The Plus and Minus of Weight Satisfaction
For most people, dissatisfaction with their current weight is the biggest motivator to lose weight. This dissatisfaction is a direct function of an individual’s concept of what constitutes ideal weight. Thus a change in the perception of ideal weight, and thus in weight satisfaction, is likely associated with a change in weight-loss practices. This notion is very much in line with a recent finding by Jennifer Kuk (CON Bootcamper!) and colleagues from Toronto’s York University, just published in the American Journal of Epidemiology. Kuk and colleagues examined the relationship between self-declared ideal weight, body weight satisfaction and health practices among 15,221 men and 4,126 women in the 1987 and 2001 participants of the Dallas Cooper Clinic Aerobics Center Longitudinal Study. Interestingly, participants in 1987 reported higher ideal weights than participants in 2001, an effect particularly pronounced from 1987 to 2001 for younger and obese men (85.5 kg to 94.9 kg) and women (62.2 kg to 70.5 kg). Perhaps not unexpectedly, for a given body mass index, higher ideal body weights were associated with greater weight satisfaction but lower intentions to lose weight. Body weight satisfaction was also associated with greater walking/jogging, better diet, and lower lifetime weight loss but with less intention to change physical activity and diet or lose weight. In contrast, BMI was negatively associated with weight satisfaction and was associated with less walking/jogging, poorer diet, and greater lifetime weight loss but with greater intention to change physical activity and diet or lose weight. Thus increased weight satisfaction, in conjunction with increases in societal overweight/obesity, may decrease motivation to lose weight and/or adopt healthier lifestyle behaviors. On the other hand, as argued before, weight satisfaction may also be protective against weight cycling and negative psychological effects, which may well be as, if not more, troubling than carrying a few extra pounds. It will clearly be of interest to determine where exactly the psychological benefits of weight satisfaction and failure to adopt a healthier lifestyle cancel each other out. AMS Edmonton, Alberta
Sharma on Oprah
OK, I am not actually on Oprah (yet?) – rather, this post is only about comments I was asked to make about Oprah’s “catastrophic” weight regain by Judith Timson, who interviewed me for her column, which appeared in yesterday’s Globe and Mail. To read what Judith (and I) had to say – click here Last week, Yoni blogged about the same topic – for his take on Oprah – click here I think Oprah has made the same mistake that most people make – they think there somehow must be a “cure”. Unfortunately, there isn’t – there are only treatments – when you stop the treatment, the weight comes back – ALWAYS! End of Story! AMS Edmonton, Alberta
When will Health Professionals Understand Obesity?
With all the talk about obesity and its increasing role as the root cause of many chronic diseases (type 2 diabetes, osteoarthritis, and sleep apnea to name a few), you would think that health professionals are now regularly counseling their patients to manage their weight. Well, this clearly does not seem to be the case, at least according to a new study by Jean Ko and colleagues from Johns Hopkins, Baltimore, MD, just published in Preventive Medicine. Not only does this national (US) cross-sectional survey in over 1800 obese adults show that only around 40% of individuals reported being advised by their physicians to lose weight (this advise was more likely to occur in women and in people who also had chronic diseases), but that the advice given clearly did not reflect much understanding of obesity management. Thus, although ample data show that exercise is NOT the most effective way to lose weight, this was exactly the advise given to 86% of the subjects. In contrast, changing diet, the best way to lose weight, was only recommended in 64%. Overall only 60% received the recommendation to both change their diet and to increase physical activity. But the really scary finding of this study was the amount of weight loss recommended: 21%! To put this into perspective – the average long-term result of the best behavioral intervention studies is 3-5% weight-loss, while adding pharmacotherapy to lifestyle results in long-term weight loss (while treatment continues) of only 10-15%. Sustained weight loss of 21% is in fact at the lower end of the average weight loss achieved by bariatric surgery (long-term weight loss in the SOS study was only 16%), which is generally in the 20-30% range. I can well understand, when patients have ridiculous ideas about sustainable weight loss, but for health professionals to be advising unrealistic weight loss targets that are inconsistent with the ample evidence to the contrary is simply embarrassing! I am convinced that few health professionals actually appreciate that for a 200 lb individual to lose 20% (=40 lbs), they are talking about a SUSTAINED energy deficit of 140,000 KCal. For a daily energy deficit of 500 KCal – difficult enough to achieve, let alone sustain – this would require at least 280 days (~ 9 months) of “dieting”. In reality, because of the obligatory homeostatic counter-regulation that occurs with weight loss, to sustain this degree of weight… Read More »
Waist Loss Trumps Weight Loss
Yesterday, I had the pleasure of listening to Robert (Bob) Ross from Queen’s University, Kingston, Ontario, speaking at the 77th European Congress on Atherosclerosis, Istanbul. Turkey. Here are his key messages: 1) Exercise helps reduce visceral fat even if you don’t lose much weight. Walking as little as 60 mins a weeks can have an effect – of course, the more the better 2) Measuring waist circumference can detect changes in abdominal fat even when overall weight does not change 3) People who are exercising to lose weight may lose their motivation if they solely focus on weight and fail to recognize the “other” health benefits of exercise Anyone who has heard Bob speak, knows that he is a most eloquent and persuasive speaker. Very much enjoyed his talk. Great work Bob! AMSIstanbul, Turkey
Back Surgery Does Not Cure Obesity
Immobility, due to pain or otherwise, is certainly a major contributor to weight gain. Pain is indeed often presented by overweight and obese patients as a factor limiting their ability to lose weight. Given the widely-held (but false!) belief that exercise is the most effective way to lose weight, the general expectation of both patients and health professionals is probably that restoring mobility by relieving pain will enable patients to be more physically active and thereby lose weight. But is this actually the case? This issue was recently addressed by Ryan Garcia and colleagues from the Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH in a study just out in the Journal of Bone and Joint Surgery. Garcia and colleagues examined weight changes in 63 overweight and obese patients with neurogenic claudication who experienced substantial pain relief after lumbar decompression surgery for spinal stenosis. Although Zurich Claudication Questionnaire (ZCQ) Symptom Severity and Physical Function scores significantly improved by a mean of 56.4% and 53.0%, respectively, body weight and BMI significantly increased by 2.48 kg and 0.83 kg/m(2), respectively. Overall, an average 34 months after surgery, 35% of the patients had actually gained at least 5% of their preoperative body weight while only 6% of the patients weighed at least 5% less than before their operation. The vast majority (59%) remained within 5% of their preoperative body weight. This study, consistent with several previous studies on joint surgery, nicely documents that increased mobility after pain-alleviating surgery does not necessarily translate into weight loss – in fact, most people will either continue to gain weight or simply stay the same. Obviously, this should not be an argument against alleviating pain in obese patients – no one deserves to live with pain. It just goes to show that increased mobility alone is not likely to substantially lower body weight – at best, it may prevent further weight gain (difficult enough even at the best of times). This is probably something patients should be counseled about to not raise any false expectations. On the other hand, it is important to note that this was not a weight-loss study. This means, that patients were not expressly counseled for weight loss or offered obesity treatments. The question therefore remains whether or not improving mobility in patients by alleviating pain would improve efficacy of obesity management strategies (which I believe it would). That is obviously… Read More »
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