Weight-loss research roundup

February 27th, 2009  |  Published in Stumpblog  |  5 Comments

The New England Journal of Medicine recently considered the problem of “which diet is best” in an editorial. The author observed several problems with weight loss trials, including the lack of control groups, the problems with monitoring people, and the difficulty of getting folks to do something that they may not really want to do.

Astutely, the author notes:

The inability of the volunteers to maintain their diets must give us pause. The study was led by seasoned investigators who were experienced in the performance of diet and drug trials. The participants were highly educated, enthusiastic, and carefully selected. They were offered 59 group and 13 individual training sessions over the course of 2 years. Nonetheless, their body-mass index (the weight in kilograms divided by the square of the height in meters) after 2 years averaged 31 to 32 and was moving up again. Thus, even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed to reverse the obesity epidemic. The results would probably have been worse among poor, uneducated subjects. Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices.

It is obvious by now that weight losses among participants in diet trials will at best average 3 to 4 kg after 2 to 4 years and that they will be less among people who are poor or uneducated, groups that are hit hardest by obesity. We do not need another diet trial; we need a change of paradigm… Like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action.

Now, I’m sure we can all agree that having some level of self-motivation is important. Otherwise you’d just end up “lying in bed just like Brian Wilson did”. But as motivated as we all are, it’s really hard to fight against the tide of shit food and inhumanely constructed physical environments that practically demand that we sit in cars. On my last days in LA, I was on my own in a hotel. I almost literally had to forage for food: the nearest grocery store was nearly 2 miles away, and I was the only person walking. The streets were laid out to privilege the car, not the walking human. I had to dodge traffic and trudge across vast parking lots. When in the store I had to filter out plenty of loud, colourful, visually attractive things begging me to buy sugary procssed garbage.

Imagine trying to shop for a family of 4 without a car in this kind of community. Imagine trying to deal with a toddler while trying to pick up dinner, excavating the aisles to find something — anything — not full of crap: colourings, sodium, sugar, hydrogenated fats, paradichlorobenzeneestermethyl-blue. I’m a food magazine editor and so called expert, and it still took me way longer than it should have to figure out what kinds of things I could safely and sanely consume. (New sugar discovery: in fish. Why? WHYYYYY?!) The hilarious irony of that situation is that I walked past two gyms and a Pilates studio to get to that grocery store… and of course nobody else would have walked to their gym.

In other words, trying to lose weight and keep it off, and stay in shape in an obesegenic environment requires a massive act of will and motivation. It can be done, of course — and many of y’all are a testament to that. But it’s really fucking hard. Why don’t we start trying to make it easier on ourselves?! Demand better from our grocers and our food providers. Demand better from our community planners and municipal governments. Demand sidewalks, parks, bike lanes, good public transit, and high-density, human-scale urban planning. Reconsider our priorities in real estate — do we want a big cavernous house in the middle of a razed field or a smaller, manageable home in a community that allows us to know our neighbours and walk to the damn grocery store?

Meanwhile a study in the International Journal of Obesity reports a comparison between people who lost weight via surgery and via non-surgical methods such as diet and exercise. While both groups regained a bit of weight, they weren’t substantially different. What surgery patients shared, though, was less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress. People who were susceptible to external cues (such as availability of food, or stressful situations) gained weight back regardless of how they lost it. As always, “what diet should I follow” is an important question, but perhaps not as important as “what’s around me and how am I dealing with it?”

Responses

  1. Lillian says:

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

    Krista, I really respect your site and you have inspired me immeasurably.

    However, I do think you are being unfair in your US vs. Canada criticisms. The US, Mexico, UK, and Canada are the top four countries for obesity. I find it hard to believe that all of Canada is some kind of mystical wonderland where all the food is healthy and the all the populace exercises daily. I know for a fact that in many parts of the US, wholesome food is every bit as available as pre-packaged junk food. There are many places where people are able to walk to the store or readily access exercise.

    You recognize that income, education, and personal decision making all play into a healthy lifestyle. Your perception of the US may be skewed as you travel from hotel-to-hotel. Let’s stop the US vs. Canada mudslinging–people are every bit as capable of making healthy choices here in the US, if they are blessed by the education and resources to do so.

  2. Mistress Krista says:

    February 27th, 2009at 6:15 pm(#)

    I’ve traveled all over the US, UK and Canada. I’ve also studied the social welfare systems in each country. Can’t speak for Mexico. Generally what we find is that there is a continuum that usually runs from US — UK — Canada on most social issues and indicators. Canada definitely isn’t a Nordic state in terms of addressing public health nor does it have the incredible food culture of some place like Italy or France. However there are notable differences that are easily measured. Health indicators, for example, such as mortality and morbidity, quality of life, degree of disablement, etc. For instance, US data indicates that well over 90% of Black women living in poverty are either overweight or obese. Infant mortality in the US is quite high. Etc.

    There are a few things that make the difference.

    1. Each countries’ approach to social welfare systems and the public good. This is a combination of generally shared attitudes and policy initiatives — a sense of who’s responsible for various outcomes. Canada has a broader social welfare system, including socialized health care, than the US or UK, although it has eroded since the 1980s with the advent of privatization. None of the three countries have been particularly brilliant stars with public health, but on the other hand I think that Canada’s conceptualization of health care as a public right makes a big difference to how policy is developed and enacted.

    2. All 3 countries have different regulatory and legal environments. In the US for instance, you get certain food products because of the way the regulation of food production works. Many sports supplements easily available in the US are not permitted in Canada; in the US there is a “negative billing” kind of situation where the FDA has to prove that something is actively harmful. Other countries presume the substance is harmful unless otherwise proven. Also, the US permits direct-to-consumer pharmaceutical advertising, which is not the case elsewhere. The UK is regulated by many of the EU conventions, which control labelling and production methods, and are usually the most stringent of the three.

    3. All 3 countries have different spatial/geographical layouts, although the US and Canada are closer in this regard, and the rural-suburban-urban distinction is perhaps more significant. The UK is much more organized around central, walkable hubs with accessible public transit. However many US cities are also like this (I love NY for this feature) although I’ve been in places like Atlanta and LA where I’m the only person on the sidewalk.

    4. The US probably has the best potential to produce amazing food as it has pretty much the full range of microclimates, unlike Canada and the UK which never really get very warm in most parts (although I’ve heard one can grow palm trees in the very southeast of the UK; not verified though). I think CA is awesome for this feature, and I always try to go to farmers’ markets whenever I travel. We picked up some fabulous veggies in Valencia. The problem here I think is that none of the three countries have a particularly great “food culture” like elsewhere in the world. In large cities (at least in affluent areas) you can do very well for food availability. Less affluent urban areas struggle; there are fewer fresh food markets, etc. In suburban and rural areas it can also be harder simply because of the dominance of chain stores, although in rural areas of course one may have better access to small producers.

    So there are several factors like this that do, in fact, create distinctions, even though to folks who have not observed national differences in great depth, it may not be self-evident.

    The point is not to say “the US sucks” but rather “these things suck, and they work contrary to socially positive outcomes”. There are assholes everywhere. The real question is how we fix the things that are broken.

  3. alicia says:

    February 28th, 2009at 1:52 pm(#)

    I live in an untrendy part of Chicago. One of the best things about my neighborhood is our big A&G Market. The produce section is right in the middle of the store–and it takes up at least a third of the entire store. The deli and meats take up another third. Dairy and small aisles for packaged food take up the other third. The bakery area is tiny and tucked in the back; helps me forget cakes exist.

    The second I walk in the door, I start craving salad and fruit.
    Shopping here, as opposed to the chain stores, has completely convinced me of what you’re talking about in this post.

    Oh, and the store is exactly 1 mile from my house, so I can either walk or take the bus there. :)

  4. HalcyonNwar says:

    March 1st, 2009at 10:14 am(#)

    Living in New York (for the most part) seems to be better than the LA experience you had. I don’t know anyone with a car, though sometimes we use the zipcar, and we walk/subway everywhere. Also, there are fruit stands everywhere. I get excited getting off the subway and seeing all the beautiful produce laid out. so nice!

    On the downside, my gym is so crowded, I walk there, but I also have to fight people during my rest between sets. :)

  5. Toby Wollin says:

    March 1st, 2009at 6:13 pm(#)

    Anyone who challenges the idea that here in the US we have incredible challenges to fighting obesity just has to ask themselves a couple of questions:
    1)if you have children, can they and do they walk to school? If they have access to sidewalks and are not walking to school, who is making that decision?
    2) if you wanted to ‘run’ to the store to get a quart of milk or a dozen eggs, could you literally do so? Could you ride a bike there or, are the streets so dangerous and lack pedestrian faciltiies, that you would literally have to get in your car?
    3) How do you get to work? Could you walk or ride a bike? When you want lunch, can you walk to get lunch and be back in time? Or, do you have to bring your lunch and eat at your desk?
    4) Are you sitting at a desk all day long? Does your workplace have any facility for you to get any sort of exercise through the day at all?

    As a culture, because of the way public policy has been developed, we spend our days either behind the wheel of a vehicle or sitting behind a desk. These factors alone are killing us and as informed citizens, we should involve ourselves in our local planning boards, pedestrian/bike committees, traffic safety and so on and DEMAND sidewalks and traffic control devices so that we CAN walk to shop; that we CAN walk or ride bikes to school or work and that we DO have facilities the meet the health needs of the populace. (my two cents)


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