You’ve got to get the costs right love

Obesity now comes second only to smoking as a cause of premature death in Europe and North America. It’s estimated to cost the NHS around £4bn a year. Yet last week, surgeons lambasted the NHS for severely limiting access to stomach-shrinking surgery. There were just 5,000 of these potentially lifesaving operations carried out in the UK last year, many fewer per head than in countries such as France, Belgium and Sweden.

What’s going on? The procedure is the most effective way of helping people who are obese to lose weight and can have a radical impact on their quality of life. At approximately £6,000 per operation, it’s relatively cheap and saves the NHS significant amounts of money on more expensive procedures such as hip and knee replacements further down the line. But here in Britain, it is being reserved only for the most extreme cases.

It’s actually cheapest for the NHS if the fatties die from exploding…..

Not that that’s the point of having an NHS or anything, but it is important to note if you’re going to start talking about the cost to the NHS of obesity.

63 thoughts on “You’ve got to get the costs right love”

  1. ‘The procedure is the most effective way of helping people who are obese to lose weight..’

    Bollocks! It’s the most effective way of helping those people who are obese and lack willpower and discipline to lose weight.

  2. I checked the source reference. It’s another Guardian article about obesity, which itself references The Lancet, which in turn references a meta study.

    This study presents statistical analysis of a large number of other studies, looking at obesity related mortality. However, there does seem an awful lot of cherry picking of data, exclusions and assumptions going on.

    I’ve often found it better to use life insurance company data/summaries as those companies have bet an awful lot on being right about this sort of stuff. Especially with regard to the effect of smoking on, say, monthly life insurance premiums.

    The single biggest cause of increase (of premium ££) is age. Followed by BMI – but they know it’s a flawed measure.

  3. “fat discrimination campaigns have to find a way of reducing stigma and challenging harmful body image stereotypes, without giving the impression that being obese is OK”

    I wonder whether Sonia puts this forward with a straight face. This is actually a very difficult dilemma she justs shoves out there at the end. To be fair Sonia does cite a study that concludes shaming makes it harder for obese to lose weight. Maybe so, but the shame response isn’t targeted only to the extremely overweight, it’s targeted at everyone. It’s a sliding proportionate response that is ramped up the bigger you get. The extremely obese have experienced the whole scale and still are the weight they are. It’s not worked for them, its’ had unpleasant consequences for them but it’s not quite true to say it hasn’t worked for everybody else. It’s a kind of a survivor bias type of situation. So if you’re saying the extremely obese aren’t helped by the extreme reactions well ok. But to determine the efficacy you also have to ask how many people have avoided becoming extremely obese because those reactions do actually work as a motivator (pour encourager les autres) . I understand the humanitarian urge to want to cut off the extreme responses targeted at the extreme end of the spectrum, but there’s more to it than that, and pretending otherwise doesn’t help.

  4. Given that many of these people are being paid to shovel food into their mouths all day, maybe it would be cheaper still to stop doing that?

    And it would be more moral to pay those beneficiaries who aren’t fat, to post on tumblr all day and shame the fatties into stopping gorging themselves.

  5. There is also an issue with whether the statistics for a whole population (which axiomatically are of concern to a NATIONAL health service) relate to an individual. So, a 0.09% risk if you take the drug and a 0.10 risk if you don’t are indistinguishable to the patient, but can be trumpeted as a 10% improvement overall.

    Indeed, if you get to the 0.09 by giving some of the patients a worse outcome, and some patients horribly debilitating and painful side effects (short of death), taking the medication might do fuck all, and the statistics might just be phoney anyway.

    Statins anyone?

  6. Government is jerks. They insist on picking up the tab, then COMPLAIN ABOUT THE COST! Don’t pay it, or STFU.

    The obese have decided that eating a lot is more important to them than how they appear, or any risk of premature death. Shaming them is the BEST way to affect that decision.

    ‘Premature death.’ Nebulous term. Perfect for epidemiology studies which give you any result you want.

    ‘Yet last week, surgeons lambasted the NHS for severely limiting access to stomach-shrinking surgery.’

    Let’s see, do surgeons get paid for doing stomach-shrinking surgery?

    ‘The procedure is the most effective way of helping people who are obese to lose weight’

    I betcha locking up their fat asses would be more effective. It’s like Trump’s Wall. The U.S. did fine without a wall for 200 years. Then the Federal Government decided not to enforce immigration law. The Wall is a sign of failure of government. I see it as indirection. Put it up, and we’ll still need to enforce immigration law.
    If government is going to spend money for elective stomach surgery, it would be far cheaper and SAFER to send lardies to fat camp. Spending two weeks on 800 calories a day could be life changing. A shrunk stomach – a stomach “wall” – will eventually stretch.

  7. ” To be fair Sonia does cite a study that concludes shaming makes it harder for obese to lose weight.”

    But is it, or is that just what the obese say?

    The reason people don’t like obese people is that apart from being less fuckable, mostly, it says a great deal about their character. They’re lazy, they aren’t sociable, they don’t do much. OK, there’s Barry White, Gabe Newell and most sopranos, but in my working life, I’ve rarely observed that the obese guys are the best people. You meet some people who just prioritise things like knowledge or working all night on stuff, but in general, people are fat because they spend their spare time watching TV and eating ice cream.

  8. @Gamecock

    The obese have decided that eating a lot is more important to them than how they appear, or any risk of premature death. Shaming them is the BEST way to affect that decision… I betcha locking up their fat asses would be more effective…
    If government is going to spend money for elective stomach surgery, it would be far cheaper and SAFER to send lardies to fat camp.’

    Fucking hell, Gamers. My weight’s fine, I do a lot of exercise (and my joints are probably fucked) from past stuff), but I don’t think it’s my business to ‘shame’ fat people, much less lock the fuckers up. It’s their choice. I thought we were the UNcensorious cunts?

  9. Gamecock,

    “If government is going to spend money for elective stomach surgery, it would be far cheaper and SAFER to send lardies to fat camp.”

    It worked for Terry Waite and Nelson Mandela.

    it’s almost entirely about sugar and lack of exercise.Even general exercise like walking to a local shop.

    It’s why America is so fucking fat. They actually make the options other than getting into a car difficult. Live in the ‘burbs, there’s no footpath to the local shops. There’s no bus services, so even walks to bus stops don’t happen. And food stamps. So, you are encouraged to buy even more food.

    The funniest thing I found was in the malls where the refillable drinks came in different sizes. I had to ask my sister-in-law why anyone would be the large refillable. “It’s so they don’t have to get up so often”.

  10. Bloke on M4-
    well the point was that the negative connotations, fair or not fair, has positive outcomes. Sonia didn’t acknowledge the dilemma. She fudged it saying in effect “This is bad, so don’t do this but all those people acting like this is bad should stop and should be quiet.”

  11. OK, my theory is as follows.

    90% of why you die when you die is due to genes. If you are a boozer or a smoker or a fat fuck, your behaviour will make minimal difference the the age you pop your clogs. Except at the outliers – the 100 a day man and the barrage balloon.

    However, the big chunky costs of the smokers and 30-stoners are a concern for the NHS so they make a fuss about it (even though some will conveniently keel over aged 62).

    And admitting that it’s mainly luck would undermine 50 years of trying to control people via their health.

  12. It seems to me that banning hate-filled rants about darkies or poofs or whatever has led to their being replaced by hate-filled rants about fatties and about the old

    Yup, we need our 2 minutes of hate.

  13. It’s fair to say that a proportion of the obese population will have become so because of some genuine medical problem. I don’t think that’s likely to be a high proportion, but I’ll wager that it’s higher amongst the most extremely obese than among the everyday lardarses.

  14. Lefties seem to be saying
    – the persistent fatties should get your money because they are human beings
    – but they cannot lose weight other ways even if they want to because they do not have free will
    So which is it?
    A bit harsh but I don’t think they understand their stance themselves, hence they’ve had to force the data to say there will be a net lifetime saving to the NHS.

  15. “The procedure is the most effective way of helping people who are obese to lose weight”

    I would have thought not eating so much might be equally effective, as well as cheaper, but then what do I know?

  16. I disapprove of obesity, because the obese inconvenience others – on pavements and planes, in queues and in cinemas, etc. They seem to have very little understanding of how their bulk inconveniences others. That said, I don’t hate them; nor do I shame them, except perhaps with a disapproving glance. Such disapproval is arguably the middle way between censoriousness and the view that anything goes.

  17. “90% of why you die when you die is due to genes. If you are a boozer or a smoker or a fat fuck, your behaviour will make minimal difference the the age you pop your clogs. Except at the outliers – the 100 a day man and the barrage balloon.”

    Our genetic inheritances rule pretty much over everything else.

  18. It’s why America is so fucking fat. They actually make the options other than getting into a car difficult.

    I was pleasantly surprised with San Fransisco. You could walk. My knees hated me after a couple of days.

  19. “I disapprove of obesity, because the obese inconvenience others – on pavements and planes, in queues and in cinemas, etc.”

    I don’t like looking at them.

    Obesity is a psychological problem. Surgery for a psychological problem is malpractice. But the surgeons demand more!

  20. Fat people choose to be fat despite what they say (expressed vs revealed)

    I choose to be a skinny runt despite saying I’d like muscles and a six pack (revealed vs expressed)

    As for the NHS, either provide the services mandated across the board and cut administrative costs if needs be or stop calling it universal healthcare and allow me to opt out of contributing to a service that I will never use.

  21. “I thought we were the UNcensorious cunts?”

    HA! HA! HA!

    “It’s fair to say that a proportion of the obese population will have become so because of some genuine medical problem. I don’t think that’s likely to be a high proportion, but I’ll wager that it’s higher amongst the most extremely obese than among the everyday lardarses.”

    Hooray! Well done!

    “I would have thought not eating so much might be equally effective, as well as cheaper, but then what do I know?”

    It works for about the first 6 months, then the metabolism resets to use less energy and you put it all back on over the following few years.

    The body’s energy storage is controlled by biochemical feedback mechanisms – like breathing or drinking water – and has a set range it considers correct. If your weight is above that, it ramps up your metabolism to burn more energy and shuts down the appetite. If your weight is below the range, it switches into ‘starvation’ mode, increases appetite, and shuts down non-essential systems (like bits of your immune system) to conserve energy. Starvation mode is dangerous, of course, so it only does that after a few months when it’s clear the famine is not a short-term blip and its fat storage is going to run out.

    Whether you’re fat has relatively little to do with how much you eat. If you eat a lot and burn a lot, you can stay thin. If you eat only a little but burn very little, you can stay fat. It’s mostly genetics and age, with a few environmental influences like Ad36 infection and gut flora known to have an effect.

    It’s also well known to researchers that the obese live longer than those with the ‘normal’ weight. (‘Normal’ for a 20-year old is not ‘normal’ for a 50 year old, when dying starts to become and issue.) They call it the “obesity paradox” because it goes against their religious beliefs. But it’s not really a paradox. It just says that the healthy optimum increases with age.

    And most of the rest of the “obesity epidemic” is due to statistical malfeasance changing the definition of ‘obese’, and the same improved nutrition that has also increased people’s height by 10 cm.

    It’s another moral panic. It started off as a way to fake looking younger (and hence more sexually attractive), turned into a massive diet book/club/food industry, and has now mutated into yet another excuse for joining a mob and bullying people for not fitting in with the way we think they ought to be, the way we think they ought to live. “Yup, we need our 2 minutes of hate.”

  22. Anoneumouse: I was signing up to a new doctors’ and there was a baby-weighing session in the lobby, and the midwife doing it was of Nanny Oggian proportions. In a previous job I did IT installs in GP surgeries, and was amazed at the amount of blubber.

  23. NiV

    It works for about the first 6 months, then the metabolism resets to use less energy and you put it all back on over the following few years.

    False. True only if the individual returns to his previous eating habits and/or doesn’t reduce his intake of carbs.

    You talk so much bilge that I believe you must be IanB in drag – and I claim my bitcoin!

  24. ‘It works for about the first 6 months, then the metabolism resets to use less energy and you put it all back on over the following few years.’

    Horseshit.

    It takes 2.34 calories to raise 1kg by 1m (or 0.00234 food Calories).

    A 30 stone man uses 445 calories to rise 1m
    A 20 stone man uses 297
    I use 147

    It doesn’t matter how efficient (fit) your body becomes at converting food into practical work, if you currently weigh 20 stone and you take in 296 or less calories for every metre you rise (equiv) then you will lose weight until a new equilibrium is reached.
    The only ways to break this new equilibrium is to either reduce calorie intake further or increase output (metre rise equiv) or a combination of both.

    I walk greater than 15 miles per day at a brisk pace and I eat like a fucking mouse, it’s no coincidence that there is not an ounce of fat on me.

  25. I’ve just used the NHS online BMI calculator. It tells me I’m obese at 15.5st and tells me to lose 5-ann-half stone. I think I’d die before I managed to get down towards 10 stone, I got down to 13st a few years ago by living six miles from the nearest bus stop and cycling there and back twice a week.

    Additionally, it ignores the fact that my spine has been compressing and I’ve lost 4 inches in the last 20 years. Even putting my original height in puts me right on the overweight/obese cusp, and tells me to get down to 11st.

    I just cannot believe that 11st is *really* a healthy weight for a 48-yar-old male. I was last that weight when I was something like 16 years old.

  26. jgh,

    they have downsized an unrepresentative measure (BMI) to capture more victims (because victims need counseling).

    At 48 and 15.5 stone you could lose a few pounds and feel better for it but is it worth the sacrifice (smaller amounts of the food you like) and the effort (more work) ?

    Just dropping a stone is like losing most of a leg !

    Turn your central heating down by a degree and go a bit easy on the pies, you will soon notice you need a new hole in your belt.

    24 miles by bike is the equivalent of walking 8 miles, I’ve done that by lunchtime every day.

  27. Bloke in North Dorset (mid channel)

    The simple way to sort out how much extra obesity costs in health care is to move to an insurance based system with the government acting as insurer of last resort. The insurance companies will soon figure out the cost of lifestyle and everyone can be left alone to navigate their own way to their grave.

    That we’ve been persuaded as a society to adopt a free at the point of delivery single payer system does not give the advocates of that system the right to moralise and shame people in to changing a lifestyle they don’t approve of. They should be told at every opportunity to fuck off.

    And yes I’m aware that doesn’t address all social costs of obesity, but it’s a start.

  28. @JuliaM, September 3, 2017 at 9:19 am

    ‘The procedure is the most effective way of helping people who are obese to lose weight..’

    Bollocks! It’s the most effective way of helping those people who are obese and lack willpower and discipline to lose weight.

    +1 Spot on

  29. @Hallowed Be, September 3, 2017 at 9:59 am

    …have to ask how many people have avoided becoming extremely obese because those reactions do actually work as a motivator…

    It works for me, I look at photos of me and think: damn, must lose weight.

  30. “False. True only if the individual returns to his previous eating habits and/or doesn’t reduce his intake of carbs.”

    No, it applies even if they maintain the same eating habits. The amount of energy used is variable. If you eat less, the body economises to compensate.

    “Horseshit. It takes 2.34 calories to raise 1kg by 1m (or 0.00234 food Calories).”

    Heh! You think the only thing the body uses energy for is lifting itself? You think everything else is a constant?

    Here’s an interesting experiment, where someone wound up eating 10,000 Calories a day and not exercising, and maintained a constant weight. How much heavier would he have to be according to your lifting weight calculation? (Show your working!)

    https://idmprogram.com/the-astonishing-overeating-paradox-calories-part-x/

    Did you get the right answer?

  31. @Gamecock, September 3, 2017 at 11:07 am

    …A shrunk stomach – a stomach “wall” – will eventually stretch.

    Yep, stomach became enlarged due to overeating and will do again.

  32. The simple way to sort out how much extra obesity costs in health care is to move to an insurance based system with the government acting as insurer of last resort. The insurance companies will soon figure out the cost of lifestyle and everyone can be left alone to navigate their own way to their grave.

    Exactly! A socialist healthcare system encourages, if not requires, endless nagging of the populace to adopt habits perceived as healthy by the public health wallahs.

  33. @Interested, September 3, 2017 at 11:47 am

    “…I betcha locking up their fat asses would be more effective…”

    …Gamers. …I don’t think it’s my business to ‘shame’ fat people, much less lock the fuckers up. It’s their choice. I thought we were the UNcensorious cunts?

    imho he meant really locking up their asses with a butt plug. Their pain will modify their eating behaviour.

  34. No, it applies even if they maintain the same eating habits. The amount of energy used is variable. If you eat less, the body economises to compensate.

    If that were true, nobody would ever have lost weight and not regained the weight.

  35. Perhaps doctors in the UK do not believe that a stomach operation is the better solution.
    There are multiple solutions to the obesity problem, surgery being one option.
    Not everyone who is obese even wants surgery.
    Not everyone can have surgery.

    Ultimately the right to choose what happens to your own body and someone deciding you will have surgery / weight reduction don’t really go together.
    I could lose weight. I could also eat a horse at the moment (OK, a few horse burgers anyway, no uni-quorn).

  36. @Bloke on M4, September 3, 2017 at 12:01 pm

    …It’s why America is so fucking fat…

    Way back in ~1981 on first holiday in USA on day at Disney World asked dad why so many fat adults were in wheelchairs, mobility scooters, golf buggies etc – he told me they were too fat/heavy to walk. I was flabbergasted.

  37. “If that were true, nobody would ever have lost weight and not regained the weight.”

    The body has a set range it aims for, but sometimes the range can change. It commonly increases with age, but sometimes it decreases sharply. When that happens, people find they can lose weight without effort, and easily keep it off. They often experience that as “I just decided to lose weight, and did. It was easy!” But that’s a biochemical switch, not willpower.

    The same sort of thing happens if you get a wasting disease like cancer. It flips the switch and you lose your appetite, and starve.

    Here’s the results from a medical study on different diets. The first graph shows energy intake and energy use per day per kg.
    http://jamanetwork.com/data/Journals/JAMA/5118/joc70018t2.png

    The second table shows the weight loss.
    http://jamanetwork.com/data/Journals/JAMA/5118/joc70018t3.png

    You can see BMI dropped by up to 2.65 at the 6 month mark, but then rose again to only 1.65 below the initial baseline at the 12 month mark. The first table shows they hadn’t reverted to their former Calorie intake, but were still about 300 Calories under. (At 3500 Calories per pound of fat, that ought to be a pound every 12 days.) Had the experiment continued, the weight gain would also likely have continued.

    And here’s another interesting story about sudden weight gain!
    http://www.bbc.co.uk/news/health-31168511

    If gut flora has such a dramatic effect on weight in one direction, why not the other? Could it be that a sudden change in flora could be the cause of those instances of sudden easy weight loss?
    https://www.scientificamerican.com/article/how-gut-bacteria-help-make-us-fat-and-thin/

    Are you absolutely *certain* it’s impossible? Why do you think so?

  38. Here’s some more reading – with plenty of links to the scientific literature to follow up.

    http://junkfoodscience.blogspot.co.uk/2007/12/part-two-what-does-evidence-reveal-can.html

    Any significant caloric restriction will result in initial weight loss for virtually all bodies. However, studies show remarkable similarity and the data is impressive, Garner and Wooley explained, indicating homeostatic metabolic adjustments to return body weights to their genetically-determined setpoint range as normal for each individual, and that this body weight defense occurs in ‘obese’ and ‘nonobese’. Even short-term caloric restrictions result in rather dramatic metabolic adjustments (as much as a four-fold increase in metabolic efficiency) to preserve the body’s normal state. This phenomenon appears to explain why restrained eaters eating less actually weigh more than those with unrestrained eating styles.

    The obesity scare is like all the other scares – overpopulation means we’re all going to starve, the oil is running out, global warming will boil the oceans, acid rain will kill the trees, pesticides in our food will poison us, saturated fat will clog up our arteries, salt will cause hypertension, robots will steal all our jobs, mobile phones will zap our brains, wanking will send you blind, …

    It’s utter shite, the lot of it.

  39. NiV,

    did you actually read your linked article ?

    fat people burn more calories at rest than thin people.

    2.34 calories to raise 1kg by 1m at 1G is a standard measure of the energy to work ratio.

  40. “fat people burn more calories at rest than thin people.”

    Not true.

    The GUTS and DONALD studies join a profusion of other studies, both clinical and epidemiological, over the past fifty years demonstrating that fat children and adults as a population normally eat exactly the same as thin people. And regardless of their diets, children will still naturally grow up to be a wide range of heights and body weights. “Multiple researchers, using a variety of methodologies, have failed to find any meaningful or replicable differences in the caloric intake or eating patterns of the obese compared to the non-obese to explain obesity,” concluded David Garner, Ph.D. and Susan Wooley, Ph.D., for example, in their review of some 500 studies on weight in Clinical Psychology Review.

    http://www.ideasinactiontv.com/tcs_daily/2004/10/on-obesity-what-the-researchers-didnt-find.html

  41. My better half has been on multiple weight loss programs over the years.
    She can lose weight for a few months then her body adapts and she will not lose any more.
    Medical conditions don’t help, and most of the jobs she has done have been hard work or lots of walking.

    She saw a consultant a few weeks back about an ongoing issue, nothing to do with weight. He mentioned in passing he has had patients who have been on same diet, both sticking to it – and one gains weight while one doesn’t.

    My baby brother would be classed by BMI as several stone overweight. He’s had 2 or 3 hard working jobs at a time much of his working life and been doing kickboxing most of that time on a regular basis.
    Built like a brick wall would describe him pretty well, he outmasses me a fair bit.
    So of course he’d be classed as obese.

    Lots of muscle, eats the right stuff (and lots of it), burns calories a lot – and at age 35 is pretty fit. Yet far higher weight than his height should be according to the NHS.
    They were glad of that body when a patient kicked off in the hospital he worked at.

  42. NiV,

    ‘It’s utter shite, the lot of it.’

    at least we agree on one thing.

    ‘fat children and adults as a population normally eat exactly the same as thin people.’

    Wow, and I thought that all those skinny people in the camps on ‘World at War’ was because they had inadequate diets, I never realised that that was their natural condition even though they were stuffing their faces all day long.

    ‘How can this be reconciled with the laws of thermodynamics?’

    Easy if you believe in perpetual motion.

  43. “Wow, and I thought that all those skinny people in the camps on ‘World at War’ was because they had inadequate diets,”

    Which part of “normally” didn’t you understand?

    I’ve already explained – if you cut Calorie intake, people go into ‘starvation mode’ and start shutting down non-essential systems to economise. But there are limits to how much of this the body can do before you start shutting down essential systems. The body forced below that lower limit needed to supply essentials ekes out its supplies for as long as possible, trading weight loss against damage done, but will eventually run out.

    However, above that unhealthy minimum, which is where most people are “normally”, weight rebounds.

  44. “Here’s an interesting experiment, where someone wound up eating 10,000 Calories a day and not exercising”

    Here’s a better experiment: eat ZERO calories a day. Let’s see their metabolism adjust out of that shht.

  45. When Disney first opened Disneyworld Paris they had to adjust all their cash flow projections when they realised that the Europeans simply didn’t ‘snack’ like the Americans. In addition to not buying the trinkets, Europeans simply didn’t waddle around with a bucket of ‘soda’ permanently in one hand, nor did they feel the need for cookies, donuts and other sugar hits in between meals. Interesting also that as of today more people in the world die of eating too much rather than not enough. Progress of sorts I guess.

  46. The one REALLY important element that doesn’t seem to have been discussed is muscle mass. Particularly for men. Muscles, big muscles, consume energy even at rest. It is becoming much clearer that the excesive reliance on cardio to ‘burn’ fat doesn’t really work. Fat men should go to the gym and develop their musculature. They may even gain weight. But the fat % will drop sharply. Schwarzenegger in 1975 would have had a BMI way off the scale. But he was in magnificent condition. Eat what you want but get strong. Physically strong – by pushing heavy weights. You’ll get a fit body.

  47. “Interesting also that as of today more people in the world die of eating too much rather than not enough. Progress of sorts I guess.”

    Yes. Dying of some obesity related illness in your sixties is better than starving to death when you are four.

  48. NiV

    Whenever discussing this, you never easily seem to accept that this is not binary (ie either stay (or revert to) the same weight, or starve), but instead is a gradation, based on lighter bodies needing fewer calories (even with recalibrations on route, and which I agree makes sense).

    Ie, if you cut the calories (permanently), logically one should stabilise at a lower weight, even if one might initially overshoot (and then also change metabolism) to some extent on route to that new equilibrium.

    Indeed your own evidence (above) does seem to suggest precisely that.

    Here’s the results from a medical study on different diets. The first graph shows energy intake and energy use per day per kg.

    http://jamanetwork.com/data/Journals/JAMA/5118/joc70018t2.png

    The second table shows the weight loss.

    http://jamanetwork.com/data/Journals/JAMA/5118/joc70018t3.png

    You can see BMI dropped by up to 2.65 at the 6 month mark, but then rose again to only 1.65 below the initial baseline at the 12 month mark. The first table shows they hadn’t reverted to their former Calorie intake, but were still about 300 Calories under.

    Ie, after twelve months, sure they had gained some weight back, ie initially overshot, but were still less than before (whilst maintaining that lower calorie input).

    Your comment:

    Had the experiment continued, the weight gain would also likely have continued.

    is pure speculation, but I do note that you refrain from suggesting that all the weight would be put back on.

    Ie the evidence you present, insofar as it goes, does tend to support a “new lower equilibrium” that most of us either intuitively or anecdotally know to be true.

    You’ll have to extend the study further out if you want to use it to prove a case of “no permanent long term weight loss” (whilst continuing to maintain that same lower level of calories)? I think we all know that if the lower calorie level is maintained, we are not going to see those people back at exactly the same level as they started.

    I’m not suggesting that the 12 month position will be the final point, but some new equilibrium will be found – at less than the original start point – and for everyone one of them; the level of change in equilibrium quite possibly varying quite a bit between the group sample.

  49. OK hands up all those who weigh less now than they did 30 years ago?
    A new lower equilibrium found by anyone over the course of a couple of decades or more?

  50. @Mark T, September 4, 2017 at 7:21 am

    Thanks for the Disney France info. Maybe partly explains the loses they were making.

  51. “Whenever discussing this, you never easily seem to accept that this is not binary (ie either stay (or revert to) the same weight, or starve), but instead is a gradation, based on lighter bodies needing fewer calories (even with recalibrations on route, and which I agree makes sense).”

    The problem with this is that there are dozens of factors affecting energy use, of which the energy needed to move the body around is only one. If everything else was held equal, then sure. But everything else never is held equal.

    When I was in my 20s I used to eat a lot more than I do now, but weighed a lot less. I’d sometimes get up in the morning and grab something out of the fridge, like half a full-size quiche (600 kcal), then go to uni. I’d have a large baguette or sandwich for lunch (600 kcal) with something sweet for desert 600-800 kcal). During the day I might fill in with snacks (I used to like those trays of flapjack (1200 kcal) or a box of individual apple pies, of which I’d have several (1500 kcal). Then I’d go home for my tea, which would often be a large curry and rice heaped up on the plate (800-1200 kcal) I might or might not have a desert after that (300 kcal). Then I’d go to the pub or a bar and drink five pints of ale (1000 kcal) before coming home past midnight, when I’d have the munchies and grill bacon and thick slices of cheese on toast, melted under the grill (I’d guess around 800-1200 kcal). There was a thing I used to do boiling a tin of condensed milk in a pan of water to turn it into toffee, and then eat it with a spoon! (1300 kcal.)

    Something like wasn’t an everyday affair (I’d guess about 4000-5000 kcal would be more typical), but it was common enough.

    I never thought about controlling my eating, or my weight. And yet I maintained a pretty constant weight about a stone lighter than I am now, and I’m currently eating less than a third of that!

    So I *know* for certain that the idea that Calories burnt is a simple monotonic function of weight is not true.

    As for the rest, I’m citing the medical literature on the subject, which I will agree is always to be taken with a pinch of salt, but which does seem to have a reasonably logical and well-developed explanation.

    In the Vermont prison experiment, one subject was documented eating 10,000 calories per day, maintaining a constant weight, and was 10 pounds heavier than when he started! You’re not telling me that carrying around an extra 10 lbs is going to burn up 8000 Calories!

    “is pure speculation, but I do note that you refrain from suggesting that all the weight would be put back on.”

    It wasn’t speculation, it was from other medical research. Longer term trials find the weight all goes back on over about 5 years, but very few people testing diets run their experiments for that long. One or two years, tops. But I will agree that I hadn’t referenced it explicitly, so you’re to be commended for being sceptical!

    “Ie the evidence you present, insofar as it goes, does tend to support a “new lower equilibrium” that most of us either intuitively or anecdotally know to be true.”

    Intuition and anecdote… *know* to be true?

    The idea that weight equilibrates at the point where energy needed to lift the body equals energy intake is at least physically plausible, but it predicts that weight should be a monotonic increasing function of Calories eaten, with a near perfect correlation between the two. But the empirical evidence is that they’re not. My own example, or the Vermont prisoner, or any of the 500 studies examined by Garner and Wooley show that. (“Multiple researchers, using a variety of methodologies, have failed to find any meaningful or replicable differences in the caloric intake or eating patterns of the obese compared to the non-obese to explain obesity,”) The hypothesis is falsified. It’s only one influence among many, and not the strongest.

    (Which is a pity, really, because it would mean that the easiest way to lose a stone in weight would be to strap a 14 lb lead-filled belt around your waist and carry it around all day. Easier than dieting, certainly.)

    But intuition and anecdote are more powerful, and people won’t let the hypothesis go. They *know* it’s true. And if the empirical evidence contradicts the theory, then the empirical evidence must be wrong!

    And I can’t possibly argue with that.

  52. “Your earlier years.”

    Yes, sure, and we have the early thirties metab slowdown, another *known* variable (to “add” to that).

    “Longer term trials find the weight all goes back on over about 5 years, but very few people testing diets run their experiments for that long. One or two years, tops.”

    That’s the key point, isn’t it.

    Unless someone did those longer surveys (over many years), always with careful monitoring of calories throughout, then one should be sceptical of what was asserted.

    And that’s because, for those that lose weight, and put some back on – I reckon quite often that may well be the point where psychology (or other) kicks in (and calorie control plays second fiddle – “it didn’t work”) and which is why they end up back at square 1 or worse.

    (“Multiple researchers, using a variety of methodologies, have failed to find any meaningful or replicable differences in the caloric intake or eating patterns of the obese compared to the non-obese to explain obesity,

    OK, but not relevant to my point? I am talking about changes to the equilibrium of each indvidual, I accept that each equilibrium is different wrt their own metabolism. Ie, if tubs and skins both eat 2,500 calories today (I’m perfectly happy with different metabolisms), I’m more interested in what say 2,200 calories (slowly falling say to 2,000 and 1,800) does for tubs over the very long term (decade +)? My bet is a new lower equilibrium over time.

    Re intuition, anecdote, known – actually it’s different. I know it’s a limited sample, and it’s clearly not scientific, but I’ve never myself seen examples (over long time periods) that don’t broadly fit the “what you eat / new eqilibrium” process, all other things being equal, and yes obviously lots of other variables, like exercise, age, etc.

    Those people I know who are quite a lot heavier than they might be, and can’t ever seem to exert any control over that process, and despite their protestations of keeping to a diet and all that – well, I know them, I know the personalities! Some are actually perfectly happy with who they are; others claim they want to lose weight, but it’s all mouth (pun intended), etc. But I agree, that’s not empirical.

    And yes, I’m happy that none of this is “simple”, or a straightforward relationship between calories and weight, lots of other factors kick in, but I was only questioning your more binary lack of relationship (ie zero long term) between the two.

    Anyway, interesting stuff, and thanks for replying.

    14lb around the waist – err not really (?), you’re not passing blood through it, keeping it warm etc..:)

  53. Part of the problem in long term studies is that people change over time. Their diet changes, new products come out, new foods tried, new methods of cooking tried. Lifestyle changes.
    They decide to try fasting, they decide to join a gym and alter calorie intake, they take nutritionist advice…

    Best that may be possible is look at multiple studies with multiple methodologies, look at common factors and declared diets (not the same as actual eating) and so on.
    Its not usually going to be the same people participating.

  54. Trouble with the dieting studies is, how much do people tell the truth? Even if they think they’re telling the truth, do enough of the participants in the studies actually properly monitor their whole calorific intake for a couple of years?

    Human nature suggests that the rigid commitment to the diet starts slipping after the first few months.

  55. “Human nature suggests that the rigid commitment to the diet starts slipping after the first few months.”

    This is surely the key.

    From my observations (it’s that horrible anecdote thing again!), those that have been overwight and adjusted (smaller or greater degrees) didn’t go on “diets”. Instead,1) they were generally committed, and 2) it was more a change in lifestyle. Yes, sure, they cut their calories, but a gradual and permanent change. There was no “end” to the process.

    Presumably because it’s much easier to cut calories (as part of your daily routine) if you are not being unduly radical with that routine at any point and the new routine is habitually pleasant and easy to maintain.

Leave a Reply

Your email address will not be published. Required fields are marked *