal weight, and the proximate cause was employment unhappiness and a near-by French bakery. I have lost the extra weight and kept it off with a more or less paleo approach to eating. It is now 18 months since I made this comment and my weight still has an upper bound of around 78 kg.

The missing information in the articles above is about the effect of food that is very calorie dense, very available, and engineered deliberately for maximum stimulation. I am sure that genetic predisposition and metabolic changes make it hard to keep the weight off once you've lost it, but surely the ambient food environment makes a big difference too. If sweet starchy salty fatty flavour bombs still figure in your diet, it will always be a massive effort of will to maintain portion control.

Eat better, exercise more, that is all.

There is a huge debate about what consitutes "better" (low/high fat? low/high carb? low/high protein? more vegetables? more meat? no meat? whole grains? no grains? supplements?), and recent research confirms what was accepted wisdom 50 years ago, namely that exercise mostly stimulates people to eat more in compensation (not to say that exercise isn't good for you, but it's not especially effective for weightloss). This advice is too simplistic to be helpful.
posted by i_am_joe's_spleen at 11:45 PM on December 28, 2011 [18 favorites]

I find it very easy to lose weight, but that's not the problem. I'm still overweight, because maintaining a low weight is worse than obesity for me. I either have to restrict my calories to the point where I feel tired and unmotivated all the time, or I have to ramp up my hours of exercise a day to the point where I can't spend enough time actually working and earning a living.

I'm thinking about changing careers to something more physical so that I can keep weight off, but for now I'm content to just stay relatively fit even if I'm packing a few extra pounds.
posted by BrotherCaine at 11:45 PM on December 28, 2011 [4 favorites]

What I don't understand is if there are such strong biological indicators, why do we not see more of a similar distribution throughout the world and throughout history? Have many people been living, and are some currently living, under their 'set' BMI, forever in a way malnourished? Not a facetious question, I am wondering how deep this thing goes.

It seems that the modern diet is bringing to bear the biological differences that have for thousands of years or longer been less than important. But things like fast food and the prevalence of sugar and bad fats in the most affordable and easiest-to-procure meals has emphasized these differences.

I believe I'm one of the lucky ones, though I do have to work a bit to stay in shape, and I can never understand (I mean that in its strictest sense) that someone could exercise every day, eat carefully and frugally, and not lose weight or stay at it. It seems to fly in the face of anatomy that someone (as BrotherCaine experiences) must exercise so much and eat so little to keep off weight. At least, as he also notes, the body can be fit while still encased in an extra layer. But it seems such a gross inefficiency in design (speaking figuratively) that such a thing should even be possible.
posted by BlackLeotardFront at 11:54 PM on December 28, 2011 [7 favorites]

And, personally, what slapped me in the face was: some of the "fat" people I might occasionally reflexively disdain might even be eating the same diet I am (slightly overweight myself!) and be larger than I am, just because their bodies—here's the kicker—have a metabolic process that's more efficient than mine. That our senses of satiety or how much to consume to feel healthy and content and full and untroubled might be identical but how our body processes that food is, as the genetic studies show is rather plausible, different enough for me to be a large and for them to wear an XXL. So, I should tell that automatic-judging voice I (and I suspect many others) have to shut the fuck up unless I know any better, because for 99% of people I meet, I really, really, really don't.
posted by Keter at 11:55 PM on December 28, 2011 [31 favorites]

But it seems such a gross inefficiency in design (speaking figuratively) that such a thing should even be possible.

Actually, it's a great EFFICENCY in design. Historically, people like that would have survived famines much better than people with a metabolism that doesn't store fat until calories are ramped up extremely high.
posted by lollusc at 12:03 AM on December 29, 2011 [4 favorites]

Eat better, exercise more, that is all.
posted by karmiolz at 4:41 PM on 12/29

For every problem there is a simple and straightforward wrong answer.
posted by DoctorFedora at 12:13 AM on December 29, 2011 [83 favorites]

slapshot57> The problem with losing weight is that it's quick to decrease the size of fat cells but slow to decrease the number. [emphasis mine]

Is this actually correct? I was under the impression that absent surgical intervention, the number of fat cells in an adult can't decrease (although individual fat cells die and are replaced).
posted by UrineSoakedRube at 12:17 AM on December 29, 2011

Overeating is emotional, like cigarettes and liquor, consumption.
posted by Mblue at 12:26 AM on December 29, 2011

Overeating is emotional, like cigarettes and liquor, consumption.

[citation needed]

Clearly, eating isn't like cigarettes and liquor. Every organism is driven to consume nutrients, but not to take alcohol or nicotine. In many environments, a strong drive to consume is adaptive. Further, appetite can be way out of kilter with energy needs not for emotional but for metabolic or even neurological reasons that are not to do with emotional needs, unless you think hunger is itself merely an emotion.

Where do these dogmatic untruths come from?
posted by i_am_joe's_spleen at 12:32 AM on December 29, 2011 [12 favorites]

Where do these dogmatic untruths come from?
Life.
posted by Mblue at 12:34 AM on December 29, 2011

BMI, eh?

Well, don't think I'm going to bother with the rest of the post, then.
posted by stavrosthewonderchicken at 1:02 AM on December 29, 2011

Hmm. The point of this FPP seems to be, don't castigate people fighting weight problems as immoral. I think we all agree. But -- that is subtly but crucially different than saying, it's bad to gain weight beyond a healthy range.

If anything, the research you present shows that it's terrible to gain weight beyond a healthy range, that it's 100 times harder to lose it again than to not gain it in the first place. Some moralizing against that might make the lives of millions much easier. Unfortunately, for most of us, it seems like our bodies are opportunistic, evil fat-misers, just waiting for us to let our guard down, to feel depressed and eat out of it, to drink too much beer freshman year, or whatever.

I'm concerned that the helpful impulse to not stigmatize heavier people slides over into not discouraging weight gain, especially in younger years. And there is a large food processing-advertisial complex happy to drive a truck through any loopholes created in the process.
posted by msalt at 1:14 AM on December 29, 2011 [4 favorites]

once you got fat you can't get back

and

It takes effort and conscious choices to maintain a healthy lifestyle

Funny enough the science does not look at why people get fat in the first place and why it's so difficult to "maintain a healthy lifestyle".

Meanwhile in most parts of the world there is simply not enough high-sugar, high-carb, high-fat food around for people to get obese. In these circumstances whether you have genetically a predisposition to eat a lot and accumulate is not relevant, as there is little to accumulate in the first place.

Of course the gorilla in the kitchen / elephant in the room is that the solution to obesity starts with training and education; to explain that abundance of food is more than a luxury, that it actually has the same side-effects in the long term as addictive drugs: it feels good, the body wants more of it, it even "feels right" while you're at it, and you must recognize the danger and avoid it before it starts.

And then on top of that you might want to introduce government regulation for access to food, since you can't trust uneducated people to realize this and make the ~~healthy~~ long-term economically sensical choice (obesity removes via health costs and lost productivity the economical gain on the food market; same as drugs remove via health and lost productivity the economical gain on the drug market).

Oh wait... regulate consumption, is that good for "the economy"? Of course in America telling people to buy less food, or taxing unhealthy food, would be a tough sell.

Obesity is not the sickness of the rich. It is a endemic scourge that comes as a side-effect of a flawed economic system and lack of cultural self-restraint.
posted by knz at 1:21 AM on December 29, 2011 [7 favorites]

Another way that the body seems to fight weight loss is by altering the way the brain responds to food. Rosenbaum and his colleague Joy Hirsch, a neuroscientist also at Columbia, used functional magnetic resonance imaging to track the brain patterns of people before and after weight loss while they looked at objects like grapes, Gummi Bears, chocolate, broccoli, cellphones and yo-yos. After weight loss, when the dieter looked at food, the scans showed a bigger response in the parts of the brain associated with reward and a lower response in the areas associated with control.

this stood out to me a bit - that they can measure an emotional response in people that are just looking at food. We are inundated every day with a staggering amount of food advertising - it's everywhere, billiions of dollars are being spent to manipulate us into wanting more than we ever need, and wanting food that is terribly unhealthy. Have there been any studies comparing obesity rates in different populations to how much advertising they are exposed to?
posted by 5_13_23_42_69_666 at 1:40 AM on December 29, 2011 [1 favorite]

Overeating is emotional, like cigarettes and liquor, consumption.

If you read the NYT article, you'll find that apparently rigorous studies have found that formerly fat people who eat "normal" amounts gain weight anyway. A formerly fat person who wants to stay thin has to eat fewer calories than a person who never got fat in the first place.
posted by BungaDunga at 1:46 AM on December 29, 2011 [6 favorites]

By the way, if you're American (and think BMI is worth something for broad populations, at least), the only image you need to see is the animation here.

America has become an obese (according to BMI numbers) nation only in the last 25 years. You can argue 'til the goddamned cows come home, but the answer to the obvious question (why has the picture changed so radically in a single generation?) is really the only answer that's needed here.

Reverse the causes of that change, most of the problem will go away. And I think we all have some pretty good guesses about what has made the picture change.
posted by stavrosthewonderchicken at 2:06 AM on December 29, 2011 [13 favorites]

My guess is gluttony and sloth.
posted by the cuban at 2:48 AM on December 29, 2011 [2 favorites]

OK, clearly not all of us have good guesses.
posted by stavrosthewonderchicken at 3:06 AM on December 29, 2011 [25 favorites]

A rising tide of fat lifts all butts. Lifts, insofar as your butt expands in every direction.
posted by XMLicious at 3:35 AM on December 29, 2011

knz: Obesity is not the sickness of the rich.

Interestingly the correlation between obesity and income level in the US appears to be quite complex: Among men, obesity prevalence is generally similar at all income levels, with a tendency to be slightly higher at higher income levels. Among women, obesity prevalence increases as income decreases. Among men, there is no significant trend between education level and obesity prevalence. Among women, obesity prevalence increases as education decreases.

Lots of more interesting statistics in the pdf linked above.
posted by sour cream at 3:46 AM on December 29, 2011 [5 favorites]

Since this time last I've lost about 80 lbs (250+ to 169). There is one thing and one thing only that terrifies me -- even moreso than death: gaining all of that weight back.

It actually has almost nothing to do with health. I just can't stand the idea that I'll be in a position again where society will judge me as being severely sub-standard. Where people will take one look at me and instantly form an opinion about my worth as a human being based on my waistline.

I'm 5'9", 28 years old and I plan on eating around 1200-1400 calories today plus an hour of cardio if that gives you any idea of the seriousness with which I take my continued weightloss.
posted by Avenger at 4:26 AM on December 29, 2011 [12 favorites]

Since this time last I've lost about 80 lbs (250+ to 169).

I'm 5'9", 28 years old and I plan on eating around 1200-1400 calories today plus an hour of cardio if that gives you any idea of the seriousness with which I take my continued weightloss.

Nice work. I know this isn't supposed to be that thread, but really that's a lot of willpower right there. I salute you, sir.
posted by jaduncan at 4:52 AM on December 29, 2011 [7 favorites]

Where people will take one look at me and instantly form an opinion about my worth as a human being based on my waistline.

This isn't a slam on you, Avenger, I think a lot of people have the mindset that you have and for very good reason... it seems to be more true every single day, every single new year.

I've seen my workplace become more and more toxic with the sheer amount of frantic "I will never be good enough." People openly lamenting how they are "absolutely starving," but are cheering on each other's "healthy choices" (which often involve the most processed crap) and showing off their calorie count as if it were some kind of race. God forbid I bring any lunch to work that looks "healthy," because it's an instant comment inviting unwanted inquiry into whether I'm dieting.

The thing that never fails to surprise me is that no matter the weight loss, these people still shy away from the camera, they still continue to comment openly about how they despise the way they look and often lament about how they wish they looked like XYZ. Why does it feel so toxic? Because I remember doing exactly the same thing.

So, I've made a different kind of new year's resolution: complement people on ANYTHING, anything but weight. Because whether or not we're a nation that's into shaming ourselves, we sure seem to be desperate for compliments. Who can blame us? It's obvious, everywhere, that the easy way to get noticed is to lose some weight.
posted by Wuggie Norple at 4:58 AM on December 29, 2011 [14 favorites]

I printed out the article because it confirms my life-long experience and reminds me of why I fight the battle over and over again. I have weighed as much as 185 (normal height woman) and prefer to weigh 145, and with sheer focus, plenty of exercise, a balanced diet, and writing everything down, I have gone from slowly (usually over the course of a year or more) gaining and losing 40 pounds repeatedly to (more encouraging) slowly gaining and losing 15-20 pounds repeatedly. I have lots of willpower, whole bucket loads, and I have exerted it with determination and gumption over the course of the last forty years, by golly. Over and over and over again. All I can say is, I'm glad I have never gone on an extreme diet, because I don't know if I could stand it if I could only eat 800 calories a day for the rest of my life.

They tell me my kind of weight loss and gain is worse for my health than maintaining, but over 160 my feet and knees hurt.
posted by Peach at 5:03 AM on December 29, 2011

If you read the NYT article, you'll find that apparently rigorous studies have found that formerly fat people who eat "normal" amounts gain weight anyway. A formerly fat person who wants to stay thin has to eat fewer calories than a person who never got fat in the first place.

But only for a while. The problem is twofold:

1) The "I look, weigh and feel good" signal comes long before the body's metabolic processes correct themselves. The fat cell size versus quantity metaphor might not be exactly scientifically correct, but it is close enough. One has to maintain their diet and weight for years before they can get to the point where the occasional over-indulgence won't be immediately converted to weight/fat.

2) "Normal" amounts of food for the formerly obese are what got them fat in the first place. Even if their bodies were completely metabolically identical to someone who was never overweight, there is a psychological desire to eat more because that's what they are used to. It's not a moral failing or a mental disorder, just reality. Eating habits and preferences are wired in deep. (Especially when someone's "diet" is viewed as a temporary thing.)

It proves out in every case I have personally witnessed or experienced myself. When someone loses weight, the longer they maintain that new weight, the longer it takes them to re-gain the weight if they go back to old habits. Going back to the fat cell size/quantity metaphor, it takes significantly more calories to build a new fat cell than it does to fill an existing one up. And it takes significantly more time to kill a fat cell than it does to empty one out. And until they die, they plead and beg to be fed with powerful hormones.
posted by gjc at 5:03 AM on December 29, 2011 [4 favorites]

America has become an obese (according to BMI numbers) nation only in the last 25 years.

FWIW, my observation is that America is absolutely not alone in this, just a decade or two ahead. Western nations seem to be pretty much all on the same path, heading in the same direction. Some are further ahead than others. :-(
posted by -harlequin- at 5:05 AM on December 29, 2011 [2 favorites]

Eat better, exercise more, that is all.

It's too simplistic to say "that is all," but it's also too simplistic to dismiss the ideas of eating better and exercising more or to think that it is impossible to know what eating better is. I'm personally uninterested in any sort of fad diet where you eat only meat or whatever, but I think there is plenty of evidence that eating highly processed foods changes what we eat and how we metabolize it. I don't think we're ever going to get to the point where research tells us vegetables are bad and we should maximize refined sugars in our diet.

I'm no weight loss expert, but good diet and exercise over the long term will probably make pretty much anyone more healthy and help most people maintain a healthier weight. People will still have radically different metabolism and there are still huge obstacles to eating well and exercising, but the advice does address what are probably the two biggest problems, western diet and sedentary lifestyle.
posted by snofoam at 5:06 AM on December 29, 2011 [2 favorites]

This is what I've seen regarding the differences in food and its ability to support weight gain - the US was the very worst country/continent. I don't think its people and their habits, I've often suspected its collusion between fast food industry, weight loss industry and processed food big corp industry that is far more prevalent there than anywhere else I've lived long enough in.
posted by infini at 5:10 AM on December 29, 2011

I've always suspected that humans have genetic issues processing corn and processed corn products. Almost like an allergy.

The biggest problem is that people think that corn is a vegetable. The second biggest problem is that, for generations, people have been taught that eating fat makes you fat. When it is carbohydrates that are most easily converted into bodyfat. They don't feed cows bacon to fatten them up, they feed them corn.
posted by gjc at 5:12 AM on December 29, 2011 [5 favorites]

Weight loss:Some MeFites :: Global warming:GOP

No matter how much scientific evidence is presented to the contrary, some MeFites just know that obesity is a minor issue that could be fixed if only those lazy butter-eating lardasses would get off their butts and exercise once in a while.
posted by kcds at 5:33 AM on December 29, 2011 [23 favorites]

Eat tons more fat. It won't hurt you. Eat less- but nowhere near low-carb. Never be hungry and eat delicious food. Lose weight. Have tons of energy. Eat as much as you want. Walk every day. This is not rocket science. It's just that bad science and propaganda make us think it's dangerous and that it won't work:

http://www.amazon.com/Perfect-Health-Diet-Youthful-Vitality/dp/0982720904
posted by zeek321 at 5:42 AM on December 29, 2011 [3 favorites]

This is really harshing my post-Chrismas, pre-New Year gluttony vibe *has another mince pie with cream*
posted by fearfulsymmetry at 5:42 AM on December 29, 2011 [2 favorites]

(Oh yeah, and don't eat corn, soy, fructose or any vegetable oils except coconut and olive oil.)
posted by zeek321 at 5:43 AM on December 29, 2011 [2 favorites]

I will get lost in the noise, and maybe I'm just a crackpot, but I'm pretty sure this is a solved problem. See my comment above...
posted by zeek321 at 6:13 AM on December 29, 2011

go to the gym 6 times a week for the rest of my life

That's rough. I don't have your willpower, so I concentrate on finding more enjoyable forms of exercise that I'll want to do regularly for the rest of my life. Finding games or sports, dance, less fun but useful or money-saving stuff like walking/cycling to work, or getting groceries on foot.
posted by -harlequin- at 6:22 AM on December 29, 2011 [1 favorite]

"They don't feed cows bacon to fatten them up, they feed them corn."

True, but think how tasty that would be!
posted by etherist at 6:33 AM on December 29, 2011 [1 favorite]

Also, looking at the NYT slideshow in the top link, the Bridges' plan, which is laid out to look or seem ridiculous, seems to fit pretty well with Michael Pollan's seven-word diet plan, plus a reasonable amount of daily exercise. Not nearly as radical as this presentation might lead you to believe.

Other than the food weighing and record keeping, their eating and exercise habits don't look extreme at all to me. Our idea of "normal" has shifted so far towards the sedentary that it amazes me.

America has become an obese (according to BMI numbers) nation only in the last 25 years. You can argue 'til the goddamned cows come home, but the answer to the obvious question (why has the picture changed so radically in a single generation?) is really the only answer that's needed here.

Reverse the causes of that change, most of the problem will go away. And I think we all have some pretty good guesses about what has made the picture change.

This is absolutely the key. We've made huge societal decisions that affect everyone -- cheap food, cheap gas, sprawl, etc -- and have produced the changes charted in that CDC link. So why do we keep talking about obesity and health issues as individual choices? That makes no sense, and there are more effective and more humane options. I wish we could move away from talking about "willpower" and individual morals, and towards societal wide changes, such as zoning laws, subsidies and taxes, things like that.
posted by Forktine at 6:36 AM on December 29, 2011 [7 favorites]

Funny enough the science does not look at why people get fat in the first place and why it's so difficult to "maintain a healthy lifestyle".

On the contrary, this is actually what much of the science is about:

...an emerging consensus among obesity researchers points toward strong, common physiological and individual genetic factors as causative for heightened BMIs in the modern world and the general failure of dieting to produce BMI outcomes. A recent study... [suggests] that chemical messengers held to contribute to altered "efficient" metabolism and increased hunger in the wake of low-calorie dieting are (on average) significantly elevated up to a full year (if not longer) following a substantial drop in weight from dieting. ... On a population level, BMI may be anywhere from around 40% to 80% inheritable for modern humans.... Genetic factors appear to influence not just energy intake and reward from eating, but also to what extent caloric content is retained as fat and the efficiency of general metabolism. At least individual 32 genetic loci have been associated with risk for being overweight or obese.... One of the most well-studied genetic polymorphisms (FTO: the fat mass and obesity-associated protein) predisposing to higher BMIs is present with at least one gene copy in roughly 65% of the Caucasian and African-American population, with less prevalence (27-44%) in Asian-American populations.

These genetic factors definitely interact with environmental factors like the availability of high-calorie food in the Western world, and these 32 loci almost certainly do not explain all the heritability of BMI. And I agree with you that economic incentives have caused our diet and activity level to change, almost certainly not for the better. Still, though, there are many people in the West who drive cars and eat sugar with casual abandon, and yet are underweight. The scientific evidence, which supports the idea that there are strong genetic influences on weight, can help us understand what their bodies are doing that other people's aren't.
posted by en forme de poire at 6:41 AM on December 29, 2011 [1 favorite]

Having lost 30 lbs in the past year (and kept it off)

That's it, snofoam. You never complain that this country has an electrical code, or that there are laws and regulations for pretty much everything. But as soon as someone mentions, hey, how about noting the servings clearly? Half of the country jumps to cut your head off!
posted by Tarumba at 6:58 AM on December 29, 2011 [3 favorites]

slapshot57 already extracted the essence from the (really great) New York Times Sunday Magazine article: The problem with losing weight is that it's quick to decrease the size of fat cells but slow to decrease the number.

The thing is that unwanted fat is composed of living cells who absolutely do not want to die. That few months at the beginning is only the beginning. You have to keep it up for years (4? 5? 6? -- it varies but it scales up for the length the system has gotten used to being obese; if you have been obese your whole life you may have to spend the rest of your whole life working on it.) I have known dozens of people who lost a bunch of weight in a few months and gained it all and more back in a sadly short amount of time.
posted by bukvich at 7:01 AM on December 29, 2011 [2 favorites]

I'm one of the lucky ones. I'm skinny by default. I can afford to live somewhere I can walk to stores. I'm not stuck in a depressing situation where food becomes a way to comfort myself. I'm not in a job situation that saps all my energy and leaves me listless in front of the TV, absorbing ads for fattening snacks.

I look at some of the people I've known and sometimes I feel like I've dodged a bullet. I know a guy who peaked around 700lb. He's down to like 400 after serious surgical intervention. Poor bastard.
posted by egypturnash at 7:07 AM on December 29, 2011 [1 favorite]

I too lost 30+ pounds these year, and I am terrified that I will gain it all back. It depresses me that I will have to eat 1300 cals every day, go to the gym 6 times a week for the rest of my life, just to look chunky (I am a size 12 now, which was a huge achievement for me) instead of obese.

I still am 20+ pounds overweight, and keeping this rhythm I have managed to stagnate at 175 pounds. What now? Should I cut back to 800 cals? Excercise 2 hours a day instead of one? Save for a lipo? It's very discouraging, and sometimes I feel like never putting fucking toe in the gym again and staying at home watching the lord of the rings while eating shortbread until I die a sweet and crumbly death.

That, in a nutshell, is why "diets" fail, and this science proves true. Our genetics and our physiology are just as strong as willpower. (*) Assuming you are eating nutritionally and getting some strength training in too, there WILL be changes over time. Your weight might not change for a long time, but under the skin, the fat distribution will change and muscle mass should be growing. It takes a LONG time for this change to occur.

Also, a plateau might be a sign to look at other things besides just calories in versus calories out. Make sure you are eating to "fuel up" for your activities in the future, not to refuel. In a perfect world, all of our caloric needs would come from food that is in our digestive system. Sometimes a plateau means that the timing is off, and when you exercise you are emptying your fat cells, and then when you eat they are getting filled back up. Fat cells that get fed won't die.

(*) Also, viewing healthfulness as a willpower thing is a recipe for failure. Ask any addict- willpower can get your through the occasional craving, but the key to successfully changing behavior is to change one's mindset. Instead of being something to tolerate and fight with, making healthy choices needs to be incorporated into who we are. When we allow ourselves to have that "me want" thought when faced with temptation, even if only for a moment, we reinforce the desire / fight desire dichotomy. "Me want" has to be faced with "no I don't" and not "no I can't", even if it is a lie, until the new pattern solidifies in the mind.

Not trying to criticize, but trying to encourage.
posted by gjc at 7:07 AM on December 29, 2011 [2 favorites]

Having lost 30 lbs in the past year (and kept it off) by maintaining a regular program of exercise (running, marathons, etc.) I have come to one conclusion. What works for one may not work for all. You have to find your own healthy balance of diet, exercise, and well-being.

I have mentally favorited this one million times. gingerbeer and I began a thing just about a year ago, a low-carbish sort of thing. She got a personal trainer and stuff, and I only changed how and what I eat, and we've both lost roughly the same amount of poundage. She's definitely in better shape than I am, what with the exercising and all, but apparently my body finds it fairly easy to shed pounds even without going to the gym a lot. Or at all. For god's sake, I even managed to lose weight over Christmas (and I wasn't trying), when we were visiting her parents and pretty much all we did was eat, drink, sit around the fire in the living room and read, and take walks. Not death marches, mind you, just walks.

We were very lucky to find a way of eating right out of the gate that we both like and is sustainable for us - it's really become a habit, to the point where I don't even think about it any more. I don't think "Oh, but what will we have with the fish if we can't have rice?", for instance. I splurge occasionally - we went out for breakfast yesterday and I had French toast (and eggs and bacon) - but that kind of eating is no longer the norm, and not doing it doesn't feel like a punishment.

Also fortunately, I like liquor, so I can have a whisky or bourbon instead of the daily beer ;-)
posted by rtha at 7:15 AM on December 29, 2011 [1 favorite]

(
I have a lot of discomfort with the "health at any size" movement, because it seems pretty obvious to me that some sizes are inherently less healthy. But I have come to the realization (in part through reading these threads on MeFi) that there is a core of insight there, because the path to health is not shaming and is not a focus on weight loss, but rather simply a focus on health.

A quick note that I can't really support: my understanding of HAES is not "you will be as healthy as a triathelete even if you are very substantially overweight as long as you do X" but "weight is very hard to control, especially in our fat-shaming, creepy culture, and realistically most big folks are not going to get a lot thinner, so if we do X, we will be as-healthy-as-possible-for-our-bodies; if someone had blown knees and could not do weight-bearing cardio, they would also have a similar philosophy because they would want to be as healthy as possible given their actually-existing body". The idea is to live in the body you have now, since science strongly suggests that you can't change its size that much.)
posted by Frowner at 7:18 AM on December 29, 2011 [18 favorites]

Don't want to be a downer, but don't start making those assertions until you've kept it off for several years :( Most testimonials to weight loss are based on a very short amount of follow-up, and "the past year" is short. Hang in there, and keep working!

Thanks for the encouragement and I'm all too aware of how easy it would be to slip back. I maintain a running blog where I talk about my adventures racing and running. Not because I expect a large readership but mostly for the fact that if I TALK about it a lot, and keep it on my brain. I'll stay focused and keep on running. I try to run at elast three times a week. I gave away all my fat clothes and I cannot afford to purchase a new wardrobe again (despite how much fun it was buying skinny stuffs).

As you said, it takes years of hard work and I only just started with a healthy lifestyle. This is after 10 years of not exercising and eating shit foods. It's a journey.

A day at a time.
posted by Fizz at 7:19 AM on December 29, 2011 [3 favorites]

It is really hard to know, from the article, whether there truly is an "emerging consensus" from scientists about the nature of weight loss here, especially the idea that overweight people get "reset" to a higher weight. There might be, but we all seem to be assuming that because there are strong hints of various things (genetic links to weight gain, difficulty in maintaining weight loss, etc.) that they come together in the coherent (and fairly fatalistic) view expressed in the article.

The key study on long-term metabolic changes was conducted on 7 patients. There are notoriously difficult problems in studying dieting and weight gain (people record inaccurate data, there are sample biases, etc.). There still isn't even a consensus on the best way to diet.

None of this says that this work is not important, but given that the underlying message of the article is that those who are overweight are basically doomed by genetics and self-regulating body systems, I would really hope for a stronger case before we decide that this must be the right story.
posted by blahblahblah at 7:20 AM on December 29, 2011 [5 favorites]

Forktine makes a good point about societal decisions. One could go a step further and consider that there is huge corporate interest in promoting unhealthy lifestyle choices and vigorously opposing things like more informative labeling of food (and "food"). This is exacerbated by the prevalence of an attitude that even better labeling is equivalent to a nanny state that is taking away our freedoms.

The problem is that there are people out there who are completely in favor of nanny-stating. Banning things never solves anything, instead it fails to teach people to make good decisions.

And the corporate interest is in maintaining the status quo, rather than promoting a specifically unhealthy lifestyle. They are entrenched in whatever thing it is they do, and know how to make money doing that. The sad fact is that people want the unhealthy choices because they lack either the desire to do any different, or a knowledge of why and how to make good decisions. When people start demanding healthy choices, corporations will change.
posted by gjc at 7:24 AM on December 29, 2011

I suppose this topic is relevant as we approach the new year. If depressing.

I used to obsess about weight, which has certainly been a problem for me and my family members, which include more than one person who had weight loss surgery. But nowadays I can't help thinking that climate change and other issues are either going to solve this long-term (not that I'm hoping for food shortages, but we may certainly have to change how we grow food that requires lots of water and fertilizer) or we're going to come up with medical solutions.

Low carb is the only thing that's worked for me, but as someone who doesn't love meat and really doesn't enjoy the taste of most vegetables, it's a serious challenge. Salad bars look like piles of shredded paper from a taste standpoint, to me. Just another argument against intelligent design.
posted by emjaybee at 7:30 AM on December 29, 2011

I used to be a judgy moralistic type before metafilter. Due to the many comments I've read here over the years from people who struggle with their weight (or who have accepted it), I've come to think of it differently. When I look at my own diet, which is abjectly terrible, it's only by the grace of Whomever that I'm not obese. My portion sizes are small because I'm small, not because I'm saintly.
posted by desjardins at 7:33 AM on December 29, 2011 [6 favorites]

I dropped about 50 lbs and kept most of it off for two years and this 'fat trap' theory pretty closely matches my experiences. I used Livestrong's daily plate with exercise and calorie counting to get the weight off but found that once I was a healthy weight my baseline net calorie rate to maintain no longer matched Livestrong's recommended caloric allowance which was frightfully accurate for the first year of my diet. It now turns out to be roughly 400kcals less. One meal. Also weight seems to go back on far far faster than calorie counts indicate it should.

I can still manage to maintain my target weight but christ what a disappointment not to get back the full 750 kcals a day I was denying myself to lose the weight.
posted by srboisvert at 7:36 AM on December 29, 2011

Also, there's no way I'd have the dedication to count calories and exercise every day. I can barely summon the willpower to fold my laundry.
posted by desjardins at 7:36 AM on December 29, 2011 [8 favorites]

blahblahblah: The NEJM study that showed persistence of dysregulated hormones out to a year was conducted on 50 patients. I don't think much of this story actually hangs on that 7-patient study; it's supportive but the evidence for metabolic changes that oppose weight changes goes all the way back to 1959.
posted by en forme de poire at 7:38 AM on December 29, 2011

Most people who sell or advocate weight loss solutions acknowledge the science one minute and then negate it the next.

"DIETS DON'T WORK! But I don't call my plan a 'diet' so it will totally work. So you should reject all the other 'diets' and follow my 'non-diet'."

Bottom line: making a change in your weight your goal is almost always a bad idea and will generally backfire. Let your weight be whatever it's going to be, and live as healthy a life as you can, in terms of eating foods that are good for you and getting exercise. It may be that as part of that your weight will go down; it may be that it won't. It may be that it will go down for a while and then go up as you get older or after you have kids. Either way, doesn't matter. Your weight is an ephemeral matter, not a core issue; an uncertain side effect. STOP USING WEIGHT AS AN INDEX OF HEALTH. It isn't. It absolutely is not.

And beware of the "DIETS DONT WORK but this thing which is totally not a diet will make you lose weight seriously im not even kidding" people. Their half truth makes their bullshit even more poisonous.
posted by edheil at 7:48 AM on December 29, 2011 [5 favorites]

Everyone has one of those friends who can eat anything and everything in sight, and does so while maintaining a perfectly healthy body.

I hate to be that guy, but: I am that guy. I wasn't always like that though. I cycle about 750-1000 miles a month.

I'm that guy too. I bike around 600 miles a month commuting and getting around town. I am thin because I exercise, and when I eat I tend to eat a little less than I need to be completely satiated. This puts me into a mild state of starvation from time to time, and my body uses the excess fat that I've stored up.

In addition to the effects of exercise, there are seasonal differences which play out in terms of my motivation to eat. When it's dark, I eat more, and I gain a little weight which helps me to be comfortable and safe in the winter. I wonder how many people in the US overeat when they are deprived of exposure to natural light.
posted by melatonic at 7:51 AM on December 29, 2011 [2 favorites]

And the corporate interest is in maintaining the status quo, rather than promoting a specifically unhealthy lifestyle. They are entrenched in whatever thing it is they do, and know how to make money doing that. The sad fact is that people want the unhealthy choices because they lack either the desire to do any different, or a knowledge of why and how to make good decisions. When people start demanding healthy choices, corporations will change.

This argument seems naive to me. I agree that corporations are not motivated by a desire to make people ill, but the foods that they promote are the ones that are most profitable and scalable, so they're going to fight change and do all they can to keep consumers from demanding it for those reasons. With that backing, it will be extremely hard to change attitudes without some counterbalance that actively promotes health and education about food. Moreover, the profitability of many of these foods is supported by government farm subsidies. The idea that consumers will magically change their tastes and force corporations to give up their profitability simply through the workings of the supposedly free market is pretty far-fetched.
posted by snofoam at 7:58 AM on December 29, 2011 [2 favorites]

Wuggie Norple: 've seen my workplace become more and more toxic with the sheer amount of frantic "I will never be good enough." People openly lamenting how they are "absolutely starving," but are cheering on each other's "healthy choices" (which often involve the most processed crap) and showing off their calorie count as if it were some kind of race. God forbid I bring any lunch to work that looks "healthy," because it's an instant comment inviting unwanted inquiry into whether I'm dieting. The thing that never fails to surprise me is that no matter the weight loss, these people still shy away from the camera, they still continue to comment openly about how they despise the way they look and often lament about how they wish they looked like XYZ. Why does it feel so toxic? Because I remember doing exactly the same thing. So, I've made a different kind of new year's resolution: complement people on ANYTHING, anything but weight. Because whether or not we're a nation that's into shaming ourselves, we sure seem to be desperate for compliments. Who can blame us? It's obvious, everywhere, that the easy way to get noticed is to lose some weight.

This is a bit of a tangent, but:
When I was in highschool, I came down with (what would eventually, a year later, be diagnosed as) five ulcers. This meant that, for about a year, I couldn't eat anything without throwing it back up. I lived on yogurt and watermelon, the only things I could keep down. I lost about 40lbs in one month, and kept losing weight. I was in and out of doctors offices and hospitals, and nobody could figure out what was wrong with me. I was under a hundred pounds, still losing, and slowly starving to death.

It was the first time in my life someone called me "hot." Everywhere I went, people kept telling me how great I looked. My peers, yes, but also adults--teachers, family friends, people in the clothing store when I had to replace my size 12 jeans with size 1. "That's great!" one clerk who was helping me figure out what style would fit my suddenly all-new-body-type. "You must be so proud!" No, I thought , I'm actually pretty terrified that I might be dying, but that isn't something you really say to people who are trying to be nice, even if you hate them for it. Finally, one day I snapped at a girl who was whining that she wished she could lose weight as easily as I could. "Actually, I lost weight because I can't eat. I throw up twenty to thirty times a day, even if there's absolutely nothing left in my stomach, not even stomach bile. And no one can figure out what's wrong with me." She was quiet for a minute, and then she muttered under her breath, "Man, I wish I could come down with something like that..."

It's thirteen years later, and I actually hit the weight I was before I got sick for the first time a few months ago (probably because of the medication I'm taking that makes my life infinitely better but does cause weight gain). Sometimes I look in the mirror and think, "maybe I should try to lose some of this." And then I think, "Fuck you people" and go eat a piece of cheesecake just because I can.

All of which is to say: those kind of compliments you're talking about are poisonous, and can reveal an even more poisonous attitude towards weight and weightloss that masquerades as a concern about health but mostly isn't.*

*Eating "right" and exercising are good things (mostly), and being really overweight can have negative health consequences, sure.

/end tangent.
posted by kittenmarlowe at 8:01 AM on December 29, 2011 [42 favorites]

Diet anecdote designed to bring out the hipster-bacon-hating in everyone: I've lost 16 pounds in 2 months by dropping wheat/other grains and eating an absurd amount of bacon from our CSA. We probably eat bacon 3 times a week. The mister has lost even more, well over 20 pounds.

Did the bacon do it? No, but dropping the wheat sure didn't hurt, and bacon a. makes us not feel deprived b. makes us happy and c. all of the above helps you maintain a changed food intake long term, so...

STAY TUNED IN 2012 FOR BACON-GIRL (the artist fka bitter-girl)'S MAGICAL ALL-BACON DIET! AVAILABLE IN A FINE BOOKSTORE NEAR YOU!

/snark
posted by bitter-girl.com at 8:06 AM on December 29, 2011 [3 favorites]

Forktine is very right in pointing to societal issues. Think of it. most of us are crackheads when it comes to sugary,salty, fatty crap foods. We were built that way so we'd be able to gorge in flush times to survive in famine times.
As I understand it, all the fat cells we will ever have are made fro minfancy until about kindergarten age. So if you are a typical american with fast food and junk. You are going to build a lot more fat cells as toddlers than your thin friends. So even as an adult those fat cells will be screaming at you 24/7 to eat EAT EAT!!!!

Now in the West, we have all the sugary, salty, high fat foods we want engineered the way coca leaves were engineered to be crack, to be as irresistable as possible. And we have it so cheaply that even the poorest in wealthy countries can afford corn chip puffs. That is the thing, most of us were predisposed to be obese but until now in the west few of us were both sedentery and able to afford the abundance of constant food.

So we are crackheads with legal cheap crack literally everywhere and advertisements for legal cheap crack everywhere. It is the holidays, a tour around the office reveals one cube with German Kräcken right there for grabbing. Off to accounting? Try some Swedish kråcka! Or Marisol in Payroll has some great homemade Crack-molasses jacks! Homemade straight from abuela in Colombia!!!

Most of us live in a place that obligates us to use cars for most of our daily transportation instead of the hunter-gatherer walking, and most of us have access to cheap crap food where before we simply couldn't afford to eat all we wanted. and a lot of fat people (self included) were fat from childhood, with fat parents, so we not only did not learn good lifestye choices, but we have more little fat cells torturing us daily with their fat/crack demands.

So from personal experience losing weight is easy. Keeping it off is almost impossible. Better for me to eat as well as my food/crackhead self can allow, exercise a lot (That *is* easy for me. I live in NY, walked to work today from Harlem to near UN, beautiful crisp winter day, mmmm). Better to realize I will never be thin, but I don't have to be morbidly obese, I will always be a bit chunky. If other people draw value judgements from that it is their problem.

Society needs to change, society needs to bring back livable walkable spaces.Society needs to end farm welfare to large corn producing agribusinesses. I don't think HFCS is necessarily evil per se, but since my tax dollars go to making it insanely cheap, it will flood the market and allow people to gorge. The reason the didn't in olden times is because they couldn't!

Remember that, price is a hidden factor in the modern obesity epidemic.

If this analogy doesn't apply to you then I salute you. But well, trust me when I say it is not just a matter of education, eating less exercise and will power.
posted by xetere at 8:07 AM on December 29, 2011 [5 favorites]

A point and a question.

Point: I can say that I've tested the "corn causes obesity" theorem and discovered it is probably not accurate. Discovered I was allergic to corn about 7 years ago. Cut it out of my diet. Gained SIGNIFICANT amounts of weight immediately after (20% of my body weight) which has been damn hard to take off. And I can't have ANY corn, I mean, not even a pinch of cornstarch, and I used to eat it at every meal (and was very sick because of it, but that's another story). True, I'm only one person, but if cutting out corn was the magic fix I'd be skinny now.

Question: If the inherent issue is that the fat cells linger after weight loss, causing leptin resistance etc., then in theory wouldn't liposuction after weight loss to get rid of some of those fat pockets immediately resolve the problem? Have there been any tests of that theory?
posted by rednikki at 8:12 AM on December 29, 2011 [2 favorites]

All of you "just eat less and exercise more!" people are contributing to the problem. That simplistic and wrong message, combined with the moralizing that goes with it ("sloth and gluttony") is the reason that people struggle so mightily with their weight. They are convinced that it's all about willpower and that they are bad people because they don't have as much willpower as all those thin people. This causes shame and hopelessness, which causes overeating, which causes weight gain.

While it's true that eating less and exercising more works for as long as you can do it, few people are willing or able to put up with the increasing misery that engaging in such behavior takes on as you reach and try to maintain your goal weight. THAT'S WHAT THIS STUDY SAYS, but even in this thread people are ignoring that hard fact.

What's desperately needed is a way to short-circuit the PHYSIOLOGICAL issues that cause the obese and formerly obese to overeat. Yes, physiological, not psychological and certainly not moral.

Weight loss surgery is one (very crude) attempt at accomplishing that. I'm not sure how well it works, but I have heard some bad things about long-term maintenance. Plus, it's sort of an enforced misery.

Low-carb, ketogenic diets are another. It's possible that by keeping the body in fat-burning mode and avoiding foods that raise insulin levels, the body will not try to put on fat as it does on a (merely) calorie-restricted diet/lifestyle. Anecdotal evidence says this is true. Look in any thread on the internet, and the majority of those who keep it off have drastically reduced carbohydrates in some way and they claim that they do so without struggle.

That is my plan, and since starting a ketogenic diet, I've been able to lose 18 lbs effortlessly in 2 months. When I say effortlessly, I mean there is no struggle to maintain a calorie deficit. There is a calorie deficit because PHYSIOLOGICALLY I'm just not as hungry any more, but it's got very little to do with willpower or moral strength or any of that other bullshit that ignorant people keep talking about.

Obesity is a physiological problem that ignoramuses insist on treating like a psychological or moral one. Start treating it as it is and we as a society and species will have much more success.
posted by callmejay at 8:38 AM on December 29, 2011 [7 favorites]

the kind of fat pockets that can be removed by Lipo are insignificant, fat surrounds and even permeates many of our internal organs so no, Lipo won't do it.

I work in a related field and I can confirm that there is an emerging consensus because the evidence is simply overwhelming, take for example the genetic basis, two significant studies immediately spring to mind:
Canadian children
http://www.obesitynetwork.ca/page.aspx?page=2712&app=209&cat1=579&tp=12&lk=no&sortseq=cat2%3D&menu=50
German children
http://www.ncbi.nlm.nih.gov/pubmed/21283747

Obese children are more sensitive to the factors that help create overweight, I've attended some lectures led by John Dixon who has worked for 18 years in the field and as he says, the key time for prevention is 0-4years, so basically in utero and even maternal health and genes all play a part.

along with Leptin, ghrelin etc., some of the stories of the attempts to come up with the wonder drug to help people who pile on the pounds easily are almost tragicomedic.

there was the French one about cannabis receptors in the brain, the observation that cannabis gives you the munchies was followed by the natural conclusion that blocking those receptors would cause the opposite, hey presto, no hunger=weight loss.

But cannabis also makes people feel happy and peaceful....I don't know what number of suicides were sufficient to get the message but that one was ended.

Basically obese people will have to diet and exercise all of their life in an obesogenic culture, surrounded by food messages, and their body fights any and all efforts to keep the weight off. Food isn't something like a particular drug or alcolhol and even tobacco that you can eliminate 100% to help with this condition. That in itself is a pretty big mindfuck but layer onto that societal disgust of the overweight, the constant messages that thin is gorgeous, the number of medical professionals who share this attitude that it is a lack of will-power and you start to get a small insight if you do not have a weight problem of the complexity.

Working with surgeons as I do of all disciplines the "relative" question is frequently posed, e.g. "if your Mother, sister, uncle etc., had X, what would you recommend?"
Of the general surgeons who know anything about the safety and efficacy of bariatric surgery the answer they give immediately is Gastric Banding. Notice, not gastric bypass, at least here in the UK. Several surgeons I work with have had bands. In the backroom discussions at conferences of BOMSS the joke is "where did all the fat cats in the City of London disappear to?" and the answer is generally "Mr X's consulting rooms on Harley Street"

The amount of formerly obese politicians, celebrities, professionals, opera singers etc., who claim to have been one of the lucky ones for whom the X diet/personal trainer/cutting out carbs really worked is a sad refelction on how appallingly judgemental we've become. I was recently told that 1/2 of the sitting Indian Cabinet have had bariatric surgery, athough I don't know enough about Indian politics to confirm that, but I do trust my source.

Despite the fact that it is pretty extreme, although in a good high-volume centre is safer than a gallbladder removal, the same predjudices rear their heads, "easy way out" is the most common comment despite the fact that it only works well with continued Hypervigilance regarding diet and excercise (as the NYT article says of those few successful dieters)

Hearing big names like Finer and Le Roux guesstimate that any magic bullet is 20 years away is a bit of a downer but despite the multibillion dollar Diet Industry/Food lobby we will get to a combination of interventions that improve the awful graphs.
posted by Wilder at 8:44 AM on December 29, 2011 [4 favorites]

Is there anyone who really believes a quarter pounder, a coke and large fries are good for you? I don't see how treating people like idiots and saying "Hey, fast food is bad! Eat more kale!* WALK MOAR!" is helpful to anyone. I'm not your target demographic but I find it quite insulting and patronizing.

*reference
posted by desjardins at 8:53 AM on December 29, 2011 [1 favorite]

callmejay, we are seeing some of the long term damage of the malabsorptive surgeries like Roux-en-Y Bypass (did you know that Roux got his name on it because he agreed to the engagement & marraige of his daughter to the guy who really invented that technique, sheesh!), or the even more severe Biliopancreatic diversions & Duodenal Switch.

because of the ongoing adjustments necessary for the much safer Gastric Bands, surgeons are looking into the first stage (Sleeve gastrectomy) of the Duodenal switch as a primary procedure but it's too early to say whether is will in fact be a substitute for AGB. Even if it is, it's difficult to justify the higher mortality and morbidity rates even after the learning curve.

Nationally here in the UK we have been poor at the aftercare of bands, but there is an increasing swing back towards them as a result of some of the more extreme complications of the malabsorptive surgeries, particularly the incidence of intestinal failure.

tl, dr: if you have gone beyond BMI 28-30 for more than 4-5 years and have had several episodes of sucessful dieting that didn't last, investigate bariatric surgery.
posted by Wilder at 8:56 AM on December 29, 2011

Wilder: thoughts on ketogenic diets?
posted by callmejay at 8:57 AM on December 29, 2011

I've never known anyone who has had long term success with a gastric band, and very few who have even had short term success. There's no effect on leptin and ghrelin, so you're hungry and you can't eat. THAT is enforced misery.
posted by elsietheeel at 9:02 AM on December 29, 2011 [1 favorite]

Let your weight be whatever it's going to be, and live as healthy a life as you can, in terms of eating foods that are good for you and getting exercise.

But it is okay to want to lose weight. It is okay to set out on a programme of exercise and healthy eating, with weight loss as one of the intended end goals alongside improved fitness and better health. It is very hard and shouldn't by any means be compulsory, but if people do want to lose weight, it is okay to do things with that goal in mind.

I hated my body for years and years, since I was a mildly overweight 14-year-old. I spent the next twelve years alternating between 'mildly overweight' and 'significantly overweight', loathing every cubic millimetre of fat the whole time. I very, very much wanted to lose weight, but the only ways that had ever worked for me were either extremely disordered eating or a very restrictive diet (giving up all animal products for Lent; weight loss actually wasn't the intention there, but the weight fell off me), and both times I put the weight right back on again soon afterwards.

Okay, looking back, it's hardly a surprise that fuelling your weight-loss efforts with hunger pangs and self-loathing is a bad, and doomed, idea. But I don't think I really knew that, at the time; I just thought that clearly I wasn't hungry or self-loathing enough, or I could be thin like all those other pretty teenagers! I could not conceive of any route to weight loss that did not involve starving myself, and I hated being unable to maintain that forever. At the same time, I hated playing into the self-loathing diet and beauty industries, for being an insufficiently dedicated feminist for internalising all the societal anti-fat messages, and for being willing to starve myself for a stupid ideal in the first place rather than just live healthily and love my body whatever it looked like. The inside of my head was a pretty messy place, basically.

And then, five years ago, I lost 30+lbs slowly and healthily by... sensible calorie-counting and exercising. Which I'd always thought had to be this obsessive, awful, time-consuming thing full of hunger and exhaustion, but it turned out that doing it properly suited me really well. I got fitter and felt great, and for the first time in my life I felt like my weight was actually something I could control, and that my body wasn't just going to do whatever the hell it wanted regardless of how much I put in it or how much I made it do. I no longer felt like my thigh circumference said anything about me as a person, and I no longer felt like a crappy feminist for thinking 'well, I'd like to tone those up a bit' about my thighs in the first place.

The weight stayed off for four years, until I changed job, city and living situation, developed a new love for takeaway pizza and stopped exercising, at which point it came back again. I started making an effort to live and eat healthily again, and in months when I can be bothered to do it (which is... not all of them), I count calories to keep a 500-cal-per-day deficit on top of that. In the calorie-counting months, I lose about 4-5lbs per month; in the just-living-healthily months, I lose about 1lb per month. My general happiness levels, health, hunger and diet variability don't change. Counting calories doesn't suddenly and drastically change what I'm doing or how I'm living, it just makes my weight loss go a bit faster.

I appreciate that weight loss works differently for everyone, and that never having been severely obese I don't have any first-hand experience of how hellishly hard it is to lose weight from that starting point. I also don't think anyone should have to lose weight, and that fat-shaming is a loathsome and despicable thing. All I'm saying is that for me, as someone who wanted to lose weight, learning that it was possible and just fine to do so in a healthy and sustainable manner - that it wasn't totally doomed, that it wasn't anti-feminist, that it didn't have to mean starving myself or loathing myself or spending hours every day calorie-counting - felt freeing, in a way that 'live healthily and forget about your weight' messages never had.
posted by Catseye at 9:03 AM on December 29, 2011 [9 favorites]

kittenmarlowe touches tangentially on something that I don't think gets enough attention generally, which is the increase in medications that are available to us (and the increase in the marketing of those medications) - some huge number of which have 'weight gain' as one of their possible side effects.

My personal battle with weight (I'm 5' 8" tall and weigh about 270 lbs) began when I had one shot of Depo and ballooned from a healthy size 10/170 lbs (sturdy Russian farmgirl stock) to 230 over the course of three months, despite the fact I was fighting the weight gain tooth and nail, combined with the effect of other, steroid-based medications I've had to take over the years to combat respiratory issues have put me in the spot I am in now: fat, with nothing short of starvation-level dieting and triathlete-level exercise having any noticeable effect.

I'd love to see more studies done that try to more explicitly triangulate obesity with medications. I have a sneaking suspicion that if we looked at this more closely, we might find at least part of the reason obesity has increased so dramatically in this country over the past 25 years.
posted by anastasiav at 9:09 AM on December 29, 2011 [10 favorites]

I definitely agree with those who say it's important to recognize environmental interactions with the biological factors discussed in the post and in the additional science some folks have brought into the comments thread. Some genetic influences can have very different manifest phenotypic heritability or expressivity (e.g. to what extent it is expressed) depending on their environment.

I could definitely see plausible interaction effects between shared environmental conditions for Westerners and biological factors that have always been extant but now combine to drive body weight upward. There are some of these interactions we've already discussed: "thrifty" metabolisms paired with "normal" appetites in a relatively food-rich environment making consumption to satiety possible but producing of higher weight, the separation of "job time" from "active time" (i.e. many Westerners are not physically "working hard" while working) changing obligatory daily caloric expenditures leading to creeping weight gain that may not have happened before but may now be hard to lose due to a physiological tendency to keep weight, possible dietary influences to body "set-weight" having an additive effect to existing genetic tendencies toward higher "set-weight" (e.g. the corn syrup hypothesis), etc.

I don't know the obesity literature well enough to find an empirical or review paper on this matter specifically. However, I've always found philosopher Ned Block's takedown of Hernnstein and Murray's "The Bell Curve," which argues for strong racially-lineaged inheritance as primary explanation of the black-white IQ gap in the US, as being an excellent reminder of how different environments could very well drive sharp phenotypic differences and apparent heritability despite common gene pools between populations. (For the case of obesity, between, say, the populations of people living in the 1940s to people living in the 2010s.)
posted by Keter at 9:37 AM on December 29, 2011 [2 favorites]

(One thing I don't know anything at all about is the history of extramural exercise in the Western world! Is extramural exercise a phenomenon of the 20th Century in the West, or? Any [amateur or professional] cultural historians want to chime in here?)
posted by Keter at 9:39 AM on December 29, 2011

Which I'd always thought had to be this obsessive, awful, time-consuming thing full of hunger and exhaustion, but it turned out that doing it properly suited me really well.

One of the weirder things I ran into when my weight loss started being noticeable to people who are not me (the first place I lost weight was my face!) was a strange kind of sympathy from co-workers, who would say things like "Wow, you're doing really well - how hard is it to stick to your diet?"

And I felt *guilty* because it didn't feel hard for me. I wasn't suffering. I mean, I missed beer, and the easy kind of "I don't know what I want for dinner I'll just eat a bowl of cereal" lack-of-dinner-planning (now it's "I don't know what I want for dinner okay I'll just eat a couple boiled eggs"), but that was about it. I have seen a couple of these co-workers yo-yo through dieting stuff over the years, and I know it's been a struggle for them, so especially when talking to them, I felt bad because I didn't feel worse, if you know what I mean.

I don't think this is unique to American culture, but we are medal contenders when it comes to tying suffering to virtue. So when H., or T., at work, ask me about how it's going, I've been very conscious of talking a lot more about finding a thing that worked for me - finding a thing that didn't feel like work, or suffering, and that that thing might not be the right thing for everyone. My models for this have been our downstairs neighbors and friends, who launched a calorie-counting thing a few years ago that's really worked for them, and they don't talk really about "Oh, I can only have one cookie because it's X calories poor me!" - they talk about foods and cooking techniques they've discovered that they really enjoy that are a sustainable part of the way they eat now.

Suffering is not a virtue, and tying suffering to how you eat is just a destructive mind-fuck.
posted by rtha at 9:56 AM on December 29, 2011 [8 favorites]

I suffer when it doesn't work. If it was fool proof and I knew that I didn't have to plan my meals carefully and count calories for the rest of my life, I would probably have a good time, too. But the weighing, measuring, planning, counting and comparing is forever, and it may not even work. That's what sucks.
posted by Tarumba at 10:06 AM on December 29, 2011 [3 favorites]

If it was fool proof and I knew that I didn't have to plan my meals carefully and count calories for the rest of my life, I would probably have a good time, too.

I'm experimenting with turning that on it's head. I had a lot of 'calorie counting' anxiety until I started considering only my weight's trend. If it's trending down, continue doing whatever I'm doing. If it's not, then do something different, either eat less/different or exercise different/more...

Not a whole lot of specific, "Thou must..." pronouncements. It's a very dudely way, I think....
posted by mikelieman at 10:13 AM on December 29, 2011

@tarumba--of course it will work (if you add in some exercise) and yes you may have to do it the rest of your life. So what. If you had any other disease is that the attitude you would assume--well, I've got juvenile diabetes--it would not be so bad if I did not have to take insulin/diet/exercise (plan, organize, compare, exercise)the rest of my life. I've been diagnosed with depression, I wouldn't mind if I did not have to take medicine, eliminate most alcohol/drugs, get regular sleep, exercise regularly, organize my days. There are scores of life long illnesses/diseases/injuries that require life long maintenance. It is not fair, it is not just and it sucks. But the alternatives are not all that pleasant.
posted by rmhsinc at 10:21 AM on December 29, 2011 [1 favorite]

rmhsinc, you seem to be missing the whole point of the study (and of decades of observation of dieters' long-term abysmal success rates.)

"You may have to do it the rest of your life" may be damn near impossible. It may mean being hungry and miserable all the time and never giving in to your body's demands to eat more and move less for the love of god, I'm starving here!

This study (and decades of collective experience) show that it's not just an inconvenience, not even just a huge inconvenience, but it may involve an immense struggle that 90%+ of people are not up for and that may not even be worth it from a quality of life perspective.

Comparing it to having to take medicine or avoid alcohol/drugs (at least for a non-addict) is minimizing the difficulty. You're fighting your own body's deepest instincts if you try to maintain a big weight loss through conventional methods.

Imagine if our culture had a taboo on growing over 5'6" and adolescent boys were pushed to limit their calories and increase their exercise to avoid growing taller than that. It would be possible, maybe, but damn hard. As long as that HGH (or whatever) is pumping through their veins, their bodies would be trying to grow and screaming at them to eat more and sleep/rest more. Would we blame them for lack of willpower and call them whatever the opposite of gluttons and sloths would be if they failed to win that battle?
posted by callmejay at 10:33 AM on December 29, 2011 [4 favorites]

er, not the opposite, but gluttons and sloths. Those damn lazy, worthless kids, always growing. Why that one had thirds at dinner! And she slept 10 hours last night!
posted by callmejay at 10:34 AM on December 29, 2011

Additives and preservatives play a big part. Obesity is visibly increasing elsewhere in the world as marketing penetrates with its messaging and consumer products.
posted by infini at 10:39 AM on December 29, 2011

Thanks for this interesting discussion. One bit of hope: I've lost 25 pounds eating lowish-carb ("primal") and have another 20 to go. The idea of eating this way for the rest of my life is actually appealing. I'm not hungry or deprived. I don't count or weigh anything except for occasionally figuring out how many carbs I get on a typical day.

I walk and ride my bike most days and officially "work out" about 2 times a week. I eat satisfying food. I go out to eat often and just don't eat the high-carb part of the meal. If a meal gets delayed or I'm stuck somewhere without food, I no longer get desperately, crankily hungry.

This is totally sustainable and even enjoyable. It's not fast, at least not for me (.5 to 1 pound/week; 50 years old), but it also doesn't feel like starvation. If I have to eat this way forever to keep the weight off, no problem.
posted by ceiba at 10:45 AM on December 29, 2011 [3 favorites]

callmejay - does that mean that at 5'0", I am a saint?
posted by desjardins at 10:46 AM on December 29, 2011

kcds: "No matter how much scientific evidence is presented to the contrary, some MeFites just know that obesity is a minor issue that could be fixed if only those lazy butter-eating lardasses would get off their butts and exercise once in a while."

Are you reading the same thread as the rest of us?
posted by schmod at 10:51 AM on December 29, 2011

rmhsinc, I work out 6 times a week for one hour (15 minutes running at 5.5 mph, 15 minutes elliptical (hard) and 30 minutes of weight lifting).

Still stuck for two months now...it really isn't that simple for many people!
posted by Tarumba at 11:19 AM on December 29, 2011 [1 favorite]

For those interested in this thread, you might also want to check out this NOVA documentary (52 min). It tracks 13 sedentary people with various levels of cardiovascular fitness as they train for the Boston Marathon. SPOILER ALERT: by the end, all are much healthier - excellent or superior VO2 maximums. NONE have had much change in weight or body fat. The only exception is one woman who was also restricting her calories, doing a boot camp on top of marathon training (!) and whose weight gain had been relatively recent (i.e. she was re-losing "new" fat).
posted by peep at 11:21 AM on December 29, 2011 [4 favorites]

Eat better, exercise more, that is all.

RTFA. That is all.
posted by blucevalo at 11:29 AM on December 29, 2011 [7 favorites]

Is extramural exercise a phenomenon of the 20th Century in the West

I don't think so. Some 19th century examples I can think of: British public schools were fixated on healthy exercise for the boys and manly pursuits -- mens sana in corpore sano, y'know! Or German Turnvereinen (gymnastic associations). I suspect they're a class-based phenomenon though. The working classes had no leisure, hard labour, and not enough food.
posted by i_am_joe's_spleen at 11:31 AM on December 29, 2011

If I have to eat this way forever to keep the weight off, no problem.

This has been my experience as well, and I feel goddamn lucky.
posted by rtha at 11:40 AM on December 29, 2011

@callmejay--No i did not miss the point of the story or the other literature in the field. i did not say it was inconvenient or it was just like taking medication. It is very hard work, quite difficult and takes a long term, if not life time, commitment. i have spent my life working with folks with a variety of psychiatric and physical limitations, including obesity. Just because something is very difficult does not translate into being miserable for a life time--it means it is difficult. And it may not be for everyone--people will have very different genetic, psychological and environmental situations which may make losing weight (and maintaining weight loss) easier/more difficult. I do believe you are catastrophizing the anticipated misery. And, if you think maintaining a healthy life for a person with juvenile diabetes is just taking medication you are way off base. A life time of medication, aggressive diet control, regulating sleep/infections/pregnancy etc. Please do not confuse long term and very hard work with misery, fighting innate impulses or whatever. While I am fully aware of the statistics on 'failure and relapse" I have met very few people who succeeded who would describe it as a life time of misery.
posted by rmhsinc at 11:41 AM on December 29, 2011

I have met very few people who succeeded who would describe it as a life time of misery.

That may be true, but there's a pretty strong selection bias at work in that sample.
posted by Ragged Richard at 11:50 AM on December 29, 2011 [2 favorites]

Keter, thank you for the very evident care you took in putting together your post.
posted by hat at 12:07 PM on December 29, 2011 [3 favorites]

Re: "selection bias", that's simply how lifestyle change works. Study after study has shown that people vastly overestimate how bad "a life of misery" will be ahead of time, but tend to adjust to actually living it better than they thought they would.

I eat a restrictive diet due to health reasons; it tends to bother other people (and pre-diet me, for that matter!) a lot more than it does me. At this point I'm used to it, and what was once quite painful to imagine is just breakfast, lunch, and dinner.
posted by vorfeed at 12:13 PM on December 29, 2011

I understand it's hard for some people to do that in our modern world, but that is because we have engineered our cities and our food supply to support this sedentary way of life.

You did read the article, right? Wherein the successful couple has not only had to completely change the way they live (they use bikes both as transportation and recreational vehicles, grow their own food, etc.), but still have to research and/or weigh every single item to be consumed, record everything they eat every day, and calculate every calorie burned through every routine activity, differentiating between things like "gardening" and "vigorous gardening"?

The point of the article is that for people who are trying to maintain considerable weight loss, even a revolutionary change in lifestyle is not enough. Right now, and for most people, there may not be a way to make it work without the all-consuming soul-sucking parts. Which, well, soul-sucks.
posted by evidenceofabsence at 12:32 PM on December 29, 2011

It's not about willpower, it's about making actual, real lifestyle changes. I don't really know any skinny people who spend hours and hours at the gym or counting calories, because those things are soul-suckingly boring and miserable. The healthy people I know are out hiking, riding bikes, or whatever because those things are fun and that's what they do. It's just their life.

But healthy != skinny. I know plenty of healthy people who aren't skinny who are out hiking, riding bikes, or whatever. I am sure you also know or have seen such exotic creatures. I am one of them. You wouldn't look at me and sign me up for a reality show, but one would only call me slim in a lame attempt at irony.

Yet even though I am a double-X, and then supposedly immune from body image issues, well let me tell you that is bunk. I am probably as skinny as I am going to get give or take ten pounds, and well mi BMI is borderline obese, and I am according to the charts, for my height, 40 lbs or so overweight.

Point is that lifestyle changes are good, and the truly morbidly obese need them, but if you are inclined to heavy, all the lifestyle changes in the world won't get you slim. Healthy, and slim*er*, but still probably portly.
posted by xetere at 12:34 PM on December 29, 2011 [4 favorites]

catseye: But it is okay to want to lose weight.

I'd say it is okay to want to lose fat, or get more fit, or become healthier. Losing weight is not a good goal for the simple reason that muscle weighs more than fat. You can gain muscle, lose a bunch of fat, become much healthier and the scale will say you are losing ground.

Solution: throw away the scale.
posted by msalt at 12:41 PM on December 29, 2011 [1 favorite]

Yet even though I am a double-X I meant to write even though I am NOT a double-X. Long day here @ work. I do know my modern biology.
posted by xetere at 12:46 PM on December 29, 2011

I read this article and it royally pissed me off. The research done on weight-loss so far is extremely disingenuous. Researchers put their subjects on unrealistic, very low calorie diets--requiring only 800 calories per day in shakes, for example--and crow over the metabolic damage done to those bodies after they're put on those diets for an extended period of time.

Any trainer, anyone successful at long-term weight loss will tell you that crash diets are dumb and do not work. You fuck up your body and it doesn't teach you long term healthy habits. And the diets in these studies are the equivalent of that. All these studies do is prove exactly what we knew already.

I would like to see more studies done on people who lose weight over a long period of time. The author makes one nod to the total lack of research in this area by acknowledging a long-term study is being done on this, but immediately dismisses it by saying it's the amount of fat lost rather than the way it is lost. But again, that conclusion is based on people who lost their fat very quickly!

Our bodies do try to work around fat loss and do resist significant loss in body mass, but there are intelligent ways to address those problems and they all involve taking a moderate approach. But I suppose "Combine a moderate caloric deficit with diet and exercise, on occasion allow yourself to cheat a little" are not the kind of sexy results that get you highlighted in the New York Times.
posted by Anonymous at 12:57 PM on December 29, 2011

I can still manage to maintain my target weight but christ what a disappointment not to get back the full 750 kcals a day I was denying myself to lose the weight.
posted by srboisvert at 10:36 AM on December 29 [+] [!]

You weigh less now. Your body does not have as much mass to move. Of course you don't burn as many calories as you were when you were heavier. Oftentimes the reason people gain back weight is they assume they can return to the quantities of food they were eating when they were heavier.
posted by Anonymous at 1:02 PM on December 29, 2011

I agree with you schroedinger, but the focus should not be on weightloss, it should be on understanding what's going on with the whole stress/hormone/metabolic system and increasing external supports that make healthy living possible for people with impaired functioning, fatigue, high stress reactivity and other associated conditions. I genuinely suggest you read the paper I'm suggesting below and consider the level of biological processes going on in some people's bodies. Not all bodies are functioning the same and many have deeply set gene functioning patterns that are not going to be altered in the way you propose.

There's actually some really interesting research being done on how the maternal and paternal life experiences influence and alter gene expression in the offspring, affecting metabolism and weight gain. This includes a number of generations of envirionmental factors affecting the gene expression of future offspring. Environmental exposures of stress, dietary factors or toxins that happen while a fetus is in the womb, and in early childhood can alter the epigenome the strongest and affect a number of generations. This paper was really interesting to me and available without a pay wall (Though I need not remind mefites to always be a skeptic and read critically):

Future Medicine-Timescales of human adaptation-the role of epigenetic processes.
"As one well-known example, reduced growth rate in utero and after birth predicts a diverse set of outcomes that include increased risk for cardiovascular disease and diabetes and lower adult production of reproductive hormones [7–10]. Similarly, ingestion of the body fat-derived hormone leptin during brief early windows of postnatal life can permanently modify feeding behavior, weight gain and risk for diabetes [11], while there is evidence that exposure to stress hormones in utero modifies long-term stress reactivity after birth [12]. Interestingly, not only do many of the biological effects of early environments linger into adulthood, but some transcend the affected generation to be passed onto grand offspring and even great-grand offspring."

More outside support. More focus on whether the system and emotions are stressed and what kinds of EXTERNAL supports might help people such that their environment is more secure and reliable. Giving people with altered stress reactions a HIGHER level of required personal achievement will make the stress system more overloaded and ultimately backfire for a majority of people.
posted by xarnop at 1:05 PM on December 29, 2011 [2 favorites]

I'm perfectly fine going nanny state on this : Replace all alcohol taxes with an across the board calorie tax that's worse on calories that get digested easier, like ones in liquid form, like soda and alcohol, and unnecessarily elevated calories, like fast food restaurants. Also, tax harmful consumption patterns like restaurants that stay open late, offering an exemption to night shift workers. Ask that everyone reads some minimal exercise guidelines. etc.
posted by jeffburdges at 1:12 PM on December 29, 2011

Losing weight is not a good goal for the simple reason that muscle weighs more than fat.

I'd suggest it's a great goal to get from say, 350 to 250... Then you worry about muscle mass gain v. fat loss. But keep in mind that the audience playing along at home might just be in the "Dear G-d, PLEASE help me stop this downhill slide" part of the process...
posted by mikelieman at 1:30 PM on December 29, 2011

Any trainer, anyone successful at long-term weight loss will tell you that crash diets are dumb and do not work.

Based on the things I see on women's - and, increasingly, men's magazines - while I'm standing in line at the grocery store, I'd bet money on the fact that most people (especially at high-pressure times like the holidays) don't get their dietary advice from good trainers or dieticians. They get their advice from magazine covers, which crow shit like "Lose 10 pounds the easy way - with grapefruit!" It takes effort and planning and attention to change the way you eat, and if you don't have buy-in from the people you live with (spouse, kids), well, that doesn't make it any easier.

It doesn't surprise me that the researchers put subjects on super-restrictive, boring diets, because I bet that that's what an awful lot of people do in the wild. The popularity and huge number of "Eat This One Thing You'll Lose Weight Quick!" books tells us a lot.
posted by rtha at 1:32 PM on December 29, 2011 [1 favorite]

I'm perfectly fine going nanny state on this : Replace all alcohol taxes with an across the board calorie tax that's worse on calories that get digested easier, like ones in liquid form, like soda and alcohol, and unnecessarily elevated calories, like fast food restaurants. Also, tax harmful consumption patterns like restaurants that stay open late, offering an exemption to night shift workers. Ask that everyone reads some minimal exercise guidelines. etc.

It was all going so well.
posted by desjardins at 1:45 PM on December 29, 2011 [1 favorite]

My views informed by seeing Dr. Friedman give his talk at The 2010 Nobel Conference at Gustavus Adolphus College. (SLYT)

He doesn't really get started until 5:30 but the whole talk is worth watching.

He makes a great case that the accuracy of the body in calibrating calories in vs calories out alone points to a biological feedback loop of amazing capability.
posted by The Violet Cypher at 1:57 PM on December 29, 2011 [1 favorite]

xarnop, I absolutely agree that we need to look at the role of society in terms of weight gain, from how food production is structured to evaluating the quality of diet and exercise science in mass media (both suck). Without question, for improvements in rates of obesity in society as a whole we need to make serious changes to the social aspects. And with any luck, changes to social aspects will result in positive epigenetic changes (the reversal of some of those switches discussed in the paper) and a further cascade of health in future generations. I'm not saying it does us no good to understand the complex biological processes underlying metabolism.

But I also view weight loss and body composition improvement the same way I view drug addiction. There are many ways someone becomes addicted to and stays addicted to drugs. There are complex biological and social factors underlying the process--some people lack social support, others are biologically and psychologically predisposed to addiction, etc. There is a lot we as a society can do to help or impede the recovery of an addict. But ultimately the decision to pursue recovery and stay on recovery is the addict's themselves. Nobody else is going to make them get well or give up. The addict has to commit themselves to those changes and to maintaining those changes.

Weight loss is the same thing. At some point it will suck. For some people it will suck more than others. But it is not impossible, and if you are smart in the structure of your diet and exercise program it will be a lot easier to execute and maintain.
posted by Anonymous at 2:42 PM on December 29, 2011

Like callmejay, I, too, have been on a ketogenic diet and found it to be highly effective. I'm now a firm believer in the idea that carbohydrate overload is the primary cause of obesity and dietary problems.

I've been overweight almost all my life and my doctor was starting to waggle his finger at me about blood pressure, elevated triglycerides, and poor insulin response. The list of drugs he was threatening me with was truly frightening. This is a choice that I made because the next step was some kind of surgery. I didn't want to forever have to give up chocolate cake, but I was, am, and will be, willing to give it up for a while. But I still have the choice.

Like any bad habit there are other factors involved. The choice to kick that bad habit, however, comes form only one place, regardless of the number of positive and negative external factors. The ease of that choice is what these studies are showing may have been called into question.

I don't care. It's easier, for me, to have a more restricted diet than it is to weigh 340 pounds.
posted by Revvy at 3:41 PM on December 29, 2011 [2 favorites]

Can someone who understands simple biology explain the part to me about shrinking fat cells vs. losing fat cells? I am truly ignorant when it comes to the actual processes the body goes through when losing weight. I mean, ignorant to the point of not even understanding the meaning of "burns fat stored in fat cells for energy." Well, but... where does it go?

So, when you're in a deficit (taking in less than you need to function), your body "uses" the fat stored in fat cells. It's used for fuel, I get that, but what becomes of it? It's not like the fat just walks away (unless you are on Doctor Who). And then, if you do this, and keep it up, apparently the fat cells leave too? Where do they go?

Please excuse my dreadful ignorance on the topic. I've lost 40 pounds this year by following Weight Watchers (which is not a "diet" in the sense of "diets don't work but THIS ONE does!"--it simply teaches portion control and how to balance your food intake for each day, when you get right down to it), but I don't have an understanding of how it happened, physiologically.
posted by tzikeh at 4:09 PM on December 29, 2011

"It's all biology!" "Predetermined!" "Physiologically predisposed to gain weight!" "No matter how much I diet and exercise, I can't lose weight!".

So why did the obesity epidemic explode in just the past 20 years or so? Did biology change? Genes shifted? Human beings evolved faster than flies? Suddenly gobs of people acquired novel physiologies?

"Well, the environment is different!" "You can't compare the 1920's to the 2000's!" "Happened really big time in just the last 15 years (see link above)? It just means you can't compare the environment of 1997 to 2008!"

OK. Now I understand what happened. If it really were the case that people's physiology changed, and people are really helpless to affect their weight without superhuman determination and misery, if it really is epigenetic shifts, then you'd expect it to happen randomly from a geographic point of view. It's not like there's a God Of Malicious Physiology who selects people in the South for special treatment and saddles much greater numbers of them with Fat Genes, whilst sparing Colorado. And yet - see link above - the obesity trends first appeared in the South, and are still the worst there.

And times? It's all contemporaneous. We're not talking 1920's or even 1997. We're talking comparing 2010 to 2010. It's not the times.

So is it really biological determinism? I think I know what happened. Some communities simply kept people of the fat physiology out - barred them. That's how you got numbers to skew like that across different communities. Here's a great example:

Manhattan Beach has the lowest child obesity rate in L.A. County, Bell Gardens the highest. Their demographics are starkly different, and residents' perceptions on the issue can contrast sharply:

"Just 4% of children in affluent, mostly white Manhattan Beach are considered obese, the lowest rate countywide, according to public health officials. In poor, predominantly Latino Bell Gardens, the rate is 36% — higher than in any other city.

"They are like two different worlds," said Paul Simon, who directs chronic disease prevention for the county health department.

Obesity among the young is starting to level off in California and around the nation. But stark disparities persist, posing vexing obstacles to further change."

Reading this thread, I see that (a) it's all biologically pre-determined and (b) random luck as to who has the fat physiology and who not. So in order to account for the disparity between these two communities 4% child obesity vs 36% not far from each other geographically, one has to conclude that the way to account for that would be that while fat physiology is randomly dropped on both communities, one community simply ejects them since they can't change them - because after all, we know from reading this thread that you can't change the weight without superhuman efforts... and knowing many people from Manhattan Beach, none of them strike me as superhuman.

Of course there are also crazy people making crazy claims, like: education DOES matter, economic realities DO matter, cultural factors, environmental factors and so forth - they all clearly show that they can account for a 4% vs 36% difference in obesity rates WITHOUT REFERRING TO PHYSIOLOGY as an explanation even once. At best, it seems, physiology might account for 4% of the obesity rate in this country - today, not in 1920, not in 1997, not at any magical time or magical place, but today, in the U.S. of A. These Manhannites are not paragons of masochistic self-control, freaks of diet and exercise regimens. Somehow, still they manage to keep it to 4%, without all that. Perhaps we should look at the environment for at least 96% of the explanation (and by environment, I mean it in the broadest sense, including economics). But that's just crazy talk. Carry on!
posted by VikingSword at 5:27 PM on December 29, 2011 [5 favorites]

Straw man much, VikingSword? Nobody discounts the environment or postulates that Americans underwent a drastic genetic shift in the past generation. If you ask me, what happened is that (1) everybody started saying that dietary fat is bad for you and (2) snacking on carbs, especially HFCS increased drastically.

Anyway, we're talking about LOSING weight not avoiding gaining it in the first place. Very different topics.
posted by callmejay at 5:37 PM on December 29, 2011 [1 favorite]

Late to the thread, but the article mentions someone who considered "gardening vigorously" as exercise.

Just wondering what other people's expectations are when someone says the word "exercise."

Anecdotally, I've experienced a couple times in my life where I wanted my body to do something different -- run a particular distance faster or get stronger -- and I had to put in a lot of effort to get there. Effort as drastic as finishing a workout and having body shakes or cramps or even throwing up. And being able to repeat the experience the following week, for weeks on end, all part of a regular regimen. Said regimen would involve changing sleep schedules and limiting certain types of social events.

I know the article was more about dieting, but it gave such short shrift to exercise, and when it did, the exercise mentioned sounded really pathetic.
posted by scelerat at 6:05 PM on December 29, 2011

If you're interested in the physiology of adiposity and lipogenesis (and insulin resistance and stuff like that), check out publications from Mitchell Lazar's lab [free pdfs].

: Reading this thread, I see that (a) it's all biologically pre-determined and (b) random luck as to who has the fat physiology and who not.

I think I found your problem there. Do you assume everyone who tells a story is making a broad case for all humanity?

: Suddenly gobs of people acquired novel physiologies?

Historically speaking? Yes. Suddenly gobs of people are at a phsyiological place where gobs of people weren't before-- outside the norm. So scientists have this broad new phenomenon to study. It's pretty novel phsyiology. We don't understand it yet. Should we discount it because it doesn't explain everything, or should we try to work it into the models?
posted by zennie at 6:23 PM on December 29, 2011 [1 favorite]

Well, but... where does it go?

It gets split up into smaller molecules and moved about. Wikipedia is full of semi-helpful bits and pieces which I recognize slightly from highschool-level biology:

Once inside the mitochondrial matrix, fatty acids undergo β-oxidation. During this process, two-carbon molecules acetyl-CoA are repeatedly cleaved from the fatty acid. Acetyl-CoA can then enter the citric acid cycle, which produces NADH and FADH₂. NADH and FADH₂ are subsequently used in the electron transport chain to produce ATP, the energy currency of the cell.

So it gets sliced into lots of acetyl-CoA molecules, which are transformed into NADH and FADH2 molecules and then ATP. ATP is super energetic and is used to directly power cellular stuff. I think there's CO₂ produced somewhere along the way, which you breathe out.

When cells die, they dissolve into their constituent bits which either are used by surviving cells or get, well, pooped out. Dead skin cells get sloughed off instead.
posted by BungaDunga at 6:23 PM on December 29, 2011

Or not free. WTF. :P
posted by zennie at 6:23 PM on December 29, 2011

Can someone who understands simple biology explain the part to me about shrinking fat cells vs. losing fat cells?

IANABiologist, but this is what I've learned.

The number of fat cells in the body probably doesn't change all that much, either up or down (up maybe, down probably not, experts disagree). When you burn fat, you're burning the fatty acids stored in the fat cells, which is released by an enzyme.

So, you've got a caloric deficit. You're expending more energy than you're taking in and your body needs to make up the difference. Oh, hey, look, there's some fat cells (called adipocytes) over there, storing up some nice energy just for this purpose.

The process for getting at that energy is called fatty acid degradation and there's a lot involved in triggering it. Long story short, an enzyme called a lipase gets activated by a long hormone/ezyme phone tree so that it can free fatty acids from the fat cells (a process called lipolysys). The fatty acids can roam free in the blood stream to be picked up by whatever tissues need them at the time. The mitochondria in those needy cells then go through a really not-easy-to-understand process called beta oxidation to process the complex fatty acids into more readily-consumable acetyl-CoA, which your cells pull apart through the cirtric acid cycle, which is how all metabolic organisms process energy, regardless of protein, fatty acid, or carbohydrate source.

The fat cell is still there, just missing all of the fatty acids in it. It's essentially empty, just sitting around, waiting to store up more fatty acids in a process called fatty acid synthesis. The current best thought is that if you become severely obese, your body may have filled up all of the fat cells that it started with and have to create new ones.

Folks on ketogenic diets (like me!) are forcing their bodies to take this process even further. The brain can't use fatty acids for energy because they're too big to pass through the blood-brain barrier. Because we're not taking in a lot of carbohydrates, we've cause a separate process to happen.

We've removed the easy-to-use sugars from our bodies, causing a drop in blood-glucose levels, also known as hypoglycemia. Gluconeogenesis, where the body tries to make glucose out of anything it can get it's grubby little hands on, kicks in pretty quickly, but it can't last that long because it's a really expensive process. The key here is that sustained gluconeogenesis (more than 24 hours) deprives the body of a chemical needed to process acetyl-CoA in the citric acid cycle (oxaloacetate). So, now the body is completely without any method of feeding the brain or the muscle tissues.

Have no fear, the liver has a plan.

The body reacts with ketogenesis. In order to feed the brain and body energy, the liver takes the rapidly-building acetyl-CoA in the bloodstream and transforms it into ketones (primarily acetoacetate, which breaks down into two others) which can be used by the brain (and other body parts) as an energy source.

Simple, huh?
posted by Revvy at 6:35 PM on December 29, 2011 [7 favorites]

Anyway, we're talking about LOSING weight not avoiding gaining it in the first place. Very different topics.

Neat trick. Note, that the statistics of 4% vs 36% are for childhood obesity. It is well accepted that obesity in childhood has a carryover effect into adulthood. And to speak of "not gaining in the first place" is disingenuous when you are starting in childhood - because if anything, the reality of environmental influence is thrown into starker relief, it would be absurd to berate a child for not exercising or dieting enough. Which shows up the emptiness of the "blame the patient" model, of which the fat shaming is just the surface. Where do you put the dividing line of gaining weight in the first place and the subsequent problems of trying to lose it? What then leads to some people gaining weight in the first place and others not doing so (4% vs 36)? Physiology again? Personal responsibility (those terrible morally deficient lazy fatties)? It's nonsense.

What changed, is not people's physiologies, and not people's morals, but the environment, in very measurable ways. We have the same physiologies and will power we've always had - yet today the rates of obesity have skyrocketed - so these are not the variables responsible, since they have not changed. But the environment has - ergo it is the environment that's responsible. In the LATimes article I linked to, some of the reasons are hinted at. To try and shift all this onto blaming the victim (fat shaming), or disempowering narratives ("it's physiology, you're doomed!") allows the real culprits to escape being held to account, and more importantly, prevents real solutions. Overworked, poverty struck people, with little hope of advancement trapped in an economic system that doesn't pay living wages and robs them of any free time, where healthy food is harder to obtain and more expensive than readily available fattening junk food, are on average fatter in Bell Gardens, than are the privileged people in Manhattan Beach. And it has not a damn thing to do with different physiologies in Bell Gardens compared to Manhattan Beach.
posted by VikingSword at 8:48 PM on December 29, 2011 [4 favorites]

VikingSword, you might be interested in this paragraph from one of the linked articles:

Although inhabitants of the developed world share an increasingly homogeneous environment and the proportion of overweight adults has risen, there has been a particularly pronounced increase in those who can be defined as morbidly obese (BMI >40 kg m^-2), which exceeds what would be expected from a shift in population mean alone [Flegal 2002]. This implies that the ‘obesogenic’ environment that has developed since the mid-to-late twentieth century has caused a subgroup of the population, who are genetically susceptible to severe weight gain, to become excessively obese [Friedman 2003]. A theory to explain this has its origins in the classic paper by J.V. Neel that outlines the ‘thrifty gene’ hypothesis, whereby genes that predispose to obesity would have had a selective advantage in populations that frequently experienced starvation [Neel 1962]. People who possess these genes in today’s obesogenic environment might be those that ‘overreact’— that not merely become slightly overweight, but become extremely obese. This can be seen in certain high-risk groups, such as Pima Indians and Pacific Islanders [Friedman 2003], and recent studies in the United States have shown that there is also a disproportionate level of obesity in African-Americans and Hispanic-Americans compared with Caucasians [Cossrow 2004]. These differences cannot be explained by lifestyle, economic or environmental factors alone, indicating an important role of genetics.

Your example of the different demographics and obesity rates of Manhattan Beach and Bell Gardens neither supports nor refutes this claim: the environments are different, but so are the genetic backgrounds of the inhabitants. I don't hear anyone saying it's pointless to change the environment, or that the environment plays no role. Indeed, the economic disparity between these two neighborhoods is incredibly unjust, for all of the reasons you pointed out, and we should be working to make that better. But even within a shared environment, some people are going to become obese and some people aren't and I think it's worth investigating why that is.
posted by en forme de poire at 9:10 PM on December 29, 2011 [4 favorites]

VikingSword, I don't disagree with anything you're writing, but I get the feeling you think you're disagreeing with me. Maybe I haven't been clear about what I'm saying.
posted by callmejay at 3:07 AM on December 30, 2011

Also - I nominate this thread Exhibit A: Let it no-longer be said that the Blue can't handle discussion about fat.
posted by -harlequin- at 3:14 AM on December 30, 2011 [1 favorite]

A lot of the paradox of apparently genetically similar populations exhibiting dissimilar obesity rates even when controlling for diet, exercise and lifestyle has to with the various exquisitely unique polymicrobial colonies of arse bacteria that are usually transmitted through proximity and close family contact and their slight differences in enhancing the efficiency of the host gut's ability to maximally extract usable energy sources from ingested material. Once established, the colonic ecology is remarkably resistant to long-term change.
posted by meehawl at 7:14 AM on December 30, 2011

"if it really is epigenetic shifts, then you'd expect it to happen randomly from a geographic point of view."

I think you completely did not read the paper I posted. Epigenetics is largely a study of ENVIRONMENTAL INDUCED alterations of physiology and gene functioning--- that can be passed on to offspring for a number of generations.
posted by xarnop at 7:18 AM on December 30, 2011

But yes, epigenetic alterations can revert back in a number of generations WITHOUT the environmental stimulous. Meaning sure, if we could alter the environment, which might need to involve systemic and individual actions and decisions, then yes we might could change the variables that are pushing people into poor health. Again-- the focus still needs to be on health. Epigenetic alterations usually revert back BY GENERATION of healthy environments.

Meaning that we might not expect individuals revert gene functioning patterns that are designed to last a few generations to meet with potential circumstances. What we CAN hope for is that we find out and understand what sorts of variables are taking people out of health-- then we develop better strategies to give people tools that work WITH their will capacity rather than against it.

If you say you found a cure for disease but it's a pill that most people can't swallow or keep vomiting up-- you can't say the problem is that the patients are failing, you need to fix your medicine so that it works with capacity of the patient to use it.
posted by xarnop at 7:26 AM on December 30, 2011

If you say you found a cure for disease but it's a pill that most people can't swallow or keep vomiting up-- you can't say the problem is that the patients are failing, you need to fix your medicine so that it works with capacity of the patient to use it.

Yet this is not analagous to improvements in one's lifestyle in order to lose weight at all. There is a big difference between failing due to physiological impossibility and failing due to poor education or unrealistic expectations. The latter can be fixed by the person in question and is not impossible to overcome.
posted by Anonymous at 7:38 AM on December 30, 2011

schroedinger- you say that but what are YOUR expectations, because it sounds like your expectation is that a persons weight will revert back to a standard BMI if they have good education and "realistic expectations". It's possible that this expectation itself, that in a good environment and with healthy diet and exercise, everyone's weight will revert to a healthy BMI might be an unrealistic expectation itself. That doesn't mean a healthy diet and exercise aren't good things, but I also think you have an unrealistic idea about the capacity of people with metabilic disorders/fatigue/mental health issues/low motivation/blood sugar issues and a host of common problems associated with these physiological changes to be ABLE to carry out and get a benefit from a lifestyle change program.

Also, if you look at the variables inducing these physiological changes you will find that alterations of the stress system are a huge component. Meaning that things like, housing instability, job instability, isolation, poor peer relations, lack of meaningful work, psychological issues and much more are part of what is altering physiological and that will not be resolved with exercise and diet. High stress in non human animals induces dietary change patterns as well and in some studies these changes are PROTECTIVE against a high stress environment.

Meaning the genes might actually be doing the right things to meet with high stress environments and the goal is to alter EXTERNAL factors such that humans are not living in conditions that are not compatible with human health. If you expose rats to aggressive rats, shocks, chronic isolation and a housing environment that is not compatible with the needs of a rat-- it does not MATTER if you give them a healthy diet or an exercise wheel-- their physiology will still be altered by the poor conditions. We're missing key variables causing these alterations that are NOT diet or exercise patterns.

What's more if you expose a rat mom to prenatal stress, or expose the infant rat to maternal separation or abusive maternal rearing, the alterations are found to be lifelong regardless of diet. There DOES seem to be positive influence to physiology from an appropriate diet and exercise, but some of these alterations are more deeply rooted than can be altered by an appropriate diet.
posted by xarnop at 7:53 AM on December 30, 2011 [1 favorite]

What changed, is not people's physiologies, and not people's morals, but the environment, in very measurable ways. We have the same physiologies and will power we've always had - yet today the rates of obesity have skyrocketed - so these are not the variables responsible, since they have not changed. But the environment has - ergo it is the environment that's responsible.

Yes, of course the environment changed to promote obesity. But the body reacts to the environment. And the way it reacts changes with obesity.

No, the sequence of DNA has not largely changed. But the physiology has. Because DNA gets turned on and off and modified in all sorts of ways, and there's where epigenetics comes in.

Many people do not "have the same physiologies and will power we've always had" because, regardless of how it began, it's gone on for a long time. Second and third generations have been affected.

Simply taking away the original environmental conditions will not immediately reverse the changes in physiology. We don't know if some of the changes are reversible at all with a human's lifespan.

It's just not that simple.
posted by zennie at 7:56 AM on December 30, 2011 [2 favorites]

xarnop, are you honestly arguing that the majority of obese people are living under such deeply, irrevocably stressful conditions that it is simply impossible for them to make any positive choices towards changing their lifestyle? That weight loss is impossible? Because that is a rather broad and sweeping statement to make. The vast majority of people I know who are overweight are not suffering from crushing poverty and job instability and food deserts, but from simple lack of education and bad lifestyle habits. Societal factors shape our lack of education and lifestyle habits, but that doesn't mean it's impossible for us to change them.

schroedinger- you say that but what are YOUR expectations, because it sounds like your expectation is that a persons weight will revert back to a standard BMI if they have good education and "realistic expectations". It's possible that this expectation itself, that in a good environment and with healthy diet and exercise, everyone's weight will revert to a healthy BMI might be an unrealistic expectation itself.

I spend a lot of time in the health and fitness sector. The only person I've ever seen to fail at losing weight when they followed a decent program was a woman who'd been receiving dexamethasone shots for her breast cancer treatments. It is a powerful corticosteroid and has likely messed up her cortisol levels something terrible. Every other time people fail it is due to reverting to old habits. Few people get abs or vascularity or some nonsense, but everyone drops weight and improves their fitness levels.

You know, if someone is two days away from being homeless and suffering from untreated bipolar disorder and just watched their parents die in front of them, then weight loss is certainly the least of their problems.

But the vast majority of people are not living under those conditions. Studies of American time use show people are watching an average of three hours of television a day. You're seriously arguing they're so incapacitated by their social environment they can't turn off the television for one of those hours and go work out?

Weight loss is difficult and I'm not denying that. But you are painting it like being obese is fate, dictating wholly by our environment and totally out of our control, and it simply isn't. It has to be a dual process. There are things we can change about our society but at some point people have to decide they're going to change themselves.
posted by Anonymous at 8:14 AM on December 30, 2011

Every other time people fail it is due to reverting to old habits.

"Reverting to old habits" is exactly what this study (and decades of other studies) predict for the overwhelming majority of people who lose through deliberate calorie restriction.

Nobody is arguing that it's technically impossible for people to maintain a substantial weight loss through diet and exercise, so let's dispense with that straw man. What people are suggesting is that it may be so difficult as to be practically impossible.

The suggestion seems perfectly plausible given what we know, which is this. Take the subset of obese people who are both motivated and able to lose a substantial portion of their excess weight via the standard advice about diet and exercise. They clearly understand the advice and they can clearly apply the advice over many months. I think it's fair to say that this subset of people have well above-average levels of both willpower and knowledge. And yet. And yet the overwhelming majority of them will gain it back.

To me, this indicates that the traditional advice is seriously flawed. You may want to blame those who fail to maintain despite all their efforts or to refer to several anecdotes, but the data are overwhelming. The traditional advice just does not work, except for a tiny subset of people, and according to the study in this article, it's no picnic even for the success stories.

It's time to stop blaming people for failing to maintain and to recognize that it's only their fault if you hold them to a standard that 90%+ of motivated and capable people cannot meet.
posted by callmejay at 8:29 AM on December 30, 2011 [2 favorites]

Few people get abs or vascularity or some nonsense, but everyone drops weight and improves their fitness levels.

And how many have kept that weight off two years down the line?
posted by callmejay at 8:29 AM on December 30, 2011 [2 favorites]

Nobody is arguing that it's technically impossible for people to maintain a substantial weight loss through diet and exercise, so let's dispense with that straw man. What people are suggesting is that it may be so difficult as to be practically impossible.

This is where "education" and "reasonable expectations" comes into play. We have a culture that promotes "LOSE FAT FAST!" and "EAT COOKIES TO LOSE WEIGHT!" The faster you lose weight, the harder it is to maintain. And you can't eat the way you did before you lost weight, because that was the way you got fat. Which provides another reason to lose slowly--habits that are changed bit by bit over time become lifestyle changes, crash-diets are quick-fixes.

My whole objection to the original article is it profiles studies where people lost their weight in a relatively short period of time--crash-dieting scenarios that will clearly result in long-term failure of maintenance. My question is how do the people who lose their weight lose it? And when they finish losing, do they maintain the same habits or think they can go back to eating the way that made them fat? As I said in my first post, where are the studies done on people who lost their weight in a reasonable manner? You're saying it's so difficult as to be practically impossible. I'm saying that difficulty is dictated by how the person approaches their weight loss in the first place, and that most people approach their weight loss in silly ways.

(Oh, and people who were smart about their weight loss and incorporate the strategies they use as life-long changes? They maintain.)
posted by Anonymous at 8:40 AM on December 30, 2011

For example--I would say oftentimes the more obese someone is the slower they need to take changes. Obesity is a symptom of something being so severely out of whack in their life that it is important to be slow and careful in taking changes so those changes can be lifelong. Different people can handle different rates of change, it is important for people to be honest with themselves about how fast they can handle change and have it stick.
posted by Anonymous at 8:46 AM on December 30, 2011

"I spend a lot of time in the health and fitness sector. The only person I've ever seen to fail at losing weight when they followed a decent program"

How much does the program cost? What kind of mental and emotional health are the people making the kind of money required for such a program already in?

Is it possible you're judging the entire US population from the success of an expensive program that already requires a certain amount of functional will capacity to even get into?

I think that for a majority of people eating lot's of vegetables and doing exercising and having healthy peer relations and family life and working on emotional health variables will bring about positive changes. The problem is that these kinds of supports are not equally accessible and that motivation and drive and will capacity itself can be affected by these kinds of physiological changes.

The majority of over weight people ARE people histories of past trauma, poverty, and difficult life conditions. The fact that you disregard the huge percentage of the US population who is dealing with difficult life variables such as prior child abuse, sexual trauma, poor academic performance, struggle with work performance, housing instability, exposure to dangerous neighborhoods and people in childhood, and the BAZILLION other things that people deal with tells me that you work with a set of very privaledged people for whom the rest of the US is an "anomoly".

Intelligence is also a trait that can be impaired by adverse life circumstances. The idea that "smart people get better jobs" or "smart people do well in school" or "smart people lose their weight" is based on EXTREMELY privaledged way of looking at the capacity for human performance. I am not saying that all humans shouldn't put forth their best or that that can often result in wonderful things happening. I'm saying you aren't taking into consideration how much the environment can impact human behavior, thought, drive, and internal axis of control perception. I believe that with supports a lot of people can have better health then what they have now.
posted by xarnop at 8:47 AM on December 30, 2011 [1 favorite]

This is where "education" and "reasonable expectations" comes into play.

Yes, well one of my points is that if "education" focuses on the old "eat less, move more" routine than it won't work. If you're saying it does work, there's a big fat CITATION NEEDED and a couple of anecdotes aren't going to cut it.

My whole objection to the original article is it profiles studies where people lost their weight in a relatively short period of time--crash-dieting scenarios that will clearly result in long-term failure of maintenance.

I agree that is a major flaw, but the speed of weight loss is only one possible explanation for the long-term failure, while you seem to be leaping on it as essential.

As I said in my first post, where are the studies done on people who lost their weight in a reasonable manner?

There have been studies and metastudies looking at all kinds of diets, although we always need more.

You're saying it's so difficult as to be practically impossible. I'm saying that difficulty is dictated by how the person approaches their weight loss in the first place, and that most people approach their weight loss in silly ways.

What are you basing your claim on, though?? Just "common sense?" A couple of anecdotes?

(Oh, and people who were smart about their weight loss and incorporate the strategies they use as life-long changes? They maintain.)

Citation needed. Vanishingly few people maintain.
posted by callmejay at 10:50 AM on December 30, 2011 [1 favorite]

(Oh, and people who were smart about their weight loss and incorporate the strategies they use as life-long changes? They maintain.)

Well, yeah, but that is not most people (obviously). I get that you're irritated with the studies that seem to be forcing the participants into unrealistic dieting scenarios, but I think that your deep involvement in a community that's focused on healthy behaviors is giving you a little bit of selective bias. Most Americans don't get their nutritional advice that way - they get it from TV and magazines. I suspect that most focus on short-term goals (gotta fit into that wedding dress!), or vastly overestimate their ability to stick to the All Grapefruit Diet.

The Daily Beast, of all places, pulled together a thing that looks at the most popular diets and what the science is behind them. It's in gallery format (HATE!), but the most illuminating thing to me was the numbers for 6- and 12-month attrition rates for things like Jenny Craig, Atkins, the Mediterranean diet, etc..
posted by rtha at 10:51 AM on December 30, 2011 [2 favorites]

How much does the program cost? What kind of mental and emotional health are the people making the kind of money required for such a program already in?

Is it possible you're judging the entire US population from the success of an expensive program that already requires a certain amount of functional will capacity to even get into?

Uh, nothing. Nothing at all. These are people who work out on their own using information they've gleaned from the Internet and talking with others and tweaked to their needs. These are real people. Sorry?

There have been studies and metastudies looking at all kinds of diets, although we always need more.

Really? There are research studies on the success rates of programs that emphasize small measurable changes and re-evaluating one's relationship with food and one's body? Could you provide links to them before you blare CITATION NEEDED at me?

What are you basing your claim on, though?? Just "common sense?" A couple of anecdotes?

Citation needed. Vanishingly few people maintain.

I apologize, I have no citation for the people I know and have worked with nor the compendium of success and failure stories I've read. I have no proof that it is easier to make small instead of large changes in a person's life, though I'm sure there are behavioral studies out there addressing it. But do explain to me how you think it is impossible for people to change their habits--I suppose this is why nobody who enjoys sleeping in has ever managed to get up early for a job, or nobody who hates English has ever managed to pass a course in it.

Well, yeah, but that is not most people (obviously). I get that you're irritated with the studies that seem to be forcing the participants into unrealistic dieting scenarios, but I think that your deep involvement in a community that's focused on healthy behaviors is giving you a little bit of selective bias. Most Americans don't get their nutritional advice that way - they get it from TV and magazines. I suspect that most focus on short-term goals (gotta fit into that wedding dress!), or vastly overestimate their ability to stick to the All Grapefruit Diet.

Absolutely, which is why I advocate education and hate articles like the above that claim DIETS DON'T WORK when that conclusion is based in research irrelevant for real-life scenarios.

People can't diet. They have to change the entire way they look at food, and they have to find a pattern of eating they can maintain for the rest of their lives.
posted by Anonymous at 11:41 AM on December 30, 2011

What are you basing your claim on, though?? Just "common sense?" A couple of anecdotes?

I can't talk for schroedinger, obviously, but there's more evidence than 'a couple of anecdotes' behind the idea that people who approach weight loss in a particular manner (small, reasonable, life-long changes) are much more successful at maintaining that weight loss. The research outcomes of the National Weight Control Registry, for example, suggest that there are commonalities between people who have lost a significant amount and maintained that loss. This paper, for example:

Obesity is now recognized as a serious chronic disease, but there is pessimism about how successful treatment can be. A general perception is that almost no one succeeds in long-term maintenance of weight loss. To define long-term weight loss success, we need an accepted definition. We propose defining successful long-term weight loss maintenance as intentionally losing at least 10% of initial body weight and keeping it off for at least 1 year. According to this definition, the picture is much more optimistic, with perhaps greater than 20% of overweight/obese persons able to achieve success. We found that in the National Weight Control Registry, successful long-term weight loss maintainers (average weight loss of 30 kg for an average of 5.5 years) share common behavioral strategies, including eating a diet low in fat, frequent self-monitoring of body weight and food intake, and high levels of regular physical activity. Weight loss maintenance may get easier over time. Once these successful maintainers have maintained a weight loss for 2-5 years, the chances of longer-term success greatly increase.

Crash diets have an incredibly poor success rate (and in my experience, lead to an awful lot of misery and unhealthy attitudes on top of that), but crash diets aren't the only way to weight loss. 'Education' should be less along the lines of 'being fat is unhealthy/unattractive/morally bad!' and more along the lines of 'if you want to lose weight, here's what current research suggests is the best way to do that, and here's how to deal with living in an obesogenic environment'.

Also, I'd be totally remiss if I didn't give a nod to Greta Christina's great blog posts on weight loss from a feminist, skeptical, and fat-positive perspective, which is where I learned about the NWCR to begin with.

Weight loss is hard, and a lot of people who want to achieve it do fail at it. And people who don't want to achieve it shouldn't have to try, and shouldn't have to face any bullshit body-shaming judgement for that decision. But for people who do want to try, it's not reasonable or accurate to show them crash-diet studies as incontrovertible proof that successful weight loss is virtually impossible and they shouldn't even bother.
posted by Catseye at 11:44 AM on December 30, 2011 [2 favorites]

Thank you Catseye for saying what I was trying to say but in a lot less attack-y tone.
posted by Anonymous at 12:03 PM on December 30, 2011

Absolutely, which is why I advocate education and hate articles like the above that claim DIETS DON'T WORK when that conclusion is based in research irrelevant for real-life scenarios.

Diets don't work! That's exactly the point of studies like this - the thing commonly understood to be a "diet" is not going to be a long-term solution for most people looking to lose and keep weight off. The study scenarios are *not* irrelevant to real-life ones - just look at the "most popular" diets ranked in the Daily Beast link. These are the diets tried (and often failed by) most people who diet.

Of *course* education and support are two key things in helping people make sensible, sustainable changes. Studies like this add knowledge that people (individuals, public health educators, doctors, talk show hosts, etc.) can use when figuring out how to make those sensible, sustainable changes rather than the all-shake-and-bar-eat-our-special-food diets.

I think you're mad at the wrong people, here.
posted by rtha at 12:10 PM on December 30, 2011 [1 favorite]

That is a good quote and a good source of anecdotes (the NWCR) but even after redefining success to mean a 10% reduction of bodyweight (e.g. a 300-lb person losing 30 lbs) there is "perhaps" a greater than 20% success rate. Turning that around, it still means that almost 80% of overweight/obese people are not able to maintain even a 10% loss of weight and really, most of them are probably looking for a lot more than 10%.

I'm not trying to be pessimistic or alarmist, but I think a lot of damage is done when we offer a solution that works a small minority of the time and then act like it's the patient's fault when it does not work. "Education" is only helpful if the education is correct.

Again, as I mentioned upthread, I am currently losing weight myself using a ketogenic diet. (In fact, I am down approximately 10%, which your paper would consider a success even though in fact I am still well into the obese range.) I'm just sick of people acting like lasting serious weight loss is achievable for everybody when real-world results show that to be quite possibly a fantasy.
posted by callmejay at 12:16 PM on December 30, 2011 [1 favorite]

One piece of "good" news that hasn't been brought up yet -- though checking now, it appears right at the end of the NYT article -- is that significant but less extreme (5-10%) weight loss, combined with physical activity, is apparently enough to see big changes in the prognosis for things like type 2 diabetes. Importantly (as on preview callmejay has pointed out) this doesn't necessarily entail getting down to a "normal" BMI - someone who goes from 200 to 180 might still be classified as overweight, or even obese.
posted by en forme de poire at 12:22 PM on December 30, 2011

rtha, I am mad at this study and the article because it characterizes "dieting" and "weight loss" as binary--either you lose nothing, or you lose on shakes-and-bars. The studies in the article talk about long-term metabolic damage done to people who lose weight, but the people they study are ones who lost weight in a crash-diet or very fast way. The article seems to portray weight loss as impossible to carry out and impossible to maintain, when really, they are studying weight loss within a very restricted and unhealthy scenario.

I wrote this example somewhere else in response to this article. If you make a couple tweaks in your lifestyle and lose 2lbs/month, that's 24lbs in a year. That's almost 50lbs in two years, 100lbs in four years. It's not sexy or fast and you don't have a beach body for the summer from a diet you started at New Year's. But I can tell you the tweaks it takes to lose 2lbs in your first month are terribly small ones, especially compared to what it might take to lose 10lbs in the first month.* Over that four-year period you'll have to keep making more tweaks, but each individual tweak necessary to maintain that 2lbs/month weight loss will still be relatively small.

I would be very surprised if the guy who lost 100lbs in a 4-5 year period is physiologically exactly the same as the person who drops it in a one, even two-year period. I would bet slow-loss guy also finds his rate of weight loss infinitely easier to sustain until he hits his goal body fat, and when he switches to maintenance the changes he's made to his lifestyle along the way feel much more easy and natural.

But in our culture we're conditioned to think you have to have a big epiphany and turn your life around and drop 15lbs the first month, and if you don't you're not working hard enough and your diet is shit. So people keep throwing themselves into stupid cycles and scientists keep churning out dumb studies that make you think weight loss is impossible because they're basing their conclusions on these stupid cycles.

*Of course, if you are, say, 5'0'' and 110lbs and looking to lose that last 10lbs, 2lbs/month is going to be a lot harder than a 6'4'' 350lbs guy, so scale appropriately.
posted by Anonymous at 12:30 PM on December 30, 2011

I guess the important point I'm trying to make is that we don't know why so many fail. You may think you know, but how could you distinguish "he gave up and went back to his old way of eating because he didn't know any better or was too lazy or he didn't have the correct strategies or whatever" with "he gave up and went back to his old way of eating because his body was screaming at him for calories all the damn time and he just couldn't take it any more" from the outside looking in?
posted by callmejay at 12:33 PM on December 30, 2011 [3 favorites]

5'0'' and 110lbs and looking to lose that last 10lbs

I know you meant this as an example, but 110 lbs is well within the normal range for 5'0".
posted by desjardins at 12:43 PM on December 30, 2011 [1 favorite]

desjardins, that's my point, that's why any 5'0'' 110lbs woman looking to cut another 10lbs is going to have an incredibly hard time doing it. I picked an extreme example there.
posted by Anonymous at 12:47 PM on December 30, 2011

Okay, I was ready to get all indignant there. :)
posted by desjardins at 12:51 PM on December 30, 2011 [1 favorite]

There's little in the articles about the kind of exercise that people do, but I found this part kind of interesting:

Muscle biopsies taken before, during and after weight loss show that once a person drops weight, their muscle fibers undergo a transformation, making them more like highly efficient “slow twitch” muscle fibers. A result is that after losing weight, your muscles burn 20 to 25 percent fewer calories during everyday activity and moderate aerobic exercise than those of a person who is naturally at the same weight. That means a dieter who thinks she is burning 200 calories during a brisk half-hour walk is probably using closer to 150 to 160 calories.

This would suggest to me that there is a possibility that doing exercise that develops "fast twitch" muscle fibres (weightlifting, sprints, etc) could be more effective than the hours upon hours of cardio that is typically assigned for obese people? It would really interesting for that sort of research to be carried out.

Anecdata (n=5), but nearly everyone I know who's maintained a weight/size loss (including myself) over many years has incorporated a fair amount of strength training (either lifting or bodyweight exercises like pushups, pullups and squats) in their regimens. Some of this is likely psychological (long periods of cardio get boring after and spell and I say this as someone who completed a marathon so if I got bored, I suspect most would) but I'm kind if tantalized by the hint at a possibly neglected area of study.
posted by Kurichina at 1:55 PM on December 30, 2011

I think it's definitely why health and fitness professionals have been touting weight training and high intensity interval training over steady state cardio.
posted by gyc at 2:05 PM on December 30, 2011 [1 favorite]

[N]early everyone I know who's maintained a weight/size loss (including myself) over many years has incorporated a fair amount of strength training (either lifting or bodyweight exercises like pushups, pullups and squats) in their regimens. Some of this is likely psychological (long periods of cardio get boring after and spell and I say this as someone who completed a marathon so if I got bored, I suspect most would) but I'm kind if tantalized by the hint at a possibly neglected area of study.

To this engineer, it seems obvious that building more muscle makes the body fundamentally less energy-efficient -- a good thing, as far as keeping weight down. A 150lb well-muscled person will burn more calories under all conditions (not just running, swimming, biking, etc., but also sitting, watching TV, sleeping) than a 150lb flabby person. Muscle takes more energy to operate than fat.

Has there really not been a study to confirm this?
posted by LordSludge at 2:13 PM on December 30, 2011

rtha, I am mad at this study and the article because it characterizes "dieting" and "weight loss" as binary--either you lose nothing, or you lose on shakes-and-bars. The studies in the article talk about long-term metabolic damage done to people who lose weight, but the people they study are ones who lost weight in a crash-diet or very fast way. The article seems to portray weight loss as impossible to carry out and impossible to maintain, when really, they are studying weight loss within a very restricted and unhealthy scenario.

I understand way better now what you're saying, and I really appreciate you explaining it a lot so I could grok it. Thank you.

And I think I mostly agree with you, in the sense at least that the framing of the article is certainly problematic in some ways. But I still think studies like this are valuable (and vulnerable, as with all Science!, to the simplification that inevitably occurs in most pop science journalism), because they provide a much more detailed and nuanced look at what happens biologically when people try the quick-fix methods, which an awful lot of people do.

This, from the NYT piece, is certainly true for more people than not:

Wing says that she agrees that physiological changes probably do occur that make permanent weight loss difficult, but she says the larger problem is environmental, and that people struggle to keep weight off because they are surrounded by food, inundated with food messages and constantly presented with opportunities to eat. “We live in an environment with food cues all the time,” Wing says. “We’ve taught ourselves over the years that one of the ways to reward yourself is with food. It’s hard to change the environment and the behavior.”
posted by rtha at 2:15 PM on December 30, 2011 [1 favorite]

Has there really not been a study to confirm this?

I didn't find one among the links and I haven't seen any double-blind medical style studies myself testing the idea, but that doesn't mean they do not exist anywhere.
posted by Kurichina at 3:07 PM on December 30, 2011

At that point, the 34 patients who remained stopped dieting and began working to maintain the new lower weight. Nutritionists counseled them in person and by phone, promoting regular exercise and urging them to eat more vegetables and less fat. But despite the effort, they slowly began to put on weight. After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.

Another nail in the coffin for low fat diets. I would love to see what would have happened if they instead had discouraged alcohol, sugar, refined carbs, and wheat, and promoted a more paleolithic diet.
posted by spacediver at 4:43 AM on December 31, 2011 [1 favorite]

I would love to see what would have happened if they instead had discouraged sugar, refined carbs, and wheat, and promoted a more paleolithic diet.

FTFY...
posted by mikelieman at 7:14 AM on December 31, 2011 [1 favorite]

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