Is Obesity Incurable?

[David Wong]

...over the long term?

I started doing research on the effectiveness of various diet plans five or more years down the road (for a Cracked article) and what I found floored me. The studies boasting of long-term success of structured diets are talking about incredibly modest weight losses:

http://www.ajcn.org/content/74/5/579.full

We're talking about a permanent loss of 15 pounds is regarded as a raving success. So congratulations, you were 300 pounds, now you're 285. The average weight loss of the 3,500 participants who saw success from structured weight loss programs was 3%... so our 300 pounder would be all the way down to... 291.

It's the same for this article, raving about the success of Weight Watchers:

http://www.cbsnews.com/2100-204_162-620201.html

Dig into the numbers and they're talking about how great it is that so many people were able to keep off 5% of their weight.

So when you go and try to actually find the real "fat to thin" success stories, the "before and after" diet product commercial photo guy who weighed 300 and got down to 160, the "Jared from Subway" weight loss, and they're so rare as to fall into the realm of medical miracles of the "surviving an inoperable brain tumor" category.

This blogger tried to do the math and figured that 2 out of 1,000 Weight Watchers qualifies:

http://fatfu.wordpress.com/2008/01/24/weight-watchers/

I fully realize that person is just doing back-of-the-envelope calculations (WW is very careful to make sure you never, ever, ever see the true stats on what percentage of customers are successful over the long term) but to be honest, I can't find any study on people who have actually permanently beaten obesity. And I'm starting to think that the ones who do are simply freak stories, like the guy told he has six months to live but who survives 20 years. Here's a nice article that breaks down why the body makes it all but impossible:

http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html?_r=1&pagewanted=all

Has any study ever shown anything else? If so, I can't find it.

Yet, if you say this on a message board, the replies usually fill up with useless anecdotes ("My brother lost 75 pounds just by cutting out the junk food!") or personal judgments of the obese ("If they'd just get off their lazy butts and run a little bit they'd lose the weight in no time!") or personal incredulity ("I refuse to believe it's incurable when you can simply STOP EATING!"). But as far as I can see, the data makes it clear: obesity is effectively incurable, perhaps with the exception of surgical options.

Can anyone point me to a study that says I'm wrong?

 

[ieathedead]

G'day,

I can only seem to find articles on treating other medical problems that can cause obesity, not much on an actual cure itself. From what I can gather, losing the weight doesn't really help because the underlying problems cause the weight to return.

...as obesity is associated frequently
with other disorders such as diabetes, hypertension, dyslipidaemia,
sleep apnoea and osteoarthritis, it is important that the physician
treat all of the relevant treatable diseases. For the scientist, the
challenge of obesity is to identify those major pathways where
pharmacological intervention can safely and effectively help those
who are clinically overweight

Source: http://www.facmed.unam.mx/pibc/segundo/guias/referencias/3092818.pdf

A few other articles have said that there is no 'cure' for it, but obesity can be managed. There are a lot of articles on gastric banding and other methods on google scholar as well and they seem to have higher success rates than dieting but I'm not sure if that's what you're after or not.

On a kind of related and unsourced tangent, I think I heard Dr Karl talking about an obese man who lived for maybe a 100? days without eating, just living off his own... fat, almost like hibernation I suppose. I think he lost over 100kg's. I'll try and find something about it...

ETA: Here is the abstract from the story. http://pmj.bmj.com/content/49/569/203.abstract I'm pretty sure I heard Dr Karl talking about it on either of these 2 podcasts, Conversations with Richard Fidler or Dr Karl on Triple J.

Here is a diet story from Dr Karl which might help with a few facts and figures. http://www.abc.net.au/science/articles/2011/11/29/3378938.htm

I hope you got something from these links.

Cheers.

P.S - Cracked is awesome. Thank you.

 

[JFrankA]

David, in my opinion, you are right. No way can obesity be "cured".

The thing with obesity is that, instead of being caused by some outside virus or something, it's a behavioral change (that's why I hate using the word "cured" for this).

You're absolutely right about how WW and the like don't show long term effects after the weight loss. There's a reason for that. Now personally, I love WW because it did help me lose 130 pounds, but after I got down to my goal weight, there was not much they did that helped maintain it. In fact, the advice was "add four points to your daily points and keep to the plan". Which sounded kind of lame, actually. It seems to me that all these weight loss programs are designed to lose weight, but once one is there, the programs have no clue as to what to do. As it stands eight years after hitting my goal weight, I'm back up 40 pounds.

This is exactly what I have been going through all my life, and at the risk of sounding like anecdotal evidence, I've been thin then fat then thin fat then thin again over and over.

This is because there is a major difference between actually trying to lose weight and trying to maintain the same weight. It becomes a balancing act that involves permanent behavioral changes. So while WW and the like may actually be a good plan to lose weight, IMHO, nothing really can help you maintain that weight when one reaches the goal.

The same behavioral problems are also with weight loss operation on the stomach. (Which I haven't done). Those who do go through the operation have to go through a major change in diet and behavior. And, although the person's body does give signals of "I'm full" (by needing to go to the bathroom more, etc), it still does not change the basic behavior patterns of the mind.

I realize that I'm giving anecdotes instead of hard facts, but I don't know if you've been through major weight loss. I've been part of it and seen it and been through many ones, so I just thought I'd give my two cents, (which, I'm sure two cents is worth more than this post ).

IMHO, Obesity cannot be "cured", it can only be consciously controlled. It's an everyday conscious fight in self-behavior and basic physical needs. One can only see WW and the like as tools, not a cure.

By the way, if I may say, I love Cracked.com as well. Your book is amazing. Can't wait for the movie and the sequel.

 

[JJM 777]

People who got their stomach surgically reduced go from extremely overweight to normal weight, and stay there permanently.

Obesity is as curable as our eating habits and/or appetite. For the latter surgical operations are known, so appetite is curable / reducable. Maybe one day they invent a pill that does the same, or prevents the body from extracting energy from the food in stomach, and not only claims to do so.

The Roman orgy method is to eat and then go vomiting, then come back to eat more and then vomit again.

 

[Baylor]

David Wong, you're the guy who did the article on the girl who committed suicide, and everyone thought she did it because she like to eat poop. I loved that article! So that's a true story, huh? I came across that article like two days ago. Crazy ****

 

[JFrankA]

People who got their stomach surgically reduced go from extremely overweight to normal weight, and stay there permanently.

Obesity is as curable as our eating habits and/or appetite. For the latter surgical operations are known, so appetite is curable / reducable. Maybe one day they invent a pill that does the same, or prevents the body from extracting energy from the food in stomach, and not only claims to do so.

The Roman orgy method is to eat and then go vomiting, then come back to eat more and then vomit again.

Oh. I guess I'm wrong about the surgery.

Without surgery, though, it is a constant behavior (i.e., controlling eating habits and aware of one's own appetite) struggle.

 

[Tatyana]

Probably not.

Even all the studies that people use to state that 'low carb diets are better' show that in the low carb group lost 1.5 kg more than the other groups in the experiment. The weight loss is the same by the end of six months to a year.

The only diet program I am aware of that includes counselling is the Cambridge diet, I think it is also called something like Slim Sure, however, I haven't looked for any studies on it.

I think in the long run, it is going to be prevention of severe weight gain, because once you are obese or morbidly obese, the vast majority of people are basically going to stay that weight.

There is evidence that even a modest weight loss can improve health outcomes, so while the 15 lbs may not seem like a lot of weight, it may actually be a wee bit beneficial.

 

[Professor Yaffle]

Every year more than 100,000 U.S. patients undergo gastric bypass surgery for the treatment of obesity. Experience now shows approximately 20 percent of these patients will regain weight within a few years after the surgery, due to the stretching of the stomach, and will be at renewed risk for diseases such as hypertension, diabetes, and cardiovascular disease.

http://www.sciencedaily.com/releases/2008/05/080520160855.htm

 

[Halfcentaur]

The biggest issue I think over eating habits is how the body reacts to weight loss. I think eventually we will crack the science of exactly how the body maintains and metabolizes and we will eventually be able to manipulate it with ease. I think it's possible the day will come when a pill literally can fix this sort of problem.

 

[The Don]

People who got their stomach surgically reduced go from extremely overweight to normal weight, and stay there permanently.

Bariatric Surgery is successful, but not uniformly so:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/

Conclusions

This study of isolated gastric bypass with a 5.5-year follow-up rate of 88.6% revealed a success rate of 93% in obese or morbidly obese patients and 57% in super-obese patients.

Obesity is as curable as our eating habits and/or appetite. For the latter surgical operations are known, so appetite is curable / reducable. Maybe one day they invent a pill that does the same, or prevents the body from extracting energy from the food in stomach, and not only claims to do so.

If only it were as simple as that, it's like saying that anorexia can be cured by eating more. There appear to be a range of emotional and psychological issues at both ends of the weight scale.

The Roman orgy method is to eat and then go vomiting, then come back to eat more and then vomit again.

Advocating bulimia even in jest is not helpful.

 

[zeggman]

What about a colostomy that branched at the duodenum? That would avoid spewing stomach acid all over your teeth, would allow you to eat to the point of feeling full, but if you'd already exceeded your allotment of calories for the day, you'd just turn the valve and direct that sludge to the compost pile instead of the absorption pathway.

Seems simple enough. Should I take it to Shark Tank?

 

[Horatius]

Yet, if you say this on a message board, the replies usually fill up with useless anecdotes ("My brother lost 75 pounds just by cutting out the junk food!") or personal judgments of the obese ("If they'd just get off their lazy butts and run a little bit they'd lose the weight in no time!") or personal incredulity ("I refuse to believe it's incurable when you can simply STOP EATING!"). But as far as I can see, the data makes it clear: obesity is effectively incurable, perhaps with the exception of surgical options.

Can anyone point me to a study that says I'm wrong?

On a kind of related and unsourced tangent, I think I heard Dr Karl talking about an obese man who lived for maybe a 100? days without eating, just living off his own... fat, almost like hibernation I suppose. I think he lost over 100kg's. I'll try and find something about it...

I've been up and down with my weight all my life, and have done a lot of the different programs out there, including medically supervised extremely low calorie diets. What a lot of the simplistic "eat less and exercise!" crowd don't seem to get is that there are a lot of factors that make that a lot harder than it sounds.

For one thing, which should be obvious, you're hungry all the time. I've heard people say things like "I just forget to eat!", which in my experience is like saying "I just forget to breathe!" When you're looking at the clock at 9AM, wondering how long it is until lunch, it becomes hard to do or think about much else.

Secondly, and less obviously, I've found that low calorie diets make you stupider than normal. When I was on that diet, my brain just didn't work the way it usually does. I made more mistakes, and had a harder time focusing, than ever before. You can do that for a month, or two, or three, to lose weight, but can you do it forever, to keep the weight off? Only at a great cost to quality of life. My brain is the one thing that makes me above average, and I should sacrifice that?

Thirdly, even if you lose a lot of weight, for a lot of people, they're still overweight. So even if you do manage to overcome all the difficulties, and "eat less and exercise", anti-fat bigots still look down on you for being a fat slob. I've had more than one person looking at me boggle-eyed as I go into the gym, wondering what a fat bastard like me thinks he's doing there. I'm enough of a bastard that I can ignore those idiots, but a lot of fat people don't have the self-esteem to do that.

And don't get me started on trying to find exercise equipment designed for large people. You know, those people they keep telling to exercise?

 

[Horatius]

Oh, and while were at it, check out this concurrent thread:

http://www.internationalskeptics.com/forums/showthread.php?t=239088


No matter what diet you choose, someone will come along and tell you that it's crap, and their diet is the one you should be following.


Hey, here's a question: have any of you ever thought that maybe different people lose weight in different ways? "NO! WE ARE THE BORG. WE ARE ALL IDENTICAL."

http://www.ottawahospital.on.ca/wps...rmCS/Programs/WeightManagementClinic/Research

Variation in Weight Loss Study

In our clinical experience we have observed that some people lose weight very slowly when they diet. Traditionally these people were accused of not telling the truth about what they were eating. We have been able to show that people who lose weight slowly or diet-resistant people have a genetic abnormality that makes it difficult for them to lose weight. We are continuing this study to learn how this genetic abnormality can be altered. This has been the first study in humans to show an association between Uncoupling Protein 3 function and responsiveness to caloric restriction. This is a collaboration of Dr. Robert Dent, Dr. Mary Ellen Harper, Dr. Ruth McPherson and others. Reference: Harper M, Dent R, Monemdjou S, Bezaire V, van Wyck L, Wells G, Kavaslar N, Gauthier A, Tesson F, McPherson R. Decreased Mitochondrial Proton Leak and reduced Expression of Uncoupling Protein 3 in Skeletal Muscle of Obese Diet-Resistant Women. Diabetes, 51:2459-2466,2002

That's one reason I've always like Dr. Dent. He admits that reality isn't as simplistic as so many people make it out to be.

 

[ponderingturtle]

I've been up and down with my weight all my life, and have done a lot of the different programs out there, including medically supervised extremely low calorie diets. What a lot of the simplistic "eat less and exercise!" crowd don't seem to get is that there are a lot of factors that make that a lot harder than it sounds.

The problem is that they mistake simple for easy. Running marathons is pretty simple too.

That is also the lies of diets, that it is complicated but easy to loose weight instead of simple but very difficult.

 

[casebro]

One datum often overlooked- Once corrected for Diabetes, Obesity does NOT shorten life.

One big study also showed that a BMI of 17 to 34 is PERFECT. 17, 27, or 34, one is no better than the other. Seems the negative aspects of carrying extra energy add to lifespan in those who would die of wasting diseases, like cancer and fever.

Anecdote: Last visit to the Docs, I was down 90# from my lifetime high, No more insulin, cut BP meds to 1/4. Feeling better than I have in 40 years, since last I was at this weight. Doc says: You are still Obese, by ONE pound". Damn pedant. But how did I lose the weight? Cut back to one meal per day, stay so busy I don't hear the refrigerator calling me. Burn an additional 5,000 calorie per day- 10 pounds per week loss. ( the 10 pounds is a mathematical average. The 5000 is calculated from there.) It was actually heavy labor, restoring a truck chassis. Now I'm doing body work, all hand sanded.

If you are hungry, instead of eating, go take a walk. It works. "Put down the fork. Step away from the fridge- a mile or two? " ?

(eta: I just calculated my Net Calories Burned per running a mile. At my weight, 10 pounds per week is like running 29 miles per day. Everyday. No wonder I stopped, and regained 10 pounds.)

 

[Horatius]

If you are hungry, instead of eating, go take a walk. It works. "Put down the fork. Step away from the fridge- a mile or two? " ?

Sure, that works great. Until you have a job that doesn't let you take off for two mile walks every hour.

 

[marplots]

I look at weight as an environment issue. If food isn't available, people can't be obese. Since we live in a situation where food is available and people are free to choose it or not, you naturally get a sorting based, not on availability, but on desire to eat.

This ecology model would say a cure exists if you look at the whole picture and not just the individual as the flawed element. A cure would entail regulating food. This is essentially what diets do, but without any authority other than the individual to back them up.

If I am correct, you shouldn't see as much obesity in prison as outside of prison, assuming that diets in the big house are set by nutritionists and restricted by enforced rules.

Apparently, this has been studied: http://blog.crchealth.com/2012/04/2...earchers-study-diet-exercise-among-prisoners/

"In addition, they found male prisoners were between 13% to 67% less likely to be obese than non-imprisoned males."

And, while the results are what I would expect, the difference goes one way for males (lower weight) and another for females. I was surprised to find that women in prison are (overall) fatter. My guess is they no longer have to compete on the "beauty" spectrum (like they would outside of prison) and the weight gain is a rebound, but I don't know.

I also don't know if the prison authorities are actually trying to keep weight down by calorie restriction. That's something they could do, and it would be interesting to see what happens in those prisons where meals are closely regulated to check.

 

[casebro]

Sure, that works great. Until you have a job that doesn't let you take off for two mile walks every hour.

It helps that I am retired, on medical disability - due to health probs, of course.

But if you want to eat like a lumberjack, you have to work like a lumberjack.

 

[David Wong]

The problem is that they mistake simple for easy. Running marathons is pretty simple too.

That is also the lies of diets, that it is complicated but easy to loose weight instead of simple but very difficult.

Well, I've learned to ignore the corners of the internet where you get crushed by a horde of thin 20 year-olds alerting you that you just need to "take care of yourself" - that's a basic misunderstanding of human impulse. You can tell them to try going just 48 hours without food. Why not? Your body can easily handle it, it's not dangerous if you keep hydrated. It's just a matter of "not eating." If it's so easy, surely a mere two days would be no problem.

Or, you can suggest they try stopping all sexual activity, or quit smoking, or drinking, or if they complain about money problems, to just "go make more money." Then they realize that they don't actually have complete command over their physical impulses, either, and in fact the physical, psychological and emotional cost of controlling them is so high that they'll judge it not worth it.

So I'm not confused about how that mechanism works, that the body can override will power if it's something the body really wants (like maintaining fat stores once they have been gained). You can lose and keep off 15 pounds, but if you've had a miracle weight loss of 100 pounds then your body has a whole arsenal of weapons to force you back to what it considers your "goal" weight, mainly by hammering you with urges to eat with such mind-numbing frequency that even if your willpower wins 90% of the time, succumbing to the eating impulse that other 10% will get you there.

 

[Horatius]

But if you want to eat like a lumberjack, you have to work like a lumberjack.

And here's the "Everybody is the same" issue sneaking in again. Sure, there are fat sedentary people who "eat like lumberjacks". However, there are also fat people who don't eat like lumberjacks, but are still fat.

I mentioned the extremely low calorie diet I was on above. This plan had pre-measured diet shake mixes that provided 900 calories in four shakes per day. In the group I was in, there was one woman who kept gaining weight on that number of shakes. She had to cut it down to two shakes per day to lose weight. That's 450 calories per day, for those playing at home. Her metabolism was just that efficient.

Take a good look at what 450 calories of real food looks like, that ask if it's reasonable to expect her to only ever eat that much - even if it's the only way she could keep the weight off.