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Philip Welford

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Is diet and exercise a huge oversimplification of obesity? Do we need an unprejudiced reconsideration?

My partner of 35 years passed away in 2010 aged 53. When we met, she weighed around (126 lbs/56kgs). Following childbirth (two pregnancies) her weight doubled. She ate healthily; typically fruit, cereal and salad. This makes me consider obesity. Many people without a weight problem attribute virtually all obesity to blame, failure, but is it as blatantly simple as diet and exercise? If my partner hadn't had her problems I’d probably believe it.

If a diet worked we'd all be on it and there'd be no obesity. Dieting is self-imposed famine and we, as with many other animals, are equipped to cope with famine. We eventually recover what we lost.

People without a weight problem think they're in control but how do they know they've taken in enough to keep them going until their next food? We need reserves to obtain our next food, even to chew it.

Do we keep every bit of nutrition in what we eat, does some of it pass right through? Intake travels at a rate through the system. Does a quick rate mean less is absorbed than with a slow rate?

Do we store more fat for winter but with the comfort of central heating we don't use it? Has the rise in home heating paralleled the rise in obesity rates?

Is "junk food" an abstract imagination of something fat people eat in large quantities? People focus on fat people eating in public who fit the prejudice but don’t notice others eating as much, or more, who aren't fat.

Is it right to determine all fat people failures? Are there no fat scientists, doctors, or professors? Are they clever in every department except food intake?

Pregnancy hormones reorganise how the metabolism handles food to some extent, providing for the foetus. Are there female dieticians for whom weight has become significantly difficult to control following pregnancy?

Why are there families where just one child is fat and has been since infancy, but the others aren't even though they're all been raised with the same care?

Do other animals exercise on a recreational basis?

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  • Apr 9 2013: We should get real When something unique in the history of man happens, something new has happened.
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      Apr 9 2013: I agree with you George.
      it may have something to do, (if only in part)with the fact machines that do a lot of our physical labor for us.
  • Apr 9 2013: These are all extremely good questions. As far as calling all "fat people" failures I don't think that would be right. Obesity can stem from many things; hormones, genetics, stress, etc. It does not typically come from just one simple thing, like having a poor diet and not exercising (although these do play a role). It is entirely possible for people to change these things though, and therefore change their hormone levels, their gene expression, among many other things. Eating healthy is just the beginning, and quite a few people who "eat healthy" don't realize that they don't have a good grasp on what is healthy. Nutrition is a very complex and tricky subject. But eating healthy is not enough to overcome obesity. To lose weight there must be a caloric deficit and the best way to achieve this is by eating less and exercising (and when eating less, eating better as well..whole foods, nothing processed). Also many people think that cardio is the best way to lose weight so they ignore weight training, when, in fact, weight training can be one of the best things for your weight loss journey. Anyways..obesity is very complicated and there are many things that can lead to it, but there are also ways out of it.
    • Apr 9 2013: Thanks for your reply Alyssa. Please forgive me if I seem cynical, it's borne from years of experience and isn't in any way personal. I appreciate all comments, they stir my thoughts. : o) They actually illustrate the advice fat people receive, very well.
      Many obese people are aware of the value of nutrition and exercise, but it doesn't work for them as it does for Mr and Mrs Average.
      I have a friend who is a Uni professor, a well respected, no nonsense woman (she has a little red dragon on the dash of her car. A present from one of her offspring), still teaching in her 70s. She's had a problem with her weight since the birth of her 4th child nearly 40 years ago and even she has returned from her nutritionist frustrated and close to tears at the condescension. When people are sensible in their regime, some even more sensible than those without a problem, and it's failing, then they are often tacitly dismissed as self deluding liars.
      When we're ill we often don't want to eat but we are also lethargic with little or no energy and take to our beds. The short term diet is appreciated but the lethargy isn't. I suspect the two are both deliberately controlled by the metabolism and a similar thing happens with dieting, lowering our intake reduces the propensity to expend energy, not just physical movement but internal energy usage too.. A similar thing might be when people are lost in such places as the desert for days without supplies, they move in a slow measured, perhaps natural, innate conservatory way to make maximum use of stored energy supplies.
      As far as I'm aware no one has achieved permanent weight loss without continued low calorific intake or surgical intervention. There is much to be learned.
      • Apr 10 2013: When talking about nutrition, a diet may do some good in the beginning; but if the person goes off the diet and resumes their original ways then the diet was useless. It is the lifestyle change, the permanent change that will induce the results. Are you talking about illness in other regards, like thyroid issues, etc?
        • Apr 10 2013: My experiences are that if you don't fit the average biological pattern, then, whether nicely or nastily put (my wife had both), you are a failure and, or, a liar. 35 years is a long time to study a person and I hope I've demonstrated with this conversation and my replies so far that I have some logic and awareness.
          She had the full battery of blood and endocrine tests and nothing was found to be wrong. Ergo she was at fault. She was put on three regimes over the years. A food replacement diet, a fat busting drug then an anti addiction drug (now withdrawn in the Europe). In other words, "We don't believe you."

          I suspect that if we go on a long term weight loss regime the body goes into a scavenging mode because it thinks it's in famine. Unless you continue in a low intake mode you will recover losses but for some that mode is so low it's an intolerable lifestyle.
          If you lose a limb or a sense, such as sight, you have no choice but to adapt. With weight you have to fake your own disability and for most it becomes an impossible task.
          I can understand anyone within the average body range looking for, at worst a blame factor, at best a contributory factor, but my observations and considerations have led me beyond that, hence my wondering if there are any qualified dieticians, especially female, who've found considerable difficulty with their body mass that they didn't always have.
          :o)
  • Apr 23 2013: Yes, Philip, religating the cause - and solution - to obesity to diet and exercise is an over simplification. Breakthrough work has been accomplished, and continues to provide new answers, in an unlikely place: reality television! The Biggest Looser has challenged, changed, and refined the way obesity is being treated and cured today. It is amazing! The "contestants" run the gamut from life-long beriatrics in their 20's, to previous athletes now obese, to yes: plenty of mothers and grandmothers who didn't put on weight until having children. And each has their unique treatment plan but each includes a similar diet and exercise regimen. The previous references to the animal kingdom are appropriate, as function-limiting obesity isn't tolerated in the wild. A person MUST FIGHT with an animal intensity for their life, if they are to beat this disorder. But the fact that humans can get away with carying twice their ideal weight is both a BLESSING and a CURSE. It means we live with choice. Make healthy weight a life or death fight to obtain, or rather spend your time working on something that MEANS MORE! It shouldn't be for society to judge that person's focus. But we should all be honest enough to know ourselves, and allow each other to have a unique focus. To say we don't have all the answers is true, but more accurate is we don't like the answers we have.
  • Apr 18 2013: Firstly, genetic traits can certainly have an effect on body type, just as much as they can determine height or mass. Some people have more lean muscle, and it's safe to assume that genetic variability can lead also to increased fat stores, or lack thereof.

    But obesity, which is carrying an excess amount of weight to the point of being a danger to overall health, is not possibly genetic. From a purely scientific standpoint, it takes 40,000 + years for a species to exhibit changes from genetic selection. This would mean that for a gene to cause obesity, humans would have to be living, breeding, and surviving as obese species for conservatively 40,000 years. We all know this is not the case. This epidemic of obesity we have has occurred completely within the last 50 years.

    Our diets (in countries affected by obesity) have become increasingly animal based. Our calories have become increasingly easy to consume. Western nations have the highest caloric availability on the planet, and we work little to obtain the calories. These developments also occurred in relatively recent history - maybe the last 150 years at most - and again we arrive at obesity epidemic.

    Furthermore, research into cancer and autoimmune diseases, many of which are still considered inherited, has shown that through proper diet and exercise and meaningful living genetics actually account for only 1-3% of "inherited" or "genetic" disease.

    Genetics, in effect, may lay a foundation. You may have genes that predispose you to putting on weight easily, or genes that allow you to eat as you wish and not notice much weight gain. But eventually, with age and accumulation of dietary and lifestyle effects, what you build on that foundation is going to be of your own making. Proper diet, which is a plant based diet low in animal product and fats, is the best way to develop health - weight related or otherwise.
    • Apr 19 2013: Your reply underlines the reasoning behind my question: fat people are the authors of their own condition.
      You say "genetic variability can lead also to increased fat stores" but then you say ". obesity is not possibly genetic".
      We have an automatic capacity to estimate what our needs will be, how much we need to store to keep the metabolism going until the next food. This forecast might not be constant, e.g. it may vary with seasons. We may not hibernate in winter but that doesn't mean we haven't got an innate awareness that changes either the intake or what we absorb from intake , storing more energy to cope with cold or reduced supplies.
      Full home heating, especially in winter, has paralleled the obesity rise for over 50 years too.
      Some pregnancy hormones (HPL)
      http://en.wikipedia.org/wiki/Human_placental_lactogen
      change the absorption metabolism to provide for the growing infant. There is no need to "eat for two".
      If it's all down to calories why are there variations in children in the same family observable from infancy even thought they've all been raised the same?
      We don't absorb every calorie from what we take in. It varies.
      http://www.bmj.com/rapid-response/2011/10/31/unabsorbed-calories-important-consideration
      We have an automatic control that caters for what the body thinks its mass should be.
      If that mass setting is higher, reducing weight becomes extremely difficult, needing either permanent starvation or ridiculous amounts of exercise, or both.
      I can understand people who are within the average seeing obesity as self authored if they don't have personal "live in" experience of someone obese, (in my case a partner) who they know tries.
      There is much to be discovered.
  • Apr 12 2013: You are right Philip - It is a difficult problem.
  • Apr 10 2013: When it comes to overall health there are many factors involved and it is almost impossible to account for all of them. When it comes to obesity, many people focus on the diet and exercise but seem to leave out another important role: genetics. While a person such as your partner (my condolences) may eat well and exercise regularly, genetics may still be against them. Genetics plays a role in basal metabolism, your bodies fat percentage, and a wide range of other systems in the body. A healthy lifestyle can offset the adverse effects of bad genetics but it will never be able fully cancel them out. When it comes to diet, studies have shown that this is less important than overall exercise. While it is true that you should eat more nutrient dense foods, have a good variety of foods, and consume less sugar and saturated fats, if you do not exercise your body will simply not utilize the nutrients and calories as it is intended to. With modern technology making convenience a main priority in our lifestyles (similar to your example on central heating) it allows us to get by with less exercise. Less exercise means we do not need to consume as much but the convenience factor has made this nearly impossible as food is almost always readily available to us. This leads to the storage of excess nutrients which is the natural reaction of our body handed to us by our ancestors who never knew when their next meal would be (genetics). For this reason, exercise plays a central role in boosting the metabolism and reducing the amount available for storage. Other animals spend practically their entire lives in a state of exercise because they need to go out and work for their food unlike us.
    As far as determining all fat people to be failures, this concept needs to be struck down immediately. People, regardless of weight, all have certain things in their lives with which they have trouble controlling or simply have no control over. Failure cannot be determined by a number on a scale.
    • Apr 11 2013: My partner's doc said, "It's just the luck of the draw in the gene pool." but that doesn't explain why her weight doubled following childbirth. She wasn't obese before that and she wasn't on her own. The internet is littered with threads from women who have a similar problem.
      Your contribution has prompted the thought, "Do we eat to replace energy we used yesterday or are we estimating what we'll need tomorrow?"
      We may live in modern societies but we aren't removed from nature. Evolution travels at a hugely slower rate than civilisation.
      Why do animals, especially those that hibernate, prepare for hibernation? Why do other animals that don't hibernate grow thicker winter coats? What prompts it? This is what makes me think we are also seasonal and we naturally prepare for what is to come.

      As an aside, I recently thought about the "munchies", where we have days when we have the urge to eat bits of all sorts of foods. Is it because we are short of a particular component, e.g. a vitamin? The brain or body doesn't know what food contains what, so it makes use consume various foods until the right food with the right component is eaten.

      Thanks Paul.
      p.s. I know the munchies is associated with cannabis but I don't use it lol
  • Apr 10 2013: I got up over 300 pounds at one time. I've had two doctors with different attitudes on causes. A great deal of fiber can help. there are other things. Personally I accept cut out the sugar and salt. Also, I was convinced that stress influences the functionning of your thyroid. The thyroid can play a big part, but one of my Doc's was doubtful.
    • Apr 10 2013: If the docs aren't sure then what chance do we mere mortals have?
      Interesting point though. Does stress cause obesity or does obesity cause stress. I might do a Rip van Winkle sleep on that.
      We seem to know so little about what controls our nutritional needs. Even the experts argue.
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        Apr 10 2013: Stress is very harmful to health and stress that's left unchecked can contribute to health problems such as high blood pressure, heart disease, obesity, diabetes, and other health issues. It has been proven the unmanaged stress will shorten your life span.

        Not only can depression/anxiety/stress directly cause weight gain, they can cause weight gain indirectly via decrease activity and as a side effect to many of the medications use to treat those conditions.

        P.S.
        "Does stress cause obesity or does obesity cause stress."
        I think that likely varies per person, but ether way they do build upon each other.
        More stress leads to more weight gain, more weight gain leads to more stress, In a hard to end cycle.
        • Apr 10 2013: My main interest is postpartum weight retention/gain. Also the relationship between postpartum weight and postpartum depression/anxiety. A few studies have been carried out but none have produced a definite result. e.g.
          http://www.biomedcentral.com/1471-2458/10/766
          My interest has only been aroused by personal experience. I'm not involved medicine at all.It may be better that way because then I'm not clouded by the mainstream. It has taken me 20 years of on/off consideration to get this far.
          All replies on this topic are valuable because they spur further thought and I appreciate them all.
      • Apr 11 2013: Yes Philip it makes me uncomfortable too. Maybe this is why it is so hard to lose weight. Losing weight doesn't seem to work really well and produce happy campers.
        • Apr 11 2013: It disheartens people when they know they try so hard with their weight but are not believed.
          Admittedly there are some with eating disorders, they aren't common, but people seize on them as an example of naturally obese people. They fit the picture/prejudice.
          We all have a homeostasis, (natural ambient body settings), and the body tries to maintain those settings. If things go off course, action is taken to restore the balance. Restricting intake is wandering off course and slowing energy expenditure is one way of counteracting it. Perhaps that includes slowing down the digestive system, going into a scavenging mode extracting more from our intake than we might normally do.
          As I've said in another reply, when we're ill and not eating we are often lethargic too and take to our beds. The system causes both deliberately. One is not a temporary boon and the other just a nuisance.
          Good luck with your efforts George.
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    Apr 9 2013: How do you explain your partner becoming fat when she was eating healthily? Did something else change from the time she weighed less?

    If central heating did away with the need to store fat, I would think we would adjust and not store as much fat.

    I don't think animals exercise recreationally, but probably get a lot of exercise hunting, scavenging, etc. Also maybe don't get much to eat.
    • Apr 9 2013: She got pregnant twice. No one knows why women have weight (and depression/anxiety problems). Something changed in her metabolism. One problem might be the people looking for the cause are those dealing with the symptoms. The best study I've found is here.
      http://www.ncbi.nlm.nih.gov/pubmed/14634683
      Evolution doesn't plan. It has conquered the seas, the earth, the skies and even under the earth to some extent without any planning or calculations. Admittedly it's taken a long time with a lot of failures but it's had the time and resources. I doubt it's taken account of any man made developments.

      From what I've seen of wildlife documentaries it doesn't seem many of the greater animals spend more time hunting than relaxing once they've caught and eaten prey.

      As far as getting enough to eat, I said in the question, "We and many other animals are equipped to cope with a fair amount of famine and we recover from it when times are better.
      Would dogs chase balls and sticks if man wasn't there to throw them in the first place?
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    Apr 9 2013: Besides legit heath issues being a good reason for us not to judge a book by its cover.
    I have to say that there is nothing simple about diet and exercise.

    I’m a strong believe in that everyone needs to create their own custom diet based on their own unique heath needs, taste and a diet that they can stay with for life. I know first-hand that diet can boost or reduce the effectiveness of medications. Also we should not rely on diet and/or exercise alone to treat a lot of health issues, neither is it just a matter of willpower.

    So even discount health issues, the standard diet and exercise often does not work because we are all unique.
  • Apr 9 2013: First, If a nutritionist is condescending to clients, the nutritionist should find a different line of work.

    Viewing the big picture, it is really no surprise that we have an obesity epidemic in the USA. It is the combination of modern foods and modern lifestyles. Evolution prepared us for scarcity, not abundance. The picture from an individual point of view is very different.

    I have not been critical of overweight people for many years, because I learned the same lessons that you did. Weight gain and loss is very complicated. After her second pregnancy my wife would eat almost nothing, and she would still not lose weight. I cannot imagine how this occurred, because her daily activities were normal and she had to be burning more calories than she was eating. Her doctor was as stumped as we were. This is in stark contrast to my personal experience. I can still fit into suits I bought twenty years ago, and pastries have been a big part of my diet. I have never had a weight problem, spent my life sitting in front of computers, and have never had an exercise routine. I take no credit for this, I am just lucky to be born this way. (I will take a little credit, I have practically given up ice cream, one of my favorite snacks, and I miss it.)

    I know that many professionals just go with what they were taught, and do not really view their patients as individuals. Many assume that if a person is not losing weight according to the plan, then the person is cheating and eating more snacks than reported. The means for measuring caloric input and output during daily life is still very crude.

    I suspect that the answers we need will be difficult to find. I think most of the research in this area is devoted to finding a miracle pill that will allow us to eat all we want and remain slim, providing profits aplenty.

    So my answer is yes, that the whole issue of weight is grossly oversimplified.
    • Apr 9 2013: Same here Barry. I'm made of pies and nicotine, although I don't drink, not a choice, alcohol tried to escape the same way it got in so I never got into the habit.
      My wife's problems started after the first birth and became worse with the the second. She was given all the endocrine tests and because nothing showed she was put on a strict diet of 3 fortified drinks a day. All she was allowed to drink was water or black coffee. She stuck to what she was told, she always did, and did lose weight but how long can you force yourself to live like that? She eventually sorted her weight herself for a while, calorie counting, 800 to 1,000 cals a day. She wrote down everything she ate or drank, even for the milk in her cups of tea. Took her a year. When she relaxed the diet she rapidly regained the weight. I remember doing the sums at the time and worked out she regained weight if she stepped over 1,200 cals per day. Funny how today's bariatric surgeons aim for 1,200-1,400 cals intake. She did it again some years later with the same result. Eventually she gave up trying.
      I've searched on the internet for years and nearly all help for post pregnancy weight retention is, "Persevere, eat lettuce for the next 20 years, run 5 miles a day and you will see a difference." Is my cynicism showing?"
      As for medical professionals my experience has been, "If you haven't been to medical school you don't know anything so just follow professional advice."
      I'm normally easy going but I've kicked off a few times with people who see a fat person and say, "Why do people let themself get like that?"

      Thanks for replying.
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    Apr 9 2013: Hi Philip,

    Thank you for bringing up this topic, this is something that I have been debating with myself about more than a few times but have not been able to articulate here. I think many people ought to ask themselves those same questions you raised when they judge others. It has unfortunately come to fact that overweight people are robotically labeled as malfunctioning elements of society. There is (as you mentioned) a lot more than meets the eye: good nutrition is expensive; genetics are at play; illnesses also cause weight issues. Weight and appearance do not define a person, as you cannot judge a book by its cover.

    Thanks,
    /S