Saturday, May 19, 2007
the News abounds with news - some of it junk
On the good side of the news, Gina Kolata has written a book which tells its readers some of the things about weight loss that the diet industry would like to keep from us. For example, she reports on a study - first done in 1950 and repeated many times since, with the same results, by Hirsh and then, Hirsh's associate, Rudy Leibel which suggested that obese people trying to maintain a weight lower than their high set point exhibited psychological and physiological symptoms of starvation, even if they were eating ENOUGH FOOD to maintain that weight. Although this group of studies is not new, it certainly IS new to the American public, large segments of whom are still under the impression that if a person loses weight, they can reset their set point and be slim forever doing nothing more than "eating less and moving more" (an expression which, I recently discovered, originated in the mid 1800's!). This is definitely what the diet industry would like us to believe.
The symptoms of starvation can be very ugly. On the psychological side, depression, suicidal ideation (can over dieting explain the high rate of teen suicide?), aggression, food fantasies including dreaming about food, a desire to binge eat. On the physiological side, the symptoms can be things like being cold all the time, extreme fatigue, voracious hunger, hormones produced which regardless of what is eaten, cause a weight gain and burning as much as 24 percent FEWER calories when exercising. Metabolic damage can last, stated Leibel in an oft quoted message, as long as 10 years after the diet has ended and eating patterns are more normal.
These symptoms were first observed in the Ansel Keyes study of the 1940's. Keyes was trying to find how to rehabilitate the starving refugees from WW II and asked several conscientous objectors to volunteer for this study. Interestingly enough volunteers were given 1700 calories a day (which was considered starvation back in those days).... rather interesting because many of today's slim women are eating less than half that.... and also volunteers were exercised for several hours a day. There is an interesting video about the Keyes starvation study on the University of Nebraska conscientous objector website.
I know bariatric surgery patients who, to maintain weights over 290, cannot eat more than 1000-1200 calories a day or less. We blame regainers from diets and bariatric surgery but is it really their fault or is it, as the studies suggest, something physiological - that "strong biochemical system" defined by Rudy Leibel, which goes to an extreme to defend the higher weight?
On the junk science side, there is a new study which suggests that drinking fruit juice can risk your risk for diabetes. The problem with that study as pointed out to me was the researchers never asked about physical activity except for a yes or no question i.e. "are you physically active?" Of course most answered "yes". A lack of exercise IS a known factor for raising the diabetes risk.
Stories about gastric bypass patients in the news have (as usual) featured new ops who have taken all their weight off and are "happy" (the usual catch phrases are quoted - "can buy clothing off the shelf" "can fit on carnival rides") without one word about things like the need to take vitamin B12 shots for the rest of your life or many people requiring iron infusion which is done in the same place chemo therapy is done. And without mentioning the most important thing - that those who can keep their weight at goal and remain healthy are less than 5 percent of all patients! And that a rebound gain of 50 percent is expected in about 65-70 percent of patients!
A medical provider once told me that patients are NOT given informed consent (i.e. told the risks and dangers of medical procedures) because (as he put it) "then they would never have anything DONE!" Perhaps that is true but in view of the fact as reported by the JAMA in 2000, that a combination of medical treatments, errors and side effects of medications are responsible for 250,000 deaths a year (twice as many as attributed to obesity!), should not people have that choice of whether to have a treatment or not? And especially with elective surgery like bariatric surgery!