Can we do anything about Obesity?

"I hardly eat anything, but can't seem to lose weight

Yesterday at the gym, I had a chance to speak with a man I have seen shrink in size during the past few years from serious obesity to what looks like half his original weight. I was curious to find out how he had achieved losing what proved to be 125lbs (from 365lbs). Presently at around 240lbs, he was still working hard to lose more weight. He said: " I have been heavy all my life and now I am at it seven days a week. In retirement, exercizing at the Gym has become my daily job." As far as diet was concerned, he cut out red meat as his only change. He got the message something had to change when he became a SCD survivor.

This discussion has prompted a review of the recent obesity literature as well as the new dietary guidelines:

There are more than 1.5 billion overweight adults, including 400 million world-wide. A new study, published in NEJM, suggests that diet and exercise alone is not particularly effective in the treatment of obesity. The study showed that obese dieters regained much of their original weight after one year. The authors concluded that although dietary restriction often results in initial weight loss, the majority of dieters failed to maintain their reduced weight, perhaps because of hormones involved in the regulation of body weight, and not simply be the result of the voluntary resumption of old habits.

(Among other things, body weight is regulated by hormones released from the GI tract, pancreas, and fat tissue integrated, primarily in the hypothalamus. Hormones that regulate food intake and energy expenditure include leptin and insulin).

While undoubtedly true for some patients, after my discussion in the gym I have several observations:

  • Diet alone is not good enough, it requires hard work. Supporting these data, another study followed 34000 US women in their fifties from 1992-2007. The results suggested it is necessary to exercise hard (21 MET hours/week, equivalent to 60 minutes, or about 600 Calories/day of moderate - intensity activity per session), impossible with occasional 30 minute mild work-outs:
    • Even so, only those with a BMI <25 were successful in maintaining their weight by gaining less than 2.3 kg throughout the study period. Note how alike the graphs look:

  • Under normal situations dietary habits are hard to change! The discussion in the gym proved that - even after extreme exercise such as seen with this man, he has not yet been able to get down to a normal weight. Would an equally strenuous diet and the new 2010 dietary guidelines make a difference, or is it just a "hormonal imbalance"?
  • It is hard to believe that today’s “obesity epidemic” is only the result of factors we cannot control. How does that account for the much more normal weights of only a few generations ago? 
  • Are these factors, once activated by obesity, impossible to turn of?

The new dietary guidelines and Michelle Obama's sponsorship of childhood obesity, helped perhaps by subsidizing healthful food options, may be a start.

Dr T


1) Long-Term Persistence of Hormonal Adaptations to Weight Loss. Priya Sumithran, M.B., B.S., et al. N Engl J Med 2011; 365:1597-1604

2) Physical Activity and Weight Gain Prevention, I-Min Lee, MBBS, ScD et al. JAMA. 2010;303(12):1173-1179.


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