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Saturday, May 9, 2015

8 years after writing Rethinking Thin: People still have false hope of diet and exercise

In 2007 I first read about the false hope of dieting in Gina Kolata's book; Rethinking Thin.

Pg. 221:  "I (the author Gina Kolata) wanted Carmen and Graz, and Jerry and Ron and all the others to succeed.  I wanted it so much that I began to suspend belief.  I knew, I knew, the science and the overwhelming convincing evidence that most obese people will not be able to diet, get thin, and stay at a new low weight.  But in those first six months, when everyone was dropping pounds, when Graz lifted her shirt and said to me, "Look I have a waist!" I fell under the dieters spell.  I allowed myself to think that maybe, these people would make it.  Maybe they would fulfill their dreams." 

LOOK AHEAD trial graphs has since nailed the coffin on the dream of false hope of dieting, yet at NY Presbyterian/Columbia Obesity Board review in April 2015 I found the false hope perpetuated that somehow St. Luke's program had better results than the largest and longer diet trial ever with millions of dollars poured into it.  Is it explained by scalability as Sharon Akabas suggests below?  

40 sec clip: St Luke's nutritionist avers her program works despite Leptin reset of reduced obese, hence my frustration with even the best weight loss programs: false hope continues.

Brian: Does your calculation for calories needed to lose weight include the extra 20% that Dr. Leibel says the reduced obese need to do just to maintain weight loss Plateau explained?

Betty Kovacs:" Not if their resistance activity is and they replace the muscle loss.  We've got Rich (Weil).
They are supposed to be doing resistance activity. .
If they are not losing (weight) we can adjust it.
They lose (weight) without that factor."

Then Sharon Akabas (the director of the Board Review) doubles down on this false hope.

If people had access to this type of program it would help (link)

Sharon Akabas: "(Betty), your's is an amazing program.  Gary (Taubes) was here last week and he was talking about the issue of scalability.  So to what extent of what you (Betty) are seeing is dependent on you (Betty) and Rich (Weil).."

Betty Kovacs: "The world we live in is not what people... We have a very different environment that we get these people for 75 minutes each week for a year where we get to do all this.  We get to enforce it, hours of exercise and balance of the food.  So I don't believe that everything we see... I said that in the beginning our data does not match what is out there.  Because this is a very different population and a different environment.  Ultimately, if people had access to this kind of intervention it would help."

 I reviewed Richard Weil's lectures at the Obesity Board Review and found him show this graph.  Rich said he has this graph on the wall of his office.  It shows the variability of the results of his program and virtually every other obesity trial.  There is a great variability of results.  Some people do better than others.  This seems to be in conflict about the success of the program that Betty suggested. See link below for his comment on his and Betty's group of patients results. 

Mr. Weil says of his 600 patients 8% don't lose weight link

Back to pg. 221 of Rethinking Thin:

"Some scientists, including Jules Hirsch and Jeff Friedman, suggest an intriguing hypothesis.  The origins of people's recent weight gains may have little to do with their current environment or with their willpower, or lack of it, or with today's social customs to snack and eat on the run or with any other popular belief."

1min 40 sec clip on why we can't maintain weight Loss: Dr Leibel

Jeffrey Friedman, MD, PhD  is a molecular geneticist at New York City's Rockefeller University  His discovery of the hormone leptin and its role in regulating body weight has had a major role in the area of human obesity.

I listened to four great lectures on the science of obesity by Leibel, Rosenbaum and Vasselli.
I was enthralled by these scientist's lecture.
The lectures lead Sharon Arabas to have a different feeling. Introducing a lecture she says in this clip:  "another whole hour of very depressing things to hear" 1 min 40 sec clip

 In summary, the incredible cognitive dissonance displayed but denied at the NY Presbyterian/Columbia College of Medicine where the giants of the science of obesity had just spoken at,  I hear the St. Luke's people (make the same old claim), "but their program is different, it works".

As Dr. Mike Rosenbaum said on April 23, 2015 at this conference: Stop bilking! 3 min video

Revolution in Obesity as far back as 1995 reference:


Maintenance of a reduced or elevated body weight is associated with compensatory changes in energy expenditure, which oppose the maintenance of a body weight that is different from the usual weight. These compensatory changes may account for the poor long-term efficacy of treatments for obesity."

Leibel RL, Rosenbaum M, and Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med, 1995, 332: 621-628

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