Exercise and obesity.

Great Debates
41

Slackergirl, I hope the band works for you. I had no idea they were that expensive. Several years ago I worked in a natural foods store and one of our regular customers was once morbidly obese (335x). She had lipo and used that as a jumping off point for excercise. She excercised very hard, mainly as a weight lifter. Last I saw her she was around 150x and was getting cosmetic surgery to remove the folds of loose skin. I doubt she’ll ever be heavy again.

My wife’s parents are both obese and it’s sheer laziness. They were both thin for most of their lives, but 10-12 years ago they became completely sedentary, i.e. refusing to even walk the one block to the store. They spend most of their evenings smoking weed, eating munchies and playing on the computer. They are incredibly unhealthy now and it is rubbing off on my wife’s youngest sister (14yo) who is now overweight. I believe a lack of exercise is a major factor in what led them to obesity. But unlike a lot of overweight people, they don’t even care/try to slim down.

My wife works incredibly hard to keep weight off. She’s a size 6 and PT’s three times a week in addition to the active things we do. Her PT involves running and weights. Lots of running.

When I boxed my walking around weight was 165-70 and my fighting weight was 155. I could get down to that weight in two days. But I worked out like a bastard to do it.

I’m sorry to say this but I agree with your docs. They say the same thing in the military, where you have to maintain measurement standards. If you fail the standards you have to do mandatory extra exercise for a few months. If you fail again, you’re gone. The military docs bluntly say, “Eat less and exercise more. Why are you even asking me how to loose weight? You know how, you’re wasting my time!” And I hate to say this but, I think that searching for proofs that the studies are flawed or the industry is just trying to get your money is never going to help you or anyone loose weight. I believe docs get frustrated telling someone that exercise, motivation, discipline and healthy foods are the way to weight loss and there isn’t any silver bullets. Then having that person tell them they are wrong and throwing in a bunch of stats. What can a doctor say to that?

Irregardless I wish you luck. Don’t give up.

42

Someone burning more calories than they ingest and not losing weight is a physical impossibility.

>> mainstream books I’ve read show a failure rate of +90% after 5 years

The failure is the people sticking to their regime of calories consumed and calories burnt. The whole thing is a matter of discipline, not a matter of whether the laws of physics are suspended for fat people. Yes, some people are naturally thin just like some people are naturally intelligent. They are lucky. But, let’s face it, people are fat because they eat more calories than they burn. It is a basic law of nature.

43

I agree that most of the fad diets out there are bunk. Low fat diets, Low carb diets, some work, but for the most part are temporary. There are no magic pills that will block fat, no miracle diet that will shed pounds and keep it off even though the person eats McDonalds and Burger king 3 times a day.

But I am not saying diet has anything to do with losing and maintaining weight off. Well, Diet as in what you put in your gob every day, not some fad starve yourself or put diretics in your food diet. I am saying proper exercise will do this as long as calorie intake is watched. And by watched I mean maintained at recommended levels with few cheat days. Alot of people run to lose weight, but for a large person that is eating 2000 calories over what they should be, running for 75 mins and burning off 600 calories is not doing them any good.

If you lift heavy weights 3 days a week for a half hour a day, and maintain current food intake, you WILL lose weight, no ifs and or buts about it. It is how the body works. For every pound of muscle you have you burn some 50 calories just sitting there. Beats running on a treadmill no? If you don’t eat more food than you are currently digesting, and keep lifting weights, you will maintain it. It is that simple. If a person cannot keep lifting weights after they lose a bunch of weight, or cannot stop from eating even more food AFTER they initually loose the weight, there is something wrong.
Also eating 5-6 smaller meals a day, eating the same calories, but splitting them up, will shoot just about anybodies metabolism through the roof. (I eat so much food I get sick of eating, but I still keep loosing weight, and I used to just look at food and get fat) Doing this and lifting weights for 90 mins a week will do wonders. Add in 30 mins of treadmill or bicycle work a couple days a week if you want, and that will speed the process up even more. It just takes time, commitment, and discipline.
Of course it won’t make you skinny as heck, but it will make you stronger, thinner, and you will lose a bunch of weight.

All that the studies (or lack thereof) prove to me is that people lose some weight, are happy, and quit because of some other reason. (injury, family, laziness, whatever) Quit working out and your body resets itself to default after a time. If Fat is how somebody is genetically, well, they will gain the weight back.
It’s not that the program does not work.

Do you have any online sites to those studies that have those figures you have mentioned? Or is this anectodal?

44

I think part of the issue involved in discussions of this sort is that statements of fact are different from judgements of worth or motivation.

Undisputable fact: Almost all obese people got that way from consuming more calories than they burn up.

Undisputable fact: Almost all obese people who consume fewer calories than they burn up will lose weight.

Undisputable fact: The disadvantages of being obese do not disappear when being obese is not the obese person’s fault.

Undisputable fact: The substantial increase in obesity in the US population is not caused by a new fat gene being expressed.

Undisputable fact: Most obese people who lose weight gain it back.

Extremely questionable and contentious assertion: Fat people are lazy.

Very extremely questionable and contentious assertion: Fat people are doomed to be fat.

Somewhat contentious and questionable assertion: There are major health disadvantages to being obese.

Undisputed fact: There are major social disadvantages to being obese.

And now for the standard disclaimers: I am not obese. I exercise (weightlifting and aerobics) with great regularity, partly because it feels good and partly because obesity runs in my family. My brother is celebrating the 17th anniversary of his 115-lb. weight loss by training for his second Iron Man triathlon. I mention it because I am aware of the effort involved in not becoming obese.

So what are we to do? Do we throw up our hands and say that obesity is incurable? Do we re-adjust our attitudes and say that obesity is not a problem at all? Do we mark time until the medical establishment comes up with some safer way to block appetite?
Or do we sue health clubs who put up billboards saying “When the aliens come, they will eat the fat ones first”?
Regards,
Shodan

45

How is it questionable?

http://www.mercola.com/2002/jan/26/obesity.htm
http://www.ultradave.com/universityfit6.htm
http://www.aande.com/class/admin/study_guide/archives/aetv_guide.0816.html

Maybe I am wrong, but I thought (extreme) obesity is indeed very unheathy.

46

My brother in law is obese.

He has tried everything (including gastric bypass surgery). He is still obese.

He is very hardworking. He is very disiplined.

He is also incapable of eating a meal without clearing his entire plate. He cannot stand to see food go uneaten. If there is an leftover piece of lasagna, he feels it is his duty to consume it. This seems to be more of a form of OCD than anything related to disipline, willpower, or the willingness to work hard.

47

In the 'zine I cited, there were a number of studies that contended that obesity is not necessarily the cause of early death.

I almost hate to start doing Google searches for studies that argue against the health disadvantages, since I am not contending that obesity is not a complicating or causal factor in many health problems, but I know that this position is argued, so I listed the assertion as “somewhat contentious”.

Another contention is that the health problems lead to obesity, and not vice versa. People use this argument against the correlation between obesity and osteo-arthritis of the weight-bearing joints.

Although I doubt that people would argue there are no health disadvantages to extreme obesity. I know the life expectancy rates for sumo wrestlers is less than for the Japanese public in general. http://www.usatoday.com/news/health/spotlight/2001-08-08-sumo-retirees.htm

FWIW.

Regards,
Shodan

48

OCD?

49

Another fact: in the above quotes the word “almost” is superfluous and the following phrases are correct:

All obese people got that way from consuming more calories than they burn up.

All people who consume fewer calories than they burn will lose weight.

No exceptions. Sorry.

50

[cheap, slutty voice]

Hello, sailor -

[/cheap, slutty voice]

IANADoctor, but the reason I said “almost” all was because I used to post on another message board (one mentioned here, in the Pit, and with good reason for it being there and not here - those people are nucking futs). On that board, they had a discussion about obesity and related issues.

One of the posters there alleged herself to weigh in excess of 600 pounds. Her stated reason was that she suffered from (I believe) PCOS, or poly-cystic ovarian syndrome. I have no way of evaluating this, other than that I think the largest tumor ever removed from a patient (303 pounds, IIRC) was an ovarian tumor. Thus I can see how problems with your ovaries might screw up your metabolism, and/or make you overweight.

I suppose you could argue that these people are not obese, but I threw in the qualifier because I have learned thru bitter experience that there is nearly always a Doper who can come up with a counter-example for nearly any statement that begins, “All…” Plus I am basically an intellectual weasel at the best of times.

If some MD on the board could enlighten me as to whether PCOS can really cause people to be overweight, or if the person mentioned was blowing smoke, I would be appreciative.

Regards,
Shodan

51

OCD - Obsessive Compulsive Disorder.

Most commonly, people are obsessive about something like cleanliness - they wash their hands over and over again. Or vacuum obsessively. But it manifests itself in different ways.

IANAD, nor a therapist. I have been diagnosed with OCD at one point. (neither cleanliness or food) It ain’t the easiest thing to stop obsessing about something, or to stop compulsivly doing something.

I

52

slackergirl, thanks for your reasonable attitude and replies. I thought you would get upset with me.

I know it doesn’t help, but I know the frustration from knowing and hearing nothing but, [irritating skinny person voice] “eat less, exercise more, eat less, exercise more” [/irritating skinny person voice] when there are very few exercises you can do without injuring or further injuring yourself, you have to exercise 90 minutes a day, every day (who has that kind of free time?), and there is nothing but food, food, food everywhere, on the t.v., in the magazines, fast food joints all over the place.

As **Scylla **said, all too often the desire to eat the right things and get more exercise is overpowered by the desire to eat what you want and not exercise, because it hurts. This is why (in my completely uneducated opinion) I think the gastric bypass and the band like you plan to get are very good ideas for the morbidly obese, to sort of give you a “jump start,” like someone here said. I also did not realize it cost that much. I’m sure most morbidly obese people can’t afford it and, you’re right, will never lose the weight, for whatever reason. BTW, I have recently read that gastric bypass will decrease the “hunger hormones” so that people who lose weight that way do not have the hunger problems of those who lose weight through diet and exercise, and thus are less likely to gain it back.

Do you happen to know any stats about the long-term “success” of the band? Is it the same as gastric bypass? I hope this isn’t a hijack, but I think we’ve pretty much answered Epimetheus’ original question.

53

Thanks for the well wishes on the band. I have high hopes for it, it’s been proven effective over the long term in Europe and Australia, and it has substantially fewer risks than the bypass. The long term stats that get tossed around are an average loss of 60% of excess weight over time. It seems that people actively involved in support groups come closer to 80-90%. I don’t know if that’s because of the support, or if they are self-selected, i.e. they are happy they are doing well and like being in that club. If anybody is curious about my personal decisions and progress on this topic, send me an email and I’ll give you a link to my LiveJournal.

I live in the San Francisco area which seems to make everything cost more. The official cost of my surgery is $25,000, but I also have to pay for some of my labs, medications, nutrition counseling, fills and fluoroscopy, and other incidentals out of pocket since my insurance doesn’t cover this surgery. There are several doctors in Mexico who have excellent success rates who will do it for $7-10,000 US. I believe the rates are about the same in France and Belgium.

The success rates for banding and bypass are about the same long term, based on international studies. The FDA study (it was only approved in the US last year) on the band was very negative. They concluded that the band was less effective over the course of a year. Well, it’s true, but the “window of opportunity” for weight loss is different over time.

Bypass patients really have about twelve to eighteen months to lose everything they’re going to. Band patients lose more slowly, but the loss continues for a longer period of time because it is adjustable. In some cases it has been recorded as long as 7 years. The weight loss ratios between the two surgeries tend to equalize about 2 years out. There is some good, but very biased towards the bypass, information at www.obesityhelp.com. Some band information is available at www.thebandsters.com.

To everybody who keeps repeating the obvious. One last time. We are fat because we eat more calories than we burn. I’m not disputing that. I’m saying that diet and exercise don’t happen in a vacuum.

Re. the military comment. I’m not surprised. They should be able to maintain their weight. They joined the military as adults. They are a self selected group that is by its very nature more fit and healthy than the general population. I was barraged by recruiters as teenager and into my early twenties because I scored in the 98th percentile across the board on the ASVAB. (Everyone in my school had to take it as sophomores.) The only thing that I could do to get them to go away was tell them how much I weighed.

Also, by diet I don’t mean a fad thing. I mean a lifetime of eating. My diet is everything I have ever eaten through the course of my life. My diet in the last few years happens to be a medium to low carb diet. I mostly stay away from starches and breads, but I eat several servings of fresh fruit and veggies per day, as well as protein from soy sources and meats(usually chicken and seafood). My weakness these days is no-sugar-added fudgecicles. I live dangerously.

I wasn’t going to bring it up here, because I felt it would cloud the issue at hand, but I too have PCOS. Shodan, if you do a search for it here you’ll find several threads covering that subject in the past year. My history with it is explained in detail, several times in those threads. Just last week I had a brief exchange with Qadgop about my medication strategy.

Briefly, PCOS affects 6-10% of women of child-bearing age. The syndrome is identified by a constellation of symptoms including:

  1. weight gain
  2. insulin resistence
  3. male pattern hair growth (beard, chest)
  4. male pattern hair loss
  5. cystic acne
  6. cessation or extreme irregularity in menstruation
  7. cysts on the ovaries
  8. infertility
  9. precursors for diabetes and heart disease

Some people have one or two, I have them all except the hair loss. Some good information, as well as some general quackery, is available at www.pcosupport.org.

Insulin resistence is generally accepted to ease and reinforce weight gain. There’s a big debate in the community about which comes first, insulin resistence or weight gain. My experience was that IR came first. I started growing a beard at 15, but didn’t start gaining a serious amount of weight until I was 19. That tells me my hormone profile was seriously screwed up way before my weight increased.

Unfortunately many of the no and low carb diet books are predicated on the idea that every overweight person has IR. That isn’t necessarily true ( I don’t have the numbers or interest in looking for them, have fun with it if you’re curious). For those of us who truly are it creates lots of problems, i.e. everybody assumes all fat people are lying when we say that we gain on 1800 calories a day.

Many are, I happen to have one of those disorders that makes this my reality. I don’t think that this changes the basic more-calories-in-than-burned idea, it just means that my body may be more efficient. The band should enable me to take in about 800 calories per day and not be heinously hungry all the time. I’m done defending myself on that subject, and won’t discuss it further here.

As to support for some of my numbers – I’m getting a mix of information from books and online sources. I’m generally wary of the online stuff, for all the obvious reasons. This is the most comprehensive thing that I’ve found. Many thanks to KarlGauss for originally digging it up for me.

54

Good point, Scylla. I suspect that the idea of “mind over matter” is really b.s. - the only way an overweight person can change their behavior is if the motivation to lose weight is stronger than the motivation to eat. And like slackergirl pointed out (and I hope I’m understanding her correctly), when people attach negative connotations like “lazy” to it, it just adds to the problem by making overweight people feel inadequate. Human behavior just isn’t as simple as saying “o.k., I’m gonna eat less and exercise more”. If food provides pleasure or relieves discomfort, you will continue to consume more than you burn off, unless the desire to lose weight overcomes it. It doesn’t make you good or bad - that’s just how it is. We need to stop attaching value judgments to it.

And what Dangerosa, brought up about people finishing everything on their plate is interesting. I think the prevailing attitude of previous generations that you MUST eat everything on your plate has screwed up a lot of people. How many of us had that drilled into our heads by our parents? “Old habits die hard” really is true. When you learn a behavior as a child, and continue it most of your life, it becomes extremely difficult to change. And how are you going to eat less, when you have been conditioned to associate leaving food on your plate with being a bad person?

Slackergirl, I wish you luck. Looking at your last post, it sounds like you have had a lot of obstacles thrown in your way, and I applaud your perseverence. I really hope the surgical procedure works for you. Don’t get discouraged.

55

Did you see slackergirl’s numbers on PCOS? 6 to 10% of women of childbearing age. That is not an insignificant number of people.

I exhibited 7 of those symptoms for 15 years before my current doctor diagnosed PCOS. I’ve had this arguement on this very board hundreds of times. Posters would chime in with ancedotal evidence. I am now on Weight Watchers and I am losing weight, but I have to drop down to the “point range” underneath the one for my actual weight in order to lose.

People who do not have a weight problem can’t see how it could close to impossible, to “just eat less cals than you burn” if less cals is under 1800 a day. Also, many posters like to point out how fat people under report their caloric intake, thus invalidating their claim that they don’t eat that much more than their leaner cohorts. But guess what, everybody does, whether lean or obese. Sure they’re eating more than they think they are, but so is everyone else.

And there are very real differences in individual BMRs. There are factors other than weight that determine individual BMR Even in this study that set out to prove that there are minimal differences in individual BMRs found as much as an 8% difference in BMRs. The study calls these differences “insignificant” but a 2% difference means that one person will remain just as lean after eating 2500 cals a day and the next person will gain a pound a year.

56

I was not aware that medical conditons such as PCOS were so prevelant. It was my understanding that less than .5% of the population suffered from a medical condition that made them unable to lose weight conventionally. I would definately say a big tumor would keep that from hapening.

Good luck on your surgery slackergirl, I hope it is a sucess.

biggirl: I am not really surprised to find out that there is a difference in BMR in people. Interesting that something like a fever changes it. Nice link.

57

**

I’m confused. You’re not really saying that someone can’t exercise without getting injured are you?

Marc

58

I think AlaItalia’s statement was meant to apply only to the morbildy obese.

59

Coupla things…

First, I just realized that I may have convinced you all that I am an absolute ogre in my description of PCOS. Well, I was, and it was not a pleasant place to be at 19, especially after being a fairly attractive teenager. (Nobody knew about the beard, I spent 45 minutes every morning plucking stray hairs out of my chin and neck with tweezers, and yes, it hurt like hell.)

Through diet, medication, and years of electrolysis, I have resolved everything except the weight and fertility issues. As miserable as being fat has made me, at this point only being fat is quite a relief.

Second, MGibson, I don’t think AlaItalia is saying that nobody can exercise without getting injured. I think s/he(?) is giving me credit for my personal injuries, and statements I made regarding the morbidly obese being much more injury prone in general.

Finally, blowero, yeah I think you’re reading me right. I think that a big problem is that the wrong carrot has been held out to us for too long. Vanity is the real motivation for most people’s weight loss efforts.

So the belief that diet and exercise will cause weight loss is an easy one to buy. We want to believe it. We want to believe that the people in the studies are thin and attractive, and that we can join them some day.

The fact is that the people in the studies aren’t, and the vast majority of us won’t ever get there either. The problem is that by creating such an overwhelming sense of failure, and not really publicizing exactly how normal failure is in this situation, people feel worse.

People who believe that they are failures have less motivation to do anything for themselves. I know you all mean well by saying “willpower” over “lazy”, but the connotation is still “personal failure”.

I’m never going to have what it takes to do this on my own. I always thought I could, until I saw those numbers. That’s why I picked surgery.

I think the personal failure angle also feeds into the general stigma about the surgeries. Many, many people who have bariatric surgery are in the closet about it. They tell people they went on a long vacation at a spa and started weight watchers when they got back. I don’t have official numbers, but based on the support groups I’ve seen online, I’d ballpark it at about a third.

I hate that. Because every other fat person who hears those stories, and watches them lose weight is going to feel like an even bigger failure for not having the “willpower” to do the same thing.

No, it’s not going to help anybody lose weight. But giving people the right information, letting them know exactly where they stand can change their motivation. If they know that eating well and exercising aren’t going to give them what they seek vanity-wise, they won’t feel like shit for not making it.

If we all let them know how normal it is to not become thin, they won’t feel like failures and may be more likely to find they like the way they feel when they eat right, instead of seeing it as a punishment.

I think that everybody should try a couple of times. There are people like SenorBeef who do make it on their own. More power to them. (You thought I forgot about you, didn’t you?)

The people who don’t succeed should know why they didn’t, and that they are perfectly normal for it. Then they can make educated choices about eating well to feel better, or sticking with twinkies and accepting that they’ll feel like hell for doing so. They can make educated choices about surgery, and not feel backed into a corner and panicked when they get to that point.

Giving people the whole truth will take the pressure off and allow them to make smarter decisions, and feel good about themselves no matter the outcome. The truth isn’t going to make anybody fatter, but somebody who eats healthfully to feel better just might end up losing a little by accident.

60

Ok, getting back into this. What vast majority? The vast majority of 8% of obese people that suffer from a medical condition that inhibits them to lose weight? 10 or 15% of people that cannot lose weight are not a vast majority, sorry. The fact is that the vast majority of people that are heavy can lose weight, the minority of people with real problems cannot.