Weight gain and hormones

Cecil's Columns/Staff Reports
21

The cite and quote you put after this does not seem to back up any strategy that counting calories by an individual is negative. Your quote addressed preschoolers who had parents trying to adjust their diets.

I actually think we need to establish a couple of basic facts, in a language we can all understand:

  1. I assert that accurately knowing the caloric content of foods can help a person of any weight make life-decisions towards their weight which can be beneficial.

  2. I further assert that the average person cannot count calories well, for a variety of reasons, including ones out of their control.

  3. Therefore, improving the ability to do number (2) will in some manner assist with number (1).

Above and beyond any collection of papers one chooses to select (and there are thousands of papers on obesity out there - I’ll wager I can find one finding any conclusion one wants to make their argument), there has never been any compelling argument I have ever seen that knowing more about what you eat is a bad thing.

22

Una, you’ve made an assertion that knowing how to properly count calories can prevent obesity in the first place. I have linked you to the expert panel review of the available evidence on obesity prevention (based on likely thousands of papers) which fails to include calorie counting as among the methods that have any evidence-based support as a means to prevent obesity. I have pointed out to you that deficits in calorie counting have no more suddenly increased than have the genes that predispose to obesity risk when placed within an obesogenic environment.

Your list of “facts” consist of one fact and two assertions. Yes, people do not count calories well. That’s a fact. You assert that knowing the calorie content of individual foods will make people make better choices and that training to do that will therefore help prevent obesity. Neither of those are facts; they are assertions.

I would like to establish a few facts of my own:

  1. Obesity often begins in childhood. For some fraction the prenatal environment is a contributing factor to establishing the metabolically “thrifty phenotype” and for some it becomes apparent during preschool years with an early adiposity rebound. Some not until later. Even those who do not manifest true obesity until adulthood have the habits that set it up established during childhood in most cases.

  2. Therefore any means of preventing obesity in the first place must focus on effective techniques in children.

  3. A list of prevenyion techniques that have been shown to be effective has been provided. Calorie counting is not on the list.

  4. Any counting of calories done in early childhood will be done by the parents. Parental restriction of intake (rather than control of available choices) increases the risk of future obesity. For children at high risk of obesity it is particularly important that parents NOT engage in trying to restrict the amount eaten, but instead focus on what food choices are available, and teach children to better listen to their own internal body cues.

  1. Calorie counting teaches older children to pay attention to information outside of their bodies, rather than monitoring for satiety, when deciding how much to eat.

Indeed “knowing more about what you eat” is A Good Thing. Being aware which foods are highly caloric and which have more nutrition and engender more satiety per calorie, knowing about reasonable portion sizes, knowing how to make your own personal environment not obesogenic … all of these are important. There is however no reason to believe, neither evidence or compelling argument, that explicit calorie counting, proper or not, is an effective strategy to either treat or prevent obesity.

You are right of course: for any assertion in science, be it climate change or obesity, you can find “one finding any conclusion one wants to make”, and that tactic is often used by those who want to dismiss what the overwhelming body of evidence shows. Do you really want to throw your lot in with those who respond to cites, including those from expert groups, with statements that they are sure they could find one study that says something else?

23

This graph (from this page) may answer your question.

Obesity (BMI over 30 up to 40) has increased dramatically. Morbid obesity (BMI over 40) a bit less so. Overweight (BMI over 25 to 30) has been stable. Of note, many studies show that BMi in the lower portion of “overweight” is actually associated with a* lower* mortality rate than “normal” BMI.

As for the thin

(Although the numbers, while not statistically not significant, do seem to trend down overall some.)

Make of it what you will.

24

I contend that there is no strong evidence for this, because there are no good peer-reviewed studies on weight loss. Physicians find the Weight Watchers approach of calorie counting backed up by group support to be plausible though. Then again, so is Volumetrics (eat lots of low calorie bulky foods), drinking a glass or water before every meal, the Ornish Diet (exercise and eat low fat) etc. Cite

Granted, subject to the caveat above. Hey, I’m not saying that nothing works: lots of people have gained and lost weight (myself included). I’m just saying that strong evidence isn’t in, although there are boatloads of suggestive studies.

Interesting graphs: they seem consistent with your story. As to whether they represent compelling evidence though – I confess that I can’t tell. What I’d like to see are some weight histograms for various demographic groupings, with the time periods overlaid on top of one another.

Well I for one would find better food labels to be helpful. Bottles of pop with 2 1/2 servings per container are ludicrous. Oh, and to the extent that sweet diet soda appears to stimulate the appetite how about plastering a sweetness measure on the can? Technology is a wonderful thing, but my take is that a lot of what’s on the grocery shelf is plain crap.

25

The thing is, to treat childhood obesity, you usually have to treat the parents’ obesity also. Basically, in order for the child to eat better, generally the whole family has to eat better, or else the child ends up feeling deprived. My mom wasn’t going to stop making greasy, salty crap from a box, or start any kind of exercise program to compensate for the junk she was feeding us, so she and I continued to gain weight.

Oddly enough, whenever my mom and I live in the same house(I’ve had to bounce home several times due to financial reasons) I’ll start gaining weight…mainly because she buys me tempting, high calorie, fatty, salty food that I wouldn’t otherwise eat, and she’s constantly grazing.
Between the two-having more palatable food around and watching someone else eat, I tend to eat more and blow up.
When I live on my own, I tightly restrict my own diet-the stuff isn’t in the house, and I have enough restraint that if it’s not in the house, I won’t generally go get it.

If it’s present in the house, look out, though. My wife made cookies. They didn’t even come out that good. I had to have her put them in one of those jars that has a levered lid and a rubber gasket, then put a padlock on that hinge, so that the lid couldn’t be removed, because I kept scarfing down cookies like a maniac.

At one point in my life, before I was placed on antidepressants, I had full-blown Binge Eating Disorder: Binge eating disorder - Wikipedia
If I had been better at vomiting I’m sure this would have progressed to bulimia, because as a teen, I certainly tried on many occasions, especially when I was topping the scales out at 320 pounds.

I can and do still occasionally get extremely stressed out and tuck into about 2,500 calories in the space of an hour, but it’s much better than it used to be.

So, I actually feel safer committing to a permanent life of counting calories, because otherwise I’m afraid all the weight, all the binge nuttiness, and the disabling illness will come roaring back.

26

There are lots of variations:

Q: What is the difference between an enzyme and a hormone?

A: You can make an enzyme.

27

BayouHazard, I’d modify your initial statement some and then endorse it wholeheartedly: you do not have to successfully treat the parents’ obesity so long as you succeed in getting them to improve the whole household’s behaviors. The adults may or may not lose weight. One of the few approaches with proven efficacy for treating childhood obesity is family centered cognitive behavioral therapy and it turns out that it doesn’t particularly matter if the child is present for the sessions; it matters if the parent is there.

Measure yes, lots of what is on the shelf and in the house and all around us is pure crap and lots of it. Sometimes I think of it as being surrounded by supranormal stimulii: these are things that were uncommon during evolutionary history and desiring them, gorging on them when given the chance, was associated with increased survival rates. Most of us are sensitive to those stimulii to some degree or another, some much more so than others. The odd thing is really that there are some who do not have much sensitivity to them at all, not there are so many who do.

One of your links led to another, “If Diets Don’t Work, What’s the Solution to Obesity in America?” , that is worth a quick read. The argument made there is that America’s high emphasis on individuals personal responsibility may not be an effective stand-alone approach to deal with the obesity epidemic. The argument is not to abdicate individual responsibility but that we need to figure out what community interventions work as well. This American attitude is illustrated even in Cecil’s article: “suck-it-up”; “get a grip” … and many who read these boards are tired of my attempts to slap down those who manifest it by feeling entitled to insult the obese for their obvious individual personal failings (they must have them since they are fat), justifying it by arguing that they are shaming them into personal responsibility. Unfortunately, as the article points out, we do not yet have the complete data on what environmental changes are most effective. And our countrymen are very resistant to anything that they perceive as nannystatism.

Over the past several years there has been an emphasis across the country on trying to make some changes in the environment of children (changes in school cafeteria menus, etc.) and the little reported fact is that something has been beginning to show effect:

The last few years have seen rates at least top off in the High School age group as well. It’s a long way to getting the rates back down to where they were in 1980, but after years of consistent increases I see these numbers as good news.

28

People are not just being pushed by outside forces, nor just their hormones (though I’m hypothyroidal, and I can tell you that I gained significant weight without changing a gram of my diet until we sorted that out), there are also an array of evolved and sometimes learned behaviors and physical traits that complicate the matter.
For example, studies have shown that people tend to eat whatever is on their plate regardless of size – if your plate is smaller, you eat less. Some think this is evolved (our ancestors lived in marginally habitable areas, so we gorge when we can and live off the fat when we can’t), but there are also societal pressures (“don’t you like your food?” or serving birthday cake in celebration) and learned behaviors (“eat all your food! Kids are starving in [poor country]!”).
Your emotional state affects not only how much but what kind of food you crave and therefore eat. Obviously this has an effect if your body thinks it is storing fat for a crisis when in fact you are merely eating too much.
And let’s not forget that most Americans spend their time behind a desk or computer or TV instead of moving around.
Obesity and eating behavior in general is a highly complex issue. After all, food is a necessity, and specific tastes can become addictive above and beyond basic needs. Unlike alcohol, heroin, or tobacco, you can’t live without food. When you combine the necessary nature of food with addictive behaviors, you have a formula for obesity in the right situation.
Tell your inner Puritan to take a hike, Cecil: “lack of willpower” is an excuse often used by people who don’t have the problems or oversimplify the issue, used to demonize the person instead of address the problem. Would you say the same of an addict? (I speak as a motivational psychologist, so I know whereof I speak!) It behooves you to take a somewhat more nuanced view. Saying that two-thirds of Americans lack “willpower” – and that that percentage has been increasing – makes no sense. Clearly there are larger issues at play, and probably several.

29

Hello stevekelner.

Usually it is asked that you post a link to the column so that others can easily find it.

Is this it? Link

30

Sure, there are many conditions which lead to people being overweight, but that doesn’t mean the person has to just accept it. Blaming everything on external conditions is convenient, but the the person should still have some control over their behavior.

Work in an office all day and feel compelled to clear your plate? – spend your lunch hour walking 2 miles to a Subway and get a 6" sandwich instead of driving 1/2 mile to China Buffet.

Can’t control your late night binges? – Have healthy foods in your house that are not as binge dangerous like fruits and vegetables. Don’t have foods which are harmful to binge on (ice cream, cookes, sweet cereal, etc).

Yes, some people have brain or body differences which makes it easier to gain weight, but that should not mean that they just give in to those desires helplessly.

31

The problem—as you yourself appear to concede—is that people eat too much / don’t exercise enough for their needs. How else do you propose addressing that problem?

Phrase it more nicely, perhaps? “It’s not *all *your fault that you’re fat… but pretty please eat less and exercise more, and you’ll lose weight”?

32

True story: I initially read the title as “Do fat people get in the way because of a hormone condition?”

33

I know the rules, link to the column but my cut and paste is broken.:frowning:
Anyway, in the collumn Cecil states that growth hormone defiency can lead to obsesity.
What is the source of that statement? Are there any medical journal cites? If so, could you link me to them?

34

There is a difference between proximate cause and ultimate cause. The proximate cause in much of the increase in obesity is “willpower” (such an ambigous phrase really, because no one meal or exercise session matters much; staying thin requires an entire lifestyle).

But the ultimate cause is more akin to steve’s point. I would personally lean towards evolution a ton; we evolved in scarce times, but no longer live in them. Our body is spectacular at saving for a rainy day, so to speak, and we are well off enough that said day never arrives (even scarier thought: there does not seem to be any significant evolutionary force that will reverse this trend, meaning the genes that code for our bodies to store as much fat as possible are not going anywhere soon).

35

We’re working on adding the sources right now, but one you could examine with respect to your specific query is:

Gharib, Hossein (Chairman) “American Association of Clinical Endocrinologists medical guidelines for clinical practice for growth hormone use in adults and children—2003 update” Endocrine Practice 9.1 (2003): 64-76.

36

Thanks, Khadaji, that is the proper link.
filmore, Vinyl, you are missing my point. My point is that there are more factors than Cecil described, some of which are not under conscious control or even in conscious awareness, so telling someone to “have more control over your behavior” may be exactly comparable to telling Stephen Hawking to get out of that wheelchair and walk – he just needs more willpower.
For example, I mentioned I am hypothalamic. This is relatively common, as Cecil notes, but fortunately very treatable. (Though it took over a year to adjust my meds properly!) But the symptoms duplicate depression, in addition to lowering your absolute bodily energy, so you not only have less energy, you have (effectively) less willpower to bring to the game as well. Telling someone to walk two miles at lunch is not an effective strategy when the patient physically lacks the energy to walk around the living room, let alone being too depressed to care.
This is a known factor. There may be many others. Some studies have suggested that high-fructose corn syrup (HFCS) is not processed the same way as sucrose or glucose, which could lead either to different processing and/or lack of satisfaction in the system, both of which could lead to overeating or increased fat production. When you don’t change your eating patterns, but the manufacturer changes your food, where does willpower come in? Whether this particular set of studies is borne out (and its uncertain), who knows how many other factors there are? We’re a long way from the hunter-gatherers of the African savannahs. Either we should all live like the !Kung San, or we should expect some weird occurrences. It is my belief that an epidemic like this is not attributable purely to lack of willpower. I think there are other things involved which we have not sorted out.
Hope that makes more sense.

37

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Merged three threads on the same topic.

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38

I have no doubt that unreliable perception of intake and satiety are partly to blame. I’m sure we’re all familiar with this study, for example.

I think the biggest disconnect is equating a failure of will with laziness or moral failure. If our minds could easily ignore hunger and pain, our species simply wouldn’t have made it this far. No doubt that calorie restriction causes weight loss… the trick is how do you fool a sophisticated limbic system into not punishing you for rebelling against millions of years of evolutionary hardening that directs us to eat, eat, eat.

I also believe strongly that the set point concept is psychological in nature. Again, not to trivialize the overwhelming influence of psychology… on the contrary, this probably makes it more difficult to crack, not less, but we need to be looking in the right place.

39

Well I suspect that unreliable perception of of satiety and intake have something to do with it … I just don’t know it, and satiety perception has little to do with calorie counting.

And I’d request you read this link I gave up-thread, in which the science behind “settling point” is reviewed. There may be psychological factors as well but the physiological factors are significant and fairly well documented.

From a practical POV however, short of bariatric surgery, “will” is the still the main means to crack the nut. But will needs to be supported with reasonable expectations and proper support … and primary prevention requires some work at both family and community levels, especially for those at greatest biologic risk.

40

You mean I’m not the only one who likes to sit and stare at the back of the television set? :smiley: