Katarina Borer: My First Impressions of her Recent Work

In Weight-Loss Maintenance on June 30, 2011 at 3:04 pm

It’s taking time, but I am working my way through a study, an article and a commentary surrounding some recent work by Dr. Katarina Borer and colleagues on endocrine, appetite and exercise.  

I believe I mentioned that Dr. Borer contacted me in response to my Open Letter to Weight Management Scientists.  I may have also mentioned that she said my postings were, ahem, interesting and remarkably well informed for a person who is not actively engaged in research. I am digging deep to find my inner objective scientist who would not be moved by such flattery.

I am working my way through these pieces simultaneously because they are based on the same trials, but they present two sets of conclusions.  The first set may be found in the study itself, entitled Appetite Responds to Changes in Meal Content, Whereas Ghrelin, Leptin and Insulin Track Changes in Energy Availability and was published in July 2009 in The Journal of Clinical Endocrinology and Metabolism.  To give credit where due, her co-scientists are Elizabeth Wuorinen, Kimberly Ku and Charles Burant, not that those names are meaningful to me.  Actually, very few of the names in this line of research are meaningful to me . . . yet. 

The way I read a study or article is to turn first to the footnotes to get an idea of the bricks that form the foundation for the work or thought at hand.  I screen through the lens of my own evaluation system to determine what biases are present.  Mostly, in the past, I have read studies that are solely obesity focused, and, whether they admit to it or not, most scientists in this area come with one or more biases.  Some feel that obesity is a medical and social ill that must be reversed or cured, and their research is colored by that view – it may prevent them from seeing certain options.  Some of these scientists have accepted support from commercial interests – diet companies, foundations associated with pharmaceutical companies, and the like, and that makes their work horribly suspect.  Others who publish in this realm are testing the “Health at Every Size” paradigm, or, more accurately, are Hell bent on proving the efficacy of that model, and that limits their view.  In any event, I often can see a study or article’s self-imposed limitations in its footnotes.  Certain names pop up together over and over, and they indicate a point of view.

I don’t have a grasp of such biases and limitations in the world of endocrine and exercise.  In this world, obesity and weight loss are sometimes the focus, but often just confounding factors. With the exception of Cummings et. al., who produced a Ghrelin study that I happened upon by accident, I recognized no one.  I am, therefore, trusting that these are all sterling people, and none is a “scientist for sale.”  Feel free to correct me if I’m wrong.

In addition to the study, I’m reading a follow-up article that Dr. Borer wrote, that was accepted by Exercise and Sports Sciences Review for publication in April 2010, Nonhomeostatic Control of Human Appetite and Physical Activity in Regulation of Energy Balance and a commentary on that article by Dr. Barry Braun, Why Doesn’t Weight Gain Blunt Appetite and Increase Movement?  Nonhomeostatic Responses to Energy Surplus in Humans.  (I apologize for not getting you beyond the abstracts.)  This follow-up is not merely reinforcing or selling her prior research, but viewing it through an entirely different lens, one that acknowledges that homeostasis (or set point) is a misunderstood player in the regulation of energy balance and inconsistently affects fat storage.  We have discussed in these pages that dicey creature, homeostasis.  I look forward to synthesizing this scientist’s findings, and I applaud her for being able to look at her own work from different angles.

Next week, I hope to present my thoughts on what she said, and I hope you will have had time to read her writings too, but here I will summarize, sans most scientific jargon, my understanding of what she did, or her methodology, which is enough for today.

The subjects were nine post-menopausal women who submitted themselves for testing on five different days.  When you see what they went through, you will acknowledge that they are saints, regardless of how much they were paid.  Testing ran from 6 am to 5 pm.  They were fed at 6 am and 1:00 pm.  Meal content was 60% carbohydrate, 25% fat and 15% protein.  Subjects had to consume all of their breakfast meals, but were allowed to eat their 1 pm meals to their own satisfaction (to evaluate for homeostatic energy compensation.  Pardon the jargon.).  Hourly, subjects were asked to evaluate their hunger, except from 10 am to 1 pm, when they gave evaluations every half hour.  Blood was collected hourly and at 15- and 30-min intervals at the start of meals and exercise.  Blood panels were evaluated for ghrelin, leptin, insulin and glucose insulinotropic peptide (GIP), and sent for additional analysis of plasma glucose, nonesterified fatty acid (FFA) and a substance I am positive that I am mentally mispronouncing – Beta-hydroxybutyrate?  Here are the variables manipulated on each of the five days, presented to subjects in a random order:

1.  A small meal (100 kcal) + saline infusion + rest

2.  A small meal + intravenous nutrient replacement (TPN) of 364 kcal — the same macronutrient content as the meal + rest

3.  A small meal + TPN calorie replacement + exercise (administered over a two-hour period and tailored to the individual based on pre-testing in order to burn roughly 550 kcal)

4.  A large (500 kcal.) sized meal + exercise

5.  A control day where they were simply given a nice 500 kcal breakfast and allowed to rest

All of this testing resulted in multitudinous graphs that will test my brain to its capacity, and I look forward to talking about them. 

Not to ruin the outcome, but there are sentences and paragraphs in the early narrative that I have already marked with special stars.  They give me comfort.  For example, in the introductory remarks in the study itself, she tell us (using three citations for support) that “Hunger stimulus is less clearly defined (than satiation), with the stomach hormone ghrelin a potential mediator.  Ghrelin and satiation hormones communicate with the hindbrain through the afferent vagus.”  Is it my imagination, or is that a nice way to say that my “eat impulses” are REAL!?  Leptin and pancreatic insulin are much more vulgar in how they communicate with us, reaching “the hypothalamic arcuate nucleus through the circulation.”  Seems to me, this probably creates a wholly different sensation. 

Meanwhile, people bemoan weight regain in women’s magazines and blame themselves, because they’re sure they’re too emotional.  The Jillian Michaels of the world bark at them that they have “NO excuses.”  Maybe.  But maybe not.  Perhaps some of them aren’t so emotional as they are hormone imbalanced.  Maybe when they are weight reduced, a 24% elevation in ghrelin is quietly pickling their hindbrain (by way of their afferent vagus, of course) and compelling them to eat.

I also put a star next to this footnoted sentence, because of its practical applications for those of us who are maintainers:  “Exercise does not affect appetite at low intensities and volumes but suppresses it as both increase.”  Yeah, baby.  That’s why 90% of maintainers on the National Weight Control Registry, are exercising fairly intensely for one hour a day.  It’s suppressing our appetites!!!!

Speaking of appetites, I hope this post has whetted yours.  Over the weekend, I will try valiantly to understand and translate these interesting words of Dr. Borer et. al. into a less technical jargon.  Someday, I may also have to read some of the articles that serve as foundation bricks in the footnotes.  There are many interesting titles there. 

Eventually, I will also respond to Dr. Jay Olshansky, who last week jumped into the comments of my March 5th post on whether obesity is lowering life expectancy for our children.  He thinks I have misinterpreted his article.  I owe his work a second look for paying me the respect of a comment, but I am not optimistic.  Maybe he was more careful in his language than I recall or gave him credit for, and if I owe him an apology, I should extend it.  But one thing I know is that his article is continually used to inflame fat phobia and push forward the “war on obesity” agenda (translation: war on fat people or, in this case, war on parents of fat children).  In that regard, Bacon and Aphramor got it right.  Perhaps I have missed those times he has jumped in and corrected people who have overblown his findings, but, again, I am not optimistic.  I should also look at Olshansky’s more recent work, as well.  He is kind hearted for taking me seriously and visiting this blog.

  1. As usual, I await your next post with bated breath.

    In the meantime, I’d like to comment on the sociological rather than scientific aspect of how science is used in the war on fat people (re: Olshansky).

    A few weeks ago, the charming young men at Obesity Panacea posted an article on the dangers of obesity in pregnant women. Most of the article was in French, but you don’t have to speak a word of the language to know that the article was yet another series of examples of how dangerous (!), bad (!) and terrible (!) it is to be overweight and pregnant. I responded extremely angrily and got a long answer back, assuring me that at OP no one hates fat people, etc. etc. Now, I really do believe that the OP bloggers and their guest posters are absolutely chock full of good intentions. But I also know how such context-free, seemingly purely “scientific” articles are perceived not only by the general public, but also by healthcare professionals. It is almost impossible to discuss the issue without immediately jumping on the blame and shame bandwagon. I, in turn, responded and believe it or not, they got my point. Maybe we should keep crying out in the wilderness…

    Every day, we the fatties and you the maintainers are assailed with science, or what passes for science: the ?th law of thermodynamics, ELMM, or simply: stop stuffing your face, it’s all your fault. Although not as dedicated to understanding the intricacies of science as you are, Debra (and for that I salute you!), I know that any hope of understanding what’s really going on lies with our scientific brethern. But they must also understand, accept and fight against the misuse of their research and recognize what a powerful weapon they (sometimes) unwittingly give to those who feed the fires of fat prejudice.

    Herein endeth the rant.

    • Amen, sistah! So glad the OP guys took notice. You are so right about the misuse of science and the need to scream in the wilderness. And a tip of the hat, too, to our brethern and sisterns in science.

  2. i guess i love science too; “silent spring”, for example was a classic, roundly condemned by popular media (carson was accused of being another joseph mccarthy and, alternately, a kind of mystic or pagan tree worshipper); as beautiful and inspiring and helpful (and potentially revolutionary!) as her biological information could have proved to be, for our world, it is not the paradigm which prevails in our current social structures. it does not inform our decisions as social beings within global systems, at least not in ways that change the status quo; in other words, the science we encounter in print these days and the scientific research which now gets funded and which then ends up in print (and is granted credibility by the great academies) are problematic. as you suggest, often.

    i notice that many of us return to the same dry well, again and again, each time expecting or hoping to find a different outcome: to see some water in our buckets. at least a few drops! to be able to sing “eureka.” or maybe simply say, “ah, yes, a bit of evidence, thank goodness, progress…”

    well, i see empty buckets. and i also see these empty buckets as significant signs of knowledge.

    so, i’m not saying we should throw them (science or research) out. but. it’s okay to see the patterns being revealed through research, even though those patterns are not at all what we are looking out for. it’s okay to see that which we are not seeking– a different kind of eureka moment, perhaps.

    just my solitary opinion. 🙂 offered respectfully, i hope.

  3. Hum… bad news for me. The intensity at which I have to exercise in order to not be hungry is quite intense indeed. (We are talking “I would throw up if I ate anything after” intensity.)

    My preferred mode of maintenance is actually being one of those rare souls who doesn’t exercise and just doesn’t eat much. I have found pleasurable exercise (I actually competed in a World Cup for my former sport a few years ago), but I could never maintain a low weight while doing *pleasurable* (non-totally exhausting) exercise.

    • Ah, Amy, you are in the ten percent of the three percent. I say that based on the notion that roughly 3% of us are maintainers, and here’s my original post on that, if you want it. And, since the NWCR claims that 90% of maintainers exercise an hour a day, that would put you in the other ten. Actually, less than that. How many of the ten percenters are putting in a half hour of exercise? Hmmm. My math and my imagination aren’t good enough to figure out how rare you are. I know there are some scientists who have put themselves on Very Low Calorie diets to study whether it extends their life spans. They, like you, don’t exercise. I saw a TV special about them. They are the most low-key individuals you’ll ever encounter.

  4. I had a breakthrough this week. I’m sorry that responding to this posting is probably not the right place to share it, but I need to share it with somebody who might understand and share my excitement. My husband’s response was, well, unenthusiastic to say the least.

    You know how Barbara Berkeley talks about non-triggering treats?

    Well, I haven’t found mine yet. BUT. I have discovered that oats (or porridge) are a triggering “treat”. A big, juicy, scarf-every-piece-of-sugar-or-starch-laden-something-you-can-find-anywhere trigger.

    Who’d have thunk it?

    It being winter here down under, everybody is extolling the virtues of porridge for breakfast.

    Nuh-uh. No way. Not for me. That way lies madness.

    God Bless you Barbara Berkeley!

    An interesting documentary from the BBC aired here last night – you may all find it interesting. It was called “Why are thin people not fat?” and a quick Google (a quoogle?) suggests it may be available to view for free. One key finding from the study undertaken was that those who have lost a significant amount of weight struggle to maintain because their body thinks its former weight is the *right* weight and, in order to maintain, a person must be prepared to live with hunger.

    • Ali, I hope you tell Barbara herself about your breakthrough. She does like hearing from people who are using her work. I don’t agree with her on everything, and she is fully aware of that, and we have lovely “conversations.” Mostly, I communicate with her via the comments at RTR, but she also leaves an email address on her site. You could leave a comment on the “evergreen” page where she advertises her book, if you don’t feel comfortable availing yourself of her email.

      For what it is worth, my nontriggering treat is Extreme Dark chocolate, 88% cocoa content. My brand is Endangered Species, All-Natural, Black Panther. (Added bonus: ten percent of proceeds go to animal preservation.) Because it costs close to $3 per bar, I find it easy to only eat a couple of squares at a time. I keep it in my medicine cabinet, which sets it apart from other foods in my mind (AND keeps it out of my kid’s and husband’s line of sight).

  5. $3 a bar! That’s a bargain. I pay about $8 a bar (in Australia) for really high quality, organic, dark chocolate.
    I’m jealous.
    I’ll definitely contact her.
    Thanks for the tip!

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