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De-Kleined —

January 16, 2013

This was one of the most difficult interviews I’ve ever done. I was really glad to see what I saw of Dr. Samuel Klein, the Director of the Center for Human Nutrition at Washington University, on Weight of the Nation, but I had a whole bunch of questions I wanted to ask him about his work and his understanding of the issue of obesity and metabolic health. The minute I learned that he was available for an interview, I began preparing by printing out as many of his papers as I could get my hands on, and read them on the train.

There are many interviews I’ve done that I’m extremely proud of, from the On Hold series to the newly minted Big Ass Questions. But this interview seems kind of overwhelming to me because I wasn’t really sure what to expect. I hope not to make a complete ass of myself, but it’s often unavoidable. At the same time, I love preparing for interviews and trying to come up with the perfect set of questions to learn what I can from the particular expert I get to ask.

And I definitely had a long list of questions I wanted to ask the man who put 7% on the map during the second “episode” of Weight of the Nation. Throughout this segment, he explains how losing just 7% of your starting weight is enough to produce a significant improvement in your metabolic health. Most exercise and diet programs yield somewhere between 5% and 10% of starting weight after one year if you stick with the program, so it’s convenient for the dismal records of Weight Watchers and Jenny Craig.

Dr. Klein’s position seemed refreshingly moderate. So, I hoped to have some of Dr. Klein’s time to pick his brain. Conveniently, he’s based at Washington University and I’m from St. Louis. I sent an email last May, but was not surprised that he didn’t respond. The man’s publishes research like they’re Tweets. It’s incredible and impressive, and I’m just some schmuck with a video project.

And then, in October, out of nowhere, Dr. Klein responds. I can have a half hour!

A half hour is good chunk of time. I can usually fit everything I want to in 30 minutes. An hour is like a luxury box of time. I can ask stupid or random questions.

Thirty minutes with Dr. Klein was a sandbox. And having read a dozen or so papers, I typed up a list of questions to progress smoothly through the interview.

When the day finally arrived, I was very prepared for our interview. I sat in the office of Dr. Klein’s secretary as she waited for him to be available. Finally, 15 minutes after our appointment, he called me in and informed me that he was not aware that I was waiting for him. And since he had a meeting scheduled in 15 minutes, our interview was cut in half.

So in a panic, I had to trim and prioritize my questions, and it threw me for quite a curve. With that in mind, here is the first part of the interview with the transcription of Dr. Klein’s answers to follow. I will have more comments on this interview at a later date.

“That’s exactly right, it should be a healthy behavior, healthy lifestyle. And if you have a healthy behavior, healthy lifestyle, you won’t be obese. You should be normal weight.”

“You can have improvements, but you may not be completely normalized. Or you may be normalized, depending on where you’re starting with a person who is obese. Obesity is just another marker.”

“Fitness, your ability to consume oxygen during physical activity, is another marker of cardiovascular health, another predictor of diabetes and heart disease, but it may not necessarily be better than obesity markers as well. Although there are epidemiological data from Steve Blair’s studies that if you’re obese and fit you have less risk for diabetes and heart disease than if you’re lean and unfit.”

“Insulin resistance can affect people of any size, but it’s much more common in people of larger size. Being overweight and obese is the greatest risk factor for type 2 diabetes. It’s rare to see type 2 diabetes in people who are lean. As you increase your body weight in relationship to your height, you have a linear relationship with the increased risk of type 2 diabetes. So it’s an important risk factor for insulin resistance.”

“What most studies will tell you is that it’s much more difficult to get people to be physically active and become fit than it is to get them to lose weight by dieting, even though it’s difficult to get them to lose weight by dieting. Increasing physical activity improves your metabolic health, doesn’t do much for your body weight. Decreasing food intake reduces your body weight and also improves your metabolic health. And the two together are the best approaches for treating metabolic dysfunction.”

“More often, people who lose weight will regain weight over time, even if they’ve had a therapeutic intervention. Even with bariatric surgery, for example, there’s a high — there are people who regain weight over time as well. But there’s no evidence, in fact there’s even less evidence, that people can exercise and maintain exercise long-term also.”

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4 Comments leave one →
  1. Marilyn permalink
    January 16, 2013 1:15 pm

    I don’t know of any research in this area, but I have heard that fit people exercise, not that exercising makes one fit. I mean that there are people that liked to exercise, like myself, that go out of their way to exercise. I feel confided or trapped when I don’t get enough exercise. I need to walk, do housework, bike ride, something everyday. I feel restless without it. Even when I worked retailed and was on my feet at my job nine hours a day, I lifted weights at home, bike rode and took long walks.

    I know many people that have exercised all their lives. I have periods of weeks or months when I don’t exercise, but when I’m happy and healthy I do. My live-in boyfriend joined the Y. I’m on his membership, but he doesn’t go. He’s reluctant to exercise no matter how much he knows that he would feel better if he did. He claims it’s boring and a waste of time.

    Exercising one or more hours a day to me is normal. I feel bad if I don’t get to do it. I wonder if there are people that enjoy exercise for exercise sake and others that just don’t. I think the way we approach exercise makes a difference. For example, many people like walking at a slow pace, but the fitness industry tells us that we have to walk fast for it to be exercise. We need to find a way to encourage people that like to move to do movement that they enjoy. Help people find movement that they enjoy and not treat people badly if they abhor exercise.

    I think research needs to be done on how to make people want to exercise more. What makes people that enjoy exercise keep doing it. I suppose there are hundreds of questions about exercise that hasn’t been answered or I don’t know where to find the answers.

    • January 18, 2013 2:33 am

      You raise some good points Marilyn. You’re right that some people are naturally more inclined to exercise than others. Interestingly, there is some evidence that at least some of the growing range of obesity-related genes also impact on response to and enjoyment of exercise. As with most genes, environment can help over-ride natural tendencies though.

      Getting people to exercise more may well be difficult, but getting them to exercise LESS is relatively easy. Good evidence shows that experience of weight stigma in both adults and children makes them less likely to engage in both exercise in general, and in higher intensity exercise in particular. So shaming people about their current lifestyle is probably not the way to go here!

      In addition to the stigma aspect, both prior to and during exercise, there are other reasons that big people often don’t exercise as much as thinner people – this is not to say either group is great here, but there is a clear relationship between increased BMI and decreased tendency to exercise. So yes, fear of being mooed at is a biggie, but also, can’t buy suitable clothes that fit, can’t fit into equipment at gym, and being harangued about weight loss at every opportunity can all be off-putting. In addition, many fat people have made numerous attempts to force themselves to exercise over the years. They’ve worked themselves into sweaty panting heaps and found that it made absolutely no difference to their weight at all – because while exercise is good for just about everything else, it’s not great for weight loss. So they stop doing it and learn to hate it. Those instructors who tell you it has to be hard to be useful are not helping here either.

      The kind of fitness talked about in Stephen Blair’s work – the levels that improve health outcomes, irrespective of weight, do not require hours in the gym with sweat pouring down your cheeks. If you can walk several blocks and take a couple of flights of stairs you’re probably good to go. Is this optimal fitness? Of course not, and some people enjoy working harder and longer, but if you’re very unfit to start with, you don’t need to do a lot to improve very quickly. The Fit Fatties Forum is a great, free resource and support community for this kind of thing – for all bodies, abilities and goals: http://fitfatties.ning.com/

      • Marilyn permalink
        January 18, 2013 9:21 am

        I’ve experienced the stigma of not feeling fit enough to exercise, being told that I’m doing it wrong or not hard enough and it made me stop exercising for weeks or longer. I often did no more exercise than the walks that I enjoy. No matter how awful and unfit I felt, I walked because I loved it or needed it. I wonder if research has been done or can be done to find out why certain people like to exercise or need to exercise while others want to avoid exercise. I know why I avoid exercise and why I do it. I understand that just walking is exercise and I love walking, but that doesn’t help the people that hate exercise.

        Reducing stigma and/or understanding it, helps people that like to exercise, but have stopped doing it, return to exercising. I won’t help people that abhor exercise start doing it. I hope I’m making sense.

  2. fatology101 permalink
    January 16, 2013 1:46 pm

    Shannon, great interview. I would like to have really pinned him down on a few things, that is why you did the interview and not me. LOL. Have you read my book yet? I have a chapter in there #5 where I talk about putting the “cart before the horse”. I am refering to insulin resistance. We dont get fat and get insulin resistance, we have insulin resistance and we get fat. I just dont get why doctors and such cant just take a look on how to ‘cure’, if you will, the insulin resistance. During your interview he said several times “We dont know why…..(such and such)” That is my main point, we dont know why so lets take a look at it. If people in research would put their prejudice aside and look at the causes, maybe we will get somewhere on how to deal with insulin resistance. Dr. Barry Sears (Zone diet fame) talks a lot about how we are just sh&% out of luck if we are insulin resistance. My wording, not his. Anyway, you and I are in agreement on this and I appreciate you taking the time and effort to study Dr. Klein’s work and to talk to him about it. Job well done. If you would like a copy of my book, please email me or FB.

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