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."

There is a continuous conversation going on in everyone's head. This conversation goes on from the moment of waking until falling asleep.

The inner dialogue continues while working, studying, reading, watching TV, talking, walking, eating, etc. There is a constant judging of people, commenting on what is going on, planning, gossiping, and mental conversations with people.

These inner dialogues bring about a snowball effect. The more we conduct them, the more we become chained to them and unable to stop them. When the emotions are also evoked, more power, energy and attachment are added. This affects our behavior, judgment and performance.

When our inner dialogue is negative, it strengthens any negative attitude and behavior. Negative inner dialogues are very common for just about everyone.

The process and effect of these inner conversations is similar to the way affirmations work. Constant thinking about the same subject affects the subconscious mind, which consequently, accepts these thoughts and words and acts on them.

Negative inner dialogues bring negative results, and Positive inner dialogues bring positive results.

It is not so easy to mentally separate oneself from the thoughts and words the flow through the mind.  However, over and over again, we can work to keep our attention on what is going inside our heads, and eventually we will be able to become aware of the inner dialogue for longer periods of times. Watching the mind and what is going on inside it helps us develop detachment, and this makes it easier to take control of the mind and its chatter.

Whenever we catch ourselves conducting a useless, futile conversation with ourselves, stop it.   Change it to something more useful and meaningful. Replace the subject, and the words. It is just like listening to a recording. So replace it with another recording that we like. We can change the words of the inner dialogue to positive ones, about good health, happiness and success. 

The video below is an amusing Example of Inner Dialogue.

The notion that true Habits,

meaning:
... Behaviors that automatically persist even in the face of major life upheavals and adversities ...

can be forged in 21 days
flies in the face of reality.


Where did that idea come from?

In 1960 Maxwell Maltz, a cosmetic surgeon, reported that it took 21 days for amputees to stop feeling phantom limb pain. Maltz then said that consciously cultivating a new behavior for just 15 minutes a day for 21 days could create a habit. 

However, a 2009 study published in the European Journal of Social Psychology looked at the time it took for subjects to "automate" an eating, drinking or exercise behavior "carried out daily in the same context"—i.e., a habit. Using examples such as the time it took to automatically drink a glass of water after waking, or to do 50 sit-ups before breakfast, they concluded that it took participants between 18 and 254 days for these behaviors to happen "automatically."

There’s quite a lot of time between 18 and 254 days. That study didn't control for the real-life upheavals that tend to get in the way of our very best intentions, and the behaviors they chose to study are so minor in scope, it seems like their results would not even apply to the real world. Especially not to the prospect of cultivating an entirely new eating lifestyle, which involves many new and complex behaviors and choices.

Ex-smokers know quite a lot about how long it takes to make or break a habit. According to the National Institutes of Health, nicotine's physical withdrawal symptoms are usually over within a week. But any ex-smoker will tell you, the fight to break the habit of smoking, and cultivate the habit of not smoking, lasts much longer.

Most smokers have difficulty quitting. They commonly report that the first few weeks are truly miserable, with a nearly constant, conscious battle not to smoke. As time goes by, the battles became less frequent, but even two to three years after quitting, they still have occasional moments or circumstances when they have to consciously fight the urge to light up. And even if someone who hasn’t smoked for many years, lites up again, they're back to a pack a day in no time.

Changing eating behaviors and creating new eating habits takes an awfully long time. While a some people might be able become comfortable with a new behavior in just 21 days, ordinarily, habit formation takes years of consciously reminding ourselves of our new choices.

While it can seem tedious to keep our new eating behaviors in regular focus for several years – or more - by continually and consistently reminding ourselves, it is a price most of us have to pay in order to establish habits involving new eating behaviors.

The authors of a research study about OBESITY MYTHS recently published in the New England Journal of Medicine, said the following statement has proven NOT to be True:

 “Large, rapid weight loss is associated with poorer long-term weight outcomes than is slow, gradual weight loss.”

This “MYTH” came from:

“…a reaction to the adverse effects of nutritionally insufficient very-low-calorie diets (less than 800 calories per day) in the 1960s; the belief has persisted, has been repeated in textbooks and recommendations from health authorities, and has been offered as a rule by dietitians.”

In the 1960’s, very-low-calorie diets had inadequate protein content and a few other nutritional deficiencies, which resulted in rapid loss of lean tissue, thereby reducing metabolic rates beyond what may have been expected with a more gradual nutritionally balance weight loss.

However, here in 2010’s, low-calorie formula diets are generally high in protein and nutritionally balanced (except perhaps for fibre) and have in fact been shown in some cases to preserve lean body mass compared to simply eating less. Today, there are many documented situations where rapid weight loss by the use of Dr.-Supervised-low-calorie-diets are both indicated and  beneficial.

The study points out, that when comparing longer-term outcome data … more than a couple of years ….,  people who lose large amounts of weight rapidly, have no worse chance of keeping weight off, than those who lose weight slowly. The ultimate question with any diet is whether or not patients can live on a restrictive caloric intake, and possibly a rather high amount of physical activity, in the long-term.

Maintaining a significant amount of weight loss, is ongoing hard work.

Although we might assume that the radical changes which are needed for fast weight loss are less likely to be sustainable than more moderate and gradual changes, we must recognise that the effort to keep a given amount of weight off is the same irrespective of whether that weight loss was fast or slow.

 

SuperBowl Sunday

SuperBowl Sunday is a major Holiday in our house.
My husband is a long-time faithful 49er fan, and he has been looking forward to this day all season. 
His personal choice of Foods will be available to him throughout the day, and I will deal with it as best I can. I'm hoping to keep my personal calories reasonable, and for the 49ers to win the Superbowl.