response 22 of 378:

Mar 3 23:48 UTC 2006

Apparently not.

response 24 of 378:

Mar 4 01:47 UTC 2006

Jim was told that his cholesterol was too low (145 total) so he started eating
eggs and cheese once in a while.  160 is supposed to be ideal.  I have not
bothered measuring mine.  Changing the types of things you eat affects your
weight without trying to diet.  I weighed 20 lb more when I ate school food,
which was always greasy and had a lot of desserts.

My grandmother was obese all her life and died at about age 70 of diabetes.
Nobody else in the large family has had diabetes.  I have one neighbor,
overeight, with diabetes, who was told to lose weight and it would get better.

response 26 of 378:

Mar 4 07:34 UTC 2006

I didn't say that a doctor should tell a patient they should lose weight 
(though it is a reasonable thing for a doctor to do).  Because of your 
sensitivity to the subject of losing weight I said "Isn't it reasonable 
for a doctor to tell people....... what their most healthy weight would 
be?" Then you can decide what you will do about it (but don't blame the 
doctor if you get sick).

I don't understand the argument that doctors should not tell patients to 
lose weight because the patient will inevitably (really?) gain it back 
again. That sounds like the patient intends to gain it back again. After 
all, if one goes through the trouble of losing weight, it is less trouble 
to keep it off. 

Re #24: I am surprised that Jim's doctor thinks a cholesterol level of 145 
is too low. Mine is 135 and my doctor is delighted. 

response 28 of 378:

Mar 4 12:53 UTC 2006

You'd be winded too Jeanne if you had 100lbs on your back and carried it
up a flight of stairs! ;)

response 30 of 378:

Mar 4 14:05 UTC 2006

re 28.  I have had that in the past.

re 29.  That's because you're starting to reach your capacity with 
your lungs.  What would be interesting it to check your heart rate 
after each flight to see how much it increases.

response 32 of 378:

Mar 4 14:15 UTC 2006

except there are only two flights of stairs to go up there. I'll need to
go to a taller building. I sometimes wonder if the two flight thing is
related to the fact that usually the only stairs I climb are at work so
I have gotten used to going up two flights. 

response 34 of 378:

Mar 4 16:41 UTC 2006

If you know of a study of morbidly obese patients who enter a structured
weight loss program where the success rate was better than 95% over a
five year period, please share it. I tried to find one via google but
wasnt able to. The only weight loss method that I found that had better
success rate was gastric bypass surgury (and that was on a website put
up by people who do gastic bypass surguries). 

There are health risks associated with severe obesity, especially if a
person is more than a hundred pounds overweight (as I am). I dont doubt
that severe obesity even causes some things like joint pain just like I
dont doubt for a minute that excess body fat is a complication in
surgury. I havent ever heard about the PE thing from sitting on a couch
for a couple of days but that doesnt surprise me. But since the failure
rate for diets is so high and because dieting causes health problems of
its own, telling people to lose weight is not good medicine imho. People
should be encouraged to be as healthy as they can be at whatever weight
they happen to be. (some of those healthy behaviors might cause some
patients to lose weight and that is great but it is the healthy
behaviors that should be the focus)

I also have seen statistics that show that obese people are less likely
to seek regular preventative health services. Based on my own experience
and on what I have heard a lot of other fat people say, it is likely
that is due to way doctors and nurses often treat fat people. Even when
the doctors and nurses are completely professional, they still often
share our culture's idea that it is immoral to be fat and that can come
out in subtle ways. 

response 36 of 378:

Mar 4 22:54 UTC 2006

resp:35

I first read that statistic in "The Obesity Myth" (aka "The Diet Myth")
by Paul Campos. I gave my copy away though but it was my impression that
yes, 95% (give or take depending on the study) of participants gained
back all of the weight they had lost or were actually heavier than when
they started. The current book I am reading which was writting by a
couple of eating disorder experts mentions it too but doesnt cite
specific studies, unlike Campos. 

No, I am lumping obese people in with everyone else who has something
about them that is a health risk that either would be impossible to
nearly impossible to change. I remember my health econ prof, while
talking about health studies and evidence based medicine, mentioning
that being male is a huge health risk. He said it wasnt as risky as
smoking but it was about as risky as being obese. But being male isnt
something a person can control, you say. It is a state of being and not
a behavior. But is obesity also a behavior? Or is it a state of being?
Eating a healthy diet is a behavior. Exercising is a behavior. Being fat
is not a behavior. 

response 38 of 378:

Mar 5 00:33 UTC 2006

Interesting study. Thanks for the link. 

Some comments about the study mentioned in resp:147

*It studied only two very specific types of diets. I dont know anything
about them. They do seem to be two types that involve more medical
intervention than the average self imposed diet. 

*a lot of the people in the original groups (some groups had as few as
50% of the original subjects available) that lost weight were not
available for the 4 or 5 year followup. I think the possibility for self
selection should be considered i.e. people who gained all of their
weight back would be more likely not to want to participate in the
followup. 

*There is no mention of the percentage of original subjects who had any
weight loss at all. Which means that when they say something like that
there was an average weight loss of 3.0kg (Which is around 6.5 lbs)
there is no way to know if 3.0kg is a typical amout of weight loss for
most people in the study or if a few people lost large amounts of weight
.

Mary says, "It's pretty much understood that an obese person can make a
significant improvement in health by losing just 10% of their body
weight." 

I am not sure that is true but I dont exactly doubt it either. But ok,
lets assume that you have a 300lb person who is 6ft tall and who loses
30lbs by eating a healthy diet and exercising regularly. Would you say
that person is healthy? Would you say that person is doing all they can
for their health assuming they dont engage in other high risk behaviors?
I would. But that person would still be over a hundred pounds
overweight! 

Mary says, "Heck, not gaining sounds positive, which is what probably 
would have happened had they given up and not tried to lose weight to
begin with." 

I dont believe that is true necessarily. FWIW, most of the people I know
who have stable weights dont diet. I havent gone on an "official" diet
in around five years and I havent gained any significant weight during
that time. (not counting when I gained back the weight I lost when I
went on Zoloft a couple of years ago). 

FWIW, I am not advocating that people start stuffing their faces with
pizza or french fries or snickers bars or anything like that (although I
think if someone does want to do that, they should be able to without
being subject to ridicule and shame but that is another subject). I am
saying that for a lot of people, dieting is harmful for their health.
Not all weight loss diets are healthy. Most weight loss diets fail.
Diets can lead to eating disorders. 

I am not even against weight loss, btw. I think that whenever an
overweight person with a bad diet and poor exercise habits changes those
behaviors, they will probably lose some weight. That is natural. But
they will not necessarily lose enough weight to put them into a normal
weight catagory. Some people will still be fat even if they eat a
healthy diet and exercise. 

response 40 of 378:

Mar 5 01:07 UTC 2006

at first, i was going to read mary's post, but then i realized it wasn't about
me.  :(

response 42 of 378:

Mar 5 12:41 UTC 2006

Re: 38 The research looked at two different types of diets, not really 
specific diets.  VLEDs are very low energy diets (low calorie) diets and 
HBEs are diets where the Harris-Benedict equation is used to calculate a 
person's specific caloric needs and then setting a caloric goal just under 
maintainance requirements.

 "But ok, lets assume that you have a 300lb person who is 6ft
  tall and who loses 30lbs by eating a healthy diet and exercising 
  regularly. Would you say that person is healthy?"

I would say that person is healthier.

 "I am saying that for a lot of people, dieting is harmful for their 
  health. Not all weight loss diets are healthy. Most weight loss diets 
  fail. Diets can lead to eating disorders."

Agreed, not all diets are safe.  But for the most part people don't tend
to tolerate reckless diets for long so they don't damage their bodies as
much as they give themselves the message they are failures and it makes
it harder to try again.  And if someone weighs ~300 pounds they already
have an eating disorder. 

response 44 of 378:

Mar 5 15:34 UTC 2006

resp:39 - I would consider such a diet a success too!

resp:42 I think I will have to disagree with you. I think it is possible
for a person to be overweight and healthy. In fact, in my own family, my
severely obese grandmother has been healthy her whole life (until
recently) and is currently in her nineties. I think that when you get
into the over 100lbs catagory, there are some weight related health
risks but because diets fail so frequently, it causes more harm than
good to tell people to lose weight. It is better to recommend a healthy
diet and to encourage exercise. 

Here is an exerpt form Laura Fraser's book _Losing It_ where she talks
about a study done at Cornell.

"The health risks of being underweight haven't been calculated into any
of these equations... In a 1996 study, David Levitsky and his colleagues
at Cornell University analyzed 60 previous studies involving weight and
early deaths, involving 357,000 men and 249,000 women (many times more
than the Nurses' Health Study), and found that the health risks of
moderate obesity were exaggerated, whereas the risks of being
underweight have been neglected. For women, there was little
relationship between weight and early death at all. For men, after
controlling for confounding factors such as smoking and disease, the
data showed . . . those men who were very underweight were as likely to
die early as people who were seriously obese. For everyone between the
extremes, weight wasn't a substantial factor in their death. "The health
risks of being moderately underweight are comparable to that of being
quite overweight and look more serious than most people realize,"
Levitsky said."

Here is an exerpt from an article in The New England Journal of Medicine
written by Jerome P Kassirer, MD and Marcia Angell, MD.

"Given the enormous social pressure to lose weight, one might suppose
there is clear and overwhelming evidence of the risks of obesity and the
benefits of weight loss. Unfortunately, the data linking overweight and
death, as well as the data showing the beneficial effects of weight
loss, are limited, fragmentary, and often ambiguous."


I also do not necessarily think that every person who is overweight or
even severely overweight has an eating disorder at least not in the way
I think of eating disorders. I think anyone who eats when they are
hungry, eats reasonably healthy foods,  and who stops eating when they
are no longer hungry probably doesnt have an eating disorder. Of course
if one defines an eating disorder as having any eating habits that lead
to be one being fat than any fat person would have an eating disorder by
definition. 

However, I will grant you that it is probably pretty hard to find
someone who weighs over 300lbs who doesnt have some sort of messed up
ideas about eating. Partially because I doubt you can find anyone who is
that overweight who hasnt tried just about every diet in the universe.
And partially because of the way our culture treats obesity as a moral
issue. If a person is given the message that being fat is a moral
failing (and trust me, every fat person gets this message in one way or
another), and that no one who eats a healthy diet and who exercises can
possibly be fat, then every bite of food gets questioned and a person
might find they have food issues. 

resp:43 - I think there is a lot of room for improvement in my own diet.
But, my diet isnt totally bad. I eat a lot of fruit and veggies. I never
have been a big fan of pop and have recently pretty much cut it out of
my diet totally because I have decided not to eat high fructose corn
syrup. I did buy a pop imported from Mexico and made with sugar last
week though so it isnt that I dont drink it. On a typical day I will
have oatmeal for breakfast although twice a week, I have pancakes and
sausage. For lunch, I'll have something like baked chicken and a side of
veggies from the work cafeteria. Dinner is often pasta with garlic and
olive oil and maybe some parmesan cheese and a salad or something.
Sometimes I have toast and goat cheese and sliced fruit. I used to eat a
lot of processed food for dinner (i.e. frozen dinners) but I have been
getting away from that. I usually take an apple to work in case I get
hungry. I snack on fruit a lot and veggies less often. Sometimes I will
eat sweets in the evening. Not every day but often enough that I am
probably eating too much sugar.  Until I hurt my knee in January, I took
the dogs on a half hour - 45 minute walk 3 or 4 days a week which is
more exercise than a lot of thin people get but not exactly a huge
amount of exercise either. 

FWIW, I probably have an eating disorder although on the spectrum of
eating disorders, I would say that I have a mild case. I binge once or
twice a year, usually as a response to stress. I have found that I eat
on a schedule more than as a response to actual hunger. I respond to
external cues about when to stop eating (i.e. I clean my plate) . I did
get a book recently about eating disorders and I am following their plan
for overcoming it. I am not totally sure about all of their advice yet
but I have decided to give it six months. Even if I do happen to
normalize my relationship with food, I dont expect that I will lose much
weight. 

response 46 of 378:

Mar 5 19:20 UTC 2006

http://www4.army.mil/ocpa/read.php?story_id_key=8157

Just amazing!