Tuesday, August 23, 2011

The Politically Incorrect Guide to Weight Loss

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Don’t try this at home.

Currently I have something important in common with British welfare mother Susanne Eman. We are both watching our weight. She is doing so in order to more than double her mass such that she will weigh over 1,600 pounds and be the heaviest human in history. I, on the other hand, have the more modest goal of losing 40 pounds. I was pretty skinny most of my life, but after college my weight gradually rose until my BMI entered the low overweight range. I have been surprised at my success so far, so I thought I would share my tips and some provocative science.

1. Love yourself, but do not accept your weight.

I have heard physiological arguments for fat acceptance. I do not doubt that weight has a complex endocrine regulation, and as obesity spreads, genetics influences who becomes obese first. However, personal psychology is what allows this shocking spread of obesity in America, which the CDC has illustrated with this animated map.


People tell themselves many excuses to relax their weight control expectations. Among these excuses are shifting blame to bad genes, previous pregnancy, or advancing age. I could help them by citing some additional causes of obesity. Race, work hours, stress, sleep, smoking, and various drugs affect weight. Some think that Helicobacter pylori eradication increased ghrelin production, and, thereby, obesity. Two adenoviruses have been linked to obesity, but obesity primarily spreads like a virus because relaxation of weight control expectations is normative. Such was the conclusion of a 32-year Harvard study, which found that obesity increases the obesity risk of others in a social network to three degrees of separation. Geographical distance had no effect, so the influence was exerted by having knowledge of one’s associates becoming obese, not living in the same place.

Nothing better illustrates the truth of that study as the incredible success of Singapore’s “Trim and Fit” (TAF) program, which lasted from 1992 to 2007 and decreased childhood obesity from 14% to 9.5%. After its end, childhood obesity rose to 12%. Why would such a successful program come to an end? TAF received substantial criticism for using peer pressure to motivate children to lose weight and for stigmatizing children. A pair of studies (only one of which appears to have actually been published) claimed that TAF drove children to have eating disorders. Briefly, I should mention how remarkable the hysteria over anorexia nervosa is, given what we know about how rare and how heritable it is.

Another example of this dynamic is the success of fat acceptance in promoting obesity among African-American women. Whereas a third of non-Hispanic white women are obese, most non-Hispanic African-American women are obese, but they think they are thinner than they are and are more satisfied with their size. This has forced the usually politically correct public health researchers to advocate “multifaceted intervention” to dispel these “overly optimistic beliefs.”

Clearly the feminist fat-acceptance movement is destroying lives, so I would be remiss to not thank Michelle Obama for her campaign against obesity. I find it very strange that conservatives have joined radical feminists in criticizing her just because she happens to be married to a Kenyan Muslim.

2. Buy a digital scale.

I had a spring scale that grossly underestimated my weight. Family practice doctors typically use balance beam scales, but those are expensive and less convenient than a simple digital scale. Digital scales are so precise that I can immediately see the consequences of my actions. If I overindulge at a meal, it shows. Water loss from a heavy workout shows. This feedback is great for overcoming a sense of weight inertia.

3. Do not play sports.

It should not surprise that the country with the largest sports market has the highest obesity rate. Of course, some people have improved health from playing sports, but I would advise against it for several reasons. First of all, I have met so many people who suffer from obesity and its co-morbidities and are helpless to do meaningful exercise due to an old sports injury. Australian researchers determined that, over a 2-week period, 5% of participants will have a sports injury. Injury prevents physical activity in 20% of 18-to-59-year-olds and 40% of those over 60. Sports injuries, therefore, contribute to obesity, which aggravates injuries. Many turn to prescription painkillers to mask the pain, leading to a downward spiral of opioid tolerance and addiction.

For those who avoid injury, sports can lead to obesity in other ways. American football actually encourages weight gain to produce massive players. In fact, many sports emphasize muscularity or other athletic qualities as more important that cardiovascular endurance. Sports participation is associated with excess alcohol consumption, which can cause obesity. Also, the mentality of sports deprives exercise of spontaneity. As people age, the infrastructure of organized sports leaves their lives, and they let their bodies go. Finally, sports create winners and losers. Those who repeatedly lose will feel discouraged from continuing, and those who always win might not feel a need to push themselves further.

4. Run instead.

When someone takes my pulse, they initially panic before they remember to ask me if I am a runner because runners have slow heart rates. Since heart disease is America’s number-one mass murderer, I find it comforting to know that my heart is not working too hard.

I suppose I should support the need for exercise, itself, before I further try to sell running. The straw-man critique of exercise, laid out last year in The Guardian, is that exercise alone does not reduce weight because people tend to compensate or reward themselves with additional calories or time of inactivity. So, while some might react to such an article by thinking that exercise is worthless, the studies it cited actually called for coupling exercise with dietary changes and increasing exercise intensity. One of the studies actually emphasized health benefits to exercise other than weight loss, including improved blood pressure and reduced abdominal fat.

So, here is my case for running. Running might be difficult for some people in inhospitable climates, but for the rest of us, it is a simple, time-efficient means to a lifelong exercise regime. Running is also a fun, stress-relieving activity that allows one time to think. At the end of a run, I have a renewed sense of well-being.

My routine is a 6-mile distance that allows me to minimize contact with traffic while still reaching a park for water, restroom access, and equipment suitable for toning exercises like pull-ups. USA Track and Field allows you to create a route map and measure its distance or look at others’ maps, which can include markers for water fountains.

I realize that some people believe in swimming because it puts less strain on joints, but I have heard conflicting data on whether running really is bad for joints. Running is certainly good for bone strength, but, above all, I think running is more conducive to an intense, enjoyable workout. When I swim, I am tempted to just have fun rather than do laps, and I cannot lose myself as I can running because I would bump my noggin.

5. Music helps.

I do not believe in sweating to the oldies, folk, jazz, country, or Rebecca Black. If you decide to take up running, I challenge you to channel your inner Kurt Cobain. I would place the motivation and enjoyment that music provides as a more important component to running than shoe type, and some forms of music have great artistic merit but do not fit a running habit. I generally prefer two styles of running music: energetic release music and runner’s high music. For the former, I need the uninhibiting verve of punk-inspired angst anthems and mechanized industrial torture devices. I look for the atmospheric and sublime in the latter, like a good Radiohead song or an electronic instrumental tapestry. Of course, every athletic badass has a secret pop smash hit somewhere on his mp3 player.

I would recommend Bluetooth headphones for running, rather than earbuds. Some mp3 players do not support Bluetooth without an adapter, but Insignia used to make decent Bluetooth mp3 players, which can be bought used for very little.

6. Do not run marathons.

I know a number of very healthy people who strongly believe in running marathons. Some run so many marathons that preparing for them is their typical running regimen. I do not share this enthusiasm for marathons because I think these push some people to treat running like an occasion for an accomplishment, rather than a steady exercise habit. Some studies show that marathon running is perfectly safe, but one MRI study found evidence of cartilage damage.

7. Exercise controlled shopping.

I have a sweet tooth. I love rich foods. Therefore, I am keenly aware that will power starts at the supermarket. Many people who struggle with their weight unfortunately decorate their homes with bright advertisements for unhealthy snacks on the sides of bulk packages. Instead of conditioning oneself to sugar highs like Pavlov’s dog, one should shop to bolster will power by purchasing fruit and sugar-free gum.

8. Do not overthink dieting.

Debates over diet types among advocates with vested interests are startlingly ugly. Any diet that truly decreases calorie intake will facilitate weight loss, and I think most people have a decent conception of the difference between healthy and unhealthy foods. Whole grains are better than refined. Soda increases weight, and I cannot understand why anyone ever drinks it. Fish is a good source of healthy fats. My problem with dieting plans is that they make people obsess about eating and create an illusion that picking the right diet will make weight loss easy. Eat less. Focus on something other than food.

9. Skip meals.

I believe in skipping meals because it has been helping me lose weight, but I am aware that nutritional studies warn against skipping meals and suggest benefits from small, frequent meals. These studies might be flawed by poor reporting of eating habits. The important factor is overall calorie intake and nutritional value. If breakfast is one’s most healthy meal, then skipping it could cause weight elevation, especially if one compensates with a larger dinner. I think a lot depends on how a person can best control his or her own appetite. I have found that by not eating for extended periods, hunger pangs decrease in intensity. People who let their bodies go will often develop diabetes, which requires them to control their blood sugar, making meal-skipping infeasible.

Why Lose Weight?

An extension of the fat acceptance movement is the contrarian view that weight is not important for health. This view flies in the face of recent progress in calorie restriction research, such as a new study that showed that calorie restriction lowers core boy temperature, which is believed to promote longevity. However, most people would not want to join the Calorie Restriction Society. A new study seemed to support the contrarian view when it found few lifestyle differences between a control group and people who have lived past 95. Although overweight women were significantly more likely to have longevity, long-lived men and women tended to not be obese, and if more men over 95 were in the study, perhaps their increased likelihood of being normal weight would have reached significance. A second recent study corroborated that weight control is especially important for men. In fact, optimal male body mass index for reduced mortality was lower than the threshold of being overweight.

Finally, I think it is worth confronting the masculine ideal of the husky, thick-necked man. Some men might have a substantial neck circumference due to heavy muscularity, but that criticism is just as valid for body mass index. I think neck thickness is more associated with masculinity among the lower classes. Doctors are now considering neck circumference as an alternative to body mass index as an indicator of cardiovascular health.


TGGP said...

How heritable is obesity?

nooffensebut said...

Good question. The most recent review paper that I found, Ramachandrappa and Farooqi, says that “changes in environmental factors undoubtedly drive the rise in prevalence of obesity,” but “within a population the variance in BMI … is largely genetically determined with heritability estimates ranging between 40% and 70%.” After the current epidemic began, heritability estimates increased to 77%. If we were talking about height or IQ, then heritability would have more meaning in industrialized societies, but the “heritability of obesity” as something distinct from variant BMI response to an environmental epidemic makes less sense in wealthy Western societies.

n/a said...

Visscher and colleagues estimate 17% of the variance in height can be explained by common autosomal SNPs (compared to 40-50% for height and IQ).


Elsewhere, you posted: "I am all for conceptual simplicity, but I do
not understand why a program that weights variants according to maximum
predictive power is not value-added and within our capabilities with computers."

If I understand what you're asking, they did basically do this in the IQ paper. The problem is the sample sizes are too small, and you can't extract more information than is there. So while it's possible to estimate 40-50% of variance in IQ is explainable by common SNPs (and in this analysis, the relatively small sample sizes just make the result less precise, not biased in any particular direction), when they attempt to use a model built using one set of samples to predict IQs in another sample, they can only predict something like 7-11% of variance right now.

n/a said...

"Visscher and colleagues estimate 17% of the variance in height can "

Should be "17% of the variance in BMI"

Chris said...

I believe I saw research once that showed listening to music actually decreases exercise intensity, by creating cadences below optimal exertion.

Anonymous said...

I'll eat what I want. Period.