Is Obesity Incurable?

[Puppycow]

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/

Yes, bariatric surgery seems to be the one intervention that could reasonably be called "a cure". A 93% success rate is really outstanding. Even the 57% success rate among the super-obese is nothing to sneeze at.

So, no obesity is not "incurable" but the cure is a rather drastic and expensive procedure.

The only other cure is a permanent lifestyle change, and some people can actually do that, but if you allow yourself to go back to old habits, the weight will come right back. For a few years I controlled my weight with a program of diet and exercise, but I had a rebound when I got lazy and went back to old habits. I'm not really fat enough for bariatric surgery though, but fatter than I should be.

 

[casebro]

But my point was that "eat zero calories per day, lose 1/2 #, Work like a lumberjack, lose 1 1/2 #/day". The changes to Kc in vs Kc out can be mush more extreme on the 'out' side. And as an added bonus, some day I can sell the truck, and get paid to lose weight! Though I can't ignore the $10,000 in parts and materials. But can you re-sell Jenny Craig?

 

[Puppycow]

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.

I wonder if exercise wouldn't help increase that metabolism. (Or maybe she found a way to cheat?). If she worked her way up to running 5 K every day, the metabolism would have to go up.

 

[David Wong]

The only other cure is a permanent lifestyle change, and some people can actually do that...

It's statistically close to zero.

That's what I'm finding. It's so rare that studies can't find enough examples to even examine.

The "2 in a thousand" number that Weight Watchers seems to show, it has to be in that neighborhood. And that's even with WW's incentives and all of their follow-up help.

 

[Weak Kitten]

Speaking of exercise, what is this "endorphin rush" that other people keep talking about? I've never had it, to me exercise is just a boring, painful and tedious activity that I do for my health. It certainly doesn't take my mind off of it if I am hungry, I just find myself hurting in my stomach as well as everywhere else.

Has anyone taken a look at whether different people have different reactions to exercise? I would certainly exercise more if I got the sort of rush that other people talk about!

 

[GlennB]

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.

In practice, probably. But as JFrankA has mentioned, the 'behavioural change' required to lose weight tends to revert to over-eating once some artificial target has been reached. "I'm 300 lbs and my target is 200lbs. Made it! Whoopee, let's hit the cream cakes!!"

The basic science, though, is undeniable: burn more calories than you consume and weight loss is inevitable. The trick is to maintain this in the way that recovering alcoholics and ex-smokers have to maintain their abstinence.

 

[Horatius]

Speaking of exercise, what is this "endorphin rush" that other people keep talking about? I've never had it, to me exercise is just a boring, painful and tedious activity that I do for my health. It certainly doesn't take my mind off of it if I am hungry, I just find myself hurting in my stomach as well as everywhere else.

Has anyone taken a look at whether different people have different reactions to exercise? I would certainly exercise more if I got the sort of rush that other people talk about!

^This. I've exercised a lot in my life, but have never felt this "rush" thing people talk of. Just recently I started carpooling a couple of days a week with someone who also attends the gym I use. She asked why I didn't go to the gym in the morning, and was surprised that I said it's because exercising made me feel like crap for the rest of the day, so I usually did it later in the day, just before going home and spending the rest of the evening relaxing. She said exercise made her feel better. Never in my life has that been true.

The trick is to maintain this in the way that recovering alcoholics and ex-smokers have to maintain their abstinence.

But a big difference is, no one needs alcohol or tobacco. You can realistically go cold turkey on those forever. But everyone needs some amount of food, and that's the thin edge of the wedge. Try treating alcoholics by telling them to only have two beers per day, and see how successful you are!

 

[marplots]

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.

Now I'm envious. I'd recoup at least an hour a day if I didn't have to eat. Not as good as not having to sleep, but pretty good.

I find eating to largely be a chore, or at least an interruption. I put it in with other biological functions like having to urinate. My question to the above and the objection that we treat all the obese the same would be whether or not she suffered as much or more on that restriction than others did at the higher daily calorie count. Maybe she craved just as much, making the numbers different, but the effect the same.

I do agree that a set number of calories is a broad generalization derived from statistics and not worth much on an individual basis. Still, if I could survive on 450 calories a day, that would be sweet.

 

[David Wong]

The trick is to maintain this in the way that recovering alcoholics and ex-smokers have to maintain their abstinence.

It's much, much harder for the formerly obese, and the success rate is lower. Which makes sense, they're fighting against the body's own starvation prevention mechanism.

 

[Horatius]

Still, if I could survive on 450 calories a day, that would be sweet.

Sure, it would be sweet, if there were no downside to that. Which is my whole point - there are, or at least, can be, huge downsides that too few people give any weight* to.

It's really a question of how much do you expect people to sacrifice to lose weight? Saying, "Oh, just pass up dessert and lose 20 pounds" isn't quite in the same league as, "Oh, just eat half a bagel with cream cheese, then spend all day ravenously hungry looking at the clock to see if it's time for you to eat the second half."










*See what I did there?

 

[marplots]

It's really a question of how much do you expect people to sacrifice to lose weight? Saying, "Oh, just pass up dessert and lose 20 pounds" isn't quite in the same league as, "Oh, just eat half a bagel with cream cheese, then spend all day ravenously hungry looking at the clock to see if it's time for you to eat the second half."

Is it really like that? Like heroin addiction or something?

Do the cravings ever fade?

 

[Weak Kitten]

I think there is also the fact that some people actually get a rush of some sort when they eat. Not only are they hungry but it feels extra good to them when they do eat. I can understand that myself, it feels really good when I eat after being really hungry too, but if they are hungry all the time and it feels good when they eat all the time...I can see where this could get messy. If you add to that a lack of endorphin rush when they exercise it could be really messy indeed.

And yet i haven't see much research into the endorphin release mechanism in these cases. If exercising felt good and eating didn't feel quite as wonderful maybe those who are seriously overweight would have an easier time adjusting their behavior. Maybe the real trick is to figure out the root cause of their behavior to begin with.

 

[Beerina]

Bariatric Surgery is successful, but not uniformly so:

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





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.



Advocating bulimia even in jest is not helpful.

Fair enough. Why?

The number of people who starve themselves to death has always been greatly exaggerated. Meanwhile...diabetes and heart disease...?

One of the things which irritates me is there are certain speed-like weight loss drugs that are safe and effective, but are banned in the US because addicts might illegally get ahold of them.

So, many remain fat and die young because a relative few other jackasses might abuse it. Nice that we've apparently hired government to issue value judgements in this way.

 

[EdipisReks]

Is it really like that? Like heroin addiction or something?

Do the cravings ever fade?

food cravings due to hunger end about two minutes after the heart stops.

 

[Horatius]

Is it really like that? Like heroin addiction or something?

Do the cravings ever fade?

Dude, we're talking about hunger here. It's not like, "Man, I'd really like a Big Mac" cravings, it's "Man, I'd like some food, period." It's a fundamental aspect of human physiology, it doesn't just "Go away", short of major health issues like chemotherapy, or old age.

 

[Modified]

Dude, we're talking about hunger here. It's not like, "Man, I'd really like a Big Mac" cravings, it's "Man, I'd like some food, period." It's a fundamental aspect of human physiology, it doesn't just "Go away", short of major health issues like chemotherapy, or old age.

When I am intentionally gaining weight, eating maybe 5000 Calories per day, skipping a meal will result in intense hunger. After a few weeks on a more normal diet (3000 Calories per day or so), that stops. So at least in this sample of one, it does go away. Of course, I've never eaten that much for more than a few months.

 

[Halfcentaur]

Speaking of exercise, what is this "endorphin rush" that other people keep talking about? I've never had it, to me exercise is just a boring, painful and tedious activity that I do for my health. It certainly doesn't take my mind off of it if I am hungry, I just find myself hurting in my stomach as well as everywhere else.

Has anyone taken a look at whether different people have different reactions to exercise? I would certainly exercise more if I got the sort of rush that other people talk about!

I certainly get it when I push the limits of my exercise. In my experience it takes hitting a stride where you are in a sort of zone, a point where you are heavily exerting yourself for a while until suddenly things change and your breathing has regulated to the point you are taking small relaxed breaths and it becomes almost effortless, like a machine at optimum efficiency. For me it takes pushing myself to the limit of my endurance for about 10 minutes, then the body adjusts to that heavy exertion and I hit a kind of exultant altered state. But I soon adapt and have to push harder to attain it.

But with regular exercise I feel a markedly intense shift in my sense of well being and overall comfort. Even with the anxiety and anhedonia I've been dealing with the past 6-7 years, when I do finally get into exercising the difference is profound. But I go a long time without exercising sometimes to the point I feel miserable.

I've never felt like crap from exercising other then when I initially start up exercising after not having done it for a long period of time.

Often at the point I get, only 5 minutes of intense exercise has me forced to pause and take a break for 60 seconds or so. Then I push on and try for 6-7 minutes, then I try for 10. Eventually within about a week I get to 20-30 minutes without needing a break, and then I start getting that exercise high and fall into the feeling of being an optimally calibrated plodding machine.

 

[Halfcentaur]

Is it really like that? Like heroin addiction or something?

Do the cravings ever fade?

Yes it is, more so that once you drop the weight, you can never go back to eating normally let alone over eating because the body will over conserve thinking there's a fast coming on. To keep the weight off, you have to perpetually limit your intake of food to below the normal level, it's not just a matter of not binging or eating too much. It takes constant dedication once you get to that point to maintain it.

The cravings are not just a result of old addictions and bad habits, you have to pretty much keep yourself hungry or strictly eat bland filling food.

A lot of people seem to think it's a matter of ending over eating and then eating normally, when it's more like a matter of both ending over eating and also not being able to eat normally with a constant need for maintenance. It's not like when you drop the weight you just have to avoid over eating.

 

[ponderingturtle]

In practice, probably. But as JFrankA has mentioned, the 'behavioural change' required to lose weight tends to revert to over-eating once some artificial target has been reached. "I'm 300 lbs and my target is 200lbs. Made it! Whoopee, let's hit the cream cakes!!"

The basic science, though, is undeniable: burn more calories than you consume and weight loss is inevitable. The trick is to maintain this in the way that recovering alcoholics and ex-smokers have to maintain their abstinence.

The thing is that going from say 300 lbs to 200 is fairly common. It is that in five years the person is likely to be 320.

And the alcoholics and smokers don't have to have just a bit every day.

 

[mike3]

I'm curious about this: If it is hard to lose the weight and harder even to keep it off, is there a way for those who are not already obese to prevent becoming obese in the first place?