More weight-loss research

February 27th, 2009  |  Published in Stumpblog  |  11 Comments

In my previous post I considered some of the extrinsic, i.e. outside, factors that contributed to (or hindered) long term weight maintenance. A recent systematic review examines the intrinsic, i.e. internal, factors, that help people lose weight and keep it off. It confirms the findings of a 2005 review. Are you ready for the big secret?

Eat less and exercise.

I know, that is some crazy shit! Indulge me, if you will.

The 2005 study performed a systematic review — a carefully controlled, procedurized review of the available evidence, assessing both the quality of the evidence and what was found. So they didn’t just look at a bunch of studies; they excluded ones that sucked or didn’t measure up to the standards of rigorous peer review. The findings from the studies that passed the grading: Diet associated with exercise produced a 20% greater initial weight loss, and diet + exercise also resulted in a 20% greater sustained weight loss (of about 15 lbs) after 1 year than diet alone. But here’s one problem: In both groups, almost half of the initial weight loss was regained after 1 year. Thus, although diet + exercise is the best way to go, if people don’t fundamentally alter their habits and life patterns, the weight will come back.

The 2009 study did pretty much the same thing, and produced no surprises. Again, diet + exercise is better for sustained weight loss than diet alone, even for long-term studies (such as those lasting 2 years or more). But as the researchers note:

A combined diet-plus-exercise programme provided greater long-term weight loss than a diet-only programme. However, both diet-only and diet-plus-exercise programmes are associated with partial weight regain, and future studies should explore better strategies to limit weight regain and achieve greater long-term weight loss.

In other words, losing the weight is only half (or maybe even less than half) the battle. While diet + exercise is obviously the best method, it has to be a long-term commitment and you have to reconsider the habits and environment that helped you gain the weight in the first place.

Much has been made of the “diets don’t work” finding. People have interpreted it to mean that any attempts to change body composition are pointless — that somehow the body “knows what it wants” and has a magically determined setpoint. Well, that’s crap. What has a “set point” (which is almost entirely arbitrary) is your behaviour, habits, and cognitive approach. You might as well say your teeth have a “set point” of decay, or your armpits have a “set point” of funk. Sure, you have a set of biological cues that send you messages. But just like we don’t pee our pants any time we feel a sphincter tingle, we don’t need to eat a Twinkie whenever our brain decides the glucose thermostat is getting a little chilly.


  1. bikechick says:

    February 27th, 2009at 11:18 am(#)

    OMG – ‘sphincter tingle’?! Funniest post ever.

    Mistress, I love the way you dish out the facts and debunk the underpinnings of excuses that so many of us who are/were fitness victims like to use. As a former ‘but it’s my metabolism/genetics/thyroid’ excuse-spewing victim myself, I appreciate the no bullpoop approach.

    Like many before me, I prostrate myself at your feet. And while I’m down there, I’ll pump out a few Burpees – ‘k?

  2. Mistress Krista says:

    February 27th, 2009at 5:56 pm(#)

    Don’t be too hard on yourself. We’ve all lied to ourselves a hundred times over. (I was convinced my dryer was shrinking clothes… yeah, shrinking clothes all the way up to 10 sizes bigger! Dumbass = me.) And genetics… oy. Don’t get me started. I figured I was doomed to be a Weeble, based on my genes AND family thyroid disease. I had every whammy there was. But you know what? YOU are the boss of you. To me, that’s not harsh, it’s freeing. The world is your oyster; all it takes is a little hard work and consistent effort. Pretty sweet, I’d say.

  3. Lynda Lippin says:

    February 28th, 2009at 3:58 pm(#)

    Really, can you believe that cutting calories and exercising are the way to lose weight? Who woulda thought? ;-)

  4. Barbara Ling, Virtual Coach says:

    February 28th, 2009at 4:09 pm(#)

    It never ceases to amaze me quite how “duh” research can get. I’ve been on my lifestyle change now since, what, 2006? and don’t see it changing anytime in the future.

    Still can’t believe quite how gullible people can be!

    But instead of doing burpees in admiration, I’d prefer to offer pullups. Say, 3? :)

    Data points, Barbara

  5. Lynne says:

    February 28th, 2009at 8:49 pm(#)

    I get really tired of hearing “diets don’t work,” and “it’s not calories.” One of my friends explained to me that for some people, the suffering is nearly unbearable.

    Tell me something I don’t know. I am a person who struggles to maintain a reasonable weight. I am convinced that I am leptin deficient because “insatiable desire for food” describes me pretty accurately. The suffering that saying “no” to myself an unknown number of times every day is very real. None of the tricks work. I’m not hungry. I just want to eat every moment that I am awake. I lie in bed at night and if I could, I would be stuffing myself until I fell asleep.

    One of the things I ask myself at least a hundred times a day is: “Is the suffering you will experience if you do NOT take care of yourself going to be preferable? When you are so fat that you can’t walk well, is your life going to be better because you get all the Little Debbie snack cakes you want? When you are scheduling chemotherapy, waking up from surgery, etc., will you be happy then?”

    There are no guarantees, of course. But the statistics are real. I can reduce my chances of all kinds of disease. I’m the only one who can. And if you are blessed with legs that work, is becoming disabled because you are lazy a grateful way to live?

    The NAAFA (National Association to Advance Fat Acceptance) website has a forum for people to discuss their mobility issues. It actually leaves me speechless.

  6. Mistress Krista says:

    March 1st, 2009at 6:59 am(#)

    Lynne, first of all, I feel your pain. I could eat all day long. I could take down a whole cake after an enormous dinner. I am almost never uninterested in food — except when I am sick or so overstuffed my intestines are about to rupture. I believe that obesity/overweight is multifactorial and something akin to alcoholism in many cases: it has many symptoms of addictive behaviour including neurological circuitry that is oriented towards the rewards that eating offers (which actually seem differ from person to person), coupled with a less functional “shutoff switch”. For some people eating is attached to emotional cues; for me it is simply a function of having strong appetite signals and weak satiety signals, finding hunger uncomfortable, and enjoying the taste of food and the sensation of being full.

    You may be interested in a recent article that appeared in the International Journal of Obesity. It looks at a genetic disorder, Prader-Willi syndrome, which is characterized by “hyperphagia [overeating] and obesity… Individuals with PWS begin displaying an insatiable appetite that, if left unchecked, leads to obesity by early to middle childhood. Behaviors associated with extreme overeating in PWS include food foraging and hoarding, theft of money to purchase food and consumption of non-food items. Zipf and Bernston reported a mean consumption of over three times the normal caloric intake in individuals with PWS when they were allowed to consume sandwich quarters ad libitum. Consequences of unattended hyperphagia in PWS include maintenance of over 200% ideal body weight (in 1/3 of the PWS population) and occasional stomach rupture (isolated cases reported).” What is interesting is that despite this overwhelming desire to eat, “Treatment for hyperphagia and obesity in PWS requires a regimented diet and environmental control, which can be successful in preventing obesity.”

    L M Holsen, et al. Genetic subtype differences in neural circuitry of food motivation in Prader-Willi syndrome (2009) 33, 273–283; doi:10.1038/ijo.2008.255; published online 2 December 2008

  7. Beth says:

    March 4th, 2009at 6:27 am(#)

    Such a drag! I was hoping you had something magical to say because I swear it’s in my genetics that I carry 20 extra pounds! :)
    I haven’t been to your site for awhile because I’ve been a little bit of a lazy fat ass. I was thrilled when I saw your new design! You’re awesome. I just took a job in marketing/communications and am working with a firm on a site redesign. Yours is one I’ll be showing them to illustrate what I like – there are so many sites out there I don’t like.
    You did a great job keeping a “clean” look and it’s very easy to navigate. You just seem like someone who does a lot of things well and this is another example of your talent. Thank you for being such a great resource.
    Now can you get going on that magic pill for me?

  8. greengirl says:

    March 10th, 2009at 3:00 pm(#)

    Hi Krista,

    I’ve been reading your site for a few years now, and find it very inspiring. I’ve recently (last few months) began working on improving my fitness levels. I’ve applied to join the military as a paramedic, and so my goal is to be fit enough to be accepted and to attend basic training.

    At first, I wanted to focus on improving my fitness only, and not on losing weight as a goal. I’ve been moderately overweight since age 18 (I’m late 20s now), and I think I felt defensive about being bigger or something. I also think that there is an unhealthy obsession in our culture with women being thin/skinny (apart from fitness), and I’ve seen so many women in my life, who were normal weights, torture themselves thinking they needed to lose weight. I don’t want to fall in to this pattern myself, but neither do I want to sabotage my health if my weight is in fact a problem.

    I’m on a quest for accurate information about all of this. I’ve been reading a lot of “health at every size” information that says 98% of people who lose weight regain it all, dieting is bad for your metabolism, and that you can be fat and still very fit. Is this true? Or does becoming fit require losing fat? There is so much conflicting information out there that it’s hard to know what is true, or what my goals should be. Your site seems to be pretty balanced and well-researched, so if you had time to address my questions I’d really appreciate it. I’m not able (yet) to offer you pull-ups in supplication. Will you accept push-ups instead?

    If this helps you answer my question, I am 5’6″ and weigh around 185. I’ve been the same size/weight for at least 5 years, even during periods when I’ve eaten crap and not exercised. When I’ve been very active for periods of time (eg. working on a farm last summer), I maybe lost 5 or at most 10 pounds. My weight tends to be pretty stable regardless of what I eat or do. I’ve had hypoglycemia since elementary school. I’m trying to clean up my diet to address this, as having blood sugar crashes in the middle of a run or workout sucks a lot, and I’m really tired of feeling like crap from fluctuating blood sugar levels. In the last few weeks, I’ve quit caffeine (harder than quitting smoking for me). My next step is to remove refined carbs and processed stuff from my diet as much as possible, and up my protein and veggie intake. Previous efforts to cut calories and eat less were really disastrous due to blood sugar issues, so I am more concerned about getting my blood sugar under control.

    Thanks for any information or advice you can offer.

  9. Mistress Krista says:

    March 11th, 2009at 11:33 am(#)

    All good questions. Here is what the evidence shows.

    1. It is completely possible to lose fat and keep it off for life. People regain weight after loss because generally they don’t maintain the good habits that enabled the loss, and/or they failed to restructure their lives. Saying “diets don’t work” is like saying “brushing your teeth doesn’t work”. Sure, a short term, often drastic solution, doesn’t work. Starvation makes you crazy. But a well-planned commitment to life changes that includes a mild caloric deficit and good food choices — that DOES work.
    2. Fitness (i.e. the ability to engage in physical exertion) is a bigger determinant of health than fatness BUT past a certain point fatness does matter.
    3. The body has optimal and non-optimal ranges of things. Underfat is bad. Adequate fat is good. Too much fat is bad. “Adequate” bodyfat can be a range from, say, 15-25% in women.
    4. Overfat is non-optimal for two reasons: the mechanical loading on joints and other structures such as the soft tissues of the throat (which can cause sleep apnea, for example); and, perhaps more importantly for overall health, the chemical effects on the body. Fat is both energy storage AND hormone generator.
    5. Don’t think in terms of “bad” or “good” with fat/fit; think in terms of “optimal/efficient” and “non-optimal/non-efficient”. Excess fat hangs around, producing inflammatory chemicals, screwing with your hormones, and crushing your joints. Adequate fat does its job of cushioning your organs and producing enough of what you want.
    6. Thus becoming fit DOES involve getting your body fat into a range that is more optimal and more efficient, because if you do not then you cannot fully do what is necessary to engage in physical exertion. BUT what that range is varies from person to person.

  10. greengirl says:

    March 11th, 2009at 6:20 pm(#)

    Hi Krista,

    Thank you so much for answering my questions. It is good to know that I am not setting myself up for failure by attempting to reduce body fat as part of improving my fitness level. I did a big grocery shop today, with my new dietary goals in mind – more protein and fruit/veggies, fewer carbs, cutting out sugar and white flour. I feel like 85% of the foods in the grocery store had white flour and/or sugar in them. Unbelievable. I knew they were in a lot of things, but I was still a little surprised.

    Thanks again for the info. As I said, I’m aiming to attend boot camp this year, and from what I understand it tends to be a few women and lots of very fit 20 year old guys. I’d like to do everything I can now so that I’ll be able to keep up with group. I’ll dedicate this evening’s run to you, in lieu of pull ups.

  11. MVE says:

    August 13th, 2009at 3:21 am(#)

    I approach the claim that “dieting doesn’t work” differently now that I’ve quit smoking (having done a fair bit of research on the subject). Reviewing the smoking cessation literature in the same bone-headed way would lead one to claim that studies show that “quitting smoking doesn’t work.” The relapse rate on nicotine addiction is huge.

    And yet, here I am, nicotine-free.

    I found that it helped to have a bit of an arrogant, elitist streak to apply to the statistics. Yeah, sure, a majority of people couldn’t quit smoking or maintain a reasonable level of nutrition and exercise. But based on what else I know about the U.S. population, a majority of them are ignorant, foolish, undisciplined buffoons. I’d damn well better be able to rise above THAT.

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