neo-neocon » Blog Archive » What we don't know about obesity …

The New England Journal of Medicine has published an article that sounds both interesting and brave, about obesity’s myths vs. what we actually know.

I write “sounds” because the article itself is behind a firewall, and I’ve only read this NY Times piece describing it. But it’s a rare thing for a medical article to try to explode the common “wisdoms” about obesity that are not based on much of anything except some correlations.

Here’s the gist of the article:

MYTHS

Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.

Set a realistic goal to lose a modest amount.

People who are too ambitious will get frustrated and give up.

You have to be mentally ready to diet or you will never succeed.

Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Ideas not yet proven TRUE OR FALSE

Diet and exercise habits in childhood set the stage for the rest of life.

Add lots of fruits and vegetables to your diet to lose weight or not gain as much.

Yo-yo diets lead to increased death rates.

People who snack gain weight and get fat.

If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

FACTS — GOOD EVIDENCE TO SUPPORT

Heredity is important but is not destiny.

Exercise helps with weight maintenance.

Weight loss is greater with programs that provide meals.

Some prescription drugs help with weight loss and maintenance.

Weight-loss surgery in appropriate patients can lead to long-term weight loss, less diabetes and a lower death rate.

Personally, I’ve long been impressed by how much garbage is out there about weight loss. My own observations?

(1) There’s a difference between overweight and obesity, and it’s not even clear that the first has negative health consequences.

(2) The path to overweight and/or obesity is different for different people, and there is no universal remedy.

(3) In fact, remedies are very difficult to come by, and it’s not because of some moral weakness or lack of willpower in overweight people. Losing weight and keeping it off is very, very hard for most overweight or obese people.

(4) Nevertheless, it’s easier for men than for women, and for young people than for the middle-aged. This is for physiological, not psychological, reasons.

(5) Many people who are overweight do not eat more than many thin people, or exercise less.