Probably no piece of medical advice is so frequently given, and with so little rational basis, as the pressure on fat people to lose weight.
1. For The Vast Majority Of Fat People, Weight Loss Dieting Doesn’t Work
When I say a weight loss diet (or “diet,” as I’ll refer to WLDs for the rest of this post) doesn’t work, I mean two things. First of all, I mean that for most, the amount of weight lost isn’t enough to turn a fat person into a non-fat person. Second of all, I mean that for most, the weight loss cannot be sustained over the long term (say, five years).
Here’s a remarkable fact: There isn’t a single peer-reviewed controlled clinical study of any weight-loss diet that shows success in losing a significant amount of weight over the long term. Not one.
Isn’t that amazing? It’s not as if Weight Watchers, Slim-Fast, diet clinics, Jenny Craig, and the thousands of other companies making billions of dollars from promises of weight loss haven’t been trying. If anyone could reliably make fat people thin, they’d soon have more money than Microsoft and Haliburton combined.
From a review of empirical tests of weight-loss plans by Wayne Miller, an exercise science specialist at George Washington University:
No commercial program, clinical program, or research model has been able to demonstrate significant long-term weight loss for more than a small fraction of the participants. Given the potential dangers of weight cycling and repeated failure, it is unscientific and unethical to support the continued use of dieting as an intervention for obesity.
Let’s closely examine a study cited as proof that weight loss diets work (I examined this study in a previous post): “Behavioural correlates of successful weight reduction over 3y,” from The International Journal of Obesity (2004, volume 28, pages 334-335).
First of all, let’s notice that the definition of “successful weight reduction” is extremely forgiving: According to the study, “weight loss of 5% or more from baseline to 3 y FU [three year follow up] was defined as successful weight reduction.”
So if a 400 pound man becomes a 380 pound man over the course of three years, according to this study that is “success.” But there isn’t any evidence that a 400 pound man who loses 20 pounds will be any healthier, or have a longer life expectancy, than a 400 pound man who maintains a steady weight. (In fact, as we’ll see, the opposite is true – the 400 pound man who never lost weight will probably live longer). Nor is there any evidence that it’s healthier to be 190 pounds than 200 pounds.
And keep in mind, the amount of weight loss drops steeply over time – so when a study like this defines “success” as weight loss at three years, the effect is to unrealistically exaggerate the success of the diet plan being studied. If “success” was described as taking the weight off and keeping it off for a lifetime, the success rate of these studies would be barely above nonexistent.
Still, three years is relatively good methodology – many diet studies measure patients at 3 or 6 months and that’s all. Unfortunately, this study’s methodology is terrible in another way: the 77% drop-out rate. This means that the researchers have no idea how many people followed their instructions, found that they weren’t losing weight, and so quite reasonably dropped out.
So – of the 23% of subjects who didn’t drop out altogether – how many actually succeeded in maintaining a 5% weight loss over the course of three years? 48%. Put another way, of the 23% minority who stuck with this study’s plan, most weren’t able to lose even 5% of their weight over three years.
But what about the most successful group of dieters – those who managed to obey the seven separate diet restrictions this study called for, for all three years? (That’s a grand total of 198 dieters out of the initial group of 6,857, or 2.8%). Of this tiny, select group, 40% failed to meet this study’s extremely forgiving standard of “successful weight loss.”
Now, the above study is one that weight-loss advocates themselves cite as proof that weight loss is practical and possible. Is there anything there to convince a 300 pound person that becoming thin is a practical and likely effect of weight-loss dieting?
One possible factor making it difficult to lose weight permanently is that our bodies may adjust to situations of reduced food intake by lowering metabolic rate and increasing the proportion of food stored on the body as fat. (Some studies support the existence of this effect, but it’s not proven beyond all doubt.) The evolutionary benefit of this is obvious; humans who lower their metabolic rate and store more fat in conditions of famine are more likely to survive and reproduce. But as a result, the more you diet, the harder losing weight becomes over the long term, and the harder your body will fight to retain fat.
2. Losing Weight Makes It More Likely You’ll Die Sooner
Most of the time, people on weight loss diets gain back the weight they lose. But that doesn’t mean they’re back where they started, healthwise. Many studies have found that losing weight – even if the weight is regained – is associated with higher mortality rates. From David Garner’s and Susan Wooley’s review article “Confronting the Failure of Behavior and Dietary Treatments for Obesity”:
There are few studies in the medical literature that indicate that mortality risk is actually reduced by weight loss, and there are some that suggest that weight loss increases the risk of death. In an American Cancer Society prospective survey of over 1 million people, individuals indicating that they had lost weight in the past 5 years were more likely to die from cardiovascular disease than those whose weight was stable. In a 10 year follow-up of men who were asked their weight at age 25, Rhoads and Kagen reported that heavy respondents who had later lost weight had almost twice as high a death rate as those who maintained a high but stable weight. Moreover, those with a high but stable weight had the same or lower death rate as thinner men. […] Although weight change was unrelated to mortality for women in the Wilkosky et al. study, the odds ratio… for men indicated that each 10% loss of weight was associated with a 14% increase in all-causes mortality and a 27% increase in cancer mortality.
Finally, in a study of mortality risks among 16,936 Harvard alumni, Paffenbager at al. not only found that the highest mortality occurred in those with the lowest body mass index (below 32), but also that those who had gained weight since college had a significantly lower mortality risk compared to those who had minimal weight gain since college. According to the authors, “alumni with the lowest net gain since college had a 29% higher risk of death than their classmates that had gained the most.” Thus, even if one accepted the premise that obesity is a dangerous condition and weight reduction a realistic goal, it is an unproven hypothesis that weight reduction actually translates into increased longevity.
When you read that, you probably had the same reaction I first did, which is to wonder if the higher death rates associated with weight loss might be caused by unintentional weight loss among already sick people. Glenn Gaesser’s book reviews several studies that distinguished between unintentional and intentional weight loss. One study found that for overweight women with pre-existing health conditions (such as high blood pressure), even a very small weight loss – just a couple of pounds – decreased mortality. (There was no increased benefit in losing 20 or 30 pounds instead of just 2 or 3). A similar effect existed for diabetic men. For virtually all other groups, however, intentional weight loss either had no effect or led to increased mortality.
Among the two-thirds of the study participants who were healthy to begin with, intentional weight loss was anything but good. For example, compared with healthy, overweight women who remained weight stable, women who intentionally lost between one and nineteen pounds over a period of a year or more had premature death ates from cancer, cardiovascular disease, and all causes that were increased by as much as 40 to 70 percent. Unintentional weight gain, on the other hand, had no adverse effects on premature death rates for these nonsmoking, “overweight” women. These findings suggest that if you are overweight and have no health problems, you are probably better off staying at that weight (and not worrying if you gain a few pounds) rather than dieting to conform to some height-weight table “ideal.”
It’s worth noting that the negative effects of weight loss seem to exist regardless of if the weight is regained or not.
I would be remiss not to mention the dangers associated with yo-yo dieting. Too many Americans – especially fat Americans – will lose weight a few times in their lifetime, and then regain. This is referred to as “yo-yo” dieting, and it’s both common and dangerous. (Many yo-yo dieters may not think of themselves as yo-yo dieters, since there may be years between each cycle of loss and gain.) According to Case Western Reserve University’s Paul Ernsberger:
Obese humans typically show repeated loss and regain of large amounts of weight. Men with large fluctuations in weight between the ages of 20 and 40 have increase systolic and diastolic blood pressure and cholesterol. these yo-yo dieters are two times more likely to die of coronary heart disease, even after adjustment for known risk factors, than are men with stable or steadily increasing weight. Fluctuations in body weight have been shown in many other major epidemiological studies to have deleterious cardiovascular effects resulting in increased mortality.
If you’d like to maximize your longevity, probably the best thing you can do is a program of moderate exercise. This may not cause any weight loss – but no matter what your weight, even moderate exercise is likely to increase your lifespan.
3. The Idea Of “Normalizing” Eating Habits Is A Myth
The case for weight loss dieting typically assumes that fat people are fat because they eat more and exercise less than thin people; that thin people, if they ate as much as fat people, would also be fat; and that if fat people only “normalized” their eating habits, they would be thin.
Under this model, fat people eat like fat people, and so need to “modify their lifestyle” to eat “normally,” after which they’ll lose weight.
But evidence indicates that all these assumptions may be false.
First, do fat people eat more than thin people? Study after study has attempted to show that fat people eat more calories, without success. It’s true that many fat people have lousy diets with too much fatty food – but the same is true of many thin people. And, anecdotally, I’ve met fat people who were extremely healthy eaters, and fat vegans. It doesn’t appear that fat people are “eating like fat people,” compared to how non-fat people eat, in any measurable way. From Garner and Wooley:
…[A] tremendous body of research employing a great variety of methodologies… has failed to yield any meaningful or replicable differences in the caloric intake or eating patterns of the obese compared to the nonobese…
[In a study of children], Rolland-Cachera and Bellisle found that food intake was about 500 calories greater and obesity about four times more common in the lowest versus the highest socioeconomic groups studied; however, within each socioeconomic group, there were comparable levels of caloric intake among lean, average weight, and obese children. […]
…It may be concluded that nature and nurture both exert influences on body weight and that the eventual expression of obesity is a complicated matter…. Regardless of these factors, the myth of overeating by the obese is sustained for the casual observer by selective attention. Each time that a fat person is observed to have a “healthy appetite” or an affinity for sweets or other high calorie foods, a stereotypic leap into causality is made. The same behaviors in a thin person attract little or no attention….
…The major premise of dietary treatments of obesity, that the obese overeat with respect to population norms, must be regarded as unproven.
What happens when naturally thin people eat the way fat people allegedly eat? In the 1960s, before ethical rules prevented this sort of study, scientists tested this question on prisoners, doubling their calorie intake in an attempt to make them gain 20-40 pounds. From Garner and Wooley:
Most of the men gained the initial few pounds with ease but quickly became hypermetabolic and resisted further weight gain despite continued overfeeding. One prisoner stopped gaining weight even though he was consuming close to 10,000 calories per day. With return to normal amounts of food, most of the men returned to the weight levels that they had maintained prior to the experiment.
Do fat people who lose weight, do so by taking on “normal” eating habits? Some studies indicate that a high proportion of the few fat people who keep weight off, do so not by “normalizing” their eating habits, but by becoming effectively anorexic. From Garner and Wooley:
Geissler et al. found that previously obese women who had maintained their target weights for an average of 2.5 years had a metabolic rate about 15% less and ate significantly less (1298 vs 1945 calories) than lean controls. Liebel and Hirsch have reported that the reduced metabolic requirements endure in obese patients who have maintained a reduced body weight for 4-6 years. Thus, successful weight loss and maintenance is not accomplished by “normalizing eating patterns” as has been implied in may treatment programs but rather by sustained caloric restriction. This raises questions about the few individuals who are able to sustain their weight loss over years. In some instances, their eating patterns are much more like those of individuals who would earn a diagnosis of anorexia nervosa than like those with truly “normal” eating patterns.
Too many diet advocates still believe in the above myths – and that weight is a simple matter of input and output. But real human bodies are far more complex systems. From the New England Journal of Medicine (emphasis added):
Many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose….
Why is it that people cannot seem to lose weight, despite the social pressures, the urging of their doctors, and the investment of staggering amounts of time, energy, and money? The old view that body weight is a function of only two variables – the intake of calories and the expenditure of energy – has given way to a much more complex formulation involving a fairly stable set point for a person’s weight that is resistant over short periods to either gain or loss, but that may move with age. …Of course, the set point can be overridden and large losses can be induced by severe caloric restriction in conjunction with vigorous, sustained exercise, but when these extreme measures are discontinued, body weight generally returns to its preexisting level.
4. So To Sum Up….
1) No weight-loss diet has every been scientifically shown to produce substantial long-term weight loss in any but a tiny minority of dieters.
2) Whether or not a weight-loss diet “works,” people who go on weight-loss diets are likely to die sooner than those who maintain a steady weight or who slowly gain weight.
3) For fat people (or anyone else) concerned with their health, the best option is probably moderate exercise and eating fruits and veggies, without concern for waistlines. In other words, Health At Every Size (HAES).
4) The model on which most weight-loss diets are based – in which fat people eat like fat people and must learn to eat like non-fat people – is probably a myth.
* * *
Citations
Anderson JW, Konz EC, Frederich RC, Wood CL (2001), “Long-term weight-loss maintenance: a meta-analysis of US studies,” American Journal of Clinical Nutrition, vol 74, p 579-584
Blair, S.N., Kohl, Paffenbarger, Clark, Cooper, and Gibbons (1989). “Physical Fitness and All Cause Mortality, A Prospective Study of Healthy Men and Women,” Journal of the American Medical Association, vol 262 p. 2395-2401.
Ernsberger, Paul and Koletsky, Richard (1999), “Biomedical Rationale for a Wellness Approach to Obesity,”Journal of Social Issues, vol 55, p. 221-260.
Gaesser, Glenn (2002), Big Fat Lies: The Truth About Your Weight And Your Health, Updated Edition, Gurze Books, Carlsbad, CA..
Garner, David and Wooley, Susan (1991), “Confronting the Failure of Behavior and Dietary Treatments for Obesity,” Clinical Psychology Review, vol 11, p 729-780. Pdf link.
Kassierer, Jerome and Angell, Marcia (1998), “Losing Weight – An Ill-Fated New Year’s Resolution,” New England Journal of Medicine, vol 338(1), p 52-54.
Miller, Wayne (1999). “How effective are traditional dietary and exercise interventions for weight loss?,” Medicine and Science in Sports and Exercise, vol 31 no 8 p. 1129-1134
Westenhoefer J, von Falck B, Stellfeldt A, and Fintelmann S (2004). “Behavioural correlates of successful weight reduction over 3y. Results from the Lean Habits Study,” International Journal of Obesity, vol 28 (2), p 334-335
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Well said, well documented, and very well likely to be completely ignored by those who blindly accept medicalized fat bigotry as an unasailable truth.
Great job, Amp. Now let’s place bets on how long before somebody pops up and says, “but, but, but—fat is UNHEALTHY!!!!”
Cuz you know it’s gonna happen.
Diet = Die with a T. Thus spake Garfield, I forget which year.
A favorite subject of my relatives–when they get started on how fat they are, they just don’t quit! I am thinking of alerting them to this post. [After I go out and gather some more or less organic [wild] greens. ]
If a person must obsess about something, gee whiz, why can’t it be something fun??
I suspect we just don’t know enough yet. Getting rid of the blame game would be a nice start. So thanks for the info…
I gave up on the scale years ago, and I stopped paying attention to my dress size a year or so later.
I am the healthies now than I have been since I was a kid. I think I’m a size 10 (it varies by brand, store, and type of clothes), and I have no idea how much I weigh. I know that I can jog a mile now, bend over an touch my toes without pain in my back (huge improvement), and I feel better generally.
I exercise not only for the health benefits, but also for stress relief. I do mild weight training and walk the treadmill in front of the tv. I’ve been told to lose weight by a doctor, and I was told that I was fine by my GP.
We don’t really know enough yet because predjudice makes asking reasonable questions impossible.
Btw, great post Amp.
Interesting articles.
A request: could you post the date with each citation? thnx
Yikes. This is worrisome as my husband has just lost a significant amount of weight. He has done it by eating enormous amounts of vegetables every day which in turn has led him to consume fewer calories per day. He intends for this to be his life-long habit but it’s early days yet.
He doesn’t exercise because he doesn’t like any of the options available to him as a person with a disability. He used to use a stationary arm cycle but that hasn’t really stuck.
But…but…but…fat is unhealthy! It’s all squishy and gross!
(Just wanted to validate your expectations, kactus. No charge.)
The insanity of the lose-weight-now crowd never ceases to amaze. And the moral turpitude that is implicitly or explicitly assigned to fat people is disgusting. Right, she’s a bad human being because she’s shaped like a pear. He’s a moral monster because he has a big ol’ ass.
“Healthy at any size” makes a lot of sense to me. (Although I personally prefer “lazy and genetically gifted at any size, so neener neener neener I can eat whatever I want and sit on my ass and I never vary from a 20-pound weight range and still have great health even though I do nothing, ha ha you all suck and I rule”, I appreciate that other people might want to take better care of the old corpus.)
Useful post for backing up my intrinsic belief. Thanks.
My hubby lost a good chunk of fat (picked up a good chunk of muscle) when he started working the night shift at UPS… luckily, I think he’s near the end of the 5-year window mentioned above and no sign of heart trouble, so we may be out of those woods… (p.s., he’s still “morbidly obese.” Yup, even after years of a 4-hour workout 5 nights a week. Put that in your pipe and smoke it, diet pushers.)
“Healthy at any size” – yes, absolutely, and amen. My switch to healthier habits caused me to drop 1 or 2 pants sizes (depending on which maker you ask) over the course of a year, and it’s just annoying because I still hate shopping for new clothes. According to the scale, I didn’t lose anything. And you know what? I don’t care if I swapped fat for muscle. I don’t care if the scale stays at 295 for the rest of my life. I’m more healthy at my size, that’s what matters.
While I don’t take issue with the claim that people can be healthy at any size (within reason), this post doesn’t seem to address the primary motivation of most dieters, which is appearance. Rolls of fat just aren’t attractive, and a lot of fat people, myself included, are more upset at the unpleasing site that greets them in the mirror than at the scare stories about the health effects of obesity.
I doubt many would be deterred if it turned out that dieting is as dangerous as this post suggests. Personally, if I could trade 5 or 10 years of my life in exchange for having a normal weight the rest of my years I would make that trade in a second. The social stigma, the sexual unattractiveness of being fat, and the indignity of looking in a mirror and trying to pretend to yourself that you aren’t really repulsed by what you see are more than enough to make dieting worthwhile even if it is unhealthy and the chances of success are low. A low chance of success is better than none.
If dieting were thought of as a drug with a success rate and side effects (along with anything else, it’s a gateway behavior for many cases of eating disorder), do you think it would pass the FDA?
I appreciate this post a lot. Health at every size, indeed.
I actually started weight watchers at the end of last year when I was tired of sitting by and watching my weight and my energy levels go to total crap (I was a size 24, and felt 50 years old at age 23).
The one thing ww did for me was to put my eating into perspective, and make me pay attention to what I was putting in my mouth. Oh, you mean popping those little cheese cubes while I was looking for what to make for dinner just ate up 1/3 of my points for the whole day? Yikes. It made me realize that a lot of my eating was unconscious and brainless, calories I wasn’t even savoring.
Wanting to stick to the program also got me to totally cut out fast food (which I had a major love/hate relationship with). Now even though I’m still a size 20 and “morbidly obese”, I have tons more energy and feel good. I’m not on a huge crusade to lose a ton of weight, I just want to feel my best, and their guidelines for healthy eating have helped me do that.
I’m sure anyone with common sense could do that on their own, but for me, a 10 year relationship with disordered eating and food-as-medication, I needed guidelines, ya know?
Awesome, Amp. Simply awesome post. I have never seen a better blog post.
I just wanted to address Mendy’s comment — size 10 isn’t fat. I don’t care what the dressmakers say.
If you were to take all the women I’ve dated (including my wife) and put them in front of a doctor (specifically, my doctor), he would say that all of them needed to lose weight. They’re all between 5’4 and 5’6 (except for one who was 5’10), and they all weigh between 140 and 170 (except for one who weighed 120).
Hell, my father-in-law is tall and fairly lean (and in his early 60s), and his doctor said that by current government standards, he’s considered obese. (He’s about 6′ and maybe 170 pounds.)
How does ANYONE live up to that?
I’m willing to bet that the vast preponderance of women are closer to a size 16 than a size 0. The vast preponderance of men may look at ultraskinny women in Sports Illustrated or pornography, but in the end they settle down with the women who make them happy. Women who don’t spend their entire lives obsessing about their appearance. In other words, women who are a size 10 and secure with that.
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Thanks for a thorough and informative post that certainly accords with my personal experience.
One thought. What may be true on an individual level (that humans are resistant to long-term change in weight from their body’s set point) seems not to be true on a population level (there are cases of societies getting “fatter” when exposed to a Western diet, e.g., in the Pacific Islands, and there is no question that Americans today weigh more than in previous generations without any genetic explanation). That suggests that food intake is a critical component of weight, but that whay may be resistant to change is how humans make eating decisions in response to food availability, cultural pressures, etc. You can control your breathing for a few minutes or your eating for a few months, but long term your body goes back to doing what it wants to do.
Well, keep in mind that saying people who lose weight die sooner is an “all else held equal” thing. It’s also probably the case that people who eat a lot of veggies live longer, on average, so perhaps it’s a wash for your husband. :-)
I’ve been a fatty all my life and wasn’t too concerned until diabetes started ( I’m not sure it was only age/ weight related).
While I don’t have much use for diets per se: I do keep to some rules to try and keep things from going completely to hell in a handbasket
No soda pop ( not even diet – aspertame makes you fat ! )
Eat your greens and fruit
Almost no sugar ( stevia for when it’s a must ) – doing this resets your perception of sweetness and enhances natural flavours !
You cannot satisfy hunger without eating root vegetables ( not just potatoes )
Speaking of potatoes – baked is best – try steaming, the starch goes into the steam water and they taste better !
If you don’t get up and walk, at the very least, circulation will be impaired and your legs will give you grief.
Here’s the toughie. Restrict fried foods and fast foods.
Maria, I’ve added a citations section, with year of publication, at the end of the post.
I think that in addition to food intake, the fact that the average person doesn’t have to do a great deal of physical labor is a part of this as well. Instead of going out and working the fields every day, I drive to my office and sit at a desk for 8 hours, with genes that developed at a time when it took lots of hard work every day just to survive.
The thin vegan myth unfortunately is one perpetuated by those who try to market veganism, sell products to vegans, and unfortunately even the vegan community. (Vegetarian Times and PeTA do this.) I hate seeing thin = healthy and fat bashing in places I’d like to feel safe.
My personal experience on maintaining weight loss shows that in theory it can be done. Though honestly I think it would be more accurate to say “it happens” rather than “it can be done”. My weight has gone down-up-down a couple of times in my life, but I’m pretty sure I don’t quite fit the yo-yo dieter profile. Whenever my weight has changed it’s been because of a complete lifestyle change: different city with more/less walking, being depressed/not being depressed, cooking for myself/eating mostly ready-meals. The worst up was when I was on an antidepressant and gained a good 50lb in 4 months. Recently I’ve lost weight because of restricting processed crap and upping the vegetable and whole food intake. Interestingly, I’d lose pounds over the course of a month or so, but stay the same pants size, level out at a new weight for a couple of weeks THEN change shape and require new smaller jeans. The times I’ve tried “dieting” have been disasterous: Weight Watchers is such a severe calorie restriction I’m sure it can’t be good for your metabolism. Which is a point already made here.
I think it comes down to people being far too focused on the cosmetic aspects, even though diet plans pay lip service to health, the main goal is shrinkage not nutrition. People find it easier to think of changing and restricting what they eat, since they will always have to eat, rather than adding the awful drudgery of exercise to their lives.
You know: fat is ugly, exercise is too difficult, pop a pill and “melt off” the pounds. It’s the standard line!
Keep bringing these studies up, it’s going to take a lot of yelling to get people to listen through their advertising-padded earmuffs.
I have some reservations about this post. I joined Weight Watchers and have seen it really do some good for people. And by good, I don’t mean, “Now I weigh size four jeans.” I mean, people could cut their heart medicine in half. They could stop taking asthma medicines. They could walk up a flight of stairs without being in agony. They could stop wheezing when they walk to their cars. Self-acceptance for a moderately overweight person is one thing, but some people are in great physical agony because of their weight. Their bones hurt, they have chafing and rashes, they feel distended and miserable, and they are damaging their organs.
No one must lose weight to have my respect. I have great friends of all sizes. It is a personal matter. But for some people it seems like a pretty good idea!
Your weight has gone up and down, but you aren’t a yo-yo dieter? That’s what yo-yo dieting is. I also wouldn’t put too much stock in temporary weight reductions induced for food restrictions. Whether they be self-invented or purchased from Weight Watchers. Obsessive relationships with food aren’t healthy and they aren’t sustainable. Whether one counts carbs or points or calories or whatever, that’s neither a mentally or physically healthy existance and it will come apart. Your fat isn’t a problem. You aren’t a mindless glutton. You aren’t a lazy sloth. Fat people are driven to judge themselves harshly and unrelentingly, and this must change.
We also should recognize that increasingly, not only are posts like going to be subjected to… “but… but… but… fat is BAD!” style responses, but also “Oh, I totally agree. And the disordered eating plan I’m on really works but is totally not called a diet so that means its okay.”
All of which could be achieved by more regular exercise, without having weight loss as a goal. Using weight loss as a goal sets up the vast majority of people for long-term failure, even if they achieve short-term benefits. It would be better to encourage people suffering as you describe to find solutions that are more likely to be maintainable over the long term.
If he makes it a lifelong habit, he’s probably fairly safe. It’s probably the yo-yo effect that causes much of the damage. Does he feel excessively hungry between meals or even after eating? If not, his body’s probably not desperate for more food and is not going into stress mode over the weight loss. It couldn’t hurt for him to keep an eye on his cholesterol and blood pressure anyway, though, since he should be doing that anyway…
OK, there’s ample evidence that weight loss diets don’t work.
But I’d love to see the post about the effect of an increase in physical activity. I believe that the evidence shows that increasing physical activity, without paying any attention at all to diet, will lead to all sorts of good effects, including increased heart health and decrease in diabetes. And anecdotally, it seems that people who start to exercise more have an easier time maintaining the lifestyle change than people who go on restricted diets.
Starting on an exercise program might lead to moderate weight loss. Even if it doesn’t, the exerciser will probably feel better.
Is a change in exercise habits more sustainable over the long term than a change in eating habits? My own experience has been that I do well for a while (say six months to a year) and then gradually slack off. This is true also of completely non-health-related resolutions such as playing fewer computer games and reading more, keeping the house tidier, etc., etc.
I think it’s just human nature to find any path but that of least resistance very hard to stay on.
One thought about intentional versus unintentional weight loss. A lot of people are or believe that they are overweight. Therefore, they may be more or less chronically trying, on a low level, to lose weight with little or no success. Suppose they then get sick with some disease that causes wasting (ie lymphoma, other cancers, autoimmune disease, hyperthyroidism). Suddenly, they start loosing weight. They may report this weight loss as “intentional” even though it is, really, due to the illness, not the sporadic dieting. This might confound the results somewhat.
The chart of mortality versus BMI versus age confirms a hypothesis I’ve had for many years: that the ideal (ie healthiest) weight is higher in older people. I suspect that diseases like osteoporosis, which occur in older, thin people, and the lack of reserve that a very thin elderly person may have may account for some of the increased mortality in older thin or “normal” weight people.
Josh (13):
Either your doctor has no idea what he’s talking about, or you’re misquoting him. By government standards, a six-foot-tall man is overweight at 184 and obese at 220. Even that’s pretty silly—BMI doesn’t scale well weight height, and any man that height with a reasonable amount of muscle mass will be “overweight”—but 170 isn’t even close to “obese,” even by government standards.
Ampersand:
I agree with you on some of this—in particular, I do think it’s naive to believe that all people react the same to the same lifestyle factors—but I’m somewhat skeptical about other parts. A few questions and comments:
1. Do you know of any theories regarding the mechanisms by which weight loss increases mortality?
2. The second chart is for hospital patients. Can we generalize from that?
3. One problem with the third chart is that men on the low end of “normal” (say, BMI < 23) are probably underweight. I’m 6’/200, and I can’t imagine losing the 50 pounds it would take to get my BMI down to 20. Similarly, it’s quite normal for a reasonably fit man to have enough muscle mass to get him well into the “overweight” range. We saw this with that CDC study (the one for which they issued a correction last year)—the authors discussed the results of playing with the bucket boundaries a bit, and found that the RR for obesity was much greater relative to the 23-25 bucket than it was relative to the 19-25 bucket (the results in the abstract, and those reported in the media, used the 19-25 bucket).
4. Do you have any theories regarding what is different about those who do manage to lose a great deal of weight?
5. There’s nothing particularly unhealthful or fattening about animal products, so I wouldn’t draw any conclusions about the fact that you know fat vegans.
BStu:
What do you mean by “disordered eating plan?” You seem to be suggesting that any dietary restrictions, or at least those that happen to induce weight loss in some people, are inherently disordered. Am I reading that wrong?
Lu, I think that has a lot to do with it for certain groups of people. Think about all of the New Year’s resolutions that absolutely go down the toilet by June! Any change of behavior is difficult to sustain unless it’s easier than the old behavior, and sometimes not even then.
But being fat has added dimensions that other “health” issues do not. For instance, sleep deprivation is not considered an evil thing to do to yourself unless you fall asleep while driving your car and run over a little old lady. Thousands and thousands of people are perfectly capable of going to bed at a time that would let them get an adequate amount of sleep (I’m not including people with sleep disorders, BTW), but TV, the Internet, or a good book – or other activities – keep them awake and then they are trying to get through the next day with less than optimal shut-eye. “I’ve got to get more sleep!” they cry, but the next day, and the next, and the next, they fail to do so, because it’s become a habit. And then maybe they do make the big effort and get back on a good schedule, until the next really cool fun thing comes along (or at least, more fun than stacking Zs). It’s almost a virtue to be able to get around on only 4 or 5 hours of sleep a night, but I don’t see that it’s healthy. I bet if voluntary sleep dep was a subject for study the way fat is, you’d see a lot of the same language being used by experts.
Just my rant for the day!
Get a job at UPS! Four hours a day, great upper-body aerobic workout, hellofagood health plan thanks to the Teamsters, and THEY pay YOU! Not much, but it’s better than paying some gym for the chance to do pretty much the same thing. And if you don’t show up for work, they call your house and pester you in a desperate tone of voice because they’re chronically shorthanded!
But as I noted earlier, one can do this for years and establish a new, stable waistline that is still socially unacceptable. I can personally vouch that my UPS-suffering hubby eats the same or less than he did when he started work there. Some of us have got the stubborn, fat-clinging DNA.
BMI is one of the most malevolent inventions of modern times. Mass comes from so many different sources and is different for everyone; muscle, bone, water… and yes, fat. Extreme excess fat certainly isn’t healthy, but neither is starvation or stressing your body by radically changing the habits it has adapted to.
Lu (27): It can be hard to stay on an exercise program, but what about societal changes that force people to be less sedentary? Zoning so that people can walk to the grocery store, stopping subsidizing parking, stuff like that? Those can cause a longer-lasting change in exercise behavior– or, at least, people who live in those environments are less sedentary than others.
Individuals who gain weight because they eat too much processed sugar and fats and exercise too little can indeed lose weight permanently by changing habits, and I would advise them to do so. It won’t turn everybody into a size 2, but tough cookies. I gained about 60 pounds during college (in-dorm cafeteria meals, one price all you can eat), and lost it in two years or so after college by skipping the pies and sour cream on potatoes and soda pop etc, and sticking to lowfat dairy, a little meat, a lot of vegetables fruits and whole grains/starches with very little fatty seasoning. In other words, a healthy diet, with occasional non-healthy treats in small amounts. I still eat this way, and 28 years later I have gained about 5 pounds, probably natural aging plus more directed weightlifting. Do I feel bad about being size 12 or 14 while friends are size 6? NO. They are ectomorph build, I am mesomorph. The only thing I feel I need to do is bench press more weight.
Oh, and my clothes fall apart before I need to change sizes. Unfortunately I tend to buy clothes, particularly pants, in batches, and I had a month where I split my pants in public twice. :( And immediately reviewed the others of that batch and realized they had about two threads left.
As a “weight-loss success” story, having lost 120 lbs and kept it off for over 6 years, let me tell you that I only achieved success once I quit dieting.
I, like most obese people, went up and down over the years with various diets but always put back on more than I lost. After getting my ‘shot across the bow’ by having a very minor heart attack at age 48, I decided that I wasn’t quite ready to die yet. I threw away all the diet books and just started using a little common sense. I ate the things I knew were good for me like fruit, vegetables, whole grains, lean meats and dairy and stayed away from junk. I never measured a thing or count a calorie. I also started doing exercise that I enjoyed so I would stay with it, in my case that was bike riding, and gradually built regular exercise into my life.
It took about 2 years to lose the weight but now I feel better and stronger than I have since high school. And the weight has stayed off, my cholesterol is 127 and my blood pressure is 110/60.
My point? Weight loss diets don’t work but eating healthy and exercising as a way of life does.
And what’s best is I stopped getting hustled by the weight loss industry. They, like narcotics detectives in the war against drugs, have no real interest in solving the problem. It would put themselves out of business. No careers to be made in that!
Yes, the concept of eating packaged “weight loss” foods always struck me as counterintuitive – wouldn’t you want to enjoy what you ate? I can understand packaged weight GAIN supplements for special needs eg, the high protein supplements used by serious weightlifters.
Not really. I think your attack on weight-loss studies because they aren’t controlled clinical trials is bit unfair. You can’t run controlled clinical trials in situations where people get to choose whether to assign themselves to the control or treatment group, or get to switch groups once the trial is running based on a whim. Clinical trials are okay if you just dole people out with drugs or placebos, but the moment people can actively seek out treatments or the effect of treatment depends heavily on the behaviour of your subjects they become a not very realistic standard.
Diets don’t work at inducing weight loss. They don’t work at improving health. They do work at inducing weight gain and damaging health. Fat people aren’t fat because they eat too much or too differently, making restrictive eating an especially dubious treatment. Fat people haven’t been shown to be at risk because of their fat, and indeed what risks have been shown could easily be attributed to a life-time of weight cycling among nearly 100% of fat people. Nevertheless, studies have repeatedly shown that it is possible to be healthy and fat. Emphasizing this point, it has been shown that moderate and healthy changes to one’s eating and activity has a nominal impact on weight but is extremely beneficial to one’s health.
And the response to all this? “I lost weight! Let me tell you how.”
Well BStu, yes, weight cycling can be more damaging than maintaining obesity at a constant weight but study after study shows obesity itself increasing health risks dramatically.
I think the object is to find ways to control weight without the detrimental effects of yo-yoing. I’m sorry that you’re not interested in hearing alternatives.
How can increased mortality in people with weight loss be interpreted as weight loss causes heart attacks or cancer? Moribund people often waste away from their illnesses and surgeries.
Josh Cohen
It isn’t just the dressmakers, but the doctors that think I am fat. According to the chart, at 5’2″ I should weigh from 115 to 125. I actually got on the scale at work today, and I weigh in at 150. However, I’ve had three children, and that does certain things to a woman’s body.
I don’t think I’m fat. I know I am not a size 2 nor do I care to be one. I rather like that my ribs don’t show and my hipbones do not potrude. I didn’t start exercising to lose weight, I did so for my spiritual and physical well-being.
Diets are a joke, and until we get to the point that fat doesn’t equal bad we won’t ever be able to do the research necessary to truly understand the mechanism by which entire populations become larger or smaller.
I’ll second (third?) the idea of focusing on the exercise rather than on your size or the amount you weigh. In my case, the weight-lifting drove all the other lifestyle changes and eventually resulted in the 50lb weight loss (not quite done yet). Said weight loss was a nice fringe benefit, but the increase in strength and energy were more important by far.
Dieting is damaging not just physiologically but psychologically as well. It has been published for years that the most successful diets induce a 5% or less long term success rate. And yet over and over and over again fat people are told that they have to lose weight or they will die. About 8 years ago my doctor put me on medication to lose weight, and I did, 60 pounds gone then it stopped. My body wouldn’t lose any more weight. Shortly after that it was publicized that the medication caused damage to the heart and lungs. How is this better than living fat?
The loathing of fat is often tied to the assumption that fat people are solely to blame for being fat. What the studies above say to me is that that is not necessarily the case. Not every physical state is caused because someone didn’t live the optimal lifestyle, there is no magic optimal lifestyle. Sometimes people get sick, sometimes they get cancer or heart disease. There isn’t always a controllable cause. Sometimes people get fat because they are meant to be fat.
It’s called life. We are all born, we all live wonderful, terrible, imperfect lives. We will all die. I don’t want the sum and total of my life to be she was fat and she spent her life hating herself because of it. I don’t want my life to be spent in a nightmare of obsession about food and working out. I want to eat because it tastes good, move because it feels good, and enjoy the short time I have here.
2. The second chart is for hospital patients. Can we generalize from that?
There are a variety of studies on healthy people One is. “Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults.” 1999, Calle, E.E., Thun, M.J., Petrelly, J.M., Rodriguez, C., Heath, C.W., New England Journal of Medicine. Vol. 341. No. 15. pp 1097-1105.
Reports on a huge (over a million people) demographic study of the relationship betweem BMI and mortality. I pulled out the data and plotted them and then posted the graphs at my private web page.: You can see the graph alonehere
The BMI with the lowest mortality does fall somewhere in 20-25 range for all groups — but eyeballing the minimum is always in the upper half of that range! However, you will notice that the BMI of 30 has lower mortality rates than a BMI of 18 for all groups studied.
There are a numer of caveats: initial weights were self reported; the researchers do suspect this means people tended to under report their weight and over report their height. This is important when comparing to the hospital data Barry shows; patients in hospital were likely weighed and measured.
Also, who had lost significant weight for any reason prior to the study are not included in the graphs I posted. There are probably other important details associated with how sampling was conducted, but those weren’t discussed in the article.
Exercising moderately is good. Eating lots of veggies is good.
I’d be curious to see a study of the effects of yo-yo dieting on the person’s natural set point later in life. If as I suspect, yo-yo diets increase the natural set point, then dieting is really giving everyone a double-whammy; not only do fad diets lead to increased weight gain, but they drive the ‘normal’ point for your body higher.
Exercising, especially weight lifting, is fabulous. It’s hard to feel bad about being heavier set when you know you could bench press those Twiggys.
Ed makes a good point about diets, and the bounce-back.
I mean, from a cynical viewpoint: Every overweight person who becomes permanently non-overweight is a lost customer for the diet industry.
Ergo, from an economical viewpoint, dieting industry doesn’t have an incentive for creating permanent results.
Hey, Tuomas, would you please drop me an e-mail? Thanks.
Sure, give me an address. I don’t have an anonymous mail, and I’m uncomfortable exposing my full name to the whole world (considering I have sometimes bit radical views):
Oh right, you can’t see my e-mail address here.
bnneditor@gmail.com
Mich, when you refer to your “incidental” weight loss as “not quite done yet”, you betray your motivations and intent. You are attempting to lose weight. I’m sure you are convinced that you’re doing it some special way that actually works and is totally okay and no one should have a problem with, but the attitude of making weight loss a moral virtue is an an integral part of our culture’s oppression of fat people. That attitude is precisely the problem, no matter how much an individual who believes assumes that the problem is everyone else. Seeking or valuing weight loss isn’t a healthy approach. Period. Talking about a no-diet approach as if it is actually a weight loss strategy isn’t a healthy approach. Period. What I’m seeing here is exactly what the Diet Industry tries to foster. They were faced with a major problem as awareness of dieting’s futility became more widespread, but the spun it masterfully as each diet simply blames all the other diets while staking a claim that they are somehow different. It is a demeaning message of false hope that has regretably resonated with the Weight Loss industry’s consumer base.
Healthy at any size. Absolutely. You’ve written the blogpost I’ve wanted to write for years.
I’m one of those obnoxious naturally thin people whose mother was the same way (and died at 62) and whose grandmother was the same (and died at 93). In the course of having people bore me with this issue (you wouldn’t believe the flak you can get for eating two desserts, especially first), I’ve noticed a couple of what seem to be real differences in the eating habits of fat (ie like over 300 pounds) and thin people. 1) Thin: slow eaters; fat: quick. 2) Thin: either not much snacking, or nothing but snacking and no real meals; fat: plenty of (unconscious?) snacking plus three squares a day. Amber also mentions that in comments, and it sure fits what I’ve seen.
The other pattern that struck me as interesting is the correlation between low status and high weight. Low status is associated with measurably increased stress hormones, whether you’re talking about animals or people. Given that fat deposition is the body’s way of getting you through bad times, it makes sense that stress by itself, without any particular “low class” eating habits, could explain some (most?) of that weight. (Which implies that *real* democracy might solve a lot of stress-related issues too??)
That might also relate to a possible correlation someone needs to study: childhood family situation and weight. When Frist was giving us his expert diagnosis of Schiavo, I was reading through comments on a post about her bulimia (which had caused the coma to begin with). Most of the commenters were women, most discussed how difficult the whole food issue was for them. One said she had no problems, but she was the only woman she knew who’d grown up in a women-only family surrounded by strong-willed and opinionated people. I nearly fell off my chair, because that’s my situation exactly. No food obsessions (I love the stuff and savor it but that’s different), no weight problems, and grew up with a bunch of determined and successful women. (It was interesting that the studies cited often seemed to focus on men, when women do most of the obsessing.) Now they need to repeat all those studies, include women in all of them, and see where women with that somewhat unusual family situation come out.
Lucia:
For some reason both of your links redirect to this page, so I can’t see the chart you’re talking about. I wouldn’t be surprised if the “optimal” BMI (in terms of correlation with mortality) were in the mid-to-high 20s. I’m just skeptical of the idea that it’s in the 35-40 range, as shown in Amp’s chart.
Tuomas:
Ergo, from an economical viewpoint, dieting industry doesn’t have an incentive for creating permanent results.
The diet industry isn’t a monolithic entity. It consists of hundreds or thousands of competitors. Taken as a whole, the “diet industry” is better off if no one ever creates an effective diet. But anyone who found a surefire way for anyone to lose all the weight he wanted with no effort and no negative side effects would have a very strong incentive to market it and capture all the profits for himself instead of sharing them with his competitors.
The old “it’s more profitable to treat than to cure” canard only holds for monopolists.
Brandon Berg:
Good point. I’m not making a conspiracy theory here, a mere observation.
a surefire way for anyone to lose all the weight he wanted with no effort and no negative side effects
…and since such surefire way does not exist (with the caveats you provided), the competition is “which diet is coolest and has the highest feel-good factor”. I believe the surefire way does exist and is dirt-cheap, but it is not marketable. People have too much money in their hands (and that’s not a complaint) and want to “buy health”. Snake-oil peddlers are willing to sell it. Your theory assumes that everyone behaves rationally. Plenty of evidence exists to prove that people are suckered into buying completely useless and ineffective things. “Brand waters”, anyone?
“The fool and his money are soon to be parted” -is a truism that appears to hold true when discussing diet industry (and alternative medicine, but that’s a different issue).
Damn, I meant to bolden the second usage of “a surefire way for anyone to lose all the weight he wanted with no effort and no negative side effects”
…And when I say I believe a surefire way exists, I mean it exists with caveats (effort and/or possible negative side effects).
I do think it’s very restrictive and depressing to go on a diet where you have a list of foods written out for you, etc. However, although there are certain medical factors which can influence weight to some degree, by and large, it’s pretty clear that the more you eat, the more you weigh. Most people who weigh more DO eat more than people who don’t. This is not to say that heavy people have less value than people who don’t. It’s just that this is a fairly direct relationship that really does have SOMETHING to do with the person who’s doing it. To not be in touch with that is actually fairly disempowering because a. it’s not true, and b. it makes one’s physical being seem like something that is too far out of one’s control.
Alexandra, you are masking moral judgements in a cloak of “common sense”. Do not claim you aren’t making a moral judgement when you seek to condemn all fat people as gluttons without any evidence, implicitly demean anyone who would disagree with you as a liar, and contend that the mere concept of fat being a normal state to be disempowering.
You’ll excuse me if I fail to appreciate the efforts of a Weight Watchers customer to define my empowerment.
Okay, in my post, you’ll find references to studies. I’m attempting to argue from evidence. I’d appreciate it if you could do the same. What evidence do you have supporting your opinions?
quixote said
“I’ve noticed a couple of what seem to be real differences in the eating habits of fat (ie like over 300 pounds) and thin people. 1) Thin: slow eaters; fat: quick. 2) Thin: either not much snacking, or nothing but snacking and no real meals; fat: plenty of (unconscious?) snacking plus three squares a day. Amber also mentions that in comments, and it sure fits what I’ve seen.”
And do you live in a herd of 300 + pound people? You are making a blanket statement for all 300+ pound people because you have stalked the eating habits of, how many 300+ pound people?
I could point out that I was married to an obnoxious thin person for 20 years and he could and did eat constantly. Snacks all day, and 3 squares a day. Do I think all thin people eat like him? No, because I know that isn’t being realistic.
The worst one I’ve heard is negative calorie foods. That cracks me up. Besides, these companies wouldn’t make money if everyone loved the way they looked and were healthy. The money’s in the treatment not the cure.
Besides, I used to eat tons of unhealthy food. Never gained weight (was quite slim) but I’m sure my heart was about to fall out. I started working out and now I’ve gained weight (muscle) and am very healthy.
A rawhide dog bone might qualify as negative calories, since in order to ingest it, you need to chew it about a million times.
Lucia:
For some reason both of your links redirect to this page, so I can’t see the chart you’re talking about. I wouldn’t be surprised if the “optimal” BMI (in terms of correlation with mortality) were in the mid-to-high 20s. I’m just skeptical of the idea that it’s in the 35-40 range, as shown in Amp’s chart.
Right-click the links and choose “Copy shortcut” or “Copy link location”; then open a new window and paste the address into the URL line. Lucia’s chart shows that the optimal BMI is in the 23-25 range, with a slow increase in death rates to the right and a fairly sharp one to the left, especially left of 20.
Yo-Yo dieting never saved anyone from actual starvation. During wars and crises when people do not get enough food, as in Sarajevo, WWII, etc., EVERYONE gets thin. Nobody stays fat when they don’t have enough food. It is not a moral judgment but a fact that more food adds to more weight. I DO think people can be healthy and fat up to a point. But someone who’s four or five hundred pounds really can’t get very much exercise without damaging their bones and joints. People who are that fat are people who are hurting.
Brandon, Sorry my links redirect. The html is correct; I visited your blog but couldn’t find your email to send my links.I guess you’ll need to look at the source code for the page, search for “lucia” and cut and paste.
My impression from what I’ve read is the diet advice tends to suggest the idea is a BMI in the very low 20’s (example 21-22) while much of the literature shows the optimum point from a mortality point of view slightly higher (22-24) range. Of course, if you look at BMI only, you will not get the whole picture. Fitness matters a lot, as do other factors.
I haven’t seen numbers as high as posted by Barry, but Barry is showing figures for people who are sick enough to be hospitalized, which is a special case. I’m not particularly surprised at that figure; my sister is a physician and does say it’s know that if you are already ill, being very thin is not a plus.
I’d like to comment Barrys response (#59), this is a “for what it’s worth”. If, you examine the standard empirical equations nutritionists use to estimate a person’s daily resting metabolic rate, you would conclude that on average, heavier people’s resting metabolic rate is slightly higher than those of lighter weight people. This would suggest that, on average, heavier people do consume more calories than lighter people.
However, the difference is not as great as one might imagine. The average 200 person person’s resting metabolic rate is not twice that of the average 100 lb person, the difference is more like 20%. Also, if you read the papers those equations are based on the variability for people of similar weights is sufficient to suggest that some heavier people have lower resting metabolic weights than some thinner people. (I’d post a link to an old page with calculators, but I must have borked the page reloading at some point, and I’m pretty sure the link will redirect anyway. But, if you’d like to see some numbers, I might actually install a side blog to post these calculators.
Heck, Amp might even be interested in my take, even though I think it’s fine if individuals decide to take measures to keep their weight down, and I do take them myself.
One of the problems with weight cycling is the change in body composition. Weight loss is not just fat loss – it is a mix of fat and lean (mostly muscle). Animal studies have shown IIRC that there is a shift towards greater fat gain and less muscle gain when weight is subsequenty increased. the net result is that you could start at 220lbs and be 35% body fat, go through several yo-yo cycles and end up at 220lbs and be 40% body fat. What each cycle does is change the metabolic needs of the body to maintain itself. So, with no change in activity, the body will need fewer calories to maintain itself (muscle is far more metabolically active than fat) and further weight gain is easier while weight loss becomes more difficult.
It is very difficult to lose just fat – you have to do weight training to maintain all of your musculature while losing fat. Cardio won’t maintain muscle in non-active parts of the body (chest, arms etc) while it will in heavily exercised muscle. Strength training has a positive effect on calorie burning during exercise, the increased metabolic activity of the muscle itself and an increased metabolic activity that occurs in remodelling (breakdown and rebuilding). Muscle is more dense than fat, so it is entirely possible to maintain weight while losing clothing sizes.
One thing that has not been mentioned much, but is a crucial factor in the health/morbidity of fat is its location. There are essentially two fat depots in the body and where the fat is distributed is genetically determined – subcutaneous and visceral. Subcutaneous (directly under the skin where you can pinch it) fat is more of a cosmetic problem and less of a health risk. Visceral adiposity, that is fat located within the body cavity around internal organs, is a potential killer – it is highly correlated to what is now called the metabolic syndrome, a constellation of risk factors related to cardiovascular disease, diabetes and a few types of cancer: hypertension (blood pressure), hyperlipidemia (high LDL/low HDL cholesterol and high triglycerides), hyperglycemia, hyperinsulinism (Type 2 diabetes) and other related problems. So it is possible to have 25% body fat for a male and be reasonably healthy while another male is at risk when he is 25% body fat.
A simple way to estimate where the fat is is to measure the waist. Relatively large waists (often compared with hip measurements) usually mean more visceral adiposity. Further blood tests for cholesterol will also indicate a relative level of internal fat. And a CAT scan will definitively show how much visceral vs subcutaneous fat there is.
The small health risks related to subcutaneous fat are usually related to psychological factors, increased risk of osteoarthritis, skin problems, reduction of activity etc. and not highly correlated to the major killers like cardiovascular disease.
Alexandra, I think you’d be hard pressed to get anyone here to claim that people who are actually starving to death won’t lose weight. And that’s the thing about people in famines brought about by war. They are starving to death.
My physician brother in law has told me that the BMI index is falling out of favor and a waist measurement ratio- or something like that- is being used more and more. He’s an internist, and an interesting person to talk to about all of this, because he always says that what people think is eating healthy and exercising enough varies widely. Patients will say ” I exercise every day” but when he asks what they do it turns out they only walk to their car. Or they say they eat healthy but after probing he finds they drink four bottles of soda a day.
So when I hear “healthy at any size” I wonder what is meant by that. Does it mean that I’m not allowed to conclude that weight might have something to do with a person having diabetes or knee problems? Does it mean that people are assuming that I and others like me think that 20 pounds over “ideal” weight is evil or unattractive? Since we can’t see each other, maybe we are arguing about nothing- I agree that many people who are so-called overweight aren’t at all, and others may agree that it’s hard to argue that 300 pounds is a healthy weight for just about any human who isn’t a very tall weight lifter.
It’s a really brilliant job on the subject. Clean. clear, and precise in really useful ways.
And naturally, the cry of “what about the people who are 500lbs!” is used to justify an abusive industry which primarily targets people who weigh a fraction of that. And of course, weight loss doesn’t magically work because a person “needs it”, so all the morally indignant tut-tutting of people deemed “too fat” still doesn’t prove useful.
What’s more, I don’t even begin to know where to start addressing what is wrong with the oft repeated “Holocaust as Diet Justification” arguement you see so often. Its one of those “common sense” tidbits that is bizarely used to justify the diet industry. I’m not one to use Nazis as a casual perjorative, which is why I find it utterly bizarre to see their abuse heralded as proof of the achievability of weight loss. Is that really a comparison you want to draw? Sure, there are no fat Jews in those Concentration Camp photos. For one, they were probably killed long before the Allied forces liberated them. Moreover, no one is going to suggest the inhuman starvation won’t induce weight loss. Sure, it works “great”. Doesn’t mean it keeps working once a person stops starving. The biggest lie that diet companies use to get dieters to turn blame for dieting’s failure back on themselves is just that notion. If you lost weight at first, that means the diet works, and the fault is your own for failing on it. This premise is a lie. There is an axiom that I rather like that explains this. Losing weight is as easy as holding your breath. Keeping it off is as easy as continuing to hold your breath. You are presenting a false proof and using a quite disturbing example to make it.
I think this is a great post and I hope you’ll submit it to the Skeptics’ Circle carnival, which is being hosted next by Pooflingers Anonymous. I think the Big Fat Carnival is great, but I really think that this will reach a wider (and less preaching-to-the-choir-ish) audience at the Skeptics’ Circle. Please submit!
Alexandra,
Yo-Yo dieting never saved anyone from actual starvation. During wars and crises when people do not get enough food, as in Sarajevo, WWII, etc., EVERYONE gets thin. Nobody stays fat when they don’t have enough food. It is not a moral judgment but a fact that more food adds to more weight. I DO think people can be healthy and fat up to a point. But someone who’s four or five hundred pounds really can’t get very much exercise without damaging their bones and joints. People who are that fat are people who are hurting.
Hmm. Would this still apply to someone who weighs 300 pound? Certainly when I’m not in university, I rather enjoy exercizing–both cardio and weights–and it doesn’t seem to have damaged my bones or joints. I won’t bother noting what I can do, particularly in terms of weights, as you wouldn’t believe me anyway. Let’s just say you’d be a little surprised.
I don’t believe the CW re: yo-yo dieting. I’d have to see a lot mroe data, and SERIOUS long-term studies done, to believe it.
While I’ve never been obese, I have gained and lost weight (20-25 lbs on a regular weight of about 160lbs) numerous times (I have a very tough time in the winter months without sunlight and eat way too much sugar), and I’m in excellent health. Maybe I’m an anomoly?
A simple quote from 1 study does not have me convinced. I’d like to see much more information on this matter. Also, it could very well be coincidental that people who yo-yo diet tend to also be at higher risk, or are obese to begin with.
Does teh % of weight lost/gained matter, or is it the starting point that matters? Age? Condition? etc. etc.
It’s just far too simplistic to say “weight cycling is dangerous”.
From the standford website:
Weight cycling
Weight cycling is losing and regaining weight multiple times. Some studies suggest that weight cycling, also called “yo-yo dieting,” may result in some health risks such as high blood pressure, gallbladder disease, and high cholesterol. However, these studies are not conclusive.
while I agree that “weight loss diet” doesn’t work and advocate eating healthy & an exercise routine, my concern about this blog is that is that some may misinterpret it as “statiscical proof” of why they shouldn’t alter their eating and exercise habits, regardless of what ever size or weight they may be. I don’t have a medical background to support any of what I’m about to say–all I have is my personal experience.
Up until the last 1.5 years, I have always been overweight. At my highest, I was about 210 and I’ m 5″7. I currently weigh 150. I was never the stereotype of a “fat person”. I had plenty of friends, played sports for over 10 yrs, & was always very social. I wasn’t someone who NEVER exercised, who was recluse, or had Pizza Hut on speed dial.
But being overweight, despite VERY healthy, was painful psychologially. I couldn’t fit in to the cute clothes like my friends. I wasn’t able to run fast , so I didn’t play varsity sports, which I really loved. Boys wouldn’t give me the time of day, no matter how nice, outgoing or friendly I was. Everyone goes through growing pains when they’re a kid, but having glasses, braces, etc. are seen as something that are out of one’s hands. People that overweight people are lazy & can lose the weight.
I agree (to an extent). There were things that I & my parents could have done, along time ago, to focus on healthy eating. It wasn’t like I ate healthy 24/7–there was junk food galore in my house, and when you’re a kid, of course you’re going to go for the junk food. And I heard all the other excuses too–that I am “big boned”. That I still play sports. How people should like you for who you are & not your looks. Unfortunately, our world doesn’t work like that. People placed every “fat” stereotype on me imaginable.
It wasn’t until I stopped blaming other factors and took things into my own hands that I was able to lose the weight. I eat [my idea of ] healthy 95% of the time and exercise EVERY SINGLE DAY. I had to make it a part of my daily routine and that’s the only way to successfully lose fat and become stronger and healthier. I didn’t do it with surgery or fad diets. Just will & perservance; healthy eating & exercise. I know it’s not THAT simple for everyone, but sometimes, yeah, it is.
I’m not gonna sit here and say that my life is better after having lost the weight. It’s not like I was just given an all access pass to complete and utter happiness. In some ways, it’s harder. Now it’s like I’m expected to maintain this weight and that’s pressure on it’s own. And it takes WORK! And it’s really weird to have people who ‘weigh more’ than I do say things, “well, it’s not like you understand what’s like to have a weight problem or anything…”, when really, I understand perfectly.
But I will say this–it is an AMAZING feeling to have people who have known you a long time tell you how great you look. To be able to wear clothes you never dreamed of fitting into. To be able to walk into a room with complete confidence. To be able to say that I can run an 8 minute mile. To have a friend comment that I am really “strong”. To know that I what I put in my body every day WILL help prevent diseases in the long term, and gives me energy and great health right now. To know that when I have kids one day, I will be setting a great example of how to be “healthy”, not just thin.
If you want to lose weight/fat/ etc, do it for health reasons & do it for yourself. Don’t let others or yourself give excuses.
Thanks for putting this all in one place — even the comments that demonstrate just how blind people are.
I’ve linked to this from: http://ethesis.blogspot.com/2006/04/diet-is-still-working.html which is about a non-diet, diet that I’ve used.
BTW, speaking of starvation as a diet method, something they got from analysis of the Bataan Death March survivors is that the fat among them died first and the naturally skinny were the ones most likely to survive.
How then do you explain two facts:
1) Obesity has significantly risen during the past 20 years in the United States. In fact, it has risen even in the past 10 years. The greatest increase is among children.
2) Americans’ diet has, over the same period, greatly increased its consumption of saturated fats and refined carbohydrates. Americans have also sharply reduced exercise with a shift to cars over walking, and sedentary activities like television over active sports.
At most, you can argue that #2 should lead *all* people to be obese, not just the 30 percent or so that are, and those 30 percent may suffer a genetic predisposition. But you cannot deny a correlation between #1 and #2.
Everytime I’ve engaged in a serious exercise regiment, I lose about 15 pounds (taking me from the high end of the healthy BMI down 2 or 3). I can’t imagine exercise that didn’t eliminate weight (unless you gained muscle), and I actually can’t imagine maintaining exercise without losing weight (it’s just so much more pleasant running without my thighs rubbing each other and with less shifting).
tyronen — well, if you go to Paris and look around, all the French look tiny and scrawny compared to the Germans and Americans. Much of it is the difference in exercise.
The interesting correlation is that between reduction of the percentage of fat in the diet and weight of children. Some good research to indicate that many regulate their intake of food not by the total calories but by the amount of fat they eat. I never thought of it until I dated a girl whose idea of dieting was eating icecream. When she upped her fat intake, her total calories would drop.
But, given the world, the question is whether reduced calorie diets in the world work. The answer is a resounding no — they are harmful.
Other issues are worth looking at and considering.
BTW, weight loss by sport is an interesting concept. Swimmers lose a lot less weight than runners, even with the same amount of calorie burning.
I’m trying to figure out why there are so many posts here from people who want to talk about their weight loss. If you’re exercising for hours every day, this isn’t about you. If you’re willing to monitor everything you eat for the rest of your life, this isn’t about you. If you used to have crappy eating habits and be inactive, changed that, and lost some weight, this isn’t about you. This is about fat people who have already gotten past any problems with nutrition, inactivity, or eating disorders, and are still fat.
I do exactly the same things to stay healthy that I would do if I were thin: I walk for a half hour a day, to work and back. Most times, I work out a few hours a week. Most of what I eat is healthy and nutritionally balanced. My blood pressure and cholesterol have always been fine. And, my BMI is above 30 (as it always has been, since I reached my adult height). What Amp’s information is confirming for me is that it would probably not be worth it to starve myself in order to reach a “normal” BMI. This data supports the idea that my body is the right one for me, even if it doesn’t conform to a weight or BMI table. I’m not interested in being an athlete any more than I’d be happy as someone who never walks further than to the car and back. I love fruits and veggies and eat a lot of them, but I have no desire to monitor everything I put in my mouth. And you know what? There’s nothing wrong with that, and it may well be a healthier attitude than “weight loss at almost any cost.”
(cynorita: Actually, rather more 300 lb+ people than most people, although not exactly a herd. I trained as a naturopathic doctor in south Germany, where there really are, say, flocks, if not herds, of fat people. Also, being medically inclined, I watch out for things that somebody with other interests might not observe. So I do things like (unobtrusively!) watch people eat in restaurants, I’d talk to patients (not just overweight ones, of course) during clinical rotations at the school, and so on. The sample size is larger than my personal aunt, which I think is the point you were making.
I think it would be great if someone did do a real, controlled observational study of eating speed and health issues, including unhealthy obesity. The problem with anecdotal evidence, even when it involves more than your immediate family, is that it can suffer too easily from selective attention.)
I guess it’s so difficult to really figure out what’s going on with food intake v. weight because keeping an accurate record of food intake is an inconvenient chore (that I’ve attempted at different times).
Speaking only about my own experience:
All the significant weight gain in my life, beginning when I was a teenager, is related to the amount/type of food I was eating at the time and my activity level. No claiming ignorance here. I quit walking a paper route and started working at Wendy’s and inhaling French fries and Frosties at age 16 – with the predictable results. Ten years after that when I get in a habit of many, many Oreos dipped in milk most days after work…I hit my highest weight ever. I am all too aware of when I am overeating for emotional reasons, stupid reasons and just plain caprice (“because I wanna!”). And the weight follows like night follows day.
There is obviously a genetic/metabolic component to how a particular person is affected by food intake, but to say the volume of food isn’t a factor simply isn’t true.
Lately I’ve decided that diets don’t work because the truth is no one likes being told what to do. Eventually the self-will takes over and we do what we want (eat, laze on the couch) to demonstrate our free will to ourselves. Or maybe I read too much Dostoyevsky in college… ;)
I don’t think I’m alone in feeling like food is a constant battle of wills that occupies way too much of my time and attention (Am I being good/slave today or bad/free today?).
I agree and disagree with this post.
On the one hand diets don’t work because science really doesn’t understand weight loss/gain. If they did, it wouldn’t be a problem.
On the other, I have PCOS which is a metabolic/endocrine disorder. It’s one of the leading causes of infertility and, while some are thin, most women with PCOS are overweight due to impaired glucose metabolism. It’s estimated that up to 90% of women with irregular cycles have PCOS which puts them at a higher risk of diabetes and heart problems.
The key to ameliorating the syndrome is to cutt down (or cut out completely) on all carbohydrates from all sources and losing weight, if it is at all metabolically possible, (fat produces hormones that are really not helpful when someone with PCOS is trying to ‘normalize’ their hormonal physiology).
Since I’ve been diagnosed and finally been able to lose weight on a doctor supervised protein fast (after 10 years of dieting and exercising with no weight loss) I notice overweight women, notice how many of them have the thinning hair, the apple shape, the acne, the irregular menstrual cycles, the skin tags, and the common complaint that they can’t lose weight and I see how pervasive PCOS is.
Unfortunately, it is still underdiagnosed and there are tens of thousands of women out there with doctors who’ve never heard of PCOS and who will never get diagnosed and who will suffer because of it. So, while I agree diets don’t work and it’s much healthier to simply be healthy and let your weight be what it is, the caveat I would add is this pertains to NORMAL HEALTHY PEOPLE WITH NO OTHER HEALTH PROBLEMS. It’s important to try to identify the cause of the weight. Is it poor diet or an underlying disorder, one that needs a little more attention than a dismissive ‘diets don’t work’?
With PCOS, long term, the carbs and the weight faulty carbohydrate metabolism packs on will kill its victims.
I do think your post ignores some of the newer information on glucose metabolism (hyperinsulinemia) and provides a rationalization for people who want to give up and just eat (and I know there are a lot of people NOT like this, but still there are many who are just looking for an excuse) when, without bloodwork, they really don’t know what their medical situation is. I also believe the frankenfoods we eat, the processed fats and starches, are a big reason for our increasing waistlines–not dieting does not remove the need for good nutrition and I fear some people will use this data to eat more junk than whole foods.
M
THis is A BIT off Topic: I had a neighbor who weighed about 600 pounds and was bedridden, and she died after ten years (of hell.) I currently have a friend who is so obese that she can JUST BARELY function physically. Sitting in a CHAIR makes her short of breath. I KNOW that “dieting” wouldn’t help (or have helped) either of them. Some people say bariatric surgery is the answer (it would at least give my alive friend some hope!). But I have also read that it is a HUGE KILLER !!! Obviously I am talking about seriously seriously obese people here; not plain obese (like me !) but bedridden and almost bedridden. What is the REAL story about Bariatric surgery? If I try to research it on the innernets, I just get a lot of people PUSHING it. Again, my concern here isn’t for two or even three hundred pound people…it is for the 400-900 pound people. WHat are they supposed to do? Is there anything they CAN do?
I want to third Elena and Natural Cynic about BMI. I’ve done lots of medical writing and was a journalist for a cardiovascular health website years ago. BMI is almost never used in serious research on CV risk of weight. It is waist to hip ratio or waist circumference (there seems to be a slight edge in using waist circumference, although it varies with ethnicity).
As mentioned, where you store fat is genetic, and largely beyond your control. But BMI breaks down so fast it is mostly useless except as a quick pass to decide if you should look more closely. It will fall out of general favour soon, I suspect, especially since a simple waist measurement tells you more and doesn’t require math.
I gained a whole heap of extra weight last year (above and beyond the ‘baby weight’ from my pregnancy) due to being mentally unwell and food was all that made me feel ‘safe’ and ‘sane’.
However since being told by the doctor at the end of September last year that there was no physical reason for me being so fat I decided to get real with myself and I joined the gym and started the long process of trying to overcome my food addiction.
I have lost 21 kilos so far. Some days I feel really pleased with myself and then I might see something on tv or in a magazine that makes me feel bad about myself and it is ‘not good enough’. That show ‘The Biggest Loser’ — for starters, I hate the title of the show. I think it is derogatory (though of course I understand the double-meaning) and watching how much weight they lose, and so FAST… it can put unrealistic expectations on someone like me who has taken 6 months to lose this much weight (less than 1 kilo a week).
I will be lucky if I get to my ‘goal weight’ in a year. I have found that the more weight I lose the less and less I have to eat in order to keep losing weight. I mean — less than 1000 calories a day and I am freakin starving. I have tried eating ‘normally’ but I put on weight.
I put this pressure on myself to lose weight. I am vain to the extent that I want to be able to fit clothes from a ‘normal’ store where they are also CHEAPER. I envy people that can look through the $10 sales racks and find stuff that actually fits them.
I want to get down to a size 14 which I was before I became pregnant and I was completely happy with that. I looked and felt sexy then. I was not skinny by any means but I felt good in my own body and I could also move the way I wanted — walk up a hill without huffing and puffing, for example. Another good thing about my exercise and weight loss is that I have not been unwell anywhere near as much as when I had a BMI of 37. I am now down to 29. I used to have to visit the GP for antibiotics etc every 3 weeks or so. This is probably largely because I have swapped from eating chocolates and cakes and bread all day to eating vegetables and lean meat, however! :)
I think everybody should do what feels best to THEM personally. I have been tempted to try and get down to a ridiculously low weight due to media pressure, but then I recognise it as such and realise what a stupid idea that would be. Being a size 14 is GREAT for me. I can wear whatever I like and I feel healthy.
I want to lose weight because I believe it is better for me physically and also because being overweight makes my depression worse which in turn makes me eat more and gain more weight. If I didn’t put a stop to it I would have ended up absolutely HUGE. So, I guess it is a trade-off. I think it’s better to feel psychologically more up-beat and lose the weight than to stay so fat.
In summary, I believe that if a person is fat, thin, somewhere inbetween, or in the process of losing weight – it is their personal choice. Just make sure you’re not doing it because of outside pressure. I think losing weight for the wrong reasons and when you are *not ready* is the worst mistake people make.
Sometimes I decide to have a while off from trying to lose weight and I stay around the same weight (usually putting on about 2 kilos) and eat pretty-much whatever I want. Then when I feel psychologically ready I start working again at losing weight. It is hard work to lose weight!!! I figure I would rather lose weight slowly than put myself through *utter hell* for 5 or 6 months like celebrities do to lose it all very fast.
Take care all!
Oh also – I agree with others about not being sucked in to spending heaps of money in order to lose weight. I actually read recently that it’s been proven people who lose weight ‘off their own bat’ are more likely to keep it off that those who join highly supervised weight loss programmes.
I tried to sign up to Jenny Craig then was hit with the HUGE bill for the food ($120 for 1 week). I couldn’t believe it! I could not afford it for more than one week! At this stage my lifestyle changes are SAVING me money. I am on an Invalid’s benefit with a husband who works at a rather low-paid job, and we have a young daughter. We NEED to save money – not waste it!
Now I pay $15 a week on the gym. Nearing the end of the year I may cancel that though (when I have reached my goal weight) and trying just exercising by walking etc and see how it goes. I am also saving a whole heap on money because 1 cake every 2 days, and 2 packets of chocolate biscuits and I king-size bar of chocolate every day does add up, financially.
Yes. I really was eating that much of that rubbish every single day. Now tell me that I should have stayed like that! :P I was on the fast-track to developing diabetes.
Z