Sounds Too Good to Be True

By | August 14, 2008
23 Comments

But, hey, it might be worth a shot.

First, let me say that I have nothing but admiration for those who have adopted a restricted calorie diet in the hopes of realizing some of the health and life extension benefits that have been demonstrated repeatedly in the lab with animals (mostly mice) following similar diets. The only reason I haven’t personally tried to adopt the CR lifestyle is fear of failure.

I think I could manage it for six months, maybe a year at most, and then I expect would fall seriously off the wagon. Even following a much more modest program over the course of a couple of years, my weight has been gradually creeping back up — probably through a combination of metabolic changes and not sticking with the program as carefully as I might have.

A few months ago, I wrote about an emerging critique of diet and exercise as a cure for obesity:

In study after study over the course of the past century, the number of clinical trial subjects who have kept more than 40 pounds off for a period of five or more years is vanishingly rare. The number that’s thrown around on Dean’s World is 0.1%, although I haven’t seen where Dean specifically raised this number, only where people arguing with him have. So if we can name people who have met the criteria — Jared comes to mind — we have only found an example of that 0.1% of the population for whom diet and exercise is an effective long-term obesity cure. Likewise, the participants in the National Weight Control Registry (NWCR) study were asked to participate if they had already achieved a certain level of long-term weight loss — it’s just another example of this same selection bias.

It’s like “proving” that the lottery is a smart bet because somebody won!

So diet and exercise become a real double-bind for the obese. Typically, it doesn’t work out; but it’s the only “cure” out there, so people try again and again, and you get the dreaded yo-yo effect. People who want to argue that diet and exercise are an ineffective cure only because fat people are lazy or undisciplined or lack self-esteem aren’t really contributing much to the discussion, other than venting. Show me an effective way to combine diet and exercise with acquiring discipline or self-esteem — and by effective, I mean one that has been demonstrated to work with a significant population of obese people, not more anecdotes about Jared or your aunt — or shut up.

And if the normal, moderate diet-and-exercise cure proves too difficult for most people, how much progress can we expect from the much more ambitious calorie restriction lifestyle?

  • David Govett

    You will not be motivated enough to diet and exercise daily, until a doctor’s diagnosis motivates you. Trouble is, it may be too late then.

  • David Govett

    You will not be motivated enough to diet and exercise daily, until a doctor’s diagnosis motivates you. Trouble is, it may be too late then.

  • David Govett

    You will not be motivated enough to diet and exercise daily, until a doctor’s diagnosis motivates you. Trouble is, it may be too late then.

  • The Chad

    I have a question about this ALA concept–where do all the calories and fat from the food you suddenly start eating go? I can only assume it will flow through the system and out the other end. If they start eating whatever they want, won’t the pay the price with massive, ahem, bowel movements?

  • gf

    People talk about a ‘cure’ like obesity is a disease, but has that been shown? I understand there’s benefits to thinking of it like that, but is it really more than being an animal suddenly thrust into a super high calorie environment, and not having evolutionary time to figure that out?

    If you eat badly, you DO have bad things coming to you, don’t you? Actions do still have consequences, at least until we DO manage to defeat nature.

    And I am TOTALLY for defeating nature, but meanwhile, I’ll deal with the hand I’ve been dealt and not pretend it isn’t my own fault.

  • https://blog.speculist.com Phil Bowermaster

    David –

    I was going to delete your duplicate comments, but the fact that you kept leaving them shows that you weren’t really paying attention to what’s written in the comment box, just as the content of the comment istelf shows that you couldn’t be bothered to follow the link to the archive of my weight loss chronicles. Thanks so much for the heartfelt warning. Three times is a nice touch.

    The Chad –

    That’s an interesting question. I’m guessing they wouldn’t be all that much bigger. I have found (if we really must talk about this) that adding a fiber supplement increases volume considerably, but we’re talking about mass here, so I’m in over my head — how’s that for an unfortunate mixed metaphor? :-)

    GF –

    The fault issue is the killer. Diet and exercise are probably a great way to prevent obesity, but they have not been shown to be an effective way of dealing with it once it’s there. Maybe it’s metabolism, maybe it’s psychological, maybe it’s just that fat people are lazy slobs who refuse to take responsibility for their lives, but whatever the reason, the research indicates that once you’re obese, you’re in a hole that diet and exercise are not terribly likely to pull you out of.

    That being the case, you can certainly take the stand that obese people “deserve” to be fat based on their past behavior. I just don’t buy the punitive aspect of it. If somebody drives carelessly for 20 years, I don’t think they “deserve” to have a wreck even during those 20 years. It’s just the thing that’s most likely to happen. But never mind, let’s say they do deserve it. Now, after 20 years of driving carelessly, let’s say our driver turns over a new leaf and drives as carefully as he possibly can for the rest of his life. He’s not perfect, but he’s really trying.

    Does that individual “deserve” to have a wreck based on his years of driving carelessly?

  • Ryan

    Taking the example of the careless driver, his risk of getting in an accident does in fact go down if he begins driving carefully. Careless driving can’t be a disease any more than obesity can, since the disease comes and goes based on a person’s behavior.

    I think gf’s point is that we don’t do ourselves a great favor by considering obesity a disease and out of our control. I second the notion of wanting to defeat nature, but until then we’ll just have to eat less in order to be thin.

  • Tood

    Obesity is like cancer. It is easy to prevent it early, but once you get it, it is hard to permanently fight off.

    Americans were not obese 50 years ago. Poorer Americans are fatter than richer Americans. Blacks are much fatter than Asians. So a large part of it is in a person’t control.

  • https://blog.speculist.com Phil Bowermaster

    Ryan –

    So what favor do we do ourselves by telling obese people that diet and exercise is the answer, knowing that 90% or more of them will fail?

    Also, I don’t get the whole “overcome nature” argument from you and GF. Evolution programmed our bodies to be highly efficient at storing fat. If ALA works, it will be one possible workaround for that (now unnecessary) programming. There are others on the horizon.

    How is this different from a model of “overcoming nature” that you would in fact approve of?

  • Hal

    Found Dr. Goyns paper here:

    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T31-4SBHWY0-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=f7f2fee648205b67a9129b455dcec8fd

    “Abstract

    Dietary restriction feeding extends survival in a range of species but a detailed understanding of the underlying mechanism is lacking. There is interest therefore in identifying a more targeted approach to replicate this effect on survival. We report that in rats dietary supplementation with alpha-lipoic acid, has markedly differing effects on lifetime survival depending upon the dietary history of the animal. When animals are switched from DR feeding to ad libitum feeding with a diet supplemented with alpha-lipoic acid, the extended survival characteristic of DR feeding is maintained, even though the animals show accelerated growth. Conversely, switching from ad libitum feeding a diet supplemented with alpha-lipoic acid to DR feeding of the non-supplemented diet, blocks the normal effect of DR to extend survival, even after cessation of lipoic acid supplementation. Unlike the dynamic effect of switching between DR and ad libitum feeding with a non-supplemented diet where the subsequent survival trajectory is determined by the new feeding regime, lipoic acid fixes the survival trajectory to that established by the initial feeding regime. Ad libitum feeding a diet supplemented with lipoic acid can therefore act as mimetic of DR to extend survival.”

    Interpreting this gibberish, it sounds like the ALA does not keep the weight off (the rats showed “accelerated growth”) but does maintain the lifespan extension properties of calorie restriction (aka diet restriction, DR).

    One weird thing is that they took some rats and started them on ALA and a normal diet, then switched them to calorie restriction with no ALA – and those mice didn’t get the usual lifespan increase from the CR. Very strange.

  • RebeccaH

    I finally gave up the weight fight, and went for weight-loss surgery (in my case, the lapband). For the past year I’ve been losing weight, but the real secret is not the surgery. That’s only a tool that allowed the weight loss to begin. The real secret is a lifestyle change incorporating more physical activity (walking and elliptical machine, as well as dumbbell exercises for at least a half hour a day), and accepting that I can live and enjoy life on a lot less food than I thought was realistic. The weight-loss surgery allowed me to experience a lack of hunger I didn’t think was possible.

    That said, it’s major surgery and needs to be researched thoroughly as to the correct procedure (lapband or Rouen-Y gastric bypass) for each individual. And it absolutely requires a commitment to change.

  • jaed

    Erm… you do realize that supplementing with alpha lipoic acid is not a new idea, right? It’s been a fairly popular supplement for years, and if it were the Wonderful Cure that will Magically Change Your Natural Body Shape, I think we would have heard about it by now.

    Starvation dieting – that is, deliberately eating less than your body needs – does not do much of anything except prompt temporary weight loss, along with some increased metabolic responsiveness to input. (Which is another way of saying it makes you diet-resistant – metabolically responsive bodies adjust their metabolic rate rapidly in response to changes in caloric intake, so if you eat less, your metabolic rate drops very quickly to compensate. Counterproductive, in other words.)

    I wondered for a long time why, in the face of much data indicating that starvation dieting, alone or in combination with exercise, fails to permanently change body shape, we still have people chirping “All you have to do is eat less and move more, and the pounds will melt away like magic!” every time this subject comes up. I finally decided it’s because people overgeneralize from their own experience.

    Say Joe Blow graduated a few years ago, isn’t exercising as much, grabs a candy bar every afternoon from the machine, etc., and has put on 20 pounds. He’s up at the top of his personal weight range, and doesn’t feel great. So he takes measures: eats a little better, goes for a walk every day at lunchtime, maybe lifts a few weights. A few months of this and he’s lost about ten percent of his weight and feels better. So good for Joe.

    Now take John Doe, who’s in a similar situation: his habits have gotten bad, he’s gained some weight, he takes similar corrective measures (eating better [not less!] and being more active), and has similar results – he loses about 10% of body weight. John, like Joe, has gained a lot of health benefits by doing this. Problem is John’s natural weight range is higher than Joe’s, so he gets no credit with doctors or anyone else for his improvements. And Joe, if he sees John, will likely think “Hey, I ate a candy bar a day and weighed 20 pounds more than I do now… so this guy must be eating, like, ten candy bars a day! And never ever moving!” Because everyone naturally has the same body type, and deviations must be caused by differences in eating and exercise levels.

    Written out like that, the fallacy is pretty obvious. But people still stick to it. There’s an ideal shape, and if you fall short of it, it’s All Your Fault, and we will keep saying that until you admit you’re a bad fatty and repent – preferably by limiting your food intake to the point of causing yourself permanent metabolic damage. Whereupon we will announce that you have “failed”. Makes me berserk, that kind of ugly thinking.

    Meanwhile, the result of this mindset that you can change your body type by sheer force of will is:

    - Fat people feel perpetually guilty, shamed, and afraid. They try to do the impossible (change their fundamental body shape) and feel like weak-willed failures when it predictably doesn’t work.

    - Thin people feel like they have nothing to worry about healthwise, even if they eat gak and never exercise. They’re thin. And that means they’re healthy, right?

    - People who exercise, feel better, and obtain health benefits but don’t lose a lot of weight feel as though they might as well not bother – after all, thin is healthy, and all this exercise isn’t making them thin, so it can’t possibly have a good effect on their health, right?

    Relying on conventional wisdom and old wives’ tales is usually not great for health. This matter isn’t an exception.

    Sorry about the longwindedness. This whole topic gets me wound up.

  • Ryan

    Maybe if obesity as disease were less a part of the culture, people would be less inclined to fail.

    Instead, society gives the seal of approval to massive overeating by calling it a disease instead of a behavior.

    I don’t disapprove of this ALA. Even if it doesn’t work I still expect we’ll eventually see something like it that does. But is it a good risk to hope that will happen soon enough to help people currently obese before its too late?

  • M. Dolan

    This is silly.

  • M. Dolan

    This is silly.

  • Mama73

    I had to take pathophys for my graduate degree. We were taught that your metabolism doesn’t really slow as you get older. You become less active, you loose muscle mass and then your metabolism slows down. But it doesn’t have much to do with age per se.

    I hope you can discover exercise you really like. I think that is the “secret” to weight loss, even more than dieting.

  • rezzrovv

    I recently was having some issues w/ carpal tunnel and plantar fasciatis as well as the typical apple shape around the middle (about to turn 40). I decided to do something about inflammation. I knew that starvation diets aren’t the answer. It doesn’t make sense so whatever I did I was determined to not regulate my calories in anyway in terms of quantity. I decided to focus in on eating saturated fat! I probably increased my caloric input but my mid-section bulge has been rapidly disappearing and I have been able to stop wearing my wrist support. Oh yeah, it no longer hurts when I get up in the morning to walk to the coffee maker. I don’t care what anyone says, I love that my body is changing in positive ways so I’ll keep eating fat and avoiding carbs. At least I’m not hungry.

  • gf

    Phil,

    I’d like to say that I am NOT against finding alternative methods, and I am, indeed, looking forward to them (and that’s what I mean by defeating nature).

    I think your analogy is a bit weak though, I’d say it’s more like chopping down a tree, or putting your hand in a fire. No single chop makes the tree fall down, but you can’t really not expect to have it fall after it’s been chopped at for a while. Thus, I think ‘deserve’ is a relatively fitting word, even though I don’t wish harm on anyone. If you stick your hand in the fire, well we’ve got good medical treatments, and we would never deny them to you, but imagining that you don’t DESERVE to be burned seems a bit trite to me. It abrogates personal responsibility.

    I guess my take on it (and I’m a guy who has actually come down 40 pounds and kept it off since 1999), is that for now, diet and exercise are the answer. Or at least ONE answer, that will work if applied. It’s a real fix that works, it’s just hard to implement.

    I *am* all for new ways to help people with the health problems associated with obesity, I just want to make that perfectly clear.

  • https://blog.speculist.com Phil Bowermaster

    GF –

    We’re not that far off, but I still have trouble with the word “deserve.”

    If you stick your hand in the fire, well we’ve got good medical treatments, and we would never deny them to you, but imagining that you don’t DESERVE to be burned seems a bit trite to me. It abrogates personal responsibility.

    Nonsense. Accepting personal responsibility in this instance requires a respect for cause and effect, period. In your analogy, would a developmentally disabled person who is unclear about fire deserve to get burned? How about a firefighter who sticks his hand into the fire in order to rescue somebody? We can agree that they don’t deserve to have their hands burned. But the drunken teenager who stumbles into the campfire when out in the woods with his friends — surely he deserves the second-degree burns.

    I think not. Burning one’s hand (or worse) is a predictable consequence of being drunk and stupid around a campfire. But is it a fitting punishment for the same? I would argue that it is not. The teenager might learn a valuable lesson from that experience, and he certainly doesn’t have any complaints coming to him, but I would be slow to say he “deserved” it.

    But never mind. When Stephen gets back from vacation, he can settle this. He’s the house lawyer. ;-)

    BTW, congrats on the weight loss. I’m two and half years in on a 50 pound loss (although it was closer to 70 at one point.) My lifestyle hasn’t changed much, but my weight has kept trying to creep back up. That’s one of the reasons I’m interested in things like ALA — something that could help “lock in” weight loss sounds appealing.

  • http://www.mfoundation.org David Gobel

    1.6 years ago I gave up sugar, corn syrup and all pseudo sugars/sweetners and even honey and dried fruits. I experienced a very rapid reduction in weight over 3 months to the tune of 17 pounds and had marvelous health benefits as a superb bonus. In the intervening time I have totally remained faithful to the limitation listed above. But oddly, my weight began to rise so that I ascended to within 5 pounds of the original weight prior to the sugar/sweetener ban. After analyzing what changes in my behavior might account for the weight rise, I recalled that I no longer walked appx 1 mile a day both to/through the Washington DC metro system to work, but was a full time teleworker. It turns out that over time, not walking that mile was the main culprit. I have recently taken to walking on a treadmill while I work, and over the last three weeks have lost 5 pounds, and 3 inches (as measured on my belt buckle) from my waist. My balance and strength are dramatically improved, but BEST OF ALL, I don’t notice that I’m exercising. The treadmill turns and I just unconsciously walk two hours or so each day while I work.

    Cheers,
    Dave

  • Stephen Gordon

    This is very encouraging. I hadn’t heard about alpha lipoic acid prior to this post.

    Yeah, I can lose weight, temporarily, with the best of them.

    It would be awesome if I could get some help making that loss permanent.

  • Stephen Gordon

    I take offense at the whole – you have a weight problem because you have no will power – meme.

    I’m a college graduate, completed an MBA degree, and I successfully completed law school.

    I’ve been happily married for 16 years in part due to my ability to say no to certain temptations.

    A lack of self-discipline isn’t the problem for me, nor is it always the problem for others who are overweight.

    Our bodies evolved to survive famines. Technology has rid us of famines, but it hasn’t helped us overcome our evolution.

    Yet.

  • gf

    Actually, I would never argue the ‘mentally disabled’ bit, but I would argue that a firefighter deserves to get burned if he puts his hand in the fire. He had good reason for what he did, and chose the consequences, hence being ‘deserving’ of them. I get that the word ‘deserve’ may be a bit too emotionally loaded though.

    As an aside, I am a LOT less concerned with fat, than with being able to use the ol’ body. I could care less how much fat I have, but if I can’t run and jump and play, then I’m really missing a big piece of life (in my opinion, naturally, YMMV). The ultra-toned physique is not the ultimate goal in my mind. (This may be coloring the way my words are read, so I thought I’d mention it).

    I also do tend to assume a mind that *can* be taught when speaking, and a lack of disease. I do personally know people from all pieces of this spectrum, from medical-causes, to pro athlete, to naturally skinny, and everything in between, and we talk about it a lot.

    It’s just my opinion that our bodies are designed to be used, and operate in a particular environment, and we’ve messed with the expected scarcities by, oh, gettin’ civilized. It’s too damn EASY to get a bajillion calories and still be malnourished.

    We’re going to NEED medical interventions of some kind to work that out, but meanwhile, I try to stay as flexible and strong as possible. I get that self control and discipline aren’t in high supply, but that doesn’t mean they’re stupid to work towards. And I know (believe me, I know) that it isn’t FAIR. I have to work harder than lots of people I know to achieve the same results. But once there’s a pill that says ’10% bodyfat, go’, I’ll be right there in the lineup, baby. I like my beer and wings, I do, so I make the sacrifices, but making it easier is always good. Mark me safely on the pro-medical-tech side.

    Anyways, apologies for the late replies and keeping this thread going so long, I’m certainly always glad to see new posts on this feed, this is one of my favourite sites.