Sunday, August 24, 2008

More blogging on Fit/Fat Times blog

For original postings, and to view more of the discussion, click here.

To Sharon X; post #115 - Sharon said: "Dr. Abby A. wrote: “BMI discriminates against women, since we are genetically programmed to store more fat in hips breasts and thighs, yet are held to the same BMI standards as men.” This statement is illogical because men almost always carry more lean muscle than women (testosterone vs. estrogen) at the same weight, so the man at 5Åå9Åç
and 180-lbs is automatically going to be leaner than a women at that height and weight. Muscle weighs more than fat."

Great Point, Sharon X! After thinking about it, it seemed that you were right, so I bounced it off a highly credible and influential researcher, Paul Ernsberger, Ph.D. He wrote back to say, " She’s right in so far as, for a given BMI, a woman will have a higher % body fat. This is only important if you believe that % body fat is important, which I do not."

I wrote back and said, "Paul, am I correct in assuming that even though a woman probably has a higher body fat at any given BMI, it's irrelevant because it has nothing to do with fitness, as measured by endurance and/or strength?"

He wrote back and said "yes." So I thank you again for making me think, and for helping us towards a greater understanding of these issues.

Wednesday, August 20, 2008

Responses To My NY Times Post

Here is a conversation that is posted on Tara Parker-Pope's NY Times "Well" blog. Click here for original posts:

To: Dr. Abramowitz (#91),
Excellent post.

Continuing the thread from one of Tara’s other columns (Maybe you have already commented upon this), how would you suggest physicians address weight loss issues with obese or mobidly obese individuals who are metabolically unhealthy? Would it be better for doctors to not focus on weight per se, but to discuss life style changes generally known to be associated with improved metabolic health; while offering verbal praise during future visits for any incremental improvements in target biomarkers?

— Posted by W

Here's my response: RE: W - #113 Regarding your question: "Would it be better for doctors to not focus on weight per se, but to discuss life style changes generally known to be associated with improved metabolic health; while offering verbal praise during future visits for any incremental improvements in target biomarkers?" YES, W - This sounds like the perfect answer! The word "weight" should no longer be mentioned, in my opinion, and the ritualistic weighing of the masses should be extinguished for good.

There are many factors for health and longevity that can be suggested, including physical activity (regardless if weight is lost), eliminating transfats, listening to bodily signals of hunger and satiation, and drinking green tea or red wine. (The latter can be easily incorporated as tinctures or capsules; I put a few drops of green tea concentrate in my juice, and take a resveretrol capsule - all the benefits with minimal effort!)

Doctors must educate themselves about how to be fit at any size. They should ask patients questions about lifestyle, instead of assuming that overweight people are sloths. Gathering information about previous weight loss attempts and weight regain might be enlightening, as many overweight have tried numerous weight loss plans, which inevitably plan. It would be nice if doctors offered compassion and understanding for the struggles that fat people have endured when trying to follow damaging diets and discrimination from others. Overall, research has found that dieting leaves people fatter than those who have never dieted!

Here's another response:

August 20th,
11:46 am

Dr. Aronowitz, #91–
Thank you–I always enjoy your postings to this blog. I have a question about set-points, though.

Why is it that for many “yo-yo” dieters, our set-point seems to *rise* with each regain of weight after a substantial weight loss?

I am a 54 year old woman. Over the past nearly 4 decades, I have lost a total of well over 200 pounds and regained more like 280. Each time I’d lose between 40 to 60 pounds on a carefully-followed diet (Weight Watchers, 4 different times, and others as well); and then within 5 years I would have gained it all back PLUS about another 10 to 15 pounds.

The upshot is that I am now about 60 pounds heavier than my “setpoint” was when I was 18. I suspect that repeated weight loss and regain somehow nudges the setpoint ever higher and higher, but I wonder if you have any thoughts on that point. Thanks.
— Posted by me

My Response:

RE: #91. Thanks, ME! Regarding your concern, "I suspect that repeated weight loss and regain somehow nudges the setpoint ever higher and higher, but wonder if you have any thoughts on that point." YES! I believe that each time weight is lost and regained, the body's survival mode kicks in by making more "efficient" use of the calories it's given. This means storing more of them as fat, to ensure enough stored energy to use for the next famine. The body can't distinguish between self-imposed semi-starvation (i.e. a "diet") and a nuclear holocaust where food supplies are tainted, and we can't eat until the next harvest. I have watched hundreds of patients diet and regain weight, and believe that it takes a lot fewer calories to regain the lost weight than would be expected.

General knowledge states that a simple formula - calories in vs. calories burned results in a certain weight. However, our genetic blueprints vary tremendously in how our bodies use calories. Did you ever have a skinny friend who can eat all the crap in the world and still stay thin, while others practically gain weight with the smell of baked goods? There are so many factors operating, and we must treat our bodies as a miracle of nature - by taking pretty good care of it and being grateful for letting us experience pleasures on earth.

Tuesday, August 19, 2008

Fit And Fat?

This post was originally posted on Tara Parker-Pope's wonderful blog entitled "Better To Be Fat and Fit Than Skinny and Unfit. Click here for original post.

There are thousands of genes responsible for creating our individual "set points." Set point is a range, which can be influenced to some degree by lifestyle. For instance, someone who is supposed to weight around 150, may weight 120 or 180, depending on feeding and activity levels, but it seems impossible that they could ever weight 400 lbs, since the body speeds or slows metabolism to maintain homeostasis. Similarly, someone who is programmed to weigh around 400 lbs might weigh somewhat more or less, but could never weigh 150lbs, without gutting their guts...and even then, it seems highly unlikely.

The Weight Control Registry documents people who have lost significant amounts of weight and kept it off, but we know that they are a minority of the population, since most people regain lost weight. What we don't know is how many people develop an eating disorder in order maintain the loss.

As a psychologist specializing in weight management, I could tell if someone has an eating disorder by the extent to which they are preoccupied with food, exercise, weight and body image. To maintain a severe weight loss, people generally must live in a state of semi-starvation. A primary psychological symptom of starvation is preoccupation with food. This is for survival, much like if you can't get enough water, all you can think about is finding water, or when sleep deprived, the drive to sleep trumps all else. The NY Times once did a video montage of Mike Huckabee's constant references to food on the campaign trail.

Statistically speaking, a normally distributed bell curve dictates that 68% of people are "average," 14% are somewhat more or less, and 3% are extreme. This holds true for things like height, weight and IQ. BMI arbitrarily splits up the average range, by separating "normal" from "overweight" without any statistical integrity. If someone falls into the 70th percentile for height, do we call them "overheight?" Furthermore, BMI is not a measure of fitness; we would do better to routinely consider measures of endurance and strength.

BMI discriminates against women, since we are genetically programmed to store more fat in hips breasts and thighs, yet are held to the same BMI standards as men.

In this time of cultural abundance, the bell curve has shifted slightly to the right, with obese people becoming more obese … since their genes direct their bodies to store fat in times of abundance. This has been the most significant group of gainers. Perhaps this is for survival of the species, since they could live off their fat longer, if there was a famine. This perspective might offer newfound respect for body size diversity.

On average, most Americans have gained approximately 20 pounds in 20 years, which is a pound a year, or 10 calories per day....which is not even measurable. One explanation is our aging population, since some gain is normal. Another explanation is the increased availability of food and health care, which means that we are maximizing genetic potential for height, weight, and even IQ. Nobody talks about the corresponding increase in HEIGHT, which is a fact as much as the increase in weight.

In fact, a very influential cancer study earlier this year found that weight was the #1 correlate for many cancers; alcohol was the 2nd, and the 3rd was height! Media never espoused that taller people had more cancer - perhaps because on the surface, it seems absurd. However, a chart of international ages of deaths revealed that Americans were among the longest living people, while Indians had much shorter life expectancies. Indians also had lower BMI's, so what was happening is that better nourished countries produced people who were taller and heavier, and lived long enough for cancer to develop. Indians never lived long enough for slow growing deadly cancers to develop!

There's plenty of solid research suggesting that fitness is more important than weight, but stigmatizing overweight people offers permission to discriminate. It also fuels the 40 billion dollar diet industry, by making us hate ourselves, and then selling faulty remedies which fuel yo-yo dieting, which may negatively impact cardiac fitness, insulin sensitivity, blood pressure, and self esteem, while making us fatter to protect against the next self-induced famine.

Friday, August 15, 2008

Risk Factors Vs. Heart Attacks and Deaths

The following post was first featured on a NY Times blog -

An important new study found a quarter of thin people, half of overweight, and three quarters of obese people have at least 2 risk factors for cardiovascular health. But let us remember that a risk factor is very different from an “event” such as a heart attack, or death – which is the bottom line.

A huge government study called NHANES found that “overweight” people had 86,094 FEWER deaths than “normal” weight people! “Underweight” people had 33,746 MORE deaths than those in the “normal” range, which remained stable even after eliminating smokers and other confounding variables! " Obesity” (BMI > or =30) was associated with 111,909 excess deaths, primarily due to heart disease, diabetes and certain forms of cancer. Overweight adults (BMI of 25 to 29.9) had no higher risk of dying than those of normal weight and perhaps a lower risk.

Study after study from around the world confirms that the arbitrary label of “overweight” has the lowest mortality rate, i.e. in China, 170,000 adults: Gu and colleagues found lower mortality in the overweight category than in the normal weight. Results in Finland, Germany, and other countires confirm these results.

Furthermore, Aug 5th Reuters- Daily News reported that overweight and obese patients with heart failure seem to have a lower risk of dying than their normal-weight counterparts, according to a review of published studies involving more than 28,000 heart failure patients who were followed for an average of nearly three years. These results are consistent with previous studies.

We know that the vast majority of people who lose weight gain it back, attesting to the strength of our genetic set point. The Nurses' Health Study II provided information on intentional weight losses of 2476 young and middle-aged women and found that weight cycling was associated with greater weight gain, less physical activity, and a higher prevalence of binge eating. Other research has found negative effects on blood pressure, cholesterol and other risk factors.

Living a healthy lifestyle by eliminating transfats, moving one’s body, and listening to bodily cues of hunger and satiety will maximize genetic potential for health – regardless of weight.

Feel free to check out my blogpost on, which is featured today on their home page:\'t+Bowl+Over+Those+Last+10+lbs.&blid=11991