Thursday, January 31, 2013

Mythbusting and syncrhonicity

Since two blogs I follow regularly, Debbie's and Yoni Freedhoff's, were both blogging about the same article today, I had to chime in. I'm a busybody that way. I don't have the weighty credentials of the obesity researchers who wrote the article or Dr. Freedhoff, so like Debbie, I am chiming in as a veteran of the Diet Wars. I am going to borrow Dr. Freedhoff's format of posting the study authors' comments chiming in on each one individually.


I have to say that I feel that this article was less than helpful. Weight loss research doesn't have much to do with what happens in real life for most of us.  My goal is to live a lifestyle that is healthy, sustainable, enjoyable,  and compatible with a healthy weight.  


The Myths

1. "Small sustained changes in energy intake or expenditure will produce large, long-term weight changes". 

Sure, probably true. But small, sustained changes are the only way most of us can start. We start with small changes, and then make more little changes, and eventually, we have a new lifestyle.  That seems more practical for most people than a huge but unsustainable change.

2. "Setting realistic goals for weight loss is important, because otherwise patients will become frustrated and quit". 

I think it's important to match your goals to the amount of change you are willing to make.  I also think that a combination of big, inspiring goals and smaller, midrange goals, can work.  Setting goals for a realistic rate of weight loss is important, so you don't get frustrated and quit.  

3. "Large, rapid weight loss is associated with poorer long-term weight-loss outcomes as compared with slow, gradual loss". 
If you are getting large, rapid weight loss, you are probably doing something drastic to make it happen. Is that drastic change something you can sustain? If not, your results won't be sustainable either. Some people do things (the HCG diet leaps to mind) that are actually potentially dangerous to lose weight, and that seems to defeat the purpose of losing weight for medical reasons.

I feel like this one is included as a myth because the researchers think that surgery is an effective and safe way to lose weight. I suppose it can be. But if you look at the actual BMI distribution of the adult U.S. population, most of the new "obese" people are in the BMI range of 30-40, which makes surgery to permanently change the way their bodies work seem overly drastic.  We also don't know right now what the real long-term (20-30 years down the line) results of having weight loss surgery will be. I have been hovering right around that "obese" BMI of 30,  and I'm certainly not thinking about getting my guts rearranged.

4. "It is important to assess the stage of change or diet readiness in order to help patients who request weight-loss treatment" 

I don't know that "readiness" is a constant variable. I think that people who want to make a change are probably as ready as they will ever be. Making the changes less drastic (see the numbers above) makes it less important to be ready.

5. "Physical-education classes in their current form, play an important role in reducing or preventing childhood obesity

If my high-school gym experience is any measure, I would agree. Our P.E. classes consisted of giving the chance to let the jocks blow off steam playing sports while I cowered as far as possible from the missle (volleyball, dodgeball, softball) as possible to avoid getting hurt. 

I think it would be possible for P.E. classes to be valuable if they taught skills and created an accepting environment for people to learn to love activity. I just don't think that most P.E. teachers design their classes this way.  

I do think it's a bummer when I hear from a kindergarten teacher that she doesn't send her kids outside for recess, but keeps them in to watch videos. Running around on the playground was something I actually did enjoy in school, and without a chance to burn off steam during recess I think even I, a relatively nerdy kid, would have been too restless to pay attention in the afternoon.

6. "Breast-feeding is protective against obesity

I am agnostic on this one. I don't know, and I don't think it matters. I can't imagine that would be the most important reason for deciding for or against.  

7. "A bout of sexual activity burns 100 to 300 kcal for each participant" 

I would think anything you'd do in bed to burn that many calories would have all the neighbors calling the police.  It doesn't seem all that romantic to be thinking about your calorie burn during sex. 


The Presumptions 

These are subjects that as yet remain unproven one way or the other.

1. "Regularly eating breakfast is protective against obesity

I don't care if it is or isn't. I eat breakfast because I'm hungry when I wake up. I can't imagine not eating in the morning.  I lived in a household of non-breakfast-eaters, and they have just as many weight struggles as I do. Skipping breakfast seems like a bad idea if it means you will be snacking more later. I know that I do better when I sit down for a real meal than when I'm grazing. 

2. "Early childhood is the period in which we learn exercise and eating habits that influence our weight throughout life"

I am proof that diet and exercise habits can be changed. I used to hate vegetables and exercise, and now I love both. I think that believing this could be very defeatist for most people who didn't have marathon-runner, junk-food-hating parents. You can't change the past. Start from where you are now.

3. "Eating more fruits and vegetables will result in weight loss, or less weight gain, regardless of whether any other changes to one's behavior or environment are made"

I can't imagine that eating more fruits and vegetables is a bad idea. They have a lot more nutrients and a lot less calories than cookies.

4. "Weight cycling is associated with increased mortality.."

I think weight cycling is at least discouraging and demoralizing.  I don't think weight cycling is a reason to avoid starting a healthy, reasonable diet change.

5. "Snacking contributes to weight gain and obesity." 

I think it is probably about the total calories and the way you feel. For me, planning a healthy snack is better than pretending I won't want to snack and then digging around for change for the vending machine when I'm starving at 3 p.m.

6. "The built environment, in terms of sidewalk and park availability, influences obesity."

I definitely notice that people in cities are thinner. And when I visit a big city with public transit, I lose weight every time.  I chose my neighborhood partly because there are sidewalks and places to walk.


The Facts

These are the nine points the authors feel there's sufficient evidence to be true.

1. "Although genetic factors play a large role, heritability is not destiny"

I think, since we can't change our genetics, we have to do the best with what we have.


2. "Diets (reduced energy intake) very effectively reduce weight, but trying to go on a diet or recommending that someone go on a diet generally does not work well in the long term."

It's all about sustainability. Most people go on diets that they hate. And then they quit. People who are pushed to go on diets by others won't be as motivated as people who decide on their own to lose weight.


3. "Regardless of body weight or weight loss, an increased level of exercise increases health."

I can't imagine anyone arguing with this. 

4. "Physical activity or exercise in a sufficient dose aids in long term weight maintenance."

This one seems obvious. 

5. "Continuation of conditions that promote weight loss promotes maintenance of lower weight."

This is why I don't understand why the authors seem so against small, sustainable changes.

6. "For overweight children, programs that involve the parents and the home setting promote greater weight loss or maintenance."

It makes sense to address the factors that made the kids fat in the first place. Sending them off to fat camp and then bringing them home to the environment where they gained weight wouldn't seem helpful.

7. "Provision of meals and use of meal-replacement products promote greater weight loss."

Agree with Dr. Freedhoff that this doesn't make sense given #5. And it seems like a conflict of interest might be involved here.

8. "Some pharmaceutical agents can help patients achieve clinically meaningful weight loss and maintain the reduction as long as the agents continue to be used."

Ditto my response to #7. Drugs for life, with potential side effects? No thanks.

9. "In appropriate patients bariatric surgery results in long-term weight loss and reductions in the rate of incident diabetes and mortality." 

I am sure this is true, but it's not a solution for the majority of people.


2 comments:

  1. The last point, and your response to it, is something I should have emphasized more strongly when I wrote about it. The number of morbidly obese patients who would benefit from weight-loss surgery is such a small percentage of the total number of obese and overweight population. Why would any researcher think that's where they should be "investing?" The only reason I can think of is "follow the money." It's potentially more profitable to work on expanding the potential number of patients (by modifying the requirements or coming up with a technique for the masses) or coming up with yet another drug. Sorry to hijack your blog with such a long comment!

    ReplyDelete
    Replies
    1. I appreciate the comment. And you are right, the whole article seems to be asking for money for research (on the presumptions) or trying to support tax dollars for drugs, surgery, and meal replacements. Not exactly news the rest of us can use.

      Delete

"Count your calories, work out when you can, and try to be good to yourself. All the rest is bulls**t." -- Jillian Michaels at BlogHer '07