About Fat

The New York Times has a good summary of the current state of research into weight loss, and why so few people (five percent is probably a generous estimate) who attempt to lose a significant amount of weight will succeed in doing so over the long term.

When I turned 30, my metabolism changed and I began putting on weight very rapidly. I gained about thirty pounds in a year. Alarmed, I tried every sort of diet—low fat, low carb, calorie-counting, periods of fasting—and managed lose five or ten pounds at a time only to see them inexorably creep back. My pregnancies exacerbated the problem. At 35, I’m about a hundred pounds overweight. I’m not sedentary—I walk three miles in the course of my daily routine, taking Robin to school and picking him up—and I cook healthy meals for our family based on the week’s batch of fresh vegetables from our CSA box. I don’t drink soda, I don’t eat junk food. Everyone but me in our household has no trouble keeping to a “normal” weight. By every measure other than weight (blood pressure, cholesterol, etc) I’m quite healthy. But the fat has been a torment.

There is this myth in our culture that weight loss is easy, that it just takes a bit of self-discipline. That’s demonstrably not true.

Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, says that while the 10,000 people tracked in the registry are a useful resource, they also represent a tiny percentage of the tens of millions of people who have tried unsuccessfully to lose weight. “All it means is that there are rare individuals who do manage to keep it off,” Brownell says. “You find these people are incredibly vigilant about maintaining their weight. Years later they are paying attention to every calorie, spending an hour a day on exercise. They never don’t think about their weight.”

Janice Bridge, a registry member who has successfully maintained a 135-pound weight loss for about five years, is a perfect example. “It’s one of the hardest things there is,” she says. “It’s something that has to be focused on every minute. I’m not always thinking about food, but I am always aware of food.”

My friend Jessie pointed out something, years ago, that I thought was incredibly smart. She said you can tell just by looking at a newsstand that weight loss isn’t something most people have control over. If there were a known, reliable, hard-but-doable method for losing weight—if it really came down to “eat less and exercise more” in a way as simple and moderate as that formulation makes it sound—then there wouldn’t be the constant proliferation of magic powders, recipes, diets, and other snake oil peddled to the fat.

I mean, compare it to giving up cigarettes. Everybody understands that quitting smoking is hard, but doable. It takes self-discipline, it takes a program, and there are medicines that can help. There’s this idea in our culture that losing a large amount of weight takes roughly the same amount of effort. But do you see people on the cover of magazines: I Gave Up Cigarettes in Six Months—and You Can Too! Or This Woman Gave Up Two Packs a Day! How She Did It Page 58? Do you see it every time you pass a magazine rack, cover after cover, month after month, year after year—always peddling a slightly different “secret”?

No. You do not, because those people, the people who successfully kick a nicotine addiction, are not news. They are common. And there are no “secrets” to ditching cigarettes because there actually are known, reliable, hard-but-doable methods that work.

By contrast, the people who make the covers of magazines, standing in their old fat pants and proudly holding out the waistband two feet from their tummies: they are newsworthy because they are rare. Someone like Jared the Subway Guy can get a lucrative corporate sponsorship deal for his weight loss precisely because it’s not something anybody could do. If it were, everyone would know a Jared, he wouldn’t be exceptional, and the company would have no reason to spend a lot of money making him famous. The media can perpetually sell weight-loss “secrets” because there is no known, tested, reliable, repeatable weight-loss method that actually works for the majority (or even a large minority) of people who try it.

It’s not that weight loss is impossible. People do it. All of these fad diets, they’ve worked for some people. Not many, but some. “Eat less and exercise more” works too, if by that you mean eating much, much less, and spending hours working out, every day, forever.

“I think many people who are anxious to lose weight don’t fully understand what the consequences are going to be, nor does the medical community fully explain this to people,” Rudolph Leibel, an obesity researcher at Columbia University in New York, says. “We don’t want to make them feel hopeless, but we do want to make them understand that they are trying to buck a biological system that is going to try to make it hard for them.”

Leibel and his colleague Michael Rosenbaum have pioneered much of what we know about the body’s response to weight loss. For 25 years, they have meticulously tracked about 130 individuals for six months or longer at a stretch. The subjects reside at their research clinic where every aspect of their bodies is measured. Body fat is determined by bone-scan machines. A special hood monitors oxygen consumption and carbon-dioxide output to precisely measure metabolism. Calories burned during digestion are tracked. Exercise tests measure maximum heart rate, while blood tests measure hormones and brain chemicals. Muscle biopsies are taken to analyze their metabolic efficiency. (Early in the research, even stool samples were collected and tested to make sure no calories went unaccounted for.) For their trouble, participants are paid $5,000 to $8,000.

Eventually, the Columbia subjects are placed on liquid diets of 800 calories a day until they lose 10 percent of their body weight. Once they reach the goal, they are subjected to another round of intensive testing as they try to maintain the new weight. The data generated by these experiments suggest that once a person loses about 10 percent of body weight, he or she is metabolically different than a similar-size person who is naturally the same weight. The research shows that the changes that occur after weight loss translate to a huge caloric disadvantage of about 250 to 400 calories.

There are also changes that occur in the brain, to actually heighten the effect of food cravings and to simultaneously weaken the control systems that allow us to resist such cravings.

Another way that the body seems to fight weight loss is by altering the way the brain responds to food. Rosenbaum and his colleague Joy Hirsch, a neuroscientist also at Columbia, used functional magnetic resonance imaging to track the brain patterns of people before and after weight loss while they looked at objects like grapes, Gummi Bears, chocolate, broccoli, cellphones and yo-yos. After weight loss, when the dieter looked at food, the scans showed a bigger response in the parts of the brain associated with reward and a lower response in the areas associated with control. This suggests that the body, in order to get back to its pre-diet weight, induces cravings by making the person feel more excited about food and giving him or her less willpower to resist a high-calorie treat.

In other words, once you’ve lost the weight, you will never be able to eat as much as a person who is “naturally the same weight,” and you will never stop being hungry. Under those conditions, yes, most people can’t sustain significant weight loss even if they do manage to take the weight off in the first place. I keep saying “significant” because these biological systems don’t seem to kick in for someone who just needs to lose the ten pounds they put on over the holidays, which is one reason why people who’ve successfully dieted to lose five or ten pounds don’t understand why the truly fat can’t slim down.

I have not given up on losing weight. I agonize every day, over every thing that I put in my mouth. Basically, I struggle to keep my weight stable and I look forward to the day when there will be real medicine to counteract the biological, neurochemical mechanisms that inhibit substantial weight loss. I also desperately wish that our culture would accept that fact that fat people are not simply lazy and weak-willed. It’s not like quitting smoking, it’s not something that just requires a significant but temporary amount of self-discipline. Nor is it, as the “eat less and exercise more” formulation suggests, something that just requires moderate and reasonable lifestyle changes. It’s something that requires complete dedication, forever, and there’s a complex mix of genetic and environmental factors that makes it more difficult for some than for others. And it’s time our society moved beyond the magazine-cover snake-oil stage and started looking at fat in a realistic way.

12 Responses to “About Fat”

  • Dom Camus Says:

    I don’t know about the US, but over here the trend is in the opposite direction. The pressure to “do something about” fat people is increasing all the time and the government, the media and the medical profession are pretty consistently clear that they consider fatness to be a lifestyle choice.

    Barring some miracle research breakthrough I’m expecting it will take a generation at least before this attitude improves.

    • shannon Says:

      I can’t really tell what direction it’s going in here. There’s certainly a lot of junk science and fallacious “conventional wisdom” floating around, but there’s also pushback from the scientifically-grounded. Unfortunately a lot of the research into metabolism and nutrition seems to be at a really early stage. The whole area of glycemic response, which looks like it might be key, is woefully under-studied as far as I can tell.

  • Nina Says:

    *round of applause*

    The only person I know who’s managed to lose a substantial amount of weight and keep it off for 8+ years does it by exercising for over an hour every single day and adhering to a very strict low-fat diet, with every single thing she eats being a major decision. That’s not what was required to take it off, it’s what’s required for her to keep it off. You will not find many people willing to do that for the rest of their lives, because most people are sensible about costs and benefits, and the cost of that is enormous.

    As someone who’s not very healthy, and who has been often told that the solution to my health problems is to lose weight, it kind of feels like being told “DO THIS NEARLY IMPOSSIBLE THING OR DIE”. :/

    The only good thing is that it does seem like a lot of scientists are interested in unraveling this problem, and I’m hopeful that some solutions will be found in my lifetime.

    • shannon Says:

      Me too. It feels like there’s a lot of promising leads, a lot of pieces to the puzzle have been identified, but we just don’t have the whole picture yet.

  • tom Says:

    3 miles of walking in your daily routine isn’t much, and certainly should not be counted as exercise.

    • shannon Says:

      I didn’t say it was a lot. I said I’m not sedentary, which is true.

      Walking is one of those things that is often promoted to fat people as something that will make them lose weight. Like, “just take the stairs instead of the elevator! And walk or bike to work instead of driving!” The fact that walking several miles a day won’t make you thin is kinda my point here.

  • Madeline Says:

    Thank you for this brave, honest, and very well-stated piece. This is excellent. Go you!

    I’m so sorry that you agonize over every bite of food. I hope you can find some peace with it, though I realize how difficult that is. I’ve come to realize more and more how hard it is to lose weight and how easy it is to gain it. Your piece here adds to my understanding. Thanks!

    Oh, and as a mother of two young children myself, I’d say that walking three miles a day IS rather a lot, particularly given the time and space restraints on stay-at-home parents. It’s certainly more than most Americans walk in a day. It’s very healthy. And it certainly “counts as exercise.”

  • Madeline Says:

    Here’s one good example of the complexity of the issue (a link between childhood obesity and an adenovirus):

    And another example (a link between intestinal bacteria and weight gain):
    (This article also covers the ickiest new medical treatment I’ve read about this year, “fecal transplants.” Oog. Apparently can be very helpful…)

    • shannon Says:

      Gut flora are another piece of the puzzle that I feel like must be important, but it’s not at all clear how it fits into the larger scheme!

      Wouldn’t it be great, though, if that *does* turn out to be the answer? I mean, nobody wants a fecal transplant, but if it comes down to something as simple as taking the right probiotics…it will be a very easy answer to something that’s causing a lot of suffering right now.

  • Jessie Says:

    Man, just seeing the word “fat” in my LJ or Facebook friendslist gives me a surge of adrenaline. Not a good one, either–it’s kind of sad how I see it and immediately prepare to be attacked, in the abstract if not in person.

    One thing that especially freaks me out is many people’s tendency to think that a condition (body size) is the same thing as a behavior (eating or exercising), to the extent that “fat” will be used interchangeably with “overeating and inactivity,” even in some scientific papers.

    Another is the practice of making everything a fat person does symbolic. Not only is every public action you perform invested with great meaning, but to a certain extent anything you do gets the reaction of, “Oh, So That Must Be What She’s Doing Wrong,” simply because as a fat person, you must be doing something severely out of whack.

    • shannon Says:

      Ugh. I’m sorry. (About the adrenaline thing.)

      There is so much weird folk-belief coalesced around the fat. We’re like witches or vampires of the modern day. Everyone’s looking for the charm, the totemic thing that will keep us at bay.

      • shannon Says:

        I mean, do you remember a few years ago when everybody seized on some study or another (later debunked, of course) to say that obesity is contagious? “Run away from the fat people! You’ll catch it!!” It’s ludicrous, of course, but all the talking heads were repeating it solemnly–I think because it fits perfectly with the boogeyman role that fat plays in our culture. There’s all this sheer folk magic masquerading as science.

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