08 May 2007

Is This Fucking AM New York? No. It's The New York Times.

[Updated below.]

This article in the Times today, "Genes Take Charge, and Diets Fall by the Wayside," is a load of bullshit. I'm not saying genes don't affect weight, and I'm not saying bodies might not have weight ranges they tend to gravitate to. But the way these conclusions were reached is seriously messed up.

A major setpiece of the research involves repeatedly demonstrated weight gain (re-gain) by formerly obese folks who'd been put through a diet to lose a lot of weight. After losing weight, their metabolisms dramatically slowed, and once released from the study, they regained their weight. They also went into "semi-starvation neurosis... They dreamed of food, they fantasized about food or about breaking their diet. They were anxious and depressed; some had thoughts of suicide. They secreted food in their rooms. And they binged." Gosh. I wonder why. What was this diet like?

The only food permitted was a liquid formula providing 600 calories a day, a regimen that guaranteed they would lose weight. Finally, the subjects spent another four weeks on a diet that maintained them at their new weights, 100 pounds lower than their initial weights, on average.

Jesus Christ! 600 calories a day? No wonder these people felt like they were starving - they were! How can you expect these newly-thin, formerly-obese people to maintain drastically lowered body weights (and the newly reduced calorie requirements of their smaller bodies) without any sort of revision of their eating habits? First of all, if anyone were put on a 600-calorie diet, they'd be fantasizing about food and binging. And second, these people were obese for a reason - because of their lifestyle. Without addressing their eating habits and (lack of) exercise, there's no way they wouldn't regain the wait, genes or not. As usual with rebound gain, I'd bet they gained back more than they lost, since a good bit of the weight lost on the 600-calorie STARVATION DIET was likely muscle. Jeez. Way to fuck these people up for a long time, researchers.

Okay, that study took place in 1959. But why is it the centerpiece of the article? Why are the flaws in the study not at all addressed?

Also mentioned is a study (with prisoners! yay!) where average-weight men gained a bunch of weight and, shocking, once they were off the 10,000-calories-a-day rampage, returned to their previous weight!

So are our bodies predisposed? Or are our habits hard to break?

I know what I think, but the article gives us this:

The implications were clear. There is a reason that fat people cannot stay thin after they diet and that thin people cannot stay fat when they force themselves to gain weight. The body’s metabolism speeds up or slows down to keep weight within a narrow range. Gain weight and the metabolism can as much as double; lose weight and it can slow to half its original speed...

The message never really got out to the nation’s dieters, but a few research scientists were intrigued and asked the next question about body weight: Is body weight inherited, or is obesity more of an inadvertent, almost unconscious response to a society where food is cheap, abundant and tempting?

My answer: yes. To both. Obviously, body type and predisposition is inherited. My hips look just like my mom's, and we both tend to be about the same weight. But that doesn't mean we're shackled by genetics. My mom spent a decade of jazzercise as a teeny thin person. And I find my weight's much more about my own habits (healthy & unhealthy) than any preordainment.

The Times article goes on to reference a study from 1986 and its "unequivocal" results. A survey of adopted adults showed that they were "as fat as their biological parents, and how fat they were had no relation to how fat their adoptive parents were."

So fatness might be inherited. But what if certain habits and attitudes towards food are inherited? (Every nail-biter I know has a nail-biting parent.) What if my ancestors' time on the plains of Siberia doesn't make me physically hold on to fat any harder than my more metabolically-inclined friends, but rather makes me more prone to polish off my meal, because we never know where the next slice of vegan pumpkin cheesecake is gonna come from? Or what if it has nothing at all to do with food, and you inherited a tendency towards anxiety and the tendency to self-medicate with Twinkies?

The article goes on to be slightly less moronic, but putting that 1959 study right up at the top, without addressing any of the (even to my layperson eyes apparent) extreme logical sketchiness is annoying, frustrating, and borderline irresponsible. Tucked in at the bottom we get this:

The message is so at odds with the popular conception of weight loss — the mantra that all a person has to do is eat less and exercise more — that Dr. Jeffrey Friedman, an obesity researcher at the Rockefeller University, tried to come up with an analogy that would convey what science has found about the powerful biological controls over body weight.

He published it in the journal Science in 2000 and still cites it:

“Those who doubt the power of basic drives, however, might note that although one can hold one’s breath, this conscious act is soon overcome by the compulsion to breathe,” Dr. Friedman wrote. “The feeling of hunger is intense and, if not as potent as the drive to breathe, is probably no less powerful than the drive to drink when one is thirsty. This is the feeling the obese must resist after they have lost a significant amount of weight.”

I wonder how the obese who've lost a significant amount of weight SLOWLY AND IN A HEALTHY FASHION would feel. Shame they weren't included in the study.

I'd like to close with some sanity from Mistress Krista. I wish I could share it with every person who read that Times article, but I'll have to just settle for sharing it with you:

I call my mother's side of the family the Dominant Gene Family. This is because they all look alike. The men are spitting images of one another, separated from identical twindom only by differences in age. The dozen or so women have slight differences in their bodyfat deposition patterns, with some being more apple- than pear-shaped, but there are no tall lanky ones lurking among us. Put our faces side by side and it starts to look like some kind of X-Files cloning situation. My genetic inheritance is pretty clear. Yet even among this genetically similar group of Eastern European peasant stock, there are differences. And the differences are clearly connected to our choices of activity and nutrition.

For example, my mother and her sister look a lot alike. They both have dark hair and eyes, the same distinct nose, many of the same mannerisms. They are both short, stocky, and rounded. My aunt has struggled for years with obesity. Her tiny frame objects to the load it carries; her knees have been operated on several times, her hip bothers her, and she now has difficulty walking. My mother has also struggled for years to maintain a healthy weight in the face of hypothyroidism and cancer. Unlike her younger sister, she has been successful in this project. The key difference between the two is their lifestyle. My aunt loves fatty foods, bacon, butter, pirogi, potato chips, and anything that suggests comfort. She can, and frequently does, put down a whole bottle of wine in one sitting. My mother, on the other hand, has a B.Sc. in food sciences and worked as a nutritionist. She rarely drinks, always eats her veggies and vitamins, and no matter how cold or crummy the weather, doesn't miss her daily brisk walk around the neighbourhood. In her life, nutrition and activity are non-negotiable items. Now pushing sixty, she maintains a healthy body weight for her age and body type, and looks younger than her baby sis.

Genetics is only a blueprint. It is not a destiny. Genetics tells us what will happen given certain environmental conditions. We might say that I am genetically programmed to gain fat if I eat 5000 calories a day. But we might also say, equally correctly, that I am genetically programmed to lose fat if I eat 1000 calories a day.

Given the condition that both my parents have the dominant gene for brown eyes, and that everything else is in place to allow that gene to be expressed, I will have brown eyes. Quite often, even for something simple such as eye colour, there needs to be, say, one gene that says "brown eyes" and another one that says, "make 'brown eyes' happen". Or, to take another example, let's say we have an athlete who is genetically gifted. Every ball she throws hits the target dead on. She is the fastest and strongest athlete on the field. Her body is a slab of rippling muscle ennervated by lightning reflexes. But what if she doesn't have any interest in training hard, constantly striving to improve her performance, and focusing on her goals? What if she just can't be bothered get out of bed in the morning? Is she going to be an elite athlete? Probably not. Genetics alone isn't going to make her an elite athlete if she doesn't get off her ass.

We now know that there is no single gene that controls something as complex as metabolism. We also know that in the case of genetics and bodyfat levels, genetics is only one part of the puzzle. Genetics can only create a plan of action for various contexts.

I used to think that my body composition was my genetic destiny, given the rest of my family. I felt very out of control. I felt like everything had been preplanned for me and I had had no say in the matter. I now know that my genetics are only a predisposition, not an unalterable fate. Given a context of caloric excess and sedentary living, I will become overfat. Given a context of regular activity and controlled, high quality nutrition, I will stay lean. The same genes that say I'll be out of shape when I do X also say that I'll be fit when I do Y. Boy was I relieved to discover that I do have control over my fitness and health! Phew! Now that seems kind of dumb, but we are all experiential learners and sometimes the simplest, most obvious things… aren't.

Update: I emailed Krista to share the article (and my frustration) and get her take. Which is thus:
Argh, yeah, I actually have that article open in my browser right now. I've been mentally grousing about it all morning. What bothers me most about this is the sense of inevitability. It's very disempowering. Well, in practice those of us who have made major life changes know that people DO have control. It's just that the "how" part is not always immediately obvious. And then the bit about weight maintenance -- gee, big surprise, to stay lean you have to eat carefully! Duh!

Research is suggesting that people do respond differently to similar diets. Some people are naturally able to regulate their appetite and intake better than others. But it's not so radically different that it breaks laws of physics. And genetics doesn't mean inevitable destiny.

1 comment:

Larry said...

I came across your blog in the process of doing some internet research on Ms. Kolata's article and her book "Rethinking Thin". I'm also in the 7th month of a medically supervised weight loss effort where I've lost about 90 pounds.

Ms. Kolata's book and article have generated a lot of unfavorable reaction. Your reaction is not typical, by the way -- it is well reasoned and relatively calm. But you're not giving Ms. Kolata's work the respect it deserves. Allow me to briefly make her case:

1. First and foremost, the national effort to lose weight and combat obesety is a huge failure. All studies show that people CAN lose weight, but the vast majority of these people will gain the weight back and then some. This phenomenon is not something you see in comparable areas of life -- efforts to combat smoking and alcoholism are much more successful. You may not like Ms. Kolata's conclusion that many people are genetically predisposed to be overweight -- I don't like it much, either -- but you'll need to come up with a counter-theory to explain the massive failure of science and medicine to come up with weight loss strategies that actually work in practice.

2. Ms. Kolata appears to be correct when she says that a person who has dieted to achieve a "normal" weight is, metabolic speaking, very different from a person who is naturally at a normal weight. In this regard, you might want to look at statistics from the National Weight Control Registry, which collects data from thousands of people who have successfully lost weight. To maintain their weight loss, these people eat 700 - 1000 calories a day less than the US recommended daily allowance, and they exercise an average of an hour a day at about a 400 calorie per hour clip. That's a lot of exercise, and not very much food -- 1300 calories a day for women, 1700 a day for men, and that's for MAINTENANCE. I've personally been on weight LOSS programs that allowed for about this many calories and didn't require this much exercise. If this is the effort required for maintenance, then you can understand why most dieters fail to maintain their weight loss.

3. You stated that we should not be surprised that subjects would experience "semi-starvation neurosis" at 600 calories a day. Actually, the original 1948 experiment, performed at the University of Minnesota, had its subjects on a diet of 1570 calories a day. This is what the study estimated to simulate the food available in Europe under the conditions of shortage during World War II. (This is about the level of food required to maintain weight loss, and WAY more food than I've seen in a day in quite some time!) The 600 calorie a day regimen that you mentioned was part of a study done a decade later at Rockefeller University Hospital to study the effect of dieting on fat cells. The Rockefeller dieters all eventually regained the weight they lost, leading the Rockefeller scientists to repeat the experiment and to notice the semi-starvation syndrome first noted in the Minnesota study.

(By the way, there's evidence that the semi-starvation syndrome may disappear in time, after about a year's worth of maintenance. See http://content2.apa.org/journals/hea/17/4/336.)

4. You assume that the 600 calorie a day dieters probably lost a lot of muscle weight. You're probably right that maintaining muscle mass will also help you maintain a decent metabolic rate (metabolic rate will slow with weight loss, but may not slow quite so much if you can maintain your muscle mass). But there's no evidence I've seen that slow weight loss will preserve muscle mass more effectively than rapid weight loss. The only study I've seen remotely on point favors rapid over slow weight loss. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11684524&itool=iconfft&query_hl=43&itool=pubmed_docsum.

5. Finally, there's the question of whether books like Ms. Kolata's are discouraging to people like me who are trying to lose weight. To be certain, Ms. Kolata's book is disturbing, but it's also frank and realistic. I'm personally going through my own version of semi-starvation neurosis, and it's helpful to know that this is a syndrome of my weight loss and not a reflection of some kind of deep-seated emotional or psychological problem. Also, if I'm going to manage to maintain my weight loss, I might as well know what I'm up against. The truth seems to be that maintenance is every bit as difficult as weight loss -- not a happy thought, but something I need to keep in mind if I'm going to succeed.

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