Actually, you do need to make dreastic changes
March 3, 2010 3:38 PM Subscribe
Small changes to caloric intake and lifestyle that don't lead to serious changes result in small improvements in weight and health that don't lead to serious (or even ongoing) improvement.
Michelle Obama is championing a "small changes make a difference" approach to childhood obesity. You don't need to reassess your lifestyle, habits, or ways you go about your life. The little gestures you make around the edges "add up".
The thing is, they don't.
The human body is not a bunsen burner. It is an adaptive bio-mechanical organism that responds to it's environment & inputs in a much more complex way than "a pound of fat is 3,500 calories", including a significant genetic component. The general weight range ones body strives to stay within, known as the set point that takes significant effort to overcome. [Previously]
In order to see significant, lasting results, significant, lasting changes are required.
Michelle Obama is championing a "small changes make a difference" approach to childhood obesity. You don't need to reassess your lifestyle, habits, or ways you go about your life. The little gestures you make around the edges "add up".
The thing is, they don't.
The human body is not a bunsen burner. It is an adaptive bio-mechanical organism that responds to it's environment & inputs in a much more complex way than "a pound of fat is 3,500 calories", including a significant genetic component. The general weight range ones body strives to stay within, known as the set point that takes significant effort to overcome. [Previously]
In order to see significant, lasting results, significant, lasting changes are required.
This post was deleted for the following reason: The front page is not the place to make a post about your personal opinions. If there's a way to frame this just based one the quality of the link, fine; otherwise, it's something for your personal blog. -- cortex
Actually for all but the most seriously obese that habit of consistently lowering intake by a couple hundred calories a day is exactly what causes the weight loss to start. For most people it really is just basic physics. So even though this craptacular post is sure to take the express train to deletiontown I thought I'd mention that.
posted by docpops at 3:51 PM on March 3, 2010
posted by docpops at 3:51 PM on March 3, 2010
Ah so that's what a Bunsen burner is.
posted by polyhedron at 3:53 PM on March 3, 2010 [8 favorites]
posted by polyhedron at 3:53 PM on March 3, 2010 [8 favorites]
So I guess I'll just eat that extra cookie then. Thank you.
posted by demiurge at 3:55 PM on March 3, 2010
posted by demiurge at 3:55 PM on March 3, 2010
Yeah, the first link makes it clear small steps are a good idea.
In a study of 200 families, half were asked to replace 100 calories of sugar with a noncaloric sweetener and walk an extra 2,000 steps a day. The other families were asked to use pedometers to record their exercise but were not asked to make diet changes.
During the six-month study, both groups of children showed small but statistically significant drops in body mass index; the group that also cut 100 calories had more children who maintained or reduced body mass and fewer children who gained excess weight.
...but that if you want significant weight loss you have to go further. I don't think that is at all out of line with what Michelle Obama is proposing. Even if you just stop weight gain and instill healthy habits that is a BIG DEAL when you are talking about kids. It's not gonna help a 300lb thirty year old that much, but childhood obesity is what she is campaigning about.
posted by furiousxgeorge at 3:56 PM on March 3, 2010 [1 favorite]
In a study of 200 families, half were asked to replace 100 calories of sugar with a noncaloric sweetener and walk an extra 2,000 steps a day. The other families were asked to use pedometers to record their exercise but were not asked to make diet changes.
During the six-month study, both groups of children showed small but statistically significant drops in body mass index; the group that also cut 100 calories had more children who maintained or reduced body mass and fewer children who gained excess weight.
...but that if you want significant weight loss you have to go further. I don't think that is at all out of line with what Michelle Obama is proposing. Even if you just stop weight gain and instill healthy habits that is a BIG DEAL when you are talking about kids. It's not gonna help a 300lb thirty year old that much, but childhood obesity is what she is campaigning about.
posted by furiousxgeorge at 3:56 PM on March 3, 2010 [1 favorite]
Docpops:"Actually for all but the most seriously obese that habit of consistently lowering intake by a couple hundred calories a day is exactly what causes the weight loss to start."
From the original article:
From the original article:
As a recent commentary in The Journal of the American Medical Association noted, the “small changes” theory fails to take the body’s adaptive mechanisms into account. The rise in children’s obesity over the past few decades can’t be explained by an extra 100-calorie soda each day, or fewer physical education classes. Skipping a cookie or walking to school would barely make a dent in a calorie imbalance that goes “far beyond the ability of most individuals to address on a personal level,” the authors wrote — on the order of walking 5 to 10 miles a day for 10 years.posted by Pirate-Bartender-Zombie-Monkey at 4:00 PM on March 3, 2010
How useful are short term improvements when the long term results almost universally reverse them? Nutritionists and doctors have mostly been shoving the same treatments at us with a peculiar blindness to their long term non-effectiveness across the population as a whole. Other aspects of medicine, treatment, public health seem to look much harder at long term effectiveness, and try and find workarounds for patient non-compliance or diminished returns. How come we've got this weird tendency in nutrition/medicine to throw up our hands and adopt some kind of Calvinist attitude when it comes to obesity?
To use an imperfect analogy, if condoms took 90 minutes to open the package, and STD infections were through the roof, we'd look at improving the package, and not rail at the users for being lazy.
posted by BrotherCaine at 4:04 PM on March 3, 2010 [3 favorites]
To use an imperfect analogy, if condoms took 90 minutes to open the package, and STD infections were through the roof, we'd look at improving the package, and not rail at the users for being lazy.
posted by BrotherCaine at 4:04 PM on March 3, 2010 [3 favorites]
PBZM - I'm glad you can copy and paste a $15 article synopsis.
I'll say it again. In medical practice we see countless examples of people who lose 10-20 pounds very easily over a few months and quickly by simply stopping one specific habit, most commonly soda or second helpings. These people tend to have relatively normal metabolisms and no significant history or morbid obesity in their genetic history. We also find that their is a tipping point with weight for many illnesses that are difficult to control - hypertension, diabetes, back pain, acid reflux - where a mild reduction in weight eliminates a bulwark against treatment.
posted by docpops at 4:05 PM on March 3, 2010 [4 favorites]
I'll say it again. In medical practice we see countless examples of people who lose 10-20 pounds very easily over a few months and quickly by simply stopping one specific habit, most commonly soda or second helpings. These people tend to have relatively normal metabolisms and no significant history or morbid obesity in their genetic history. We also find that their is a tipping point with weight for many illnesses that are difficult to control - hypertension, diabetes, back pain, acid reflux - where a mild reduction in weight eliminates a bulwark against treatment.
posted by docpops at 4:05 PM on March 3, 2010 [4 favorites]
Well, Brother Caine, now you are on the whole bandwagon of frustration that doctors can't fix obesity. Perhaps you could tell me what you would propose in much the same way I should fix the depression of a homeless and abused 30 year-old drug-addicted patient? Seriously? Most obese people get there gradually over decades. You are insulting legions of people that didn't waste their time in a doctor's office and instead joined a gym and started exercising 5 days a week and eating properly. If that's Calvinism I don't see it, since it's hardly deprivation to be healthy and fit.
posted by docpops at 4:09 PM on March 3, 2010 [1 favorite]
posted by docpops at 4:09 PM on March 3, 2010 [1 favorite]
It's funny because The Esteemed Doctor Bunsen Honeydew said GYOB and the OP said bunsen burner.
posted by fixedgear at 4:10 PM on March 3, 2010 [3 favorites]
posted by fixedgear at 4:10 PM on March 3, 2010 [3 favorites]
Oh boy, another obesity thread.
Let me get some popcorn.
With extra butter and salt.
Because nothing matters. It's all in my genes. I'm completely absolved of blame. I'm free. FREE! Mmmm, butter. Butter, butter, butter.
posted by Cool Papa Bell at 4:16 PM on March 3, 2010
Let me get some popcorn.
With extra butter and salt.
Because nothing matters. It's all in my genes. I'm completely absolved of blame. I'm free. FREE! Mmmm, butter. Butter, butter, butter.
posted by Cool Papa Bell at 4:16 PM on March 3, 2010
Huh? I only wandered in here because the linked sentence was so grammatically confusing.
Now, I'm neither a researcher nor a doctor but my own experience suggests that cutting one thing could be the catalyst for more healthful eating. And I don't see how this method can't be defined as "lasting change"; I stopped drinking several sodas a day two years ago, and it's made me more aware of what I put in my body. I think the goal of Michelle Obama's campaign is to get that sort of thing rolling. Sure, kids are gonna fall into all sorts of different body and metabolism types but teaching them when they're still young to curb snacking habits and eat less junk is going to far-reaching effects.
posted by Partario at 4:21 PM on March 3, 2010 [4 favorites]
Now, I'm neither a researcher nor a doctor but my own experience suggests that cutting one thing could be the catalyst for more healthful eating. And I don't see how this method can't be defined as "lasting change"; I stopped drinking several sodas a day two years ago, and it's made me more aware of what I put in my body. I think the goal of Michelle Obama's campaign is to get that sort of thing rolling. Sure, kids are gonna fall into all sorts of different body and metabolism types but teaching them when they're still young to curb snacking habits and eat less junk is going to far-reaching effects.
posted by Partario at 4:21 PM on March 3, 2010 [4 favorites]
Hello, is this the right room for an argument?
posted by The Bellman at 4:23 PM on March 3, 2010 [2 favorites]
posted by The Bellman at 4:23 PM on March 3, 2010 [2 favorites]
From the NY Times article:
“As clinicians, we celebrate small changes because they often lead to big changes,” said Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston and a co-author of the JAMA commentary. “An obese adolescent who cuts back TV viewing from six to five hours each day may then go on to decrease viewing much more. However, it would be entirely unrealistic to think that these changes alone would produce substantial weight loss.”
posted by proj at 4:24 PM on March 3, 2010
“As clinicians, we celebrate small changes because they often lead to big changes,” said Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston and a co-author of the JAMA commentary. “An obese adolescent who cuts back TV viewing from six to five hours each day may then go on to decrease viewing much more. However, it would be entirely unrealistic to think that these changes alone would produce substantial weight loss.”
posted by proj at 4:24 PM on March 3, 2010
I am making small changes to my body to gradually turn myself into a bunsen burner, little bits of metal here and there. It's like that Tetsuo movie, but with fewer pork chops and less gravy. Around day 58 is when I hook up to the natural gas line, which is when the calories will really start burning.
posted by Blazecock Pileon at 4:28 PM on March 3, 2010 [4 favorites]
posted by Blazecock Pileon at 4:28 PM on March 3, 2010 [4 favorites]
I guess I'd prefer that these things not be topics of national nannying. I know I need to relose my weight, I know how to do it, and I don't want to be nagged. I'd imagine parents of children would feel similarly.
By the same token, Oprah makes me want to pull my cell phone out and start yakking every time I get in my car, just for the orneriness of it.
posted by St. Alia of the Bunnies at 4:30 PM on March 3, 2010
By the same token, Oprah makes me want to pull my cell phone out and start yakking every time I get in my car, just for the orneriness of it.
posted by St. Alia of the Bunnies at 4:30 PM on March 3, 2010
...and until children get more time and access to the out of doors to play, and until it is easier for parents to get healthier food at drive thrus etc because of two parent working families, I don't expect the nation's kids to get any skinnier. Shoot, if we'd just have real recesses for elementary school again it would be a start.
posted by St. Alia of the Bunnies at 4:31 PM on March 3, 2010 [1 favorite]
posted by St. Alia of the Bunnies at 4:31 PM on March 3, 2010 [1 favorite]
These people tend to have relatively normal metabolisms and no significant history or morbid obesity in their genetic history.
I totally agree, that applying the lessons learned from thin people's behavior to other people with normal metabolic function makes sense, and I have no quibble with it. Where I have an issue is thinking that the same results make sense with no modification in people with metabolic abnormalities. I'm not accusing all doctor's and nutritionists of doing so, but we have obese people in this country, and I see quite a few of them working out hard in the gym all the time without much appreciable loss of weight over long intervals. As a public health issue, this has been an inarguable failure, and focusing solely on patient behavior seems to be the default. Someone was talking, I think on Mefi, about the prospect of a pill that keeps people from becoming obese, and there was a definite backlash against the idea that it should be that 'easy'. I find that attitude disgusting.
I don't think individual practitioners are at fault here, and I don't know what you can do to improve weight loss for obese patients, other than maybe getting them off sugar and trans-fats (good luck with that).
Docpops, I've got a very skewed look at these things because of my Type I diabetes. I've been oscillating between 185 and 215 pounds for a while now. I find it very easy to lose about 8 pounds a month with over 10 hours of exercise a week at 75% or so of my max heart rate. When I inevitably get sick or injured, I gain all that weight back in about a month. If I try and restrict calories beyond a certain point, my energy levels are so depleted that my quality of life suffers, and paradoxically I gain weight due to not having the energy and motivation to exercise. This is anecdotal, but I have met plenty of people who have similar experience with trying to restrict calories. Medicine (although the blame here probably has more to do with lay reporting of medicine) seems to keep looking at people who don't have a family history obesity, and trying to apply the way they tackle weight loss to people who do have an obvious genetic or environmental component.
I'm sorry if I unintentionally impugned your professionalism or the care you take with your patients. This is a hot button issue for both of us for obvious reasons.
posted by BrotherCaine at 4:33 PM on March 3, 2010 [3 favorites]
I totally agree, that applying the lessons learned from thin people's behavior to other people with normal metabolic function makes sense, and I have no quibble with it. Where I have an issue is thinking that the same results make sense with no modification in people with metabolic abnormalities. I'm not accusing all doctor's and nutritionists of doing so, but we have obese people in this country, and I see quite a few of them working out hard in the gym all the time without much appreciable loss of weight over long intervals. As a public health issue, this has been an inarguable failure, and focusing solely on patient behavior seems to be the default. Someone was talking, I think on Mefi, about the prospect of a pill that keeps people from becoming obese, and there was a definite backlash against the idea that it should be that 'easy'. I find that attitude disgusting.
I don't think individual practitioners are at fault here, and I don't know what you can do to improve weight loss for obese patients, other than maybe getting them off sugar and trans-fats (good luck with that).
Docpops, I've got a very skewed look at these things because of my Type I diabetes. I've been oscillating between 185 and 215 pounds for a while now. I find it very easy to lose about 8 pounds a month with over 10 hours of exercise a week at 75% or so of my max heart rate. When I inevitably get sick or injured, I gain all that weight back in about a month. If I try and restrict calories beyond a certain point, my energy levels are so depleted that my quality of life suffers, and paradoxically I gain weight due to not having the energy and motivation to exercise. This is anecdotal, but I have met plenty of people who have similar experience with trying to restrict calories. Medicine (although the blame here probably has more to do with lay reporting of medicine) seems to keep looking at people who don't have a family history obesity, and trying to apply the way they tackle weight loss to people who do have an obvious genetic or environmental component.
I'm sorry if I unintentionally impugned your professionalism or the care you take with your patients. This is a hot button issue for both of us for obvious reasons.
posted by BrotherCaine at 4:33 PM on March 3, 2010 [3 favorites]
Is this going to trigger another fucked up eating pattern in me or can I actually read the thread?
posted by The Whelk at 4:44 PM on March 3, 2010 [1 favorite]
posted by The Whelk at 4:44 PM on March 3, 2010 [1 favorite]
Sorry, Sugar: The Bitter Truth should have had (previously) after it.
posted by BrotherCaine at 4:47 PM on March 3, 2010
posted by BrotherCaine at 4:47 PM on March 3, 2010
fucked up eating pattern it is!
posted by The Whelk at 4:48 PM on March 3, 2010 [1 favorite]
posted by The Whelk at 4:48 PM on March 3, 2010 [1 favorite]
I guess I'd prefer that these things not be topics of national nannying. I know I need to relose my weight, I know how to do it, and I don't want to be nagged.
The problem is that a lot of people don't know how to do it. I don't have weight struggles, but left to my own devices (i.e. when my husband's not cooking), my diet is horrible because I was never taught to eat properly growing up. Guess what, my mom grew up not knowing anything about nutrition either (and poor and in the South, where everything's fried). At 35, I basically have to learn how to eat.
posted by desjardins at 4:49 PM on March 3, 2010
The problem is that a lot of people don't know how to do it. I don't have weight struggles, but left to my own devices (i.e. when my husband's not cooking), my diet is horrible because I was never taught to eat properly growing up. Guess what, my mom grew up not knowing anything about nutrition either (and poor and in the South, where everything's fried). At 35, I basically have to learn how to eat.
posted by desjardins at 4:49 PM on March 3, 2010
I guess I'd prefer that these things not be topics of national nannying.
Suggesting that people do something is not even remotely close to "nannying;" it's not even "nagging" by a long shot.
On my end, I'm constantly aware that I need to lose a bit of weight; having lots of different sources giving optimistic, empowering, practical messages about it is a good source of inspiration and encouragement. I suspect "nannying" and "nagging" are in the ear of the beholder. Er, behearer.
and until children get more time and access to the out of doors to play, and until it is easier for parents to get healthier food at drive thrus etc because of two parent working families, I don't expect the nation's kids to get any skinnier.
I'm trying to figure out what you mean by this. Nobody should bother trying to improve anything until every child has a playground, and all drive-throughs serve salad? That doesn't seem very practical. How about we try to make some incremental changes to improve things despite living in an imperfect world instead?
posted by Shepherd at 4:59 PM on March 3, 2010 [1 favorite]
Suggesting that people do something is not even remotely close to "nannying;" it's not even "nagging" by a long shot.
On my end, I'm constantly aware that I need to lose a bit of weight; having lots of different sources giving optimistic, empowering, practical messages about it is a good source of inspiration and encouragement. I suspect "nannying" and "nagging" are in the ear of the beholder. Er, behearer.
and until children get more time and access to the out of doors to play, and until it is easier for parents to get healthier food at drive thrus etc because of two parent working families, I don't expect the nation's kids to get any skinnier.
I'm trying to figure out what you mean by this. Nobody should bother trying to improve anything until every child has a playground, and all drive-throughs serve salad? That doesn't seem very practical. How about we try to make some incremental changes to improve things despite living in an imperfect world instead?
posted by Shepherd at 4:59 PM on March 3, 2010 [1 favorite]
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posted by The Esteemed Doctor Bunsen Honeydew at 3:45 PM on March 3, 2010 [18 favorites]