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Post Info TOPIC: Interesting NYTimes article on weight


Chanel

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Interesting NYTimes article on weight
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May 8, 2007

Genes Take Charge, and Diets Fall by the Wayside

It was 1959. Jules Hirsch, a research physician at Rockefeller University, had gotten curious about weight loss in the obese. He was about to start a simple experiment that would change forever the way scientists think about fat.

Obese people, he knew, had huge fat cells, stuffed with glistening yellow fat. What happened to those cells when people lost weight, he wondered. Did they shrink or did they go away? He decided to find out.


It seemed straightforward. Dr. Hirsch found eight people who had been fat since childhood or adolescence and who agreed to live at the Rockefeller University Hospital for eight months while scientists would control their diets, make them lose weight and then examine their fat cells.


The study was rigorous and demanding. It began with an agonizing four weeks of a maintenance diet that assessed the subjects metabolism and caloric needs. Then the diet began. 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.


Dr. Hirsch answered his original question the subjects fat cells had shrunk and were now normal in size. And everyone, including Dr. Hirsch, assumed that the subjects would leave the hospital permanently thinner.


That did not happen. Instead, Dr. Hirsch says, they all regained. He was horrified. The study subjects certainly wanted to be thin, so what went wrong? Maybe, he thought, they had some deep-seated psychological need to be fat.

So Dr. Hirsch and his colleagues, including Dr. Rudolph L. Leibel, who is now at Columbia University, repeated the experiment and repeated it again. Every time the result was the same. The weight, so painstakingly lost, came right back. But since this was a research study, the investigators were also measuring metabolic changes, psychiatric conditions, body temperature and pulse. And that led them to a surprising conclusion: fat people who lost large amounts of weight might look like someone who was never fat, but they were very different. In fact, by every metabolic measurement, they seemed like people who were starving.


Before the diet began, the fat subjects metabolism was normal the number of calories burned per square meter of body surface was no different from that of people who had never been fat. But when they lost weight, they were burning as much as 24 percent fewer calories per square meter of their surface area than the calories consumed by those who were naturally thin.


The Rockefeller subjects also had a psychiatric syndrome, called semi-starvation neurosis, which had been noticed before in people of normal weight who had been starved. 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.


The Rockefeller researchers explained their observations in one of their papers: It is entirely possible that weight reduction, instead of resulting in a normal state for obese patients, results in an abnormal state resembling that of starved nonobese individuals.


Eventually, more than 50 people lived at the hospital and lost weight, and every one had physical and psychological signs of starvation. There were a very few who did not get fat again, but they made staying thin their lifes work, becoming Weight Watchers lecturers, for example, and, always, counting calories and maintaining themselves in a permanent state of starvation.

Did those who stayed thin simply have more willpower? Dr. Hirsch asked. In a funny way, they did.


One way to interpret Dr. Hirsch and Dr. Leibels studies would be to propose that once a person got fat, the body would adjust, making it hopeless to lose weight and keep it off. The issue was important, because if getting fat was the problem, there might be a solution to the obesity epidemic: convince people that any weight gain was a step toward an irreversible condition that they most definitely did not want to have.


But another group of studies showed that that hypothesis, too, was wrong.

It began with studies that were the inspiration of Dr. Ethan Sims at the University of Vermont, who asked what would happen if thin people who had never had a weight problem deliberately got fat.


His subjects were prisoners at a nearby state prison who volunteered to gain weight. With great difficulty, they succeeded, increasing their weight by 20 percent to 25 percent. But it took them four to six months, eating as much as they could every day. Some consumed 10,000 calories a day, an amount so incredible that it would be hard to believe, were it not for the fact that there were attendants present at each meal who dutifully recorded everything the men ate.


Once the men were fat, their metabolisms increased by 50 percent. They needed more than 2,700 calories per square meter of their body surface to stay fat but needed just 1,800 calories per square meter to maintain their normal weight.


When the study ended, the prisoners had no trouble losing weight. Within months, they were back to normal and effortlessly stayed there.

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 bodys 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.


That, of course, was contrary to what every scientist had thought, and Dr. Sims knew it, as did Dr. Hirsch.


The message never really got out to the nations 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? An extra 100 calories a day will pile on 10 pounds in a year, public health messages often say. In five years, that is 50 pounds.


The assumption was that environment determined weight, but Dr. Albert Stunkard of the University of Pennsylvania wondered if that was true and, if so, to what extent. It was the early 1980s, long before obesity became what one social scientist called a moral panic, but a time when those questions of nature versus nurture were very much on Dr. Stunkards mind.


He found the perfect tool for investigating the nature-nurture question a Danish registry of adoptees developed to understand whether schizophrenia was inherited. It included meticulous medical records of every Danish adoption between 1927 and 1947, including the names of the adoptees biological parents, and the heights and weights of the adoptees, their biological parents and their adoptive parents.


Dr. Stunkard ended up with 540 adults whose average age was 40. They had been adopted when they were very young 55 percent had been adopted in the first month of life and 90 percent were adopted in the first year of life. His conclusions, published in The New England Journal of Medicine in 1986, were unequivocal. The adoptees were as fat as their biological parents, and how fat they were had no relation to how fat their adoptive parents were.


The scientists summarized it in their paper: The two major findings of this study were that there was a clear relation between the body-mass index of biologic parents and the weight class of adoptees, suggesting that genetic influences are important determinants of body fatness; and that there was no relation between the body-mass index of adoptive parents and the weight class of adoptees, suggesting that childhood family environment alone has little or no effect.


In other words, being fat was an inherited condition.


Dr. Stunkard also pointed out the implications: Current efforts to prevent obesity are directed toward all children (and their parents) almost indiscriminately. Yet if family environment alone has no role in obesity, efforts now directed toward persons with little genetic risk of the disorder could be refocused on the smaller number who are more vulnerable. Such persons can already be identified with some assurance: 80 percent of the offspring of two obese parents become obese, as compared with no more than 14 percent of the offspring of two parents of normal weight.


A few years later, in 1990, Dr. Stunkard published another study in The New England Journal of Medicine, using another classic method of geneticists: investigating twins. This time, he used the Swedish Twin Registry, studying its 93 pairs of identical twins who were reared apart, 154 pairs of identical twins who were reared together, 218 pairs of fraternal twins who were reared apart, and 208 pairs of fraternal twins who were reared together.

The identical twins had nearly identical body mass indexes, whether they had been reared apart or together. There was more variation in the body mass indexes of the fraternal twins, who, like any siblings, share some, but not all, genes.


The researchers concluded that 70 percent of the variation in peoples weights may be accounted for by inheritance, a figure that means that weight is more strongly inherited than nearly any other condition, including mental illness, breast cancer or heart disease.


The results did not mean that people are completely helpless to control their weight, Dr. Stunkard said. But, he said, it did mean that those who tend to be fat will have to constantly battle their genetic inheritance if they want to reach and maintain a significantly lower weight.


The findings also provided evidence for a phenomenon that scientists like Dr. Hirsch and Dr. Leibel were certain was true each person has a comfortable weight range to which the body gravitates. The range might span 10 or 20 pounds: someone might be able to weigh 120 to 140 pounds without too much effort. Going much above or much below the natural weight range is difficult, however; the body resists by increasing or decreasing the appetite and changing the metabolism to push the weight back to the range it seeks.


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 ones 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.


This is an excerpt from Gina Kolatas new book, Rethinking Thin: The New Science of Weight Loss and the Myths and Realities of Dieting (Farrar, Straus & Giroux).

http://www.nytimes.com/2007/05/08/health/08fat.html



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Chanel

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I'm not sure if this article is depressing or enlightening. I'm not a "thin" person and my parents aren't "thin" people. They're both within a healthy range for their bodies (although my mom has struggled most of her adult life with weight), but neither are what I would consider skinny. (Bad word, I know.)

I've accepted the fact that I'll never be able to be that person who can eat junk food and get away with it. I'll also never be that person who doesn't worry about food. I'll always have to watch what I eat, be theoretically adament about exercise (ha!), and still have to worry how my ass is going to look in jeans. But seriously - do I have any real amount of control over this area at all? I can make sure I don't gain weight, of course, but can I ever lose weight without the constant struggle that keeps it from being a permanent change? And, if so, should I just accept what I can't change, all the while knowing that that acceptance probably hinders positive change? Tricky, tricky...

Anyway, it's an interesting article and definitely worth the time it takes to read it. What are your thoughts?



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Marc Jacobs

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Not quite sure what my thoughts on that are.

I know personally that I can gain weight very easily and certain foods for me are off limits since they always result in instant weight gain. I just remind myself daily that I like being thin, more than I like the food I want to eat that is bad for me.

I know it sounds lame , but someotimes when I really want to cave in and eat crap I will ask myself " do I want that cupcake to control my emotions and my weight" because it seems to put into perspective that it is just food and that food shouldnt control me.

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Gucci

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I don't believe this article provides the answer to obesity by saying it is predominately genetics. 

Americans are getting fatter and fatter with each generation.  The kids today are fat and they sure as heck weren't when I was growing up in the 80's and 90's. 

There has to be a heavy environmental component that has to do with our lack of activity and over consumption of calories. 

Plus, if it's genetics, then why is it that a lot of people from Asian countries gain weight when they move to America and assume our fast-food eating habits?  This happened to my step-mom and lot's of her friends. 

I certainly think there is a genetic component - like for the people who are overweight as children and grow up to be overweight, but I think that's like any other inherited disease, limited to a small portion of the population. 

I don't starve myself and I don't feel starved.  I watch my weight by dieting and exercise.  If I eat too much I gain weight and it isn't hard as the article seems to suggest, on the contrary it's way too easy to gain weight!  I really don't think the article hit on the source of obesity at all. 

Besides, a study group of all  of 8! people hardly constitutes a scientific study that would render results we could use to generalize to the entire population. 

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Kenneth Cole

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 The only food permitted was a liquid formula providing 600 calories a day, a regimen that guaranteed they would lose weight.

This makes me skeptical of this test. We know very well that going under 1200 calories per day will send your body in to starvation mode and is not a good way to loose weight permentaly. I'm not suprised that they all felt starved, binged and gained it all back. It also does not say how many calories were allowed in the "maitenance stage" of the diet...

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Chanel

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I think that this is partially true based upon my own observations of friends and family. I'm thin and I take after my dad's side of the family (thin, with an athletic build) and not a strong propensity to gain weight beyond a certain point no matter how much I eat.

In my adult life, my weight has fluctuated in a range of about 20-25 pounds. When I was at the high end, I was eating (and I'm not kidding) about 6,000-7,000 calories a day. I was a crazy college freshman and all I did was eat junk food all day long and in large quantities. But even then, I wasn't considered overweight, even though I was eating enough for three people. Of course, I felt disgusting, so I stopped eating like that. And the weight fell off.

I gained a little back last year, but recently, I've revamped my eating habits to a mostly vegetarian diet (not with the intentions of losing weight). And I've lost 10 pounds in the last month without even noticing until my clothes were looser.

I also know that I'll stop losing weight at a certain point no matter how little I eat (barring starving myself) because that's just where my body is comfortable. This is obviously genetic. I've never struggled with my weight or had to be overly conscious of what I've eaten and neither has my dad. My mom gains weight more easily, but she also loses pretty quickly if she's watching what she eats.

On the contrary, I've had friends, who no matter how little they ate, they couldn't lose weight. So yeah, I definitely think that there is a lot of truth to this article.

Wow, that was long.

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Coach

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what a fascinating article!  i'll have to search for these articles later this week; i'd love to see all their results.

a quickie point:

the 600 calories/day study on 8 people was conducted in 1959 into the 1960s, when there was still much to learn about dietary needs.  i'm sure they were following the best standards at the time.  the sample size is small, but if they had rigorous controls, their results may very well be statistically significant.  i can't speak for clinical research, but a lot of basic biological experiments have small sample sizes ranging between 3-5.  as a science geek, i have to stand up for these guys :)

main beef:

although she did exercise quite a bit of caution (compared to other science reporters these days), i think kolata is taking a wee bit too much liberty in coming to these conclusions.  the only thing you could really deduce is that genetics does play a factor, but there's no way to quantify that with the methods they employed.  the NEJM and science magazine are the gold standards for clinical and basic research respectively, so i don't doubt the science and thought behind these studies, and i'm not too quick to dismiss their results; i just question the author's conclusions.

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Chanel

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I don't question that people are getting larger based on eating and exercise habits. Agreed - yes. But what I do question is the idea that this is the only factor. That if you are "fat" or "obese," you are automatically lazy, a bad nutritionist, etc. I know lots of people who fit those descriptions and are nowhere close to fat. I also know overweight people who are active and careful with what they eat but are still overweight.

I'm not sure how much genetics play a factor in obesity, I'm sure it plays some role, perhaps even a significant role, but I am sure that there are all kinds of stereotypes out there about people's sizes (big and small). And I believe the concept of beauty and commercialism in the modern world have gotten so mixed up and abused that it's hard to adequately describe and shoot for "healthy" anymore.

And can I just say that it's cracking me up that the amazon button at the bottom suits itself to the discussion at hand - forget what that's called in the advertising world. It's hilarious.

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Chanel

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wow, very interesting.  
Drew- I wonder if we're having more problems now because once we get a little fatter from eating bad foods- our fat cells become larger and we pass that along to the next generation, and so on and so forth- so that today's generation is the most obese.  I don't know much about genetics though, maybe whatever we pass along is just what we were given at birth and environment doesn't really change that?  Although, that doesn't really make sense either since smoking and stuff can effect your fetus.  Maybe something bad happens when you eat junk food while pregnant???  Or from the hormones in our foods, or whatever.

I agree that we all have a range of "healthy weight" and that it is very different for everyone.  But its hard for me to say that "obese" is in anyones healthy range, unless they have a medical condition (which isn't a healthy range per se, but something beyond someone's individual control at least.)  Maybe you'll never be 5'6" and 130 lbs- and are perfectly healthy at 150 or 160 lbs.  But to say 300 lbs is "normal" for you just doesn't make sense to me.   I know some people struggle with their weight a lot, and some don't at all.  To me, that's genetic.  My healthy range is probably between 125 lbs and 150 lbs (i'm 5'6").  I have to work hard to get to 125 ( i weigh between 135-140), and i'm not eating complete crap now- i do splurge and don't exercise a whole lot.  I could eat more cupcakes and reach 150, but doubt i'd really go beyond that without having to eat COMPLETE crap, every meal.  Both my parents are still fairly slender and in their late 40's, early 50's. 

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Gucci

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blubirde wrote:

I don't question that people are getting larger based on eating and exercise habits. Agreed - yes. But what I do question is the idea that this is the only factor. That if you are "fat" or "obese," you are automatically lazy, a bad nutritionist, etc. I know lots of people who fit those descriptions and are nowhere close to fat. I also know overweight people who are active and careful with what they eat but are still overweight.




I think a lot of obese people hide how much food they eat.  When I was gaining weight a few years ago I started hiding how much I was eating so people wouldn't think I was a piggy, and perusing a few weight loss boards back then I noticed A TON of people on those boards that admitted to hiding just how much they eat from family and friends.  Just an observation based on my limited experience.



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Gucci

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lynnie wrote:

wow, very interesting.  
Drew- I wonder if we're having more problems now because once we get a little fatter from eating bad foods- our fat cells become larger and we pass that along to the next generation, and so on and so forth- so that today's generation is the most obese.  I don't know much about genetics though, maybe whatever we pass along is just what we were given at birth and environment doesn't really change that?



I am not 100% sure (or even 90%), but am pretty confident that you pass on the genes you are born with (that is 100% true for women who are born with all the eggs they will ever have), plus any real changes come from mutations which happen at an extremely slow rate for people who live to be 70-100 years (compared to mutations which happen very rapidly in microsopic organisms with very short life spans).  I personally don't think that's it.

I did read an article in a magazine once that said if you gain over 50 pounds more than you should, then your body kinda changes and refuses to give up that weight, maybe that's where the starvation thing comes in.  Plus, I've heard of studies done on overweight and obese people compared to average weight people and they found that overweight and obese people still find food to taste good even after they are full, where as in average weight people, they did not find the food to taste as good once they were full. 

I'm sure there's an awful lot that goes into obesity, but I still think it has more to do with what foods we eat and how much exercise we get.  Remember, we did not evolve to be generally inactive with food ready at our disposal, it's just how we ended up in modern times.



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