What If Nothing Works?

by Lou Schuler on Jul 5, 2007 12:17 PM EDT in News

Nutrition advice has been notoriously flawed over the years. So, for that matter, has exercise advice. Put the two of them together, and you get the biggest problem of all:

Weight loss advice almost never helps anyone lose weight.

And yet, something must work. We all know people who've lost weight and kept it off. We've all known non-exercisers who became exercisers. We all know people who've turned their lives around by eating better and exercising more, or at least more effectively.

The problem, says Sydney Spiesel, M.D., in Slate, is that we have no idea how or why diets work for a few but not for the overwhelming majority of people who try to lose weight.

Instead, researchers tend to discover, over and over again, that whatever we're doing now just isn't working for most of the people who try it. And sometimes the results are worse than they would've been if the dieters hadn't tried at all:

In 14 studies that lacked control groups, but followed dieters for at least four years after a prescribed reduced-calorie diet, the average early weight loss after dieting was almost 31 pounds. But by the end of the follow-up period, on average the dieters gained back more than 24 of the pounds they had lost. In 10 studies in which nutritional scientists tracked the weight of people who put themselves on any diet of their choosing, the results were even worse. Of the 10 reports, only one described lasting weight loss, two showed no long-term effect, and the remaining seven studies found that dieting led to weight gain in the long run.

That result, of course, is particularly disturbing because it suggests that dieting is somehow monkeying with the body -- perhaps by resetting the thermostat that controls how efficiently we utilize food -- so as to make the struggle to lose weight all the more difficult. For instance, an excellent 2003 study of almost 15,000 preteens and teens followed for three years clearly showed that the kids who dieted gained more weight than the nondieters. This excess gain could not be explained by initial chunkiness, differences in caloric intake, or in the amount of energy contained in dietary fat.

Since a doctor's credo starts with that famous admonition to do no harm, Dr. Spiesel, a pediatrician, no longer prescribes diets for even his heaviest patients:

Ultimately, I think we need to start at the other end: by preventing kids from putting on excess weight in the first place. There's no easy fix, but in addition to increasing exercise, we need to somehow encourage families to shop and live differently.

Funny he should mention that, considering this report in today's news:

The federal government will spend more than $1 billion this year on nutrition education -- fresh carrot and celery snacks, videos of dancing fruit, hundreds of hours of lively lessons about how great you will feel if you eat well.

But an Associated Press review of scientific studies examining 57 such programs found mostly failure. Just four showed any real success in changing the way kids eat -- or any promise as weapons against the growing epidemic of childhood obesity.

"Any person looking at the published literature about these programs would have to conclude that they are generally not working," said Dr. Tom Baranowski, a pediatrics professor at Houston's Baylor College of Medicine who studies behavioral nutrition.

I've made fun of abstinence-only sex education a bunch of times, but my team isn't doing any better when it comes to nutrition advice targeted to children. I think the reasons are obvious: Kids, like teens with hypercharged hormones, know bullshit when they hear it. Junk food tastes better than carrots and celery. Sex feels better than abstinence. A minority may feel better about themselves when they take the more virtuous path, whether we're talking about sex or nutrition; we just can't expect the majority to react that way.

But the analogy falls apart when we compare the influence parents have. Teens are mobile and prone to trust their friends more than their parents. After all, what could a bunch of lumpy, wrinkly, badly dressed adults possibly know about sex? (Never mind that sex, or at least reproduction, is what made us lumpy and wrinkly to begin with, according to this story in today's New York Times. And once you're lumpy and wrinkly, dressing badly is almost inevitable.)

But young children aren't mobile, don't have their own walking-around money, love their parents, and have little choice but to follow our direction. Which means parents have a duty to prevent bad habits from forming in the first place:

Experts agree that although most funding targets schools, parents have the greatest influence, even a biological influence, over what their children will eat. Zeitler says when children slim down, it's because "their families get religion about this and figure out what needs to happen."

But often, they don't.

"If the mother is eating Cheetos and white bread, the fetus will be born with those taste buds. If the mother is eating carrots and oatmeal the child will be born with those taste buds," said Dr. Robert Trevino, at the Social and Health Research Center in San Antonio, Texas.

Most kids learn what tastes good and what tastes nasty by their 10th birthdays.

"If we don't reach a child before they get to puberty, it's going to be very tough, very difficult, to change their eating behavior," said Trevino.

So what do we do now? What hasn't been tried that might work better than what has been tried?

(Hat tip to Andrew Birkhead for the Slate story.)

Post-holiday blog meat

Reader Scott Bradley sent along this story, about young women with type 1 diabetes who forego insulin shots so they can be thinner. His comment: "In a world of people looking for quick fixes for weight loss, this is one of the scariest I have ever come across. I am unsure if this is misguided, uneducated, or just plain dumb, but I am sure that the consequences are truly terrifying. Sure, you might be thin, but blindness, kidney malfunction, and amputation are going to make it difficult to pull off that little black number for Saturday's party."
A new book asks if the self-help movement breeds helplessness in its adherents. My friend Steve Salerno believes this with such conviction that he's created a blog to explore every aspect of that question.

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Losers

I know a couple of people, including me, who've lost "some" weight and kept it off, but I don't know anyone, including me, whose gone from obese to "normal" weight, and managed to keep it all of over any extended period of time. I think part of the problem is that too many define success as looking like the cover of a fitness magazine, rather than seeing the improvement they have made. I know from my own experience that once I stopped comparing myself to a younger version of myself or some self selected ideal, and strictly tried to be a better version of me, it became easier to maintain a "reasonable" weight, rather than the "ideal" weight I had been shooting for.

by kadill on Jul 5, 2007 12:40 PM EDT 0 recs

SLATE piece

Ahhhh, ya scooped me, Lou. I've been blogging about the SLATE piece all morning. Look for my brilliant analysis tomorrow over at my virtual stomping ground. Cheers--Andrew

andrew@dynamicfitness.us blog.dynamicfitness.us www.dynamicfitness.us

by Andrew on Jul 5, 2007 4:04 PM EDT 0 recs

Not on board with the maternal cheeto intake guy

The idea that maternal diet influences the "taste buds" an infant is born with is pretty ridiculous. Further, plenty of people change their diets post-puberty -- I would argue that's a big part of the problem, since the majority of overweight adults start out as normal-sized kids.

I am not a big fan of teaching children to diet. If it were up to me I'd teach counter-programming, actually (albeit counter-programming that focused on eating adequate and properly scheduled quantities of healthy foods, not non-stop pizza). Without supervision -- 85% of kids really don't need a diet, supervised or otherwise -- kids don't "diet", they starve. They follow weird food rituals. They develop eating disorders. None of this is very productive in developing a healthier population (or for that matter a thinner one).

I suspect that we know what works, but it's just not easy or sexy. My money is on 5-7 hours of exercise per week and modest calorie reduction with frequent moderate re-feeds. Not that I have the organizational skills to stick with that personally. :P

by kimuchi on Jul 6, 2007 12:05 PM EDT 0 recs

Well ...

There's a whole new field called epigenetics, which shows that the circumstances and choices of one generation can actually create genetic imprints that carry over in their chromosomes to the next generation.

I can't begin to understand or explain the science here. But we do know that genetic shifts can occur in a single generation.

I don't know if this is a valid example, but I'll try it anyway:

We know that starvation changes an individual's brain chemistry. As kimuchi said, people who have been starved develop obsessions with food and eating disorders.

If that could somehow get implanted into someone's DNA, it might move from one generation to the next.

Again, I have no idea if that's a valid example of epigenetics in action.

But if it is, then you might have a genetic propensity to overeat passed on from our grandparents, many of whom had to go hungry in the Depression.

We know that soldiers who see combat have much higher obesity rates than the rest of the population, including soldiers in the same wars who didn't see combat. Maybe that's something that ends up in a chromosome somewhere.

So the Cheetos quote, I believe, is a shorthand reference to the emerging science of epigenetics.

On the bright side, positive changes can end up in our genes as well. At the recent ISSN conference, I sat in on a lecture on nutrigenetics and nutrigenomics by Darryn Willoughby. At least 95 percent of it was over my head, but the parts I was able to understand suggested that, with good exercise habits and dietary choices, we can change the way our bodies respond to carcinogens and alter our hormonal and inflammatory responses.

We can do this by altering gene expression and by making our DNA stronger and more resistant to damage. (Dr. Willoughby said alcohol, fiber, folate, A and B vitamins, and zinc all help strengthen DNA.)

Epigenetics, if I have this right, looks at how we might carry that strengthened or weakened DNA from one generation to the next.

Somebody please correct me if I've gotten this wrong.

by Lou Schuler on Jul 7, 2007 9:06 AM EDT 0 recs

Epigenetics

I had a longer comment, but I decided I really know nothing about this except that it's interesting and surprising, and a bit worrying considering how people eat today. Here are a couple of links:
Sex-specific, male-line transgenerational responses in humans, by Pembrey and others
Environmental influences in an overview of Epigenetics

by Sanctimonious Hypocrite on Jul 7, 2007 12:06 PM EDT up 0 recs

You gave me some homework!

Thanks, I look forward to digging into these.

by Lou Schuler on Jul 8, 2007 9:45 AM EDT up 0 recs

The real problem...

The real problem Lou to me is right here...

"The federal government will spend more than $1 billion this year on nutrition education -- fresh carrot and celery snacks, videos of dancing fruit, hundreds of hours of lively lessons about how great you will feel if you eat well."

What is the first thing that pops out to you in that statement? Would you ever tell someone to have celery as a snack?

The problem is lack or proper education and bad education on proper nutrition. How can the average person have a chance when the recommended amount of exercise to lose weight is 90 mins and the average Registered Dietitian prescribes 1200 calorie diets that stunt metabolism and lead to hormone dysfunction. Don't even get me started either on what doctors really don't know about nutrition, I should know I am now training 3 right now alone.

I find that once people understand the right methods, dealing the their will and mental struggles become a picnic compared to what they used to be.

We don't need genetic influence, we need better educated nutritional leaders.

Its funny that this seems to be the issue in more problems in this country. Education and our leaders lack there of.

http://www.avidityfitness.net

by Leigh P on Jul 8, 2007 12:20 AM EDT 0 recs

Thanks ...

... for making me more depressed than usual about these subjects.

Building on what you said:

The two most powerful mechanisms we have for manipulating our metabolic rate -- and thus controlling our weight as much as our genetics allow -- are physical activity and eating.

The thermic effect of food (TEF) may be just 10 percent of an average person's overall energy burn in a day, but it's still something that can be manipulated upward in two key ways:

Eating more protein (and correspondingly eating less of something else, which is easy since protein makes you feel fuller than whatever it replaces in your diet).
Eating more, period.

And yet, our nutritional establishment wants everyone to eat less, thus negating TEF and making it harder to control weight. And it's politically incorrect to tell people to eat more protein.

As for physical activity, we know that intermittent exercise (varying speeds, either in start-stop sports or interval workouts) is more effective than steady-state exercise. I've seen studies showing that this is true even in low- or moderate-intensity exercise.

But for some reason, people are never told that just walking around the block a bunch of times isn't as effective as a combination of jogging and walking. The idea is that if you're going to jog, you have to do your entire workout at that pace. And if you can't jog, you should walk for the entire workout.

I understand where the suboptimal nutrition advice came from, but I've never quite understood why we fetishize steady-pace exercise over the more effective alternatives.

by Lou Schuler on Jul 8, 2007 9:44 AM EDT up 0 recs