There isn’t another person on the Intertubes who respects and admires Stephan Guyenet more than I do. But Stephan’s recent comment on Melissa’s blog as well as his diet recommendations represent an academic’s view of obesity.
I certainly couldn’t converse with Stephan about the specific details of his theories (though I find his explanations on his blog very readable and compelling even for a lay geek like myself). But that said, I think I follow enough to know one thing: I don’t see it translating, as written, to real-world success. In fact, I’d be willing to bet some real money that if a low reward (LR) diet is ever studied (perhaps in a trial like Gardner’s A TO Z study), we will see essentially the same J curve with the LR diet that is shown, time and time again, with both LF and LC diets.
I expect that people will initially lose weight but then start bailing out left and right. Why? Because eating simple food for long stretches of time (whether low in reward, carbs, or fat) is very, very hard to do in our modern industrialized world with its all hyperpalatable food cues all the time.
The clinicians, like Yoni Freedhoff, work with real people every day and understand that what looks good on paper doesn’t always translate. Yoni is on a roll lately. He almost single-handedly got Disney to shutter its Health Heroes attaction shortly after its debut. Earlier this week he took on yet another poorly designed study (Weighty Matters blogger dismantles chocolate news release & study).
And today, he takes on the eat less, exercise more folks with a blog post titled A Plea to Folks who Lose 20lbs to Stop Thinking They’ve Solved Obesity.
The point is that people wanting to lose weight don’t do so in a vacuum. There is stigma, there is conflicting research, and probably the worst, there are people who think shaming us fatties or coercing us to exercise is the answer.
The devil’s in the details
I happen to be a fan of Stephan’s food reward theories. For me personally, it’s all about appetite and the desire (or compulsion) to eat despite lack of hunger. But context matters. Being able to understand the molecular goings-on of the hypothalamus and nucleus accumbens may well be valuable in terms of understanding the causes of obesity, but understanding is not enough as Kurt Harris so clearly suggests in his pessimistic prediction regarding obesity.
As a maven (a person who wants to help others by first helping myself), I’m not as pessimistic as Kurt. But ultimately, any really effective weight loss protocol is going to have to go past the mechanics of how to eat less and move more — however that happens.
As Yoni has said, it’s important for people to live a life they’ll love, not one they’ll tolerate. For some of us, any approach to weight loss can last for months or even years (I’m going on month 19 myself). That’s a long time to simply “tolerate” what’s perceived as a restrictive diet.
For me, one cheat meal a week worked for the better part of 2011. It may have slowed down my weight loss, but it also kept me compliant. [As an aside, I still am planning to write up my post-holiday up and down in which I gained 21 pounds between Christmas and Ash Wednesday. Oy! Fortunately, I've taken care of 14 of those already ;).]
Call me a cockeyed optimist, but I have high hopes for events like AHS12. I’m hoping that one of the benefits of the collaboration between the academics, clinicians, and lay folks can be progress towards better approaches to solving the challenges for folks who are struggling in a world filled with hyperpalatable food.
While there are people who’ve sustained a desirable weight despite having been 75+ lbs overweight-3 times in my case-we both know just how challenging that really is. I doubt anyone who hasn’t had that degree of excess fat CAN understand-just as you said above.
I sometimes think I’ve made the challenge even harder by choosing to limit myself (mostly) to whole foods. BUT I am much healthier, and therefore more active, and I don’t seem in imminent danger of starting a weight regain even though by my count I’m 6 months further into remission/control than I’ve achieved in the past.
If there’s a magic bean for me so far, it’s fasting-particularly ADF (alternate day fasting.) For some odd reason, the act of fasting seems to enhance my ability to manage emotional hunger even though I find that counter-intuitive rationally. It’s as if hunger becomes such a frequently-present force that cravings lose their power over me.
I hope that lasts! I hope to reach an acceptable body fat level this year and then we’ll see how well I can do long-term.
Thanks for the kind words Beth!
I agree, arguing about the minutia of theory or nutrition isn’t what clinical practice actually looks like - and if there are clinicians out there who insist their patients go their way or the highway, I feel for their patients.
Thanks Yoni! BTW, I agree with your tweet to me that “consistency” is a better term than “compliance” from a practical person-oriented perspective.
I love the point about living a life you love, not one you tolerate. I remember one of those pieces in the NYT that made a splash a while ago about the futility of weight loss. It featured a couple that had together lost a very large amount of weight. They had a picture of the couple before and then many pictures of them ‘after’ preparing food, exercising, measuring, and weighing… The most powerful element of the article, for me, was the pictures. The “before” picture showed an (arguably very overweight) couple smiling in DC. The article detailed the difficulties this couple (and others) go through to achieve and maintain weight loss through a calorie restricted diet combined with a rather extreme exercise regime. The ‘after’ pictures showed people who were arguably much slimmer, but who showed no hint of a smile.
I really disliked that article.
Beth, your “academic versus real world” comment has much validity. An example is the great fanfare with which tPA (a clot-buster) was hailed as stroke cure a decade ago, based on academic medical center’s experience. A couple years later, a community-based study in multiple Cleveland hospitals seriously questioned tPA’s real-world effectiveness.
I see this repetitively.
-Steve
Thanks Steve. Interestingly, over at Prague Stepchild, at least one FRH critic is also unhappy with the academic aspect of it as well, saying that “Eat less of the foods you eat the most” is the essential message. While unfair criticism (IMO), there is an aspect of it that resonates. It feels a bit like saying to a smoker “smoke less” or an alcoholic “drink less.”
But food is different from cigarettes or alcohol. I remain convinced that the trick is to learn, per commenter Harry, “intelligent control” of hyperpalatable (or “moreish” per Nigel) foods.