Search Results for "will losing weight make you fat"
Will Dieting Make You Fatter? Only If You Are Skinny!
At the recent European Congress on Obesity, I had the occasion for a long chat with my friend and colleague Abdul Dulloo, from Friburg in Switzerland, who has worked extensively on the issue of weight regain. I asked him how much evidence there is to support the common notion that losing weight makes you fatter – something many dieters claim to have experienced. Indeed, both in animals and humans, weight loss, as a rule, is followed by a more rapid regain of body fat than lean body mass (i.e. preferential catch-up fat) than of lean body mass, as a result of which body composition post-weight regain results in a greater proportion of fat mass than before. But does this increased “fatness” persist over time? This is where Dulloo made me aware of a recent paper he published in Obesity Reviews that examines this question. What his analysis of prospective studies on this issue revealed is that paradoxically, people within a the normal weight range appear much more prone to weight gain over time with dieting than people who already have overweight or obesity. Indeed as he points out, “…it is dieting to lose weight in people who are in the healthy normal range of body weight, rather than in those who are overweight or obese, that most strongly and consistently predict future weight gain.” The reasons for this rather unexpected finding are unclear and some have argued that repeated dieting to lose weight in normalweight people may represents unsuccessful attempts to counter genetic and familial predispositions to obesity – these people are genetically prone to weight gain, which is why they are dieting in the first place. Thus, rather than a causal relationship, the association between dieting and subsequent weight gain is just what would have happened to them anyway. Others have argued that the metabolic effects resulting from the psychological “fear of fatness” (which prompts dieting) per se may increase the risk for weight gain hence a contributing factor to the obesity epidemic. However, as Dulloo and colleagues discuss at length, based on their reanalysis of a wide range of human studies of weight loss and refeeding on body composition data on fat mass and fat-free mass (FFM) losses and regains, there is increasing support for the biological plausibility that dieting predisposes lean individuals (rather than those with overweight or obesity) to regaining more body fat than what had been lost… Read More »
Healthy Obesity: Losing Weight Won’t Make You Happy
There is ample evidence for improvements in mood and other aspects of mental health with weight loss in people with excess weight, who have these problems to begin with. But whether or not weight loss in otherwise healthy people living with obesity is associated with any such benefits remains unknown. This question in now addressed by Sarah Jackson and colleagues from the UK in a paper published in PLOS | ONE. The researchers examine data from 1,979 overweight and obese adults, free of long-standing illness or clinical depression at baseline, from the English Longitudinal Study of Ageing. Participants were grouped according to four-year weight change into those losing ≥5% weight, those gaining ≥5%, and those whose weight was stable within 5%. The proportion of participants with depressed mood increased by almost 300% in the group that lost weight (about 15% of participants) compared to a rather modest 85% and 62% increase in mood problems in the than weight stable or weight gain groups, respectively. Compared to the weight stable group, the weight loss group was almost 2 times as likely to report mood problems. Similarly, individuals in the weight loss group were also more likely to report lower wellbeing. All effects persisted in analyses controlling for demographic variables, weight loss intention, and baseline characteristics and despite adjusting for illness and life stress during the weight loss period. Given the longitudinal nature of this study, it is impossible to determine causal relationships in these observations but the findings do suggest that the issue of psychological harm in otherwise healthy individuals undergoing weight loss may warrant closer study. For the event that there is indeed a causal relationship between weight loss and adverse pychological outcomes, the authors have the following explanation to offer: “The poor long-term maintenance of weight loss is notorious, and in itself could be interpreted as demonstrating that the personal costs of losing weight exceed the benefits. Resisting food in environments that offer abundant eating opportunities requires sustained self-control, and given that self-control appears to be a limited resource, other areas of life may suffer as a consequence. Loss of fat stores may also initiate signals for replenishment of adipocytes, thereby stimulating hunger and appetite and making weight control progressively more difficult. These observations suggest that weight loss is a significant psychobiological challenge, and as such, could affect psychological wellbeing.” On the other hand, weight loss could also result… Read More »
Why I Am Not Losing Sleep About NHANES’ Flawed Data
Regular readers may be well aware of the US-National Health and Nutrition Examination Survey (NHANES), the billion dollar juggernaut of a research enterprise conducted by the the US-CDC and the Department of Agriculture since the early 70s. It turns out that rather simple calculations, published in PLoS One by Edward Archer, from the Arnold School of Public Health at the University of South Carolina in Columbia, and colleagues, show that the dietary data collected in this survey (using a 24-hour recall), widely used by researchers and policy makers as the primary source of data on the impact of nutrition and diet on health, is rather “implausible”. As the calculations in the paper show, the caloric estimates that people are reportedly eating are simply not physiologically possible given their reported age, size, weight and levels of physical activity. In short, given the overall “iffyness” of the dietary information in NHANES, it is rather impossible to accurately determine the relationship between changes in caloric intake (and I would assume the same goes for nutrient composition) and the obesity epidemic. So, why do I not really care? For one, even if these data were fully accurate, knowing that Americans are consuming more calories today than they did before does not really tell me much – irrespective of whether or not these numbers have gone up or down, the fact is that somewhere along the line, the net amount of calories Americans consume is larger than the net amount of calories Americans need – probably by several hundred calories a day – end of story! Secondly, as in all observational studies, what you get are correlations, which may or (more likely) may not give you useful insights into causality. Thus, as larger bodies need more calories to sustain (and larger people consume significantly more calories by just moving themselves around), I would expect average caloric consumption to have increased. Thus, even if we assumed for a minute that the obesity epidemic was caused by a viral infection that makes people fat, those larger people would now be eating more calories than before to sustain their larger bodies. Thus, showing that obese people eat more calories (which incidentally is not always the case), does not really provide much insight into what is causing the problem. Thirdly, we are dealing with population averages on an issue where we know there exists a rather wide range of… Read More »
“No, You Do Not Need To Lose Weight!”
Recently I saw Betty* in my clinic. She is 44 years old and never had a “weight problem” till her 8 year-old only son met with a fatal road accident. That was 12 years ago. Since then she has steadily gained almost 10 pounds a year, which is why she is now 120 pounds heavier than she was at 32. “I desperately need to lose weight“, she told me between sobs. “No“, I disagreed with her, “You don’t“. “What you need to do first“, I added, “is to stop gaining weight!” This is a conversation I have had with hundreds of patients, who come to me seeking weight loss. Many of them are gaining even more weight than Betty every year – all of them want to dive straight into losing weight. They are desperate, ready to embark on the next diet or exercise program – even bariatric surgery – whatever it takes! I understand their desperation – not seldom do they come to see me because their doctor has suggested they come to our clinic for weight loss. But here is the problem. Betty is out of control. Steadily gaining 10 pounds a year means she is eating 1000s of extra calories a day – the more weight she gains, the more excess calories she eats (here is why). No diet, no exercise, not even bariatric surgery will address her need to eat. Before even remotely contemplating weight loss, Betty should be working on gaining less weight next year than she did last year. Indeed, if Betty could manage to just put on 5 instead of 10 pounds in the next 12 months, she would have spectacularly succeeded in cutting her weight gain in half – quite the achievement! Perhaps, with a professional help and empathic support she can even manage to make it through the next 12 months with no weight gain at all – imagine the success – for the first time in 12 years, Betty will not have gained a single pound in a whole year! Imagine if Betty had only received the help she needed 12 years ago – she may well have avoided a 120 pound weight gain! Had she even just cut her annual weight gain in half, she would be 60 pounds lighter than she is now. But, why not simply jump into the next diet or exercise program – or book… Read More »
Post-Surgery Weight Regain: Nutritional Factors
One of the key reasons why bariatric surgery is so much more effective for treating severe obesity than non-surgical approaches, is because of its profound effect on food intake. Thus, bariatric surgery significantly affects hunger and satiety and may even have important effects on “wanting” and “liking” of high-caloric foods. However, this effect on ingestive behaviour is neither “guaranteed” not are these effects consistent between individuals. As I tell my patients, “The surgeons operate on your gut, not your brain”. Thus, it can only be expected that a certain proportion of patients will struggle to control their food intake despite surgery, thereby either losing less weight than expected or putting the weight back on. In an article, published in Obesity Surgery, we systematically reviewed the published evidence on the role of dietary factors in this issue. As may be expected, patients reporting “loss of control” of eating behaviour post-surgery lost less weight or had a higher risk of gaining back any weight they may have initially lost. Thus, individuals with self-reported “high-adherence” scores tended to lose and sustain greater weight loss than those who did not. Given that bariatric surgery may limit the amount of food that can be eaten at a single meal, some patients resorted to grazing behaviours (defined as consumption of smaller amounts of foods over extended periods of time) leading to subsequent weight regain. In addition, it was reported that poor diet quality, characterized by an excessive intake of calories, snacks and sweets, as well as oils and fatty foods, was statistically higher in patients experiencing weight regain. Interestingly, even short-term dietary “indiscretion” (or falling off) can result in very rapid weight regain. This is not surprising as, in this regard there is little difference between someone who has lost weight through surgery or simply through diet and exercise. Irrespective of how the weight is lost, the body appears to retain its ability to rapidly regain lost weight if allowed to do so. Thus, as we discuss in our article, “The existing literature strongly suggests that nutritional and lifestyle compliance is crucial to weight management post- bariatric surgery.” “Comprehensive weight management programs must therefore provide improved patient education and promote adherence to post-bariatric surgery diets in order to ensure success. These programs must take action to support patients towards a long-term goal of healthy and appropriate dietary choices with active monitoring (journaling) and reinforcement (review of… Read More »
