We live in a world of Unrealistic Expectations.

Like I keep saying:

Being Fat is Hard
Losing Weight is Hard
Maintaining Weight is Hard
Choose your Hard.

Fat Is Officially Incurable (According to Science)
              By: David Wong

Let's get this straight: The number of people who go from fat to thin, and stay there, statistically rounds down to zero.

Every study says so. No study says otherwise. None.

Oh, you can lose a ton of weight. You'll gain it back.
Here's one study running the numbers.
Here's a much larger analysis of every long-term weight loss study they could find. 
They all find the exact same thing: You can lose and keep off some minor amount, 10 or 15 pounds, for the rest of your life -- it's hard, but it can be done. Rarer cases may keep off a little more. But no one goes from actually fat to actually thin and stays thin permanently.

And when I say "no one," I mean those cases are so obscenely rare that they don't even appear on the chart. They can't even find enough such people to include in the studies. It's like trying to study people who have survived falling out of planes. Being fat is effectively incurable, every study shows it, and no one will admit it.

So the guy or girl you see in the "Before" and "After" photos in weight loss commercials, who completely changed body type with diet and exercise? You know, like Jared from Subway, who lost 230 pounds? Either they're about to be fat again in a couple of years, or they're a medical freak occurrence, like the sick guy who was told he had six months to live but miraculously survives 20 years. That guy exists, we all know famous examples. But it's a rare, freak situation, living in defiance of all of the physical processes at work.

How rare? Well, this person did the math and as far as they could tell, two out of 1,000 Weight Watchers customers actually maintain large weight losses permanently. Two out of a thousand. That means if you are fat, you are 25 times more likely to survive getting shot in the head than to stop being fat.  

Meanwhile, here's an article where scientists marvel at the amazing success of Weight Watchers, because a study of their most successful customers showed they permanently lost 5 percent of their weight. Wow! You come in at 300 pounds, you stay at 285!   Next stop, thong store!
 
So please remember this the next time the subject comes up at the office or on some message board and you get bombarded by thin 20-year-olds insisting the obese need to just "cut out the junk food" or "take care of themselves" or "do some exercise." The body physically won't allow that for a formerly fat person.

"Well, just stop eating so much!" Sure, kid. To feel what it's like, try this:

Go, say, just 72 hours without eating anything. See how long it is until the starvation mechanism kicks in and the brain starts hammering you with food urges with such machine gun frequency that it is basically impossible to resist. That's what life is like for a formerly fat person all the time. Their starvation switch is permanently on. And they're not going 72 hours, they're trying to go the rest of their lives. It's like being an addict where the withdrawal symptoms last for decades. Here’s a breakdown of the science in plain English.

As that article explains, the person who is at 175 pounds after a huge weight loss now has a completely different physical makeup from the person who is naturally 175 -- exercise benefits them less, calories are more readily stored as fat, the impulse to eat occurs far, far more often. The formerly fat person can exercise ten times the willpower of the never-fat guy, and still wind up fat again. The impulses are simply more frequent, and stronger, and the physical consequences of giving in are more severe. The people who successfully do it are the ones who become psychologically obsessive about it, like that weird guy who built an Eiffel Tower out of toothpicks.

Statistically, the only option with any success rate is a horrible, horrible surgical procedure. I can find no data whatsoever that says otherwise. Keep all of this in mind the next time you see a Jenny Craig or Bowflex commercial.

            David Wong of www. cracked.com

A recent research study published in the New England Journal of Medicine has received quite a lot of recent media coverage.

Here are the basics of that study.

 
Myths, Presumptions, and Facts about Obesity

                    Research Study Published 1/31/2013 
                             in the New England Journal of Medicine.

BACKGROUND
Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may
divert attention away from useful, evidence-based information.

METHODS
Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations.

RESULTS
We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations.

CONCLUSIONS
False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press.

(Funded by the National Institutes of Health.)

 Below are the myths, presumptions and facts:

Here are the beliefs that were found to be untrue.

The Myths

1. "Small sustained changes in energy intake or expenditure will produce large, long-term weight changes".

2. "Setting realistic goals for weight loss is important, because otherwise patients will become frustrated and quit".

3. "Large, rapid weight loss is associated with poorer long-term weight-loss outcomes as compared with slow, gradual loss".

4. "It is important to assess the stage of change or diet readiness in order to help patients who request weight-loss treatment"

5. "Physical-education classes in their current form, play an important role in reducing or preventing childhood obesity"

6. "Breast-feeding is protective against obesity"

7. "A bout of sexual activity burns 100 to 300 kcal for each participant" (Their calculation comes to about 14 calories).

These are subjects that as yet remain unproven one way or the other.

The Presumptions

1. "Regularly eating breakfast is protective against obesity"

2. "Early childhood is the period in which we learn exercise and eating habits that influence our weight throughout life"

3. "Eating more fruits and vegetables will result in weight loss, or less weight gain, regardless of whether any other changes to one's behavior or environment are made"

4. "Weight cycling is associated with increased mortality.."

5. "Snacking contributes to weight gain and obesity."

6. "The built environment, in terms of sidewalk and park availability, influences obesity."

These are the nine points the authors feel there's sufficient evidence to be true.

The Facts

1. "Although genetic factors play a large role, heritability is not destiny"

2. "Diets (reduced energy intake) very effectively reduce weight, but trying to go on a diet or recommending that someone go on a diet generally does not work well in the long term."

3. "Regardless of body weight or weight loss, an increased level of exercise increases health."

4. "Physical activity or exercise in a sufficient dose aids in long term weight maintenance."

5. "Continuation of conditions that promote weight loss promotes maintenance of lower weight."

6. "For overweight children, programs that involve the parents and the home setting promote greater weight loss or maintenance."

7. "Provision of meals and use of meal-replacement products promote greater weight loss."

8. "Some pharmaceutical agents can help patients achieve clinically meaningful weight loss and maintain the reduction as long as the agents continue to be used."

9. "In appropriate patients bariatric surgery results in long-term weight loss and reductions in the rate of incident diabetes and mortality."

 Regarding the issue of potential food and drug bias within the study, I think that it's worth noting that the author of the NEJM paper, Dr Allison, has the following disclosure regarding his relationship to the food and drug industry:

"Dr. Allison reports serving as an unpaid board member for the International Life Sciences Institute of North America; receiving payment for board membership from Kraft Foods; receiving consulting fees from Vivus, Ulmer and Berne, Paul, Weiss, Rifkind, Wharton, Garrison, Chandler Chicco, Arena Pharmaceuticals, Pfizer, National Cattlemen's Association, Mead Johnson Nutrition, Frontiers Foundation, Orexigen Therapeutics, and Jason Pharmaceuticals; receiving lecture fees from Porter Novelli and the Almond Board of California; receiving payment for manuscript preparation from Vivus; receiving travel reimbursement from International Life Sciences Institute of North America; receiving other support from the United Soybean Board and the Northarvest Bean Growers Association; receiving grant support through his institution from Wrigley, Kraft Foods, Coca-Cola, Vivus, Jason Pharmaceuticals, Aetna Foundation, and McNeil Nutritionals; and receiving other funding through his institution from the Coca-Cola Foundation, Coca-Cola, PepsiCo, Red Bull, World Sugar Research Organisation, Archer Daniels Midland, Mars, Eli Lilly and Company, and Merck."

 
What about eating frequency? How often should we eat?

Should we eat 3 Square Meals?

Or should we eat 6 Small Meals?

Or should we eat only inside a window of 8 hours or 5 hours?

Or should we, intermittently, have days with only one small meal, or even zero food in a total water fast?

Or should we eat whenever we feel Hunger?

Each of these “Diets”, “Non-Diets”, “Ways-of-Eating”, or “Lifestyles” claims that Scientific Research supports their individual position.

So what DO we do?
The following article by Dr. Yoni Freedhoff of WeightyMatters, supports my own personal position on this question.

Does New Study settle the
3 Square vs. 6 Small vs. the 8 hr Diet Debate?

So this month yet another study in a never-ending line of studies looking to compare the impact of meal frequency on fullness and biochemistry came out. This one suggested that small frequent helped decrease energy intake in normal weight men.

Honestly I pretty much disregard all of these studies.

Not because I'm doubting or questioning their results, just that I don't think their results really matter.

What I mean is that all of these studies fail to address the practical aspects of living with their recommendations, and as a clinician, that's really all that matters to me.

I've seen people controlling calories, loving life and preserving health with 6 small meals daily. I've seen people do the same on 2, 3, 4, and in some cases even 1 meal a day.

Regardless of the research that comes out, what matters more than what a physiology paper says is how you personally feel.

In my office we do tend to start people on small and frequent meals and snacks. But if that doesn't suit or help the individual we'll shift to 3 square meals. We've also recommended the intermittent fasting style that's suddenly finding some traction on the diet book shelves.

You need to find a life that you enjoy, and just because a new study or diet book suggests there's a "better", or "right", way, if you don't happen to enjoy it, it just isn't going to work.

The specific new study referred to is: Psychology and Behavior
www. sciencedirect.com/science/article/pii/S0031938413000243

According to all of the scientific research I’ve read, when we get right down to it, any actual “Health” or “Metabolic” Benefit Differences between all of these eating plans are truly miniscule, and therefore, not even worth the individual effort of personal consideration. The question to consider is which one can we DO?

I ask myself:

• Which Eating Behavior will work for ME in MY weight-loss or maintenance efforts?.
  
• Which Behavior will allow ME to consistently eat less than, or the same as, the amount that My body uses for energy?
  
• Is one Eating Behavior more manageable for ME than another?
  
• Which one can I consistently stay on?
  
• Can I live with one of these Behaviors as a lifetime Habit?

Why is it so difficult to keep weight off?
Apparently, evolution has given us
the mechanisms to gain weight
but not to lose it.

BEFORE indulging over the Holidays, think about what Dr. Ayra Sharma, professor of medicine and chair of obesity research and management at the University of Alberta, Canada has to say about this issue.

How The Hedonic System Ratchets Up Your Weight

“Bill Colmers, the neuroscientist, presented an overview of how the brain affects eating behaviour and regulates body weight.

I was particularly impressed by how Colmers described the respective roles of the hedonic and homeostatic systems in human evolution.

While the hedonic (pleasure seeking) system evolved to help our hunter-gatherer ancestors seek out and take advantage of any highly palatable energy dense foods they happened to come upon, the homeostatic system evolved to protect from wasting away those extra calories that they did ingest.

Thus, according to Colmers, the hedonic system’s job was to make it hard to resist, in fact, make our ancestors to often go to considerable lengths to searching out those rare palatable energy dense foods and then to eat as much of them as possible, whether they were actually hungry or not. They could of course always store those extra calories as fat tissue for later use - a tremendous survival advantage.

In contrast, the job of the homeostatic system was to ‘defend’ those stored calories - in fact, it is designed to regard any accumulation of fat stores as the ‘new normal’ and from then on make sure that this increased level of fatness was maintained (or regained) ever after.

Indeed, the homeostatic system is ‘designed’ to readjust its set point of body weight - after all it has to do this starting from birth as body weight continues to increase as the baby grows into a toddler that grows into a kid and ultimately into an adult.

Unfortunately, the mechanisms that allow the set point to reset to ‘defend’ a progressively higher body weight - generally works in only one direction - after all that is all that is required by nature, where people do not naturally ’shrink’.

Colmers used the analogy of a ratchet to describe how the homeostatic system is designed to defend ever increasing body weights without having the ability to reset itself to a lower body weight even if the person now wants to lose weight.

Once set to a higher weight (e.g. resulting from ‘overindulgence’ driven by the hedonic system or other factors that may promote weight gain), the homeostatic system uses a wide range of mechanisms affecting hunger, satiety, appetite, metabolic rate, etc. to ‘defend’ this weight from then on.

A very helpful analogy I thought, nicely explaining why evolution has given us the mechanisms to gain weight but not to lose it.”

Dr. Arya Sharma, professor of medicine and chair of obesity research and management at the University of Alberta, Canada.

 Previously, I posted an article detailing this ratcheting analogy, for more see:  Set Point

Recently the Stanford University Medical School, Health Policy Forum hosted an event examining the reasons why we get fat and how different diet trends and food policies affect our nation’s obesity rates.

The forum featured a conversation between science writer Gary Taubes and Christopher Gardner, PhD, director of Nutrition Studies at the Stanford Prevention Research Center.

During the discussion, Paul Costello, the medical school’s chief communications officer, talked to Taubes and Gardner about Americans’ misconceptions about food, diet and nutrition, the driving forces behind the obesity surge of the late-80s and the path to a healthier, leaner lifestyle.  Below is a video of that 1 hr 24 minute forum.