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700 Club —

May 16, 2014

Weight LossFat HealthFat ScienceExerciseDickweedDiet Talk

Trigger warning: Discussion of the science of weight loss as presented by weight loss charlatans and snake oil salespersons.

So I’ve got this little project I’ve been working on since last July. I’ve been taking screencaps of Huffington Post’s front page stories about weight, diet and exercise to get an idea of how they cover stories that are often used as an arsenal in the War on Fat.

I started this project shortly after writing this piece on how far HuffPo had actually come on covering these issues. I mean, back in 2010, when you searched “Fat Acceptance” in HuffPo’s search bar, you got this hilariously passive aggressive message from whoever codes this shit:

As of 2013, HuffPo’s coverage could best be summed up by this juxtaposition appearing on a single day’s front page:

A nutshell, over the past near-year, I’d say we’re at about a 65/35 mix of “HOORAY FOR FATTIES!” and “OBESITY ARGLE BARGLE!”

Now, you may be thinking, “Shannon, if you don’t like HuffPo’s coverage, don’t go there.” And I have searched for a general news and politics aggregator I enjoy as much as HuffPo that also has reasonable coverage of fat issues. So, I continue clicking, while simultaneously criticizing, in hopes that HuffPo will continue to improve.

Indeed, there are signs of hope, particularly on HuffPost Live, where there have been numerous panels featuring an all fat positive guests. And HuffPo has had some awesome articles covering stories on weight issues, as I noted in my exhaustive takedown of the Kramer study. I gave huge props to HuffPo for publishing Anna Almandraia’s excellent piece, which was pretty much the only article exposing the statistical shenanigans.

But currently, the only dedicated areas on the subject of being fat are Weight Loss (self-explanatory) and “Obesity,” dedicated to sensationalism coupled with hilarious stock photo choices.

Obesity Section

It would just be nice if HuffPo took the next logical step and included fat people in their conversations. HuffPo has a history of taking a nihil de nobis, sine nobis approach to covering other groups, such as  its Black Voices, Gay Voices, Latino Voices, Religion Voices, Asian Voices, and Transgender Voices. Of course, its still missing Disabled Voices and Native American Voices, among many other groups who I’m sure would like a seat at HuffPo’s huge table. And HuffPo could easily form a Fat Voices page by taking its body positive coverage, HuffPost Live segments and critical analysis like that Kramer article. Plus, I’m sure there are bloggers out there who would be willing to generate content for you…

Bear Waving

But I didn’t even intend to mention all this (including the shameless, ursine self-promotion) while planning today’s post. HuffPo was merely the inspiration for today’s post, as it often is when I come across its head-scratching coverage. As I was taking screencaps a few weeks ago, I noticed this headline on the front page.

Exercise or DIetThis is the kind of thing that irritates me about weight-centric health messages. If you want to be healthy, then there isn’t a fight between between diet and exercise. If you want to be healthy, you focus on improving your diet with fresh whole foods to the best of your ability (given socioeconomic constraints) and exercise as much as you can (if you want a goal, I recommend the ACSM guidelines, which includes 150 minutes of moderate intensity exercise and resistance training). The benefits of making those two changes go far beyond anything the scale can and will tell you. Sure, you may lose weight, but even if you don’t lose much (and most don’t), you will still be encouraged to continue those behaviors by virtue of the natural benefits of a healthy lifestyle.

However, when your primary metric of health and happiness becomes the scale, then you are subjected to idiotic discussions of what method of self-discipline yields the greatest results. Is it low-carb, low-fat, isocaloric, or vegetarian? Should you exercise or just starve the shit out of yourself? Do you start with a juice cleanse or a very low calorie diet, before committing to a balanced diet once you reach your goal? There are literally hundreds of options facing those who want to lose weight, and every single expert has the evidence to support their claims. Personally, my favorite is the “Drinking Man’s Diet.”

So, you get articles like this, making diet and exercise seem like contradictory strategies toward a common goal.

The article, which came from Oprah Magazine and begins with “Hit the Gym,” which is “as told to Sarah Z. Wexler” by Michele Olson, PhD, professor of physical education and exercise science at Auburn University at Montgomery, Alabama. Basically, Olson says that weight loss from dieting alone results in “stripping away muscle and bone density,” which is true. She then goes on to recommend 250-350 minutes of moderate exercise. Oh, and maybe resistance training.

Resistance training helps, too. But don’t just do isolated weight-lifting exercises like biceps curls — you’ll get leaner faster by using your body weight against gravity, as with movements like squats, lunges, push-ups and planks.

At the very end, Olson throws a bone to the idea that weight loss isn’t the only benefit of exercise, as evidenced by its effects”improving the quality of your sleep, lowering your cholesterol and reducing your stress level.”But I mean, weight loss is obviously the most important one, though, am I right?

From Camp “Eat Smart,” Wexler interviewed Shawn M. Talbott, PhD, nutritional biochemist and former director of the University of Utah Nutrition Clinic. Great qualifications, right? Surely he understands the important

As a rule of thumb, weight loss is generally 75 percent diet and 25 percent exercise. An analysis of more than 700 weight loss studies found that people see the biggest short-term results when they eat smart. On average, people who dieted without exercising for 15 weeks lost 23 pounds; the exercisers lost only six over about 21 weeks. It’s much easier to cut calories than to burn them off. For example, if you eat a fast-food steak quesadilla, which can pack 500-plus calories, you need to run more than four miles to ‘undo’ it! [emphasis mine]

Now, there’s a lot of standard fare weight loss bullshit in here. Basically, it’s easier to cut calories through restriction than by “burning calories” through exercise, which is true. Exercise is incredibly inefficient if you’re a Prophet of the Church of CICO, where health is a math problem where the effort you put into fitness yields paltry calories out. But what caught my eye is the flippant mention of  700 studies. There’s a bit of tricky word play here that intrigued me.

See, the “common sense” belief about weight loss is that if you adopt healthy behaviors, then you lose weight. Period. End of story.

If you’re fat, then your body is all the evidence people need that you do not lead a healthy lifestyle. And the assumption that people like Talbott count on is that the weight loss people experience during the first 20 weeks or so is indicative of what you should expect if you maintain that healthy lifestyle. I mean, if you an lose 23 pounds in 15 weeks by dieting without exercising, just imagine how much weight you would lose after 52 weeks!

Except, that’s not how it works.

At this point, the fat-hating contingency from reddit and 4chan are grumbling to themselves like a Rock Ridge city council meeting.

Because here’s the thing: if you’re going to cite a study to prove that dieting works and weight loss is possible for most people, then you can’t just cite the first half of the study that makes everything sound peaches and herb.

I wanted to know what study Talbott was talking about, so I tried to contact him. I left a comment on his blog (which never got past moderation) asking for the name of the study, but never got a response. So, I did a search for it instead and came across one study that seems to qualify, entitled “A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention” (PDF).

The reason I think this is the one is that it says in the abstract that it was that it included “493 from > 700 studies” that compared the very subsets Talbott cited, but this version basically says they started with 700 studies and whittled it down to 493 after applying its acceptance criteria. Also, the abstract results are comparable to what Talbott claims:

Exercise studies were of a shorter duration, used younger subjects who weighed less, had lower BMI and percentage body fat values, than diet or diet plus exercise studies. Despite these differences, weight lost through diet, exercise and diet plus exercise was 10.7  +/- 0.5, 2.9 +/- 0.4* and 11.0 +/- 0.6 kg, respectively. However, at one-year follow-up, diet plus exercise tended to be the superior program.

To translate, dieters lose 23.5 pounds, exercisers lost 6.4 pounds and dieter-exercisers lost 24.3 pounds. Also, the exerciser cohort included subjects who weighed 20 pounds less than the dieter cohort. And yet, Talbott cites this as proof that the diet-only approach is clearly superior to exercising only, conveniently leaving out the diet and exercise group, which had greater short- and long-term results than the diet-only group.

Speaking of long-term, Talbott completely leaves out that information from his off-hand citation. But if you click the PDF above, you can see for yourself:

Diet vs Exercise

The top red box is how much weight they lost in kilograms after their respective active weight loss phases, while the second red box is the percentage of starting weight. You’ll notice that subjects lost 10.7%, 2.9%, 11.0% of starting weight in the diet, exercise and diet-exercise groups, respectively. These incredibly optimistic percentages that Talbott boasts about are consistent with the upper end of the 5%-10% that obesity researchers define as “clinically significant weight loss.”

But in the bottom box, you’ll find that after a year, subjects maintained a weight loss of just 14.6 pounds, 13.4 pounds and 19.0 pounds in the diet, exercise and diet-exercise groups, respectively. That translates into a one-year maintenance of 6.8%, 7.3% and 8.9% of starting weight for the diet, exercise and diet-exercise groups, respectively.

In other words, in the subjects who focused on diet only were least likely to maintain their losses after a year.

It’s amazing what you discover when you read a study through to the very end.

You know what else you discover when you read a study through to the end? The actual opinions of the authors of said study. For instance, here’s what Miller et. al. had to say about their results:

As previously mentioned, expected weight loss for a 3±4 month weight-loss program is about 11 kg (< 1 kg/week), with the ability to maintain about 70% of this loss after one year. These expectations represent an initial weight reduction of 11% of original body weight which dwindles to a 7±9% reduction after one year. These values fall within the generally accepted guidelines for rate of reduction, which are 1 kg/week or 1±2% of body weight/week, but slightly higher than more recent recommendations calling for rates of about 0.5 kg/week. However, it must be remembered that these data were derived from a moderately obese population and that a weight loss of less than 10 kg in a severely obese individual may be negligible and discourage adoption of a new healthier lifestyle. [emphasis mine]

When people like Talbott are talking about weight loss, they’re often talking to people who want to lose 25% of their body weight or more. I mean, there just aren’t that many 300 pound people who want to lose weight and are going to set a goal of 30 pounds. They want to lose 100 pounds or more, so they get to a “healthy weight.” What this study shows is that no matter what strategy you use, you’re probably going to top off around 10% after three months, then taper off after that.

The funny this is, this study is from 1997, making it so old that they’re actually using the old definition of obesity (>27 BMI). The study is also so old that the authors lament the state of real long-term research (two years or more), but give a hint of what’s out there:

The conclusion that no data exists for long-term clinical trials evaluating various methods for voluntary weight control is supported by this search. We found no [exercise] studies reporting data for maintenance up to 2 y post intervention and only a handful of [diet] or [diet-exercise] studies reporting follow-up data 3 or 4 y post intervention Hence, no analyses could be performed to compare program effectiveness beyond one year. Nevertheless, the average weight loss of the 16 D and DE studies that followed subjects for 3 y was 6±7 kg (data not shown). [emphasis mine]

That’s a weight loss of 13 pounds, for those of you keeping score at home.

Finally, the authors point out the ultimate limitation that all weight loss studies share: white hat bias:

If one assumes that the tendency to publish only successful intervention strategies was evenly distributed across program types (D, E and DE), then the program comparison analyses would not  have been affected. However, if one could include in the meta-analysis the research that was not published because of an inability to produce an effect, then this would lower the mean values for the dependent variables as well as diminish the ES values. The result would then be that D, E and DE programs are even less effective in reducing adiposity than reported here. [emphasis mine]

White hat bias is when researchers don’t publish studies that have null results. Oh, my diet and exercise study subjects only lost 2-3% after a year? Fuck it, I’ll just start another study. I can’t help but think that the premature cancellation of the Look AHEAD diabetes/weight loss study was partially due to the white hat bias, along with concerns for the health of subjects.

So, we come to the $64,000 question: why would Talbott cite this rather weight and unusually unambiguous study to suggest that caloric restriction is fucking amazing for weight loss while exercise sucks ass? Well, from a “follow the money” perspective, this Talbott cat is both a frequent Dr. Oz guest and author of ten books, six of which promise to make you thin.

Given that he makes his living persuading people that diet and exercise will make fat people thin again, you can also see that Talbott is counting on the Golden Rule of citing research: nobody reads the fucking research. But when you take the time to actually read the research (and no, you don’t have to be a scientist to do so), you will find that even nutritional biochemists are capable of either having shitty reading comprehension skills or moderately slick spinmaster skills.

And it’s a shame that this has become our choice of how to view Talbott. Were it not for his insistence on linking healthy behavior to weight loss as the most important outcome, his advice would be pretty common sense:

So, what should you eat? It’s true that low-carb diets tend to be the most popular because they offer the fastest results, but they can be difficult to sustain. I recommend striving for a more balanced plan that focuses on fruits and veggies, lean proteins and whole grain carbs. And never cut calories too low (this causes your metabolism to slow, and you can start losing muscle mass).

Stop there, and I’m on board with what Talbott is selling. But then he goes that extra mile:

For a healthy daily calorie count, allow 10 calories per pound of body weight — so a 150-pound woman should shoot for a 1,500-calorie target. That way, you should be able to lose weight no matter how much you exercise.

Once you make weight loss the end all, be all, I’m immediately suspect of the expert, or the publication, dispersing such petty, short-sighted, bullshit notions of health.

13 Comments leave one →
  1. Jennifer Hansen permalink
    May 16, 2014 3:12 pm

    I’ve noticed a similar issue in a project I’m pursuing. I’ve been buying every issue of Woman’s World since January. You may have seen it in the checkout stands; it’s the one that has a Latest Greatest Diet Ever and a recipe that breaks the major rules of that diet on the same cover practically every week. While I haven’t made any graphs yet, my impression is that about two thirds of the time the diet is just a permutation on the fill up on water/restrict calories/restrict portions/exercise/take this laxative/time your eating/abstain from certain foods/eat this magic food/I treat eating like a dangerous act and you can too mix. But about a third of the diets are based on something that might actually do some good, such as an herbal extract that lowers blood sugar, or recognizing the effects of undiagnosed gluten intolerance. But that isn’t how they are sold! The actual health benefits of the eating plan are disposed of in a paragraph or less and the rest of the article, which always covers two large pages, is about becoming socially acceptably thin. I also note that nearly all of the diet articles focus on the rapid and extreme weight loss of the first weeks or months. So what happens if somebody goes on one of these diets, notices that their joints don’t hurt, their pants are looser, and they feel more alert, and don’t see the promised weight loss? Or they do lose weight and regain it later while retaining the health benefits? Should they consider themselves failures? Signs say yes.

    • LittleBigGirl permalink
      May 19, 2014 5:12 pm

      I am fascinated by your observations – are you writing an article or is it for school or…? Will you be sharing it here? I remember reading a book once that compared various diets, but I can’t think of the title. The fact that magazines come out with new fad ‘miracle’ diets and foods SO often is unsurprising and sad – but I’ve never seen or heard of anyone doing a much-needed meta-analysis or graphing or anything of them.
      Good luck with your project!

      P.S: If any of them *do* have potential merit re: health, I would like to know which are legit because I dismiss anything that promises to make me thinner out of hand. I don’t need to be thinner. I want to be healthier.

      • Jennifer Hansen permalink
        May 19, 2014 8:12 pm

        ATM I’m just doing it for myself, because I flip through those magazines and walk away thinking that I can’t have read what I just read. It’s that absurd. Also, actually laying out a year’s worth of Greatest Diets Ever of the Week in a table feels satisfying in a spectrum-y sort of way. But a big part of my fascination with this magazine is how matter-of-factly it just lays it out there: This is what your goal is supposed to be in your world; this is what we promise; this is what you are going to have to endure to get there; and never you mind that last week’s Latest Greatest Diet Ever may have preached the exact opposite, or that this issue is stuffed with recipes that you would never be able to eat if you went on this diet.

        The publishing industry used to call this kind of stuff “hen dope.” As in, women are as stupid as hens, here’s their opiate.

  2. LittleBigGirl permalink
    May 16, 2014 5:22 pm

    Okay, here’s what no one (not you, Shannon, I mean all the dumb doctors and scientists running their mouths about this topic) has bothered to explain to my satisfaction so far:
    Exercise builds muscle. Muscle is heavier than fat. Since scales weigh everything (bone, blood, muscle, fat, everything!), we have no way of knowing if/how much of our lower weight is lost fat, and how much is new muscle from exercise. If I was building muscle but using a scale to measure my progress, by the scale’s standards I would be “failing” even as I grew *stronger.*

    This is why using your weight to measure/determine anything about your health is bullshit.

    • Kala permalink
      May 16, 2014 8:32 pm

      One doesn’t necessarily put on that many pounds of muscle in general through exercise, let alone during weight loss. It doesn’t make as much of a difference as you seem to think it would make, particularly if we are talking about people who would before exercise classify as obese or larger, so perhaps this is why the “dumb doctors and scientists” have failed to explain this one to you.

    • vesta44 permalink
      May 19, 2014 2:16 pm

      I find it odd that people say exercising doesn’t increase muscle mass that much, or decrease fat that much, proportionately. I think it varies from person to person how exercise affects one’s body.
      For me, I remember a time when I weighed 175 lbs and wore a size 18/20. After exercising anywhere between 15 and 20 hours a week for a year, I still weighed 175 lbs, but had gone down to a size 14. That seems to me to show pretty positively that I lost quite a bit of fat and gained a good bit of muscle. The exercise I did wasn’t weight-lifting either, it was mainly walking 2 or 3 miles a day to work and back, riding my bike several miles a day on weekends, and roller skating 3 to 4 nights a week for 4 hours at a time.
      That worked for me, and might work the same way for some people, but I wouldn’t say that everyone would have the same results I did. But, if a cubic inch of muscle weighs more than a cubic inch of fat, it just makes sense to me that, if you’re exercising to increase muscle mass, you’re also going to be burning fat. So muscle mass, which takes up less space, pound for pound, than fat, could keep you the same weight while your body is actually getting smaller (or more compact). And I’ve never had a doctor tell me that – every one of them has been obsessed with that damned number on the scale, not whether or not I was getting stronger or my pants’ size was decreasing.

      • LittleBigGirl permalink
        May 19, 2014 5:07 pm

        Yes exactly! I had the same thing happen when I started dancing Zumba – I needed to get smaller clothes but I hadn’t lost a bunch of weight.
        I thought when looking at the pics Shaunta posted that she was also experiencing that whole “rearranging/growth of muscle *under* the still-there fat” – thing. This is what drives other people crazy – when the fat doesn’t ‘melt away’ like they think it should from exercise. Yet their is still a visible difference. And obviously a health benefit. But their tunnel vision can’t see past the number on the scale that grows even more meaningless…
        You can never know what kind of shape the muscle under the fat layer is in by looking – I remember I was the fattest person in my grade school class, but when the P.E. teacher had a sit-up competition I beat everyone. XD

      • May 22, 2014 8:17 pm

        I work out in the pool, which is non-impact to low-impact exercise depending on whether I’m swimming or doing some form of shallow water aerobics where my feet are touching the bottom of the pool. I have no idea how much muscle mass it has or hasn’t built, but I do notice that I’m more flexible and have less pain. Those things are very important to me.

  3. May 19, 2014 10:22 am

    65% “Hooray For Fatties!” is way better than I would have expected from someplace like HuffPo. That would actually place them far ahead of political sites that I think of as more advanced than they are on numerous other subjects.

    Nice overview. Now if HuffPo could only discover that fat folk have heads attached to our necks, just like skinny folk… 😉

    • LittleBigGirl permalink
      May 19, 2014 5:15 pm

      *clicking madly on screen* “Where’s the ‘like’ button?”
      That will make quite the headline won’t it? “Fatties discovered to actually have craniums affixed to their adipose!” Sadly, this will be astounding news for too many people. 😛

      • LittleBigGirl permalink
        May 19, 2014 5:17 pm

        If I had the $$ and resources, I would track down all the people who were ever used in those ‘headless fatty’ stock photos or video footage, and make an art piece of their *faces* to show that they are real people.

  4. May 22, 2014 8:14 pm

    Reblogged this on Sly Fawkes and commented:
    Diets don’t work, or the diet industry would go out of business.
    Diets don’t work, as evidenced by the fact that people who go on them tend to be hungry, grouchy, and craving “forbidden” foods.
    Diets didn’t work 20 years ago. They didn’t work 50 or 100 years ago. They still don’t work now.
    The diet industry is like a Frankenstein monster with parts gathered from various corpses. It may be walking and talking, but it isn’t really viable.

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