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Abstract Thinking —

November 20, 2012

Trigger warning: Frank weight loss science talk and calories in, calories out.

One of the less vitriolic members of FCJ has finally sent along some studies in response to some thing I said in this comment. But since Steve only quotes the abstracts, he left himself wide open for criticism since he doesn’t actually say what’s in the study. But thanks to Kala, who sent me two of the studies (the third is out of print), I can comment.

What I said was “the more you restrict, the greater the results, but the less sustainable — the less you restrict, the less the results, but the more sustainable.” In response, Steve cites three studies. The first study he quotes says, “…the literature shows that initial weight loss is positively, not negatively, related to long-term weight maintenance.”

Fair enough. But if you actually read the first study cited, the evidence is rather flimsy. It supposedly shows that the more weight you lose initially, the better the long-term outcomes. Bear in mind, this is a review, not an actual experiment or a meta-analysis that looks at all of the data. The authors are providing their opinion based on a few select studies.

But all of the studies they cite are based on very low calorie diets (VLCDs). One of the studies compares 43 adults who are divided between an 8-week VLCD of 475 calories (2 MJ) per day to a 17-week “conventional” diet of 1,200 calories (5 MJ). Both groups were also given 20 mg of ephedrine and 200 mg of caffeine thrice daily. All participants were then randomized to a one year maintenance group that either prescribed an ad lib low fat, high carb diet or a fixed-energy diet of 1,850 calories (7.8 MJ) per day or less.

The results? Both groups lost an identical amount of weight after their respective time periods (28 pounds), but a year in these respective groups, a change had taken place:

Regained weight at follow up was greater in fixed energy intake group than in ad lib group [25 pounds] v [12 pounds], group difference [13 pounds].

Not exactly reassuring. And that’s after just one year post-weight loss. The real failure rates start showing up in data during that second year, continuing through five years. And considering that the ad lib (aka eat however much you want) group maintained a greater weight loss backs up exactly what I was saying.

The other study included in this analysis was a 5-year study comparing behavioral therapy (BT) to BT and VLCD combined. Researchers followed 59 morbidly obese patients and had follow-up data for 87% of them. The review that Steve links to mentions the weight loss, which found the following:

At the end of the treatment programme the mean weight loss was [20 pounds] in the behaviour therapy group and [51 pounds]  in the combined group. Interestingly, the overall mean weight loss from pre-treatment to a 5 year follow-up was [11 pounds] and [37 pounds], respectively. Similar results have been reported by other investigators using gastric surgery for weight maintenance.

I don’t have access to this study, so I don’t know the exact caloric level, but VLCDs are typically 800 calories or less (aka starvation level). And, like I said, the only proven way to achieve significant weight loss is by restricting calories and increasing exercise drastically (i.e., The Biggest Loser). But as I said, and Steve quoted, “the more you restrict, the greater the results, but the less sustainable — the less you restrict, the less the results, but the more sustainable.”

The review that uses this study leaves on a very important bit of information that shows that what I said was exactly right: the retention rates. In the VLCD group, 56% of the subjects dropped out, while in the BT group, 28% dropped out.

So, twice as many people were unable to stick with a VLCD, meaning that for most people, such a small amount of calories is unsustainable.

Finally, the review’s main author, Arne Astrup, cites his own study of 40 obese women on a 1,000 calories (4.2 MJ) diet as evidence that the more calories you restrict, the more long-term success you’ll have.

Astrup et al. studied predictors of weight loss during a 36-week hypocaloric diet programme in obese women, and found that patients in the upper 50-percentile vs. lower 50-percentile of attained weight loss week 36 (Upper vs. Lower 50-percentile: –[39 pounds] vs. –[22 pounds]) had maintained more weight loss at follow-up 2.5 years later (–[16 pounds] vs. +[6 pounds]).

This is the only study that suggests that the more you lose up front, the less you gain back. But two things to bear in mind with this… this is not a randomized trial, but a review of 40 consecutive dieters. Hardly a rigorously controlled study. Secondly, after the 2.5 year followup, just 14 patients had maintained a weight loss of greater than 11 pounds.

An author can cherry pick his evidence (as opposed to a meta-analysis, which sweeps up all studies within a particular set of criteria), but he can barely make the case that losing a bunch of weight up front on a diet of 1,000 calories or less is the way to go. The study’s authors admit that the success is tenuous at best:

So even when the theoretically predicted weight loss for each patient in a given programme is the same, in real life there will still be substantial variations in weight loss between patients. The cause of these differences in patient responsiveness includes variability in physiological factors such as energy expenditure, physical activity and exercise, fat oxidation rates, and plasma concentrations of thyroid hormones and catecholamines, where high levels are associated with better short- and long-term weight loss outcome. Other hormones such as leptin levels may also be predictive of weight loss outcome. A high number of previous slimming attempts, depression, dietary disinhibition and binge eating is associated with relapse after weight loss and poor long-term outcome. Due to the numerous factors influencing weight maintenance, any specific beneficial effect of a greater initial weight loss per se on long-term outcome needs to be assessed by randomized, clinical trials

The second study that Steve quotes says, “According to our review, successful weight maintenance is associated with more initial weight loss…” Sounds pretty clear cut. The only problem is that the study itself contains no hard numbers, no data, no definitions of “successful” to judge what the report’s authors are talking about. We’re just supposed to take it on the author’s authority that losing more weight is better… except, when you go into the actual report under the section titled “Weight loss patterns,” the relationship is more nuanced than the abstract suggests:

Initial weight loss has been identified as a predictor for later weight loss, and also for weight loss maintenance in various treatments… The greater the initial weight loss, the better is the subsequent outcome… According to other results, larger amounts of weight loss during the total intentional weight loss phase have predicted more weight regain.

Once again, it’s a mixed bag. But when you actually scratch the surface of this study, you start to see that it’s not exactly based on an impressive data set:

To enable a review of the literature using very different definitions of weight maintenance we have used a more inclusive definition of weight maintenance that implies an initial weight loss that has been subsequently maintained for at least 6 months.

So, this study relies on studies that include a definition of weight maintenance that lasts 6 months. Again, we’re talking actual, long-term weight maintenance of more than 1 year. But the methodological pitfalls get even worse:

Another methodological consideration is that the time of assessment for evaluation of weight maintenance can differ. Pre-treatment factors determining later weight loss maintenance have the greatest informative value for recommendations on treatment assignments. Sometimes the patients are instead assessed at the time of discharge from active treatment and further weight development is predicted from these characteristics.

Loose definitions of weight maintenance and inconsistent study criteria makes for weak tea at best. But what these studies do say, across the board, is that most weight loss attempts fail, as stated bluntly in Steve’s second study:

The long-term weight loss results in weight loss programmes are usually modest. Most patients who lose weight will regain the weight.

But the most interesting result of this exercise is that my original comment that Steve responded to was in response to another rational RCJ member named Aiden, who said:

There is a big difference between living on starvation calories and restricting calories, and it’s disingenuous to conflate the two. Often what is required isn’t ‘restriction’ in any real sense, but simply bringing calories into an optimal range.

The first study, which included actual quantifiable data, basically showed that the kinds of weight loss that I’m assuming FCJ endorses for us fatties (50 pounds or more) is best achieved through a VLCD of less than 1,000 calories. That is starvation level.

If Aiden is correct, then tell me what the “optimal range” of calories is for losing 50 pounds. And can you point to a single, well-designed, controlled study that has ever demonstrated that your optimal range of calories has ever yielded long-term success for those who follow it.

This is the last post I’m writing on the subject of Fitness CircleJerk, unless someone from your braintrust can provide that information. If I’m wrong, I’ll apologize. So go ahead, FCJ: prove me wrong.

 

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33 Comments leave one →
  1. fatology101 permalink
    November 20, 2012 3:12 pm

    There you go again, stating facts. LOL. Lets get to the bottom line, IF CAL. IN -CAL. OUT WORKED WE WOULD ALL BE THIN. Holy cow!!! We have all been on this ‘diet’. This info is based on sciene from the 1800s. Most people who profess this low cal diet, have never tried it. Maybe for a day or 2 but I would like to see just one of them go on this diet for 6 months. Sure, they will lose a few lbs but it will come back on and we all know it. Put it back on them and tell them do go on the diet and prove it. They will say, I dont need to lose weight. So, just go on it and lose 20lbs just to prove your point. They will never do it.

    • Hest permalink
      November 20, 2012 3:33 pm

      What, like mindspread showed here, with pictures and everything?
      http://fiercefatties.com/2012/11/19/bob-johnson/#comment-22719

      Or you can check out /r/loseit, /r/progresspics and /r/btfc (body transformation challenge).

      Calories out > calories in is just the beginning of usable knowledge for weight loss, and even though it’s simple in concept it’s not necessarily easy to stick to it. There are a lot of concepts people use to make it easier. Some let the concept run out of control, though (I’m looking at you, /r/keto).

      • November 20, 2012 3:40 pm

        Before and after photos are not proof that a concept is valid. It’s proof that one person had success with that concept. Compare mindspread to a broad population and he becomes an outlier.

        Peace,
        Shannon

        • Hest permalink
          November 20, 2012 4:15 pm

          Sure it’s just one person, but that’s also just what fatology101 asked for. Just one single person, to disprove that it’s impossible.

          • November 20, 2012 4:17 pm

            I didn’t see that. But I don’t put stock in any one person’s success on low-carb. Low-carb and low-fat have the same failure rates, and similar drop-out rates. Neither is all that impressive.

            Peace,
            Shannon

    • XTC46 permalink
      November 20, 2012 8:36 pm

      HI!

      I am an FCJer. I also moderate /r/loseit and /r/weightroom. Between November of 2010 and now, I have lost over 100lbs, gained several pounds of muscle, increased my strength tremendously, ran a 10k, ran 2 5ks, compete in powerlifting and strongman.

      My weightloss was 100% due to caloric deficit. I lost all the weight in the first 11 months and have held that weight since then to train for powerlifting. I compete in the Super Heavy Weight class (so 308lbs as I am 6’3).

      A few things. I am a HUGE proponent of Keto diets. I love them. I did it for 8 months straight. It was the single easiest way for me to maintain a caloric deficit. I still do it most of the time, but will carb up once a week (more if I am slacking). I went 2 months of not counting my calories on strict keto, I lost no weight. I started counting again, I immediately started losing weight. When not doing keto, and not counting calories, I gain weight, easily.

      Before I found keto, I lost ~25lbs by calorie counting. It wasn’t that hard. But the first 25 rarely are at 400lbs. I can easily lose more weight now. In fact, I am currently cutting down to about 240lbs, it will take a while as its going to be a slow cut to avoid any muscle loss. I am doing it by controlling my intake.

      What this tells me is WHAT I eat effects how much I naturally eat. How much I eat effects my weight. Its pretty simple.

      So there, you asked for proof from someone who has done it. I have. I did it in a way most people will never accomplish. I did it while getting stronger, healthier and faster. My doctors are amazed at my blood work. I ride a bike to work daily, and hit the gym 4-5 times a week currently.

      Come at me.

      • November 20, 2012 10:32 pm

        We don’t care.

        Peace,
        Shannon

        • XTC46 permalink
          November 21, 2012 12:43 am

          Clearly people here DO care or there wouldn’t be multiple posts about it.

          I have absolutely no issue if someone doesn’t want to lose weight, that is 100% their CHOICE. People can do whatever makes them happy, but do not for a second try to spread some bullshit about weightloss via calorie deficit not being possible/sustainable/factual.

          Anyone who says otherwise is looking for excuses.

          • Kala permalink
            November 21, 2012 1:02 am

            “spread some bullshit about weightloss via calorie deficit not being possible/sustainable/factual.”

            LOOOOL, show me the studies, since you’re so enlightened. Where are all the studies with the amazing success rates and sustainability for large weight loss? Fuck, find the the studies with the amazing success rates and sustainability for modest weight loss. Go on ahead, I’ll be waiting. Pick your poison, diet changes, exercise changes, both, low-carb, low-fat, low-calorie, Weight Watchers, Jenny Craig, Atkins, South Beach, medically prescribed, Nutrisystem. Pick any of them, pick all of them. Because I’ve read quite a lot of weight loss research, and I’ve not seen what you’re claiming.

            The weight loss studies that are out there, show pretty lackluster results. Perhaps some initial considerable weight loss for some participants, but then a maintenance (sustainability) of the weight loss that is very weak tea indeed. Then you have to top it off with the fact that a lot of weight loss studies have methodological issues that make their validity hard to determine. High drop out rates, case-control studies with questionable choice of control, prospective studies that don’t follow participants for very long, serious case of selection bias, non-representative samples being taken from general populations. All of these issues make validity difficult to assess, and make it very difficult if not implausible to generalize results to other people.

            If it were so simple, then it wouldn’t be so fucking difficult to achieve the weight loss, and especially maintenance into the long term, that they were looking for in these and any number of trials. And you can shrug off the reality of it by saying to yourself :

            i) The fat people in those studies either gave up and went back to their gluttonous and slothly ways
            ii) They’re lying about their intake
            iii) The scientists and medical practitioners just didn’t choose the magic bullet for weight loss”.

            But that’s just you choosing ignorance. Which is fine by me, I hope not to write to you again.

            By the way, which excuse am I looking for XTC46, exactly? I’d like to laugh at it, whatever it is.

            • November 21, 2012 6:14 pm

              Yep, because people go back to their old shitty habits. It is that simple.

              What about fat people who didn’t have “shitty” diet or exercise habits to begin with? Can you please account for them?

          • November 21, 2012 1:07 am

            Dude. This is a safe space for fat people. You are not part of this community, you’re not trying to be part of this community.

            If you really believe it’s 100% a person’s choice on if they want to lose weight or not, then those who want to will seek out ways to. You are not invited to explain it in this space, you have other spaces for that.

            Educate yourself. Learn some respect.

          • November 21, 2012 7:44 am

            You misunderstand. We don’t care how one anonymous guy from the internet lost weight. We just couldn’t give a shit. Doesn’t prove anything, but one guy from the internet lost weight.

            Peace,
            Shannon

  2. November 20, 2012 3:26 pm

    > is best achieved through a VLCD of less than 1,000 calories. That is starvation level.

    What in the world? No one is ever recommended less than 1000 calories. Normal people can get by with around 2000 (2500 is below maintenance for me)

    • November 20, 2012 3:30 pm

      phrakture,
      That’s the study that Steve cited. He’s trying to show that the more weight you lose up front, the more successful you are. But those studies just showed that if you want to lose a lot of weight quickly, then you need starvation levels. Show me a study with a 2,000 calorie level that has a weight loss of greater than 10% starting weight after one year for more than, say, 25% of subjects and I will submit myself to your regimen, phrakture. Just one good study.

      Peace,
      Shannon

    • Kala permalink
      November 20, 2012 3:31 pm

      The results for weight loss and weight loss maintenance are less impressive in weight loss studies that do not use VLCD (which is a specific term, with a specific meaning, you may also see it as very low energy diet VLED).

    • November 20, 2012 11:41 pm

      No one is ever recommended less than 1000 calories.

      Um.

      Yes, I was.

  3. Steve permalink
    November 20, 2012 3:41 pm

    The best available data on successful long-term weight loss would seem to come from the National Weight Control Registry, which I imagine you’re familiar with, but here’s a link:

    http://www.nwcr.ws/Research/default.htm

    It’s a fact that most people who attempt significant, long-term weight loss are unsuccessful. But this fact should lead us to examine the factors that contribute to that failure, as well as the environmental factors in modern society which allowed obesity to rise to current levels in the first place — not to mention the factors that contribute to the success of the minority that do succeed, which is what the NWCR set out to do — so that we can better understand how to treat these public health issues effectively. That fact does not, however, support simplistic, fatalistic slogans like “calories in vs. calories out is a myth” or “diets don’t work,” which are no more useful than “eat less, move more.”

    These are complicated issues, and fortunately there are people out there doing good research into how to better address them.

    • November 20, 2012 3:49 pm

      Steve,
      The only problem is that the NWCR is self-selecting. Is it a useful cohort to study? Yes. But the people who are doing good research are the people that I have been reading up on for over two years now. FCJ has oversimplified my stance from the very beginning to say that our whole deal is “diets don’t work,” but I have tried and tried and TRIED to explain that even though it’s complex, it’s also remarkably simple. Ask any of those good researchers you discuss what a clinically meaningful amount of weight loss is, and they will tell you it’s 5-10%. Watch the Weight of the Nation documentary and you’ll see it there too, 7%. All of the best research into obesity, healthy and weight loss has shown that a very modest amount of weight loss is correlated with drastic health improvements. I believe that’s because healthy lifestyle is what improves your health and, sometimes, leads to that modest amount of weight loss. But there isn’t ANY good research that suggests that most people can lose, and maintain, the kind of weight loss that FCJ seems to think is necessary for health. None. But there is solid research, tons of it, that I am willing to share, which says exactly what I’m saying: healthy behavior matters more than weight.

      These are complex issues, and we’re only touching on the most superficial issue. I’ve completely left off any discussion of the socio-economic factors that play a role, let alone weight cycling or stress or the other confounders that make this such a fascinating issue for me. But I’m sick and tired of FCJ, and the rest of the world, assuming that Health at Every Size is just an excuse to be fat and eat Twinkies. Since learning about HAES, I have made a significant number of lifestyle changes (including diet and exercise (both cardio and resistance)) and have had a marked improvement in my metabolic numbers. My weight? Still 265.

      I believe in good research and I spend a lot of time reading as much as I can find, and interviewing the experts behind that research. And if you, or anyone else from FCJ, want to debate it, you’re welcome here. But I’m done entertaining the trolls and cockroaches who have nothing to contribute. You’ve been respectful and I appreciate that, but you’re in poor company.

      Peace,
      Shannon

      • yes permalink
        November 20, 2012 4:46 pm

        So what are you trying to achieve exactly?What is the goal behind all this? I could read everything and draw my own conclusion but I’d like you to explicitly say what’s the purpose of this whole thing (the arguments and the website).

        • November 20, 2012 4:51 pm

          In a nutshell? My own personal purpose with my writing is to discuss how the causes of obesity are complex; the “solution” is more complicated than 3,500 calories per pound; and that health is best measured by metabolic indicators (blood pressure, lipids and sugars) than weight by itself. Weight can be an indication of a health problem in some people, but not in others, and focusing solely on weight is a red herring. Insulin resistance is the “disease” (though it’s really a syndrome) that we should focus on in our public health campaigns.

          As far as what this site seeks to accomplish: basically, create a forum where we can discuss these issues and other issues that affect fat people without the judgement and abuse that we experience pretty much everywhere else in the world. It’s a safe place to not be verbally assaulted by the kinds of assholes that we have to put up with on a regular basis.

          That’s it.

          And although I was interested in the scientific discussion I was having with some of the people from FCJ, the collateral trolls have made that latter goal impossible. Like I said, you want to debate the science, you’re welcome. Got nothing to contribute? Fuck off.

          Peace,
          Shannon

      • yes permalink
        November 20, 2012 5:29 pm

        (I’m replying to your comment here, for formatting purposes.)

        And what is your stance on science, how does it work to you? Is it descriptive or explicative or both? Should studies define the world or the world define the studies?

        There’s this thing with science, you cannot prove anything right but only make strong hypotheses. To quote Einstein on this “No amount of experimentation can ever prove me right; a single experiment can prove me wrong.” Unless you work mathematics, where they already know every laws (their axioms), and derive conclusions from these truths. But we’re not there, right? We’re in the real world.

        Let’s forget about quoting other people for an instant and simply discuss.

        Now I’m going to discuss strictly on the case of studies related to obesity (which, from where I sit, seem DESCRIPTIVE, not explicative). So, we see Dr X and Y control a certain amount of people, usually small, and he concludes that this set of people lost or did not lose weight over Z amount of time under PHI, THETA, ZETA, … conditions.

        Now, what kind of conclusions are we able to draw from this? I take it from your knowledge of different fallacies that you know what induction and deduction means.

        Should we really be able to induce from this study or A study (like the one you are asking from phrakture) that weight loss isn’t or is achievable consistently?

        Notice I’m not trying to draw you away towards a conclusion or another, I’m just questioning why you put so much faith into these papers. Should they really define reality? Should we really know how or if things work before doing them? I see people using computers every single day not knowing what a compiler is. I see people shooting towards the net playing hockey without knowing the outcome before it actually happens.

        I really dislike how we have to PROVE you an outcome before you even try or try to convince others about it. But that’s just an opinion.

        • November 20, 2012 5:46 pm

          What we can induce from these studies is that in a free-living society, long-term weight loss is not likely for the vast majority of people who try. You chalk it up to lack of willpower or lack of control, I chalk some of it up (though not all, as I think it’s more complex than any one contribution) to a hormonal system that fights weight loss. I’ve posted links to lectures that go into greater detail than I have gone into, but which explain the underlying principles.

          And you’re absolutely right: based solely on these studies, we cannot determine whether your theory of willpower is correct or my theory of adaptive thermogenesis is correct. And that’s our impasse.

          You all seem to believe that the solution is to push people into trying again, trying hard, doing more, following the “right” plan. I believe that we should encourage people to engage in healthy behaviors and that they should track the metabolic indicators (blood pressure, lipids and sugars), which are better predictors of insulin resistance, which is the driver of the health issues correlated with obesity. If you make those healthy lifestyle changes, your health will improve, but you may not lose weight. My advice? Don’t fret. Your advice? Keep trying harder to lose that weight.

          But most of the people who read this blog have tried and tried and tried some more. They’ve attempted every theory they could get their hands on and either they never come close to their goal, or they reach their goal only to see their progress undone by any number of variables, but waiting to undermine them the entire time is adaptive thermogenesis.

          I promote an alternative approach that focuses on behavior, rather than weight, as a means of achieving health. Many of our readers are very active, many have very healthy diets, many of the bloggers that have been mocked for their weight are vegans or vegetarians, and many get a clean bill of health from their doctors on a regular basis, myself included.

          So you look at the evidence and see a land of failures who just didn’t try hard enough. I look at the evidence and see a land of failed outcomes caused by a flawed understanding of the system. Again, that’s our impasse.

          But you know what? Regardless of whether you agree or disagree with me, it doesn’t give you or anyone of FCJ a justification do be such assholes about it. But what I found even more incredible is that after being such unrepentant dickweeds about it, you and others had the audacity to complain that I was being mean. Really? Give me a fucking break.

          You want to disagree with me? Fine, I can handle that. You want to insult me? Fine, I can handle that. But you want to tell me I’m not playing fair because I got in the mud with you? Grow up.

          Peace,
          Shannon

      • Steve permalink
        November 20, 2012 7:29 pm

        I’ve seen Weight of the Nation; I thought it was a very well-made, balanced look at the issue, and I’ve recommended it to many people. I also thought it presented a hopeful picture of the prospects for successful dietary and exercise intervention.

        “But there isn’t ANY good research that suggests that most people can lose, and maintain, the kind of weight loss that FCJ seems to think is necessary for health. None.”

        I don’t think the FCJ folks are taking the position that large amounts of weight loss are always necessary for health. I think their position (inasmuch as they have one collectively) is more about disagreeing with an attitude of biological determinism.

        These are mostly people involved in various athletic pursuits, whether recreationally or competitively, many of which necessitate the intentional manipulation of body weight and composition.

        It is self-evident to people who are engaged in these sorts of things themselves, and engaged in helping others achieve similar athletic goals, that the body responds reliably to dietary intervention and training. That it responds reliably doesn’t mean it does so in the over-simplified sense of “each 3,500 calories = 1 lb.” — although concepts like that can absolutely be useful as baseline calculations — but these people realize that bodies are ultimately highly malleable given the proper inputs, and so they scoff at implications to the contrary. And while different people have different advantages, disadvantages, and limitations determined at birth, for the most part those things simply aren’t relevant until one starts approaching elite levels of achievement. Priorities and education simply make a larger practical difference in most cases.

        Nobody denies that our environment is increasingly obesogenic, and certain individuals are more susceptible than others to that environment through no fault of their own. But the fact remains that virtually everyone, even the genetically or environmentally disadvantaged, can improve their condition and achieve a certain level of fitness, given the right education and determination. And virtually everyone will achieve those improvements by adhering to the same basic principles.

        • November 20, 2012 11:10 pm

          “I also thought it presented a hopeful picture of the prospects for successful dietary and exercise intervention.”

          Are you kidding? The only two women shown to have lost a significant amount of weight are the two women who obsessively measure everything they eat and, if I recall, they were both under 1500 calories still and walking a shit-ton every day. Maybe FCJ people want to live a “You have to eat X number of calories” kind of life, but I would rather improve the quality of my diet and eat to my satisfaction than make every meal a math problem. And I also want to work out doing something I enjoy (I prefer the elliptical and racketball, and I’ve been using the weight machines for over a year and love it), not put in some brutal workout for two hours a day because I don’t have two hours a day. But I do get in 150 minutes of cardio and strength training at least once a week. It doesn’t sound like much, but it’s made a great improvement in my blood pressure and cholesterol. And, more importantly, I’ve been doing it for over two years because of HAES.

          If you’ve seen WotN, then you’ve seen Sam Klein explain two things: first, that losing just 7% of your starting weight has a profound impact on your health, and second, that fat people who don’t have a fatty liver are perfectly healthy. The reason is that a fatty liver is a sign of insulin resistance and it is IR, not weight, that determines whether a person is healthy, whether they are fat or not.

          Dr. Steven Blair’s widely-respected body of research shows that cardiorespiratory fitness is the greatest indicator of metabolic health, such that whether you’re normal weight, overweight or obese, if you get the recommended amount of exercise, you have no additional mortality risk.

          Fat and Fit

          So many of us are quite active, but we have not lost a significant amount of weight. If you saw us in public, you could not determine who is the cyclist and who is the marathoner and who is the lazy bum. And you know what? I can back up the fact that you can be fat and fit with exhaustive research going back decades, yet there isn’t any proof that long-term weight loss works for the vast majority of people. You can dismiss that research however you like, but the mainstream medical community is slowly coming to understand that recommending large amounts of weight loss (as we have since the early to mid-1970s) leads to long-term weight gain. Walter Willett, who is a staunch anti-obesity advocate, published a study showing (PDF) that women who were severe weight cyclers (intentionally losing and regaining (cycling) 20 pounds at least three times) gained an average of 15.9 pounds after four years. Mild cyclers (cycling 20 pounds either once or twice, or cycling smaller amounts) gained 9.1 pounds and non-cyclers gained 6.9 pounds. And this blog is frequented by a large contingency of weight cyclers. Incidentally, per your second study, weight cycling is also a predictor of failure for weight loss attempts. Weight cycling wears down your homeostatic mechanisms. There’s a great paper on the repeat overshoot theory in the 2006 International Journal of Obesity (it’s available to the public if you only have access to journals through colleagues and friends, as I do).

          Basically, each time you cycle, regardless of the reason, whatever improvements you’ve made are reversed, and in the process of worsening metabolic health, you stress the system. And this repeated switching from taking pressure off your system and putting it back on puts additional wear and tear on your cardiovascular system and ability to process glucose. So, many medical professionals, particularly among the ED community, are promoting HAES as an alternative for obese patients. The most notable proponent is Dr. Arya Sharma, who is . He explains HAES and gives a positive endorsement of it. I know you’re probably thinking “Who the fuck is Dr. Arya Sharma?” He’s a Canadian health professional who is widely respected… in Canada. I mean, really, how many Americans know the names of prominent Canadian bariatric physicians? In any case, HAES is about ensuring that the healthy lifestyle choices you make are ones that you can commit to for the rest of your life. For most people, there’s a limit to how much caloric restriction they can sustain long-term, and this is influenced by leptin and ghrelin. And if you haven’t watched that lecture by Dr. Friedman, then you can’t understand why leptin and ghrelin matter so much.

          The best analogy I’ve ever heard for long-term weight loss is that it’s like holding your breath. Yeah, some people can hold their breath for 60, 90, 120 seconds, but eventually everyone exhales. When you read the studies and you see how much weight the sliver of “successful” people lose on “moderate” weight loss plans, it’s breathtakingly small. And nearly every single person who is a part of this community has a lifetime of experiences that bear that out. And FCJ can call us liars and weak-willed and act like a bunch of petulant grade-schoolers all they want on FCJ, but we don’t need your help figuring this shit out. Whether you agree or not, I could care less, but I’ve studied this subject just as thoroughly as you have, I’m sure, and I’ve come to a different conclusion as to what is required for health. And I will happily point to the experts whose research backs up my approach. Just say the word.

          Finally, this belief that HAES is nothing more than an excuse to do nothing is absolutely idiotic. People are pursuing health for health’s sake, and FCJ mocks it because they don’t understand it. And they don’t want to understand it because it’s much more entertaining for them to assume we’re all the gallumphish caricatures they giggle about like a bunch of Nellie Olesons (that’s right, I’m breaking out the “Little House on the Prairie” metaphors).

          That’s their choice, but seriously, people. Get over yourselves.

          It’s been nice speaking civilly with you amongst this shitstorm, but I’m ready for you all to go home now.

          Peace,
          Shannon

          • Steve permalink
            November 21, 2012 9:12 am

            “The only two women shown to have lost a significant amount of weight are the two women who obsessively measure everything they eat and, if I recall, they were both under 1500 calories still and walking a shit-ton every day.”

            This is ultimately where the conversation hits a dead end. Where any given individual draws the lines between “obsessive,” “reasonable” or “lazy” is entirely subjective and relative. The things I do in the pursuit of my own fitness goals are outside the norms of modern society, and would surely be labelled “obsessive” by some. Of course I wouldn’t describe myself as obsessed; I see my activities as the pursuit of a challenging and rewarding hobby, as well as an investment in my continued functioning and well-being, inextricably bound as my mind is to my body. I also understand how fortunate and privileged I am in many ways, in that I had to overcome fewer obstacles than many people in this particular realm. But we all have to play the hand we’re dealt; we all have various advantages and disadvantages; and being disadvantaged doesn’t mean being doomed. When I see someone who has achieved more athletic success than I have, there’s a possibility that they had an easier time due to some inherent advantages they have which I lack. But, since I recognize that (despite being an extreme outlier compared to society at large) I haven’t yet become advanced enough to be constrained by my natural biological limits, the far more salient reason that they achieved more is that they wanted it more and they worked harder or longer, and I’m ok with that. Whether or not I ever reach this or that milestone, I’m still improving all the time.

            When I learn about the habits of people who succeed at long-term weight loss, I’m not surprised. The women portrayed in the documentary who maintained significant weight loss did the same things the members of the National Weight Control Registry do — in other words, they did exactly what they needed to do, so their success is unsurprising, inevitable even. 1500 calories a day (or less) is a completely appropriate amount for people of a given size and activity level to eat, and an hour of walking per day would be entirely normal in many times and places. “Making every meal a math problem” is an inaccurate description; the women were even shown as being able to accurately estimate the calorie content of a given meal without using any measuring tools. People who aren’t as susceptible to obesity are able to get by without doing this consciously, because their bodies’ homeostatic systems do it for them. Other people’s regulatory mechanisms, it seems, aren’t able to function properly in the contemporary food environment, and so they must be more educated and vigilant, lest they become obese. Perhaps society will one day come to the conclusion that our food environment is harming us, and that it would be in our best interests to actively change it. But until then, we each have to deal with the situation we find ourselves in, whether or not it seems fair and equitable.

            When I see statistics on the low success rates of weight loss, I’m also not particularly surprised, because it’s a difficult undertaking for many different reasons. But what I take from that information is knowledge about common pitfalls, and ideas about how they might be avoided. What other people take is apparently the idea that the whole endeavor is so unlikely to succeed as to be essentially impossible.

            But it’s very clearly not impossible, and this is why I find the harping on the success rate figures to be unhelpful at best and disingenuous at worst — the success of a dietary intervention or training program is not a probabilistic event. It’s not a roll of the dice with a 5% chance of success, which is how some portray it. We have a good deal of knowledge about what specifically leads to success or failure. There is an observable cause and effect taking place, not a random series of events. Unless your argument is that the universe is fundamentally deterministic and all free choice is an illusion, in which case we’d be having a very different discussion, but I don’t think that’s what you’re saying.

            As for the health risks, I don’t have much to add right now except to reiterate the fact that for many people — like those of us involved in athletic pursuits — our interests and criteria for quality of life go beyond mortality probabilities. Some people’s individual criteria for quality of life necessarily rule out a lifestyle that would bring about weight loss, and other people’s do not. It’s ultimately a personal thing. The barriers to change and achievement are different for different people, but that’s just how life is.

        • November 21, 2012 5:17 pm

          This is not a study, or anything but a highly subjective view on competitive athleticism, but I think there’s a slight mental imbalance needed to become a competitive athlete (I say this as a former Olympic hopeful; now a recreational runner, martial artist, fencer, volleyball player, BMI normal HAES supporter).

          It is self-evident to people who are engaged in these sorts of things themselves, and engaged in helping others achieve similar athletic goals, that the body responds reliably to dietary intervention and training.
          I am not disputing that fact. Bodies do respond to dietary intervention and training. Now, if you’re talking the level of training I’m thinking of, the “dietary intervention” part of the equation calls for periods of starvation-level diets including dehydration to make a lower weight class or to cut a more aerodynamic figure for some sports. You’re told to stick to a certain diet or get out of the training center (in my case, trainers tried to enhance muscle density without building too much speed-inhibiting bulk since I was fencing epee and foil)- if that doesn’t foster eating disordered thinking I don’t know what does.

          The training part, on the other hand, demands a time and monetary commitment that people who aren’t professional athletes or capable of relying on their sport for income aren’t able to keep up. I trained for upward of 20 hours a week as a teen, only made possible since I was homeschooled for a large part of my education and my parents being comfortably middle class. As a working adult in a high-pressure job, I would have to give up on half of my sleeping time to make that kind of training possible. I know there are a lot of people working just as hard who don’t get the monetary advantages I get from my job, so their training might not only be lacking in sufficient time but also in quality since quality training is very expensive. If you’re talking elite level, personal and small group training is really the only way to go.

          And while different people have different advantages, disadvantages, and limitations determined at birth, for the most part those things simply aren’t relevant until one starts approaching elite levels of achievement. Priorities and education simply make a larger practical difference in most cases.

          They come into play sooner than you think. Not that flexible by nature? Schedule in an extra half an hour for warm-ups (this, I have personal experience with). Almost anything can be compensated for with extra training, but a fact is that to enjoy most sports even on a recreational level and get the kind of encouragement that winning at something or surpassing previous limits gives you, people who don’t have the genetic predisposition to be successful (note: Not exceptional, or elite) athletes have to work three times harder just to see a minute improvement. I have a genetic advantage in having very fast reflexes and average hand-eye coordination, so training the latter to match the former is possible with some effort. A lot more effort than someone who is gifted in both areas, but I can measure my progress and feel success in a certain amount of time. Imagine someone born without any of these advantages (there is such a person on my volleyball team). They have to deal with being the slowest, the weakest, the least reliable on the team ALL the time.Even if this person made their hobby their priority in life (superseding their work, their family, their social life apart from the team), they would have to commit three times as much time to practice just to become average- so exponentially more than someone born with a LOT of genetic advantages.

          The people you are talking about have, I would be willing to bet, all been born with at least a few genetic advantages that make it possible for them to find enjoyment in an athletic activity. They feel the joy in that activity, thus enabling them to stick to a schedule that allows for that activity to feature prominently. Non-athletic people wouldn’t be able to do that- seeing no reward for what is essentially a stressful activity is demotivating enough that not even the most resilient of mentalities will be able to overcome it in the long run- or how many people do you know who genuinely enjoy a visit to the dentist?

          but these people realize that bodies are ultimately highly malleable given the proper inputs, and so they scoff at implications to the contrary.

          Bodies are also highly resilient. They will adhere to a shape that you force them into as long as you apply enough external pressure. Release that pressure and they will default to a state that is, mostly, pre-determined by genetics. Almost anything from high blood pressure to breast cancer has been found to have a strong genetic component.

          Shaping a body always, always includes some sort of obsessive thinking. Overcoming genetics is possible, but not with what is usually defined as a healthy mindset. Be it that you need to force yourself to eat extra to gain weight, or that you need to know the caloric content of almost any food you come into contact with, both of these force an organism to apply an inordinate amount of thought to something as simple as keeping up biological functions.

          For me, it took years until I was able to have a balanced meal that would enable me to live without supplements and NOT feel like I’d just failed someone, or destroyed my chances at becoming good at something I liked to do. The child shaped by rigorous training and disordered eating still has days raising her head and wailing at me for eating the entirety of my plate at dinner.

          My body has changed shape since discovering HAES- I’m now almost ten pounds heavier than before. I’ve also been able to reduce my thyroid medication dose, thereby improving heart health, and my metabolic factors have improved a lot. My energy levels are higher, I’m more capable at my sports, I’ve shaved two minutes off my 5k time (without changing my training). To say it simply, listening to my body has enabled me to use nature’s own reward system and reach what is, considering my lifestyle limitations, an optimum level of performance.

          I won’t become an elite with that kind of thinking. I won’t even reach the top of the amateur league, my genetic gifts aren’t strong enough for that. But isn’t being healthy worth more than shaping the body into something it simply doesn’t want to be? Isn’t being able to enjoy an activity equally as rewarding as fitting into the narrow range that is considered elite for it?

          I don’t dispute that almost anyone is able to shape their bodies into something society might consider desirable, at least for a short term. I’m questioning the mental and physical health of most who do so (also, their reasons, but that’s another issue entirely).

          Note: I also don’t dispute the existence of natural athletes, or that some people might be able to keep a healthy balance while also reaching elite levels at their chosen sports. I’m just saying that, from personal experience, I haven’t yet met anyone at that level who is entirely mentally stable.

          Note 2: Just to make it clear, I haven’t shaken the obsessive mindset entirely. I’ve rerouted most of it to my work- but being a workaholic has been better for my health than attempting to shape an average athlete into an elite. Some of it is hopefully gone for good!

    • Kala permalink
      November 20, 2012 4:00 pm

      Steve, if you read Shannon’s previous entry on weight loss and weight management, I think you’ll find that he has a reasonable grasp on the research. If you’ve boiled down his efforts on the issue to your fatalistic slogans, I think that shows that you haven’t put any time in reading his writing.

      I absolutely agree with this:

      “It’s a fact that most people who attempt significant, long-term weight loss are unsuccessful. But this fact should lead us to examine the factors that contribute to that failure, as well as the environmental factors in modern society which allowed obesity to rise to current levels in the first place — not to mention the factors that contribute to the success of the minority that do succeed”

      I hope that we get some concrete answers and something to do about it, and I personally think that the increased proportion of obese individuals in our society (not every obese person) is a telltale symptom of troublesome changes in a lot of aspects of our society(ies).

      However, in the meanwhile, every time a fat person tries a lifestyle intervention and has it fail, they are told by others (including often clinical professionals) that they weren’t trying enough or didn’t try the right thing, as if the right thing for every person is some kind of known quantity. If they are honest that they followed the intervention, and didn’t lose the weight, they are assumed to be liars even when the clinical research has no better results. When fat people pursue and maintain healthy behaviors, they are made to feel that it makes no difference if they’re not losing weight. The weight loss, and the social acceptance that comes with it, is seen as the prize for all the toil that it may take someone to lose that weight, if they can lose it.

      Culturally, our view on weight is pretty fucked. The average person absolutely conflates what they find attractive with what they think is healthy. The notion that a bigger person could eat well, exercise, remain fat, and have markedly increased health is a rejected result. Fat people are believed to be lazy, thought to be disgusting, emotional, masculine if you’re female, effeminate if you’re male, what have you, the list is long.

      And browsing the FCJ Reddit, I see a big bunch of morons. Perhaps everyone there isn’t actually breathtakingly stupid or ignorant, but looking at something like this:

      http://www.reddit.com/r/fitnesscirclejerk/comments/13iogq/listen_up_you_fagocrats_this_is_what_happens_when/

      I see a bunch of chumps who think themselves really edgy and funny because they take pains to be deliberately offensive behind the veil of a username. It reads as if 4chan circa 4 years ago had a weightlifting board. To be honest, I can’t see why someone as seemingly literate as you would partake in this. And the Jacques guy, I think he uses overly-flowery language on his blog, and I can’t say I liked his systems theory post much, but he also doesn’t seem to be in the same quartile for intellect as the average FCJ user.

      • Tardovski permalink
        November 20, 2012 6:27 pm

        > as if 4chan circa 4 years ago had a weightlifting board.

        http://boards.4chan.org/fit/

        > The average person absolutely conflates what they find attractive with what they think is healthy

        Hardly — I’ve lost count of how often I’ve heard people in all seriousness say “who cares if she’s anorexic — she’s hot!” Most just don’t care if what they find attractive is healthy.

        • Kala permalink
          November 20, 2012 7:54 pm

          Fit is not a *weightlifting* board.

          • Tardovski permalink
            November 20, 2012 8:22 pm

            It’s roughly as focused on resistance training and weightlifting as FCJ is. /fit/ probably has a heavier emphasis on bodybuilding whereas FCJ has a more general sport and athletic base, but both generally acknowledge that weight training has benefits that apply to most physical activities.

  4. November 21, 2012 12:16 am

    If Aiden is correct, then tell me what the “optimal range” of calories is for losing 50 pounds.

    And then please prove that my “optimal range” of calories for losing 50 pounds (and/or the actual number of pounds by which I’m overweight) is the same as is my “optimal range” of calories for metabolic health.

    Because one thing I’ve been thinking of during recent discussions is, “Yes, I could lose the weight — but I would be less healthy doing so, rather than more.”

  5. November 21, 2012 1:10 am

    It’s laughable that people don’t understand that this is not their space to discuss their shit. This is OUR space to discuss what we wish. It is a safe space for us and they are making it unsafe.

    People are seriously lacking in respect.

  6. jogeek1 permalink
    November 21, 2012 11:02 am

    I think the biggest problem is that people are trying to counter actual research studies with personal anecdotes. Bad science; no cookie! “The plural of anecdote is not data” (Roger Brinner). Citing one or two outliers does not change the data for the vast majority (98% or thereabouts) of human beings who are continuously marginalized, shamed, and encouraged to do real damage to their bodies in the name of pursuing the 2%. Come up with real, science-based, unbiased research that says that sustainable (5+years) weight loss of more than 7% of the body is possible for a significant percentage of people, and then you have a rational argument. The “I did it by dedicating my entire life to my appearance” is a strawman argument and entirely irrelevant.

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