• 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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    • Aaron

      Since this post contains two personal anecdotes I would like to deviate from the studies theme and relate another weight loss story which, although may not be universally applicable, is relevant to a significant portion of the population and also relates to a previous post with a chart of increasing future health care costs.

      My DO family doctor noted last year that my fasting blood glucose numbers had been slowly creeping up over a number of years. He is intimately familiar with my blood since he has me on simvastatin for high cholesterol likely inherited from my mother and checks the numbers four times a year. I have been with him over 10 years and we are also about the same age (about 65) and have bonded to some extent over aging issues we share. He projected that if I didn’t do something now I might reach type 2 diabetic status in 5 years or so. He also believes that we as a country are on the leading edge of a type 2 diabetes epidemic which will ultimately be a dominant driver of health care costs. He believes that diet is significantly involved and is coupled to obesity. He has read that in the not distant future a large part of the practice of family doctors like himself will revolve around managing type 2 diabetes.

      He recommended a basically no starch diet to me(look for “low glycemic load). He himself had the same glucose progression as I did along with his brother (a commercial fisherman!) and said his reading indicated about 1/3 of the US population is starch sensitive in that it is part of a process leading to insulin resistance in the muscles and type 2 diabetes. Weight loss wasn’t the main motivation for his recommendation to me although I had steadily crept up over the years from my high school weight of about 135 to about 160 (mostly around my middle) on a light 5′-11” frame. I embraced his recommendation completely and my wife kindly did too. It’s very difficult abandoning a lifetime of bread, potatoes, rice, corn, etc. but the results were startling. We lost weight and my glucose and hemoglobin A1C numbers went back to normal and my cholesterol numbers improved a worthwhile amount in spite of probably eating more animal fats (meat and cheese). I dropped back into the 140+/- pound range over a few months. My wife who shares none of my blood sugar or cholesterol anomalies also dropped over 20 pounds over the same time frame and is back in her high school sizes. We also stuck to the other important part of the prescription–1/2 hour minimum walking per day. We have held these weight averages for many months now and maybe still are drifting down slowly. My doctor had experienced the same results which is why he was so positive that I should try it.

      Our diet was very hard to maintain in our world of cheap starchy carbs and ingrained habits but we never limited our portions of the things we could eat (more protein, green vegs, etc) nor had to give up our two drinks a day. The glycemic load charts available were good guides for us but it was basically apparently all about about avoiding starch for me, not carbs per se for my blood glucose and it worked for both of us as a weight loss regimen with fairly rapid results. Granted we didn’t start from a condition of serious obesity but then again few of us are born obese.

      I don’t see us as a society moving to a diet like ours as long as our food supply is dominated by large multinational grain (starch) suppliers. As the NYT article you reference points out they own our food distribution network all the way down to the fast food chains and have significant control over our relationship to food. I am now convinced that our national diet is a significant component in our obesity problem and our probably related type 2 diabetes problem. If as my doctor says 1/3 of the US population shares our genetic propensity we are in for a rough ride on medical costs significantly due to our food culture. In relation to weight loss I believe there is a way for at least some of us to lose weight at a more than glacial pace especially if you start soon enough mainly by changing what you eat rather than how much.

      Regards to you and your efforts.

      Dick

      And don’t forget the walking.