Diets and Obesity

In My Humble Opinion
1

I’ve been reading an interesting book on the scientific basis of dieting and obesity, Secrets From The Eating Lab. It makes a number of arguments and supports them, but I have not read the studies it cites. These include:

  1. The consensus for what it means “for a diet to work” is very loose. If dieters select their “goal of weight loss”, “acceptable weight loss” and “amount of weight loss that would make them disappointed”, most fail to reach the “disappointed” goal. (About 10%, 25%, 20% and 45% per respective category). This is because losing weight is very hard and rarely a matter of willpower.

  2. Many people, not just women, diet. There are many types. None work well in the long term. Dieting studies bias for more motivated people who can stick to a short trial diet before a study, have high drop out rates and often rely on more inaccurate patient self-reporting.

  3. Some scientists used to consider 40 lbs of weight loss in the 1950s successful (though 95% did not achieve this). Then 20 lbs, 10% of body weight and now 5% of body weight. Many people want to lose more than this. One study suggested few dieters would be happy with 5%.

  4. Dieting itself is a stress. Very few people keep weight off in the long term. If you have amazing willpower and refrain from eating omnipresent deliciousness 99% of the time, you will still eat the omnipresent deliciousness 1% of the time, this have still eaten it (so it does not make much difference). Bodies are not naturally built to ignore food.

  5. Studies of twins raised by different families (must be more common than it seems) suggest 70% of weight has a genetic basis.

  6. Studies showing people trying to gain weight on purpose shows this is also much harder than you might think. Your body seeks to keep in a certain range and frustrates efforts at both weight loss and weight gain.

  7. Mild to moderate obesity is not by itself unhealthy in people who eat a good diet including adequate fibre, fruits and vegetables; exercise regularly, avoid weight cycling and get good medical care. Many obese people are unhappy with their medical care. Exercise is really important for health. So are socioeconomic factors.

  8. Weight loss businesses really do not want to show their long term success rates, which they think are discouraging.

  9. Mortality studies shows having a BMI between 25-30 or 30-35 have surprisingly small effects. It is hard to randomize weight to do controlled trials.

  10. You can make people eat vegetables if they are the only option out on the table, say before a meal or on school cafeteria tables.

So based on this, some ridiculously prying questions. Answer if so inclined.

A. How many times have you gone on a diet? What worked for longest, or for good?

B. Have you felt your weight led to lower quality medical care?

C. For you, what pound or percent weight loss would be a success, if any?

D. How often do you think about weight or dieting?

E. Do you believe obesity is unhealthy if diet, exercise and medical care are decent?

2

Not that you don’t make some good points, but I’m not sure this is one of them. A large percentage of people worldwide, including very many people in wealthy countries who are surrounded by omnipresent deliciousness all the time, are non-overweight and remain so for their entire lives.

If overeating (i.e., eating enough excess calories to increase body fat to a level generally considered “overweight” by medical standards) is essentially unavoidable in food-abundant cultures because “bodies are not naturally built to ignore food”, then how are all those people managing not to chronically overeat?

(My own guess is that it has a lot to do with how much of the omnipresent deliciousness people eat, rather than whether they simply have the “willpower” to “refrain” from it entirely.)

3

How does the author of this book explain why obesity rates in developed countries vary so much by region, socioeconomic status, and historical time period? The first two factors would seem to have minimal correlation with genetics, and the third one clearly has none; people today are not genetically different from people in the 1960s, but obesity rates are currently much higher. To me, this suggests that culture, lifestyle, and diet (though not necessarily dieting) have a significant impact.

4

This. I’ve found that if I disallow a particular food, say chocolate cake, I tend to crave it, but if I reduce access to a particular food (e.g. don’t keep the chocolate cake in my house), but allow myself a piece occasionally as a treat, I can have my cake and eat it too.

Knowing that excessive amounts of chocolate cake are bad for me, but that I can have a piece now and then and it won’t really hurt me, removes the craving that comes from total restriction.

I’ve learned that for me dieting alone never works. I can drop 20 lbs. by strict dieting, but as soon as I stop I gain it back. In order to keep off the weight, I have to burn more calories than I consume. So dieting gets me to a good weight, but exercising keeps me where I want to be without having to be on a diet all the time, which is impossible. YMMV.

5

A. I don’t know, but I’ve either been dieting—or at least watching my caloric intake and my weight together—most regularly for the past 10 years. I have maintained my BMI at 21 to 22 throughout that time. Prior to this 10-year period of maintenance, my BMI had gradually creeped up to 26. Which I considered too high (and I felt chunky). One of the few positive side effects of my near breakdown 10 years ago was it got my weight down without trying (I was actually down to a BMI of 19 to 20 a mere 6 months after achieving my peak BMI before I made a conscious decision to rebound).

B. It’s never come up.

C. I’m good where I’m at.

D. All the time. It’s a constant battle. I watch my weight in addition to tracking calories to let me know how hard I need to fight against temptation. As I said: I have maintained my BMI at 21 to 22. That’s not an approximation, it’s a range that gives me ten pounds to play with.

E. I don’t think my opinion matters much on this. Seems like more of a factual question.

6

But also their genetics. This affects satiety.

Despite the points made in the book, it is clear people who put up barriers to omnipresent deliciousness eat less crap. This includes bringing lunches, scheduling stuff so you stay in the office, not buying foods you cannot resist, keeping stuff wrapped up and in a fridge rather than a bowl easily reachable, and a million other physical and psychological barriers. People are lazier than you think.

7

I am not the author. Certainly culture and lifestyle are important.

The author might quote studies comparing the weight of over 500 adopted children to both their biological and adopted parents. It correlates largely to biology and not at all to adoption. This suggests genetics.

The author says people who are starving or on severe diets literally think of food all the time. Availability of both healthy and junk food varies by country and over time. Some junk foods are highly engineered to make you crave them.

A study of 45000 nurses suggests 80% dieted in the last four years and 25% lost more than 10 pounds three times it more (weight cycling). Is this worse than not dieting?

AFAIK the book does not explicitly address different countries or eras. I do not know if or if not much quality data exists on this. Not everyone is equally tempted by specific foods.

The author does address socioeconomic concerns at length, and lower SES means lower health across the board. It suggests availability of nutritious food, time affording healthy food
, time available for exercise, having a safe place to exercise, education in diet and exercise, having a dangerous job, living in a dangerous place, exposure to toxins may also be partially responsible for differences.

People not different genetically over a few years may have differences in their epigenomes affecting the DNA.

8

No, I think fat people who get enough exercise and eat a balanced diet are healthy people, and attitudes towards them are hostile, dismissive, and condescending. A lot of skinny people are unhealthy. A lot of dieters are unhealthy. Things are a lot more complicated than “skinny is healthy, fat is unhealthy”.

9

Sure, I definitely think people’s basic body types are largely determined by genetics. And of course the weight of children is unlikely to correlate to adoption status: it’s not like parents are feeding their biological children differently from their adoptive children, at least not in this post-Dickensian modern world. (I hope.)

But that leaves a lot of other more general family lifestyle/cultural/socioeconomic factors to influence outcomes, as you note. We certainly can’t conclude that because weight correlates strongly to genetics and not at all to adoption status, therefore genetics are the only important factor.

10

No. The studies suggest about 70%. And not all adoptive families eat the same way. Certainly other factors are involved.

The book makes other interesting points,

  1. Posting nutritional guides in restaurants made very little difference to how people eat, even if they say they read them.

  2. Calling the same soup or cookies fancier names, Creamy Homestyle Chicken Soup or Grandma’s Zucchini Delights, made people think they had more calories and were more filling and satisfying.

  3. How a food was explained to people (many calories versus few) affected their levels of hunger-inducing gherelin hormone, even though both foods were actually the same, an intermediate level of calories. So how you think about food affects your appetite.

  4. Thus, it is easier to reject generic foods (“a type of donut”) than a more specific thought (“a chocolate donut with delicious honey glaze”).

  5. People eat more if distracted.

11

As is often the case - it depends.

Morbid obesity is unhealthy even if diet, exercise, and medical care are decent. It is much less unhealthy if those are in place however, and most of the time if those things are in place the person will be less morbidly obese.

Someone of less severe obesity who is currently making healthy nutritional choices and is exercising (and has good medical care) who has lost no weight is at greater risk than a person of the same level of obesity, and same sorts of nutritional choices/exercise/medical care, who had been more obese but who has lost 10% of their body mass by making lasting changes.

When my pants get tight. Not dieting but I start to focus more on higher quality foods and exercise more consistently.

12

FTR, I’ll be 55 in September. I’m 5’ 6".

I was really fat and out-of-shape 25 years ago, and I didn’t like it. So I decided to go on a diet, and I got down to 150 pounds. I never went off the diet – I’m still on it. Since then I’ve been between 145 and 155 pounds. Right now I’m at 151 pounds. Not to humble brag, but blood work and BP are normal, and I’m not on any meds. I also run three to four days a week.

There are a number of things I simply don’t eat. At all. These include red meat, fried/breaded food, processed meats, processed food, butter, cheese, bread, ice cream, mayo, sour cream, salad dressing, cake, donuts, deserts, snack food, French fries, and potato chips.

For breakfast I eat high-fiber cereal with skim milk. For lunch I eat an apple and yogurt. For dinner I usually eat a “salad” that contains steamed broccoli, fresh spinach, and either a can of tuna in water or can of sardines in hot sauce. I will sometimes eat whole wheat pasta along with some 0 calorie chili sauce.

It’s a style of eating most people would find revolting. And I get rude and unsolicited comments from people on my eating choices. But it’s kept my weight in check, and I’m sticking with it. I recently decided I want to be down to 145 pounds, so I’ve been eating a little less and exercising a little more.

13

Here’s the basics of where I’m coming from. I’m 44 y/o, 5’ 4" and weigh 230 pounds. I’ve not always been obese. When I graduated high school I weighed 120 pounds. Over the next 5 or so years after that, I went up to 180 pounds, and then a slower climb to 230. I had one “successful” diet that started when I was around 210 pounds, losing 60 pounds over a period of about 6 months, then slowly regaining it.

A. I typically start diets on Monday mornings, and they usually last a few days. It’s always a keto / paleo / whatever you want to call it diet. This consists of healthy meats including fish, but nothing heavily processed like sausage or chorizo. Healthy vegetables, meaning no starchy foods like potatoes, rice, and corn. Low carb fruits like blueberries, blackberries, and raspberries. Healthy fats like olive oil, avocados, coconuts, and true nuts. And of course to simple sugars.

B. Not directly, but my obesity has led to me being less healthy than I should be*, and thus requiring an overall increased amount of medical care. This increased amount of medical care will naturally lead to some episodes where the care was less than optimal, but none that I would attribute specifically to my obesity.

C. It’s a continuum, but Ideally I’d like to reach 150 pounds, with that consisting of having lost enough fat to have reached about 130 pounds plus gaining about an extra 20 pounds of muscle.

D. Almost daily for the last 15 to 20 years or so.

E. Yes, obesity is unhealthy, although I also believe there is room to redefine exactly who qualifies as overweight and obese. I think it’s certainly possible for a 5’4" man to weigh 150 pounds and not be suffering adverse health outcomes due to being at that weight even though technically that qualifies as overweight. That being said, IMHO it’s not possible to be obese (assuming one isn’t highly muscled) if diet, exercise, and medical care are decent, unless one was already obese as a result of unhealthy diet and is on one’s way down to a healthy weight.

*. FWIW my adverse clinical outcomes are numerous. I have an inflammatory disease of my eyelids that leads to dry eyes, which ended up leading to a perforated R cornea and two subsequent transplants. That kicked off when I started gaining weight at age 18. I have hepatic steatosis. I have had several episodes of kidney stones requiring removal and ureteral stents, 6 episodes IIRC, all occurring when my eating is particularly unhealthy. And of course the general increased fatigue and aching joints with no specific diagnosis which all improve during episodes in which I am eating better.

14

When I was younger I would do fad things, like the all-protein diet in my 20’s where I lost 20 pounds in a month (over the holidays no less), and in my 30’s I lost maybe 40 pounds by extremely strict low-calorie dieting combined with a lot of aerobic exercise. In both those cases I was able to keep the weight off for quite a while afterwards because I was very motivated to be thin.

The most significant dieting experience happened when I was about 56 years old. I had gotten morbidly obese at 335 pounds for a height of about 6’1". I enrolled in a doctor-supervised liquid protein “fast” of 600-700 calories a day where I lost 150 pounds in 9 months, an average of about 4.5 pounds a week. Losing weight that fast is self-motivating, and it turned out that after the first couple of weeks the hunger was manageable as my body got used to it. The diet was combined with increasing amounts of mostly aerobic exercise.

Then came the hard part – maintenance. They had a maintenance program, where you wrote down everything you ate, you came to weekly meetings and weighed in, and the meetings consisted of nutritional education and psychologically understanding your motives to eat, including the things your poor deprived fat cells will do to you to make you eat garbage and fatten those cells again. I managed to keep the weight down, not completely off, until I retired 9 years later. Then balloon time.

The one habit that I came to completely loathe was writing down what I ate, and when I stopped doing that I was pretty much doomed to gain the weight back. Mindful eating is really the only way to keep weight off (along with continuing exercise).

15

I don’t write down everything I eat, but rather the calorie content of everything I eat. One thing I will acknowledge is my “diet” (in the more general sense of what is consumed) is probably deficient in many important vitamins and minerals (you won’t ever catch me eating a vegetable, and I almost have to force myself to eat fruit). Anyway, I loathe the idea of weight-loss diets that try to fool people into thinking that there is some magical difference in calories from one type of food from another. There may be health differences from one over another, and it may be easier to turn away from eating a fridge full of vegetables than a freezer full of ice cream, but I am deeply skeptical of fad diets that focus on a particular type of food (whether it be eliminated or consumed as an alternative to others).

16

A. Once, it lasted 2 years and I halved my body weight. It was over a decade ago and I regained none of it.

My mother was constantly on diets, she made weight control look awful. It certainly turned her in to a raving bitch. I saw school and later, work, friends intermittently starve themselves only to regain, that looked awful too. I just kept eating doughnuts and chocolate.

Then I went to work in an organisation where nobody was fat but also nobody was miserable. I saw them split cupcakes and cycle to work and drink and dance and they were not obsessed or even worried about it. I realised it was possible to control weight without the pain. I started tracking calories in and out and banned nothing. If I ate pizza I didn’t punish myself by starving myself the next day, I just got on with it and dropped 70plus kilos. I had a little chocolate or ice cream every day. I did not eat “lite” foods as I found them unsatisfying though I did swear off sugared soft drinks. I also discovered weight training, it made my head happy and muscle eats calories all day long so I was actually eating more than before the lifestyle change. Willpower was not required, just an understanding of the science. I didn’t notice the difference between a tablespoon of peanut butter and three when eating a sandwich but my weight did. I also bought bread with smaller slices etc. and snack size stuff instead of large packs I’d eat in one sitting.

A decade on I’m trying to gain a little back after an illness last year left me a little underweight.

B. Absolutely, doctors treated me like something they’d stepped in when I was obese.

C. I only planned to get under 100kg but didn’t find it hard so kept going. I believe not having a history of yo yo dieting made it easier, my metabolism was in good shape.

D. Never really though I stand on the scales regularly in the hope I’ve gained a little. That’s pretty new though.

E. Unhealthy no and if I had moved more I wouldn’t have had the joint issues I did. Exercise is more important than kilos.

I know it isn’t possible for everyone, I had got myself out of the situation where I needed to anaesthetise with food and I had the education to apply to food science. Eating half a pizza instead of a full one really isn’t much of a hardship. Adopting the mindset that food in the bin is less of a waste than it winding up in the toilet after leaving an oil slick on your thighs helped a lot. I didn’t radically change what I ate, just the amounts of the high calorie stuff. If I only allowed myself salad or something there would be no way I would have stuck to it. I just never upsize.

17

Well, you can eat the fridge full of vegetables and be full all day (and probably very regular) or you can eat a tub of ice cream and be hungry again in an hour or two. So one of the health differences is that it is just a lot harder to consume the same number of vegetable calories as it is to consume ice cream calories.

But I agree with your skepticism about specific food types making a huge, life changing difference.

18

depends how you count. My mother pressured me to diet when I was in high school. I am sort of vaguely dieting right now for the first time since then.

Hard to say. I think being a middle-aged woman has led to lower medical care sometimes. Depends on the doctor. But mostly my care has been good. I speak doctor-ese, which has helped.

As I said in another thread, I recently did “cool sculpt”, in an attempt to reduce the size of my belly. The issue I’m trying to address is “when I buy clothes on-line, my waist is two sizes larger than my hips, and it’s hard to find stuff that fits.” But I figured as long as I’m killing fat cells and dropping a lot of that fat into my blood stream, maybe I can diet a bit and it won’t just redeposit elsewhere. Or at least, not all of it.

So I don’t have a weight goal, but I’m hoping that the clothes that currently fit continue to fit, only with a looser waist.

Pretty much never. Except that I’m sort of dieting now, which mostly means I’m skipping one meal a day, and not eating any snacks. We’ll see if it works.

I’m sure there’s some level of obesity that’s unhealthy. I’m not sure where it is. It probably varies from person to person.

My history is of mostly having a stable weight without ever thinking about it. I was a pretty normal weight until I had kids. Yeah, I gained ten pounds when I stopped walking to classes and instead sat on my butt all day in an office job, but then it was stable. When I was pregnant, I was starving all the time, and felt exhausted if I didn’t eat constantly. I gained a lot of weight with each pregnancy, and gave birth to tiny skinny babies. I think pregnancy just messed up my metabolism.

Then my weight was stable again for many years. When I started going out square dancing in the evening, I gained ten or fifteen pounds, I think because there was junk food and people socialized over it. I lost that weight during the pandemic (not on purpose.) I seem to have regained it now that I have access to junk food again. But mostly, my weight has been pretty stable.

That doesn’t sound revolting, but it also doesn’t sound worth it to me. I don’t really have any health problems that I think are related to my weight. I have acid reflux, but so did both my parents, and neither of them was overweight. I really love food, and those kinds of restrictions would make me sad every day.

People say that, but it’s not my experience. I can eat a fridge full of vegetables and feel hungry in half an hour. And eat more vegetables and STILL feel hungry, even though I’ve just eaten as many vegetables as my belly holds. Or I can eat a cup of ice-cream, and 20 minutes later I feel full and satiated. Not right away – it takes a while for the sense of fullness to settle in. But I really do feel full after eating, especially after eating fat.

19

Absolutely. I don’t discount that. And FWIW, one of the most common “back and forths” in my diet is whether I keep ice cream in the freezer or not (I’m currently in a “keep it in stock” situation, but I am also now struggling to come down from the high end of my weight, so that may change soon). Because on the one hand I eat ice cream everyday. On other, I have, at various times, gone months in a stretch of buying by the pint, one pint a day, and only at the end of a 10 mile bike ride (the bike ride was a daily thing, but part of that life style was and is the daily trip to the grocery store is done as a part of that, rather than stocking up with car trips—really bit me early on in the pandemic, actually: I keep a very sparse fridge and freezer).

But god is ice cream by the pint expensive. A standard tub costs less than a pint.

20

It’s less the “fridge full” that the calories worth.

There basics are two fundamental brain centers involved in how much we eat: a satiety center and a hedonic or pleasure center.

Eat 250 Kcal of broccoli. That’s about five medium stalks. You would be an exceptional person to want to keep eating more. It hits hedonic center only moderately and hits the satiety center hard. Odds are you’d stop. Push away more.

Eat 250 Kcal of ice cream. Most brands that’s between a quarter to maybe a half of a pint. Half of one Baskin Robbins hot fudge sundae. You’d more than likely be very willing to keep going. It hits hedonic hard and satiety moderately.

Individual wiring and other factors vary of course.