Slow and steady wins the race. Probably.

Ta-nehisi Coates makes some excellent points commenting on Tara Parker-Pope’s piece on obesity. I agree that Tara is a bit to pessimistic sounding, although I think the message that losing weight permanently is hard  is probably right. I want to address Ta-nehisi’s comments about the research, though:

I’m not a scientist, but I have lost roughly a quarter of myself. I’ve done it at a glacial pace–almost eight years. So glacial in fact that I wouldn’t even call it a “diet.”: I’ve gained some in that time, but never yo-yoed back to the heights of my girth. The pattern has been more like lose lot, gain a some, lose some gain a little, lose a lot etc.

Obviously I wish this had happened faster and smoother. But the upshot of taking the long way is that I’ve learned a lot about how to negotiate world where, at almost every step, cheap high calorie food is at the ready. You can’t get that understanding in a lab and you’re unlikely to get if your trying to burn of 3-4 pounds a week. That sounds like masochism.

It would have been nice to see Parker-Pope incorporate studies of people who didn’t lose weight through crash dieting. Perhaps those studies don’t exist. I don’t know.

The problem is they don’t really exist. Let me be clear. I, like Ta-nehisi, believe that tackling obesity is glacial work. There’s a general rule I tell my patients all the time. However long it took for a condition to develop is about as long as you can expect for it to go away. It’s not perfectly true, but it’s a good rule of thumb. If you put on the weight over a decade, you’re crazy to think you’re getting rid of it overnight.

It took me years, way too many, to really get a handle on my weight. A number of friends who have only known me for the last five years or so were somewhat shocked by a recently posted older picture of me. But it took that long, and I still need to think about what I’m eating every now and then. It was hard. It took a commitment from my wife as well, to change the way we eat every day. We work out far more than we did five years ago. But it paid off.

And it isn’t over. I could still stand to lose a bit more. My wife, on the other hand, looks like she just taped a workout video.

But let’s get back to the problem with the studies. First of all, in order to do a good study, you’d need to be able to round up  enough people, say hundreds, willing to commit to a decade of lifestyle changes that would produce almost imperceptible results. That’s really hard to do. Even if you could, though, no one would fund that study.

You’ll have to take my word for it. It would cost tens of millions of dollars. That’s just how research is. It’s hard to do, and very expensive. Keeping enough people enrolled in the study would be really difficult. Getting enough to complete it and stick to the changes would be even harder. It would take a decade. No one will pay for it.

The longest grants given out these days might – might – cover a three year trial. So when you submit your gazillion dollar grant for a decade of slow changes, you’re going to lose when you’re up against some trial that promises short term results in a year or less. Plus, there’s less and less money out there. The agency that was most likely to consider this type of work just announced they will no longer be funding those kind of proposals.

No one wants to wait years to see results. No one wants to make the hard changes. No one wants to pay for the studies that all of this will require. So we won’t get those studies. We’ll get more of the same.

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