Waiting until someone who is obese (not just overweight), and in particular has the central obesity pattern most strongly associated with a wide variety of adverse health outcomes, has those adverse health outcomes, to begin lifestyle interventions that substantially lower those risks is foolish. Advising someone at great risk of developing (if not already having) those health problems to not bother with exercise is worse than woo.
As far as whether or not the op’s mother has central obesity or a tumor or ascites or some other relatively rare condition … well all have agreed she should see a doctor, for a variety of reasons, but in medicine there is an oft-repeated aphorism: “When you hear hoofbeats think horses not zebras.” Uh, yes, ascites and ovarian tumors are pretty uncommon compared to central obesity.
At the risk of being accused of regurgitating a google search allow me to share some actual studies regarding the importance of exercise for treating central obesity and the increased health risks associated with it in particular.
Moderate exercise with no dietary intervention causes a preferential loss of visceral fateven in non-obese women. The balance of studies confirm this preferential loss of visceral fat with exercise in the obese and even the few that have found otherwise note improved metabolic parameters by adding exercise (that study with a controlled very low calorie liquid diet, adding extra calories to the diet plus diet exercise group to make up for the calories expended by exercise and with a higher drop out rate among those in the diet only group.)
If a post-menopausal woman has central obesity and already has developed Type 2 diabetes then it seems to be nearly impossible to lose significant amounts of visceral adipose tissue (VAT), the portion of abdominal fat that is considered the most harmful, without exercise.
The exercise required to gain those benefits, that loss of visceral adipose tissue and significantly improved metabolic markers? Merely “a supervised walking program three times per week for 50 min” The conclusion that moderate exercise has substantial benefits on abdominal fat (and more importantly the health risks that the abdominal fat represents) is not highly optimistic: it is highly well documented.
You can stand by your assertion all you like but the op did not ask about “weight loss”; the op asked about treatment of abdominal obesity. The answer to that question, whether or not it applies to the op’s mother (and as middle-aged woman in Saudi Arabia it fairly likely does), is straightforward: diet and exercise along with screening and treatment of the problems that run with the condition. What diet? Room for debate. That study with the diabetic obese women used a high monunsaturated fat diet. The DASH diets are excellent. For some low-carbing works well. Some do well with what is marketed as “Paleo” (it’s actual resemblence to the macronutrient balance of ancestral humans being another debate.) Some do well with vegan diets. Lots of options and room to discuss what can work for her in her context. Clearly a diet almost exclusively consisting of yogurt and bread is not it. And exercise is critical, whether one loses weight by doing it or not.
But no that is not the only thing that can explain the obesity epidemic. The fact that we, on average, eat many more calories than we used to and move around a lot less just might also have something to do with it. The fact that we are surrounded by hyper-rewarding food stimuli, designed to be highly rewarding but not very satiating (and thus to sell more of it) also just might be a factor. The fact that the industrial trans-fats that we are exposed to cause inflammation and dysfunction in the brain’s food related reward centers possibly even with prenatal exposure onset (the prenatal bit being demonstrated so far in animal studies) may also play a role.
I have no problem with low carb; those who witness for it like born-agains, unwilling to accept that what works for them might not be the best choice for everyone else on the planet, do however annoy the hell out of me.
This article summarizes various diet plans advised for treating metabolic syndrome (with specific attention to the issue of non-alcoholic fatty liver disease - NAFLD) *Lots *of detail there but there bottom-line remains:
If you actually bother to read the article, and its review of a wide variety of approaches, you will understand the context is that a wide variety of approaches all seem to have specific pluses and minuses that may be more salient to any particular individual and the individual circumstance. There is not enough quality information to state that one is superior to another. For metabolic syndrome, and especially in the context of already having NAFLD but also in the context of someone at high statistical risk of developing NAFLD and/or diabetes and hypertension, as demonstrated by already having central obesity, any of the various nutrition plans that includes those features (and many choices do, including many versions of low carb and “paleo” and including some vegan diet plans along with many point in-between too) are highly likely to be effective in improving their health. Which one is the right one for any particular person? Not necessarily the choice that works best for me or for you.
By the way, ever see a skinny walrus? Eats a diet almost completely animal-based and universally FAT. Yes it is a silly point as is your bit about lions.
Likewise those (like doctors that Mrs Cad has gone to) that refuse to believe the empirical evidence that maybe, possibly, perhaps there is someone outside the box and maybe weight loss for them isn’t as simple as “Take the fucking fork out of your mouth!” and insist that the person doesn’t know how to measure food with a scale, count calories and exercise aerobically.
Incidently, I’ve been reading some research that seems to imply that those that have high insulin levels may benefit more from strength training than aerobic training. Aerobic training apparently lowers the amount of insulin your body puts out in response to glucose (the whole insulin resistance/sensitivity). Strength training does that and also lowers your fasting insulin. If general insulin levels are positivly related to weight gain as some researchers think it is, then already this research would imply that there is more than calories-in vs. calories-out in regards to weight control.
… but try to convince a doctor to check fasting insulin levels. The solution is “Take the fucking fork out of your mouth!”
These boards of course keep having those “debates” … and of course it both is extremely complex and very simple. Simple in that sure if one takes in less than one expends one loses weight. Complex in that both are dynamic processes under active and often not conscious control (bodies react to caloric restriction by changing drives and metabolism and activity) - that many factors play roles that we barely are beginning to understand (including the microbiome and brain center inflammation and a host of other factors) - that losing weight is not the same as losing fat and that not all fat is even the same (the issue of this thread) …
But then again simple in that at the end of the day commonsense prevails: any of a wide variety of nutrition plans coupled with regular exercise will result in better health almost always and usually at least some modest weight loss in the bargain.
Saint Cad honestly there are plenty enough of reasons to include strength training for most people that I cannot see how checking an insulin level is required. The biggest factor though in what exercise to do is determining what exercise a person will do and will keep up with. If that is exclusively slow runs, fine. If that is exclusively weight training, that also works. HIIT only? Also great. Maybe some specific combination of different sorts is most ideal, maybe some specific combination is somewhat more effective for some with certain features than others. Some good arguments are made for various different approaches … but the differences between the sorts and combinations of them are minor compared to the difference between inactivity and any of the sorts/combination of activity.
My point on the insulin was that if you think your insulin level is high which is why you are having trouble losing weight it doesn’t matter because for doctors it’s all about taking in fewer calories with no thought that there may be a hormonal interplay at work. Mrs. Cad has now been prescribed 4 different drugs for obesity. Guess what they all have been - appetite suppressents. She cancelled her last appointment because for $200 she gets weighed, told by the doctor that the medication is not working and gets a new suppressent prescribed.
Of course there is hormonal interplay at work. Fat tissue is an endocrine organ and obesity therefore induces all sorts of hormonal reactions. The issue is if the test will lead to different actions.
Assume the test is performed and her baseline insulin level is high, perhaps she even has poor glucose tolerance. And? It is impossible to say whether that is cause or effect or both in some interplay effecting each other. More importantly what is it going to suggest she, with the help of her healthcare providers, do differently?
Of course if she is out and out diabetic that needs to be treated but she is still left with:
Finding a healthy nutrition plan that works for her. That is more than “Take the fucking fork out of your mouth.” And it is more than accepting that there is only one approach that can work for all people. Sure, there is some suggestion that a low-glycemic load diet (40% carbohydrate, 30% protein, 30% fat, 15 g fiber/1,000 kcal, mean estimated daily glycemic index of 53, and glycemic load of 45 g/1,000 kcals at 30% calorie restriction compared with baseline individual energy needs) may be more effective in the context of high insulin secretion than when insulin secretion is not high. But there is no reason not to discuss trying that diet without knowing insulin levels.
Exercise. Preferably including some periods of higher intensity and including some resistance exercise. Sure such makes even more sense in the context of knowing, rather than presuming, high insulin levels, for many reasons, but it is something that she should be doing in any case.
Support. That is more than you can provide alone. Serious support systems with groups.
Realistic expectations. Those three will likely result in modest fat loss and significantly lowered risk of health problems. Many set them up for failure by expecting more than that and then go back to old habits.
And if obese enough and/or also with comorbidities, and not making any progress with those options, considering bariatric surgery.
Until we have enough information to be able to advise with confidence one nutrition/exercise plan over another based on the lab result, or some other intervention based on the lab result, doing the test seems at best an intellectual exercise.
Amphetamines, which is what I assume you mean by ‘appetite suppressant’, don’t work for everyone. However there are other medications and especially combination meds that may be more effective. For example, the combination of phentermine (a mild amphetamine) and topiramate (an anti-epileptic) has been approved as the drug Qsymia (formerly Qnexa).