A recent research study published in the New England Journal of Medicine has received quite a lot of recent media coverage.

Here are the basics of that study.

 
Myths, Presumptions, and Facts about Obesity

                    Research Study Published 1/31/2013 
                             in the New England Journal of Medicine.

BACKGROUND
Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may
divert attention away from useful, evidence-based information.

METHODS
Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations.

RESULTS
We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations.

CONCLUSIONS
False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press.

(Funded by the National Institutes of Health.)

 Below are the myths, presumptions and facts:

Here are the beliefs that were found to be untrue.

The Myths

1. "Small sustained changes in energy intake or expenditure will produce large, long-term weight changes".

2. "Setting realistic goals for weight loss is important, because otherwise patients will become frustrated and quit".

3. "Large, rapid weight loss is associated with poorer long-term weight-loss outcomes as compared with slow, gradual loss".

4. "It is important to assess the stage of change or diet readiness in order to help patients who request weight-loss treatment"

5. "Physical-education classes in their current form, play an important role in reducing or preventing childhood obesity"

6. "Breast-feeding is protective against obesity"

7. "A bout of sexual activity burns 100 to 300 kcal for each participant" (Their calculation comes to about 14 calories).

These are subjects that as yet remain unproven one way or the other.

The Presumptions

1. "Regularly eating breakfast is protective against obesity"

2. "Early childhood is the period in which we learn exercise and eating habits that influence our weight throughout life"

3. "Eating more fruits and vegetables will result in weight loss, or less weight gain, regardless of whether any other changes to one's behavior or environment are made"

4. "Weight cycling is associated with increased mortality.."

5. "Snacking contributes to weight gain and obesity."

6. "The built environment, in terms of sidewalk and park availability, influences obesity."

These are the nine points the authors feel there's sufficient evidence to be true.

The Facts

1. "Although genetic factors play a large role, heritability is not destiny"

2. "Diets (reduced energy intake) very effectively reduce weight, but trying to go on a diet or recommending that someone go on a diet generally does not work well in the long term."

3. "Regardless of body weight or weight loss, an increased level of exercise increases health."

4. "Physical activity or exercise in a sufficient dose aids in long term weight maintenance."

5. "Continuation of conditions that promote weight loss promotes maintenance of lower weight."

6. "For overweight children, programs that involve the parents and the home setting promote greater weight loss or maintenance."

7. "Provision of meals and use of meal-replacement products promote greater weight loss."

8. "Some pharmaceutical agents can help patients achieve clinically meaningful weight loss and maintain the reduction as long as the agents continue to be used."

9. "In appropriate patients bariatric surgery results in long-term weight loss and reductions in the rate of incident diabetes and mortality."

 Regarding the issue of potential food and drug bias within the study, I think that it's worth noting that the author of the NEJM paper, Dr Allison, has the following disclosure regarding his relationship to the food and drug industry:

"Dr. Allison reports serving as an unpaid board member for the International Life Sciences Institute of North America; receiving payment for board membership from Kraft Foods; receiving consulting fees from Vivus, Ulmer and Berne, Paul, Weiss, Rifkind, Wharton, Garrison, Chandler Chicco, Arena Pharmaceuticals, Pfizer, National Cattlemen's Association, Mead Johnson Nutrition, Frontiers Foundation, Orexigen Therapeutics, and Jason Pharmaceuticals; receiving lecture fees from Porter Novelli and the Almond Board of California; receiving payment for manuscript preparation from Vivus; receiving travel reimbursement from International Life Sciences Institute of North America; receiving other support from the United Soybean Board and the Northarvest Bean Growers Association; receiving grant support through his institution from Wrigley, Kraft Foods, Coca-Cola, Vivus, Jason Pharmaceuticals, Aetna Foundation, and McNeil Nutritionals; and receiving other funding through his institution from the Coca-Cola Foundation, Coca-Cola, PepsiCo, Red Bull, World Sugar Research Organisation, Archer Daniels Midland, Mars, Eli Lilly and Company, and Merck."

 
What about eating frequency? How often should we eat?

Should we eat 3 Square Meals?

Or should we eat 6 Small Meals?

Or should we eat only inside a window of 8 hours or 5 hours?

Or should we, intermittently, have days with only one small meal, or even zero food in a total water fast?

Or should we eat whenever we feel Hunger?

Each of these “Diets”, “Non-Diets”, “Ways-of-Eating”, or “Lifestyles” claims that Scientific Research supports their individual position.

So what DO we do?
The following article by Dr. Yoni Freedhoff of WeightyMatters, supports my own personal position on this question.

Does New Study settle the
3 Square vs. 6 Small vs. the 8 hr Diet Debate?

So this month yet another study in a never-ending line of studies looking to compare the impact of meal frequency on fullness and biochemistry came out. This one suggested that small frequent helped decrease energy intake in normal weight men.

Honestly I pretty much disregard all of these studies.

Not because I'm doubting or questioning their results, just that I don't think their results really matter.

What I mean is that all of these studies fail to address the practical aspects of living with their recommendations, and as a clinician, that's really all that matters to me.

I've seen people controlling calories, loving life and preserving health with 6 small meals daily. I've seen people do the same on 2, 3, 4, and in some cases even 1 meal a day.

Regardless of the research that comes out, what matters more than what a physiology paper says is how you personally feel.

In my office we do tend to start people on small and frequent meals and snacks. But if that doesn't suit or help the individual we'll shift to 3 square meals. We've also recommended the intermittent fasting style that's suddenly finding some traction on the diet book shelves.

You need to find a life that you enjoy, and just because a new study or diet book suggests there's a "better", or "right", way, if you don't happen to enjoy it, it just isn't going to work.

The specific new study referred to is: Psychology and Behavior
www. sciencedirect.com/science/article/pii/S0031938413000243

According to all of the scientific research I’ve read, when we get right down to it, any actual “Health” or “Metabolic” Benefit Differences between all of these eating plans are truly miniscule, and therefore, not even worth the individual effort of personal consideration. The question to consider is which one can we DO?

I ask myself:

• Which Eating Behavior will work for ME in MY weight-loss or maintenance efforts?.
  
• Which Behavior will allow ME to consistently eat less than, or the same as, the amount that My body uses for energy?
  
• Is one Eating Behavior more manageable for ME than another?
  
• Which one can I consistently stay on?
  
• Can I live with one of these Behaviors as a lifetime Habit?

Why is it so difficult to keep weight off?
Apparently, evolution has given us
the mechanisms to gain weight
but not to lose it.

BEFORE indulging over the Holidays, think about what Dr. Ayra Sharma, professor of medicine and chair of obesity research and management at the University of Alberta, Canada has to say about this issue.

How The Hedonic System Ratchets Up Your Weight

“Bill Colmers, the neuroscientist, presented an overview of how the brain affects eating behaviour and regulates body weight.

I was particularly impressed by how Colmers described the respective roles of the hedonic and homeostatic systems in human evolution.

While the hedonic (pleasure seeking) system evolved to help our hunter-gatherer ancestors seek out and take advantage of any highly palatable energy dense foods they happened to come upon, the homeostatic system evolved to protect from wasting away those extra calories that they did ingest.

Thus, according to Colmers, the hedonic system’s job was to make it hard to resist, in fact, make our ancestors to often go to considerable lengths to searching out those rare palatable energy dense foods and then to eat as much of them as possible, whether they were actually hungry or not. They could of course always store those extra calories as fat tissue for later use - a tremendous survival advantage.

In contrast, the job of the homeostatic system was to ‘defend’ those stored calories - in fact, it is designed to regard any accumulation of fat stores as the ‘new normal’ and from then on make sure that this increased level of fatness was maintained (or regained) ever after.

Indeed, the homeostatic system is ‘designed’ to readjust its set point of body weight - after all it has to do this starting from birth as body weight continues to increase as the baby grows into a toddler that grows into a kid and ultimately into an adult.

Unfortunately, the mechanisms that allow the set point to reset to ‘defend’ a progressively higher body weight - generally works in only one direction - after all that is all that is required by nature, where people do not naturally ’shrink’.

Colmers used the analogy of a ratchet to describe how the homeostatic system is designed to defend ever increasing body weights without having the ability to reset itself to a lower body weight even if the person now wants to lose weight.

Once set to a higher weight (e.g. resulting from ‘overindulgence’ driven by the hedonic system or other factors that may promote weight gain), the homeostatic system uses a wide range of mechanisms affecting hunger, satiety, appetite, metabolic rate, etc. to ‘defend’ this weight from then on.

A very helpful analogy I thought, nicely explaining why evolution has given us the mechanisms to gain weight but not to lose it.”

Dr. Arya Sharma, professor of medicine and chair of obesity research and management at the University of Alberta, Canada.

 Previously, I posted an article detailing this ratcheting analogy, for more see:  Set Point

Recently the Stanford University Medical School, Health Policy Forum hosted an event examining the reasons why we get fat and how different diet trends and food policies affect our nation’s obesity rates.

The forum featured a conversation between science writer Gary Taubes and Christopher Gardner, PhD, director of Nutrition Studies at the Stanford Prevention Research Center.

During the discussion, Paul Costello, the medical school’s chief communications officer, talked to Taubes and Gardner about Americans’ misconceptions about food, diet and nutrition, the driving forces behind the obesity surge of the late-80s and the path to a healthier, leaner lifestyle.  Below is a video of that 1 hr 24 minute forum.

Regarding the article I recently posted:  The Fat Trap,  I am one of those people who believes that saying “weight-loss and maintenance is easy” is an unhelpful lie, and that telling people the Truth about weight-loss and maintenance is what is Helpful.

Below are a couple of follow-up questions and answers about the article that I think are worth posting at here at DietHobby.

Reader’s Question:
Were you at all worried that by writing a high-profile article about this research you would discourage people who are unhealthily overweight from trying to lose weight?

Answer from Auther, Tara Parker Pope:
I was really worried that the story would be discouraging to people, but I have been so pleased by the hundreds of e-mails and comments sent by readers. So many readers said to me, “Finally, my life made sense….” and “Now that I understand what’s happening, I’m really encouraged to try again…” One reader wrote that she found the article to be “sobering, challenging, and comforting all at the same time.” We don’t do dieters any favors by telling them that it’s easy and simple. I think telling people the truth about weight loss leaves them far better equipped to tackle the problem.

Reader’s Question:
A fascinating and disturbing part of this article is the section where you detail the extremely regimented lives of a few formerly obese people who have managed to keep off the weight. These rare individuals, as you quote a Yale scholar saying, “never don’t think about their weight.” A Slate article on your piece argues that the mentality of these people “resembles the symptoms of an eating disorder.” They suggested that our fat problem is not obesity but that we encourage people to adopt an eating-disorder mentality to fight obesity. How would you respond to this?

Answer from Auther, Tara Parker Pope
I think if a person had epilepsy and needed to adopt a very regimented diet to control that disease, nobody would accuse them of having an eating disorder. A person with high blood pressure might cut back on salt and take medication, and we don’t judge him. A person with Type 1 diabetes has to be very careful about what they eat and constantly monitor blood sugar to stay well. Again, we don’t question this behavior or call it disordered eating. But a person with obesity as a medical condition is ridiculed for gaining the weight in the first place and then they are criticized for being hypervigilant about maintaining a healthy weight. That said, I thought the Slate article made a good point, concluding “that a society that stigmatizes people for a physical attribute that they can’t change is the real fat trap we ought to be trying to escape.”