- Jun 25, 2006
- 5,046
- 1
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by Charles Poliquin
The New England Journal of Medicine recently published an article reviewing myths, presumptions, and facts about obesity. Inspired by the need to help people comb through unsupported ideas about how to lose weight, the article discusses what the authors consider to be unproven beliefs about what makes us fat.
The review makes you think but misses the mark on the real issues underlying obesity. It’s a complicated issue, made more complex by a poorly informed medical community, the media’s tendency to blow things wildly out of proportion, and business-driven interests in the fat loss and food industries.
In fact, we know quite a lot about strategies for treating obesity and helping people lose fat so they live healthier, happier lives. In theory it’s simple: A whole foods diet, devoid of processed foods, that uses a macronutrient composition that fulfills individual, genetic needs (generally low-carb, high-protein, healthy fat); avoidance of food additives, chemicals, and toxins; a concerted effort to manage stress; appropriate supplementation to fill nutrient gaps; weight training following a German Body Composition-style program; and interval-style training when needed.
Of course, those guidelines go way beyond the scope of the article in question, which must be considered within the context of what the scientists set out to do. They wanted to identify facts about obesity based on rigorous evidence-based research. They required randomized controlled clinical trials, not association or observational studies for their proof. The authors focus on the inappropriateness of inferring causality from an association.
The problem with this is that in many cases, ethical prohibitions make it impossible to run randomized control studies: You can’t go giving humans BPA in their water to see if it will cause cancer or increase obesity rates, for example. You can only test humans for levels of BPA in urine and see if people with higher body fat also have higher levels of BPA (they do!).
Nonetheless, it’s necessary to focus on the intention of the review, because although the scientists missed out on the opportunity to provide a deeper analysis of what makes us fat, complexity was never their aim. For example, one of the seven myths reviewed is that “a bout of sexual activity burns 100 to 300 calories for each person involved.”
Who believes this? Moreover, how is it relevant to the treatment and prevention of obesity? Although there may be people who think they will lose weight by having sex, this simply can’t be our main concern in a population in which at least 33 percent are obese and 66 percent are overweight.
In addition, it seems a crime that there’s no mention that it is what people eat that contributes to them becoming fat. The only references to eating at all are with the following three points:
1.) The authors skirt around the “calorie myth,” writing that “small sustained changes in energy intake or expenditure will produce large, long-term weight loss changes.”
They make the effort to point out that eating (or not eating) two additional potato chips a day won’t help you lose weight. Good to know…
2.) They question the presumption that there is a “value of eating breakfast to prevent obesity” based on one 1992 randomized control study in which obese women had comparable weight loss regardless of whether they ate or skipped breakfast. The women were on a diet that provided 1,200 calories a day of which 55 percent was carbs.
Contrast that with abundant observational evidence that better body composition and improved cognitive function come from eating protein for breakfast. The point is that what we eat is just as important as when we eat, and maybe more so.
3.) They question the presumption that there is a ”value of eating fruits and vegetables” for weight loss “regardless of whether one intentionally makes any other behavioral or environmental changes.”
Sure, preventing obesity and weight loss is about a multifaceted approach, but the authors miss the point by spending time questioning the inclusion of fruits and vegetables, particularly when observational studies show that people who eat more fruits and vegetables have less body fat and stay leaner over time than those who eat fewer. This may be due to related weight management habits, however, it makes more sense to focus on what works, while pointing out that eating processed, chemical-filled food is a bad choice.
Aside from ignoring the role high-carb diets and processed food plays in obesity, the authors’ analysis of some of the issues ignores compelling data about obesity prevention. For example, with regards to the prevention of childhood obesity they consider “the importance of physical education for kids in their current form” to be a myth. Meanwhile, they consider it a presumption that “early childhood is the period during which we learn exercise and eating habits that influence our weight throughout life.”
This avoids the deeper issues: For example, contemporary gym classes are not only despised by most kids, but simply attending, which is all that is often required, certainly doesn’t mean that activity is performed or that calories are burned. However, there are community activity intervention models that have been shown to decrease obesity rates in youth moderately over a few years—longer term programs might show better outcomes.
Plus, strength and muscular power training programs show impressive outcomes in terms of physical performance, coordination and fitness for kids. It’s true that body weight changes haven’t been well researched in this area, but the concern is that possible solutions to obesity issues will get ignored in response to the NEJM article.
Finally, I will review the list of “facts” provided by the authors and include brief comments. First, please take note that the authors of the study had strong affiliations with the packaged food and pharmaceutical industries. Their list of disclosures is half a page long and they admit to receiving funds from the following companies and organizations (this is not a complete list): Kraft Foods, Global Dairy Platform, McDonalds, Jenny Craig, Knowledge Institute for Beer, Arena Pharmaceuticals, GlaxoSmithKline, Coca-Cola, National Cattlemen’s Association, United Soybean Board, World Sugar Research, Red Bull, PepsiCo, Eli Lilly and Company, and General Mills.
With that picture in mind, here are nine “facts” that are suggested to guide us in public policy and clinical recommendations.
1.) Although genetic factors play a large role, heritability is not destiny in terms of obesity.
Good point—the key is to use diet, weight training, and a nontoxic and unsedentary lifestyle to achieve optimal body composition.
2.) Diets (reduced energy intake) very effectively reduce weight, but trying to go on a diet or recommending that someone go on a diet generally does not work well in the long-term.
It’s true that energy reduction to create a calorie imbalance can reduce body fat. However, for the long-term a strict calorie-based approach to preventing obesity won’t work, making a lifestyle approach the obvious solution. Just make sure it considers hormone response to eating, the different effect of macronutrient ratios on energy balance, and toxic confounders such as pesticides, growth hormones, and xeno-estrogens.
3.) Regardless of body weigh or weight loss, an increased level of exercise increases health.
Good point. Why not choose exercise modes that build muscle, increase the amount of calories burned at rest—yeah, you know I’m talking about resistance training—and minimize oxidative stress?
4.) Physical activity or exercise in a sufficient dose aids in long-term weight maintenance…for physical activity to affect weight, there must be a substantial quantity of movement, not mere participation.
Yep, just showing up and going through the motions doesn’t make a
difference for body composition. You have to train and train hard if you want to lose fat. Whether you coax the body to lose fat or think of it as a war, a radical approach is necessary. That said, you can’t out-train a bad diet.
Therefore, limiting long-term weight maintenance to “a substantial quantity of movement” is one-sighted. Also, remember that aerobic exercise, which could be what people think of when the term “exercise” is used, requires an enormous volume of exercise and brings with it a slow, but dramatic loss of muscle mass.
Pair intense training with the right diet and an active (not sedentary) lifestyle for optimal body composition.
5.) Continuation of conditions that promote weight loss promotes maintenance of lower weight. Obesity is conceptualized as a chronic conditioning, requiring ongoing management to maintain long-term weight loss.
That’s why you need a lifestyle approach that enhances energy levels and well being: Eat a whole-food high protein diet, lift weights, supplement wisely, and facilitate mental health in terms of food and training.
6.) For overweight children, programs that involve the parents and the home setting promote greater weight loss or maintenance.
YES! Parents have the opportunity to start kids training at a young age and eating for body composition. Research suggests that weight training focused on teaching exercise technique with light loads is appropriate starting at age 6 or 7. By the teen years, depending on training age, youth can progress into training for strength and power.
Likewise, you CAN teach kids to eat protein at every meal. Though not a randomized control trial, this article gives tips on how to do so based on real-life experience
7.) Provision of meals and use of meal-replacement products promote greater weight loss.
Do you think this “fact” is motivated by the authors’ affiliations with Jenny Craig and companies that make meal-replacement products?
I’ll say it again, body composition and weight loss are about developing a balanced lifestyle approach that can be MAINTAINED and produces more enjoyment than struggle.
8.) Some pharmaceutical agents can help patients achieve clinically meaningful weight loss and maintain the reduction as long as the agents continue to be used.
Despite the inclination to respond to this “fact” with a critical comment, I’d like to encourage everyone to pursue lifestyle interventions that focus on diet, resistance training, and stress reduction for preventing and treating obesity.
9.) In appropriate patients, bariatric surgery results in long-term weight loss and reductions in the rate of incident diabetes and mortality.
The New England Journal of Medicine recently published an article reviewing myths, presumptions, and facts about obesity. Inspired by the need to help people comb through unsupported ideas about how to lose weight, the article discusses what the authors consider to be unproven beliefs about what makes us fat.
The review makes you think but misses the mark on the real issues underlying obesity. It’s a complicated issue, made more complex by a poorly informed medical community, the media’s tendency to blow things wildly out of proportion, and business-driven interests in the fat loss and food industries.
In fact, we know quite a lot about strategies for treating obesity and helping people lose fat so they live healthier, happier lives. In theory it’s simple: A whole foods diet, devoid of processed foods, that uses a macronutrient composition that fulfills individual, genetic needs (generally low-carb, high-protein, healthy fat); avoidance of food additives, chemicals, and toxins; a concerted effort to manage stress; appropriate supplementation to fill nutrient gaps; weight training following a German Body Composition-style program; and interval-style training when needed.
Of course, those guidelines go way beyond the scope of the article in question, which must be considered within the context of what the scientists set out to do. They wanted to identify facts about obesity based on rigorous evidence-based research. They required randomized controlled clinical trials, not association or observational studies for their proof. The authors focus on the inappropriateness of inferring causality from an association.
The problem with this is that in many cases, ethical prohibitions make it impossible to run randomized control studies: You can’t go giving humans BPA in their water to see if it will cause cancer or increase obesity rates, for example. You can only test humans for levels of BPA in urine and see if people with higher body fat also have higher levels of BPA (they do!).
Nonetheless, it’s necessary to focus on the intention of the review, because although the scientists missed out on the opportunity to provide a deeper analysis of what makes us fat, complexity was never their aim. For example, one of the seven myths reviewed is that “a bout of sexual activity burns 100 to 300 calories for each person involved.”
Who believes this? Moreover, how is it relevant to the treatment and prevention of obesity? Although there may be people who think they will lose weight by having sex, this simply can’t be our main concern in a population in which at least 33 percent are obese and 66 percent are overweight.
In addition, it seems a crime that there’s no mention that it is what people eat that contributes to them becoming fat. The only references to eating at all are with the following three points:
1.) The authors skirt around the “calorie myth,” writing that “small sustained changes in energy intake or expenditure will produce large, long-term weight loss changes.”
They make the effort to point out that eating (or not eating) two additional potato chips a day won’t help you lose weight. Good to know…
2.) They question the presumption that there is a “value of eating breakfast to prevent obesity” based on one 1992 randomized control study in which obese women had comparable weight loss regardless of whether they ate or skipped breakfast. The women were on a diet that provided 1,200 calories a day of which 55 percent was carbs.
Contrast that with abundant observational evidence that better body composition and improved cognitive function come from eating protein for breakfast. The point is that what we eat is just as important as when we eat, and maybe more so.
3.) They question the presumption that there is a ”value of eating fruits and vegetables” for weight loss “regardless of whether one intentionally makes any other behavioral or environmental changes.”
Sure, preventing obesity and weight loss is about a multifaceted approach, but the authors miss the point by spending time questioning the inclusion of fruits and vegetables, particularly when observational studies show that people who eat more fruits and vegetables have less body fat and stay leaner over time than those who eat fewer. This may be due to related weight management habits, however, it makes more sense to focus on what works, while pointing out that eating processed, chemical-filled food is a bad choice.
Aside from ignoring the role high-carb diets and processed food plays in obesity, the authors’ analysis of some of the issues ignores compelling data about obesity prevention. For example, with regards to the prevention of childhood obesity they consider “the importance of physical education for kids in their current form” to be a myth. Meanwhile, they consider it a presumption that “early childhood is the period during which we learn exercise and eating habits that influence our weight throughout life.”
This avoids the deeper issues: For example, contemporary gym classes are not only despised by most kids, but simply attending, which is all that is often required, certainly doesn’t mean that activity is performed or that calories are burned. However, there are community activity intervention models that have been shown to decrease obesity rates in youth moderately over a few years—longer term programs might show better outcomes.
Plus, strength and muscular power training programs show impressive outcomes in terms of physical performance, coordination and fitness for kids. It’s true that body weight changes haven’t been well researched in this area, but the concern is that possible solutions to obesity issues will get ignored in response to the NEJM article.
Finally, I will review the list of “facts” provided by the authors and include brief comments. First, please take note that the authors of the study had strong affiliations with the packaged food and pharmaceutical industries. Their list of disclosures is half a page long and they admit to receiving funds from the following companies and organizations (this is not a complete list): Kraft Foods, Global Dairy Platform, McDonalds, Jenny Craig, Knowledge Institute for Beer, Arena Pharmaceuticals, GlaxoSmithKline, Coca-Cola, National Cattlemen’s Association, United Soybean Board, World Sugar Research, Red Bull, PepsiCo, Eli Lilly and Company, and General Mills.
With that picture in mind, here are nine “facts” that are suggested to guide us in public policy and clinical recommendations.
1.) Although genetic factors play a large role, heritability is not destiny in terms of obesity.
Good point—the key is to use diet, weight training, and a nontoxic and unsedentary lifestyle to achieve optimal body composition.
2.) Diets (reduced energy intake) very effectively reduce weight, but trying to go on a diet or recommending that someone go on a diet generally does not work well in the long-term.
It’s true that energy reduction to create a calorie imbalance can reduce body fat. However, for the long-term a strict calorie-based approach to preventing obesity won’t work, making a lifestyle approach the obvious solution. Just make sure it considers hormone response to eating, the different effect of macronutrient ratios on energy balance, and toxic confounders such as pesticides, growth hormones, and xeno-estrogens.
3.) Regardless of body weigh or weight loss, an increased level of exercise increases health.
Good point. Why not choose exercise modes that build muscle, increase the amount of calories burned at rest—yeah, you know I’m talking about resistance training—and minimize oxidative stress?
4.) Physical activity or exercise in a sufficient dose aids in long-term weight maintenance…for physical activity to affect weight, there must be a substantial quantity of movement, not mere participation.
Yep, just showing up and going through the motions doesn’t make a
difference for body composition. You have to train and train hard if you want to lose fat. Whether you coax the body to lose fat or think of it as a war, a radical approach is necessary. That said, you can’t out-train a bad diet.
Therefore, limiting long-term weight maintenance to “a substantial quantity of movement” is one-sighted. Also, remember that aerobic exercise, which could be what people think of when the term “exercise” is used, requires an enormous volume of exercise and brings with it a slow, but dramatic loss of muscle mass.
Pair intense training with the right diet and an active (not sedentary) lifestyle for optimal body composition.
5.) Continuation of conditions that promote weight loss promotes maintenance of lower weight. Obesity is conceptualized as a chronic conditioning, requiring ongoing management to maintain long-term weight loss.
That’s why you need a lifestyle approach that enhances energy levels and well being: Eat a whole-food high protein diet, lift weights, supplement wisely, and facilitate mental health in terms of food and training.
6.) For overweight children, programs that involve the parents and the home setting promote greater weight loss or maintenance.
YES! Parents have the opportunity to start kids training at a young age and eating for body composition. Research suggests that weight training focused on teaching exercise technique with light loads is appropriate starting at age 6 or 7. By the teen years, depending on training age, youth can progress into training for strength and power.
Likewise, you CAN teach kids to eat protein at every meal. Though not a randomized control trial, this article gives tips on how to do so based on real-life experience
7.) Provision of meals and use of meal-replacement products promote greater weight loss.
Do you think this “fact” is motivated by the authors’ affiliations with Jenny Craig and companies that make meal-replacement products?
I’ll say it again, body composition and weight loss are about developing a balanced lifestyle approach that can be MAINTAINED and produces more enjoyment than struggle.
8.) Some pharmaceutical agents can help patients achieve clinically meaningful weight loss and maintain the reduction as long as the agents continue to be used.
Despite the inclination to respond to this “fact” with a critical comment, I’d like to encourage everyone to pursue lifestyle interventions that focus on diet, resistance training, and stress reduction for preventing and treating obesity.
9.) In appropriate patients, bariatric surgery results in long-term weight loss and reductions in the rate of incident diabetes and mortality.