Fat Loss: Too Many Wrong Strategies
In the wake of Kevin Smith’s big fat snit-fit over Southwest Airline’s “customer of size” policy we’re reminded that first, obesity is a serious and widespread problem and second, no one really knows what to do about it.
Well, there are a lot of people who think they know, but you know what? I’m not getting any skinnier and neither is anyone else around me.
Here are some of the things we know don’t work. Or, at least, don’t work well enough to be effective treatment:
Shame
Some people seem to think that if you shame fat people enough they will eventually give up, decide to eat a salad once in awhile for Christ’s sake, and suddenly drop half their body weight. I’ve heard some people claim that Southwest Airlines was doing the right thing and that embarassing fat people would “correct” their “behavior,” just as making stylish clothes for fat teenagers encourages obesity.
If someone is quite large, they’ve already been embarrassed many times by their size—probably simply by going to JC Penny’s. I, personally, am always very aware of my size. Honestly, if shame and ridicule worked, there would be no fat people.
Eating less, Exercising more
Lots of people have told me how simple it is to lose weight. Just take in fewer calories than you burn and you’re all set.
Contrary to popular belief, though, people are not a giant bladder. Nutrition is a very complex topic poorly understood. What should we eat for our reduced calories? A low fat diet? High protein diet? Just “less”? And what about exercise: frequent low-grade aerobic exercise? Weight lifting? How much does sitting on a yoga ball at work gain me?
Complicating that is how your choices in exercise and calorie reduction change your body chemistry. Your body does not want to lose weight, so it works against you. Cut calories and your metabolism slows so you don’t burn as many calories doing things as you used to. Sometimes the body becomes very enthusiastic about creating fat, storing it prematurely. Start doing a lot of exercise and your body won’t respond by burning fat cells, it’ll respond by increasing hunger and requesting more food.
And then there are those mysterious plateaus in weight loss. What are we supposed to do with those?
Tecnically and rationally, “eat less, exercise more” should work. But people’s bodies fight against them every damn step of the way, so it’s much, much easier said than done.
Pharmaceutical Intervention
Or drugs. Weight loss drugs are bad news, as you might expect with anything that monkeys so significantly with core body function. There are a couple approved for use now sometimes require taking them for the rest of your life, and all they do is increase, slightly, the weight lost through the “eating less, exercising more” option.
One strategy that does work, of course, is radical abdominal surgery—a non-trivial operation with significant risks and side effects, and you have to be pretty large before the benefits begin to outweigh the risks.
Of course there’s a solution. There has to be one. But I doubt anyone chooses to be fat; something to remember the next time you’re scrunched by one of us in your airplane seat.
I agree with your disdain for shame and drugs. Shame is an awful way to go about causing someone to lose weight since it can cause weight gain in response to the shame. And most (if not all) of the weight loss drugs usually end up on some Class Action lawsuit commercial.
However, I both agree and disagree with your opinion on “Eating less, Exercise more”. It works—where I disagree with you—but it is difficult—that’s where I agree with you. The problem is most folks want to exercise more or eat less. You need to do both and it will require work and willpower.
I do agree that nutrition is a hell of a lot more complicated then any fad diet out there and what’s terrifying is how little people know about it. Think about all of the packages that say “Fat Free” or more recently “Trans Fat Free”. What did they do to make those products fat free? Well typically they throw in tons of salt (peanut butter) or decrease their serving size to skirt by fat that is actually in the product (Pam non-stick spray). Then tack on the idea that there are good versus bad fats and it really starts to get difficult.
And in addition to the raw nutrients comes when and how much to eat. It’s counterintuitive, but eating breakfast will help you lose weight. Expand that out and eating small nutritious snacks between Breakfast, Lunch and Dinner helps tremendously as well.
My advice is keep a food journal to figure out what you’re eating on a daily basis. It seems like a rather mundane step, but when I did it, I was astounded at the number of calories I was consuming daily. After that, start cutting bad foods out—try Soda first, it can contribute 10-20% of your daily calories.
After that, go to the gym. If motivation is difficult take classes. If something is difficult, good keep doing it. If it hurts three days later, you should have stretched. If it hurts a week later then try an alternative (treadmill vs elliptical vs rowing machine).
There’s a lot to learn and its lot of work, but the “Eating less, Exercising more” strategy does work.
One note on the surgical issue is that even that doesn’t guarantee permanent weight loss, like many people would like to think. The body can adjust over time and allow binging and weight gain. I don’t remember the failure weight for gastric bypass, but it’s very high.
Several years ago I attended a day-long presentation on weight loss advertising, at the Federal Trade Commission. They had experts on supplements, surgery, eating disorders, etc. The first question asked was “Is there any diet method that can guarantee permanent weight loss, other than a balanced diet and exercise?” The resounding response was, “No.”
[And as you ask, what does “balanced diet and exercise mean?” But that wasn’t the topic of the panel.]
In response to Wes, John is correct that “eating less” doesn’t necessarily work if one’s metabolism has already been slowed by years of yo-yo dieting. Many people who go to a nutritionist are surprised to learn that they need to be eating MORE.
Missie: I completely agree that people can be confused with the concept of eating more and I mentioned that in my comment. Breakfast was the first thing that I cut out when I started gaining weight and adding it back was one of the first steps I took to start losing it again.
However, the quality and nutrition of the food is the key point. Eating less food, but only eating fast food is obviously a great way to become obese. You need to eat the right foods and eat the right amounts. That takes effort and education. It’s work, but it’s also your health and life.
I should have been a bit more clear when I said “eat less / move more” doesn’t work. What I meant was that this particular strategy is generally not effective for enough people for whatever reason. I know it worked well for you, but I know it’s not worked well for many other people.
I have a problem with the gym; according to recommendations I’ve read online, low-grade physical activity is best for burning fat, but “fat burner” cycles on gym equipment don’t put me anywhere close to winded—I always drift into the high end of the cardio zone. This can actually slow your metabolism down as your body decides to hold onto the calories it gets in preparation for the sudden cardiovascular demands placed on it.
At least that’s what they tell me.
Yes, it can’t help but work if you cut calories enough and increase activity enough, but bodies adjust to this as well, either by changing metabolism or by increasing appetite. And, as you observe, it requires a lot of willpower—especially if the perceived results are minimal. That’s why the success rate is so low; as a medical recommendation it’s lacking.
Great post!! As you know, a topic near and dear to my heart
. Just had to weigh in re Wes’ comment. There are a lot of folks (myself included) who think exercise is great for health, but of not so much use for weight loss.
If I wasn’t at work, I’d write this up and point to it, but for now, here are just a couple of links on the topic:
Why Exercise Won’t Make You Thin – http://www.time.com/time/health/article/0,8599,1914857,00.html
Exercise Bologna – http://www.fathead-movie.com/index.php/2009/08/05/guest-post-exercise-bologna/
Weight loss and exercise: What works and what doesn’t? – http://www.thefactsaboutfitness.com/articles/aerobicexercise.htm
BTW, Missie is right. Weight loss surgery is no guarantee either. I think it is a great help for the morbidly obese to get started initially, but once the refeeding starts in earnest, a lot of people (a number in my head is 50%) wind up regaining some or all of their lost weight.
And I think that has to do with what is causing the weight gain initially. It’s what’s in the diet that is screwing us up. One intriguing explanation I’ve heard is that it is excess omega 6s in our diet (from vegetable oils) that is causing the insulin resistance that helps with weight gain and high amounts of sugar (and fructose) causing the problems with normal regulation of appetite.
My favorite go-to is Stephan Guyenot for things nutrition. IMO, this is probably your best bet: http://wholehealthsource.blogspot.com/2010/01/body-fat-setpoint-part-iv-changing.html
That and coming to the realization that some of us just aren’t wired well to deal with the Western diet—and the way it is marketed to us non-stop!
BTW, before Wes beats me to it, I realize that two of the links promote resistance training for weight loss which is of course exercise.
Like I said, I did this very quickly. Others I follow have various ranges for how much of our health (and not just obesity, but health risks like diabetes, heart disease, cancer, etc) is related to diet versus exercise. I’ve seen very compelling cases for much more emphasis on diet than nutrition (including Doug McDuff’s Body by Science, which is a 12-minute workout each week—sounds like my speed!).
Anyways, if people can do both great, but I agree with John. It’s not a strategy that is working for people. That could be of course because we’re all lazy slackers who can’t put down the cookies, or maybe it’s something else!
so my wife and i have been talking about this on and off over the years, and my response is going to be a bit rambling.
what i think is the core is the food that’s available to most people (especially lower income populations) and the ‘industrialized’ lifestyle. much of the food that’s out there is overly processed and devoid of nutrients, and we spend most of our life indoors.
i know, it’s a pretty broad statement, but one specific example is thyroid problems. this could either be a nutritional deficiency (not enough iodine, surprisingly => potentially because of fluoride in drinking water which inhibits iodine absorption), or a symptom of abnormal hormone levels (i.e. too much stress=overworked adrenaline glands=cortisol levels not at proper levels).
speaking for myself, i gained something like 40 pounds out of nowhere after college, over the course of 2ish years. and this was when i started to eat well and move less and less from processed foods.
even now, when my eating is the healthiest it’s ever been, and i’m not overeating, AND i eat frequently and in smaller amounts, AND i’m fairly active, the fat isn’t coming off. the only time i’ve managed to lose weight consistently is on weight watchers, but there’s no way in hell i’m going to cut that many calories and count when i’m not overeating in the first place and rarely eat processed foods. i have symptoms of cortisol imbalance and thyroid imbalance (took a cortisol test which shows my levels are really low, as a result of nearly 5 years of high stress no doubt).
i think the criticism placed on any legitimately overweight person is bullshit and unfair on the whole (ignoring people being called ‘fat’ for being a normal, healthy weight/shape). there are plenty of people who are overweight through circumstances: stress eating, not having time to take care of oneself, not having time to go out and be generally active as an everyday part of life (screw the gym), etc.
of course, individuals can be to blame if someone wants a quick, temporary fix and doesn’t want to put effort into transforming their lives into health. but it quickly comes back to what’s accessible to people that would support them. these are not accessible:
- realistic and healthy attitudes towards a normal body type (especially in the case of women)
- real food
- information that won’t compel you to throw your money away on a quick fix
- not having support of your workplace or any other people (if you’re a single parent, for instance, and worse yet if you’re in the low income range)
in short, the attitude of society is not supportive of a healthy lifestyle, weight aside. this country is dying, and other parts of the world are following.
i probably should take a few more minutes and clean this up but…i’m just gonna put it out there for now.
@Beth, thanks—in a large part it’s reading your refocused weblog that’s encouraged me to think more about this instead of just giving up.
@Kaiser, the book I’m reading now—“Fat Politics”—argues that part of the reason “eat less, move more” fails to work is that our culture encourages exactly the opposite, which I think marries up pretty closely to what you’re saying.
err, an afterthought: the rise of diseases is another dimension to this, obviously, and more important. eating disorders are huge and largely ignored, cancer is on the rise, as are cardiovascular diseases, etc.
if diseases were this prevalent in early human history, we would not be where we are today, i don’t think. outward appearance is nothing in the end. if someone’s internals are busted, despite looking healthy in some superficial way, they’re at risk and unhealthy. plain and simple.
the question of being fat it seems has more to do with perception of that person’s characters/habits. yes, they are more likely at risk for certain things, but weight is not the first indication of bad health.
i am going to stop commenting for a bit, i promise
i’ll put ‘fat politics’ on my list of readings.
A lot of interesting and thoughtful comments. The shame and disgust are the worst “help” imaginable. This attitude has been made public by the Kevin Smith episode. And, my biggest irritant is, “I did it, so anyone can!”
He just found the magic charm that worked for him.
I’m still trying to lose it. My knees hurt.
Unless you have an exceptional metabolism, the equation works as stated. Saying “eat less, exercise more” doesn’t work is like saying F=ma is wrong because it’s so darn hard to launch a shuttle into space. It simplifies the problem too much.
But the latter detail is key. It’s the mental hurdle of doing the work (both the physical work, and the documentation to determine your calorie and exercise needs) that’s usually the culprit. You WILL lose weight if you increase your calorie consumption and decrease your calorie intake. You will most definitely not keep it off or succeed if you don’t change your habits.
And it only gets worse as you get older, and your muscle mass decreases. The sooner you can get into better habits, the better.
Ben, that it is most certainly NOT that straightfoward and it has nothting to do with not trying hard enough. John is correct that most obese people have metabolic issues from years of trying to diet.
When my former roommate went to a nutritionist, she was ordered to eat more (not just eating breakfast, but larger meals, snacks, and DESSERTS) and to only get a minimal ammount of exercise. Sounds like a prescription for someone who is underweight, but she was in fact obese and that obesity was caused by undereating and overexercising. This isn’t “an exceptional metabolism” – it’s very, very common.
Kaiser, you are *so* spot on. I just read something over at Whole Health Source about the role magnesium plays in glucose metabolism and how it’s getting harder to get that in our diet.
Similarly, the being indoors is definitely leading to lower vitamin D levels (mine was 25 in Sept; a doc I follow likes it to be 60-70). The same doc is convinced that iodine deficiency is real, especially (ironically) the healthier you are, because you are getting less iodized salt in your diet.
Ben, re your energy equation, it’s not that simple. Space shuttles are complicated and so are human bodies. Calories in and out are part of the equation, but so are hormones. There’s a lot going on with thyroid, insulin, leptin and more.
We may be able to solve some of these issues with the quality of the diet (not just the quantity), but those are the very things that may or may not enable someone to adopt a plan for the time needed (likely a lifetime).
Ward studies do show that eat less, move more tends to work, but that’s not a scalable solution!
BTW, if you like Fat Politics, you may like some or all of the following:
The End of Overeating, David Kessler
Good Calories, Bad Calories, Gary Taubes
The Obesity Myth, Paul Campos
Rethinking Thin, Gina Kolata
Fat Land, Greg Critser
Fast Food Nation, Eric Schlosser
The following are on my list; haven’t gotten to read them yet:
Stuffed and Starved, Raj Patel
Stuffed, Hank Cardello
If we use energy science nutrition rather than the current matter science model then we can understand the obesity problem with greater clarity.
A person plagued with obesity simply is out of balance and correcting the imbalance leads to restoration of a healthier state
There are many aspects of energetic nutrition that are ignored and need to be addressed to deal with this imbalance
Lastly this approach is NOT just another diet fad ie North Beach diet It is looking at nutrition in an an entirely different way becuase the mindbody is seen in a different way ie seeing the mindbody as an energy field not a matter field as we currently see it
beth—i didn’t know about magnesium, but i will definitely look into that. i’m actually taking iodine and vitamin d supplements daily now. my wife is very proactive in this because her thyroid issues were really messing her up, and she found good advice online and has a good doctor that’s curious about working with her specific problems. so a lot of what i’m learning is coming from her findings and experiences.
some of these things are no-brainers once you’re pointed in that direction. why/how is sun bad when our species came from a land of sun and our bodies use it to produce vital compounds? it’s just scary that it’s become so widespread and overlooked. but recognizing oppression and exploitation in daily life is helping me a lot in putting these things into perspective.
that’s another set of topics entirely, but something to consider.
My analogy with the space shuttle had the intent of fully acknowledging the complexity of the human body by comparing to the shuttle itself, please do not misunderstand.
That being said, if anyone claims that exercise and a balanced diet don’t work for them, they damn well better have two things to back it up. 1) The numbers; you must have documented your food intake and daily exertion (exercise + usual level of activity), 2) Time invested in the experiment; I propose a minimum of 6 months dedicated to a diet/exercise routine before any criticism of the process is valid.
AGAIN, I do not doubt there are individuals who fall (well) outside the norm, and struggle even more than average to lose weight. But I also posit that many people that complain about how hard it is to lose weight simply haven’t put the time and effort in. It’s really more of a psychological problem than a physical one.
Addendum: psychological problems are strongly influenced by more basic physical causes, so don’t misinterpret that as something like “not trying hard enough”. Psychological challenges can be as real as any literal physical challenge.
Ben, I’m not sure I understand your second comment in light of the first; it really does sound like you’re saying “people aren’t trying hard enough.”
If the psychological barriers are real and significant, and that prevents most people from successfully completing the treatment, then “eat less, exercise more” is an ineffective treatment strategy because it is not within most people’s reach.
Now, if “eat less and exercise more” doesn’t work—or, at least, requires such significant energy outlays and drastic caloric cuts that most bodies rebel, then what that advice does is encourage dangerous behavior in the name of willpower. In that case it’s not only an ineffective treatment strategy, it’s a destructive one.
What would be really great, since I am having trouble finding any, is if you could turn up some nice published clinical trials about the efficacy of this particular strategy. Is “eat less, exercise more” a recommendation that’s been tested scientifically? Has the medical profession logged people’s exercise and caloric intake for six months? Do they have any basis other than “common sense” for making this claim?
“Now, if “eat less and exercise more” doesn’t work—or, at least, requires such significant energy outlays and drastic caloric cuts that most bodies rebel, then what that advice does is encourage dangerous behavior in the name of willpower. In that case it’s not only an ineffective treatment strategy, it’s a destructive one. “
John, very well put.
I fully expect that there are scientific studies that back up Ben’s thesis: that people who expend the effort to reduce calories and increase exercise do lose weight. The real challenge of seems to be making this a permanent change when you aren’t being studied. For most of us, the weight typically comes back and then some, because the dieting generally reduces lean body mass and hence metabolism (so reverting back to the former eating pattern results in weight gain — mostly in the form of fat).
So it’s not do diet and exercise work, it’s why can’t people maintain these practices on their own, as compared to being in metabolic ward studies?
I bet we’re going to find out that it is in fact *what* we eat that is causing the problems with insulin resistance and appetite unrelated to physical hunger (some of these tied in to deficiencies like omega 3, vit D, iodine, magnesium). I think there’s also some interesting info coming out about the role of gut health wrt inflammation and weight loss/gain.
So people do well for a while following a healthy diet, but then a special occasion comes up or a something really stressful happens, and people let themselves go back to some processed food, and if they aren’t careful, before long, one meal stretches into two or three or a whole week’s worth, and by then the metabolic things going on are back in full swing.
Interestingly, one of my other regular reads just had a blog post about the brain and obesity that seems relevant. Here’s the money quote:
—–
These findings clearly suggest that brain function associated with food motivation differs in obese and non-obese adults and may well explain the different susceptibilities to weight gain and variability in response to diet interventions.
Given the emerging science on brain plasticity, it is certainly of interest whether or not these differences in brain function are acquired or are indeed innate. Whatever the case, we need to understand and acknowledge that our brains respond differently to the same food stimuli which easily explains why some people may find it much harder to resist overeating in our current obesogenic environment than others.
—–
Go check out the whole thing here:
http://www.drsharma.ca/do-brains-of-obese-individuals-respond-differently-to-food.html
Just catching up on my feedreader and came across this interesting post from Tom Naughton of Fat Head fame on energy balance:
http://www.fathead-movie.com/index.php/2010/02/23/energy-balance-why-the-food-cops-have-it-all-wrong/
As an aside, I’m not convinced that going very low-carb is necessary. But I do think moderating carbs (especially sugar and refined starch) is.
Kaiser, this one’s for you! Maybe it is all about the sun?
http://www.mattmetzgar.com/matt_metzgar/2010/02/the-winter-metabolism.html
Thanks, Beth! I really appreciate those links and your commentary. My wife and I shifted our diet over the last few days to include three meals (we both tend to skip breakfast), cut back carbs significantly, and add more fat and protein — the results have been almost immediate. So I think we’re onto something there.
Not a problem; I’m enjoying the discussion! BTW, you’ll have to check this one out: I’ve been working on it all day today and finally posted it!
http://weightmaven.org/2010/02/28/obesity-diabetes-and-diet/
I’m just trying to work through the arguments. Beth pretty much nailed it in her first paragraph, and I can only reiterate what I already said. It’s not the formula of burning calories vs intake that doesn’t work, it’s keeping up with it. And yes, my intuition says that most people are perfectly capable of the discipline to change their lifestyle, though it’s certainly going to be harder for some than others. It’s not “this doesn’t work”, it’s either “I didn’t work hard enough to make this work,” or sometimes, “this doesn’t quite work for me because X.”
I’ll follow up in the next thread with the tricks I use to get myself to eat healthier and get my ass on the treadmill. The only major sticking point worth noting ahead of time is that there is only one way to learn discipline, and that is to be disciplined, i.e., fake it till you make it.
(btw John when you changed the URL structure you broke the links in the older notification emails. However since the notification option seems to be gone that may not be terribly useful to you.)
Ben writes:
> And yes, my intuition says that most people are perfectly
> capable of the discipline to change their lifestyle …
> It’s not “this doesn’t work”, it’s either “I didn’t work hard
> enough to make this work,” or sometimes, “this doesn’t
> quite work for me because X.”
My intuition (and lifetime of trying) tells me that the latter is
far more likely than the former.