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The Obesity Epidemic — Is Medicine Scientific?
An anonymous reader writes "An award-winning science author, Gary Taubes, has written a book that pans the medical community's treatment of the obesity epidemic. What is interesting is that it looks like the medical community is behaving in a very unscientific manner. Taubes points out that the current medical orthodoxy — that consuming fat makes you fat and exercise makes you thin — has no basis in research. In fact, all the available research points in quite another, and more traditional, direction. Here's the (excellent) podcast of an interview with Taubes on CBC's 'Quirks and Quarks.' So, has medicine become a non-science? Is it mostly a non-science? Somewhat?"
Not more of this low-carb propaganda bullshit. Calories make you fat, regardless of whether they come from fat, sugars, or starches.
The laws of probability forbid it!
From personal, scientifically-measurable experience, I can tell you that gaining and losing weight isn't a matter of 'good calories' or 'bad calories'. It's a matter of calories. Burn more calories than you consume over a period of time, and you will lose weight. Burn fewer calories than you consume over a period of time, and you will gain weight. Yes, it's that simple. I suggest you all put down this claptrap, and read The Hacker's Diet by former AutoCAD developer and AutoDesk VP John Walker. It's done wonders for me.
My blog
When it comes to the current thinking on nutrition, there is a definite point to what he's saying.
But to say that Exercise has no effect on weight loss is just plain wrong. Exercise changes the way your body processes the food you put into it (or, more accurately, your body adapts to the amount of exercise that you get). Building muscle causes you to require more calories in your diet to support that muscle. And building stamina causes you to burn a lot of calories in the process. And if you want to venture into the unscientific realm, consistent exercise helps to stabilize your mood and makes you less prone to food cravings (the cravings for sugary foods and for fatty foods are based in imbalances in Serotonin and Dopamine levels).
There is a dire need to re-examine everything we know about a healthy diet. People get so worked up about things like trans fats while completely ignoring the elephant in the room (high-fructose corn syrup). Everyone I know who's given up corn syrup, to the extent that it's possible in the US, has lost a minimum of 10 lbs.
But to suggest that exercise isn't a vital part of a healthy lifestyle is wrong, and potentially very dangerous.
"Don't blame me, I voted for Kodos!"
I lost 25 pounds after I simply cut out bread, potatoes, and sugar from my diet.
In the mean time, I added a gallon of olive oil every 60 days and a pint of cream a week.
Tho fit already (sports twice a week, regular walking and exercise) I started developing diabetes (of course my mom and grandparents had it so I'm kinda doomed there). Despite cutting out enormous amounts of carbs and sugars (I was previously drinking 1,000 calories of soda a day), I continue to slide in the bad direction on my blood sugar. It's not diabetic yet but it is just a matter of time.
My diet consists of large amounts of vegetables, meat courses, almost no grains (2-3 ounces a day tops).
I think people have different needs based on their genetic history.
I agree that a lot of "science" these days is opinion, hysteria, or someone's hidden agenda.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
what about eating in moderation with exercise? Why does it have to be so extreme, i.e. no sugar, no fat, "no" something?
The recommended amount of exercise is 30 minutes per day -- it's actually a fair amount, if you're biking or jogging 30 minutes per day, and eating in moderation, i.e. let's say within the FDA guidelines for diet, and you're still overweight, then you might have a medical need for weight treatment. Otherwise, try all of those things first.
stuff |
To answer the questions of the summary, I don't think it will ever be an untainted science so long as the government, businesses & religion stick their noses in it. Couple that with the difficulty of applying the scientific method to humans (average life span of 75 years and ethical problems) and I think you'll see why medicine is a 'non-science.'
Patents, legislation & belief in what is good for you are what ruin medicine. Look at all the Hindu medicine that was ignored by the West for the longest time because it was
Medicine will continue to be a non-science no matter how hard the community tries. The public's assumptions and beliefs that "Since I can eat McDonald's every day and be thin, everyone should be able to" merely exacerbates the situation.
I eat whatever I feel like and I'm in great shape. This is not the case with the majority of Americans.
My work here is dung.
"For 50 years, the advice on dieting has been very clear..."
Um, hardly. This kind of sentence attempt to draw the reader into a sense of agreement from their most-remembered anecdotes so that the rest of the premise is seen as new. But in reality, fad dieting advice is all over the map and has been since it was part of pop culture, which goes back a *long* way. Spoonful of mercury, anyone?
The only good dieting advice has been through a good understand of one's own body. Allergies, lifestyle, location, education, economics, etc all play roles in what chemicals you put in your and how you burn energy.
This book's position is just another in the lineup of positions taken about the human GI system and energy usage. There are many strategies, both workable and not. Unless you know yourself well, no change is a worthwhile change - its all so much guessing.
Additionally, one has to ask the philosophical question...is the goal to eat yummy/available food or live [potentially] longer lives? There's no one answer, really.
OK, who doesn't recommend whole grains and avoiding sweets for overweight people? The quacks are all over the place, but I think we know (and have known) that vegetables & whole grains are the way to go.
-Dave
...and I have a feeling neither do they.
Look, we've all been told quite a few different contradictory things when it comes to health and diet. Milk was bad, milk was good, milk has lots of carbs, etc. Eggs are bad, eggs are good, egg yolks are bad but egg whites are good. Cholesterol issues -- have less meat, focus on vegetables and carbs. Diabetes and obesity -- must cut down on carbs. Going strictly vegetarian may make you deficient in certain things only found in meat. Coffee is bad for you, coffee is good for you. Chocolate bad, chocolate good. Wine bad, wine good.
I think the only constant I have heard is that exercise is good for you and that eating things in moderation is probably a good thing.
I don't have time to LTTFP, but I know what worked for me. I was morbidly overweight, and I tried a number of things to get rid of it, including the traditional low-fat + exercise regimen. What finally worked was to eliminate or drastically cut high-glycemic carbs from my diet (rice, pasta, potatoes, bread, sugar, and the like). That, coupled with moderate exercise (walking 1 or 2 miles) helped me to drop 90 pounds in about a year.
I believe there is a relationship between high glycemic carbs, blood glucose spikes, and insulin, which will cause certain body chemistries to convert and store much of that intake as fat.
Wish I had discovered this 15 years ago.
Proverbs 21:19
Calories in greater than calories out => gain weight.
Calories in less than calories out => lose weight.
At least, that's how I thought it worked. I decided late last year, as a new years resolution, to start Operation Flab. My weight had crept up, ours is not a physically active field to begin with, and middle age (I'm 46) didn't help.
I've made some healthier choices in my diet, cut back on portions, exercise vigorously 3 times a week, and have lost significant weight. I feel 100% better. There is no magic: I didn't gain it overnight, and I'm not going to lose it overnight either. Heroics never work, because too great a lifestyle/diet change will never last.
I didn't bother with a health club membership or anything like that. My sole expense was an MP3 player.
...laura
So, has medicine become a non-science? Is it mostly a non-science? Somewhat?
You think this article is about "medicine" in general? This is about a tiny branch of medicine dealing with nutrition and public health.
The practice of medicine long predates the development of what we currently understand as *science*: the methods of empirical analysis of theses. In particular, there is no time or means for treating each syndrome disclosed to a GP as an object of empirical study. The GP does not form more than a general hypothesis regarding etiology and treatment. Typically the treatment determines the diagnosis.
For example, it is the season of upper-respiratory infection, caused by a host of bacteria and viruses with very similar effects. The means are available to test phlegm samples and determine an exact diagnosis, but the costs are prohibitive. The GP compares symptoms to the run of illnesses she is seeing recently, prescribes in light of that insight and hopes for the best. If the AB is effective, it was a bacterial infection.
The practice of medicine, as opposed to medical research, has never been particularly *scientific* in the common sense of the word.
illegitimii non ingravare
Some people can get all they need to run their bodies on a lot less calories than others.
I can raise my burn rate for several days by playing hard sports for three hours. People comment that I feel like I have a fever.
My friend who has developed problems after a life time of being thin has low thyroid and other hormone feedback systems. And she is always hungry- constantly. Even when she eats, she will be hungry again a while later. And not eating does not cause the hunger to fade like it does for me- it just gets stronger.
I have another friend who has the *reverse* problem. He is slowly losing weight (like a pound a year) despite eating heavily and it is getting kinda critical. He has a messed up endocrine system too.
Some people are messed up so that any exercise just destroys muscle (they do not get stronger).
I wish people would not be so judgmental about these things.
Some people eat because they are sad- some were raised and trained on bad food- some were never trained to enjoy physical activity. Some people have hyper metabolisms that allow them to eat heavily and still remain thin.
And there is some evidence recently that fat people die less of many diseases. The anti-fat attitudes stink of group-think gone bad.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
FTA:
For the last thirty years, medical advice on obesity has been very clear. Eat less and exercise. But what if that was all wrong, a big fat lie, as Gary Taubes would put it? or In fact, according to Mr. Taubes, everything the medical profession advocates, in terms of eating and exercise, is at best a waste of time, and at worst, may actually be killing us. Of course medical advice is clear. Exercise does make you healthier and stronger. It helps your immune system and metabolism. It is true that you should only exercise the amount you are able, and that over-exercising can put added and unnecessary strain on important organs which can be dangerous. One thing that the medical field is learning though is that a good portion of your body shape is due simply to genetics. The "medical community" has not been caught up and derailed by the "diet and exercise" bandwagon. They are currently doing more and more research into the amount we are affected by our own genes.
There are some doctors who do not have the absolute latest information and they will sometimes claim that diet and exercise are the only thing that is making someone larger and there are (of course) a few scam artists trying to make a buck off the "simple little pill" or "this is the only piece of equipment you need to be thin" commercials and insatiably people will fall for it.
The point is, the medical field is right in giving this person that advice. He should eat less, he should exercise. It WILL make him healthier. It may not make him look like Brad Pitt, and he (probably) always be larger than normal, but just because a component of obesity is genetics does not mean everything to do with obesity is genetics. It also does not mean the "medical community" is stuck in the stone age with "non science."
The original generic sig.
Not more of this low-carb propaganda bullshit.
I understand your anger, but the issue here is whether the low-carb propaganda is really bullshit or not. It is a matter that should be investigated, otherwise those dismissing it as bullshit would effectively act as anti-low-carb zealots, instead of following the scientific method.
Also, we have to wonder why the US (the country where the Food Pyramid originated) is also where the "fatness" phenomenon originated, and why the countries that start to follow the "american way of life" (fast food, sedentary life, high-calory carb snacks) tend to follow american's fatness. This phenomenon, at least country-wise, behaves like an epidemic.
I use the Physics Diet.
It has to work, because it's physics.
He makes the extraordinary claim that Official Nutrition has been getting it wrong for the last 40 years. However, he provides and discusses a solid body of relevant and eminently respectable (Lancet, JAMA, NEJM, etc..) citations to support his claim. Color me 95% convinced.
He notes that the application of the first law of thermodynamics (the slogan is "A Calorie is A Calorie") to a homeostatic dissipative system like the human body is beyond simplistic. It is simply wrong.
The core of his thesis is that a cellular-level metabolic disorder caused over time by consumption of concentrated and rapidly available carbohydrates, and the insulin spikes they provoke, is the cause not only of obesity but also of type II diabetes. Briefly, fat cells become too good at extracting glucose from the blood and storing it. This results in cellular-level semi-starvation in other body tissues, expressed at the organismic level by eating more and exercising less.
He depicts the high level of investment in the competing "gluttony & sloth" model of obesity which exists in our medical establishment and in our culture. Indeed, from his portrayal this viewpoint is very close to being an ideology rather than a theory, in that dissenters are cast into outer darkness rather than refuted.
He discusses the personalities and politics involved in the alleged disastrous wrong turn, and points up some interesting coincidences involving what research gets funded, and what research doesn't get funded, by for example sugar producers.
I'm intentionally being very brief. If you have a personal stake, read this book and form your own conclusions.
--
phunctor
Here's a link to an article by Taubes that originally ran in 2002, and sounds like it was the seed for this book.
"What if It's All Been a Big Fat Lie?"
http://query.nytimes.com/gst/fullpage.html?res=9F04E2D61F3EF934A35754C0A9649C8B63
It's long for a NYTimes article, but it's an interesting read. I'm sure the book updates much of the data.
This is absolutely true. You can't dispute the fact of this statement taken in isolation. In isolation.
However, it's a fine example of blinding yourself to the causes. The questions at the heart of the debate between low-carb and low-fat diet proponents are the following:
So just saying calories are calories is like saying BTUs are BTUs and putting heating oil in your gas tank in the hopes of getting better MPG.
If it's for-profit but free, you're not the customer -- you're the product (e.g., the Slashdot Beta's "audience").
The recommended advice of replacing fats with carbohydrates was repeated so often and so forcefully by everyone, that it's now printed on the back of almost every box of food in the country, in the form of the "USDA food pyramid". It was so often repeated that when I was a child (in the 1970s) things like wonder bread with a bit of margarine were considered health foods (lots of carbs, no saturated fat).
I had always assumed that the medical community had done large-scale long-term studies demonstrating that such a diet led to an increase in lifespan, a reduction in disease, and a loss of unhealthy pounds. Apparently, such studies were never done.
But then the massive Harvard Nurses Heatlh Study was performed, ending in the mid-1990s. In that study, researchers followed 40,000 nurses for decades, in what was the largest and most comprehensive study on human nutrition ever. The study found that replacing fats with carbohydrates had absolutely no effect on longevity or disease. Furthermore, replacing butter with margarine (the standard dietary advice for decades) led to no benefit either. IIRC, the only nurses who lived longer and had less disease were those who ate nutrient-dense monounsaturated fats like almonds and cashews.
As a result of the Harvard Nurses Health Study, researchers in nutrition quietly dropped their assumptions about dietary fats causing disease.
I still can't believe it. The standard dietary advice from 1960 to 1990 must have been the single largest pseudoscientific load of crap in modern history. What a colossal embarrassment. If the USDA publicly admits that it was mistaken then it will be a long time before people trust it again.
Is medicine science? Sometimes.
Being married to a medical student who's going through a year of trying different specialties has been very illuminating. Some specialties, like pathology, are almost entirely scientific. Others, like orthopedics are largely mechanical, as are most surgical specialties. Specialties like family practice and pediatrics involve a fair bit of science, but also depend heavily on personal interactions. And of course every physician, just like every person, is subject to their bias.
My wife and her fellow medical students frequently talk about how for your first two years of medical school you're taught science, and for your last two years of medical school you're taken through the hospital and told how everything you just learned is useless.
If medicine could be reduced to a set of scientific rules, it could be practiced by robots. Until that happens, we're stuck with our un-scientific doctors.
Mod my comments down. It'll be fun.
By increasing my exercise, hitting a minimum of 10,000 steps a day, consuming less "sweets" and smaller portions of food, I have lost 20+ over the last three months. I have worked to lose the weight in a manner that creates a sustainable eating and activity style for life.
This has been working for me. Who knows about you, but I suspect that with some self-discipline and a change of habits, most people could lose weight.
On this point, I read a great humorous book (true story) about a man's effort to lose weight: http://conservativebooktalk.com/2007/10/22/one-third-off-by-irvin-s-cobb/
Nor is he a research scientist. He is an author, and his goal seems to be to sell books, not to add anything to the scientific community.
I have found that if I eat more calories than I burn, I lose weight (and vice versa!), no matter what kind of calories they are. When I go on long hiking trips, or field exercises with my military unit, I'm very active and burning more calories than I take in, and I lose weight. Conversely, when I sit at home for a week and eat turkey and watch football, I gain weight.
Incidentally, if you have a problem with your plumbing, then it's clear that an auto mechanic probably won't be able to give you good advice; if you have a problem with your plumbing, you should talk to a plumber. In the same way, if you want information about your body, you should probably get it from your doctor, rather than some random person who had a Bright Idea and wrote a book about it.
There was a spat in Reason years ago about exactly this.
-Ted
-=-=- Quantum physics - the dreams stuff are made of.
I do four sessions of aerobic exersize a week, one hour each. In between I lift/pull/push a lot of weight around, typically 90 minutes per session.
I eat small portions, my meals are based on instructions of a dietary specialist. No more than 1750 calories a day, and only out of "good" foodstuffs. This gets checked regularly, every three months I spend a week in a clinic where *everything* gets monitored.
I have done this for more than the last two years. In that time, I've not broken my diet or lost a day of exersize, not even once. Really.
I'm still fat, I haven't lost a single pound. In fact, I gained 7 pounds.
Imagine that.
Speaking as someone who is currently in medical school, allow me to put forth the falsifiable claim that you don't know what you're talking about.
The vast majority of medical school applicants come with degrees in scientific fields (usually Biology or Chemistry). To be considered for admission they must to do well on the MCAT, a difficult test which stresses scientific knowledge and reasoning abilities. Once in, they are drilled for the first two years with what's called "basic" sciences, where they are expected to gain an in-depth understanding of a wide breadth of information all directly based upon accepted scientific literature. Mastery of this information is tested via the USMLE Step 1--again, another very difficult test.
So, please, enlighten us as to where you're getting this idea that modern medicine is taught unscientifically, because as far as I can tell your notion is not based in reality.
The funny thing is, a common argument that I hear on a frequent basis is that because medical school is taught by PhDs and not MDs, it is focused too much on scientific details and not based on clinical reality. There is no point in training a family doctor to be able to draw out the TCA cycle or recite G-protein signaling transduction pathways as such information has no impact on treatment or diagnosis.
-Grym
Medicine is a non-science? Wow. I whole heartedly invite anyone who believes that line to go take a gander at any clinical trial design for any drug, device, or procedure.
As for the book, I haven't read it but I did read both the Amazon and boingboing summary and listen to the podcast. Taubes main points seem to be:
1. Replacing fat with starch is a bad idea
2. High fat diets don't have as much of an impact on cholesterol counts as we believe and that triglyceride levels are a better indicator of heart disease risks
3. Exercise isn't as good an idea for weight loss as we might think. (Because people might consume more calories afterward than they expended)
4. Atkins is a great diet plan.
Look, you don't sell a diet book or any book titled, "Stop eating so much, jackass!" What does sell well are systems that help us accomplish that goal and books that tell us why what we're doing is wrong.
Put simply, excess calories make you fat; it's basic thermodynamics and can be (and has been) proven with the simplest of experiments. It is easier to eat excess calories in a diet high in carbohydrates for a number of reasons. For many people, cutting those excess carbohydrates needs to happen because they aren't eating a proper diet. I've seen studies that indicate that the average American eats 3800 Calories in a day, and I'm sorry, but most of us aren't doing that with baked potatoes, whole-grain bread, or pasta - we're getting there with coke, chocolate, "coffee" drinks that might once have contained a coffee bean, and candy.
If you need a book to tell you to remove carbs before you'll start watching how much you eat, then I hope you buy that book now. If you need to be on a partcular diet scheme to force you to check the caloric value on a box of pre-packaged food, then I hope you start that diet now. If you want to build a strawman based on decades old medical advice taken out of context of what has been the constant recommendation for a balanced diet with a quantity of food suited for your activity level, then please, write that book as long as it helps people lose weight.
While there is some variance from person to person, a diet book that was two pages long could easily satisfy nearly everyone on earth. It would essentially say:
1. Burn the amount of Calories that you take in.
2. Guess what? You're probably eating way more Calories than you think you are.
3. Don't believe us? Track what you eat everyday for a week. Yes, that includes snacks. Yes, that includes really measuring how much of a given food you ate.
4. See, we told you you ate too much.
5. Stop drinking your Calories, dammit! Coke doesn't fill you up at all, but it's an easy 10% of your daily intake per glass.
6. If you sit around all day, non-stop, then you're going to need to cut back more. If you want to eat more, go get some exercise.
7. Lather, rinse, and repeat.
8. By the way, you'll probably start using fewer Calories as you get older. If you find this difficult to follow, start again at step one.
Technically, the basic principle of calories in - calories consumed still applies, but some foods affect both sides of the equation.
After having read the majority of the threads it seems that everyone on Slashdot thinks they are a nutritional expert. Somehow I don't think that is the case.
I'm not splitting hairs at all. Left handed sugars for example are not metabolised, but otherwise carry identical amounts of energy as regular right handed sugars which are metabolised readily.
That's because our bodies have specific nutritional requirements. You can push one chemical pathway by loading up with one set of energy carrying fuels and the body will respond in one way. You can push an entirely different set of pathways by using different fuels and attain a different response from the body.
All calories are NOT equal.
Deleted
high calories "carb" snacks? WTF? Find me *one* that is a snack not a drink.
Everything in snacks is either high fat, and saturated fat at that (chocolate, chips, fries, etc.), or high in the "So Great for You" high-fructose corn crap. The only high carb thing available are the soft drinks and "juices". Or people started eating high carb snacks like apples, oranges, bananas, pineapples? The calories in those are mostly all from carbs!
Fatness is from one thing and one thing only - eating too much *calories* and not getting enough exercise.
The low-carb propaganda just leads to
* depression (you need sugars for seratonin)
* kindey failure - switching your diet to high protein puts a heavy load on kidneys, and thus problems
* low energy (no carbs! guess what?!)
Carbs are really *needed* as long as you use them up! If you take a 800 calories shot of carbs from your McLarge Cola and then sit on your couch, you'll end up either fat or with diabetes or both. 800 carbs consumed => 1600 calories burned in exercise and you'll be fine and feel good. And no, diet drinks are even worse for you.
But then this the problem - people are inherently *lazy*. They will chose to die than get off their couches. At least that's what 60% of Britons would do. I bet it may be even worse in US.
http://news.bbc.co.uk/2/hi/health/6994632.stm
Several scientists are furious about the way Taubes mis-quoted them and there's a lot of science that says he's simply wrong:
http://www.reason.com/news/show/28714.html
My hypothesis: He simply sold out. Book contracts, maybe consulting with Atkins & co...
thegodmovie.com - watch it
While it may be some time before we learn if his position is correct, the book is an interesting read, even just from its reviews of prior conclusions. It is certainly not a book written in the style of "buy my diet book so I can get rich".
A review of his position can be found in a an article written in 2002: "What if It's All Been a Big Fat Lie?" http://www.frontpagemag.com/Articles/Read.aspx?GUID=%7B367127E3-4395-4DB8-90E0-AC52B2D86AF4%7D, though it written in a firebrand style, which the book is not.
Taubes is extremely biased in his presentation of available evidence. For a scathing critique of his abuse of science see this article.
Certain fats change chemically when heated, some fat is bad and some is lethal. A few fats and oils are excellent, i.e Olive oil. In our society fat is easy to aquire and in nature it isn't. High fat and protein diets are DANGEROUS for extended periods of time without an equivalent amount of fruit goodness and fibre. Fruit is the human beings best friend making up the majority of the orangutan and native human diet, want to loose fat - eat more fruit, sendentary lifestyle - eat LOTS more fruit.
But you have to excercise. Our bodies were designed to walk a minimum of 35-40 Kilometres a day - there is no other way to explain our legs in an evolutionary sense (our ancestors had to hunt and gather food) and this guy trys to wriggle out of that. I excercise a lot - train a number of different martial arts, played soccer, run and swim not to stay thin (I'm 96 kilos or 211 pounds and pretty fit) but to keep that black dog (depression) at bay and be a better coder. For some, food is a replacement for something else in their lives and they will eat lots of processed foods, not excercise and wonder how they got fat. I think obesity and depression are linked as I have seen many examples of one leading to the other, so (for me at least) the consequences of not excercising are too serious to risk.
The bottom line is it's too easy for us to get a hold of processed foods in our diets, The key to knowing is by asking yourself "How processed is this food?". I suspect the industrialisation of our food processes will be held up as the cause of Obesity and Depression sometime in the future when we stop looking at food as just broad set of components and look at it as a whole. Mass production of food stuffs have served to lower the nutritional content of all foods, and how do we know that the cruel treatment of food animals isn't introducing toxins and poisons into our diets that make us sick? Taubs is just swinging the pendulum the other way, not explaining that there are several pendulums to co-ordinate.
Now, I'm going to polish off this rockmelon before I go for a swim.
My ism, it's full of beliefs.
1. Muscle must be fed. Fat doesn't. Strength training builds muscle, which if nothing else consumes calories all the time, just much less at rest.
2. What goes in must either be used or go out. If I eat 6 pounds of food a week, and manage to consume 3 pounds of that as energy, eliminating 3 pounds as indegestible waste (you know what I mean), I neither gain or lose. If I work harder, or replace fat with muscle, I need more energy. It comes from somewhere.
3. If I eat less, I will eventually lose weight. The key word is 'eventually'.
4. If I work more, and don't change my diet, I will eventually lose weight.
5. The equation is, eat less, work more, and be patient. My body may well try to hoard resources in response to the apparent famine or starvation of not so much food.
6. Keep a balanced diet. Not feeding your body nutrients, especially calcium and trace elements, is very bad.
7. Portion control. Just do it.
8. Keep at it. Patience.
9. Drink plenty of water.
10. Read items 1-9 regularly and heed.
deleting the extra space after periods so i can stay relevant, yeah.
Science would be to actually test how well diets and/or exercise work on a group of people. And over and over for decades such studies have shown that the weight lost is very small, and what weight is lost isn't maintained. That goes for studies of animals too. That's science. And it is true that most clinicians ignore that science and give advice based on a hypothesis that has been for the most part falsified by in vivo studies.
The reason the hypothesis fails is because the system that's been blackboxed regulates fat homeostatically. Just like hydration, carbon dioxide levels, and temperature are regulated - fat mass is also regulated - largely through hypothalamic monitoring of circulating leptin and insulin levels.
What most people don't understand - because they don't plug numbers into the equation - is how closely the body has to maintain the energy balance. A 1 or 2% overage or underage will rapidly lead to massive obesity or death by starvation. So there's a very powerful and very finely tuned system that controls how much we eat and how much we expend by monitoring our fat mass. This is true of the very fat and the very thin. It makes sense when you think about it, but most people don't.
So the body aggressively tries to maintain homeostasis - that is keep fat mass within a given range - by adjusting appetite, metabolism, the relative deposition and breakdown of lean mass and fat mass, and the various forms of physical activity. You have some conscious control over some of these factors, but when you start falling outside the comfortable range - whether or not you are still "fat" - you are fighting homeostatic controls that are very hard to keep at bay long term.
(Generally people who are well below their comfortable range feel extremely hungry, tired and slothful, cold, depressed, etc. And most of all they become obsessive about food. As you can see these are all the body's ways of trying to encourage a positive energy balance. And it's no way to live.)
This kind of mechanims is why it would be very difficult to maintain dehydration indefinitely without drinking. And this is also why it's easy to hold your breath for 10 seconds, but not 3 minutes.
Most fat people - like most thin people - are staying within their range - and most who aren't trying to lose weight and thereby weight cycling maintain remarkably stable weights - just higher weights than we would like.
The real long-term solution to obesity will probably come from finding ways to manipulate the set point so that individuals with dangerously high weights don't have to live their entires lives battling (for the most part futilely) powerful internal regulatory controls just to maintain a weight loss. It is possible that the set point can also be prevented from going too high - but that too is just a hypothesis at this point, and how that can be accomplished isn't clear.
But that understanding among obesity researchers is why most of the focus on obesity is now on prevention in children. And why the research is targeting earlier and earlier ages - including the prenatal environment. I'm not entirely sure that that's a clear-headed strategy because as of yet there have been no interventions shown to be successful at preventing obesity in children either. But there is less evidence than in adults that the project is futile.
Americans' caloric consumption increased 12 percent, about 300 calories, between 1985 and 2000. The idea that this is unrelated to the fact that Americans are getting more and more obese is an extraordinary claim; advocates of high-protein diets have produced no extraordinary evidence to back it up.
My shiatsu teacher once noted that it's easier to get people to change their religion than it is to get them to change their diet. Probably true - if early Christians had made Gentile converts keep kosher, Jesus of Nazareth would likely be historical footnote today. The way that high-protein diet advocates cling to their beliefs is just another example.
As for the broader question of the scientific basis of medicine, most medicine is based on observation and experience, not controlled studies. It's hard to experiment on human beings in a controlled fashion, after all. That doesn't necessarily mean it's not scientific - astronomers don't get to do controlled experiments on stars, either.
But it is true that a lot of accepted medical "knowledge" has little evidence to back it up. It's interesting that many "skeptics" who demand double-blind studies of, say, acupuncture, are likely to have no qualms about undergoing a surgical procedure which has undergone no such testing. Medicine has the look of "Science" even when it doesn't have the substance. (More about science and Chinese medicine here, if anyone's interested.)
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
My girlfriend happens to be a doctor, and currently works in a 'obesity clinic', and she is going for a PhD in public health, with a focus on obesity, and she left me with the impression that:
- Real medicine never was a 'real' science. It's absolutely shocking how many publications, treatments and diagnosis are based purely on 'gut feelings', or incoherent theories. Just pull up any statistics on malpractices, and be shocked. No other 'science' could get away with so many errors, after such a long time of experimenting. This happens in part because medicine is a rather unique applied science: there're a lot of psychological factors, and incredible amount of measuring errors, a gigantic level of complexity and tons of historic 'baggage' that doctors have to face every day.
- Medicine is getting a lot better in this aspect - there seems to be a relatively new way of thinking (in the medical community, at least) called "Evidence based medicine", which, if i understood correctly, could be basically summed up as applying scientific principals to the medical processes
- Obesity in specific is extremely complex. Almost everything you do has some influence on you body-weight and composition. Of course the laws of thermodynamics apply to human beings, too, but there are a gazillion factors that influence just how exactly the body deals with excessive calorie intake, or lack thereof, ranging from genetical to psychological and social factors. Just a basic example would be that if you simply stop eating for a week, you usually lose LESS weight compared to if you start 'snacking' all the time, eating 5 little meals a day (basic theory behind this sems to be that the body switches to 'emergency mode' if there's no food around, trying to save as may energy reserves as it can)
- Most theories seem to me to be a wild mixture of anecdotal observations mixed with biochemistry, somehow resembling Freudian theories - they are coherent in them selves, but lack a level of 'scientific interconection' to other knowledges. So it's quite common for a specific theory in obesity to me contradictory to a theory of e.g. neuroscience. As long as both theories "kind of" work, it doesn't seem to be a top priority to resolve that discrepancy (in contrast to what i have observed in 'hard sciences'). AS far as I can tell, thee's no real proof or reason why Whiskey shouldn't be as bad as Vodka in a diet, yet (here, at least) it's common knowledge that whiskey's ok, but vodka will make you fat - and as long as this works, it doesnt matter that much why this happens, or if it happens at all.
Here is a model of how the human body works with respect to fat gain and fat loss. This is my summary of my understanding of the material in a book called Burn the Fat, Feed the Muscle by a pro bodybuilder named Tom Venuto.
Your body is designed to keep you alive, even in hard times when it's difficult to get enough food. Thus, if you simply cut your calories back (say, to 1200 kCal per day) your body will store fat at every chance it gets. If you are really only eating 1200 kCal per day, yet burning more than that, you must burn fat (and perhaps some good stuff like muscle) so you will lose weight. However, your body will store fat any chance it can, so if you eat extra you can gain fat, and once you stop the 1200 kCal per day regimen you are almost certain to gain fat. Worse, it is likely you lost muscle during the 1200 kCal per day regimen.
So, the goal is for you to lose fat, without your keep-you-alive tricks kicking in and making your body stubbornly try to store fat. BFFM recommends multiple, smaller meals each day, rather than a few big ones. If you are eating every 3 hours, how can you be starving to death? Everything must be okay, so your body will let go of the fat. Also you need to get enough sleep, and try to avoid stress in general; stress is a signal that you are in hard times.
Muscle is your friend for fat loss. Muscle burns calories 24/7, so having more muscle means your daily base calorie burn goes up. This paragraph is important, so feel free to read it again.
The primary way to lose fat is through "cardio" exercise, aka aerobic exercise: running, bicycling, swimming, various gym machines like the elliptical or the stair climber, etc.
Another good thing is to eat a diet that fires up your metabolism. Imagine for a second that you had an entire mouthful of glucose, and you swallowed it all. That will pass straight out of your stomach and go straight into your blood as blood sugar, so it's just about 100% efficient as a food. For fat loss, this is a bad thing. How about a mouth full of vegetable oil? Pretty darn easy to digest, and it will be easily stored as fat since it's fat to start out. Imagine instead you have a mouthful of lean protein (skinless chicken breast, if you eat meat; non-fat cottage cheese if you are vegetarian, say). First of all you will expend some effort chewing, and then your digestive system has to work very hard to tear apart the proteins and turn them into something that can pass into the blood stream. If I recall correctly, you can burn about 30% of the calories in a serving of lean protein, just in the effort it takes to digest it. So the bottom line rule here is: complex carbs, high fiber, and lean protein are much better than simple carbs, low fiber, and high fat foods. Corollary: if you want seconds of anything, let it be lean protein.
So, BFFM tells you how to calculate a good portion size, so you don't eat too much. (If my instincts were good and I naturally took a good portion size, I'd probably not need a book like BFFM.) BFFM encourages multiple, smaller meals, with a high proportion of lean protein, and as much natural whole foods as possible (eat apples, not apple pie). BFFM encourages working out to increase lean muscle mass, plus cardio exercise to actively burn fat. If you do everything in the book, you will lose fat, unless you are one of the fraction-of-a-percent people who have a medical condition that keeps them fat all the time. (And if you are, you have probably figured that out by now.)
Tom Venuto has nothing good to say about BMI. He points out that bodybuilders with less than six percent body fat might still have a high BMI, because muscle is heavy. Body fat percentage is the best indicator, and it's not that hard to get a useful measurement.
He also has nothing good to say about Atkins. Carbs aren't your enemy; you need some. And the idea that you can eat as much fat as you want is just insane. You don't need to go into ketosis to lose fat, and it's not all t
lf(1): it's like ls(1) but sorts filenames by extension, tersely
I'm sorry, but yes you are. Given the context of the discussion, it's pretty ridiculous to bring up calories from sources we can't digest. They're irrelevant.
yes, lets start eating lots of low GI food.
Your weight is based on how you respond to your appetite, not on how much you exercise. Fat and protein are low GI. So are most whole grains and basmati rice. It's the white flour and sugar (the primary non naturally occuring foods in our diet) that have the highest GI. Fructose (fruit sugar) is the only low GI sugar.
and for those who don't know, high GI foods increase your appetite by causing a spike in insulin levels which makes you hungry after the food you eat has been broken down.
He espouses the notion that lower cholesterol levels are not healthier. That statement is so much total bunk that it is on the order and level of other statements like "Smoking doesn't cause cancer" "The earth is flat" etc.
Conclusive proven evidence shows that the lower your cholesterol or the more you *lower* your cholesterol, the lower the risk of heart disease related events etc. Not even worth our time to discuss. A frank waste of time and valuable intertubes!
I started running about 8 years ago...
I was a bit over 100 kg (230 lbs) when I started, now I am down to about 165 lbs (75 kg), and my pulse is in the low 40's first thing in the morning... My wife loves the way I look, I feel great, I eat just about everything in sight (4,500-5,000 Cal/day), and I write better code after my mid-day run break... Ask anyone who went from a sedentary lifestyle to an active one about how they feel, and how healthy they are, and you will find similar stories...
I can accept the premise of the article, that conventional wisdom on weight is unproven, but I think that is due to not having done the right experiment yet, not the falsehood of the conventional wisdom...
"I'll have a Guinness, no wait, make that a Coors Light" -Grad student I work with, who shall remain anonymous...
True - at least calorically (sp?). Certainly not taste-wise.
The same is true for fats, proteins etc, it isn't a simple case of calories in and calories out, they all push specific chemical processes which have specific effects on the body and it's function. If the balance is wrong, people become malnutritioned. Replace calories supplied by sugar with calories supplied by proteins and there is an entirely different effect on the body.
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My family taught me something when I was young and came to America, and miraculously became pudgy... "they have sugar in EVERYTHING here", so we cooked at home, and ate at home a lot, and bought mostly the basic building blocks of food, and... (ding ding) made it at home. There was never a shortage of sweets in the house, or of food. And once we dropped the soda pop and store bought cookie fads, our fat content dropped.
:) Salads, etc. My diet is as varied as it gets, and yet I'm in good shape and I've lost weight. Interesting? I was shocked. I have had two to three week breaks in my exercise routine, and yet no weight gained, and I lose little to none of my conditioning. (First day back I usually run half a mile, but I can get back to two to three miles a day the next day... shocked the life out of me since I was so used to what the idiots in school taught us. Seems almost everything school teaches can be thrown out once you graduate... preferably before. Including the lack of a good warmup before exercise, which is what destroys so many people's joints.) Strangely enough, I have "healthy levels" of the following. "Blood Sugar", "cholesterol", "blood pressure", "heart rate", with no murmurs, no palpitations and roughly no issues whatsoever.
Here's the catch. I work out and jog (swim, bike, etc, that's beside the point), but I do it to keep myself physically strong and resilient. I don't exercise to lose weight. It didn't really work, all it did was convert some of the fat to muscle. The rest went away as I began to eat regular healthy meals and cut down on the crap food to once a week or less. (Never cut the nasty stuff completely, or the cravings will find another way to surface, psychologically speaking. We're human and we're tempted, find a way to replace your cravings with something less nasty, that'd be it.)
My secret? I eat at least an egg a day, regular tea and hot chocolate, sausages or meat once a day
Rule #1? Live a good, healthy and complete life, stop struggling for shit you don't need, and stop fighting battles that don't gain you anything, not even satisfaction (which is more important than people think.)
Rule #2? Stop living with fear. Fear is the only thing you should fear, if anything at all. If something you do makes you "afraid", find out why, and get rid of the problem, don't just suppress the symptoms. Oftentimes fear will simply be some choice you make that you don't understand. Fear is among the worst stressors out there, yet few realize this. Getting into a fight with your boss and walking out of a job without fear is better than living each day at that job constantly afraid that you'll lose it someday and that you won't make payments on that brand new SUV you didn't really need (or want) or that three story house that only you and several ghosts live in (or whatever it is that keeps turning on the lights each night.)
All in all, remove fear by understanding what causes it and deal with it. That and discover the things that satisfy and please you, and surround yourself with those things. Often they are cheaper than you can imagine. Short of hunting and fishing, I have VERY few expensive hobbies. My garage is bigger than my house, as is my shop. Most of my "toys" I built myself, and will continue to do so. I use my life as an example, merely because I've been through all the problems many complain about, and have found ways to complete the needs behind each problem without rushing into a marriage or running into the arms of the nanny state or going on clinical drugs. Do I still have issues? Hell yeah. If I was perfect, I wouldn't be human.
" What luck for rulers that men do not think" - Adolf Hitler
Obesity is not an "epidemic". It is not contagious. Being fat is not a disease. It is a by-product of poor nutritional choices and poor lifestyle. Some people have a predisposition or even illness that can cause obesity, but they are a tiny minority. If you eat Cheetos and sit on your sofa all day, you're going to get fat. And it's YOUR fault.
Treating fat as a "disease" is the typical victim mentality that's so prevalent these days to try to shirk responsibility. I'm not fat, I have a disease. I am not an alcoholic bum, I have a disease. Whether or not one tries to reclassify the word to include behavioral dysfunction, the fact is that it is self-inflicted and people would rather play victim than stand up for themselves, take responsibility for their actions, and stop cramming themselves full of cake or booze or heroin or whatever.
Cancer is a disease. If someone kept injecting themselves with malignant cells of their own will, would you have any sympathy for them?