Saturday, February 14, 2015

Diet and Exercise No Cure for Obesity

A recent article (written by weight-loss doctors, no less) finally pointed out what we have been saying for so long ─ that very few fat people actually lose weight and keep it off successfully long-term, that it's NOT just about eating less and moving more, and that the body actually has biological mechanisms that work very strongly against weight loss efforts. Here's a quote:
A group of respected physicians has stepped forward to challenge the common assertion that obesity can be easily fixed by diet and exercise. 
For most of the nation’s 79 million adults and 13 million kids who are obese, the “eat less, move more” treatment, as currently practiced, is a prescription for failure, these doctors say.
In a commentary published Thursday in the journal Lancet Diabetes and Endocrinology, four weight-loss specialists set out to correct what they view as the widespread misimpression that people who have become and stayed obese for more than a couple of years can, by diet and exercise alone, return to a normal, healthy weight and stay that way. 
...The depressing fact, said Ochner in an interview, is that “the average adult with sustained obesity has less than a 1 percent chance of reattaining and maintaining a healthy body weight without surgery...What really bothers me working around and with clinicians, is that some of them — a disturbing percentage — still believe it’s all about personal choice: that if the patient just tries hard enough, and if we can just figure out how to get them a little more motivated, then we’d be successful. And that’s just not right.”
Of course, this commentary was not perfect, naturally. The authors seem to assume that all fat people are average-sized people who only get fat over time, ignoring the many people who have higher-BMIs consistently throughout their whole lives (suggesting genetic and metabolic mechanisms). And because of this, they still called on doctors to intervene more stringently among "overweight" patients in hopes of preventing them from becoming "obese," and to aggressively use weight-loss surgery, medications, and devices with obese people to get that weight down. (Sounds like WLS surgeons trying to increase business, frankly. And it conveniently ignores the fact that it's weight loss interventions and pressure on "overweight" and Class I "obese" patients that often lead to more obesity rather than less.)

But it was refreshing to hear doctors admit what we have known for so long, that it's not just about eating less and exercising more, that success with permanent weight loss is extremely unlikely, and that the bias of what doctors want to believe about fatness is increasing stigma and inhibiting actual good care of these people.


Moose said...

I actually spent some time Google-stalking the authors of the article. At least two of them have some pretty clear links to WLS centers. The primary author is actually a psychiatrist, although a lot of his papers (and, disturbingly, pop-science books) are about nutrition. I think at least some of the authors make money by "evaluating" WLS patients. There's a clear bias here.

Unsurprising. But I really despise when the right message is sent out for all the wrong reasons.

Well-Rounded Mama said...

Yep, I agree, Moose. They are co-opting the language and message of FA in order to shill for WLS and WL medications. I had strong misgivings about linking to this article because of this.

Still, given the predominant media message of "it's only about calories in, calories out" and "everyone can lose weight permanently if they only try hard enough," I thought it was worth pointing out that many experts in the field know this is not true. It's not just fat people saying this to justify themselves, but the evidence really does support that the answers are really not so simple.

Even though the linked article is flawed by the underlying WLS shill, I still think many folks need to hear that the evidence really does support that long-term weight loss maintenance is quite unlikely, and that biological mechanisms are behind this, not weak willpower.