Weight loss ponderings

[xiphias]

I know of only two things which have a real track record of helping with weight loss -- amphetamines and tobacco.

Those both have dangers. But the medical establishment assures us that being overweight also has dangers.

So it seems to me that someone really ought to compare the relative dangers of:
1. Being overweight
2. Smoking regularly, to the extent that it helps suppress appetite enough to lead to weight loss
3. Taking amphetamines to the extent that it helps to suppress appetite and increase metabolism enough to lead to weight loss
4. Bariatric surgery

If I worked for the tobacco industry, I would commission studies to quantify these things, and find a way to demonstrate that smoking was healthier than not smoking.

Of course, if I worked for the tobacco industry, I would have been working for marijuana legalization since the late eighties when it became clear that the anti-marijuana rhetoric also hit tobacco (and, in fact, was MORE true of tobacco than of marijuana). In any case, if it WAS legalized, the tobacco industry had all the agricultural, manufacturing, and distribution to benefit.

Comments

[fibro-witch.livejournal.com]

Best of luck trying to lose weight. It is an on going problem for me. I am either to tired to move, or to active to remember to eat.

[pocketnaomi.livejournal.com]

STEADY, consistent exercise has a pretty good track record too.

[xiphias.livejournal.com]

Well, yes and no.

If you cherry-pick your sample space to only include those people who DO manage to do steady, consistent exercise, it DOES look very good.

But that's not actually good social health science -- it's good medical science in that it gives information on how things work, but, in terms of statistical effectiveness, you have to look at the success rate of those who attempt this method.

And THAT track record is dismal.

[pocketnaomi.livejournal.com]

You're presuming that it is not within individual control whether they succeed at doing steady, consistent exercise. I'm presuming the opposite.

[xiphias.livejournal.com]

Yes, I am assuming that. Because it appears to be so.

Some people can succeed. Others apparently can't.

And we have only the most superficial examination of what the distinctions between the two groups are. There MUST be differences -- but we don't know what. And without knowing what, we can't know why there are differences, and without knowing why, we can't know HOW to help people in that second, and much larger, group have more success.

[pocketnaomi.livejournal.com]

Having been, at times, a member of both groups, I don't see a difference that can be judged, let alone addressed, on a large scale. Each individual who wants to succeed has to assess for themself what is standing in their way and what can be done about it, or at least from whom they might be able to get help making such assessments if that, too, is beyond their individual ability. Trying to figure out what are the "distinctions between the groups" is pointless if the distinctions are between each individual... there may look like a 'group' statistically, but there isn't really one, because each person has their own reasons, motivations helping them and blocks preventing them, different from each other.

I'm allergic to tobacco AND marijuana smoke

[dakiwiboid.livejournal.com]

Smoking would give me asthma attacks and migraines. No thanks!

My own weight loss appears to have succeeded, but with the "help" of Topamax and intense migraines, which I don't recommend to anyone. I was losing weight when the migraines were at their peak anyway, because I couldn't stand to eat, then, for about 6-8 months, I had the side effect of diminished appetite from the Topamax. I managed to rethink my diet over those months, and I stopped the uncontrolled snacking, bad dietary choices, and over-large portions that put way too much weight onto my frame in the first place. I'd spent the first 40-odd years of my life weighing no more than about 135, and I ballooned up to about 190. I weigh 130 now, and have stayed within five pounds of that weight for the past year.

I wish I'd lost the weight sooner, because I suspect I could have delayed the bunion surgery and knee trouble I've had for at least another five to ten years if I hadn't been carrying all that extra weight. I do come from a thin family, too.

[xiphias.livejournal.com]

Mainly those. The issue of diet and excercise is that, from a statistical point of view, its success rate is dismal. The success rate of those who manage to stick to a diet and exercise program is very good -- but the success rate of those who attempt this method is not.

We know some things about how to manage to maintain a diet and exercise program, but not, actually, all that much. We know that having a regular exercise setup with other people who will notice if you're not there is better than exercising alone. We're beginning to discover that higher-protein diets tend to be more satisfying and easier to stick to than more carbohydrate-based diets, at the same caloric level. And we're beginning to start to maybe think about the ways in which diet and metabolism interact, with things like how quickly different foods manage to be broken down to glucose.

But we STILL don't know enough about how to do it to make diet-and-exercise a reliable method of weight loss.

random person passing through!

[imfallingup.livejournal.com]

it's important to point out that at this time in most western cultures, brain function is generally valued much more than body function and, in terms of profession, is the more accessible route to a living wage, much less a decent wage. most people working a full-time desk-type job have limited time and energy outside of work, as well as, frequently, limited and/or frustrating access to exercise opportunities. when you're making enough to keep yourself out of the red but not enough to get your own exercise equipment and your body can't handle jogging on cement, the decision to join a gym is often one involving sacrificing some amount of healthy food (or even just food that doesn't taste like crap) or sacrificing the bit of free cash to spend on a social life or to put away a bit of savings.

consider also the huge number of people in low-impact manual labor jobs---standing and bending and light to heavy lifting in restaurants, grocery stores, shipping departments of offices, people doing housekeeping. it's enough labor to keep you active but not necessarily enough to burn as much as a concerted exercise program would, and it's enough labor that come the end of the day you're too tired to do anything resembling intensive work (and if you're a parent, as many working-class people are, too bad; any question why so many kids are beig fed fast food regularly?).

and then there are those people who have the opportunity to exercise and state a desire but do not follow through.

personally, i'm much more inclined to support efforts to change the systems of employment and costs of living that necessitate such draining jobs than i am to find a medical 'fix' to lack of self-motivation. this seems to fall under the same category as finding cures for baldness instead of for aids/hiv or cancer.

[ron_newman]

Smoking results in a far more unpleasant death (lung cancer and emphysema) than obesity (sudden premature heart attack or stroke). I'd take the latter.

[stickylatex.livejournal.com]

I second that!

[thnidu.livejournal.com]

Smoking also has unpleasant effects on other people in the vicinity, in the room after the smoker has left (wherefore the $200? charge for smoking in a non-smoking room), and in the smoker's vicinity after the cigarette (etc.) has been put out and left behind.

[jhitchin.livejournal.com]

Now that I've actually gotten to know people who have had bariatric surgery, I do not have any interest in having it done myself. In one case, a guy who had a LAP band procedure quite some time ago is still having trouble keeping food down. Also, sometimes food gets trapped in the area above the band where Bad Things Happen(tm). I've known several folks who have had the bypass and for one woman, it didn't work.

That's too much risk for me, much as I want to be thinner than I am.

[redbird]

In terms of life expectancy, smoking is better for you than bariatric surgery. Which is not meant as praise of smoking.

[felis-sidus.livejournal.com]

Being obese myself, and having seen first-hand the effects of smoking, taking amphetamines, and bariatric surgery, I'll take the risks of obesity, thanks. That's hardly scientific, but it's good enough for me. If I can't control my weight with a reasonable diet and exercise, so be it. (This from a person who knows perfectly well that my particular problem is an extreme exercise deficiency exacerbated by a total absence of self-discipline.)

[xiphias.livejournal.com]

Is "lack-of-self-discipline" a medical issue, or one that could be addressed medically?

If it is possible to address medically/psychiatrically/psychopharmacologically -- should it be?

Just to throw another, mostly unrelated, question into the mix.

[felis-sidus.livejournal.com]

IMO,"lack-of-self-discipline" is not a medical issue; it may be a behavioral one. In either case, I don't know of any way to address it medically that I would consider acceptable personally. If I really wanted to change either the lack of excercise or the lack of self-discipline, I could do so without medication. The fact is that I don't particularly care to change either. I'd like to weigh less, and I'd like to enjoy exercise, but not so much that it's worth making an effort to attain either.

[voltbang.livejournal.com]

I don't think it's "lack of self discipline". Trying to add some amount of exercise, and partly change eating habits, is just really really hard. I have seen that approach work, but only by people who chang a whole lot. If you want to take that approach, drop most of your sedentary habits and get into an active lifestyle. Don't add exercise, become active, if that makes sense.

I was married to a smoker, who gained weight when she quit. It's not a great approach. If it works, you will eventually want to quit smoking, and you will probably gain more than you lost. Plus the other risks. You start smoking to lose weight, you will have to keep smoking to keep the weight off.

I've known some people who had the surgeries, and while it has complications, it's a great start. The complications can be a bear though. Or multiple bears, in some cases. And keep in mind that if you go that route, you go on the strictest diet you ever heard of. You can only eat a tiny amount of food, and you have to eat the right stuff. There's just no room for a snickers bar, once you've eaten your protien bars and so on. It's not a way to get out of dieting. My sister in law had the surgery, had tons of complications, and hasn't listened to a word her doctor said about what to eat. She lost a lot of weight, but she's on her way back to her pre-surgery weight, because she stuffs in as much candy as she can, and refuses to eat any healthy food.

I don't know you in real life. How much weight do you feel you need to lose?

[xiphias.livejournal.com]

If I lost 20 pounds, I'd probably snore less. If I lost 40 pounds, I'd probably be able to get back into martial arts.

But, frankly, neither is a priority to me.

I'm 220 pounds, and 5 and a half feet tall. I think my "ideal weight" would be about 165 -- which is still higher than the BMI charts say I should be, but I think, if I were 140 pounds, I'd be dead. Still, 165 would be healthy.

That's, like fifty, sixty pounds away.

I have no expectation of doing that, and I'm making absolutely no effort to do so. This post was not about me, in the least. It was about smoking, amphetimines, and weight loss.

[felis-sidus.livejournal.com]

I appreciate your supportive words and interest. Let me say that I'm not attempting to lose weight at this time. I describe myself as obese because that is the medically correct term, not because it's my perception of my weight. As for how much weight I ought to lose, I haven't bothered to calculate that. I am more than 20 percent over my ideal weight, as defined by medical criteria, but my BMI is below that where a doctor would recommend bariatric surgery. I'm 80 to 90 pounds heavier than I was 20-some odd years ago. The weight was gained over a comparatively short period of time as a result of increased caloric intake occurring simultaneously with sudden, significant decrease in activity. Although my caloric intake has returned to normal, my activity level has not. I'm familiar with the various kinds of bariatric surgery, the required life-style changes associated with them, and the various degrees of success. While I'm neutral on the subject of bariatric surgery for others, it is not an option I'd be willing to consider for myself. I'm also well-acquainted with nutritional analysis and planning. My intake has been tracked in detail over a period of time in order to ensure that my sat fat intake remains at an appropriate level. My average daily intake, with no attempt to restrict eating, is 1100 calories, varying between 900 and 1300, and going as high as 1500 on rare occasions (a particularly extravagant Thanksgiving). Composition is about 50 percent complex carbohydrates, 35 percent protein, and 15 percent total fat. My lifesytle is sedentary.

The reason I say my exercise deficency is due to lack of self-discipline is that experience has proven that I'm capable of exercising regularly over the long term when I choose to do so. It's just a matter of what happens to be most important to me at a given time, and exercise and weight-loss have very low priorty for me most of the time. I define "self discipline" as the ability to get oneself to do that which one does not wish to do, or at least to make the attempt with some regularity. When it comes to exercise, I do neither.

[voltbang.livejournal.com]

I'm full of support. It's a subject close to me as well. Not so much for me, I'm just slightly on the soft in the middle side of the spectrum. But there's plenty of people in my life for whom it is an issue. And my wife has tried a lot of the meds, and is thinking about the surgery.

I really dislike BMI as an indicator of physical condition. According to BMI, every professional athlete out there is "obese" or worse. I think that the percentage of body fat is a much more interesting and useful number. My bathroom scale tells me that it thinks I hover right at 20%, and while that number may not be accurate, it's close enough that I'd like to get it down by about 3%. In a perfect world, I'd like to see it get down to 15% but that just isn't happening. It's been as low as 16%, within the past 4 years even, but that took a major life change.

About the "self discipline" thing. If exercising isn't a priority for you, then I still say that not doing it isn't a discipline problem. If it were a priority, and you were not doing it, then yes, that would be a self discipline issue, but this is just you living according to the priorities you have set. For me, exercise is a higher priority, but I have a harder time with the food intake. I don't think I've had a day under 2000 calories in years. It's not like it was in high school, but I like to eat. In high school, I routinely had 6000 calorie days, and weighed 120 pounds. If you could bottle my metabolism back in those days, you'd have the get right now diet program :) But anyway. It sounds like you understand the stuff you need to know to make the various approaches work, and it does just become a matter of priorities. None of the approaches are easy, after all, and if you are going to make them work, there's other compromises you gotta make.

[sinboy.livejournal.com]

I'm told that hoodia extract supresses hunger. Dunno about side effects. Might be bad for you, but probably not as bad as smoking.

[ookpik.livejournal.com]

As you know, I'd be classified as morbidly obese. I've been on numerous diet-and-exercise plans, but once I went off I went back to overeating. I tried to take up smoking--for this, and only this, purpose--in high school; I think I got through maybe 2 packs of cigarettes before saying "yuck, I really hate this, I'd rather be fat."

Oh yes: and while I haven't tried the amphetamines, I've tried the appetite suppressants--not only hoodia (and the like), but dexfenfluramine (Redux). The latter worked beautifully for about a month--I lost something like 30 lbs without really trying--and then I went to my doctor and said it felt like it was affecting my lungs, and I had to stop. (And a month or two after that, it was taken off the market because of pulmonary side-effects.)

I'm seriously considering bariatric surgery; if I were sure I could stick to the strict after-diet, I'd be past just "considering".

Sorry if this is TMI, or just plain boring...I'm just feeling pretty hopeless about the situation.

[dhole.livejournal.com]

Thing is, if you want to play fair, the numbers would have to include people who weren't able to stick to moderate use of cigarettes or amphetamines; it is, after all, a known failure mode for those methods of weight control, in the same way not sticking to a diet or exercise regime is a known failure mode of those methods of weight control.

My suspicion is that because of those failure modes, both cigarettes and amphetamines are worse for you than not using them, even if you are obese, and certainly if you're just trying to drop a dozen pounds or so. But that's my instinct, rather than something supported by data, and thus suspect.

[sashajwolf.livejournal.com]

Can't see that working for the tobacco industry (if done honestly and with scientific rigour), because the first thing they'd find is that the health risks of obesity are minimal. The Obesity Myth by Paul Campos is good on this. Tipping the Scales of Justice by Sandra Solovay also cites some interesting studies, although her focus is mainly on the legal aspects.

[xiphias.livejournal.com]

(if done honestly and with scientific rigour)

Heh! This is the tobacco industry we're talking about! I was saying that this would be something they could set up to make it LOOK like smoking was healthy -- not that smoking IS.

[nancylebov.livejournal.com]

You might want to check out _Rethinking Thin_ by Gina Kolata (health writer for the New York Times). There's less evidence than the culture would have you think that being fat is bad for you.

[ewtikins.livejournal.com]

As others have already added, I would point out that being thin is not the same as being healthy; being thin and eating poorly and getting no exercise is probably nearly as bad as being fat and eating poorly and getting no exercise. Being overweight but active and strong with a good diet is probably better than being thin but eating poorly and getting no exercise; it certainly makes one more likely to be able to run for a bus.

That said, there are definite health disadvantages to obesity. The body just has to work harder. I'm not very obese - just a bit overweight, really - but I know I feel healthiest when I'm between 160 and 175 pounds (I'm six feet tall, for reference). Lower than that and I'm too tired to function, higher than that and my joints complain... and will almost certainly sustain permanent damage, leaving me with chronic pain and disability. The times I've been that weight, though, have almost entirely been times when I was getting quite a bit of exercise, so I don't know what it would feel like to be that weight but unfit. I'm focusing (among other things) on the getting fit, and trying to trust that if I get enough of the right sort of exercise, my body will end up with the strength to support my joints at the weight I eventually stabilise at.

FWIW I also find my apetite is far healthier when I am getting more exercise. I actually want to eat more fruit and veg when I am active. I have no idea why this is, but I welcome it.

[vvalkyri.livejournal.com]

I don't feel like responding directly to the folk who've commented that obesity isn't really bad for a person, but I will note that after a year of occasionally getting to watch surgery . . . at a certain level extra weight causes problems for the anesthesiologist and a surgeon. I don't think I'll ever forget watching a 350lb guy get readied to have his gallbladder out. It would have been a 45min start to finish for someone of a more 'standard' size, but even positioning was a difficulty as if he was lying flat the pressure on his lungs was high enough to cause a drop in O2 saturation. Laparoscopic surgery was out of the question (you have to be able to inflate the body cavity with gas and again, just too much pressure. That and interior fat can obscure the view.) and the surgeons were standign on stepstools and having to reach into a narrow chasm almost beyond where they could see in order to do what ordinarily would have been a pretty simple operation.

That all said, you're not anywhere near that big. If losing weight will add to quality of life, and get you able to do some really cool exercise (the martial arts you mention) it still sounds worthwhile. I do know someone who took up smoking temporarily for health reasons, to forstall weight gain on a certain drug combination, and also to keep awake at the wheel when his sleep apnea threatened otherwise. It's probably not the best of choices, but it made sense in his situation. I also know someone who's had success with hoodia. How about DDR? Stealth exercise.

[mswae.livejournal.com]

For the appetite-suppressant effects, you don't need the cigarettes. You just need the nicotine. Which, by the way, is a very dangerous drug & will do wicked things to your blood pressure among other things so please don't construe this as a suggestion that you go get addicted to the patch or anything.

weight loss

[(Anonymous)]

Well, you can try the technique developed by our former downstairs neighbor who was cooking for "many" persons on a miniscule budget back in the 60's. The technique is to have nothing in the house that can be eaten without cooking or substantial preparation. Also a Bracha for everything that goes in the mouth.

It seems to work for me.

Duzzy

[rarkrarkrark.livejournal.com]

Back when I was quitting smoking I hauled up some stats and did some math and figured out that I could gain 100 pounds (on an already overweight frame) and break even. Smoking is that much worse for you. The 100 pounds is variable though, and I'm not sure how much more variable. I have minimal family history of heart disease but a huge family history of diabetes and that did go into it. What didn't was my asthma, so it's probably even worse for me to smoke than gain 100 pounds, but I was going for a rough estimate.

And that was for 1/2 a pack/day. I never smoked more than that for more than a day or two at at a time.

Not sure about the rest.

[rarkrarkrark.livejournal.com]

Also, that hundred pounds would probably kill my joints, but that wouldn't kill me and I was looking at mortality. In reality I gained twenty and I've lost some of that without trying since.