They aren’t workable solutions for many of those people because the obesity is only a symptom of a behavioral issue. If they are unable to make lifestyle changes – that is, go from a person who eats too much and doesn’t exercise enough to a person who eats sensibly and exercises regularly – they are not going to treat the symptom.
Granted, this is not easy and it is not going to happen overnight because it’s an ongoing process. Just losing the weight isn’t a guarantee that the click in the brain that changes that behavior from unhealthy lifestyle to healthy lifestyle is going to occur. But it must, for the weight to stay off. I would say many of these people for whom obesity is an issue could benefit from some behavior modification and counseling program.
My father has been morbidly obese for the majority of my life and I’ve watched him yo-yo through the years with weight loss and suffer various health effects as a result of his obesity. As much as he loves life and wants the things his obesity has prevented him from having, he has not had the discipline or the motivation to completely change his reality, only to modify it for a period of time.
Despite his many health issues, he’s losing weight again by carefully restricting his diet and as much exercise as he can manage. The upside is that as the weight comes off, he’s been able to exercise more, improving his weight loss efforts. Hopefully, this time it changes something in his brain that he maintains this new lifestyle once he’s reached his goals. Mom is losing weight with him and together they’ve made a lot of changes to their diet and habits. He says that this time he’s making a lifestyle change. I hope that is the case. Only time will tell.
Doesn’t matter. The vast majority of people are nothing like your wheelchair-bound hypothetical persons. Those poof, unfortunate hypothetical souls are physically incapable of walking, and therefore, cannot even begin to use this walking therapy of which you speak.
Most people are not like that, though. The overwhelming majority of people CAN exercise, and they CAN make dietary changes. That is why your analogy is irrelevant. You’re attempting to paint 90% to 95% of the population as people who are physically incapable of making the necessary lifestyle changes, and that’s simply not true. I’m sure that you know that.
I would just to use this vingette to illustrate how the thinking about weight as the issue, and losing it as the goal, is not as effective for health outcomes as is a focus on the behaviors. Another day of staying true to healthier lifestyle choices is the goal, not achieving a normal BMI. If he achieves the goal of each day making the healthier lifestyle choices he will be healthier even if his resultant weight loss is fairly modest. If he sets his goal as having lost some particular amount of weight, then he is less likely to achieve the lasting changes in behaviors that he needs to make. He will hit a weight loss platueau and get frustrated and quit, or even if he meets his goal, he will then, having declared success, relax and slowly slide back to obesity and more importantly, unhealthy habits.
Your father has needed to make lasting changes in his behaviors. You recognize that. Make sure he gets his attaboys for the behavioral changes he is making and downplay the scale and he will be more likely to have long term better health outcomes.
But that has been shown to be irrelevant to the effectiveness of the treatment.
I think it’s the case, as others have pointed out, that there are so many different treatments because being overweight or obese is either symptomatic or is a natural result of the combination of our physiology and environment.
Lol. My point was that diet and exercise as a treatment for obesity is like abstinence only education as a means of preventing STDs and unwanted pregnancy. It doesn’t work. And medicine got a lot better when the public and medical community accepted abstinence doesn’t work and moved on to things like condoms, safe abortions, anti-biotics, birth control, etc.
The same thing seems like it is starting to happen with obesity. People are accepting the moralized arguments about self control don’t work and are instead looking for effective treatments instead.
I used to hang out with some very neurotic, image conscious people so I think I subconsciously assume people are far more condescending about obesity than most really are. But my post above was just me taking those neurotic, anorexic, moralizing arguments and applying them to STDs and abortion rather than to obesity to show how as a society we’ve accepted that they are a total failure with regards to sex but haven’t accepted that same argument about food and obesity. If you tell people abstinence only education is a failure and tell people they should use condoms instead everyone accepts that as common sense and write off those who call that immoral as out of touch. When you tell people diet/exercise is a failure and tell people to look for other treatments for obesity many accuse you of being lazy and say you just aren’t trying hard enough.
I was addressing Gestalt’s analogy, in which he claimed that walking would be ineffective therapy for someone who cannot walk. While that is certainly true, it is irrelevant to the topic under discussion, since the vast majority of people CAN make vital changes to their dietary and exercise habits.
If you want to argue that dietary choices and exercise are “irrelevant to the effectiveness of the treatment,” then you’re welcome to do so. That was not the point that I was addressing, though. It’s also a claim that I would never want to defend.
That much is true, which is why I do NOT claim that all we must do is say “Eat less and exercise more.” Some have been arguing strenuously against that stance, but it is clearly a stance that nobody here is advocating.
The body tends to maintain its weight though and when you lose weight, you gain it back. If you were in a famine environment and you lost weight, you’d need to regain the weight to prepare for the next famine. The animals that didn’t regain weight after they lost it died in the next famine since their fat reserves were gone. So over eons, our biologies developed to make long term weight loss near impossible.
If you take two people and give them a western lifestyle (let them eat whatever they want and never exercise) one may weigh 150 pounds and the other 250 pounds.
If you put both on a diet with tons of exercise, they may get their weights down to 130 and 220 respectively. But they probably can’t stay there. If you overfeed them they may go to 180 and 280 respectively, but they can’t stay there either. But it would take tons of overfeeding to make person A the same weight as person B is with tons of underfeeding.
WHen you lose weight tons of biochemical changes occur to make you regain the lost weight. I don’t know all of them but I do know that less T4 is made into T3 (T3 plays an important role in metabolism), more reverse T3 is made, less leptin circulates, less ghrelin, more enzymes that synthesize bodyfat are made, etc. There are probably dozens of things that happen.
I was recently reading a blurb on a blog about a woman who lost over 100 pounds. She said she was always tired, cold and hungry because her biochemistry was totally out of whack. She heard about a nearby study on leptin for weight loss and decided to apply. When they tested her they said her leptin was among the lowest they’d seen. They put her on supplemental leptin and all her symptoms disappeared, and she was able to maintain her weight loss with almost no effort. Supplemental leptin is being looked at as a weight maintainence drug, but that is an example of where pharmacology will need to go IMO to treat obesity effectively. You have to counter the biochemical changes that your body makes to get you to regain the weight you lost.
Like others have said, losing weight isn’t the problem. But once you lose it, virtually nobody can resist the endless biochemical changes designed to make them regain the weight so people gain it back. Finding ways to tweak biochemistry so the body can stabalize at a lower weight will make weight loss effective. Right now we really don’t know how to do that safely and effectively.
Diet and Exercise is never a failure. You not doing it however is a failure, but that’s on you.
On a personal level, diet and exercise is hard, very hard, really hard, sometimes close to impossible. That still doesn’t mean that it IS impossible.
Life is a myriad of choices. What you put in your body and what you do (exercise wise) are just but 2.
I have three kids, work full time, volunteer at school, coach my son’s football/soccer/baseball teams and yet I still find time to work out. It can be done.
Hey, I have a question. These studies are showing that 95% of people are gaining the weight back, but have they looked at whether these people who gain the weight back actually continue to gain weight and end up fatter than they were before? I ask because people naturally get fatter as they age, and this effect is accelerated dramatically by the current American lifestyle…
But what if there is some change being made with the 95% of so who’ve ‘‘failed’’ that prevents them from gaining more weight? They may not succeed at losing weight, but if they prevented further weight gain, couldn’t that be viewed as a success?
Yes. All summarized in this post in a past thread.
Wesley sorry for not getting what you were doing there. olives…, we have discussed the net result of loss and regain before and the bottom line is NOT that it helps. It may make for worse fat distribution and certainly increases the risk for several adverse outcomes, including heart disease and metabolic syndrome.
I wouldn’t say that dietary and exercise choices themselves are irrelevant, but that the fact that a choice exists is irrelevant to the treatment’s effectiveness. I say this because, regardless of the details of the “just eat and exercise properly” treatment, it hasn’t yielded good results over time.
I agree. I think that’s what’s confusing the participants in this thread. “Eat less and exercise more”, full-stop, is oft-repeated and held up as the one true solution to obesity. Evidence suggests it’s a necessary but insufficient part of a long-term solution. I would guess there there’s typically some underlying emotional and behavioral cause underneath that needs treatment.
As a WAG, I wonder if obesity treatments in the future will be separated into the losing phase and the maintenance phase.
Certain drugs cause weight loss (phentermine, xenical, etc) but do not work well with maintenance. They may slow the rate of regain, but after 3-5 years people gain the weight back with or without the drug.
Other factors like leptin do not cause weight loss, but supplemental leptin after weight loss may make weight maintenance easier. I’m sure other factors do the same thing, don’t help you lose weight but can make maintenance easier by correcting and countering the mechanisms the body creates to regain the weight.
So as an unprofessional guess, I’m going to assume that in the future obesity treatments may consist of doing a full blood panel to get a baseline of various endocrine readings that relate to weight gain/loss, then putting a patient on a regimin for weight loss (maybe an intra-gastric balloon combined with appetite suppressants). After the weight is lost, reread their endocrine readings, find the ones that are now out of whack (thyroid, ghrelin, leptin, CCK, whatever else they discover plays a key role in weight regain) and find a way to put them back in line so that weight maintenance is realistic.
That or maybe drugs that inhibit enzymes like FAS, which you need to build adipose tissue. I wonder if a drug that blocks an enzyme in the synthesis of bodyfat will do for obesity what statins did for cholesterol.
There usually is. Obese people are twice as likely to be depressed. Additionally, depressed people are more likely to get obese. “Strongly increased or decreased appetite” is one of the very symptoms of depression in the DSM-IV. These two modern epidemics go together so often, but there is so little research in how they really influence one another. We don’t come much further then generalized stuff like " looking unattractive or feeling like a failure or beign discriminated against because you are fat makes you sad “” feeling sad makes you stop caring about how you look and feel" or slightly more insightful ones like " eating sugar and simple starches makes your blood sugar levels spike and crash several times a day, getting the insulin balance out of whack and causing fatigue and mood swings".
I really wish there would be more serious research into the link, both ways between these two modern epidemics.
Kearsen said:
I have three kids, work full time, volunteer at school, coach my son’s football/soccer/baseball teams and yet I still find time to work out. It can be done.
That is quite a feat, and one that not many people have the energy for. And they certainly won’t when they are depressed.