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About Obesity Rest on Slim Evidence
Dr. David Lipschitz
Much of what we believe about obesity may be incorrect.
The New England Journal of Medicine recently published “Myths, Presumptions
and Facts About Obesity,” a paper from scientists at nutritional centers
in the United States and abroad. They suggest that many common beliefs regarding
obesity are not supported by scientific evidence (they are presumptions) or that
information suggests the beliefs to be incorrect (myths).
This paper raises serious questions about our understanding of obesity.
Here are beliefs the authors identify as myths.
Myth: Reducing calorie intake or increasing exercise over prolonged periods of
time leads to significant weight loss, so slightly reducing food intake while
adding moderate exercise can lead to an annual weight loss of 10 pounds. Research
shows that for most people, the loss is more like 2 pounds annually.
Myth: It is important to set realistic weight loss goals, and failure to do so
leads to frustration, limiting weight loss. New research indicates that the more
ambitious the weight loss goals, the better.
Myth: Rapid weight loss is less likely to succeed in the long term compared with
slow, gradual weight loss. Remarkably, research indicates that rapid initial
weight loss leads to a higher chance of success.
Myth: To be successful, someone must be ready and committed to weight loss. In
fact, initial attitude about weight loss does not appear to predict success.
Myth: Physical education programs help to prevent childhood obesity. Sadly, a
number of research studies have shown that frequent supervised exercise programs
at school do not affect weight.
Myth: Being breastfed reduces the lifetime risk of obesity. A recent analysis
of World Health Organization information shows this is not true.
Myth: Increased sexual activity helps weight loss. It was said that sexual activity
expends up to 300 calories, but research has shown that the actual calories expended
are typically 3.5 per minute.
And here are beliefs not supported by scientific evidence (presumptions).
1. Eating a big breakfast helps prevent weight gain by reducing hunger later
in the day. One study stated that breakfast habits showed no impact on weight,
while another showed some benefit.
2. Eating more fruits and vegetables helps weight loss. While they are healthy
for you, studies show that merely eating these foods without making other behavioral
changes may not promote weight loss.
3. Early childhood habits in regard to exercise and diet affect weight in later
life. Evidence suggests that genetic factors, not habits, affect weight in later
4. Weight cycling increases the risk of dying. It is better to maintain a stable
weight than to lose and gain weight repetitively. Although there is some truth
to the observation that weight cyclers (yo-yo dieters) often have health problems,
studies have not been done that prove cause and effect, and many experts question
the validity of this belief.
5. Snacking contributes to obesity. Here as many studies show weight loss as
6. Living in a community with great parks and sidewalks promotes weight loss.
There is no consistent evidence from the observational studies that have been
done that shows where you live affects obesity risk.
The authors listed some beliefs that have been supported by scientific evidence.
While genetic factors affect weight, their effect can be modified by changes
in diet, health and exercise.
Going on a specific recommended diet effectively leads to weight loss but rarely
succeeds in the long term.
While exercise alone may not lead to weight loss, regardless of your size, it
is good for your health, and exercise in sufficient amount (that is vigorous)
helps promote weight loss. Developing and maintaining healthy habits promotes
and, more importantly, maintains weight loss.
For overweight children, involving the parents in a plan is the most critical
factor leading to weight loss. Providing balanced meals or using meal replacement
products does appear to assist in long-term weight loss by promoting better structure
and meal habits. And finally, use of some pharmaceutical pills can assist in
losing and maintaining weight, and bariatric surgery is very effective in overcoming
What conclusions can be drawn from this information?
If you are morbidly obese, a medically supervised program that leads to rapid
weight loss may prove effective if accompanied by appropriate lifestyle changes.
If all else fails, consider gastric bypass (bariatric) surgery.
If moderate weight loss is needed, learn how to eat well. That may require joining
an appropriate weight loss program (for example, Weight Watchers). Set ambitious
weight-loss goals, and exercise as much as possible. To be effective, these habits
must become lifelong and enjoyable.
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