Dietary treatments for obesity are ineffective

Discussion in 'Food and nutrition' started by TC, Feb 10, 2006.

  1. TC

    TC Guest

    http://bmj.bmjjournals.com/cgi/content/full/309/6955/655

    BMJ 1994;309:655-656 (10 September)

    Education and debate
    Controversies in Management: Dietary treatments for obesity are
    ineffective
    C S Wooley, D M Garner

    University of Cincinnati, College of Medicine, Cincinnati, Ohio 45267,
    USA Beck Institute for Cognitive Therapy and Research, Bala Cynwood,
    Pennsylvania 19001, USA Correspondence to: Dr Wooley.

    It is surprising that debate continues about the effectiveness of
    dietary treatments for obesity. Perhaps this is partly related to
    ambiguity in the term effectiveness. It is well known that most
    treatments produce temporary weight loss. But it is equally well known
    that 90% to 95% of those who lose weight regain it within several
    years.1 This poor outcome has led to charges that traditional
    treatments for obesity should be abandoned and countercharges that it
    is irresponsible to withhold treatment for such a serious problem. The
    failure of reducing diets to produce lasting improvement was recently
    reiterated at a National Institutes of Health consensus conference,
    which also warned about the adverse effects of treatment.2

    The failure of fat people to achieve a goal they seem to want - and to
    want almost above all else - must now be admitted for what it is: a
    failure not of those people but of the methods of treatment that are
    used. It is no longer a mystery why diets have such a poor long term
    record of success. Indeed the failure of obese people to become or
    remain thin by "normalising" their food intake follows logically from
    studies on the heritability of obesity,3 the biology of weight
    regulation,4 and the physiology of energy metabolism.5

    Demand for treatment is not a justification

    Yet many remain enthusiastic about treatment. It could be said that the
    main evidence for the value of dieting is that health professionals
    continue to prescribe it. Inertia feeds on itself, failure to change
    coming to serve as a silent argument that no change is needed. However,
    this only partially accounts for the resistance to change among those
    treating obesity. Recent findings regarding the benefits of antibiotics
    in treating ulcers and the comparative outcomes of procedures for
    emergency cardiac care have been rapidly translated into medical
    practice. In these cases doctors have only had to adjust what they do;
    in the case of obesity treatment, however, there is no replacement
    procedure. The question is whether to abandon treatment, putting many
    specialists out of business, in the face of relentless popular demand.
    Desperate consumers are willing to bear the burden of responsibility
    for failure in exchange for continuing access to treatment. This
    desperation is best illustrated by Ravitch and Brolin's observation
    that patients who had had obesity surgery were unwilling to consider
    reversal even when it was discussed in terms of saving their lives.6

    As if to avert the central question by introducing more variables, the
    debate has shifted from the universal mandate for one treatment, to the
    matching of available treatments (from self directed programmes to
    surgery) to individual, depending on level of obesity and factors such
    as diet history.7 Notably, even for patients as little as 5% overweight
    the option of withholding weight loss treatment does not appear on the
    decision tree. Wadden has argued that the "no treatment" option "cannot
    be universally endorsed until there are definitive research data."8
    This is an unusual twist in medical science: demanding proof of
    effectiveness of no treatment rather than of active intervention.
    Although the no treatment stance has been viewed as radical, it is
    actually quite conservative. The drug industry has to show both safety
    and efficacy before commercial approval of its products, and, in
    general, the burden of proof lies with those advocating treatment.

    Health effects of dieting

    Proponents of dietary treatment point to the health risks of obesity.
    Amassing evidence that weight loss would be beneficial does not make
    treatment any more effective. Therapies with modest success rates are
    defensibly used when the prognosis for an untreated person is poor and
    treatment poses no additional risks. But in the case of dietary
    treatments for obesity neither of these assumptions is clearly met.
    Success rates are not even modest, and the health risks associated with
    untreated obesity remain controversial, largely because in societies in
    which dieting is common the effects of high weight are confounded with
    the effects of weight cycling.1,9 Dieting not only fails the criterion
    of being without risk but has been implicated in increased morbidity
    and mortality in several large studies.1,9,10 Dieting often has
    negative effects on psychosocial functioning and can lead to eating
    disorders such as the binge eating disorder and even bulimia nervosa.11
    Finally, dietary treatments are costly, unpleasant, and, when they
    fail, tend to damage self esteem.

    Treat the patient not obesity

    Of course obese patients should be treated for illnesses and injuries
    like everyone else. They should be counselled to eat a healthy balanced
    diet and to get appropriate amounts of exercise. They should be treated
    for the emotional disorders they have and not, as is so often the case,
    ones they do not have. They should be treated for eating disorders such
    as binge eating, if they have them. Some must be helped to stop chronic
    overeating caused by despair over repeated failure. Some will need help
    in establishing "normal" eating patterns after decades of diets and
    diet rebound. They should be helped to deal with the social and
    emotional implications of remaining fat and to improve their body
    image. One of the highest priorities should be to protect them from
    blame for their condition and the enormous costs resulting from fat
    prejudice.

    Gotmaker et al recently put the costs of prejudice in terms that
    everyone can understand: $6710 (pounds sterling 4470) a year in lost
    earnings, as well as fewer years of education and a reduced chance of
    marriage for American women in the top 5% of weight for height.12 Many
    previous studies have documented discrimination in admission to
    colleges, employment, promotion, access to housing, and attribution of
    personality traits.11,13 In a commentary Stunkard and Sorensen
    criticised the medical profession for being "among the chief offenders"
    in the perpetuation of prejudice and issued a "call to action against
    the stigmatisation of obesity."14

    But how? Prejudice is revived daily in the routine interactions of
    doctor and patient in which patients are offered dietary treatments and
    fail to benefit from them. This ongoing failure demands a culprit:
    either the treatment is flawed or the patient is flawed, failing to
    comply with the appropriate remedy. As the more credible medical
    profession is refusing to blame its prescriptions patients are left to
    absorb the stigma of failure.

    We should stop offering ineffective treatments aimed at weight loss.
    Researchers who think they have invented a better mousetrap should test
    it in controlled research before setting out their bait for the entire
    population. Only by admitting that our treatments do not work - and
    showing that we mean it by refraining from offering them - can we begin
    to undo a century of recruiting fat people for failure.

    ***********

    And start offering effective solutions like low carb diets.

    The truth is timeless. In case anyone wants to make a big todo about
    the date of this piece.

    Twelve years and counting and we still have assholes pushing low fat
    dieting.

    TC
     
    Tags:


  2. TC

    TC Guest

  3. Mirek Fidler

    Mirek Fidler Guest

    TC wrote:
    > Mr-Natural-Health wrote:
    >
    >>TC wrote:
    >>
    >>
    >>>BMJ 1994;309:655-656 (10 September)
    >>>Controversies in Management: Dietary treatments for obesity are
    >>>ineffective
    >>>C S Wooley, D M Garner

    >>
    >>http://naturalhealthperspective.com/exercise/losing-fat-without-dieting.html

    >
    >
    > What is the point of your trolling? Either add something useful to the
    > discussion or FOAD.


    Actually, the link presents quite interesting way how to loose the fat,
    one that could in fact work pretty well (at least in short term): offer
    $60000 and Lamborghini to the person that looses most fat in 12 weeks
    whatever method he uses:)

    That tells us something about importance of motivation vs. method, I
    guess :)

    Mirek
     
  4. Doug Freese

    Doug Freese Guest

    "Mirek Fidler" <[email protected]> wrote in message
    news:[email protected]
    > Actually, the link presents quite interesting way how to loose the
    > fat, one that could in fact work pretty well (at least in short term):
    > offer $60000 and Lamborghini to the person that looses most fat in 12
    > weeks whatever method he uses:)
    >
    > That tells us something about importance of motivation vs. method, I
    > guess :)


    Ever notice that when people are truly motivated to lose weight be it
    for a Lamborghini prize or a class reunion they do two things - eat less
    AND exercise. It's as grossly simple as use more calories you take in.
    If one is not motivated to rapidly lose tonnage, simply adding exercise
    such that caloric burn is more than input will work. We are an ever
    increasing population of lazy ass people all looking for a magic pill
    and have it delivered by remote control if not some dumb ass fad diet to
    keep them alive.

    When will the light bulb go off? Dear Pavlov, every time we bend our
    elbow our mouth opens for food.

    -DF
     
  5. TC wrote:

    > Are you still on the low fat bandwagon?


    Perhaps, if you were to concentrate?

    The topic of this THREAD is: Dietary treatments for obesity are
    ineffective.

    You have my condolences.
     
  6. Mirek Fidler wrote:

    > TC wrote:
    > > Mr-Natural-Health wrote:
    > >
    > >>TC wrote:
    > >>
    > >>
    > >>>BMJ 1994;309:655-656 (10 September)
    > >>>Controversies in Management: Dietary treatments for obesity are
    > >>>ineffective
    > >>>C S Wooley, D M Garner
    > >>
    > >>http://naturalhealthperspective.com/exercise/losing-fat-without-dieting.html

    > >
    > >
    > > What is the point of your trolling? Either add something useful to the
    > > discussion or FOAD.

    >
    > Actually, the link presents quite interesting way how to loose the fat,
    > one that could in fact work pretty well (at least in short term): offer
    > $60000 and Lamborghini to the person that looses most fat in 12 weeks
    > whatever method he uses:)
    >
    > That tells us something about importance of motivation vs. method, I
    > guess :)


    Actually, the EAS supplement people have a new contest every year.

    I believe the winners get a new corvette and some cash prize money.

    Of course, it shows that they make so much money on these supplements
    that they can afford to give away all these prizes to about 10 winners
    every year.
     
  7. TC

    TC Guest

    Mr-Natural-Health wrote:
    > TC wrote:
    >
    > > Are you still on the low fat bandwagon?

    >
    > Perhaps, if you were to concentrate?
    >
    > The topic of this THREAD is: Dietary treatments for obesity are
    > ineffective.
    >
    > You have my condolences.


    Are you still on the low fat bandwagon or not?

    TC
     
  8. Enrico C

    Enrico C Guest

    On Mon, 13 Feb 2006 13:44:22 GMT, Doug Freese wrote in
    <news:[email protected]> on
    sci.med.nutrition :

    > Ever notice that when people are truly motivated to lose weight be it
    > for a Lamborghini prize or a class reunion they do two things - eat less
    > AND exercise. It's as grossly simple as use more calories you take in.
    > If one is not motivated to rapidly lose tonnage, simply adding exercise
    > such that caloric burn is more than input will work. We are an ever
    > increasing population of lazy ass people all looking for a magic pill
    > and have it delivered by remote control if not some dumb ass fad diet to
    > keep them alive.


    I fully agree with you.

    BUT...

    if you eat *satiating* and *palatable* foods, it's easier... ;)


    --
    Enrico C

    * cut the ending "cut-togli.invalid" string when replying by email *
     
  9. Mirek Fidler

    Mirek Fidler Guest

    > I fully agree with you.
    >
    > BUT...
    >
    > if you eat *satiating* and *palatable* foods, it's easier... ;)


    Actually, *satiating* and *unpalatable* could work even better :)

    Mirek
     
  10. Doug Freese

    Doug Freese Guest

    "TC" <[email protected]> wrote in message
    news:[email protected]
    >
    > Mr-Natural-Health wrote:
    >> TC wrote:
    >>
    >> > Are you still on the low fat bandwagon?

    >>
    >> Perhaps, if you were to concentrate?
    >>
    >> The topic of this THREAD is: Dietary treatments for obesity are
    >> ineffective.
    >>
    >> You have my condolences.

    >
    > Are you still on the low fat bandwagon or not?


    Are you on you low carb wagon? Is ironhead on his iron kick? Is banmilk
    still tilting at his/her windmill? Very few people here without some
    strong bias with questionable scientific backing. And you have the balls
    to question other people motivation? Mucho gonads
     
  11. TC

    TC Guest

    Doug Freese wrote:
    > "TC" <[email protected]> wrote in message
    > news:[email protected]
    > >
    > > Mr-Natural-Health wrote:
    > >> TC wrote:
    > >>
    > >> > Are you still on the low fat bandwagon?
    > >>
    > >> Perhaps, if you were to concentrate?
    > >>
    > >> The topic of this THREAD is: Dietary treatments for obesity are
    > >> ineffective.
    > >>
    > >> You have my condolences.

    > >
    > > Are you still on the low fat bandwagon or not?

    >
    > Are you on you low carb wagon? Is ironhead on his iron kick? Is banmilk
    > still tilting at his/her windmill? Very few people here without some
    > strong bias with questionable scientific backing. And you have the balls
    > to question other people motivation? Mucho gonads


    So far, my "biased" ideas are winning the day.

    Low carb does work better than low fat. Low carb is healthier than low
    fatt.

    Refined carbs cause chronic disease.

    Real food, real meat, real produce is good heathy food.

    Manufactured, processed, high-carb crap is not food and is not healthy.
    Todays milk is too processed. HFCS is one of the main causes of the
    exploding rates of obesity and diabetes.

    And no pill will fix that. No pill will make us healthy.

    Pork fat rules.

    TC
     
  12. "Doug Freese" <[email protected]> wrote in message
    news:[email protected]
    >
    > "Mirek Fidler" <[email protected]> wrote in message
    > news:[email protected]
    >> Actually, the link presents quite interesting way how to loose the fat,
    >> one that could in fact work pretty well (at least in short term): offer
    >> $60000 and Lamborghini to the person that looses most fat in 12 weeks
    >> whatever method he uses:)
    >>
    >> That tells us something about importance of motivation vs. method, I
    >> guess :)

    >
    > Ever notice that when people are truly motivated to lose weight be it for
    > a Lamborghini prize or a class reunion they do two things - eat less AND
    > exercise. It's as grossly simple as use more calories you take in. If one
    > is not motivated to rapidly lose tonnage, simply adding exercise such that
    > caloric burn is more than input will work. We are an ever increasing
    > population of lazy ass people all looking for a magic pill and have it
    > delivered by remote control if not some dumb ass fad diet to keep them
    > alive.
    >
    > When will the light bulb go off? Dear Pavlov, every time we bend our elbow
    > our mouth opens for food.
    >
    > -DF


    Exercise alone will not help you lose weight. You just get hungrier. Dietary
    intervention is a "necessary evil".

    However, from my experience, it alone can help you keep weight off.
     
  13. TC wrote:

    > Are you still on the low fat bandwagon?


    I do NOT have any pet issues.

    I just like to play with Kooks, such as yourself, who do.

    Just thouight that you might want to know.
    --
    John Gohde,
    Achieving good Nutrition is an Art, NOT a Science!

    The nutrition of eating a healthy diet is a biological factor of the
    mind-body connection. Weighing in at 17 web pages, The Nutrition of a
    Healthy Diet ( http://naturalhealthperspective.com/food/ ) is now with
    more documentation and sharper terminology than ever before.
     
  14. TC

    TC Guest

    Mr-Natural-Health wrote:
    > TC wrote:
    >
    > > Are you still on the low fat bandwagon?

    >
    > I do NOT have any pet issues.


    Yes or no would suffice. Afraid to own up to the fact that you've been
    wrong all this time, banana boy?

    >
    > I just like to play with Kooks, such as yourself, who do.
    >
    > Just thouight that you might want to know.
    > --
    > John Gohde,
    > Achieving good Nutrition is an Art, NOT a Science!
    >
    > The nutrition of eating a healthy diet is a biological factor of the
    > mind-body connection. Weighing in at 17 web pages, The Nutrition of a
    > Healthy Diet ( http://naturalhealthperspective.com/food/ ) is now with
    > more documentation and sharper terminology than ever before.


    How's the brain damage? Getting any better?

    TC
     
  15. Doug Freese

    Doug Freese Guest

    "TC" <[email protected]> wrote in message
    news:[email protected]
    > Low carb does work better than low fat. Low carb is healthier than low
    > fatt.


    No eating balanced is the best and yes without the cheap sugar goods.
    Lots of yummy grains, vegetables, fruits with a little meat. By God that
    looks just like the Harvard School of Public Health. Are they on the
    take also?

    > Refined carbs cause chronic disease.


    Too many calories of any damn food causes obesity or at least a severe
    imbalance which in turn starts mud slide to chronic problems.


    > Real food, real meat, real produce is good heathy food.


    I agree but we must be careful with to limit meat. I don't really trust
    organic meat unless I see what they eat is not fertilized crap.

    > And no pill will fix that. No pill will make us healthy.


    Wait, two places we agree but there are a bazillion people out in TV
    land that are gorging themselves until the pill shows up.

    > Pork fat rules.


    Oh yes, the other white meat. Like any meat, eaten in moderation.

    -DF
     
  16. Doug Freese

    Doug Freese Guest

    "Joe the Aroma" <[email protected]> wrote in message
    news:[email protected]
    > Exercise alone will not help you lose weight. You just get hungrier.
    > Dietary intervention is a "necessary evil".


    Ideally your are correct. We need to do both. The exercise will not just
    have you thinner but a lot healthier. Last time I looked the heart and
    some of those other trivial organs are muscles and need to exercised to
    stay healthy.

    > However, from my experience, it alone can help you keep weight off.


    And what people do to win cars and get into a size or two smaller dress,
    pants for the family weeding or Cub Med cruise and then give it up once
    the superficial crash goal is met.
     
  17. TC

    TC Guest

    Doug Freese wrote:
    > "TC" <[email protected]> wrote in message
    > news:[email protected]
    > > Low carb does work better than low fat. Low carb is healthier than low
    > > fatt.

    >
    > No eating balanced is the best and yes without the cheap sugar goods.
    > Lots of yummy grains, vegetables, fruits with a little meat. By God that
    > looks just like the Harvard School of Public Health. Are they on the
    > take also?


    Eating balanced? No, eating real foods. The "eating balanced" crap is
    another ubiquitous term without any real meaning.

    >
    > > Refined carbs cause chronic disease.

    >
    > Too many calories of any damn food causes obesity or at least a severe
    > imbalance which in turn starts mud slide to chronic problems.


    Calories mean squat. If calories were the only thing, then anyone would
    be able to easily lose all the weight they wanted by applying even a
    modicum of effort. There is no shortage of low calorie foods to
    substitute for higher calorie foods. It ain't hard to find low calorie
    foods. And it is very easy to portion control, even over a longer term.
    Restricting fat is easy too. There is plenty of low fat foods. But the
    fly in the ointment is simply that none of that works. The calorie math
    fails to predict the results in almost every case.

    Whether the problem is fundamental in the nature of the calorie theory
    or in the unwieldliness of the food/calorie quantification
    estimations/average or in the day to day estimations of the caloric
    contents of a given plate of food, IT DOES NOT WORK. For all practical
    purposes, counting calories do not work. Period.

    When a given theoretical methodology fails to achieve the desired
    results is more than 95% of cases in the real world, it is time to give
    up on it and go on to consider more useful and more successful
    methodologies.

    Give it up already.

    >
    >
    > > Real food, real meat, real produce is good heathy food.

    >
    > I agree but we must be careful with to limit meat. I don't really trust
    > organic meat unless I see what they eat is not fertilized crap.


    I could say the same with any foodstuff. Like bean sprouts and e. coli.
    Any food crop and fertilizers, pesticides and herbicides.

    But real food, without excessive or any processing or refining, will
    always, always, always be the healthier alternative.

    >
    > > And no pill will fix that. No pill will make us healthy.

    >
    > Wait, two places we agree but there are a bazillion people out in TV
    > land that are gorging themselves until the pill shows up.
    >
    > > Pork fat rules.

    >
    > Oh yes, the other white meat. Like any meat, eaten in moderation.
    >
    > -DF


    The essential fatty acids come from animals. The essential proteins
    come from animals. The best foods in the world are bone broths and
    organ meats with plenty of animal fats.

    Refined grain products and manufactured and refined vegetable fats are
    fake foods and foreign to what we evolved to eat. That is the simple
    genetics of the situation. We evolved eating certain foods, when we go
    too far off that simple path of eating what we evolved to eat, we run
    into serious chronic disease. Diabetes has tripled in 30 year. Obesity
    has exploded in thirty year. CVDs have exploded in 30 years. HFCS
    consumption has exploded in 30 years. Margarine and trans fat
    consumption has increase greatly in the last 30 years. Eating from
    boxes has become the norm in the last thirty years.

    We need to get back to eating real foods prepared in our own homes as
    we used to prepare them.

    Instant foods are not real foods.

    TC
     
  18. TC wrote:
    > Mr-Natural-Health wrote:
    > > TC wrote:
    > >
    > > > Are you still on the low fat bandwagon?

    > >
    > > I do NOT have any pet issues.

    >
    > Yes or no would suffice. Afraid to own up to the fact that you've been
    > wrong all this time.


    I am right, and you are an Arse!

    How many times do I have to say this, Dolt?

    If I advocate any particular diet, I advocate the Cretan Mediterranean
    Diet. The original Cretan Mediterranean Diet is a high fat 40% fat
    diet The recommended version for sedentary people, like yourself, is
    30% fat.

    Any fool who knows anything at all about nutrition knows that it is a
    person's activity level that determines the level of fat in their diet
    that they can safely consume. Americans do not do physically demanding
    work all day long. Ergo, the recommended diet is 30% fat. There is
    one big exception, however. If you suffer from Syndrom-X, or are sugar
    sensitive, then it is 35% fat with 5% more protein.

    My dietary recommendations have been published and have not changed in
    over 4 years.

    I have a web site on this. Read it, dumb Arse!

    Just thought that you might want to know.
    --
    John Gohde,
    Achieving good Nutrition is an Art, NOT a Science!

    The nutrition of eating a healthy diet is a biological factor of the
    mind-body connection. Weighing in at 17 web pages, The Nutrition of a
    Healthy Diet ( http://naturalhealthperspective.com/food/ ) is now with
    more documentation and sharper terminology than ever before.
     
  19. TC

    TC Guest

    Mr-Natural-Health wrote:
    > TC wrote:
    > > Mr-Natural-Health wrote:
    > > > TC wrote:
    > > >
    > > > > Are you still on the low fat bandwagon?
    > > >
    > > > I do NOT have any pet issues.

    > >
    > > Yes or no would suffice. Afraid to own up to the fact that you've been
    > > wrong all this time.

    >
    > I am right, and you are an Arse!
    >
    > How many times do I have to say this, Dolt?
    >
    > If I advocate any particular diet, I advocate the Cretan Mediterranean
    > Diet. The original Cretan Mediterranean Diet is a high fat 40% fat
    > diet The recommended version for sedentary people, like yourself, is
    > 30% fat.
    >
    > Any fool who knows anything at all about nutrition knows that it is a
    > person's activity level that determines the level of fat in their diet
    > that they can safely consume. Americans do not do physically demanding
    > work all day long. Ergo, the recommended diet is 30% fat. There is
    > one big exception, however. If you suffer from Syndrom-X, or are sugar
    > sensitive, then it is 35% fat with 5% more protein.


    Why does ones activity level affect the level of fat they can safely
    consume? Why is this the case? Are you talking about safely consuming
    without weight gain, or safely consume without the appearance of
    chronic disease, or both?

    I don't think you know what you just said. Nor can you prove it.

    >
    > My dietary recommendations have been published and have not changed in
    > over 4 years.


    So you advocate restricting fat intake, albeit based on activity levels
    for some strange and unexplained reasons.

    Please explain how Inuits and Eskimos ate up to 90% or more of their
    diets as fats and still were very healthy, even in their long sedentary
    winter months.

    Would you recommend that they have restricted their fat intake to 30%?
    And for what advantage?

    >
    > I have a web site on this. Read it, dumb Arse!
    >
    > Just thought that you might want to know.
    > --
    > John Gohde,
    > Achieving good Nutrition is an Art, NOT a Science!


    Achieving good health is not repeating by rote what you found in some
    book somewhere either.

    TC
     
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