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Apr 13 2012

Is Fat the Problem?

If you haven’t been introduced to the Obesity Panacea blog, it’s time to fix that. Travis Saunders and Peter Janiszewski are both researchers who study the connections between food, exercise or sedentary behavior, weight, and health. Recent interesting posts include a review of a study that says that even a couple of hours of uninterrupted sitting has negative implications for your health and a caution that fruit juice is neither “natural” nor particularly good for you.

Yesterday, Travis posted the full text of a scientific review that he coauthored suggesting that it might be time to stop blaming the presence or amount of body fat for the increase in our modern metabolic and cardiovascular health problems. The language is slightly technical but still readable. The topic is one we should take seriously.

Although counter-intuitive, many prospective observational studies suggest that weight loss increases rather than decreases the risk of premature death [17-19]. Paradoxically, most short-term weight loss intervention studies do find improvements in many health indicators. However, given that intentional weight loss is generally accompanied by a change in dietary and physical activity behaviors, it is not known whether or to what extent the improvements can be attributed to the weight loss per se. The case of liposuction can certainly provide relevant information about the effects of subcutaneous fat loss in the absence of behavior change. In their study, Klein et al. [20] evaluated the effects of large-volume abdominal liposuction on metabolic risk factors in obese women before and 10 to 12 weeks after liposuction. Although the participants lost 10.5 kg of fat, liposuction did not improve obesityassociated metabolic abnormalities, suggesting that decreasing adipose tissue mass alone (and especially reducing subcutaneous fat stores) without behavior change will not achieve the metabolic benefits of weight loss. In contrast, most health indicators can be improved through changing health behaviors, regardless of whether weight is lost or not.

[...]

The fact that more than over 80% of individuals return to pre-weight loss levels of body fatness after otherwise successful weight loss certainly illustrates this “sad” reality [25], whereas studies of people successful at sustained weight loss indicate that the maintenance of a reduced degree of body fatness requires a lifetime of meticulous attention to energy intake and expenditure [26]. Among the adverse effects of weight loss, it is well-known that body fat loss complicates appetite control, reduces energy expenditure to a greater extent than predicted, increases the proneness to hypoglycemia and its related risk towards depressive symptoms, increases the plasma and tissue levels of persistent organic pollutants that promote hormone disruption and metabolic complications, and increases psychological stress, all of which are adaptations that significantly increase the risk of weight regain [27].

This is not a counterintuitive look at weight, because our views on weight are more cultural than instinctual, but it is a change from the mainstream views. It is certainly a change from the fat-shaming views that are prevalent outside those who have been researching the topic over the last several years. If you’re new to the scientific results on this, you may find yourself fighting the message of the paper as you read it. I recommend reading it anyway and giving yourself some time to let it sink in before you try to argue against it.

14 comments

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  1. 1
    MichaelD

    Slightly off topic but having read the juice article, I feel slightly worse about the juice I drink but slightly better about the pie I eat. I guess on the whole I’ll call that a win.

  2. 2
    unbound

    No argument against it at all. In fact, I have seen far too many issues with our health care system based solely on minimal factors such as weight.

    One such issue is with my daughter, a teenager who is on the 25% on the height chart and about 55% on the weight chart. Most doctors just look at that discrepancy and immediately start talking about my daughter’s diet and activities. However, the moment we get the doctor to actually look at my daughter, they immediately shut up. This is because, in her case, she is extremely fit and trim with muscles that are a bigger than most girls her age as well as her leg-to-body ratio favoring her body. But, because doctors are so caught up in averages and standards, a lot of the time they just aren’t thinking through the process anymore. Fortunately it doesn’t take a very long look at my daughter to understand the height-to-weight ratio isn’t actually an issue for her.

    I have little doubt that someone who exercises regularly but isn’t overly trim is almost certainly in better condition overall than the person who starves themselves to look very thin but doesn’t have the energy to exercise in return.

  3. 3
    mithrandir

    There definitely is a radical increase in obesity over the past couple decades. If this research is true, it may be that obesity is not causative of increased risk for cardiovascular illness – but instead obesity and cardiovascular illness have some other, common cause.

    @unbound, height-weight charts (and BMI, which is just another way to correlate height and weight without any reference to other body measurements) are misleading in both children and adults when applied to people with nonstandard body types, such as being very muscular. The flawed assumption of height-weight correlation is that everyone has the same fat-to-muscle ratio and therefore high weight vs. height means more fat. (Of course, the original article suggests that a high fat percentage may not be the cause of health problems anyway.)

  4. 4
    Katkinkate

    It’s like the fat gain is a symptom of the metabolic problem and not the cause of the problem.

  5. 5
    D. C. Sessions

    Indirectly related:

    Despite the well-known fact that BMI is totally bogus as a measure of obesity (doesn’t scale properly with height, a sore point for someone as tall as I am) oddly enough it is pretty well correlated with a host of health risks. Which rather strongly suggests that height is a risk in itself.

    Also, there are risks that are causally related to weight and BMI, notably including orthopaedic and peripheral vascular conditions. I know this because I scored twice: really bad varicose veins and several kinds of lower-extremity joint and tendon trouble. Being closer to average height would have prevented most of that, but losing some weight wouldn’t hurt either.

  6. 6
    dcortesi

    See also Gary Taubes who has been trumpeting the “it’s not the fat, it’s the metabolism” idea for a decade.

  7. 7
    mephistopoles

    I hope this thread attracts a lot of very informed comments because my own lifelong battles with weight and the constant social condemnation of obesity is just about too much for me. Food– even healthy food– is no longer a pleasure so much as a guilty shame i.e., oh no what’s THIS doing to my cholesterol/cardiovascular risk/glucose levels/inflammation/thyroid or whatever. I’m literally sick of it.

    All venting aside. . . I recently saw a news report about a study that found that weight loss surgery, and gastric bypass in particular, often resulted in a metabolic “correction” and normalization in blood glucose levels, and effectively reversing Type II diabetes. The astonishing thing to the researchers is that this effect obtained immediately post-surgery, BEFORE any actual weight loss occurred.

    I am curious whether anyone has more specific knowledge on this research?

  8. 8
    Irreverend Bastard

    So now juice is bad for us? See if I care.

    I suspect that the worry about harmful food is more harmful to my health than the actual harm from the food.

    Arguably, nothing is “natural” after the mega-food-corporations is done “improving” the product. Is it even possible to buy processed food that doesn’t have any added sugar or artificial sweetener?

  9. 9
    judykomorita

    Gary Taubes and Robb Wolf are the people to read. Fat IS a metabolic syndrome. I’ve been fighting it almost all my life, and like mephistopoles, I hate the guilt and the condemnation that comes from society (near and far).

    Dr. Atkins had it right many years ago. Atkins and Paleo, people. Stay away from grains and beans and most dairy. Hard to do, but boy do you feel better if you can manage it.

  10. 10
    judykomorita

    The whole idea of “eat less + exercise more = weight loss” is wrong. It doesn’t work if you continue to eat the foods that are bad for us. And “Just push yourself away from the table”???? Fuck that. What food we put in affects our brains and bodies in ways we are still just learning.

    Carbohydrates and sugars are addicting. ADDICTING. If you haven’t ever felt it, consider yourself lucky. They also reset your satiety button – making you still feel hungry. They steal nutrients from the muscles you need to live with, and store them in unhealthy places (not the fat cells).

    Read “Good Calories Bad Calories” or “Why we get fat” by Gary Taubes, and “The Paleo Solution” by Robb Wolf.

    And stop telling me it’s all my damn fault. I started having food problems before I was old enough to go to school.

    /rant

  11. 11
    judykomorita

    Food allergies have a lot to do with it, too. Many people are either allergic to or have some level of intolerance to wheat and corn, as well as the gluten that resides in almost all grains.

    And those of us who have allergies or intolerances are the ones who react the most to eating these food, and the ones most likely to gain weight.

    Unless you’ve read about all this, you probably have no idea how much of our processed food has wheat and corn products in them. Start reading the ingredients in packaged food. Wheat, corn, high fructose corn syrup, hydrogenated oils. The last two are the biggest killers.

    I’m 57, and I’ve spent the last 30+ years hearing how carbs are healthy and fat and protein are not. And the truth is opposite.

    Getting fat does not come from eating fatty foods. It comes from carbs and sugar.

    How many of you have looked at the government’s food pyramid lately? It’s almost completely backwards. Turning it upside down and following it would be healthier.

  12. 12
    Kevin

    Background: I went from a BMI of 32.5 to 20 (over the course of two years), learned as much as I could on nutrition along the way and here is my rant/comments. Feel free to ask any question.

    “The whole idea of “eat less + exercise more = weight loss” is wrong. It doesn’t work if you continue to eat the foods that are bad for us.”

    It’s not wrong in the technical sense, it’s just that you don’t want weight loss, you want fat loss. It’s just that when you exercise a lot with a diet low in protein (hard to naturally get required amount of protein when you are only consuming around ::Don’t do this:: 1000 cals/day ::Don’t do this::) usually by consuming too few calories, you burn energy from muscle and lose muscle mass. This lowers your metabolism so in order to lose weight, you need to eat even less or exercise more. This keeps spiraling until the person is hospitalized or ‘fails’ the ‘diet’ for ‘lack of will.’

    This is the result of following fad diets. You lose muscle mass (i.e. weight). Muscle mass is a large factor in metabolism so you burn less calories. If you eat what normally would be maintenance calories, you now have a calorie surplus (i.e. weight gain), which is why people who follow fad diets (i.e. yo-yo dieters) tend to (re)gain weight. They are gaining weight because they are consuming more calories than they burn. If they were to eat less, they would lose weight, but going back to the original point, it might not be from the areas they want to get rid of. What needs to be emphasized is that fat loss is the goal and not necessarily a smaller number on the scale.

    Unfortunately, when someone is told to go on a diet (by doctor or themselves), I think more often than not they look at the wrong sources. Instead of do something simple like increasing the portion size of the vegetables they already eat and decrease the portion size of rice, they might follow some insane fad ‘diet’ that will make them miserable. Instead of learning how to read a nutrition label, they might read the claims on the front of the box and be misled because things that claim to be healthy tend not to be. This is also where health myths come into play. Products that advertise as being low-fat are actually worse for you (they replace the fat with sugar to maintain taste, they usually have the same amount of calories). Products that claim to be healthy usually are not (since healthy foods typically don’t come in a box).

    There are other health halos such as made with whole wheat (i.e. some portion of the product is whole grain), whole grain (same as whole wheat), multi-grain (i.e. lots of different refined grains), natural (not a regulated term, doesn’t mean anything), Greek yogurt (fruit flavored ones have a lot of sugar),smoothies (e.g. Smoothie King puts 100 cals of sugar in every drink unless you opt-out, using juice as a base, etc.), fruity products that don’t have actual fruit, low-fat (high sugar), health claims for ingredients that are barely in the product, salads (just because it has lettuce doesn’t mean you had a healthy meal), “no-trans fat” products that have trans-fat, “fortified” junk food, etc. mislead/influence consumers to make poor choices. Some sugary foods are even promoted for weight loss that are poor choices such as Special K products (exception: Protein Plus) and Kashi’s Go Lean line (somewhat confusing since their other products nutritionally sound). Also, sometimes advice is given in the form of “this is less bad” and is sometimes interpreted as “this is good” (e.g. yogurt is less bad than ice cream, yet still has a lot of sugar). If people follow the advice of the food industry, there is no wonder why so many diets fail.

    Some of the diet industry isn’t nutritionally sound either. Weight Watchers allows unlimited fruits and vegetables. Vegetables I could understand, it is hard to eat a lot of calories through vegetables. Fruits on the other hand…I could easily gain weight on the weight watchers plan and probably rack up only a minor number of points. I noticed one of the Lean Cuisine products has trans-fat and they tend to have a lot of sodium since they are freezer meals (not weight related, but poor health wise). The portions are way too small (should be doubled), which might lead someone to over restrict, which leads to over consuming. I don’t really know much about the different programs since I have never looked into them.

    “Getting fat does not come from eating fatty foods. It comes from carbs and sugar.”

    It comes from eating more calories than you burn. It’s just that refined sugar has zero fiber (something the American diet typically is low in) so you don’t get full from eating, leading to eating more calories than you need. If someone over consumed non-carb food so that they had a calorie surplus, they would gain weight too.

    “So now juice is bad for us?”

    It’s always been bad for us. It is concentrated sugar. Regular fruit has a lot of fiber, which means that it takes longer to digest. Think of it like a pill. A pill is meant to be swallowed whole and has a dissolvable shell so that the active ingredient is slowly dissolved into the bloodstream. When you drink juice, it has no fiber, so it is like the pill with no shell (i.e. grinded up). Also, the fiber also makes you more satiated so you don’t over consume on sugar.

    “Is it even possible to buy processed food that doesn’t have any added sugar or artificial sweetener?”

    Yes, my cereal, almond milk, pasta, Greek yogurt, quinoa, tortillas, and peanut butter have no added sugar. You can buy bread that has no added sugar, but the one I have has some honey in it. That’s basically all of the processed foods I eat on a regular basis other than things like condiments/sauces.

    Regarding exercise, it is true that being fit is more important than BMI. This was confirmed via study. However, I’m not sure how much weight we can put into this finding as it related to obesity since we know the flaw BMI has when it comes to measuring people with large muscle mass. Without knowing the body fat percentage of the participants, we are unable to say whether having a large percentage of body fat poses no risk if the person exercises since the people in the high BMI category may have had low body fat percentages. However, it is plausible since the location of fat relates to risk (fat around the organs=bad) and exercise may play a role in eliminating fat in crucial areas and why someone who looks thin may be unhealthy from not exercising resulting in fat around the organs. I’ve also heard that Sumo wrestlers (can’t remember source) are known to have excellent health during their training regimen, but tend to have health problems afterwards. This would support the notion that exercise is a stronger factor than size.

    Also, what I mentioned above about fad diets is why I roll my eyes whenever the success rate of diets is brought up. Someone failing on the cabbage soup diet or GM diet does not concern me one bit. Recently, someone on my Facebook feed announced they lost 8 pounds following the GM diet. I expect them to regain every pound they lost during that time. Sustainable weight loss doesn’t come off that fast (The recommended rate is about 1 pound/ week). Their failure doesn’t concern me one bit. Some would say that I am a “freak of nature” for beating the odds, but I think it has to do with preparation and not will power.

    Personally, I think that when you’re losing weight, you should be learning healthy eating habits that will continue for the rest of your life. This means that every change you make to your diet must be permanent. Focus on one aspect at a time until it becomes habit. It doesn’t make sense to me to change your entire diet twice or do a short term plan and revert back to the same habits that led to the weight gain. You need to find healthy foods that you enjoy eating and experiment with different ways to prepare them. You need to make the options “I can either have this tasty meal, which is bad for me or I can have this tasty meal, which is good for me.” Telling someone to eat more X if they don’t like X is not going to work. Obviously, this part of the process is highly individualized.

  13. 13
    anne mariehovgaard

    #9: I have IBS (pretty much since birth), and the Atkins diet would probably cause weight loss – unfortunately that would be through diarrhea and nausea/vomiting. The safest foods for me are anything that is mainly starch + cellulose (but no bran etc.) + water (like gruel made from oatmeal flour), and lactose-free dairy. If I don’t eat this regularly, I end up in a lot of pain. The worst are lactose, raw fruit/veg, legumes or any variety of Brassica oleracea in any form, high fat foods of any kind. Well, and anything sweetened with sugar alcohols, but that is a demonic substance, not food ;)

  14. 14
    Giliell, professional cynic -Ilk-

    Ahh, could the paleo-diet people please agree on ONE point in time and place when the diet affected our genome so much that this holds true for ALL people on the planet regardless of probably millions of years of omnivore ancestry with a strong leaning on vegetarianism?
    Remember, you’re not a Neanderthal man.
    You’re not even descended from them (mostly).
    Really, whenever I hear this “paleolithic diet” crap I’d really, really like to see the research and not a “just so” evopsych story.

    ++++

    One such issue is with my daughter, a teenager who is on the 25% on the height chart and about 55% on the weight chart. Most doctors just look at that discrepancy and immediately start talking about my daughter’s diet and activities. However, the moment we get the doctor to actually look at my daughter, they immediately shut up.

    Ahhh, I have the opposite side of this problem.
    Ever since the weight-loss after birth, my daughter is well on the 25% line in growth but on a parallel line under the 3% line (oh, wait the fact that there’s a 3% line means that there have to be 3 kids who weigh less than that, right? Here’s one of them…).
    This meant that I got looked at and talked to a lot about her weight. It drove me crazy and made me run after the kid with a spoon full of food for about 3 years. Didn’t make her gain weight, only made her stop eating at the table because she could be sure that mummy would feed her anyway.
    Then I stopped doing this and I stopped worrying. She really, really could do with 2-5lbs more for “emergencies”, but she totally gets what she needs.
    And if you stop looking at the data and start looking at the kid you see a healthy, bright child who enjoys life a lot.
    She goes to ballet class once a week and she really sucks at it. But she has fun doing it, I can see it does build up her stamina and coordination and that’s the fucking important thing.

    ++++
    Ah yes, the fruit juice. My husband once complained that he was gaining weight although he was really carefull about his meals, often skipping supper alltogether. While he did so he poured some juice into a glass of water. When I mentioned this, he gave the standard “it’s juice, and I only take a mouthfull with every glass of water. I just can’t drink pure water”.
    Yes, but the mouthfull added up to the calories of two Mars bars each day.
    Now he drinks tea. He hasn’t lost weight, but he stopped gaining it.

    ++++
    Fat might not be the problem, but it seriously enforces problems like lack of exercise. Doing exercise isn’t very nice when you have to move a lot of weight. You might not be able to participate in many classes and you get shamed for it (now that’s the problem of society).
    I recently discovered inline-skates (yes, I know, they’ve been around for a while) and I really enjoyed them because they let me feel my body but not my weight. They brought back the fun of movement.

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