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.)
posted by mo pie at 10:02 AM
9 Comments:
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.
:)
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 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.
Post a Comment
<< Home