Weight Loss: Maybe Not Such A Great Idea
Warning: If you are trying to lose weight, you might not want to read this article in today's New York Times. In discussing whether or not weight-loss treatment and surgery should be paid for by health insurance, a number of distressing statistics and studies are cited:
"What is not known is whether [weight loss] surgery's health benefits outweigh its risks over the long term."
"Other studies have focused on...whether overweight or obese people who voluntarily lost weight were healthier. Some studies found that they were; some found no difference; and some found that they actually died at a greater rate."
"It is true that thinner people tend to be healthier, but studies have found that, biochemically, the formerly fat are like people who are starving: obsessed with food, needing fewer calories to maintain their body weight. Many...have slow heart rates and always feel cold; women may stop menstruating, even if they are still relatively fat. Is that better or worse than remaining fat? No one knows for sure."
"Research studies at academic medical centers, providing intensive diet, exercise and behavioral therapy, result in losses of 8 to 12 percent of body weight in six months. But most people gain the weight back in a few years."
"Clearly, doctors have not yet given up on the idea that weight loss may improve health. Yet, they said, when they urge patients to lower their expectations about how much weight they can lose, some react with shock."
"Those few who succeed at weight loss may end up on what amounts to a permanent diet. People in a national registry of successful dieters...report consuming just 1,400 calories a day and walking, or doing equivalent exercise, for an hour a day."
So to sum up, it is really hard to lose more than 5 to 10 percent of your body weight. And if you lose a lot of weight, you may not be any healthier and in fact may be less healthy. In addition, you will probably gain the weight back. If you don't gain the weight back, you will be on a strict diet for the rest of your life.
Obviously this is the worst-case scenario perpetuated by insurance companies who don't want to pay for weight-loss treatment. Still, it's kind of depressing! (Stay tuned for the inevitable "this article is horseshit" posts in the comments. It will make all of us dieters feel better.)
"What is not known is whether [weight loss] surgery's health benefits outweigh its risks over the long term."
"Other studies have focused on...whether overweight or obese people who voluntarily lost weight were healthier. Some studies found that they were; some found no difference; and some found that they actually died at a greater rate."
"It is true that thinner people tend to be healthier, but studies have found that, biochemically, the formerly fat are like people who are starving: obsessed with food, needing fewer calories to maintain their body weight. Many...have slow heart rates and always feel cold; women may stop menstruating, even if they are still relatively fat. Is that better or worse than remaining fat? No one knows for sure."
"Research studies at academic medical centers, providing intensive diet, exercise and behavioral therapy, result in losses of 8 to 12 percent of body weight in six months. But most people gain the weight back in a few years."
"Clearly, doctors have not yet given up on the idea that weight loss may improve health. Yet, they said, when they urge patients to lower their expectations about how much weight they can lose, some react with shock."
"Those few who succeed at weight loss may end up on what amounts to a permanent diet. People in a national registry of successful dieters...report consuming just 1,400 calories a day and walking, or doing equivalent exercise, for an hour a day."
So to sum up, it is really hard to lose more than 5 to 10 percent of your body weight. And if you lose a lot of weight, you may not be any healthier and in fact may be less healthy. In addition, you will probably gain the weight back. If you don't gain the weight back, you will be on a strict diet for the rest of your life.
Obviously this is the worst-case scenario perpetuated by insurance companies who don't want to pay for weight-loss treatment. Still, it's kind of depressing! (Stay tuned for the inevitable "this article is horseshit" posts in the comments. It will make all of us dieters feel better.)
16 Comments:
OK, I'll bite...this article is horseshit :-)
No wonder so many fat people throw up their arms in despair...sure, losing weight is hard and keeping it off maybe even harder. But if you lose the "diet" mentality and replace it with the "lifestyle" mentality, it is not impossible! I went from 297 to 155 without surgery or starving, I do strenuous exercise about 3-4 times a week and I do not starve myself. I never did have a lot of the problems associated with obesity (heart problems, diabetes) but I did have osteoartritis in both knees. (I'm 38.) It's still there, but much, much better than before.
Whether insurance companies should pay for these surgeries..I dunno. Personally I never would have done it because I could not see mutilating my body like that, and the amount of food that someone can accomodate after surgery is sooo small. But the defeatist tone of that article really pisses me off!
From the Times article: "The problem with weight loss, researchers say, is that the advice so often given, eat less and exercise more, has not been much help."
So what do they know? And how, exactly, do they know it?
When I take in fewer calories and exercise more, then I feel better. When I eat at least five servings of fruit or veggies a day, I feel better. 1,400 calories doesn't sound like starvation to me. An hour of intentional exercise, usually in the form of walking, each day lifts my mood like nothing else. How is that hardship?
My BMI is currently over 30, and per this article, "they" are considering making bariatric surgery availible to people like me while forcing Medicare (i.e. us taxpayers) and other insurers to pay for it. I don't need bariatric surgery. I just need to continue eating whole foods and walking as much as possible.
The Times article, it seems to me, is more about money and who gets to spend it and how, than it is about people's health. Weight-loss/control has become a very big business here in the USA, right up there with junk food.
BTW, my grocery bill has really shrunk since I started eating fewer and fewer processed foods. Betcha the agriculture industry just loves that! ;)
Oh, and about the "successful" dieters who become "obsessed with food, needing fewer calories to maintain their body weight" (again, from the Times article)? Were they obsessive before? And they need fewer calories than who? If they are always cold, than has anyone checked them for thyroid function. My internist says underactive thyroids are as common as dirt. And they're cheap to treat too, assuming the patient is willing to take their meds as directed.
Oh, geez, what a rant! Will stop now.
:)
Well- seeing as how better health is just a side effect of losing weight in order to have a firmer ass and less rolls- who the hell cares what this article says? There will only be an opposing view out tomorrow anyway. Screw them all. I raise my glass of slim-fast to them and to you, my fellow dieters- whatever your motivation may be!
Well- seeing as how better health is just a side effect of losing weight in order to have a firmer ass and less rolls- who the hell cares what this article says? There will only be an opposing view out tomorrow anyway. Screw them all. I raise my glass of slim-fast to them and to you, my fellow dieters- whatever your motivation may be!
I should probably preface with the standard "I'm speaking for me and only me." I've lost forty pounds since March, weight that was put on mainly due to medication that I've since discontinued.
The article is right in some ways. All I think about is food. I'm hungry constantly. If I eat more than a thousand calories a day I WILL gain weight. (Not false weight or water weight - weight that I actually have to lose over the week.)
To lose, I need to eat 700 or less calories per day. I don't have an underactive thyroid - I just have a really crappy metabolism or something. People talk about 1400 calories like that's a diet, but it's what I was eating before.
I think it's great that people can lose on WW or Jenny Craig or what have you. But, I can't. The alleged 3500 calories in a pound seem to have no relevance to my life. So, for me, the article is true. Make of that what you will.
I too fall into the "obsessed with food" category. I started in the high 190s; now I weigh 135. My life seems to be a never-ending series of shopping, meal-planning, snack-planning, food preparation, and the always-thrilling dishwashing after the aforementioned preparation. I eat in a range of 1200-1500 calories a day and I count them. Every. Single. Day.
I spend more time and effort planning what I'm going to eat and when than I do on any other single thing in my life.
I'm not bitter and I accept that this is The Way It Has To Be if I expect to maintain the weight loss. But it's like a second job. And I *am* always cold, and it ain't my thyroid. It's just the changed body I now live in.
I found this article depressing when I read it, too. But I believe and agree with many of the things they are saying. I have lost about 80 pounds via WW, with 40 more to go. I think about food constantly (although this has waned with the Core plan). I am always cold (normal thyroid function. I've been tested). I can't eat even what WW says I can to lose weight (After the first 50 lbs., I've always had to be in the point range below the one WW recommends to lose weight).
HOWEVER--This has been worth it to me. I can walk twice as fast as I used to. I can dress in clothing from "normal people" stores. I feel much better about myself. My sex life is better.
OTOH--do I want to pay for surgery for other folks when there are no scientifically proven health benefits for the surgery? Should taxpayers pay for people to wear smaller clothes, feel better about themselves, and have a more satisfying sex life? Personally, if I pay for this surgery with my tax dollars, I expect that I will see a return in not having to pay for this person's knee surgery, high bloodpressure, or diabetes. If this is not the case, then I say no WLS on MY dime.
I am having weight-loss surgery soon. While going through the preparations, one of the doctors said this to me:
"When a person who is very overweight loses weight, they don't actually LOSE fat cells. It is impossible to lose fat cells. You can create them by overeating, but when you lose weight you merely shrink them. The reason it's so hard to keep weight off is that these shrunken cells are crying out, every day, to be filled again. This is why you have to be very, very careful after losing weight, because the thing those cells want most is to be full again."
This article (excerpt, I didn't read the whole thing) reminds me of an interesting book I read this summer. Fat: Fighting the Obesity Epidemic. It was pretty clinical but very accessible and basically said we don't know very much about weight loss. Everytime we think we have it figured out, it turns out we're not quite right. He cited the same research, where "long term losers" or those who have kept significant weight off for a long time have symptoms resembling those of famine victims. He also talked about how hard it is, biologically, to change your weight significantly. Although I certainly found parts of this depressing, the research was pretty interesting, and I found it somewhat comforting in an odd way that this is all such a mystery. It didn't stop me from trying my best and succeeding with WW. If anything, it reminded me that my encouragment and validation have to come from my own successes and not from every scrap of diet-related writing I can find. Doesn't stop me from reading it all, of course!
Karen
As someone who has lost 64+ pounds over a three year period, I have to say that the points brought up in that article don't apply to me. I'm not obsessed with food (although I DO enjoy it:)), nor am I cold all of the time. I walk just about evrywhere and have plenty of energy. Also weight loss has helped me emotionally and mentally as well as physically. I guess between the article itself and the varying comments it just goes to show that every single body is different.
To toss my experience into the mix: I've lost 35 pounds over the course of a year. I've gone from a size 16 to a size 6. And it feels damned good. Do I obsess about food? I did for a while, when I was still getting used to the Weight Watchers Flex plan. But I have all the points memorized, and I'm so close to goal that I've started pseudo-maintenance (meaning I eat more anyways, as long as I'm still losing). For a while I did feel like I was in a concentration camp. And I obsessively exercised. And I felt guilty for eating cheesecake or brownies or whatnot. I've gotten past that.
Do I think I can maintain this weight loss? Yes and no. My personal goal is actually about 5 pounds heavier than the weight watchers ideal. I've started getting comments from people that I look too skinny. And I want to do more weight training and develop stronger (and presumably larger) muscles. I'm OK with gaining 5-10 pounds back as long as I am still healthy and it's maintainable. Going back to a size 16? Maybe when I'm pregnant, but otherwise, Not on my watch! I recently finished reading "Thin For Life", and most of the people in that book had gained some back, returning to a maintainable weight.
I think there's a big difference between losing weight for other people (because Mom/Dad/husband/friend/doctor thinks you should lose weight) and losing it for yourself. Motivation has to come form inside, not only to lose the weight initially, but to maintain it. I think many times lost weight is gained back because that internal motivation is lacking. All of the inspirational stories online (skinny daily, losing the cow, etc.) are from poeple who have made that personal commitment.
And all those empty fat cells crying out to be filled: someone somewhere said that they do die off eventually (apopsis), you just have to hold them at bay long enough. I don't know if that's fact or happy fantasy, but if fantasy it's one I want to live in!
As far as I'm aware the "starving fat cells that never die" theory has been roundly disproven, but I don't have time to dig up references to the relevant studies at the moment.
The element of truth in the theory is that there does appear to be some sort of "set-point" system that is not well understood. People's set-points change over their lives, though, so even that shouldn't engender hopelessness.
On the other side of the coin and anecdotally, my baby sister and I basically have the same metabolism and endocrine system. She chose thin at all costs when she was about 8, while I chose to focus on strength and health some time in my teens. After about 20 yrs, she weighs 125lbs, but has osteoporosis and several other metabolic issues that are common in anorexics and victims of chronic starvation. And, unfortunately she just had a baby who has neurologic problems related to malnutrition in utero. I have knee and hip problems and am around 250 lbs, but am otherwise healthy, with normal blood pressure, cholesterol, and lipid numbers, and my son is the picture of health.
I'm happy with my choice, although I hate being twice the woman, weight-wise that my sister is. And I am slowly bringing the numbers down. But there is still room for the occasional bowl of ice cream in my diet, and I make sure to get a balanced and sufficient diet.
The key, for me, to weight loss is about an hour a day of peak cardio exercise, and 30 minutes of strength training. It burns calories and builds aerobic capacity and muscle mass, and makes me feel good about myself besides. But there's not really time in my schedule for that much exercise in a day right now, as a single mother of a 4 yr old. So I do what I can and try not to beat myself up over it.
I'll never be 125lbs, but really I wouldn't want to. I am strong and healthy and comfortable at 200, and feel like a million bucks at 170. I've lost 35lbs in the past 6 months, so I think I've decisively turned my system around, at least for now.
I hope I can get it down to the 170-200lb range, but being healthy and happy is more important than obesessing over the exact caloric content of my morning oatmeal. I try not to eat much grain, and to eat plenty of protein and vegetables. I cook pretty much all of my food, so I know exactly what goes into it. I exercise when I can, as much as I can. And that's enough.
First of all, I love you Mo. There, I've said it -- because I needed it to be said. Now that that's out of the way, I can respond to this article which inspires in me mixed feelings.
I've lost 66 pounds since March, going from 284 to 218 at the time of this writing. Obviously, the road stretches before me, but I have no doubt that I'll achieve my goals whether my rate of loss slows or not. (It undoubtedly will, and that's ok.) I've done it by overhauling my nutrition responsibly and exercising purposefully -- not exactly novel, and wholly effective. I thank God that I didn't read this article before setting out on this journey. I've already disproven a couple of assertions made: I've lost over 23% of my body weight and from elevated levels, I've made lower than normal my cholesterol and LDL, blood sugar, and blood pressure levels. My doc says my risk of heart disease is "lower than normal."
I don't care if I have to wear a sweater, and I don't see maintaining exercise and my current eating habits as a punishment or a bad thing going forward. I wouldn't want to live any other way and do not suffer hardship; I still enjoy "treats" occasionally. How irresponsible to question the efficacy of attempts to lose weight and keep it off. It may not be easy, but it sure as hell beats the alternative.
I've lost about 65 pounds, and am gently working on the last 15. No big deal though.
You know what? I eat pretty much what I want, although I do think, briefly, about what I'm eating. I read nutrition information on products that I'm not familiar with to get an idea of how much energy they contain (multiplying up to get a per-box number). If I want ice cream, or pizza, I eat it. I just don't want it as much as I used to. Turns out, I didn't want it as much as I used to eat it after all, it had just become habitual. For a while I missed the habit, but that's different than craving the foods. And I don't feel that I deny myself anything.
For me, the key is exercise. I run - quite a lot. I realize that an active lifestyle makes me feel better. As a side-effect, it lets me (and forces me to) eat pretty much what I want, as long as I keep it reasonable.
Slow heart rates? Go and talk to any athelete, a slower heart rate is a sign of better cardio-vascular health (your heart's a muscle too, and it gets more efficient with exercise - and works easier if its not pumping blood through twice the body too). Feeling cold? Ya know, I enjoy wearing sweaters. I used to perspire at anything approaching 80 degrees. Now I'm comfortable being outside at close to 100, and I get to enjoy wearing good fall and winter clothing, in season. Those aren't danger signs, they're part of being healthy.
By the way, "Thinner people tend to be healthier"? Pshaw. Healthier people tend to be thinner. Don't confuse correlation with causality.
first of all the stories I read here tell me only what most dieters feel when they lose weight (been there myself) same stories, I lost this amount of weight, I feel great, can walk and do this or that what I couldn't do before, I work out to get muscles, my sex life is better, clothes fit etc.
this story is told over and over by millions of people, yet these same stories don't tell of the long term results or the extreme suffering of maintaining the weight loss over time. or the failure rate, or the fact that weight loss efforts through caloiric restriction (1500 caloires is restriction, so is 2000 if your body requires 2100 calorie just to be healthy)has serious side effects that most are not aware of.
the american medical association, says that 33 to 50 percent of americans are dieting at any time each year, most are women, many will start a new diet again because of weight regain, and will do so before all weight is regained.
what we have here is no different than starvation, albeit there is some food but the results are the same chronic starvation to lose then maintain. no one talks about the research that has shown, and I experienced this myself, that shows that restricting caloires below actual needs to force weight loss gives you weight loss alright, but the wrong kind, for every 10 pounds lost 7 pounds of that is muscles, during the first weeks.
exercise has been shown not to preserve muscles, I know several people that have recently lost alot of weight, another has managed to keep her 40 pounds off for a while about 15 years, but not without a constant struggle, complaints of gaining some then having to work it off again, and not without serious health consequences, and they exercise yet when I look at them in shorts or bathing suits they are all flab and very fatty.
they complain of being tired all the time, having no strength despite a vigorus exericise regimen, heck they exercise more than me, they complain of being cold, are dependant on caffeine to get through their day.
they lift weights, use exercise machines do aerobics several hours a week and then some. their lifestyle choice sounds like starvation to me. same symptoms as those in concentration camps.
I did the weight watchers, thing once, but most of the time I Just cut portions and I didn't even count caloires just filled up my plate with about half of what I usually would do.
did it get me healthy, thin, and full of life and energy without having to be on constant guard against my body's constant crying for food?
NO!! all it did was burn up my muscles (I jogged 12-14 miles a week, hike trails and walked non running days) long before doing weight watchers, when I was a runner I never counted restricted or worried about my food. I ate when hungry and didn't when I wasn't. it wasn't rocket science.
but once I did WW and lost 60 pounds I noticed that my strength started to give way, constant hunger after a while started to haunt me day and night, I couldn't run as vigorous or far as I used to with no sweat before.
this was 18 years ago, I never dieted again, after that, but I was still over fat, didn't like it then don't now but I did find a better way if anyone is interested and is based on biology not on work ethics or moral character training. I don't like it not because of the stigma, I am over that now, I am in it so I can be a runner again because I love to run always did, which I have started up again, plus other areobic activities, but I have no desire or need to lose enough to be in the so called healthy bmi or weight charts, they are a bunch of balony, just enough to reach my running distance and speed goals, , they are only there to keep people pursuing those impossible numbers all for the sake of money for the dieting industry, and drug companies.
weight loss the traditional way is not the cure. in fact overfatness is not a disease, the real disease or epidemic is the weight watching epidmic this country and many others are in the grip of. tho I agree if a person wants to lose weight there has to be a caloiric deficit to cause the body to use the fat up, the problem is you cannot force it through exercising it off or eating less.
you have to let the body do that, let the body decide when to reduce caloires in and make up the difference with stored fat. it can do that without all the side effects of semistarvation, sparing the muscles, without slowing metabolism etc. also since the body does it without our interference then the battle with the body never begins. but you have to show it through proper feeding that it is safe to release the extra storage tanks and this takes time, years for some to reach their natural weight.
it is called the antidiet, that is why i picked that user name, because that is my diet. I am on the naturally thin diet, antidiet is the nick name of the natural thin principles it is difficult to explain but I can if you are intersted.
I lost 20 pounds so far more than 3 sizes,
I like this illustration, if you drive from point a to point b and you fill up before going and there are no gas stations between the points and you run out of gas all teh time between there and you can't get another car what would you do?
wouldnt you add another fuel tank or take extra with you in the trunk? this extra fuel source can keep you going until you get to point b for a fill up, but more than that you will also need to fill up the extra tank cause you have to go back to point a again.
what if a station was put up between a and b, then what would you do? wouldn't you get rid of the extra weight the storage tank? why? You now longer need it anymore. you are able to keep the main tank full all the time.
our bodies work on the same principle, keep the main tank empty all the time or with very limited fuel and force extra tanks to be employed the body will want to keep the storage tanks refilled to keep you fueled while the main tank keeps running out before the need of the body runs out. it will also want to reduce the fuel need of the body too, thus burning up muscles,which are metabolism boosting, slowing of the metabolism and an increased lack of desire to exercise over time.
then as starvation proceeds, there is the fatigue, being cold, the body crying for food and lots and lots of it, there is an increase in having to force yourself to exercise, then there is needing alot more sleep then usual, then if the body can override the willpower some how, then there is the binging where your body cries out for fatty foods which can be used to fill up the fat stores quicker than lower fat foods and wham teh battle has taken on a increased urgency, for the dieter, but for a few the oppisite happens with regard to hunger, it starts to shut down, because the body has realized that you aren't going ot eat, then eventually if you don't eat above dieting and maintance level there is death (anroeixics and bulemics come to mind?)
any of this sound familiar? well it is played out by millions every year, I see it all around me, my friends neighbors relatives. for those whose bodies have a stronger survival instinct they cannot tolerate this underfed hunger anymore and the surges of obesity chemcials and thus the binge or feasting stage of the famine feast cycle and the battle is finally lost, well to the dieter it is lost but to the body it is a victory, a victory over a starvation death.
RR
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