[MrCreosote]

I was wondering what people though of the article in the Irish Times on Tuesday by Muiris Houston.

http://www.irishtimes.com/newspaper/...297612388.html

I know it's an opinion piece but I found it bizarre that a medical professional could try to excuse the levels of obesity. The vast majority are overweight not because of endocrine disorders or medications, but just that calories in>out (not saying it's personal fault, a lot of it is due to societal changes in my opinion). And saying that being overweight usually represents a lifestyle that increases the risk of heart disease and diabetes is not "judgemental"- it's just a fact.

[opinion guy]

I think the most critical sentence in that article is:

Originally Posted by Dr Houston

(Full disclosure: I am one of those who has failed to “stop the spread”, having struggled with my weight for about 10 years now.)

[seamus]

I think what worries me most is that a doctor seems incapable of understand the basic science behind weight loss/gain.

All of which would be bad enough if it could be scientifically proven that all cases of obesity were due to personal selfishness and laziness. But it is an undeniable fact that a substantial minority of overweight people can point to other factors that contribute to their extra weight.

Thousands of people in Ireland are prescribed beta blocker drugs to prevent them having a heart attack or stroke. But beta blockers are known to slow down the body’s metabolism and can make it difficult to lose weight. Thousands more take anti-depressants and other psychoactive drugs which as a side effect add to a person’s weight.

What about the many Irish people with either undiagnosed or poorly treated thyroid disease? An underactive thyroid indisputably causes weight gain as do other hormonal imbalances. Then there are genetic factors: a recent paper in Nature Genetics claims to have identified a gene that contains a “master switch” that causes weight gain.

The only thing which causes weight gain is eating more than your body requires. While slower metabolisms, thyroid problems, etc point to contributing factors, it still doesn't mitigate the fact that if you eat more than you burn, you will put on weight.
You don't spontaneously "add weight" from nowhere when you go on anti-depressants or have thyroid problem. The weight has to come from somewhere - food.

[Wyldwood]

Originally Posted by seamus

I think what worries me most is that a doctor seems incapable of understand the basic science behind weight loss/gain.
The only thing which causes weight gain is eating more than your body requires. While slower metabolisms, thyroid problems, etc point to contributing factors, it still doesn't mitigate the fact that if you eat more than you burn, you will put on weight.
You don't spontaneously "add weight" from nowhere when you go on anti-depressants or have thyroid problem. The weight has to come from somewhere - food.

I must take issue with this. I am a long term sufferer of an underactive thyroid & have recently had my thyroid go spontaneously overactive. I have not changed my eating habits & am exercising less due to feeling unwell but lost at least a half stone in a few weeks. Weight is definitely not only related to what you eat but to medical conditions also.

[seamus]

But you admit yourself that you haven't changed your eating habits. I'm not interested in starting a debate and I don't mean to offend you, but when you do have a medical condition which affects how your body processes nutrition, then the appropriate response (both from yourself and your doctor) is to adjust your food intake accordingly. In much the same way that diabetics must regulate their sugar intake, those with hypo- or hyper-thyroidism must equally regulate their diet.

Part of the message that's lost a lot is that everyone's required intake is different. While the rule of thumb of 2,000/2,400 kcal per day for women/men fits the average, there are multitudes of variables to consider. A 5 foot women will have a much lower requirement than a 6 foot woman. So too a man with hyperthyroidism will have different requirements to an ultra-fit marathon runner.

While a medical condition can explain why someone is gaining or losing weight in spite of their diet, the basic rule of "calories out == calories in" will always hold true. In fact, unintentional weight loss or weight gain should be considered a medical issue by everyone and a trigger to find a way to deal with it.

[ferike1]

My gran grew up during WW2 and then lived in communist Hungary. There was less food for everyone. Funny enough obesity was not a big problem. During school her P.E classes were graded properly and gymnastics was an integral part.

Eat less, exercise more. Simple as.

[opinion guy]

Sorry Seamus I actually have to disagree with you here.

We talk about these things in the simple terms of 'metabolism speeds up' or 'metabolism slows down' but in reality these things are highly complicated. In the normal healthy person all facets of nutrition should be balanced, but in illhealth you cannot assume that all facets of nutrition - i.e. carbohydrate metabolism, protein metabolism, cholesterol metabolism, essential fatty acid metabolism, micronutrients etc etc - are or are not equally affected.

It is possible, nay likely that these things become imbalanced.

Its not as simple to say to a sick person - eat less or eat more. If a hypothyoid person eats far less food to offset weight gain they may become malnourished, equally if a hyperthyorid person eats more to put on weight they may be increasing their risks of diabetes, heart disease etc. Furthermore these things can directly affect appetite. I can see why Wyldwood would be offended.


Strange for me to be arguing this point as I am normally on the side of the you are what you eat mentality, but I think you are going too far in including people with thyroid or other hormone disorders or people on steroids etc. By very definition of illhealth - things are not working as they should - the assumptions that apply in good health do not necessarily apply in illhealth. There is a difference between someone who sits on the couch shovelling in food who puts on weight, and the person who puts on weight due to a thyroid problem. The problem I have with the article is that he is saying we should ignore the first group because of the second group. The first group are by far the biggest issue.

[seamus]

Originally Posted by opinion guy

Its not as simple to say to a sick person - eat less or eat more.

No, it's not. And this is why I hope I avoided saying that and instead mentioned adjusting your intake rather than a simple "eat more" or "eat less".

My main issue really was that this doctor was claiming that in some cases weight gain was an unavoidable side-effect of some illnesses, as if the excess weight simply appeared out of thin air. Which is simply not the case. It's wholly avoidable once the sufferer's diet is managed properly. But on the whole, what he's actually done is display his own personal offence to the advertising campaign and used the small number of people suffering with illnesses to back up his opinion that the campaign is cruel and offensive.

I like the campaign, because it's simple. If your waist is over 37 inches, you're probably fat. That's what it says. And for 90% of men, it's right.

[opinion guy]

Originally Posted by seamus

No, it's not. And this is why I hope I avoided saying that and instead mentioned adjusting your intake rather than a simple "eat more" or "eat less".

My main issue really was that this doctor was claiming that in some cases weight gain was an unavoidable side-effect of some illnesses, as if the excess weight simply appeared out of thin air. Which is simply not the case. It's wholly avoidable once the sufferer's diet is managed properly.

And I'm telling you that's not true.
In particular I'm thinking of people on steroid medications.

[seamus]

Originally Posted by opinion guy

And I'm telling you that's not true.
In particular I'm thinking of people on steroid medications.

Look, I'll take it back to basics. You cannot create something out of nothing. Without food intake, the body will not put on weight. Even if someone's BMR was zero, unless they eat, they will not put on weight in the form of fat.

Therefore, if someone is putting on weight or losing it, there is an imbalance somewhere, which can be resolved.

[ferike1]

What proportion of overweight people are on these 'weight gaining medications'? Also many of these medications could be avoided in the first place with a healthy diet.

I am sorry but the majority of overweight people are looking for excuses or shields. The proportion of people who actually gain weight due to a medical condition far outweighs the average overweight person whos is simply lazy or doesnt care.

[Tree]

Im not sure a stigmatising bully campaign is the way to go about public health education. I think the original article didnt object to curbing obesity but more the shock tactic and guilt that is used to get the message across.

[ferike1]

Maybe because the other tactics haven't worked at curbing the rising obesity levels? Sometimes people need a reality check

[MrCreosote]

Originally Posted by Tree

Im not sure a stigmatising bully campaign is the way to go about public health education. I think the original article didnt object to curbing obesity but more the shock tactic and guilt that is used to get the message across.

This is where I have a problem- it's not 'stigmatising' and it's not bullying. Maybe a bit blunt, but just because the truth is unpalatable doesn't mean it shouldn't be aired. It's the same with those anti-smoking ads.

Now whether it works or not is a completely different question...

[kipple]

Originally Posted by seamus

the basic rule of "calories out == calories in" will always hold true.

Gary Taubes author of Good Calories, Bad Calories makes a convincing case that this is NOT the case.

His case is that metabolic problems cause weight problems, not the other way around. A lot of his research resolves around insulin and the fact that people with higher levels of insulin are typical overweight. His claim is that eating a low-glycemic diet will cause insulin levels to decrease on average which will result in weight loss without hunger.

The human body can regulate its weight regardless of how many calories we eat as long as the basic hormone system of the body is functioning. Sugar and high carb diets cause the bodies weight regulation system to break down.


I found both his books to be very interesting and both rely on clinical studies to back up his case.