• With obesity, slow and steady may win the race

    Although I’ve threatened to blog about it for some time (and still haven’t), my time with Weight Watchers continues. Quite successfully, I might add. If I lose another half a pound, I will be the lightest my wife has ever seen me. It’s rather shocking.

    What I’ve always found is that it isn’t starvation for a few weeks that wins for me, or elimination of an entire nutrient or food group, but rather a change to my eating habits that I can sustain over the long term. Sometimes it feels like a big change is needed. That may be an overestimation. Check out this new paper in the American journal of Preventive Medicine:

    Background: The federal government has set measurable goals for reducing childhood obesity to 5% by 2010 (Healthy People 2010), and 10% lower than 2005–2008 levels by 2020 (Healthy People 2020). However, population-level estimates of the changes in daily energy balance needed to reach these goals are lacking.

    Purpose: To estimate needed per capita reductions in youths’ daily “energy gap” (calories consumed over calories expended) to achieve Healthy People goals by 2020.

    Methods: Analyses were conducted in 2010 to fit multivariate models using National Health and Nutrition Examination Surveys 197102998 (N46,164) to extrapolate past trends in obesity prevalence, weight, and BMI among youth aged 2-19 years. Differences in average daily energy requirements between the extrapolated 2020 levels and Healthy People scenarios were estimated.

    When I started WW a couple months ago, they recommended I lose 10% of my weight as a goal. I scoffed. That seemed impossible. Yet now I’m less than a pound away from that goal. Reducing childhood obesity to a level of 14.6% in 2020 would also be a big deal. That sounds almost impossible.

    But let’s say we want to make that happen. What would kids need to do in order to reach that? They’d need to increase their energy expenditure an average of 64 kcal/day.

    I kid you not. 64 calories. That means they could either burn off 64 more calories, or consume 64 calories less. That’s… just not that big a deal in the scheme of things. The authors of the paper even offer some hekpful suggestions:

    1. Afterschool programs for kids in grade K-5 can burn off about 25 kcal/day.
    2. Replacing sugared-beverages in schools with water could result in consuming 12 kcal/day less.
    3. Watching an hour less of TV could increase energy expenditure 100 kcal/dey through reduced sedentary behavior and less snacking while watching.

    I really don’t want to minimize the issue. Sustained behavioral change at the population level is hard. But I’m tired of reading piece after piece on how bad obesity is or how much it costs us. WE KNOW THERE’S A PROBLEM. Let’s fix it.


    • I just posted up along a similar theme.

      A special kind of patient:


    • Moving to the UK from Texas, I was amazed at how few obese people I saw; if any. I didn’t have one co-worker who I would consider severely overweight. Many of these same co-workers would routinely eat bacon & butter sandwiches for breakfast, drink a couple pints at lunch and a few more after work. From a calorie intake standpoint, I couldn’t recognize much difference between my Brit co-workers and my former American co-workers.

      Most of my American co-workers get in their car, drive to work, sit in a chair all day then drive home. All my Brit co-workers walked from the house to the train station, walked from the train station to the office then did the same on the way home. None of them had gym memberships; they just walked about an hour a day. I had two American co-workers who moved over with me and they said they had lost considerable weight over 2 years even though they believed their eating habits hadn’t changed much. In addition, they probably drank a bit more alcohol which is so called “useless” calories.

      There could be other variables at play, but based on my experience just getting minimal exercise on a daily base can have big health benefits.

    • I am suspicious about the 64 calorie figure. I understand that mathematically if 64 more calories per day are metabolized (without taking in any more calories), or the body takes in 64 fewer calories (with the same calories metabolized), the reduction in obesity occurs. But the human body is more complex than that. For example, if a person eats 64 fewer calories, the body is likely to compensate by slowing down the metabolism and burning fewer calories. So to net 64 fewer calories, it may require eating far less than only 64 fewer calories. Similarly, increasing exercise to burn an additional 64 calories is likely to send a signal to the body to slow down metabolism and burn fewer calories during non-exercise periods (not to mention that exercise makes a person hungrier and more likely to eat more calories). So again, to net 64 additional burned calories, it may require burning far more than 64 calories. I think we do a disservice to people who are trying to lose weight to argue for these simlplistic and misleading solutions.

      • That’s not what you need to do to lose weight. That’s what we need to do at a population level to prevent young children from getting obese.