Obesity: Primarily a Food Choice Issue

I've gotten to experience something very interesting over the last couple of weeks.  Resulting from my posts on childhood statin recommendations and parental responsibility for childhood obesity, I've gotten numerous replies, comments and tweets that have both commended and criticized my views.  Being all for intelligent discussion, I've welcomed the responses; but something has become very clear to me: People who are attached to a particular point-of-view will fill any holes with their own interpretations and opinions,quite apart from anything that has ever been said or implied.  It's an interesting phenomenon.  So as promised, I will continue presenting my viewpoint on obesity in general, and specifically, childhood obesity, so I can fill those holes myself, and keep my thoughts from being assumed by others.

Let me begin with the obvious: What is obesity?  From Wikipedia:

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems.  Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 and 30 kg/m, and obese when it is greater than 30 kg/m

Wikipedia is not necessarily the end all be all as a reference source...but, in this case...well, it's right.  Weight gain, which can lead to obesity, is caused by taking in more calories than you burn, period.  It doesn't happen from eating one tootsie roll, despite a tootsie roll being an unhealthy food-like item, or from eating one French fry, or even thirty on a Saturday night for that matter; nor does it come from eating a Twinkie, or a bag of chips, or drinking a soda.  No, gaining excessive weight, and developing obesity, comes from eating lots of crap over and over again.

It is what one does repeatedly that matters, so, in that regard, obesity is a calorie issue.  But yes, there is more to it, although I would argue very strongly that the most important factor is overeating.  As a rule, Americans eat too much.  Listen, I am an American.  I eat at restaurants.  My observation is that the portions served in most restaurants are more than most people need under most circumstances.  I also observe how others eat, and can say quite confidently that most people aren't leaving their plates half-full.  No, most people put it away--all of it--plain and simple.  And this (as a habit) leads to excessive weight gain.

Here's some basic nutritional physiology: Take in more calories than you expend, you gain weight.  Expend more calories than you take in, you lose weight.  When intake and output (over time) are relatively equal...you maintain weight, no gain, no loss.  Duh.  It blows me away that some people actually try to argue against this simple fact.  Why not, then, argue against the Pythagorean Theorem while you're at it?

Listen, it doesn't make sense to try to disprove what we already know about any science.  If it's an established principle, why try to reinvent the wheel?  Oh no, the Law of Gravity is wrong, and that's why we can't unify all theories on physical forces.  No serious thinker would go that route.  Instead they would take what is already known and try to formulate a theory around that.  Freakin' duh!   So why do some self-proclaimed experts attempt it with nutritional physiology?

There is no doubt that food types matter when it comes to weight gain and obesity.  It doesn't take a brain surgeon to understand that French fries are a worse food choice than broccoli.  And it doesn't take a theoretical physicist to understand that eating wholesome foods, as a habit, is better than simply cutting your French fry intake in half.  Freakin' duh!


What amazes me is that some people think that somehow my previous posts suggested that I advocate a low calorie diet.  When have I ever said that?  Let me be perfectly clear: I've never said anything about a diet of any sort.  When I speak of "diet," I speak in terms of how one eats, the types of foods one eats, and NOT a freakin' fad diet (and that includes Atkins, or rehashed Atkin's-like theories).  I simply cannot be any clearer.  The types of foods you eat matters, and how much of them you eat matters too, and how much you burn with physical activity also matters a whole hell of a lot more than your mutated skinny genes (and you thought those were just clothing trends).

Interestingly, the notion that calories in vs. calories out and food type both contribute to obesity presents somewhat of a conundrum to people battling weight.  Some will say, "I don't eat junk food, and I just cannot seem to lose weight."  Then you eat too much, is my answer.  No, I don't eat too much.  Then the types of foods you are eating are poor choices.  No, that's not it either.  Okay, then what is it?  It's genetics.  Oh, you mean fatness runs in your family.  Well, no...I have a gene.  But nobody else in your family is fat?  Well yes...both my parents.  Listen that's called nurture--what you were exposed growing up, your learned behaviors--not necessarily genetics, or nature.  All you are doing when you blame it on your genetics is pulling yourself out of the equation, and I'm sorry, but that just doesn't cut it.  Genetics, hormones, lack of sleep, blah, blah, blah...yes, okay, they contribute...but not more than your food choices do, both in quantity and quality.

I'm going to discuss hormonal factors in weight gain in the next post on the subject, as well as list some factors that are primary in the development and maintenance of obesity.  Just remember that food choices matter--the types of foods you eat (whole, natural foods that you prepare yourself are best), as well as how much you eat.  Denying basic physiological principles isn't going to make one dent in the obesity epidemic, so the fools doing just that are merely perpetuating the problem.

Rapid Weight Loss Confusion

Listen up wrestlers, boxers, body builders, brides to be and anybody else who makes a habit of losing significant weight quickly--rapid weight loss can lead to mental confusion.  Aw big deal, right?  Yes, it is--it could mean the difference between a win or loss, increase your risk of injury , or even be a matter of life and death!

Researchers at Cal State Fullerton recently looked at 16 collegiate wrestlers to determine if losing weight rapidly before a match had negative strength implications.  But what they found might have surprised them: although they found no changes in strength, the wrestlers that lost 4% or more of their body mass had significantly higher levels of confusion on the day of the competition.  No increased confusion was observed in those who lost less than 4% body mass.  No wrestler lost more than 8% of their body mass (avg. wt. loss = 6 lbs).  The study is published in the April issue of the Journal of Strength and Conditioning Research.

So you might be wondering why anybody needs to lose weight quickly.  Fighters must 'weigh-in' before each bout, so it is common to lose weight right before the match or weigh-in, to come in lighter than their actual weight.  This has the advantage of fighting a smaller opponent if you can get your weight below a certain level.  In fact, most of the wrestlers in the study lost nearly all their weight in the two days before the match.  (They were allowed to choose the desired amount of weight to lose before the match, using methods such as exercise, calorie restriction and fluid deprivation).

The drawbacks were not benign.  According to researchers, "a sport which requires split-second decision making, a higher state of confusion and tension can detrimentally affect the wrestler's performance."  No kidding.

Lots of people want to lose weight overnight.  Shows like The Biggest Loser only perpetuate that desire, as they demonstrate how effective rapid weight loss under controlled conditions can be.  But for the most part, rapid weight loss can be dangerous.  Most people that lose weight rapidly gain it back quickly, and the physiological changes that go along with this type of weight loss can have deleterious effects on the body--cardiovascular, neurological and mental.

I never understand when clients tell me they expect their latest weight loss plan (diet or exercise program) to net them 100 lbs. in a year or less.

What?!?! 

Yes, a year or less.

You are crazy--first it probably won't happen and second, you don't want it to.  A pound a week is healthy; 50 lbs in a year.  But they are convinced.

I'm not suggesting that this study has anything to do with the type of weight loss I just describe, but it does have a correlation.  Simple--any super-rapid weight loss is going to have physiological effects.  Now extrapolate that to "if it has short-term effects in athletes, what does it do over the long-term in the obese?"  I think that's a question worth asking.

Lose Weight for Weight Loss Surgery

Thinking about gastric bypass surgery? Better lose weight first. You heard right, getting skinny by the knife requires a pre-op weight loss program. Ahem...

An analysis of medical records of 881 patients who had weight-loss surgery found that the more weight patients lost before the surgery, the less complications they suffered later, such as infections, blood clots, and kidney problems. For patients who actually gained weight before the surgery, they had two times greater risk of suffering complications.

All patients evaluated had undergone the "keyhole" Roux-en-Y gastric bypass surgery whereby staples are used to create a pouch in the stomach that can hold only a small amount of food at a time; then, a portion of the small intestine is attached to the pouch so that food bypasses the rest of the stomach and part of the small intestine.

This information is important as more and more older and sicker patients are opting for the weight loss surgery. These patients are at a definite increased risk of complications, so the answer is LOSE WEIGHT.

I know, I know...I swear I don't make this stuff up. OK, some doctors are against the notion of requiring patients to lose weight before weight loss surgery; they believe that mandated pre-surgery weight loss "may be a deterrent to surgery." Well golly...you mean if people lose weight naturally they'll just...gulp...lose more weight. That's a freakin' wallet drain.

Anyway, I get it--people want the surgery because they don't think they can do it on their own. They're wrong about that. I like the recommendations for pre-op gastric bypass patients, not so much because I advocate the operation, but because I think that doing the initial weight loss will show these people they can do it on their own. Losing weight, like everything else, requires inspiration. Money is best, studies show; but if not the green, then I can certainly understand the prospect of getting gastric bypass and further weight loss might drive some people. Whatever. I just say if you can lose fifty...seventy five pounds pre-op, you can do two-fifty by sticking with it, for sure.

T.V. Doctor Selling Power

Looks like T.V. doctors are influencing Americans in droves. Not surprising since people in the U.S. are generally obsessed with celebrity figures. Just look at internet search data and you'll see celebrity searches topping the list day in and day out. True, things like the Paris Hilton sex tape or Erin Andrews nude video make up the majority of searches; but celebrities like Oprah, Howard Stern and George Clooney come in at a close second in search volume.

This is valuable information because it shows just what types of things influence American purchasing habits. Corporations have known this for years, so the celebrity endorsement is not a new phenomenon. But what is fairly young is the use of celebrities to sell health products. Pharmaceutical companies do it, for instance using Earvin "Magic" Johnson to sell HIV drugs. And companies pushing weight loss programs and products have also been aware of the super-selling power of celebrity.

But this brings up question: Should celebrities really be selling products that might be better endorsed by doctors? I mean, didn't Tom Cruise take an s-load of heat for making statements about Brooke Shields and antidepressants? He's just an actor! Well, marketers have found a solution: Use celebrity doctors!

That's right, make doctors the new celebrity (reality celebrity-dom is in, baby). With shows like Dr. Phil, The Doctors, and now The Dr. Oz Show marketers have a powerful vehicle to sell everything from diet programs to the latest wonder drugs. Isn't the evolution of business and advertising fascinating?

Take for instance the dietary meals on wheels program, Bistro MD. Not a new concept by any means, delivering meals of a certain calorie count for people to watch their weight, much like the calorie counting concept of Weight Watchers (a personal favorite of mine for its ground-breaking model conceived more than four decades ago). The idea, though, is for Bistro MD to take the work out of it for the customer. As their website says:

"take the hassle out of preparing healthy meals for the whole family."

Sounds good to me. 'Cept does work? Well The Doctors T.V. show is pushing it, so it must, right? Most Americans would think so cuz...those doctors are on T.V.!

How about a vegan diet? I used to think that was only for nutty hippies, but hey, Dr. Oz recommended a vegan diet for a meat-eating cowbow, so I guess like most Americans I'll accept it cuz, well...that doctor is on T.V.!

And then there's Dr. Phil. He's called in Bistro MD on his show, too (see the video, here). That's a double-whammy celebrity-doctor endorsement--now that's advertising power! And so which company do you think is dominating health and weight loss web searches right now? Yes, Bistro MD. Very good, give yourself a gold star.

So what do I think about all this? Well, I'm really not all that influenced by celebrity endorsements (or so I think; but I do like Danica Patrick, hmmm...); therefore, I'll have to stick to the truth as I know it: NO MAGIC BULLETS people! You want to lose weight, it takes three things:

1. Motivation and drive--these are based on whether you value your health and looks over pleasureful sensory stimulation, which eating for many people invariably is
2. Watching what you eat--both in calories and types of food
3. Burning more calories than you take in--simply put, if you're overweight, you'll need to exercise

So diets like Bistro MD alone ain't gonna do it. Sorry. Gotta have above principles 1 and 3 in there, too. And, frankly, I find that anything that takes the hassle or work out of the process is a sure loser in my book, because it will violate principle number 1 for most people. Sure some people will succeed with Bistro MD, like it happens with most things, but in general, you gotta want it bad enough to make it happen.

My favorite T.V. example of these weight-loss principles in action occurs in the show The Biggest Loser. They prove exactly what I'm saying: You've got to want it (#1), you've got to watch what and how much you eat (#2), and you've got to burn, baby, burn (#3). Ain't no other way. But I'm not on T.V. so...who's really listening?