Results not typical: Evidence based weight loss

Comments

20 responses to “Results not typical: Evidence based weight loss”

1. 

   January 28, 2008

   Andrea

   Ahh – interesting, dissapointing but not unexpected that advice for diabetics has not changed in the last 10 years.
   I too listened to what the “experts” said, then tested on myself to work out what I could *actually* eat and what it did to me, and then got better on my own diet (until the coeliac and sleep apnea attacked).
   I’m back on diabetic drugs now (after 8 years off them), but not quite so disciplined this time 🙁

   Interesting, and not unexpected, that your scientific experiments have yielded the same results as mine 8-9 years ago.
   I still consider fruit juice an evil – but try vegie juice – carrot, celery, beetroot and a touch of apple – if you want something other than just water.

   In around 20 years of searching I’ve not yet found a dietician who actually helped me – they all seem to have such pre-conceived ideas. The last one didn’t even ask why I’d come to see him, just launched into weight-loss diet advice while suggesting rye instead of wheat products. Um, no.
2. 

   January 28, 2008

   Laura Thomson

   Hey Andrew,

   A thoughtful entry. I wish you all the best on your journey.
3. 

   February 2, 2008

   Does this… disturb you?

   The following exchange between a Western Interviewer (WI) and a Ukranian Peasant (UP) provides some insight which you may be able to adapt to weight loss issues:

   WI: All bears are white where there is always snow; in Novaya Zemlar there is always snow; what colour are the bears there?

   UP: I have seen only black bears, and I do not talk of what I have not seen.

   WI: But what do my words imply?

   UP: If a person has not been there he cannot say anything to me on the basis of words. If a man was 60 or 80 and had seen a white bear there and told me about it, he could be believed.
4. 

   February 2, 2008

   A Big Loser

   I have to disagree with you re the eat less, exercise more comment. As you know, Nodster, in early 2004 we all hit Weight Watchers. I hit my goal weight (lose 32 kg) in 29 weeks. For two years it stayed off.

   Xmas 2006 was a time of much joy, as I had finally escaped the asylum (aka University of Melbourne) and I gained 8kg in the following months, which has stuck there for the last 13 months, mainly because of me being too lazy to “eat less (crap), exercise more”. So far this year, I am down 2kg for January — 25% of the way back to goal weight. At this rate, I’ll be back to goal by my birthday (and FYI, I am not a machine, although I have been called “Potentially Highly Dangerous” and there is a rumour that I have webbed feet).

   I figure it’s a pretty simple equation (admittedly, fluctuating sugar/insulin levels complicates the model a bit, but, AIUI, not to the point that the model fails. For a man of your intellect, a mere piffle, a bagatelle): you burn a certain amount of energy during the day, X kJ. If you eat >X kJ in a day, the excess is stored as fat. If you eat X, then you can increase the value of X by increasing exercise.

   It’s how you arrive at X which is the interesting part.

   Wingco
5. 

   February 3, 2008

   vanderaj

   Paul,

   I think you missed my essential point.

   Eat less, exercise more fails 90%+ of the time. It works for a time, and then it fails, usually with a weight gain over and above the original weight. This is notoriously true.

   For example, when we started WW in 2004, I started at 136, had some initial success – down to 131 kg at one point, and then I platuead for about two months. I gave up in disgust, and between then and now I re-gained that five kg and … another 20 kg on top of that.

   For a closer example, it FAILED FOR YOU. You are the most zealous and therefore successful dieter I know of. You are literally a WW poster boy – with the story in the Father’s Day issue of the WW magazine. And yet YOU re-gained weight. If “eat less, exercise more” worked, you would have not gained that 8 kg. It’s only because you are truly exceptional at keeping the weight off that you have managed to lose it again before it becomes a health issue.

   The mechanism – eat less and exercise more works as a weight loss mechanism, but alone it’s a terrible weight management strategy. Coupled with ineffective nutrition advice – if I ate the standard food pyramid, I would be facing certain insulin dependent diabetes, it has FAILED.

   We need to do more research into methods which work, and stay working once normal healthy weights are achieved.

   If you had a drug that cured say 10% of the folks, and harmed 90%, it would not be on the market. I am in that situation right now. I have less than five years to get my weight under control, or I will always be type 2 diabetic with permanent (and life shortening) symptoms. My “drug” or prescription is to get healthy and quickly, and stay that way. I don’t have a pill to pop, just advice, and yet the advice SIMPLY DOES NOT WORK LONG TERM FOR 90% of folks. If I get to say 85 kg, and then regain the weight in three-five years, I will still be diabetic, and the health risks are there. I can’t risk that.

   I do not deny that a permanent diet change and exercise regime are part of that solution, but the current nutrition advice is clearly long term ineffectual in the midst of the worst obesity epidemic the planet has ever faced.

   The science behind the advice needs to be properly assessed as to what works in double blind trials, and for advice which clearly harmful long term has to be stopped. That was the point of my blog entry, not that WW suxxors for me.

   Here in the USA, there is another issue which is above just the weight loss issue – the mainline food supply is tainted and causes people to get fat. I gained 15 kg in five months after moving here with no real change to the way I ate. There will have to regulatory action to eliminate the unrelenting use of HFCS, and all forms of sugars, sugary starches, and sugar alcohols in surprising foods (like sugar in bread – WTF?). They weren’t there prior to 1970, and they shouldn’t be there today. That’s easy to avoid when you don’t eat processed food, but it’s actually really hard to do that here. But that is besides the point – the medical community should be ashamed of themselves to give paternalistic crap advice which causes harm. There has to be a better alternative, and only properly controlled trials coupled with prohibitions on repeating false assertions once it is established that the old regime really is deadly.
6. 

   February 3, 2008

   vanderaj

   p.s I made it to 149.5 kg today. This is a milestone for me. It’s the first time I’ve been under 150 kg since early last year, and it’s 8 kg less than my top weight of 157.5 kg in May.

   I did it by changing to the CSIRO diet, initially exercising a few times a week, but trying to stick to it during the birth of our baby, Christmas, parties, New Year’s, and the in laws here (so we ate out a bit). I hurt my foot badly in late December, but it’s nearly painless enough to let me go back to the gym.

   8 kg is equal the greatest amount of weight I’ve ever lost on WW – back when I was 21 in the early 1990’s. The diet with the biggest loss for me was Atkins with 15 kg. I hope to beat that soon.

   i like the CSIRO diet. It’s basically a slightly modified normal diet with a lot more protein and less processed foods. It’s working without exercise right now, it’s good at keeping my blood sugars under control, and it’s not hard to keep on the straight and narrow.
7. 

   February 3, 2008

   A Big Loser

   You wrote:

   And yet YOU re-gained weight. If “eat less, exercise more” worked, you would have not gained that 8 kg.

   I reply:

   In the period that I regained that weight, I was not following the “eat less, exercise more” regime. This is precisely why I regained that weight. (There are a number of reasons why I was not following it, none of which are particularly germaine to this dicussion).

   FWIW, I found that the CSIRO diet did not work for me. I maintained weight on it, but did not lose. Interesting.

   Wingco

   Since the start of the year, I went back to “eat less, exercise more” and I’ve dropped 2kg.
8. 

   February 3, 2008

   A Big Loser

   You wrote:

   The science behind the advice needs to be properly assessed as to what works in double blind trials, and for advice which clearly harmful long term has to be stopped. That was the point of my blog entry, not that WW suxxors for me.

   I reply:

   I missed that in the initial reading of your comment! I’m curious: where did you get this statistic: “Eat less, exercise more fails 90%+ of the time.”

   I’m in vigorous agreement with you that yo-yo weight is bad, but curious about the underlying statistic used to quantify your argument.

   BTW, congrats on the loss of 8kg. Well done!

   Wingco
9. 

   February 4, 2008

   Jacques Kosky

   Hi Noddy
   Will send a longer post after i re-read your blog but in the meantime have a look at Dr Mary Vernon and her approach to diabeties. Very radical, very different from what diabeties organisations tell you to do but (according to some) she has had good results. In short (by memory) she proposes a high fat low carb approach. Have a look and tell me what you think.
10. 

    February 5, 2008

    Inger

    It’s hard dude – there’s no two ways about it.

    Good on you for losing 8kg!

    Your posts have made me reflect on my own ‘journey’. I got 25kg off the first time at WW…ONLY because I was rigourous like Paul can be – it was totally a mind/control thing. BUT I have never been able to regain that rigour, I’m not sure why. At least I feel like I am not out of control. This is because of a few little WW tips that have helped me make some permanent diet changes: low fat diary products, reading and understanding food labels, knowing the ‘sneaky fats’ that are in takeaway foods, eating mostly unprocessed food…

    I am back at weekly WW meetings and it is gradually coming off again (5 kg since October). It’s agonisingly slow…and you are absolutely right that it is a personal thing finding what works for you. For me there’s two main reasons I gain weight: 1) excess carbs/portion size and 2) ‘treats’. As J says – a little bit of bad undoes a whole lot of good.

    I still recommend you listen to that health report podcast on insulin resistance. The best thing about it is that it explain why when you are overweight you feel hungrier than skinny people, esp if your weight is combined with liver malfunction. It’s not that you lack of control – you really feel hungrier because your brain has stopped having the capacity to read the ‘I’m full’ signals correctly. Eventually good food choices and exercise will work and get your brain chemistry back in balance: exercise is your best chance at turning around the chemical imbalance caused by the deadly sugars you have been eating. Increased muscle mass ‘turns on’ the right signals. Right now your brain thinks it needs the quick fix of sugar – but at least you are now feeding it with oatmeal instead of muffins! Keep going and have faith. The first 30kg are going to be really tough, but you will get there.

    For the record, my sister in law’s mother was hugely fat and got a lap band done. She’s lost HEAPS of weight and reckons she couldn’t have done it without the surgery. My view is – what ever gets you through the night. I admire your persistence, but if you have to have surgery it might be the best thing you ever do.
11. 

    February 5, 2008

    vanderaj

    Paul,

    This meta-study looked at 31 other long term studies (those over 4 years) to ask the question “Do diets work?”. They find that they don’t.

    
    The prevalence of obesity and its associated health problems have increased sharply in the past 2 decades. New revisions to Medicare policy will allow funding for obesity treatments of proven efficacy. The authors review studies of the long-term outcomes of calorie-restricting diets to assess whether dieting is an effective treatment for obesity. These studies show that one third to two thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance. In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.
    
    From Diets Don’t Work, Mann et al which appeared as a peer reviewed paper in the American Psychologist, the journal of the American Psychological Association.

    This paper is even more grim than I knew.

    I found a lot of references to weight regain, but this image shows the sad story. Graphs like this are in most of the field’s research (a key author is Wadden, but do as many searches as you like in Google Scholar):

    

    Although this is a short term graph, with a modest reduction in BMI after a few months (and btw, I’m already past that initial reduction), what do you notice? Every single subject has put weight back on. I’m struggling to find a peer reviewed study with the 90% figure, but so far, I’ve not seen a graph with less than 100% of people have failed to maintain their original goal weight.

    In pretty much every paper in which a leading researcher in that field (Wadden), they find that over time, 50% of successful dieters from the National Register of Weightloss will regain their original baseline weight in five years. So out of say Inger, yourself, and Jacques – all of whom have made goal at WW, one and a half Jacques will regain their weight, or the more likely scenario, you all put a bit back on over those five years.

    I don’t really have that luxury. Diabetes is a manageable condition, and it can be on the low end if managed correctly. What I want is simple: a proven long term way of getting down to a healthy weight and staying there. From the research I’ve read tonight, it turns out the only effective long term solution is to take “fortitude” out of our collective control and do bariatric surgery. That’s pretty depressing. I won’t go down that path just yet as I’m not convinced I have tried hard enough (that fortitude question) to lose the weight in other ways. What I really need though is a list of things that worked well for others who also kept the weight off in a repeatable and maintainable fashion, and for that population to be > 10% of the folks who tried that path.

    Such proof does not exist today. Otherwise, all those programs, fat farms, and diet books (CSIRO book included) would not exist.
12. 

    February 5, 2008

    A Big Loser

    Hey Noddy,

    I hate to be nitpicky (but I will be):

    1. You’ve quoted a paper which shows 33-66% of dieters regain their weight. You’ve also said that you’re struggling to find a paper which supports your 90% assertion in the blog post/earlier comments. Yet, your last par in Comment #11 *still* harks back to the 90% figure. Screams of tabloid sensationalism.

    2. I find the chart you’ve included to be useless. What do the legends represent? “BMI CH, P” does not mean much to me. Are these individuals, samples, what? Additionally, I notice that “BMI, CL GT” does trend down over time, so what is this chart really trying to say?

    3. So you want a list of what worked for me:
    a) low-fat diary
    b) tracking points by writing the bastards down
    c) make my lunch for work
    d) if I get the muchies, go for a salad sandwich/roll. Filling, and only a couple of points
    e) If I am standing in the food court with a milkshake in one hand and a bowl of chocolate frosted sugar bombs in the other, put them down and apply d) above
    f) do not be frightened about throwing away crap food. One time I succumbed, bought a rum ball from a certain Greek cake store on Lonsdale St, took one bite, thought, “Naah”, and turfed it. Another time I gave some Frankenstein food to a homeless guy.
    g) Avoid Loui & Franko’s as much as possible, despite child pressure.
    h) Walk/take stairs/when walking to a colleague’s desk take the scenic route. Do that 5 times a day, add 20 metres to your walk, and you included 100m of walking into your daily routine, or 1 km a fortnight.

    You should at least be able to manage g). 😉

    Wingco
13. 

    February 5, 2008

    Inger

    I agree with you – surgery may be your best option. It’s certainly better than the alternative.

    After reading all this discussion b/w you and Paul it really got me thinking again about losing weight. Consider this: there is a certain amount of grieving that you have to do when leaving behind your former (hedonistic) lifestyle and embracing a totally new one – for life.

    Reading back over the tone of your comments it sounds like you are, at times, bitter and frustrated about the whole thing. You might want to consider that you are progressing through aspects of the four stages of grief:

    1. Denial (you are over this one – things have to change)

    2. Anger (you seem to be still feeling a bit of this: ‘why me?’)

    3. Bargaining (perhaps your measuring of sugar levels to see what you can ‘get away with’ is a form of this?)

    and

    4. Acceptance

    In my experience it takes quite awhile to get to 4, and the stages are not so clear cut or even necessarily sequential.

    I know you are resistant to thinking that the problem is in your head as well as the world, but in my experience that is where the real battle lies.

    i
14. 

    February 5, 2008

    Jacques Kosky

    Tell me when that one and a half Jacques shows up and i will bitchslap the weight off the tubby dwarf. 🙂

    There is one subtle (but very important) distinction to be made here. I am not , have never been, and will never be a dieter (or a communist). Never tried a diet prior to WW and will not post WW.

    My approach is to change my lifestyle to a mode where weight gain will not happen or at least not happen to a great extent. This is my philosophy/approach.

    My body and health, taking a long term view here, cannot sustain a lifestyle of constantly eating foods that have negative effects in terms of calories and health issues like diabeties . Sure I sin/fall from grace/f*ckup occasionally but there are blips rather than a fundamental facet of my food intake.

    In my mind the party is over and I have to deal with the hangover (which in my case occurs at my belt line).

    I lived a lifestyle for years of ‘bad’ food but have realised that I cannot afford it anymore or long term. As far as i am concerned I explored gluttony, it was great fun but like all spending sprees unsustainable.

    Calories are karma. I allow myself some ‘bad’ foods but it is within a budget I allow myself. It is controlled.
    I view my health in the same way I view my credit card. I can overdraw on the odd occasion but ultimately it has to be paid for and I need to keep within my health budget.

    The stomach band surgery may offer temporary relief.
    My ex Andrea has had the stomach surgery and it was temporarily successful. It did, short term, allow her to lose weight. It does not stop her from grazing all day (perhaps chef/cook was not the wisest career choice), or from making bad food choices. A packet of chips eaten in increments is no different from a packet of chips eaten in one sitting.

    By sheer coincidence she rang me this morning to ask if i would lend her my WW point books because she has put on 8K.

    If a person wanting to lose weight, quit smoking drinking or whatever does not make fundamental shifts in their thinking then all approaches will fail as they will be internally viewed as temporary, as an blip rather than a fundamental shift. This may sound very hardcore but it is what I believe and so far it has worked for me in terms of weight loss and finances and a host of other facets in my life. This isnt (AFAIAC) for now or any finite time period, for me this is me and this is forever or at least as long as I am on this ball o dust.
15. 

    February 5, 2008

    vanderaj

    Inger,

    I am definitely in the acceptance area. There’s no point in being angry, except with well meaning folks like my nutritionist who trot out the same old same old load of horse pucky.

    I’ve been doing some more experiments, and it turns out my morning blood sugars are way better when I do a bit of physical exercise the night before. That probably means the best time for me to do my exercise is just before the gym closes.

    The real problem whilst I’ve been reviewing all these papers is the simple lack of evidence for any conclusion. I think there’s a real reluctance to publish work which is contrary to the low fat / high GL carb food pyramid.

    The NWCR results are self-selected from successful dieters. The key factor there is only exercise. Diet had no bearing on their success at maintaining their weight at healthy levels. This large set of studies is not really going to help me to get to a particular weight, but does give clues as to what’s really required after getting there.

    Most of the studies have really small sample sizes (less than 70 is pretty typical), and they often focus on women who have little to lose (by my standards).

    The folks who do the research into diets have only recently moved away from extremely low calorie (< 1500 cal / day) diets. I can't do those diets as my blood sugars would crash, and I would be in hospital. I am not in a position to do research on anyone but myself. It seems easy to me to conduct studies based upon controls, folks who do a diet one way, and then another and see which works out over a long period of time, with different sexes and different amounts to lose. The CSIRO folks did some of this, but they used small sample sizes, and more than half their studies use women with little to lose, and didn't follow them for long. This is absolutely typical of this area of research. They need to follow more folks, for longer. But it's really hard. I know I do better when I write down everything, but I don't do that all the time with my bloods let alone my food. This is what I'd like to see: a) a quick and reliable test to see which dieting path you need to follow for the rest of your days. Not so much as in calorie restriction but as in, keep to these food groups, and you'll do best. As Paul mentioned, the CSIRO diet didn't work for him, whereas the WW one did. I notice when I do points for my CSIRO diet days, I'm always under my points score, so maybe they can co-exist. b) Exercise paths which are reliable for people. I've had lots of different advice over the last few months as to what will help me lose weight, from cardio to doing 130 bpm (when I was on a beta blocker that physically wouldn't allow my heart to get 130 bpm no matter how much I tried) to doing only weights. There needs to be some advice we can all follow. I've found that walking does me good, so I'll do that for a while. c) ??? Part One The next unknown bit that allows the weight to continue to fall off for 100% of folks if they stick to it. I don't think there's one answer here, but the official One True Way is not it, that's for sure. d) ??? Part Two The last unknown that allows weight to stay off once a healthy weight is obtained, and stay that way ... again for as close to 100% of folks once they hit it. I can't lose say 50 kg this time, and gain it back - it will kill me. This bit does not exist today, and it's the key missing ingredient in the voodoo that is nutrition science today. Lastly, Paul, the study I quoted from is the only study which tries to answer my questions. The study says:
    In sum, across these studies, there is not strong evidence for the efficacy of diets in leading to long-term weight loss. In two of the studies, there was not a significant difference between the amount of weight loss maintained by participants assigned to the diet conditions and those assigned to the control conditions. In the three studies that did find significant differences, the differences were quite small. The amount of weight loss maintained in the diet conditions of these studies averaged 1.1 kg (2.4 lb), ranging from a 4.7-kg (10.4-lb) loss to a 1.6-kg (3.5-lb) gain. Participants in the control groups averaged weight gains of 0.6 kg (1.3 lb; ranging from losses of 0.9 kg [1.9 lb] to gains of up to 1.8 kg [3.9 lb]). The most positive conclusion is that dieting slows the slight weight gain that occurs with age among the average nondieter, and even this slight weight gain was not seen in all of the no-diet control groups. It is hard to call these obesity treatments effective when participants maintain such a small weight loss. Clearly, these participants remain obese.

    So essentially, for this meta study, which looked at 31 other studies, none of the participants lost the sort of weight I need to. The diets were 100% ineffective for my weight loss. The NWCR stats you quote are from successful dieters like yourself who found the magic equation that worked for you. The NWCR has only around 4000 participants in a country of 300 million, of which over 50% of the population is considered obese. Even considering that NWCR is self-selecting (you have to know about it to join and only after you have lost a lot of weight and kept it off for a year), that is failure on a grand scale. There should be a lot more folks in the NWCR if known methods worked today.

    We need more research before the rest of the world catches up.
16. 

    February 6, 2008

    Monstar

    Hi Nodstar,

    I’ve certainly enjoyed reading your posts & thought I would add a comment:

    When Kev was diagnosed with Crohn’s disease the recommended western diet was to eat anything you want, and we’ll control it with with drugs, namely steroids. After plumeting down to 60 kgs and hallucinating under the drugs, it took a visit to Rama:

    http://www.naturaltherapypages.com.au/therapist/2429

    The diet works for Kev as he knows what happens if he strays – a lot of pain!!! (My favourite stir fry with egg plant wasn’t a good idea:) )
    Without the pain effects it’s always simple to grab a quick and simple meal on the way home, and change a lifetime of eating the wrong thing.

    Might be another option worth investigating before choosing an operation.

    Monz
17. 

    February 7, 2008

    A Big Loser

    Hey Noddy,

    I’m not quoting any stats (other than those provided by you), so I’m a bit confused by your last comment.

    I’d still like two things please:

    1. A source for your 90%+ failure rate;
    2. An explanation of the graph in the earlier comment.

    Especially once I get 2., I’ll be in a position to offer more constructive comments.

    Wingco
18. 

    February 19, 2008

    A Big Loser

    Hey Noddy, you might find the first few letters in today’s Age interesting reading, along with some sources (hope the URL comes through everything OK):

    http://www.theage.com.au/news/letters/obesity-answer-is-in-the-food-that-we-eat/2008/02/19/1203190818980.html?page=fullpage#contentSwap1
19. 

    February 21, 2008

    A Big Loser

    Hey Noddy, Further to the letters debate, here is a thoughtful contribution to the debate on the Age’s Opinion page today:

    http: //www.theage.com.au/news/opinion/curbing-the-obesity-epidemic/2008/02/21/1203467280758.html?page=fullpage#contentSwap1

    Wingco
20. 

    February 26, 2008

    Brother Marcus

    I have it. I read recently that Buddhists never eat to capacity, always keeping a small element of hunger in their stomachs so that they never forget the starving people in the world.

    Become a Buddhist.

    Br Marcus
    Church of Surfing Anarchists