{"items": [{"author": "opted out", "source_link": "#", "anchor": "unknown", "service": "unknown", "text": "this user has requested that their comments not be shown here", "timestamp": "1413509080"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692893104542", "anchor": "fb-692893104542", "service": "fb", "text": "(How much should one weight evidence like RCTs vs lines of argument like \"if it were easy wouldn't more people have done it\"?)", "timestamp": "1413509222"}, {"author": "Hollis", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692894282182", "anchor": "fb-692894282182", "service": "fb", "text": "I think the thing that's interesting is that most doctors say things like \"even losing 10% of your body weight and keeping it off for life can have a huge effect on your quality of life.\" It sounds so reasonable!

But based on your data, assuming that you pick the most effective interventions (personal contact), that's only feasible if 10% of your body weight <= 4 kg, i.e., you started off weighing ~ 40 kg / 88 lbs.

I'm guessing that most adults weighing 88 lbs are not targeted for weight loss.", "timestamp": "1413509869"}, {"author": "David German", "source_link": "https://plus.google.com/111229345142780712481", "anchor": "gp-1413510587797", "service": "gp", "text": "The people in the treatment group decreased their weight by 10 pounds on average for some number of years - maybe permanently. \u00a0I'd call that evidence weight loss is \"totally doable\", but you're reaching the opposite conclusion. \u00a0Why?\n
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\nBeyond that, \"doable\" doesn't mean \"easy\". \u00a0The 10-pound loss is an average of 341 people. \u00a0Many of them did better, and a few probably did a lot better. \u00a0Do you think they accomplished that by luck, or by effort?", "timestamp": 1413510587}, {"author": "Hollis", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692896397942", "anchor": "fb-692896397942", "service": "fb", "text": "And even there, does NCWR track how many people fell out of the program? Because otherwise it's just sampling a pretty small part of the distribution.", "timestamp": "1413511224"}, {"author": "Misha", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692898139452", "anchor": "fb-692898139452", "service": "fb", "text": "That kind of matches my own experience: Whenever my habits stray away from very regular weight-loss aimed behavior my weight starts going back up. I've lost like 40 pounds but at my lowest it was more like 60", "timestamp": "1413512316"}, {"author": "opted out", "source_link": "#", "anchor": "unknown", "service": "unknown", "text": "this user has requested that their comments not be shown here", "timestamp": "1413513998"}, {"author": "Kiran", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692917640372", "anchor": "fb-692917640372", "service": "fb", "text": "There are certainly examples of people losing lots of weight. Laura Mandelberg posted an article by someone who changed their diet in an unspecified way to stave off metabolic syndrome and as an unintended consequence lost 185 (?) pounds in about a year. Closer to home one of my friends took the advice of the Wheat Belly and paleo people and has gone from middle-aged overweight to skinny. Mark Bittman had some success with his \"vegan before 6\" program. And of course Atkins dieters lose weight while eating as much as they want.

What all of these anecdotes have in common is exactly what the vast majority of diet studies don't have--they're all variations of 'macronutrient elimination' diets: you cut *things* out of your diet rather than reducing the amount you eat, and in many cases you eat more calories. (Peter Attia increased his caloric intake from 2400 to 4000 calories while losing weight and improving his health.) Virtually all diet studies restrict how much you eat. That approach does seem to be fruitless. Furthermore, most diet studies are very poorly designed--the various arms are treated differently, confounding factors aren't eliminated, the list is about as endless as the number of diet studies.

As for medicine, I don't think that weight leads to metabolic syndrome or CVD, and I don't think there's much evidence to show that *weight loss alone* in the absence of other factors causes reduced risk. (How would you study that anyway? every weight loss program I know of involves changes in diet and lifestyle, and gastric bypass surgeries affect hormones and possibly gut bacteria.)

I think that weight gain and metabolic syndrome/CVD risk are caused by the same bad thing: bad diet, namely consumption of sugar and other carbohydrates beyond what the body can handle. If this is true, and the science is piling up in support, then it's clear is that changing diet can lead to great improvements in metabolic and CV health. The recent free-living study by Bazzano (which was much better than most diet studies in several ways) seems to support this idea: the low-carb arm saw modest weight loss (much more than the low-fat arm) and huge improvements in markers for CVD risk.", "timestamp": "1413531205"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692921562512", "anchor": "fb-692921562512", "service": "fb", "text": "@Hollis: \"based on your data, assuming that you pick the most effective interventions (personal contact), that's only feasible if 10% of your body weight <= 4 kg, i.e., you started off weighing ~ 40 kg / 88 lbs.\"

Losing 10lbs at 213lbs and 10lbs at 88lbs aren't very similar. If you want to extrapolate to other weight ranges percentages would make more sense (losing 4 lbs of 88) but even then things are probably pretty different losing weight while dramatically underweight.", "timestamp": "1413540990"}, {"author": "Jillian", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692923907812", "anchor": "fb-692923907812", "service": "fb", "text": "Kiran -- the other thing all those examples have in common is that they don't tell you how long the people kept it off for, which is the real problem.", "timestamp": "1413545802"}, {"author": "Kiran", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692924631362", "anchor": "fb-692924631362", "service": "fb", "text": "True. It's hard to run a careful study for much longer than a year, and anecdotes are only useful to motivate experiments. That said, I'm less concerned with weight loss than with health. If you give up wheat and sugar and live a long healthy life without losing weight, I'm fine with that.", "timestamp": "1413546796"}, {"author": "Victor", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692925275072", "anchor": "fb-692925275072", "service": "fb", "text": "At my age, I wonder about avoiding weight gain. It seems that most people gain in their 50s and 60s and it's something I very much want to avoid!", "timestamp": "1413547673"}, {"author": "Kiran", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692926198222", "anchor": "fb-692926198222", "service": "fb", "text": "Lots of people start gaining in their 20s. A standard pattern is 2# a year leaving you 40# overweight at 40. The advice I would suggest is, if you start to gain weight, cut back on the sugar and carbs until you start to lose. If you're not gaining weight on whatever your current diet is, I wouldn't worry much.", "timestamp": "1413548675"}, {"author": "Jeff Kaufman", "source_link": "https://plus.google.com/103013777355236494008", "anchor": "gp-1413549369140", "service": "gp", "text": "@David German\n\u00a010 lbs, yes, but out of 213. \u00a0And they were still gaining it back at the 2.5y mark.\n
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\nI do agree that looking into what works and what doesn't for different people is useful, but we're not yet to a place where we have some intervention we can just roll out widely.", "timestamp": 1413549369}, {"author": "Kristen", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692929192222", "anchor": "fb-692929192222", "service": "fb", "text": "All I can say is I agree with you, and you have a great commentariat, Jeff.", "timestamp": "1413551053"}, {"author": "David German", "source_link": "https://plus.google.com/111229345142780712481", "anchor": "gp-1413551369750", "service": "gp", "text": "I don't have a control version of myself to consult, but I sure feel a lot better at 202.4 pounds this morning than I did at 213-215 pounds, 18 months ago. \u00a0If you're going to dismiss 10 pounds out of 213 as meaningless, do you have data?\n
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\nAs for interventions, let's start with what was at issue in your post. \u00a0I think doctors should continue advising overweight people to lose weight through diet and exercise. \u00a0Sure, this may not be very effective - many people will decide weight loss isn't worth the sacrifice - but it's excellent advice nonetheless, and can be dispensed at almost zero marginal cost.\n
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\nMore generally, I don't want anyone I rely on for advice to stop giving me the best possible recommendation, just because the average American isn't great at following it. \u00a0Seems like a surefire way to pull down the average even more.", "timestamp": 1413551369}, {"author": "Chris", "source_link": "https://plus.google.com/117346402173047680184", "anchor": "gp-1413552173290", "service": "gp", "text": "I do want them to stop giving that recommendation and then blaming me for my health if I fail to lose the weight.\u00a0 I want them to continue to research and try to figure out ways to help me lose that weight and ways to help me be healthier if I can't lose that weight.\n
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\nI want them to ask me about my physical fitness instead of just assuming I don't stay fit because I'm overweight.\n
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\nI also want them to stop talking about this as if it's easy. \"Lose some weight\" is not a prescription. It'd be a little like a doctor telling you to \"stop having a sore knee.\" No, the doctor prescribes you physical therapy.\n
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\nThis is very similar to when people are exhorted to \"stop feeling sad\" when they have depression. Sure, it probably helps 1 or 2 people, and if everyone followed the advice, things would be much better, but it trivializes something that is very challenging.", "timestamp": 1413552173}, {"author": "David Chudzicki", "source_link": "https://plus.google.com/106120852580068301475", "anchor": "gp-1413554973733", "service": "gp", "text": "I'd like to know what would have happened to a group that kept doing whatever they were doing during the \"initial weight loss intervention\". I know it's just 6 months, but that sounded pretty effective. ", "timestamp": 1413554973}, {"author": "David Chudzicki", "source_link": "https://plus.google.com/106120852580068301475", "anchor": "gp-1413559152915", "service": "gp", "text": "@Jeff Kaufman\n\u00a0-- \"10 lbs, yes, but out of 213\". The right denominator for intuition would be desired weight change, right? E.g. if you want to weigh 183lbs, then 10lbs is a third of the way there.", "timestamp": 1413559152}, {"author": "Ben", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692939411742", "anchor": "fb-692939411742", "service": "fb", "text": "Even people who regain the weight could still be better off, as without the intervention they could be 5% heavier (for example). Even not losing weight, but simply gaining at a slower rate should be considered a victory", "timestamp": "1413559415"}, {"author": "Jeff Kaufman", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692939870822", "anchor": "fb-692939870822", "service": "fb", "text": "@Ben: \"as without the intervention they could be 5% heavier (for example)\"

Yes, an RCT that included the weight-loss step would be helpful.", "timestamp": "1413559783"}, {"author": "David", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692940544472", "anchor": "fb-692940544472", "service": "fb", "text": "Lifting weights and building muscle is a superb way to lose weight, and always has been. But one need not lose weight to be healthier - gaining weight by gaining muscle often comes with significant positive gains in other respects.", "timestamp": "1413560324"}, {"author": "David Chudzicki", "source_link": "https://plus.google.com/106120852580068301475", "anchor": "gp-1413563669479", "service": "gp", "text": "(... I don't really know what it's like to want a different weight than you have. But I'd be pretty happy to get a third of the way toward my desired level of back pain.)", "timestamp": 1413563669}, {"author": "Chris", "source_link": "https://plus.google.com/117346402173047680184", "anchor": "gp-1413564859074", "service": "gp", "text": "I've lost about a quarter of the weight I wanted to before. I felt proud, but it didn't have a huge effect on my life other than that.", "timestamp": 1413564859}, {"author": "Daniel", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692961327822", "anchor": "fb-692961327822", "service": "fb", "text": "My personal take on this issue is that weight loss, while sometimes helpful, should not be the primary goal of health interventions. I think weight is correlated with a variety of health problems -- enough to warrant a portion of the attention it receives -- but is probably not the primary issue in most cases. At best, it's a misleading indicator, given that muscle weighs more than fat, and no one really thinks it's a problem for folks to have more muscle. This can lead to false positives and negatives -- like if you eat more healthily and exercise more, and in the process you lose 10 pounds of fat but gain 9 pounds of muscle. Phrased in this way, most people would see this example as a success, but the way we tend to measure it, all we see is \"I worked for months and months and only lost ONE pound.\"

One of Chris's comments really hit the mark for me (It's from G+, not Facebook, so use this link:
http://www.jefftk.com/p/weight-loss-how-practical...

I think that weight loss, given its difficulty (I disagree with impossibility, but it's clearly a serious undertaking), should be a tangential rather than primary health goal for most substantially overweight people. E.g. focus on eating more nutritious food, or on exercising regularly, or something along those lines. If they lose some weight in the process, great, but that shouldn't be the primary measure of success. It's good for all of us regardless of size, and if we see that as success rather than failure, we won't be as likely to quit.

I also think it's really important that doctors separate from weight the variety of health conditions that may be correlated, but almost certainly aren't simply caused by weight or fat. Yes, losing weight might help, but it certainly isn't the only way to address a problem, and it is often much more difficult to change than other factors. The person has almost certainly heard that advice a zillion times, so it's useless unless it comes along with advice about HOW to lose weight. It would be way more useful for doctors to focus on the stuff people don't already know. And the rest of us should just stop commenting on it entirely.", "timestamp": "1413574351"}, {"author": "Jillian", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692962605262", "anchor": "fb-692962605262", "service": "fb", "text": "Yeah, the focus on weight loss leads people to stop doing things that are good for them just because they don't result in weight loss. Like, I don't lose weight by exercising. I don't. I have to layer dieting on top of it or the scale won't say anything has changed. But my body is much, much healthier when I exercise regularly, regardless of whether I have the resources for it to be a full-on weight loss attempt.", "timestamp": "1413575181"}, {"author": "Kiran", "source_link": "https://www.facebook.com/jefftk/posts/692890549662?comment_id=692986706962", "anchor": "fb-692986706962", "service": "fb", "text": "Indeed. Another thing the anecdotes have in common is that the diets were chosen for health reasons, not weight loss. Will they keep the weight off? I don't know, but I think it's much more likely they'll try to stick to the diet. (Do people start to regain weight while sticking to their diets? Another thing we basically don't know b/c the data is inaccurate.) And unlike caloric-restriction diets [which work only to the extent they reduce intake of harmful foods] diets chosen for health improvement let you eat as much as you like.

A quick search for the number of calories burned during exercise will reveal why so few people can lose weight that way. But it does have many other health benefits.", "timestamp": "1413588741"}, {"author": "Adam Yie", "source_link": "https://plus.google.com/114873051319510815414", "anchor": "gp-1413666773619", "service": "gp", "text": "I went from ~270 lbs near the end of high school down to 180 lbs junior year of college and have been between 185-190 lbs since then using traditional diet + exercise. Acendotes != data and all, but in my case it seems to be possible.", "timestamp": 1413666773}]}