Feb 26 2009

Want To Lose Weight? Reduce Calories.

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Comments: 102

As a scientific skeptic I am careful to emphasize that my current position on any scientific question is tentatively based on available evidence. If new data comes in that warrants a change in my position, I will happily change it. Not only is this position scientific, it has the advantage of not tying you to a position that might be wrong. I try to become as emotionally dispassionate about specific conclusions as possible – it is only the validity of the process that I value.

But I admit I cannot help but feel a sense of satisfaction when new data supports a position I have taken on a controversial topic (a guilty pleasure, I suppose).  In this case a new study published in the New England Journal of Medicine comparing various weight loss diets supports my contention that weight loss is all about calories in vs calories out.

There has been a tremendous amount of popular marketing of diets claiming that the proportion of macronutrients – fats, protein, and carbohydrates – is important to weight loss and other health factors. For example, Atkins has made low-carb diets extremely popular. The problem has always been that the scientific data simply did not support any such claims. This did not stop the press from declaring that “Atkins is vindicated” every time a small and worthless pilot study came out showing possible short term advantage but no long term advantage, and overall very small differences in various diets. The weight of the evidence supported the conclusion that weight loss is achieved by burning more calories than are consumed, regardless of the source of those calories.

The authors of this new study summarize prior research thusly:

Small samples, underrepresentation of men, limited generalizability, a lack of blinded ascertainment of the outcome, a lack of data on adherence to assigned diets, and a large loss to follow-up limit the interpretation of many weight-loss trials. The novelty of the diet, media attention, and the enthusiasm of the researchers could affect the adherence of participants to any type of diet.

The thread of plausibility that many miracle diet advocates cling to is that their diets reduced hunger so that you could more easily curb calorie intake. This is certainly plausible, but again the problem was simply that the data did not show a big effect. I was willing to accept that maybe there was a short term effect from very low carb diets, but no study showed a persistent advantage beyond 6 months. In most of these studies at the end of a year everyone was in a similar place, with a small amount of weight loss and any differences between diets gone or diminishing.

Clearly what was needed to resolve any lingering controversy was a large study with a long follow up. That is what this current study does. Here are the methods:

We randomly assigned 811 overweight adults to one of four diets; the targeted percentages of energy derived from fat, protein, and carbohydrates in the four diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%. The diets consisted of similar foods and met guidelines for cardiovascular health. The participants were offered group and individual instructional sessions for 2 years. The primary outcome was the change in body weight after 2 years in two-by-two factorial comparisons of low fat versus high fat and average protein versus high protein and in the comparison of highest and lowest carbohydrate content.

A two year follow up is significant and long enough that any short term effects (on the order of months) should be worked out the data by then. After all, what people want and what is important for health is sustained long term weight control.  The results are easy to summarize – no difference in any of the groups. Low fat vs high fat, low carbs vs high carbs, low protein vs high protein – no difference. Weight loss correlated only with compliance with the diet and calorie restriction. The authors conclude:

Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize.

The study also found that calorie restriction and weight loss correlated with an improved lipid profile.  This is not surprising and is consistent with prior studies.

This is one of those issues, however, where I have encountered surprising emotionality. It is amazing how ideological people can become when it comes to food and weight. Especially if someone has tried a diet and they believe it worked for them – they become hardened true believers and passionately spread the word about their amazing discovery. They may quietly forget their fervor when the weight returns, however (which is does in the vast majority of cases).

Given the wishy-washy nature of prior evidence, this large and long follow-up study should put to rest the hype over macronutrient-based diets. I know it won’t, but it should. No one wants to hear the truth we all know in our hearts – if you want to lose weight you have to eat less and move more. The macronutrient claims are largely a distraction and public health would best be served (but not the self-help book industry) if we move past them.

This study does not address what should now be the real focus – how to maintain a permanent change in habits to effect a more healthy or appealing weight? Only about 5% of the population can seem to do this. Will power alone (the preferred method by default) is notoriously ineffective.  Some basic principles have been established – long term weight control correlates with sustainable changes in habits (not short-term diets) and correlates strongly with exercise. Common sense dictates others – healthy habits are more likely to be sustainable if they are easy and appealing.

There is no magic solution.  I do think that fad diets are an unfortunate distraction for many people. Hopefully this study will help reduce the distraction. Unfortunately, such appealing distractions are very profitable.

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102 responses so far

102 Responses to “Want To Lose Weight? Reduce Calories.”

  1. DanSLOon 26 Feb 2009 at 6:27 pm

    One thing I would point out is that most people who want to lose “weight” really want to lose fat, thereby increasing their ratio of lean muscle to fat, which is what really matters when you want to look good naked (which is really what most people are after). It is possible for two people of similar height to weigh the same but have very different body composition levels, and the one with a larger amount of muscle will look skinnier and more attractive. However, body fat percentage is more difficult to measure so its no surprise that the diet industry has focused on simply reducing total body weight.

    My point in mentioning this is that although the science is clear about how to reduce your weight, doing so while optimizing your body composition is not quite as clear-cut. I’m certainly not endorsing any fad diets here, but it is plausible that things like macronutrient ratios or differing methods of exercise (cardio vs strength training) do affect body composition, so its a bit disingenuous to say that these discussions are a “distraction” merely because they don’t affect absolute weight loss.

  2. Steven Novellaon 26 Feb 2009 at 6:48 pm

    Dan – that is a good point I did not address. I am talking here only about weight loss, which was the focus of the study. Diet composition does affect heart health and diabetes risk and may impact other aspects of health, as well as lean muscle.

    However, the study was looking at people who are overweight. Calorie reduction is likely to result in primarily the loss of stored body fat preferentially in such cases. There is no evidence that any macronutrient composition (as long as it is within a reasonable range – i.e. not a near total lack of protein) will result in more lean muscle than other diet compositions. Likely, exercise would be an overwhelming factor that would dwarf any effect from diet.

    And again, I am not talking about maximizing athletic potential or body building – just the average overweight person who wants to lose fat.

  3. jbowenon 26 Feb 2009 at 6:55 pm

    I have always believed it’s all about calories also but that said this study shows nothing. Why waste two years on a study and not address the biggest “fad” diet. The one the aurther of the blogs mentions.. Adkins!? The lowest % carbohydrate mentioned here is 35%, that’s not even close to Adkins. In fact, Adkins points out that reducing your carbs doesn’t really matter you need to cut them out. Even the maintenience phase should be , maybe 3-4%. 35%. Waste of time. Add this to your worthless studies list. By the way I’m not on the Adkins diet.

  4. able-xon 26 Feb 2009 at 6:56 pm

    It’s funny, I just started a “diet” this month based on this principle. As a nerd, its pretty easy to understand that weight loss is just math. What I’ve found so far is that even small changes in the amount of diet and exercise you do can have results.

    I’ve reduced (but not eliminated) the amount of red meat I eat, and reduced soda intake from several a day down to just a couple a week. I also use some of the diet tv dinner type things (healthy choice meals et al) as I know that I have an issue with portion control. After I meal, I’ll wait 10 or 15 minutes and if i still feel hungry maybe have some fruit or a veggie snack pack to curve any remaining hunger pangs.

    Combining these dietary changes with maybe 60-90 minutes of exercise on my wii fit per week has already had me lose 8 pound in the last 25 days. Its not crazy weight loss, but what the graphs and math shows is steady sustainable weight loss, and thats whats important. None of the changes I’ve done are so drastic that I can’t live with them long term.

    Also, I like it when my little wii balance board is happy with me :p

  5. Pennon 26 Feb 2009 at 7:09 pm

    Far as I can tell from other coverage of this study, it points out two basic things:
    1) All diets equally work about the same for about the first year.
    2) All diets equally fail by the two year mark, even if you stay on them.
    Essentially, if you diet you first lose weight, then you gain it all back (and sometimes more), even if you keep your calories low. Gaining the weight back isn’t lack of willpower, it’s your body adjusting to the available calories and going back to the weight it wants to be at.

  6. tmac57on 26 Feb 2009 at 7:14 pm

    Steve, this study seems to confirm what I have always suspected intuitively, but there is one question that I have, that has been bugging me for years. Are there really people that can eat whatever they want and not gain weight solely on the basis of a higher metabolism, and not any other factors such as they are extremely active people that move around a lot ? And conversely are there people that can eat normally and balloon up to obesity despite a normal activity regimen due to their metabolism?
    This is taken to be the gospel by most people I know, but I am not so sure. Any thoughts?

  7. bigjohn756on 26 Feb 2009 at 7:16 pm

    I could lose huge amounts of weight if only I had somebody to cook for me. I could tell all that person exactly what cook and how to cook it so that I could lose 5 pounds a week. It would be a completely balanced diet, I would drink lots of water, and I would have plenty of energy. So, the only reason that I can’t lose the 150 pounds I need to lose is that I’m too lazy to cook. Sad isn’t it?

  8. Eilonnwyon 26 Feb 2009 at 7:55 pm

    That’s really awesome. I’ve always been a classic of the tried and true calories in vs calories out method. I lost 20 pounds with it and I’ve never gained it back even though injuries and illness have stopped me from keeping up my exercise regiment this past year. It’s definitely very exciting to see what we always new to be confirmed. Yay science! :D

  9. Mully410on 26 Feb 2009 at 8:38 pm

    I’m saving my fat for either the Survivor (tv show) diet or the Chemotherapy/Radiation diet in case I get cancer.

  10. jbowenon 26 Feb 2009 at 9:03 pm

    Appologies, my 3-4 % was way off, rushing to diiner :) Point still stands though.

  11. weingon 26 Feb 2009 at 9:13 pm

    Higher protein content of the diet helps to lose more fat as opposed to muscle but without exercise you will still lose about 20% muscle mass with just a diet. Exercise combined with diet will ensure that nearly 100% of the weight loss is due to loss of fat. Here is a reference if you are interested. I don’t know how to post links.

    Layman, D. Journal of Nutrition, August 2005; vol 135: pp 1903-1910

  12. superdaveon 26 Feb 2009 at 11:08 pm

    thermodynamics > pseudoscience

  13. studio34on 26 Feb 2009 at 11:11 pm

    Steve, completely agree about the calories in/calories out but as you pointed out:

    >>> The thread of plausibility that many miracle diet advocates cling to is that their diets reduced hunger so that you could more easily curb calorie intake.

    This holds very true for the glycemic index which is no miracle diet. It’s common sense and is backed by a pile of science. I should point out that in Australia a “diet” refers to what a person eats normally and does not refer to some sort of dietary restriction or fad as it does in the US. I work at the University of Sydney and have been involved with GI research for a number of years. There is abundant evidence showing that by choosing low GI carbs (carbs that are primarily composed of amylose – glucose molecules that are “layered” and not branched) subjects feel fuller for longer because these sorts of foods are more satiating (these findings hold true in human and animal studies). Slowly digested carbohydrate makes it further into the GI tract and there is evidence showing that it triggers signals in the gut relaying a fullness message to the brain.

    Weight can be lost numerous ways but the real challenge is *keeping* it off. Most people rebound and usually end up heavier than before they started. The GI proves to be one very useful tool in the bag (not a magic bullet by any means) to help achieve this by making this type of diet a lifestyle choice that people can actually adhere to. It’s not rocket science either, but simply advocates dumping the highly processed, glucose spiking carbs in favour of more slow-burning carbohydrate. Most people were eating this way anyway (as did our hunter-gatherer ancestors) before highly processed foods and methods such as extrusion of carbohydrate were introduced.

    Lastly, there was a good study published in the Lancet showing how in rats a high GI diet caused an increase in body fat and less lean tissue compared with rats on a low GI diet. Furthermore, high-GI fed rats were worse off after an OGTT and also displayed “severe disruption of islet-cell architecture”.

    Effects of dietary glycaemic index on adiposity, glucose
    homoeostasis, and plasma lipids in animals.
    Lancet 2004; 364: 778–85.

  14. DarwynJacksonon 27 Feb 2009 at 12:08 am

    Dr. N,
    A medical doctor once told me that there are no significant differences in human metabolic levels and all people have the same capacity to lose weight.
    This position struck me as intuitively wrong, since hyperthyroidism, cancer and any number of pathological states show huge variations in human metabolism.
    Is there any evidence which demonstrates that some people have a naturally “fast metabolism” and can, therefore, eat whatever they want and remain at or around a set weight?

  15. Puppet_Masteron 27 Feb 2009 at 12:43 am

    Weing,

    That’s interesting, but I’m curious if their was a study done to substantiate that claim. Although the mechanism seems clear: the more proteins consumed, the more amino acids made, and the more of your own proteins can be made from those amino acids to help build muscle.

    But my question would be: For the average person, how much proteins can be made until their blood is saturated and any more is just spilled over into their urine.

    Plausibility is good, but the true test is a study to see if it jibes with reality. You could just be making a utopia for the bacteria in your toilet.

  16. Puppet_Masteron 27 Feb 2009 at 12:54 am

    DarwynJackson,

    pathologies likes hyperthyroidism can absolutely make you lose weight. The hormones secreted by the thyroid will increase your basal metabolic rate which is like the idle speed of your car. Theoretically, you could take thyroid hormones like thyroxine and you would loose weight. Although, I highly don’t recommend doing that because it causes terrible side effects like exophthalmos (budging eyes).

    I don’t think your doctor was considering pathologies and weight loose. Although clearly some people have more inefficient metabolisms than others.

  17. cheglabratjoeon 27 Feb 2009 at 1:09 am

    Hi Steve,

    Very long-time lurker, but I finally decided to sign up and leave my two cents. I have a little nit to pick, but it becomes important if you really get into this topic with a die-hard.

    It’s not technically calories in minus calories out. If you do a calorie balance on a person, you’d start with a general balance:

    In + Generation = Out + Consumption + Accumulation

    In is Eat, Out is Excrete, Generation is zero, Consumption is Burn, and Accumulation is Weight Change (subject to unit conversion, ~3500 calories per pound). So, we have:

    Weight Change = Eat – Excrete – Burning

    A minor detail, I know, but important for virtually every self-proclaimed expert’s favorite diet type (low-carb). Once you’re in ketosis, you start losing ketone bodies in the urine. You’re simply turning up the Excrete dial. This added detail also lets you cover that drug (forget the name) that blocks fat uptake.

    When someone gets all hot and bothered about their favorite diet, I like to point out how simple yet fundamental that equation is. You can’t get around that balance without violating a tenet of physics so basic that the person probably isn’t cognizant of its existence (continuity). You either have to eat less, poop more, or burn more … that’s all any diet strategy can ever be.

  18. eiskrystalon 27 Feb 2009 at 4:53 am

    The question isn’t whether people have different metabolic levels, but whether that is at all significant against the background of environmental factors.

    The sooner that exuse is put down, the better.

  19. Steven Novellaon 27 Feb 2009 at 8:42 am

    chegla – I agree with your equation – but that is contained within calories in-calories out. You are just breaking it down further. It can be broken down into even more detail, but the basic equation remains.

    Penn – some people believe that it is almost impossible to change the weight your body naturally wants to be. The fact that 95% of people who try to do so fail in the long term seems to support this position. However, some people can do it, and the predictive factors for long term success include regular exercise.

    Also, the fact that obesity rates have been climbing in recent decades suggests a cultural factor. If culture can make us fat, it can mitigate it as well.

  20. Steven Novellaon 27 Feb 2009 at 8:48 am

    I accidentally deleted a couple of posts in moderation on this thread. If your comment has not appeared, please resubmit it. Sorry for the inconvenience.

  21. daedalus2uon 27 Feb 2009 at 9:55 am

    Chegla mentions ketosis. That diet intervention was not addressed in this study. A ketogenic diet does have specific protective effects for epilepsy and probably some other disorders. It has to be a very strict ketogenic diet, going out of ketosis can cause relapse in an hour. My suspicion is that being in ketosis increases NO levels and so increases mitochondria number because ATP production needs to be shifted more to oxidative phosphorylation and away from glycolysis. I suspect that it is that increased NO that reduces seizure activity.

    Even in ketosis glucose is still produced from amino acids. Glucose can’t be produced from fatty acids, but ketone bodies can be, and the ketone bodies can be used by mitochondria in any tissue compartment. Glucose becomes more “valuable” because it is required for glycogen storage and to power red blood cells and some immune cells which have to use glycolysis because they need to operate in hypoxic tissue compartments.

    I think ketosis is too extreme (in my opinion) to use for weight control in otherwise healthy people. I don’t think it is something you want to switch back and forth in and there hasn’t been very much study of it (because it is pretty difficult to maintain).

    When excess protein is consumed, excess amino acids are converted to glucose in the liver. To maintain strict ketosis you would have to limit protein intake too.

    The basal metabolic rate of individuals is different, but not usually in the way that people think. In general, people who are obese have a higher metabolic rate. That is their basal metabolism is higher than after they lose weight. This is one of the things that makes weight loss difficult, when weight is lost metabolic requirements go down. The exact mechanism is not well understood, there are reductions in physical activity, reductions in metabolic demand for digesting food. I suspect a major source is an increase in mitochondrial number following weight loss. The efficiency of mitochondria that is how much ATP they produce per unit of substrate consumed is not constant. At higher ATP production rates (ATP/second), the efficiency is less, meaning that fewer mitochondria require more substrate to produce the same ATP. ATP needs are likely not that different, lower efficiency to produce the same ATP is measured as a higher metabolic rate.

    You want a large mitochondria number, because that gives you lots of reserve ATP production capacity. That is how you generate ATP in excess of your basal needs “at rest”. Your mitochondria have the capacity to produce more ATP. If they don’t have the capacity to produce more ATP, you are unable to increase your metabolic activity, you become fatigued if you try.

    There once were weight loss drugs that short circuited mitochondria and made them dissipate energy as heat. These “worked”, but they had pretty bad side effects.

  22. superdaveon 27 Feb 2009 at 11:23 am

    Everyone has to maintain normal human body functions to live, and these functions take energy. Highly doubt there is much variability in this amount of energy, though it is reasonable to assume it is proportional to height and weight. This leads to the counter intuitive notion that overweight people probably have a faster metabolism than people who weigh less. This number is considerable, the avergae person will burn about 2000 calories a day just doing daily life functions. However, we are talking about baseline measurements. Once you throw in exercise, this number changes drastically and people who are overewight just don’t do enough exercise to offset the extra calories they are eating. That said, abnormal physiology, like certain disease states or side effects from drugs drastically alter this picture, but again this is abnormal.

    To address another claim, I doubt there is a natural set point when it comes to weight. the stomach is known to expand with increased food count, and the heavier you are the more calories you need to satisfy your hunger and your energy needs, it’s a positive feedback loop. My suspicion is that culture and lifestyle play a much bigger role than genetics. Some people are going to be lazy and some people will be naturally more athletic, making exercise more fun for them, but the basic equation always applies.

    Lastly, blood pressure and cholesterol levels are probably better measures of overall health than weight.

  23. llewellyon 27 Feb 2009 at 11:57 am

    Steven Novella:

    Weight loss correlated only with compliance with the diet and calorie restriction.

    Are there studies that test how the degree of compliance varies for various diets?

    I have known people who claim low-carb diets work because they allow people to continue eating the ‘hardest things to give up’ – fat and meat, and thus result in greater compliance. I would like to know if that claim has been tested.

    (I don’t think I could stay on a low-carb diet. Most of my favorite foods have tons of carbs. Fortunately I likely don’t need a weight-loss diet; given the number of people who whine about how I never seem to get fat no matter what I eat, I’m probably not overweight.)

  24. daedalus2uon 27 Feb 2009 at 12:04 pm

    superdave, your intuition is correct, obese individuals do have a higher metabolic rate. This is not easy to measure long term, self-reports of food intake are notoriously unreliable. The best technique is doubly labeled water. Giving people water with both 2H and 18O allows a measurement of the balance. Water is lost both by breathing and as liquid, CO2 is only lost by breathing.

    Exercise isn’t a large calorie sink. The largest metabolic load by far is basal metabolism except under quite extreme metabolic activity. During the Tour de France, metabolic rate only increases 3.5 to 4.5 times basal levels. That is about the maximum increase that has been observed in animal experiments too.

    The changes in basal metabolism that accompany weight changes are not small.

    http://content.nejm.org/cgi/content/abstract/332/10/621

    A weight gain is accompanied by an increase in basal metabolic rate. A weight loss is accompanied by a decrease in basal metabolic rate. These changes to basal levels are over and above changes due to changes in physical activity.

    What I find very interesting is that many degenerative diseases are accompanied by an increase in metabolic rate, a hyper metabolic state. For example heart disease, kidney failure, liver failure, chronic obstructive pulmonary disease are all accompanied by increases in metabolic rate. Even ALS can be accompanied by increased metabolic rate. I think the final common pathway in all of these is mitochondria number and the amount of “slip” that accompanies oxidative phosphorylation. The ATP demand by cells is about the same, but the efficiency of ATP production is lower when there are fewer mitochondria. That shows up as increased consumption of substrate.

  25. Oracon 27 Feb 2009 at 12:31 pm

    I predict Sandy Szwarc will soon weigh in on this study with her usual posturing.

  26. llewellyon 27 Feb 2009 at 12:36 pm

    Steve, this study seems to confirm what I have always suspected intuitively, but there is one question that I have, that has been bugging me for years. Are there really people that can eat whatever they want and not gain weight solely on the basis of a higher metabolism, and not any other factors such as they are extremely active people that move around a lot ?

    If my friends, cow-orkers, and acquaintances are to be believed, I am one of those people. A few notes: (a) I do not own a car, so going almost anywhere requires a certain minimum of exercise, and anywhere that is less than about 3 miles away I will walk without hesitation. (b) I pace obsessively. I’ve had housemates and neighbors claim they moved away because of it. (c) A few years back I got into a quart-of-ice-cream-a-day eating habit. (I don’t remember how.) Unfortunately I didn’t weigh myself, but after about 4 months or so I did pick up a noticeable increase in the belly. It went away when I got bored of the ice cream. Notes (a) and (b) indicate that while I’ve seldom been athletic in any normal sense (for example, I’m terrible at sports and I avoided gym class like the plague), and I have trouble maintaining an exercise regimen for more than a month or two, I may well fit into your definition of ‘extremely active people that move around a lot’. As you might imagine, I suspect most of those people who can ‘eat whatever they want and not gain weight’ will turn out to be very active in one fashion or another.

  27. cheglabratjoeon 27 Feb 2009 at 12:52 pm

    Steve, daedalus2u, thanks for the replies. (BTW, call me whatever you like, but my handle means: cheg = chemical engineering, lab rat = grad student, joe = me. chegla works but just looks odd to me.)

    I hear you that it’s merely more detail, Steve, but my experience is that “calories in, calories out” just ticks people off and stops the conversation. Giving them this little bit of added complexity lets you explain their favorite “tricks” away (low carb diets, Alli, complex vs simple carbs, etc) as nothing special, but doesn’t give them room to obfuscate. And, really, that’s all these diet fads are: obfuscating a simple issue (we eat more than we need to).

    daedalus, I have no clue how ketosis impacts NO or visa-versa. My understanding is that ketosis is really the only way to quickly (and actually) lose weight via low-carb diets. After all, you’re literally peeing calories away. (Of course, the problem is that this is a rather precarious place to be metabolically; you need enough carbs to not die, but not so many as to stop the ketosis.) I guess I’d allow that gluconeogenesis is a less efficient use of eaten or stored calories, and thus is preferrable to say eating sugar packets, but I don’t know if it’s significant. I’d probably file that away under “Obfuscation.”

  28. MickeyCon 27 Feb 2009 at 1:27 pm

    Weight loss is not rocket science and I have always advised people you only lose weight if your calorie expenditure exceeds your intake.

    However I also usually tell them not to bother with diets as they rarely work for more than short term weight loss – far better to go and buy a pair of running shoes and start exercising – cheaper, more likely to work, you can still eat tasty food and you will feel better! And the health benefits will still accrue even if you don’t lose weight!

    Diets rarely work – humans are inherently lazy and unlike our grandparents who really had to work hard to put food on the table, we drive to the supermarket, load up and only have push a trolley a few dozen yards.

    No wonder there are so many fatties around!

  29. HHCon 27 Feb 2009 at 2:16 pm

    This posting reminds me of the story of a friend of mine who met a man who claimed he had lost 100 pounds. When she asked what his secret was, he smiled and replied, “I don’t eat.” ;-)

  30. calyon 27 Feb 2009 at 7:03 pm

    @able-x: I’m incredibly envious of you. Losing 8 lbs in a month for me requires 60-90 minutes of exercise per DAY and a 1200-1500 calorie diet. And 4 months of that didn’t even make me thin…I lost a little over 30 lbs and was still slightly overweight.

    I can’t maintain that amount of exercise now that I have two jobs, but I’m still active. I figure skate, I walk everywhere (live in San Francisco, don’t need a car), I do weight training at home.

    I eat a pretty healthy diet. Few sodas, few sweets. I don’t even like red meat. But I eat when I’m hungry – not bored or emotional hungry, but stomach hurting and growling, extremities getting cold, headache starting HUNGRY. For some reason willpower won’t make those go away. And intuitively eating when I’m hungry amounts to an intake of 2000-2300 calories a day. So I’m feeling fit and active, and according to my medical records I’m not suffering any weight related health problems (unless migraines and seasonal allergies are somehow weight related). But I stay at about 180-190lbs and according to my BMI I’m obese.

    So what gives? I’m pretty sure I’m not sleepwalking to the bakery in the middle of the night and downing pies. But the math isn’t really working out for me. On paper I’m not consuming enough calories to maintain my current weight.

  31. Parroton 27 Feb 2009 at 7:36 pm

    Hey Steve,

    I completely agree that all the little “tricks” people come up with to try and fool your body into losing weight are useless.

    However, I’m wondering if the “calories in/calories burned” equation is really a useful way of thinking about this.

    Of course, I’m not suggesting that our bodies don’t follow the laws of thermodynamics. But there are so many factors that fiddle around with the way our bodies process calories and regulate weight. Medicines, illnesses, stress, viruses, genetic conditions, the composition of bacteria in the gut….. and science has barely scratched the surface towards understanding all of the factors that affect human weight regulation.

    So, of course it’s always bunk when some quack diet inventor comes along and latches onto one small fact about the body’s weight regulation system as the basis for his diet claims.

    What I’m wondering is if convincing people to lose weight is even a goal that we should be pursuing. You mentioned that 5% of people are able to keep the weight off through constant vigilance. As I understand it, people who lose a lot of weight and manage to keep it off have essentially forced themselves to become exercise and diet fanatics. They begin living such a rigorous lifestyle of self denial, such that few people would care to follow their example.

    I also understand that those who manage to lose a lot of weight and keep it of can display signs of anorexia such as thinning hair, brittle fingernails, headaches, and feeling cold all the time. And they generally look anything but emaciated.

    I also believe that it’s well accepted that yo-yo dieting (losing weight only to gain it back) is more harmful to your health than is maintaining a higher weight for the same period of time.

    Given that most obese individuals regularly diet, and given that 95% of them regain all the weight and even gain some, I’ve got to wonder how much of the relative risk increase for disease among obese individuals is due to a history of dieting rather than the mere existence of excess weight.

    I believe that is one of those confounding factors that is rarely considered.

    Don’t get me wrong. I’m all behind the message of encouraging everybody to eat a balanced diet and to be active. I believe that such advice can definitely affect people’s health for the positive.

    But I’m not sure that losing weight should be a major goal of encouraging this kind of behaviour. My guess is that convincing people to closely watch their calories and keep an eye on the scale turns this into a chore in order to reach a goal that may not be reasonable. Then when people inevitably give up, they throw away any incentives they had to be active and eat well in the first place.

    Isn’t it more reasonable to promote healthy activity as something fun to do for yourself rather than as a means of losing weight? And shouldn’t we be promoting a varied diet as a fun way to find new taste sensations? Fruits and vegetables are tasty after all, and if there are some that you don’t like you don’t have to eat those.

    I think people can do good for their health by being active and eating well regardless of whether they lose any weight. And I think that’s the kind of attitude we should be promoting, rather than the calculating “calories in/calories out” mentality of total control over one’s body that is almost certain to result in disappointment.

    I hope my message isn’t too long. If I’ve made some sort of error in reasoning or fact, please let me know. And keep up the good work!

  32. HHCon 28 Feb 2009 at 12:54 pm

    caly, Since you like to skate consider this statistic, speed skaters have approximately 12% fat composition based on skinfold equations. Skinfold method for body fat estimation developed by
    Boscardin 1988 would involve measuring a light to medium athletic male at the triceps (vertical fold), abdominals (vertical fold) and pectorals(diagonal fold). Estimation of % fat is completed by this formula, % Fat= 6.036 + .446(Tricep) + .279(Abdominal) – .486(Pectoral)

    Note:Weight loss occurs first in internal fat, not detected by skinfold measurements.

  33. calyon 01 Mar 2009 at 1:46 am

    @HHC: I’m a girl, so I don’t know how that would affect the comparison of body composition and types of fat. I’m ‘pear-shaped’ which as I understand involves more subcutaneous fat rather than visceral abdominal fat.

    But suffice to say, I’m not overweight because I’m massively muscular. According to an at home scale that measures body fat (I have no idea how accurate those are) I’m at around 36% body fat.

    Speed skating and figure skating are, in my opinion, totally different. I would think speed skating would require a great deal of stamina, and while you do need decent stamina for figure skating, things like jumping require shorts bursts of a lot of energy. It’s more like interval training, I guess.

  34. SDRon 01 Mar 2009 at 2:02 am

    Damn, you guys and stories like this make me feel so lucky. Due to some aspect of my metabolism I am able to lose 10 or more pounds in two weeks easily with just slight changes to my diet. As my eating habits tend to change through different parts of the year, I’ve been known to lost and gain 30 pounds in very short amounts of time many times throughout a year. That’s the problem though, just as fast as I can lose weight I can also gain it.

  35. HHCon 01 Mar 2009 at 11:44 am

    caly, OK, I can give you info for female figure skating, %fat =17% of body composition. Sinning (1978) developed a good equation for female gymnasts and dancers. You will need value A, circumference of the mid- neck(cm), value B, Supra-iliac skinfold (diagonal in mm), abdominal skinfold (navel area in mm).
    Insert values into:
    1.02462 + (.002024 x A) – (.001435 x B) – (.001039 x C) = Density
    [(4.95/ Density) - 4.50] x 100 = Percent Body Fat

  36. eiskrystalon 02 Mar 2009 at 5:08 am

    -Few sodas, few sweets- How many exactly per week and what is their sugar content? How much alcohol do you drink (rhetorical)

    Try keeping a food diary, it is easy to fool yourself into thinking you haven’t eaten much. You should be eating small and often.
    You should never be so hungry you feel dizzy or get headaches.

    It can take as long to remove body fat as it took to put it on in the first place. Comparing yourself to other people and their “claims” is a hiding to nothing. Good Luck.

  37. Owenon 02 Mar 2009 at 9:50 am

    “Given the wishy-washy nature of prior evidence, this large and long follow-up study should put to rest the hype over macronutrient-based diets. I know it won’t, but it should.”

    Er, why would you think that? I’m assuming you’re referring to (amongst other things) low-carb diets.

    This study simply didn’t address low-carb diets. True there was a group following a diet based on what they called “low carb”, but no low-carb proponent would recognize it as such. 35% is not low-carb! If nothing else, low-carb diets aren’t calorie restricted, whereas all these were.

    (That’s not to say other studies haven’t done it better, or that this one doesn’t provide valuable information, but it contains nothing to persuade a low-carb fan to change their mind.)

  38. HHCon 02 Mar 2009 at 11:47 am

    Here are a few more equations you can play with to understand body composition.

    Total Weight x [Percent Fat/100] = Fat Weight
    Total Weight – Fat Weight = Lean Body Weight

  39. khanon 02 Mar 2009 at 6:47 pm

    Just an anecdote.

    I was obese for several years, tried various ‘diets’.

    Retired from a stressful job in Dec ’04.

    Lost 1/2 per week for the next 3 years = -80#; with very little conscious effort.

    Reduce calories -> lose weight. True.

    But (in my experience) first you have to overcome/eliminate the stress.

  40. calyon 03 Mar 2009 at 3:10 am

    @eiskrystal – generally no more than 1-2 sodas per week…and frequently those sodas are the fruit and sparkling water combo rather than Coke or Pepsi.

    I drink very little alcohol, since I’m supposed to avoid it because of my migraine medication. Yes, you said it was rhetorical, but alcohol has a lot of calories and some people do drink wine or beer on a daily basis.

    I have a kept a food diary, carefully calculating every last calorie. I’ve forced myself to eat less than 2000 calories and been miserable the whole time. I’ve also kept a diary while eating whatever I wanted, just to see what the results were – and regardless of what kinds of things I ate (ie: a ‘junk food’ day vs. a healthy food day) I always consumed between 2000-2300.
    I already eat small meals frequently – about 2 hours after eating I’m hitting the point where I need to eat again.

    Your type of response is a common one to people who can’t lose weight. Either we’re not trying hard enough, we’re too stupid to get it right, or we’re lying.

  41. eiskrystalon 03 Mar 2009 at 4:43 am

    Your type of response is a common one to people who can’t lose weight. Either we’re not trying hard enough, we’re too stupid to get it right, or we’re lying.

    At no point did i say that. I gave you commonly known advice which incidently you have already followed. I also wanted you to quantify what your version of “few” was and also to make sure that you were including alcohol consumption in your calories as it is easily forgotten.

    I know it’s a touchy subject, but that was way over the top defensive.

  42. Parroton 03 Mar 2009 at 9:04 am

    > So I’m feeling fit and active, and according to my medical records
    > I’m not suffering any weight related health problems (unless
    > migraines and seasonal allergies are somehow weight related).
    > But I stay at about 180-190lbs and according to my BMI I’m
    > obese.
    >
    > So what gives? I’m pretty sure I’m not sleepwalking to the
    > bakery in the middle of the night and downing pies. But the
    > math isn’t really working out for me. On paper I’m not
    > consuming enough calories to maintain my current weight.

    @caly,

    The thing is, the human body has a very complex weight regulation system. It likes to keep your weight within a certain range, and if you try to manipulate it beyond that range, it will conspire to thwart you.

    The math of calories in/calories burned is a pipe dream. You can lose weight by decreasing the calories you consume and increasing the amount of exercise you do… but go too far and your body plays around with your metabolism, and suddenly you’re not processing calories the same way you used to, and exercise is not giving you the same calorie burning potential that it did when you started out.

    You say that you’re not suffering from any weight related health problems. What’s your goal in trying to lose weight? Are you afraid of some specific weight related illness and hoping to prevent it?

  43. Fifion 03 Mar 2009 at 11:00 am

    caly – A food diary is useful to get to know one’s own eating habits but it sounds like it became a punishment not just a tool in your efforts to lose weight.

    Please feel free to take or leave what follows…

    If you want to lose weight it’s crucial to learn how to love or at least accept being and feeling hungry sometimes. Hunger is a sign that your body is about to start digging into stored energy reserves (fat). So, to lose weight we need to be able to experience and tolerate hunger.

    Make a distinction for yourself between eating for fuel/hunger and eating for pleasure. You don’t need to give up eating for pleasure, just be conscious of which is which and make sure you really, really enjoy that pleasure food. Buy one really high quality delicious French pastry or cookie (well, maybe two cookies :-) )and savor it instead of eating a whole bag of crappy calorie reduced “treats” that leave you full but unsatisfied on every level (and feeling guilty and like a failure). If food has another meaning for you (food=love, food=security, food=rebellion, food=entertainment, food=company, food=water etc), then it’s useful to figure that out so you can get those needs met in other ways (they’re real needs, they deserve to be honored and respected and addressed instead of denied/ignored/pushed aside with food). You’ll only be able to figure out what other needs get interpreted as “need food”. To do this you need to allow yourself to feel the need, which requires not filling the need with food when you feel it. Also, many of us misinterpret a desire for fluids as a desire for food (we get a lot of our hydration from food sources). When you feel “hungry”, have a small glass of water and wait a while to see if you’re still hungry. Experiment with yourself, write down what you observe and notice so you can refer back to it. A food diary is much more useful if it’s about all of how you’re doing and how food is connected with other things in your life. Sometimes we just need a hug :-)

    Stay away from “diet” food that advertises itself as being low calorie because it’s low in fat. There are a couple of reason to do this. One is that these products tend to be overly sweet or salty to make up for the lack of fat so it trains your tastebuds to want even sweeter and saltier foods to be satisfied taste-wise. Two, if your body is craving fat then sugar won’t fill that craving. Better to eat a smaller portion of something satisfying. The less processed something is, the better it is for you generally.

    As long as we view losing weight (or changing any unhealthy habit) as a negative activity and punishment – as being about outside concerns and not about our own desires and contrary to our desires and needs – then we’re fighting and rebelling against ourselves and the outside sources of our self oppression. If we look at the process of losing weight (or changing any other unhealthy condition or habit, smoking included) as being liberating and a way to free ourselves from being oppressed by our own flesh (depending on how we restrict our lives or our lives are restricted by obesity) and society/advertising/food industry (which lies as boldly as tobacco companies do).

    Of course, only you can know your own body. This is why keeping a food diary that also takes emotional and life situations into account helps us get to know our own bodies and habits so that we can start figuring out the best way for us, as individuals with individual needs and personalities, to change our life so we’re living in a way that sustains us rather than oppresses us.

  44. calyon 03 Mar 2009 at 2:11 pm

    @eiskrystal: No, you didn’t come out and say it, but it’s implied. You’re offering me “commonly known advice” under the assumption that I don’t already know it.

    @Parrot: There’s a lot of stigma with being fat. Even though I’m perfectly healthy doctors test my cholesterol and glucose with greater than neccessary frequency to make sure I’m not about to have a heart attack or become diabetic.
    And of course they all assume I never get any exercise. I had to assert to the hospital receptionist that I was seeing a PT for rehab on an old ankle injury that’s hindering my skating, not for a basic fitness class. The same receptionist also joked that walking across the street to that office must have been good exercise for me.

    Our society asserts that if you’re fat, you’re a failure. Because all you have to do is not eat all those potato chips and ice cream and take a walk a couple times a week, right?

    Beyond that, my main personal reason for wanting to lose weight is that it should improve the height of my jumps, assuming I can keep my current muscle mass and just lose fat.

    @Fifi – I understand what you’re saying, but I’m asserting that I don’t eat for emotional reasons – I eat when I’m hungry. I’m defining hunger as being at the point that my stomach is hurting and growling, my head is starting to hurt, and I’m feeling slightly dizzy and lethargic. If I don’t eat at this point I will eventually start feeling very nauseated, have a full blown headache, and become clumsy and disoriented. Drinking water does not solve any of these problems.

    I avoid diet foods like the plague because they usually contain artificial sugars or msg, both of which are migraine triggers for me.

    I could deal with the physical pain of hunger if that were the only issue I was having. But I basically become non-functional if I don’t eat when my body thinks it needs food.

  45. Fifion 03 Mar 2009 at 3:20 pm

    Caly – Ah, the low blood sugar blues. Are you a woman? I think most of us women are familiar with the blood sugar blues (particularly as we age) – though I think the symptoms sometimes get brushed off as “being emotional” (a symptom but not the underlying cause, which is low blood sugar). Have you tried keeping a snack like nuts or fruit around? Often a small handful of nuts or trailmix, or a piece of fruit, is excellent for leveling out blood sugar between meals (the worst thing we can do is reach for a sugary snack or drink!)

    I find it interesting that you describe hunger as pain. I’m not questioning your experience of hunger, only you can know what you feel. However, hunger is usually a discomfort not an extreme sensation. It also sounds like you may be creating a negative loop for yourself. Do you recognize your hunger before it reaches the point of pain?

    If you’re comfortable at your weight and have no health issues, and it’s not preventing you from enjoying your life, why do you want to lose weight? Or do you not want to? (If so, my apologies for making recommendations as if you did!)

  46. calyon 03 Mar 2009 at 3:37 pm

    @Fifi – I am a woman, just hit 30…but I’ve had this issue since my early teens. Low blood sugar is what the symptoms fit, but I’ve had my glucose levels tested, and even after fasting though it will be low, it’s still within the normal range. So I don’t think I’m hypoglycemic.

    Fruits, nuts, cheese, and yogurt are my usual snack items. I usually pair a piece of fruit or raw veggies with something with fat in it. I’m not a big meat eater, but I try to always include eggs, fish, or chicken with at least one meal a day.

    I do recognize when I’m just starting to get hungry, but I try to ignore it until I’ve at least reached the 3 hour point since my last meal.

    I’m not comfortable at my current weight, but I think part of it is feeling pressure to look normal instead of fat. I’ve lost weight before, but it was only with extreme measures. Very low calories (the Slim Fast diet), excessive exercise, and taking ephedra and appetite supressants. At the time I was taking a semester off school and only working part time, so I devoted my copious spare time to losing weight. I don’t want to be obese but I also don’t want to do that again.

  47. Parroton 03 Mar 2009 at 3:55 pm

    Caly, I definitely agree that there is a societal stigma against fat people. In a perfect world, that wouldn’t apply to doctors, but unfortunately it does.

    Even though the slight increases for excess weight in relative risk for conditions like heart disease and diabetes pale in comparison to other factors such as genetics and age, doctors still tend to narrow their focus a patient’s waist size as a primary health indicator.

    I think doctors probably find it easy to prescribe diet and exercise without a second thought. And for whatever reason, there’s been a big push towards convincing doctors to micro-manage their patients’ risk factors as though they were professional “life coaches”.

    There are groups online devoted to allowing fat people be themselves and complain to each other about a society obsessed with thinness. I even saw one somewhere with a list of “fat friendly doctors” who are considered to be sympathetic and won’t assume that you’re likely to drop dead of a heart attack next week because of your size.

    I don’t know too much about these groups or how closely knit this community is. But I’m sure if you do some searching you could find somewhere to vent some steam and connect with people who’ve been through similar situations.

    I think it would be a good idea for you to examine exactly what you want to accomplish with your diet and exercise regime. At what point are the diminishing returns no longer worth the effort you’re putting into it?

    Eating well and being active are wonderful traits to cultivate. Pushing yourself too far, though, is not a good idea.

  48. cheglabratjoeon 04 Mar 2009 at 1:02 am

    caly,

    I think the math in your first post works out perfectly well, actually. Assuming 3500 calories per pound, losing 8 lbs per month would require a ~1000 calorie per day differential. This is almost exactly the difference you claimed between your “loss” and “maintain” periods.

    As for 1-2 sodas, that’s sadly enough to offset a whole lot of exercise. If I ride the stationary bikes at the gym for half an hour, I step off them feeling like I just completed a mountain leg of the Tour de France. But, the damn machine only says 200 calories burned. That’s only enough to offset a *single* sugary drink. It adds up!

    I don’t know what to tell you. It is hard to lose weight. I did it by completely removing snacks from my diet (i.e. only eating at meals) and switching to diet soda. It was a serious struggle for months and months, but that shouldn’t have surprised me. I spent 23 years slowly accumulating excess fat, so why should losing it in a few years be easy?

    You might dismiss me as “lucky,” and indeed many of my friends and family have. It’s funny how perceptions change, or even reverse. Previously, I was “unlucky.” I had a slow metabolism, I was “a big guy,” I was just all-around “big” (I’m pretty tall, too). My favorite term was “husky.” :) Well, these armchair metabolic whizzes can think whatever they want, but nothing changed … save my diet and activity level.

    Parrot,

    The only pipe dream is believing that “the math” doesn’t work. Again, the only way it could be wrong is if your body magically violates thermodynamics. What do you mean by “your body play[ing] around with your metabolism”?

    Don’t get me wrong, I’m sure there are changes to how your body uses calories as you exercise. But, you physically cannot get around the in-out equation, and how much do you really think your body “plays around”? Let’s say you go to the gym a lot one week and burn 2000 calories. What will a “really fit” person burn, if s/he does the same exercises? 1900, 1800, 1500? Surely not, say, 100, right? So, we’re not talking drastic changes here.

  49. Parroton 04 Mar 2009 at 1:24 am

    I’m glad that Fifi brought up all those tips for losing weight, because they’re prime examples of how a non evidence based approach to health can lead us astray.

    I don’t mean to pick on Fifi here, I don’t believe that she’s trying to pull the wool over anybody’s eyes. But there are a lot of really silly theories going around about weight loss that are believed by a lot of people. So Fifi, you’re in good company.

    Let’s take a look at these tips. First there’s the advice that feeling hungry is an important part of weight loss. The idea is that hunger signals that your body is about to burn some fat.

    That’s not the way the body works. The mechanism for feeling hunger or satiety is not directly connected to the mechanism for burning calories from fat in such a manner. To my knowledge, no such mechanism has been suggested by researchers.

    In addition, it’s well known that the human body is very protective of it’s fat reserves. In fact, if the body is in need of extra energy, it has a tendency to dip into it’s stores of lean tissue such as muscle first. That’s why it’s often advised that you should combine diet with exercise in order to help compensate.

    The second part of the advice in that message involves the theory that fat people have a dysfunctional relationship with food that they need to get under control. They “live to eat” rather than “eat to live”. The suggestion, which is widely believed, is that fat people are more prone to allow their emotions to control their eating and make them pig out.

    You even once in a while see studies comparing the pleasure fat people get from food to the experience of drugs. The implication is that fat people are food-aholics. They have some addictive disorder and need intense help to get over it.

    The evidence for this position, though, is thin. No psychological tests have been able to show that fat people are more prone to addictive behaviour or any sort of mental problems than anybody else.

    The idea that what fat people need is psychological help in order to overcome their “issues with food” is widely accepted, but hasn’t been proven.

    Next, the suggestion that many of us mistake a “desire for fluids” as a “desire for food” defies credibility. Thirst feels different from hunger, there’s no way to mistake the two. It should go without saying that there’s no scientific evidence that people are in any way likely to have a snack by accident when they really feel thirsty instead.

    This isn’t science, this is just a trick that somebody, somewhere speculated might make you eat less. Maybe if you drink a few glasses of water and concentrate real hard, you can convince yourself that the bloated feeling you’re getting is actual satiety. But it will be short lived.

    I do agree that special diet foods aren’t worth the extra money you’re paying for them. And while it’s true that they’re usually jumping on this bandwagon with little evidence and fleecing customers out of their money, comparing food advertisers to the tobacco industry is going much too far.

    Cheap tricks trying to convince your body to lose weight help nobody. Eat your fruits and vegetables, and keep active. Those are the only two basic pieces of advice that show any evidence of helping people.

  50. Parroton 04 Mar 2009 at 1:43 am

    > Parrot,
    >
    > The only pipe dream is believing that “the math” doesn’t work.
    > Again, the only way it could be wrong is if your body magically
    > violates thermodynamics. What do you mean by “your body
    > play[ing] around with your metabolism”?

    cheglabratjoe,

    Your body does not have to violate the laws of thermodynamics in order for my statement to be true.

    We know that there are a lot of factors that play around with how efficiently your body processes calories. Bacteria in the gut tend to be different between fat and thin individuals, causing overweight individuals to process calories more efficiently.

    And studies have consistently shown that other factors kick in to affect your metabolism as you gain or lose weight. If you’re trying to lose weight, you can only do so for so long before your metabolism slows. We don’t know all the biological factors that cause this to happen, but I believe the fact that it does happen is uncontested.

    When your body becomes more efficient at processing calories, and less efficient at burning them, then you’re left with diminishing returns on your weight loss plan, and the calories in/calories burned formula becomes useless.

    It’s not that the formula is entirely wrong per se. It’s just that neither the “calories in” nor the “calories burned” part of the formula remains constant. It’s not a violation of thermodynamics.

  51. Parroton 04 Mar 2009 at 2:04 am

    > Don’t get me wrong, I’m sure there are changes to how your
    > body uses calories as you exercise. But, you physically cannot
    > get around the in-out equation, and how much do you really
    > think your body “plays around”? Let’s say you go to the gym
    > a lot one week and burn 2000 calories. What will a “really fit”
    > person burn, if s/he does the same exercises? 1900, 1800,
    > 1500? Surely not, say, 100, right? So, we’re not talking
    > drastic changes here.

    You would be surprised.

    The kinds of changes that the body makes to it’s metabolism are not encapsulated solely in the measurements of single periods of intentional exercise, though they certainly show effect there.

    I believe it was Dr. Ethan Sims of the University of Vermont who managed to show that naturally thin individuals trying to gain weight had their metabolism increase by 50%. So instead of burning 2,000 calories weekly on such exercise, they would be burning 3,000

    Similar effects exist for people trying to lose weight, and generally they’re unable to gain or lose more than 20% of their original body weight before these effects kick in with a vengeance.

    But like I was saying, it’s not just about burning off as many calories as possible in planned, fixed time exercise sessions. What happens outside of those sessions counts too. People trying to gain weight tend to get fidgety, and feel a constant need to move around. These little movements, performed constantly, add up.

    On the other hand, people trying to lose weight tend to feel listless, and want to move as little as possible. Their bodies are convincing them to conserve as much energy as they can, and even if they work really hard at exercising for short periods a day, the effort doesn’t overcome the body’s inclination to conserve it’s energy.

    So I would say yes, we are in fact talking about drastic differences here.

  52. cheglabratjoeon 04 Mar 2009 at 2:41 am

    Parrot,

    I would be interested in seeing that research. Do you have the references handy? I’ll look more tomorrow for myself, but if you know of them offhand I’d appreciate it.

    Nevertheless, your argument seems muddled. For instance, you say natural thin individuals had their “metabolism increase.” That is, they were burning 3000 calories when you’d think they ought to burn only 2000. So, thin people were using calories less efficiently … to get the same energy output, they needed more raw fuel.

    Well, that’s precisely the opposite of what you were saying above. You were saying that, as you exercise, your body gets MORE efficient and thus your exercise is less effective at making you losing weight. You have it exactly backwards.

    You’re using the blanket term “effects” to describe these contradictory ideas (your body getting more or less efficient). Which is it?

    If you’ll allow me to speculate, I think a lot of this confusion stems from considering our modern lifestyle as “normal.” Instead, try thinking about cheetahs and weight loss. Imagine two cheetahs, one out-of-shape and the other very fit. Let’s say you argue that the fit cheetah has a “fast metabolism,” and that helps him stay fit. The out-of-shape cheetah has a “slow metabolism,” which explains his pudginess.

    Well, does this really make any sense? No! If the fit cheetah has a “fast metabolism,” that means he’s unnecessarily burning calories. That’s fantastic if you’re a sedentary human, but it’s terrible if you’re a cheetah. He’s going to have to hunt more, lest he starve.

    And, the more he hunts, the more fit he is, the faster his metabolism, the more calories he unnecessarily burns. And so he hunts more, is more fit, has a faster metabolism, burns more calories, etc etc etc, til he dies. All the while, the “slow metabolism” cheetah is doin’ fine.

    A “fast metabolism” means you’re inefficiently using calories. You’ve now claimed that thin/fit people BOTH have a fast metabolism AND use calories efficiently. Sorry, but you can’t have your cake and eat it, too. (Thank you, I’m here all week.)

  53. Owenon 04 Mar 2009 at 7:03 am

    Joe, here’s one:

    http://www.ajcn.org/cgi/reprint/21/12/1455

    (it’s a PDF)

    By the way, I can’t follow your reply completely. Can I just confirm: you are aware that Parrot isn’t saying “fit/thin people have a fast metabolism”, but instead that naturally thin people who try to put on weight find they “use up” more calories than would be expected (for the period they are consuming extra calories)? That doesn’t necessarily mean they *need* more calories under normal circumstances, just that when overloaded with calories their bodies alter the way they respond.

    That’s not to say I am convinced, although I am sympathetic, as there is an analogous situation with body-builders bodies responding differently to exercises over time. But I feel that you don’t seem to be addressing the point Parrot is making. The efficient vs fast thing is just obscuring the argument.

    (I prefer to avoid terms like “increased metabolism” , “efficient metabolism” and “fast metabolism”, as they seem to be regularly confused with each other. The labels don’t matter, as long as the underlying concepts are clear.)

  54. Parroton 04 Mar 2009 at 7:44 am

    > I would be interested in seeing that research. Do you have
    > the references handy? I’ll look more tomorrow for myself, but
    > if you know of them offhand I’d appreciate it.

    The pioneering studies by Dr. Ethan Sims and others such as Dr. Jules Hirsch were conducted before the age of the Internet, so I’m not entirely sure where their papers would be available online. Their work is well attested, though, and has generally only been confirmed by further studies.

    I recommend reading the following article by science writer Gina Kolata about the history of this research (and if you get the chance to read her book on the 1918 flu pandemic, I highly recommend it):

    http://www.nytimes.com/2007/05/08/health/08fat.html

    I don’t think the fact that obesity is largely controlled by genetics is in question. Nor is the fact that the effect is shown through metabolism. There have been numerous studies performed on this link. Just look at any studies of the Pima Indians, whose population is about 80 to 85% obese.

    Researchers don’t believe that the reason for this is that Pima Indians are more gluttonous than anybody else. Rather, this amount of obesity is generally thought of as being due to an extreme level of “thrifty genes”.

    The Pima’s have a genetic build that allows them to easily store energy as fat. Their bodies are extremely efficient at processing and storing energy, and efficient at using the energy they do have available so that it’s burned off very slowly.

    This allowed them to survive in harsh conditions where food was scarce. But in a condition of plenty, they show a remarkable tendency to gain weight.

    I don’t think there’s much, if any, contention among scientists that this isn’t the most reasonable conclusion. And the consensus is that the population in general is likely to have varying concentrations of these “thrifty genes”, accounting for most people’s propensity to excess weight.

    It seems fairly clear that metabolism and energy use changes based on weight. If there’s any significant contention to that point, I haven’t heard of it. If you do know of any reasonable contention, I would appreciate being informed about it.

    The information about bacteria in your gut affecting calorie processing comes from a study published in the journal Nature. I believe Dr. Novella mentioned it once on a Skeptics Guide episode.

    I have a quote from the lead researcher, Jeffrey Gordon, who said:

    “Not everyone sitting down to a bowl of cereal will necessarily absorb the same number of calories from it”

    It’s pretty clear that the body’s weight regulation systems are complex, and that we don’t understand most of it. What we do understand demonstrates that there are many complex and interwoven factors that affect an individual’s weight, and that it’s almost certainly not as simple as calculating calories in vs calories burned.

    If you want more information on specific studies or more evidence, I’ll certainly do some more research and see what I can find. But I don’t believe that the statements I’ve made here are under scientific question. If you have information to the contrary, though, I will gladly look at it.

    This has gone on a little long so I’ll respond to the rest of your message later in a separate message.

  55. Parroton 04 Mar 2009 at 8:12 am

    > I’ll respond to the rest of your message later in a separate
    > message.

    During the time I was writing this, Owen has actually pretty much covered my response. So I’ll wait to see what the answer to that is.

    Thanks for saving me some time Owen!

  56. Fifion 04 Mar 2009 at 9:21 am

    Parrot – What you may not realize is that obesity is behavioral and for many people – calories in and calories out is all about eating and exercising habits (or “tricks” as you’ve designated the particular habits I’ve outlined). It’s simplistic to think that people don’t have cultural and emotional relationships with food – particularly since most cultures associate food with expressing love or being rewarded. We only really notice when these relationships are unhealthy or have resulted in ill health.

    Just so you know the context I’m coming from, I’ve followed the science about weight and appetite (I used to live with a neuroscientist whose research was into appetite) and worked with chronic pain patients to help them change their eating habits. I don’t assume all people trying to lose weight are similar to the patients I counseled but it did give me insight into the psychodynamics of lifestyle and dietary change. Some personality types work very well with a rational explanation about the nutritional values of certain foods and energy in vs energy out (particularly people who are logic driven) and can discipline themselves quite easily. The vast majority of people are much more emotionally driven than that about the topics of exercise, food and delayed vs instant gratification (aka self discipline).

    The reality is that we still have a lot to learn about nutrition and exercise. Some people do have underlying medical conditions which contribute to obesity, also some medications do. This is not most people (and I have often wondered whether obesity causes thyroid issues more often than vice versa). We’re still figuring out the exact roles of ghrelin and leptin but we are starting to better understand the sensation of hunger and its relationship to appetite. There are many reasons why I said it’s important to change one’s relationship with hunger…
    1. cutting calories and/or increasing exercise always results in increased hunger
    2. people are often looking for magic weight loss where they don’t have to “endure” the discomfort of hunger or exercise, or face the feelings of frustration, etc that arise when we do something we don’t find pleasurable
    3. hunger is a feeling first, and for most of us it’s connected to very primal emotions that have to do with being maternally nurtured. If we’re not aware of our hunger until it become painfully intense, there’s a good chance other feelings are also being ignored until they’re urgent (and quite possibly denied or changed via mood changing food or substances).
    4. it’s just generally easier to sustain discomfort (maintain self discipline) if we know that our discomfort will bring a reward. For many people food is a reward and hunger is a punishment, can you see how changing one’s beliefs can be useful here?
    5. if someone does have a biological malfunction that means they’re hungry all the time AND they want to lose weight, obviously that means they’re going to have to endure more discomfort vis a vis hunger than the average person. Until a medication is developed, people don’t have many other options if they’re eternally hungry (and a lot of money has gone into developing a magic fat busting or appetite suppressing pill since it’s potentially highly profitable).

    By the way, I live to eat (and I’m within my healthy body weight). One doesn’t have to give up delicious food to be a reasonable weight – though obviously it helps if you love food enough to know how to cook it into delicious meals. One also doesn’t have to always be on a treadmill. I’m a sensualist and I love food and eating, I also enjoy the sensual aspects of exercise. Both eating and exercise are at least partially social activities for me and my friends – we often cook together and for each other, we go on hikes, we ride and do other physical activities together. Reading cookbooks and recipes is an almost pornographic pleasure for me (cooking combines science experiments with art, does it get any better? ;-) ). I don’t believe that people have to give up all pleasure in food – social or personal – to lose weight. In fact, it’s been my experience that it’s highly counterproductive to approach permanently changing one’s eating and exercise habits as a punishment (and that when people do approach weight loss as a punishment and something done for others, there are usually other underlying issues vis a vis self-care vs being cared for by others).

    The suggestion to drink water isn’t a “trick”. Some people genuinely can’t differentiate between their needs and the water vs food one is tricky at the best of times since our bodies also get hydration through food so before consuming calories it’s a sensible thing to do to drink some water. This is also a way to get people to start being comfortable with feeling things that aren’t comfortable (delayed gratification is a skill apparently a lot of North Americans don’t learn as children so need to learn as adults, mainstream culture tends to applaud and promote immediate gratification, it’s what advertising is all about…the food industry is no different than cigarette manufacturers ethically, with much less oversight at this point).

    It’s just like how putting more exercise into one’s normal routine (taking the stairs instead of the elevator, walking or biking instead of driving, getting rid of the tv remote, etc) is a gentle way to put more activity into one’s daily routine. It’s not a “trick”, it’s simply a way to increase calories out during normal activity. Studies have shown that urban dwellers generally weight 10lbs less than suburban ones, this has to do with daily habits such as walking instead of driving.

    Parrot, I certainly don’t think all obese people are foodaholics or that there aren’t hereditary factors for some people (though we do have quite a bit of input into how our genes express themselves via nurture and behavioral habits around food and exercise are learned from parents, rarely do I see a fat child who isn’t being poorly fed by an ignorant parent who probably learned from their own parent how to eat…as so the family cycles go). People who don’t have an emotional or neurotic relationship with food or exercise can generally approach it as calories in and calories out and don’t have a hard time losing weight once they understand the concepts and re-educate themselves about food and exercise. The fact that we all have different ratios of calories in vs calories out needed to maintain certain weights just means we have individual in vs out ratios and need to deal with the card we’ve been dealt by nature and our nurture. How we nurture and care for ourselves now we’re adults – and what we’re willing to sacrifice for a certain reward (health, social attractiveness/desirability, etc) is an individual choice. I find it interesting how many people want to dismiss the psychosocial aspects yet, at the same time, express a need/desire to be accepted just as they are (which is a psychosocial need).

  57. daedalus2uon 04 Mar 2009 at 11:23 am

    caly, a measured blood glucose in the normal range doesn’t rule out hypoglycemia. The “important” glucose level isn’t in the blood, but it in the extravascular fluid adjacent to the cells that are taking up glucose. Glucose levels can’t be measured there because samples of fluid can’t be obtained, but that is where the “important” glucose level is. Glucose levels in the blood are regulated quite well and on the time constant of blood circulation (a few minutes). Glucose levels in the extravascular fluid can only change with the time constant of the circulation of the extravascular fluid which is much slower (tens of minutes or longer).

    I think you would be better off not waiting so long between eating. How hungry you are is a complex feeling derived by your body by integrating signals from all over your body. The time constant of some of those signals is slow because it takes a while for high glucose extravascular fluid to flow there and displace the low glucose fluid that is there when you start eating.

    I think that difficulties in glucose regulation relate more to low NO, which reduces the number of mitochondria and switches more ATP production to glycolysis. It takes 19 times more glucose to make a molecule of ATP via glycolysis than via oxidation. The circulation can’t supply much more glucose without going into hyperglycemia.

  58. Fifion 04 Mar 2009 at 11:30 am

    A study that points to the social and behavioral aspects of weight is this study into peer groups. Us humans are social animals, despite our illusions of self control. It’s hard to lose weight if it means you’re also losing your friends and social activities.

    http://content.nejm.org/cgi/content/full/357/18/1866

    There is also quite a bit of research into children’s eating habits and the influence of peer pressure and advertising that indicates these are big factors in obesity.

  59. cheglabratjoeon 04 Mar 2009 at 11:53 am

    Owen,

    I’m confused, too. That was my point. It seems that Parrot is using terms that signify *opposite* concepts interchangeably. My apologies if my own response was confusing, I was trying to show that, if you followed the argument in one of his comments, you arrived at precisely the opposite conclusion of his next comment.

    I’m a little surprised that you think I’m the one obscuring the argument; Parrot was the one who called a simple calorie balance a “pipe dream,” and is now mixing up concepts. I’m trying to point out that this “fast metabolism” thing isn’t anything concrete. This is best evidenced by Parrot using it to explain away both: (1) fit/thin people not gaining weight (ie using calories inefficiently), and (2) overweight people getting diminishing returns as they exercise (ie using calories more efficiently). Which is it?

    Parrot,

    I don’t think I disagree with anything in your last comment, so perhaps I misread you above and we’re on the same page.

    Well, let’s say maybe we’re on a closer page that I had thought. :) I’ll grant you that nutrition is very complicated, but it’s still perfectly explained by the following:

    Weight Change = Eat – Excrete – Burn

    Maybe some people absorb less calories from certain eaten things than others, maybe some people burn more calories just lounging around than others, maybe some people burn more calories via a given exercise than others, etc etc etc. But, that equation still holds (again, it’s impossible that it wouldn’t) and more importantly the recommendations for weight loss don’t change.

    Eat less, move more. Sure some people might respond differently to moving, and sure some people might respond differently to changes in food consumption. These complications do not change the overall balance or the overall path to weight loss. All this obfuscation does is confuse people and, frankly, give them crummy explanations for why they or others are skinny or big.

  60. Owenon 04 Mar 2009 at 12:13 pm

    Quotes from Fifi:

    “By the way, I live to eat (and I’m within my healthy body weight).”

    “One doesn’t have to give up delicious food to be a reasonable weight – though obviously it helps if you love food enough to know how to cook it into delicious meals.”

    “I don’t believe that people have to give up all pleasure in food – social or personal – to lose weight.”

    Back to me:

    And these are the reasons that you cannot reasonably comment on how other people can or can’t lose weight. To whit: you have it easier than you know.

    I LOVE food. I HATE cooking it. I /have/ lost weight (fat) — three stone over two years, with careful control of my calories and a lot of exercise. I drank water regularly, and particularly before meals. I chewed sugar-free gum to prevent snacking. In addition to going to the gym and suchlike, I made sure I walked to work on a regular basis, and walked when other people might have taken the car. I did All The Right Things(tm).

    But it was HARD. I was almost always hungry to some degree. Social events were difficult, with me fighting the urge to eat all the food on the table. The fat loss was unpredictable, some months going down a lot, some staying static, and others going back up. I was meticulous about tracking calories and exercise (and body-fat percentage), and I couldn’t work out how these things related to the results.

    Once I stopped actively dieting, I carried on exercising and being careful about what I ate (although somewhat less meticulously). I immediately started putting weight back on. Within six months I was up a stone. Three years later I’m back where I started. My activity levels and the amount I eat have varied quite a bit in that time, but I seem to have stabilized at my current weight, despite eating more than when I first stopped the diet. I have no idea why I couldn’t have stabilized a stone earlier.

    I’m very happy for you, that you can maintain a healthy weight and still enjoy your food without compromising much. I wish I could do the same.

  61. Owenon 04 Mar 2009 at 1:03 pm

    “I’m a little surprised that you think I’m the one obscuring the argument”

    I didn’t mean to imply *you* were obscuring the argument, just that the use of those terms does (which Parrot was guilty of). On re-reading, I clearly gave the wrong impression though, so my apologies. But you *are* continuing to focus on those terms when they are clearly of secondary importance. Whether the effect is caused by metabolisms speeding up, slowing down, becoming more efficient or less, the main point Parrot is making is that your body adjusts to the conditions it finds itself in. When naturally thin person overeats, it “speeds up/slows down [delete as applicable]” to maintain the status quo as far as possible. For a naturally larger person trying to under-eat, it does the reverse.

    “I was trying to show that, if you followed the argument in one of his comments, you arrived at precisely the opposite conclusion of his next comment.”

    Only if you get caught up on the whole fast/efficient metabolism thing. I wasn’t confused by Parrot’s position, but that’s because I can’t work out which way a fast metabolism is supposed to work, so I just glossed over those bits. Since Parrot has commented that my understanding of his/her(?) position is correct, I’ll just repeat it here, with minor amendments for clarity, and ask you to re-assess it with all this in mind:

    “Parrot isn’t saying ‘fit/thin people have a fast metabolism’ (despite using that confusing terminology more than once), but instead that naturally thin people (not ‘fit’ people) who try to put on weight find they ‘use up’ more calories than would be expected (for the period they are consuming extra calories). That doesn’t necessarily mean they *need* more calories under normal circumstances, just that when overloaded with calories their bodies alter the way they respond.”

    “This is best evidenced by Parrot using it to explain away both: [...] Which is it?”

    Following the above, the answer is “neither”. Please ignore the possibly poor use of the words fast/efficient/slow/inefficient, and focus on (what I believe to be) the underlying intent.

    Parrot: I hope I’m continuing to do justice to your position. I’ll gladly accept correction.

  62. Fifion 04 Mar 2009 at 2:12 pm

    Owen – “And these are the reasons that you cannot reasonably comment on how other people can or can’t lose weight. To whit: you have it easier than you know.”

    Actually, neither can you if you’re obese since you only have your own experience as someone who hasn’t lost weight to refer to (at least I’ve helped other’s lose weight and change diet and exercise habits…have you?). Seriously, the “you can’t talk about weight because you’re not fat” thing is silly. I’m not fat because I know how to manage my body weight and know my own body, not because of “luck”. My father and both his parents are obese, and I’m certainly that side of the family’s body type. (My mother is slim but she eats like a mouse and exercises like a fiend, her mother was obese and my grandfather was normal body weight.) I’m not magically at a healthy weight – I exercise and eat healthily. I know if Indulge in a high calorie meal that I need to exercise more and eat less calories the next day. I approach exercise and eating as pleasurable forms of self care. If, for whatever reason, I stop exorcising or start eating poorly, I gain weight. I could easily be obese if I changed my habits. There’s no magic or luck involved.

    “I LOVE food. I HATE cooking it. I /have/ lost weight (fat) — three stone over two years, with careful control of my calories and a lot of exercise. I drank water regularly, and particularly before meals. I chewed sugar-free gum to prevent snacking. In addition to going to the gym and suchlike, I made sure I walked to work on a regular basis, and walked when other people might have taken the car. I did All The Right Things(tm).”

    So, really, you love eating food. That’s a bit different than what I’m talking about (not that I don’t enjoy eating but it’s only a part of enjoying food for me, not the whole thing). Why do you HATE cooking food? If you love food, why isn’t preparing it a joy. (Kind of like foreplay :-) )

    You write about all your activity in the past tense. Lifestyle change that results in permanent weight loss requires permanent changes of habits. My suggestion wasn’t about drinking water regularly, it was to first respond to a feeling of “need” that is interpreted as hunger with a small glass of water. It’s not intended to fill the stomach, just to make sure you’re “hunger” isn’t for water. I don’t personally see the point in chewing gum since you’re essentially telling your body you’re eating all the time (because you’re chewing) but not providing any actual food (plus taking in empty calories and priming your taste buds to desire sweetness). It’s not about doing “the right things”, it’s about getting to know yourself and then making conscious choices. I’ve got friends who are obese, I don’t nag them about it or try to get them to go on diets. They’re adults and can decide for themselves what they want to trade off in terms of longevity for pleasure now. It sounds like you’ve only ever approached weight loss from a perspective of depriving yourself of pleasure. This too, of course, is your choice once you’re aware you have a choice.

  63. cheglabratjoeon 04 Mar 2009 at 2:55 pm

    Owen,

    No need to apologize, I think everybody’s just confusing one another. I think we’re more-or-less in agreement, in that fast/slow metabolism or less/more efficient calorie usage is something that’s easy to confuse and get caught up on.

    However, I’m not sure I buy the argument that your body works to maintain some sort of “status quo.” If that’s what you guys are arguing, I see now why I was confused and why my response only led to further confusion.

    You’re saying a naturally thin person’s body will work to keep them thin, but a naturally overweight person’s body will work to keep them overweight? (“Work” here being a very loaded word.) Am I in the ballpark? If so, I’ll need to look into those links above but for now I’m pretty skeptical of the claim.

    Most importantly, this is all an explanation of what is (or at least what might be) going on. It doesn’t change what you need to do to lose weight. Again, you need to eat less and move more. We can talk all day about how different people respond differently to the various ways to “eat less” or “move more,” but that’s ultimately what you MUST do to lose weight.

  64. son 04 Mar 2009 at 3:55 pm

    Eat like the poor and you will get fat/obese and under nourished today. The opposite was quite true not just a 100 years ago.

    http://www.ajcn.org/cgi/content/full/79/1/6 (Poverty and obesity: the role of energy density and energy costs).

  65. son 04 Mar 2009 at 4:36 pm

    A small addenda.

    Weight loss is not a simple question of calories in and calories out as most of this thread is about and partially the study in question. It is a complex genetic mechanism “tuned” by evolution to cope with varying lifetime access to food. There is research indicating that the diet of the grandparents may affect basal metabolism and regulation of fat storage of the progeny. So when you try to lose weight your genotype and phenotype may so to speak stack the odds even more against you.

    Some sample papers suggesting mechanisms:
    1. “Parental obesity and overweight affect the body-fat accumulation in the offspring: the possible effect of a high-fat diet through epigenetic inheritance” (http://www.ncbi.nlm.nih.gov/pubmed/16629875).

    2. Long-term consequences of maternal high-fat feeding on hypothalamic leptin sensitivity and diet-induced obesity in the offspring. (http://www.ncbi.nlm.nih.gov/pubmed/17553843).

    3. Methyl donor supplementation prevents transgenerational amplification of obesity. (http://www.ncbi.nlm.nih.gov/pubmed/18626486).

  66. cheglabratjoeon 04 Mar 2009 at 10:55 pm

    “Weight loss is not a simple question of calories in and calories out[.]” Why do people keep saying this? Here are the four things that can happen to calories in your body: you can eat them, you can poop/pee them out, you can burn them, or you can store them. That’s it! We’re not plants, so we can’t make them from CO2. We’re not magicians, so we can’t shazaam them out of our bodies.

    Fifi, I think you raise a lot of good points. As I said earlier, when I was bigger I was “unlucky.” I lost a bunch of weight by eating less and moving more, and now people say I’m “lucky.” A lot of this is perception, and all this obfuscation people are suggesting just gives people room to hide. “Why bother working out, if I get fit exercise will be less effective.” “My body just absorbs more calories than yours.” “My metabolism is just slow.”

    Besides, even if every one of those things is true, the prescription for weight loss is the same: eat less, move more.

  67. son 05 Mar 2009 at 5:05 am

    cheglabratjoe:

    “Resistance to the idea comes from a perception that variable weight loss on isocaloric diets would somehow violate the laws of thermodynamics, that is, only caloric intake is important (“a calorie is a calorie”). Previous explanations of how the phenomenon occurs, based on equilibrium thermodynamics, emphasized the inefficiencies introduced by substrate cycling and requirements for increased gluconeogenesis. Living systems, however, are maintained far from equilibrium, and metabolism is controlled by the regulation of the rates of enzymatic reactions.”

    In sum: the reason why it is not a simple equation is that more than one factor affect how you put on and lose weight. E.g.
    1) “Training and eating.”
    2) “Metabolic control” over 1). I.e in the end the genotype and phenotype.
    3) Gut flora effects on 1 and 2. Many unknowns :-)
    4) Thermogenesis (which is related to 2)
    etc

    This means that there is quite a wide range of inter-individual variation and intra-individual variation over the lifetime.

    Yes basically I can agree with you: that in the end it is energy in and out, but the effectiveness of this process varies. And when we diet these other biological factors get very important. Some of us can eat a lot and just burn it off when not training and then “refill” while we train (like me for example–I have weighed about 75-80 kg for 30 years, since midpuberty), while others cannot.

    Check out this paper on “Nonequilibrium thermodynamics and energy efficiency in weight loss diets” (http://www.tbiomed.com/content/4/1/27) for some hard facts.

  68. weingon 05 Mar 2009 at 10:40 am

    I believe the Nazis, through experiments in concentration camps, showed that if you don’t give people enough calories, they will lose weight. Anyone who claims they cannot lose weight on a low calorie diet is lying about what they are eating.

  69. tmac57on 05 Mar 2009 at 12:17 pm

    You might be surprised at how many people actually believe that they can eat something like a 4oz candy bar and gain “pounds” from it . That just blows me away.

  70. cheglabratjoeon 05 Mar 2009 at 12:29 pm

    s,

    Nothing you’ve said changes the validity of the equation. It is a balance, a continuity equation. Its violation would be as extreme as a violation of the conservation of mass or momentum. If you did something that was beyond that equation, it would be as strange as a rock materializing out of nothing on your desk, or your keyboard spontaneously flying out the window for no reason.

    Mind, I’m not saying it isn’t a complicated process. If everyone commenting here ate identical hamburgers then walked around the block at the same pace, everyone would gain a slightly different amount of weight. Some people would absorb more or less of the calories than others. Some people would burn more or less calories during the walk. Some people would burn more or less calories just sitting there eating. The carbs from the buns would cause differing metabolic responses in the people, resulting in different caloric usage throughout the rest of the day. All these effects would change the ultimate amount of fat stored from this burger.

    BUT! All those things would fit into one of the four categories: Eat, Excrete, Burn, Store. That’s it!

    And, I’ll say it a third time: none of these ‘complications’ change what you need to do to lose weight: eat less, move more. These complication only (assuming they’re correct) explain why someone is thin or overweight after the fact. If you want to lose weight, you need to consume less and burn more.

    Calories you don’t eat can never be stored as new fat. Calories you burn have to come from somewhere (consumption or storage). That’s all, folks.

  71. Fifion 05 Mar 2009 at 1:56 pm

    Exactly cheg, that’s why getting to know one’s own body is so important so that we can calibrate our eating and exercise to serve us as individuals. We all may have different in vs out equations (and these will vary during our lifetime according to all kinds of factors) but it’s still about in vs out.

    That said, I do have a lot of compassion for people who grew up obese and weren’t well cared for as children and were overfed to fill a parent’s need or lack of ability to express love directly. But then I’m one of those people who tends to think that people should have to go through training and have a license to breed – a highly unpopular and impractical to impose idea that borders on fascism, I know, but it’s about children’s rights and protection from my perspective since I see having kids in an overpopulated world as a privilege not a right).

  72. Parroton 06 Mar 2009 at 4:04 am

    Fifi,

    You make a lot of claims, almost none of them backed up by scientific evidence. Most of the things you claim are basically guesses, with no validity behind them. I would suggest taking a good long look at the actual evidence that is out there.

    I want to try and answer the key parts of your reply to me. I hope I’m covering the bulk of it as you intended to portray it:

    > What you may not realize is that obesity is behavioral and for
    > many people – calories in and calories out is all about eating
    > and exercising habits (or “tricks” as you’ve designated the
    > particular habits I’ve outlined). It’s simplistic to think that
    > people don’t have cultural and emotional relationships with
    > food – particularly since most cultures associate food with
    > expressing love or being rewarded. We only really notice
    > when these relationships are unhealthy or have resulted in ill
    > health.

    The bulk of scientific evidence into the factors that affect obesity don’t support your statement here. As hard as we have looked, science has yet to show much evidence supporting a cultural or emotional relationship with food as being a key factor in obesity.

    What’s simplistic is to assume that cultural and emotional relationships with food *are* a large factor in obesity – not the opposite, as you claim.

    It’s common to assume that obesity is largely a matter of a dysfunctional relationship with food. Unfortunately, that position is not backed up by the evidence.

    > There are many reasons why I said it’s important to change
    > one’s relationship with hunger…
    > 1. cutting calories and/or increasing exercise always results in
    > increased hunger
    > 2. people are often looking for magic weight loss where they
    > don’t have to “endure” the discomfort of hunger or exercise,
    > or face the feelings of frustration, etc that arise when we do
    > something we don’t find pleasurable
    > 3. hunger is a feeling first, and for most of us it’s connected
    > to very primal emotions that have to do with being maternally
    > nurtured. If we’re not aware of our hunger until it become
    > painfully intense, there’s a good chance other feelings are
    > also being ignored until they’re urgent (and quite possibly
    > denied or changed via mood changing food or substances).
    > 4. it’s just generally easier to sustain discomfort (maintain
    > self discipline) if we know that our discomfort will bring a
    > reward. For many people food is a reward and hunger is a
    > punishment, can you see how changing one’s beliefs can be
    > useful here?

    (I’ve cut out point #5 because I think people with extreme appetite malfunctions are a little bit outside the scope of our discussion)

    These points you’re making are little more than a diatribe of pop psychology. The claims are hard to refute because they’re based on little more than conjecture which is being extrapolated to unwarranted levels.

    Some of it is just wrong. Cutting calories and/or increasing exercise will not necessarily increase hunger. Things like our calorie intake varies from day to day by several hundred calories, and on days where we eat towards the lower end of that scale most of us don’t feel extra hungry.

    And then you theorize in a disjointed fashion on what people are looking for in a diet and further extrapolate from that what this means for the process of weight loss as a whole.

    Some of what you say might have some validity, but it’s all thrown together willy nilly without any thought of “Hey, maybe we should test out these speculations to see if they actually help people lose weight!”

    Clinical intervention trials are the only real proof in the pudding as to whether any dietary advice actually works. And so far, no matter the methods or advice given, the results for weight loss are dismal. Dr. Novella mentioned them here – a 5% success rate. No matter the diet, no matter the advice or “lifestyle changes” people are asked to make, none of these interventions work any better than another.

    > rarely do I see a fat child who isn’t being poorly fed by an
    > ignorant parent who probably learned from their own parent
    > how to eat

    Not to question your powers of observation, but this is clearly only anecdotal evidence, and most likely a case of confirmation bias.

    If you see a fat kid eating a chocolate bar, you shake your head and tell yourself that his mother shouldn’t let him eat like that. If you see a thin kid eating a chocolate bar, you keep on walking and don’t take much notice.

    That’s why we need actual studies to provide evidence, and can’t rely on these kinds of anecdotal observations.

    > The suggestion to drink water isn’t a “trick”. Some people
    > genuinely can’t differentiate between their needs and the
    > water vs food one is tricky at the best of times since our
    > bodies also get hydration through food so before consuming
    > calories it’s a sensible thing to do to drink some water.

    I’m sorry Fifi, but I’m going to have to just come out and call this one as pure Nutri Woo.

    Some people can’t differentiate between the need for water and food? It’s “tricky at the best of times”??

    There is no evidence for any of this. It doesn’t even stand up to common sense.

    C’mon Fifi, you don’t really believe something that ridiculous, do you?

  73. Parroton 06 Mar 2009 at 5:15 am

    If anybody’s not able to read that Gina Kolata article I linked to earlier, here’s a copy:

    http://www.gatsby.ucl.ac.uk/~pel/fat/fat_genetics

  74. Fifion 06 Mar 2009 at 8:12 am

    Parrot – As I said, I have been following the evidence and also lived with a neuroscientist who specialized in appetite research who I often discussed the subject with. I’ve also applied what I’ve learned and actually helped people improve their diets (both to lose weight and improve how they feel, poor nutrution has all kinds of side effects). Feel free to believe what you want and whatever serves your purpose, of course. It’s your body, how you take care of it is your choice. Good luck ;-)

  75. Parroton 06 Mar 2009 at 9:35 am

    Fifi,

    I can’t imagine that your appetite researching neuroscientist ex-roommate would back you on the notion that humans have some sort of in-built difficulty telling the difference between hunger and thirst.

    This isn’t a question of being “free to believe” what I want. It’s not about belief, it’s about evidence. Certainly we are free to interpret the evidence available in different ways. But what you’re doing is advocating a position on this for which absolutely no evidence exists and then spinning it as some sort of matter of “belief”.

    I’m afraid that’s not the way that science works.

  76. weingon 06 Mar 2009 at 10:59 am

    The way the economy seems to be heading, it seems entirely possible that this country will go bankrupt and food may become a scarcity. In that case, the currently obese people will have a survival advantage. They will be hungry but alive. The thin people will have died out. Will the parents with the currently fat kids be praised for their wisdom?

  77. Fifion 06 Mar 2009 at 12:01 pm

    Parrot – What you can or cannot imagine isn’t the point. It’s not a particularly radical idea that I’m presenting here regarding differentiating needs, particularly thirst and hunger. You seem extremely attached to believing that obesity is solely a genetic condition and has no behavioral components.

    http://psycnet.apa.org/index.cfm?fa=main.doiLanding&uid=1957-05721-001

    “After preliminary training in a T-maze to run discriminatively to appropriate incentive substances when hungry or thirsty, rats were tested under the various combinations (16) of 0, 11, 23 and 35 hrs. of food and/or water deprivation. Results indicated: (1) ” . . . a tendency for responses to a given drive to increase with the level of deprivation of that drive, and to continue to do so beyond the level of deprivation of training,” and (2) “with hunger and thirst drives combined, a tendency was evident for food choices to predominate at higher levels of deprivation.”

    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WDH-4TK7XDB-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=8c33425242453190afdf1ceb700c8ac5

    Abstract

    Hunger, thirst and satiety have an enormous influence on cognition, behavior and development, yet we often take for granted that they are simply inborn or innate. Converging data and theory from both comparative and human domains, however, supports the conclusion that the phenomena hunger, thirst and satiety are not innate but rather emerge probabilistically as a function of experience during individual development. The metatheoretical perspective provided by developmental psychobiological systems theory provides a useful framework for organizing and synthesizing findings related to the development of the perception of hunger, thirst and satiety, or alimentary interoception. It is argued that neither developmental psychology nor the psychology of eating and drinking have adequately dealt with the ontogeny of alimentary interoception and that a more serious consideration of the species-typical developmental system of food and fluid intake and the many modifications that have been made therein is likely necessary for a full understanding of both alimentary and emotional development.

    We can discuss this more if you’d like but you seem to have a vested interest in believing it’s all genetic and there are no behavioral components. You also don’t seem to understand the rather complex relationship between love, nutrition and brain development. I’ve already agreed with you that some people are at a disadvantage if their parents are obese – this is due to both nature/genes AND nurture/behavior (both within the womb and after birth). That doesn’t mean that calories in vs calories out isn’t relevant, it just means that some people’s personal ratio will be different than that of others.

    Parrot, if you choose to believe that your own weight is entirely outside of your control, then you can choose to do so. I’d suggest you focus on being happy at the size you are and get on with living your life as healthily and happily as you can manage. The other thing I’d suggest to you is that the vast majority of people aren’t happy with their body, including many of the people you consider “lucky”. (People often assume other people are happy or lucky or living a better life than they are based on superficial judgments about surface appearances.) The way I look at it is that I AM my body and the state of my body defines my state. We are physical beings, our brain is physical and our mind, moods and thoughts all come from our physical being. If someone is happy and content as they are – and making a conscious choice regarding quantity vs quality of life – then I’m behind them all the way.

    weing – Well if the US goes bankrupt it will be the people who know how to survive on little who will do the best. Those who need excessive amounts of food to sustain themselves and can’t walk six blocks won’t last long. Ditto people who survive on take-out and processed foods.

  78. weingon 06 Mar 2009 at 1:02 pm

    Fifi,
    Those fatties will be hungry and thin. Those who have been thin will be dead.

  79. Fifion 06 Mar 2009 at 2:50 pm

    weing – Soylent Green…it’s people. Need we say more… :o

    I guess it depends whether we’re talking about a survivalist hunter-gatherer scenario or something else where people have no agency and it’s pure starvation. On the up side, the fruitfly starvation/longevity thing may kick in…

  80. weingon 06 Mar 2009 at 3:29 pm

    Just picture a 300 pounder that is starving and you who are starving. Who do you think will win? I don’t know how to do those smileys.

  81. Fifion 06 Mar 2009 at 3:52 pm

    weing – Do you mean in a battle over the very last bag of Doritos left on the planet or in a battle to kill and eat each other? Exactly why do you think the 300lb person would have an advantage over someone who is a healthy weight?

    Food won’t be the biggest issue, by the way, water will be.

  82. weingon 06 Mar 2009 at 3:59 pm

    Fifi,
    Both. By the time it gets to that, he/she will be the healthy weight and you will be emaciated.

  83. artfulDon 06 Mar 2009 at 4:03 pm

    All the thin people need to do in the event of an impending apocalypse is subdue and eat the fat people.

  84. Fifion 06 Mar 2009 at 4:11 pm

    Parrot, this is an article on some recent research that looked at the influence of behavior on people with “fat genes”.

    http://www.sciencedaily.com/releases/2009/03/090304091329.htm

    (excerpt)

    “Lead author Dr Laura Johnson, UCL Epidemiology and Public Health, said: “This is an important finding because it provides evidence that it’s easier to eat too much energy and gain weight when your diet is packed tight with calories, so adopting a diet with more bulk and less energy per bite could help people avoid becoming obese regardless of their genetic risk. Obesity is not inevitable if your genes give you a higher risk because if you change the types of foods you eat this will help curb excessive weight gain.”

    “This shows that although our genetic make-up does have an influence on our health, it’s certainly not the only defining factor. Those with high risk genes can, in some cases, resist their genetic lot if they alter their lifestyle in the right way – in this case, their diet.”

  85. Fifion 06 Mar 2009 at 4:17 pm

    weing – You’re presuming that I wouldn’t have already killed the fatter person to eat them since my need is more urgent! ;o

    Really, we’ll all be rat food pretty quickly in a post-apocalyptic scenario. Long live our new rat overlords!!!!

  86. Parroton 06 Mar 2009 at 9:30 pm

    > Parrot – What you can or cannot imagine isn’t the point. It’s
    > not a particularly radical idea that I’m presenting here
    > regarding differentiating needs, particularly thirst and hunger.

    Yes it is. You can state the opposite all you like, crying that up is down doesn’t make it so. The theory that humans have difficulty differentiating between hunger and thirst is ridiculous, and not in any way supported by the studies you’ve presented.

    In the first study, I assume you’re referring to the conclusion that when rats are deprived of both food and water, they have a tendency to concentrate more on compensating for their lack of food than on their thirst.

    This in no way means that they’re confusing the two desires. It just means that they’re concentrating more on getting adequate food than they are on drinking. The fact that they get water content in their food, whereas water contains no calories, is probably the driving factor there.

    If the same effect is true in humans (which is often not the case in studies with rats), then it would be fair to say that if you deprived a human of food and water, that after the deprivation he or she would concentrate more on eating than drinking to compensate.

    However, the results cannot be used to make the claim that a need for water is being ignored. And the results do not support the contention that an increase of water would help abate the hunger being felt.

    And it looks like when we’re talking about deprivation in this study, we’re not talking about standard dieting. We’re talking about total deprivation for up to 35 hours.

    It only makes sense that your body would react with a higher craving for food than for water after being so deprived. Food provides you with some water, whereas water provides you with no calories.

    But this bears no relevance to most people who are trying to lose weight. Unless they’re seriously restricting their calorie intake, and reducing their water intake at the same time, they’re not going to feel any effects remotely similar to those seen in these rats.

    Where you’re going wrong here is where a lot of woo-woo nutrition quacks go wrong. You’re taking small bits of evidence and extrapolating them to unwarranted levels.

    Your second study doesn’t even mention any evidence of a blurring of the lines between hunger and thirst. There’s nothing in it to support your theory at all.

    You’re clearly making no attempt to actually understand the material that you’re quoting.

    Bottom line: people are perfectly capable of telling the difference between thirst and hunger.

  87. Fifion 07 Mar 2009 at 9:20 am

    Parrot – You’re clearly very attached to believing that there are absolutely no behavioral or external aspects to weight loss and gain. This is your story and you’re sticking to it so it is clearly pointless to discuss this with you since you’ve decided you know for sure about all kinds of issues still being studied by neuroscientists(from reading a NYT’s article no less!) and clearly feel the need to resort to emotional insults to deny anything that challenges your belief. (Going so far as to claim any experiments or research that doesn’t confirm your beliefs are “woo woo”!) I’m sure it serves your purpose.

    As I said, if you truly believe you and your environment have no influence over yourself and are simply a victim of biology, then obviously the best thing to do is get on with your life and enjoy it being the size you are now. We all have to live with who we are and you’re obviously much luckier than many others who are born with disabilities that make life much more difficult than simply being obese does. Hell, you’re even much luckier than skinny people who are genetically prone to depression or schizophrenia, or who are born deaf or blind, or even children born to malnourished mothers into war zones. All in all, you’re pretty lucky to be living in America where it’s pretty normal to be obese and there are all kinds of social and environmental constructs that cater to easy access to high caloric food with little physical effort so you don’t need to go hungry. I’m curious, do you see obesity as a disability or just a difference?

    And do you think it’s different than drug addiction since drug addicts are also biologically prone to desiring drugs and having intense cravings that “normal” people don’t have?

  88. Fifion 07 Mar 2009 at 10:20 am

    For those who may be interested in research into the ability to distinguish needs and Alexithymia in general.

    http://www.nature.com/ijo/journal/v27/n2/full/802228a.html

    http://en.wikipedia.org/wiki/Alexithymia

  89. Parroton 07 Mar 2009 at 11:03 am

    > Parrot – You’re clearly very attached to believing that there are
    > absolutely no behavioral or external aspects to weight loss and
    > gain. This is your story and you’re sticking to it so it is clearly
    > pointless to discuss this with you since you’ve decided you know
    > for sure about all kinds of issues still being studied by
    > neuroscientists(from reading a NYT’s article no less!) and clearly
    > feel the need to resort to emotional insults to deny anything
    > that challenges your belief. (Going so far as to claim any
    > experiments or research that doesn’t confirm your beliefs are
    > “woo woo”!) I’m sure it serves your purpose.

    You don’t seem to be paying attention Fifi. I haven’t even addressed any of your claims about behavioural aspects of weight gain in my last responses. This is a completely separate issue.

    I apologize if I’m having trouble finding the time to respond to everything that’s thrown at me here, but I wanted to focus on this utterly ridiculous statement you made that has no basis whatsoever in science.

    I’m calling your claim that humans confuse thirst and hunger woo not because it doesn’t confirm my beliefs, but because it happens to be unequivocally and undeniably woo!

    Either show me some evidence that the inability to distinguish between hunger and thirst is a common phenomenon in humans, or stop making this claim.

    Do you think you can do that? Do you think you can stick to the scientific mandate to back up your claims?

  90. Fifion 07 Mar 2009 at 11:49 am

    Parrot – Prove to me it’s woo, it should be easy enough to do since you’re so sure it is. If you’re so sure that alexythemia doesn’t exist and that people can’t have difficulty distinguishing hunger from thirst (and don’t sometimes feed thirst – meaning eat when they’re thirsty), prove to me why what I’ve proposed is wrong (other than asserting your belief and then claiming you’re being “scientific”). I’m not the one claiming to “know it all”, you are. All you’ve presented so far to support your position is a NYT’s article! I was already familiar with that article and some of the research behind it before we entered this conversation – I’m quite open and willing to looking at any research you present that you feel shores up your beliefs and explains why you feel yourself to be an expert and know things that neuroscientists who specialize in these areas don’t claim to definitively know.

    On a purely speculative level, people who have the sensation of being always hungry and who never experience satiation are going to be even more prone to feed their thirst by eating if we go by the study I presented.

    The claims that the ideas I’ve presented are “woo” and assertions I’m not being scientific when you are even though you aren’t (you’ve only presented an NYT’s article and clearly aren’t at all conversant with research outside of the context of the NYT’s article) sounds a hell of a lot like Pec and other promoters of faith based medicine on this site.

  91. Fifion 07 Mar 2009 at 11:51 am

    And stop dodging relevant questions such as…

    Do you think think it is different than drug addiction since drug addicts are also biologically prone to desiring drugs and having intense cravings that “normal” people don’t have?

  92. Fifion 07 Mar 2009 at 12:18 pm

    Some more interesting research into the role of the amygdalia in the role of feeling satiated.

    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WNP-4R644MC-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=e0d7c1ceb78196a3bc1bf70764ec0a2d

    And in more easily digestible article form…

    http://sciencentral.com/articles/view.php3?type=article&article_id=218393079

    (excerpt)
    “But Wang’s study found the first proof that the initial area of the brain to react to stomach expansion is the amygdala, which is also involved with emotion.

    Explains Wang, “The brain, immediately from the amygdala, will send to other areas to decide what a person should do at that point of time.”

    Wang says that the amygdala, which is involved in emotional memory, determines what our next step should be. He says all the signals are filtered through this memory and that “our memories would let us know” whether we have eaten enough or not.

    But his results showed that the amygdalas of the overweight people did not respond to the smaller volumes in the balloon.”

  93. Parroton 07 Mar 2009 at 12:18 pm

    > Parrot – Prove to me it’s woo, it should be easy enough to do
    > since you’re so sure it is.

    You made a testable statement about scientific fact and are unable to show any evidence to support it.

    That’s woo, plain pure and simple.

    > If you’re so sure that alexythemia doesn’t exist and that people
    > can’t have difficulty distinguishing hunger from thirst

    Are you claiming that alexythemia is a common problem, which is causing widespread confusion between hunger and thirst?

    You remember your claim, right? You said that “many of us misinterpret a desire for fluids as a desire for food”, and that telling the difference was “tricky at the best of times”.

    If, by these statements you were referring to alexythemia, then show me the evidence that this is a common condition among humans, and show me the evidence that it leads to a common inability to distinguish between hunger and thirst.

    > And stop dodging relevant questions such as…
    >

    I’m not dodging any questions. I’m just focusing on one issue at a time right now.

    And frankly if you’re not even able to admit that you’re wrong on your most ridiculous claim which is absolutely without any scientific merit whatsoever, then I have grave doubts about your ability to converse coherently on matters where there might be some legitimate reasons to disagree.

  94. Fifion 07 Mar 2009 at 12:21 pm

    Purely speculatively, of course, it’s interesting to consider whether stomach expension caused by drinking large quantities of water may actually provide an experience of satiation.

  95. Fifion 07 Mar 2009 at 12:47 pm

    Parrot – So, are you now changing your tune and acknowledging the existence of alexythemia and that some people may confuse hunger and thirst? And your main objection now is my use of “many” instead of “some” when I originally brought this up?

    What I have presented here isn’t “woo”, it’s research into the underlying biology and psychology of obesity and satiation. I’m not claiming to have a definitive answer (you’re the one doing that and ignoring any science that doesn’t affirm your belief that appears to be based on a NYT’s article!). That you consistently try to label it “woo” without presenting any science to discredit what I’ve presented is pretty much how Pec argues for her articles of faith here. That you’re focused solely on this one thing while ignoring other relevant and interlocking issues – combined with the obvious fact that you clearly want to believe that obesity is purely genetic and therefore outside of any form of behavioral influence or personal responsibility (even though it’s commonly known that environment influences genetic expression) – makes it seem like you’re more interested in being “right” and affirming your belief. You seem uninterested in understanding the current state of research into obesity (and haven’t presented anything recent!) and acknowledging that there is no definitive answer at this point since you’ve decided that a NYT’s article is the be all and end all of research into obesity!!!

  96. Parroton 07 Mar 2009 at 1:54 pm

    > Parrot – So, are you now changing your tune and acknowledging
    > the existence of alexythemia

    Changing my tune and acknowledging the existence of alexythemia?? What the hell are you talking about??? I’ve never made any claims one way or the other about alexythemia!

    It’s become exceedingly clear that you are ignoring my arguments, constantly changing your definitions, and moving the goal posts of your arguments in order to avoid actually addressing the points being presented.

    Nobody reading this should find any reason to blame me now for asserting that you’ve proved yourself to be unwilling to have a rational conversation. Just like the purveyors of pseudo science, you’re constantly dancing about the points being raised and won’t admit that you’re wrong even when you have zero evidence to back up your statements.

    I’ve wasted far too much time and effort already on your little dance of obfuscation when there were other more interesting posts that I let fall to the wayside.

    Rant some more against your strawman arguments of my position if you wish, this is the last time I’ll be responding.

  97. Fifion 07 Mar 2009 at 3:02 pm

    Really, talk about obsfucating and then running away. You’re focusing on one point to the exclusion of everything else and refusing to admit that there’s any possibility that obesity isn’t purely genetic. I’ve repeatedly posted links to studies that show how the amygdala (which is also involved in emotions) is related to feeling full which is related to feeling satiated, how obesity is linked to poor needs recognition in parent/child relationships and to research that shows that rats that are deprived of water and food will try to fill their needs with food. You clearly want this to be a simplistic “it’s all about genes” issue when I’ve repeatedly said that science does not know everything (but apparently you do!) and that the current evidence points to there being many factors that include genes but don’t exclude environment and behavior.

    On top of this, you’re refusing to answer questions about how this genetic predisposition is similar or different to genetic predispositions to alcoholism and cocaine addiction. You seem to want to have your cake and eat it too here.

  98. HHCon 07 Mar 2009 at 8:18 pm

    Food for thought: I worked with young patients who were mentally retarded or mentally ill and were diagnosed with polydipsia. They were unable to distinquish a feeling of fullness with respect to water consumption. In these cases, I had staff behaviorally intervene in redirecting patients to other daily living activities. I have also found elderly congestive heart patients have difficulty regimenting their diets. They take in too many fluids because they have never been aware of natural fluid intake in consumption of caloric foods. Hospital nutritionists are useful for explaining to these patients and their families basic dietary information.

  99. Fifion 09 Mar 2009 at 4:23 pm

    HHC – Thanks for sharing your knowledge and experience. We DO get a great deal of fluid from fruits and vegetables, with the added bonus of salts and minerals. So, reaching for food to slake thirst isn’t a dysfunctional instinct but if what we eat is a donut not an apple we’re not getting the fluid we’re craving and satiating the motivating need.

  100. oderbon 15 Mar 2009 at 3:37 pm

    If anyone is still following this post I’d like to see someone attempt to rebut Dr. Michael Eades’ utter demolition of this study – and thus of Dr. Novella’s argument.

    http://www.proteinpower.com/drmike/bogus-studies/last-gasp-of-the-dark-ages-of-nutrition/

  101. HHCon 15 Mar 2009 at 11:03 pm

    oderb, Beautiful color photo from link, looks like those fellows did not receive hospice care.

  102. Resveratrolon 18 Apr 2011 at 12:40 pm

    One theory of the effect of calorie restriction on life extension is that it drastically reduces the rate of cancer development, not necessarily the rate of aging.

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