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Posts Tagged ‘National Weight Control Registry’

What Katarina Borer Found: Good News for Maintainers?

In Weight-Loss Maintenance on July 8, 2011 at 12:52 pm

Before I say another word, my conscience tells me to add a BIG trigger caution here.  If you are a size acceptance proponent and are feeling the least bit susceptible to the call of the weight-loss diet fairy, skip today’s post.  If you’re feeling brave, however, I’d love your response as well as that of my maintainer friends.

In my last post I explained Katarina Borer’s methodology for comparing the effects of food intake and exercise on appetite and on certain endocrine secretions.  Dr. Barry Braun describes it as “a multicondition crossover design to cleverly disentangle the relationships between energy imbalance, exercise, energy intake, putatative energy-regulating hormones and perceived appetite.”  Yup.   That’s what it was.  Now, let’s see whether I can explain in plain English what happened and what was correlated and what was not.

In her first study, Appetite Responds to Changes in Meal Content, Whereas Ghrelin, Leptin and Insulin Track changes in energy Availability, Dr. Borer found:  

  1. Human appetite is influenced by the passage of food through the mouth and gastrointestinal tract.  When food went through the mouth, it triggered GIP, a gut peptide that is activated and serves as a marker for GI activity but seemingly has no affecting qualities of its own.  This peptide rose and fell in concert with participants’ reported appetites. 
  2. Participants’ appetites responded to the size of meals that came in through the mouth, but were insensitive to calorie replacements (or saline placebos) that came through an IV.  Moreover, exercise did not increase appetite, but marginally suppressed it.  This led her to state that “between-meal increases in circulating nutrient load and exercise energy expenditure are not under homeostatic feedback control.”
  3. Ghrelin, leptin and insulin respond in slightly different ways to changes in energy availability, but had no influence on participants’ appetites.  Whoa.  Interesting, yes?  Dr. Borer thought so too.

The graph array that interested me most, as a maintainer, however, was Figure 2 (in the second study it was reposted as Figure 4).  I was surprised, in fact, that it was not included as a “finding” in the Discussion section.

It looks fuzzy in my preview, but I was able to click on it to get a blown-up view that was very clear.  Column 4 describes the trial day Read the rest of this entry »

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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. Read the rest of this entry »

An Open Letter to Weight-Management Scientists

In Weight-Loss Maintenance on June 15, 2011 at 1:22 pm

Dear Scientist Friends:

Consider this a personal invitation to test a theory, especially if your area of expertise is endocrine and/or you have a personal interest in exercise physiology and weight management.  (Er, and if you’re just one of my regular blog readers, please eaves drop on this letter.)

For several years, I have been synthesizing scientific information and personal experience as a radical weight-loss maintainer, and I would appreciate an experiment designed to better test the relationship between exercise and endocrine, especially those dicey signals that I believe cause most people to regain lost weight – the imbalance of leptin and ghrelin, PYY3-36 and aghouti related protein.  If you know of an experiment that has already explored this relationship, then please provide me a link.  (Disclaimer, as a lay person, my knowledge is embarrassingly limited.  I have not yet read Katarina Borer’s book on Exercise Endocrinology, or any other scholarly text, so maybe I’m naive, but if we do know all that we could know on this topic, it sure hasn’t made it into the mainstream marketplace of ideas.) 

It has occurred to me that there are different kinds of “hunger.”  Those of us who maintain radical weight losses have pretty much mastered how to quell insulin-triggered hunger and vacuous (empty stomach) hunger using macronutrient management.  In short, we use carbs (such as bananas or dark chocolate) to quell immediate, sharp (vacuous) hunger, and we use proteins and fats to keep sneaky insulin-triggered hunger at bay.  But this is not the full story.  If it were, more than 3% of people would be successful at maintaining radical weight loss for five years, the depressing figure that empirical research suggests.

According to the National Weight Control Registry (which could also be called the 3% Club), where I am listed as a participant, 90% of us exercise on average one hour per day.  This finding is one of the most dramatic commonalities among us, more so than eating breakfast (78%), regular weighing (75%) or limiting our TV viewing (62%).  In fact, the only two characteristics that are more common than the hour of exercise are that we have restricted our food (98%) and increased our exercise from our fat days (94%).  (It should hardly come as a surprise that one hour daily represents an increase for most people!) 

Learned people debate the value of exercise compared to food restriction in losing or maintaining weight, assuming that  exercise is a function of energy balance – calories expended v. calories consumed.  Energy balance, however, is not a simple equation, and I think exercise serves an additional, more important, function beyond expending energy.  I think we need to know more about its effect on endocrine.  Read the rest of this entry »

Hey, Everybody: Let’s Help Diane!

In Weight-Loss Maintenance on May 17, 2011 at 12:12 pm

First of all, thanks again to Dr. Sharma for hooking us in to the private world of obesity research where the erudite players who affect our lives talk about us.  Specifically, today he linked us to the Canadian Obesity Network Presentation Portal for the Second Annual Obesity Summit held in Montreal April 28 – May 1 of this year. 

Let’s give these CON-RCO people kudos for facility and detail.  If you click on the presentations, you receive a split screen with the speaker, in focus and centered, on the left and his or her Power Point Notes on the right.  How inviting!  Whatever trouble that took, please know it is appreciated!  Hooray.  

I scrolled through the selections to find some interesting conversation fodder, and my heels came to a screeching halt on page two, where speakers were talking about weight discrimination and bias.  I first was drawn in by this title:  So I am Biased, Now What Do I Do?  Michael Vallis, the co-director of the Capital Health Behaviour Change Institute and Associate Professor at Dalhousie University spoke well, and we may want to talk about him another day, especially how he seems to ice skate between talking about solving bias/discrimination and solving obesity – interesting and discomfiting.   He also talks about Motivational Interviewing, which we have talked about some in these pages’ comments.  As I listened to him I wore Hopefulandfree’s filter:  is this just sophisticated manipulation?  I don’t think he intends it to be, but I can see how it goes there.

But I digress.  TODAY, I want to talk about Diane Finegood’s talk, Weight bias and discrimination through a complex-systems lens.   About 22 minutes into the 26-minute speech, she presents us with a question, and with an earnestness that I think calls for reply.  I think we might be able to help her.

Diane Finegood is a professor at Simon Fraser University and Executive Director of the CAPTURE Project (CAnadian Platform To increase Usage of Real-world Evidence).  She’s also a radical weight-loss maintainer.   

Her presentation, in simple terms:  It ain’t easy to change a paradigm on a complex system, such as obesity bias as it relates to health care.  You’ll want to watch the whole thing, as she starts with a complex map of the issue and then reduces the problem downward several times to arrive at five steps.   The most important:  shifting the stinking paradigm.  This has to be done by attacking lower level issues – structural elements, goals, etc.  But at the very top is that paradigm, or root assumption.  She makes a stab at one-sentence statement to express what that paradigm should become, but she’s clearly uncomfortable.  Even her Powerpoint notes have a question mark.  Her attempt at a statement:

? “Obese people are no different because of their size.” Read the rest of this entry »

A “Meta” Post About This Blog

In Weight-Loss Maintenance on February 14, 2011 at 10:35 am

In addition to adapting the Rules of Engagement post for a “page,” and looking into how to get rid of the vulture advertisements as cheaply as possible, I have been making my way through the Linda Bacon/Lucy Aphramor paper supporting a Health at Every Size (HAES) approach to weight management.  I hope to post on it soon, but it’s turning out to be more challenging and time-consuming than I’d anticipated.  I am unable to breeze through it without checking at least some of the sources.  I mostly support its premise, and yet it makes me uncomfortable.  I think Barbara Berkeley touched on it in the comments at her own blog.  It reads as a manifesto, and that rubs me (and her) wrong.  It’s kinder and better sourced than Gary Taubes’s Why We Get Fat (also a manifesto), but the Bacon paper is a manifesto nonetheless.  And, as with Taubes’s book, I have no place in it, really, or at least my place is awkward.   Barbara’s ultimate response (in the comments) indicates she will return to her position of promoting weight loss, which is appropriate for her.  It’s her job, her life’s focus, and she does it with kindness and circumspection.  I will likely end up somewhere else, though I don’t know where that is yet.

The good news, the Bacon article isn’t messing with my weight, as Taubes’s book did.  As I read Why We Get Fat, I found myself falling into his regimen, compelled to decline counting calories, trusting my satiety to keep my weight in check (since I was increasing my fat intake).  My weight crept to the top of its range and hovered for days.  Then it went over my current range by a pound.  Ack.  And then another.  Ack.  Ack.  I’ve returned to my own tried-and-true regimen, and have some days seen a number in my range.   I think I’ll stick with what my body has prescribed for me.  Please accept that as my “final answer” and I will accept carb control or size acceptance as yours, and we’ll look at various topics with respect for our choices.  How wonderful that we ARE different, because we are much more likely to see something original between and amongst our experiences, rather than in a fray of dueling manifestos that blind us by calling up our own pig headedness. Read the rest of this entry »

What is Maintenance? And Why I Like my “Job” Metaphor

In Weight-Loss Maintenance on January 31, 2011 at 11:24 am

What is maintenance?  It seems a simple, seemingly obvious, question.  Ali asked it in the last post’s comment section.   At first I was taken aback, because I thought I’d already answered it with my clever Job Description.  But I hadn’t.  Ali wanted to know whether maintenance is seeing the same number on the scale day after day after day.  Hmmmm.

For people at their highest natural weight, I think it can be.  I know when I was at my biggest, my body used its remarkable, dare I say miraculous, systems to maintain a weight, and often it was the same number day after day after day.  Most variances I could chalk up to something tangible, and many I could plot on a calendar:  the final days of my menstrual cycle would add two pounds to me, which would depart reliably on day two of my period, a day at the amusement park with salty popcorn and other water-retaining treats could add a pound or two for a day or two, then I was back at my number.   I didn’t need to concern myself over what a pound here or there meant, because my body would take care of it.  If a day hiking meant the scale showed me a pound down, I would hope it was truly a lost pound, but it never was.  It was back the next day, as faithful and reliable as the pounds that played on the other side of my equation.  I was in caloric balance.

Now that I maintain a weight that is lower than my highest natural weight, maintenance is not so easy to define.  We operate from slippery assumptions.  I can call myself a maintainer (and the NWCR accepts my proclamation) because today’s scale says I’m 57 pounds lighter than my all-time high.  However, I have been as much as 68 pounds below my all-time high.  So, am I really a maintainer, or am I a sloooooow yo-yo weight cycler?  I don’t know.  Is it important to know?  I don’t know that either.  Obsessing doesn’t seem practical.  But still, in the safety of this blog, let’s obsess a little.  Size acceptance advocate friends, proceed with caution, or don’t even click through.  (If it doesn’t make you mad, it will bore you, at best.)  Maintainer friends, let’s enter our dark territories. Read the rest of this entry »

Why We Are at War and What to do About It

In Weight-Loss Maintenance on January 26, 2011 at 11:14 am

I am still plodding through Taubes’s Why We Get Fat.  It’s slow going, because his language remains alienating.  He insults me with his word choice and tenor, and by asking me to throw out my narrow assumptions and replace them with his narrow assumptions.

First, his language.  He repeatedly refers to “the overweight and obese.”  Hasn’t he been in this field long enough to know how dehumanizing it is to define people this way:  to say you don’t have adiposity, you are your adiposity.  In this book, he’s writing for the lay audience, not the medical and scientific community whose brains are presumably immune to the influence of such short hand.  Because of this broad audience, it would simply be polite (I won’t marginalize it with the phrase “politically correct”) to talk about people, not conditions or characteristics who happen to walk, breathe, think, eat and poop.

His language is tinged with an anger that smacks of a martyr complex.  Apparently, his ideas are not venerated to his satisfaction, so, he believes, everyone who disagrees with him either lacks imagination, is ignorant and not very well read, is biased to believe that fat people are gluttonous and slothful (and he may have a point there, but not enough to justify his intense outrage), or is stuck in a post-World War II mentality that will not permit the equal consideration of ideas from scientists of German origin.  Huh?  Get real. Read the rest of this entry »

Unsolicited Review, Parts I and III

In Weight-Loss Maintenance on January 20, 2011 at 12:32 pm

My Mother advised me, when I was a child, that if I didn’t have anything nice to say, to say nothing at all.   But then she allowed that if I had constructive criticism to offer, I could do so if I began by saying something positive.  So, I will start by thanking Gary Taubes for the contributions he’s made to my life over the years. 

First I’d like to thank him for allaying my fears of dietary fat.  The world of women’s magazines had (in my yo-yo days) hijacked my brain and persuaded me to feed myself a completely unsatisfying diet.  I believe it was you, Mr. Taubes, who gave me back avocadoes and stir fry and salad dressing that has flavor.  You gave me permission to banish SnackwellsTM from my pantry forever.  How can I ever thank you enough?!       Read the rest of this entry »

Queen for a Day

In Weight-Loss Maintenance on January 11, 2011 at 11:02 am

In the discussion of my last post, Viajera asked me what I would do if I were queen of the National Weight Control Registry.  Ah, what an irresistible question!

I think for those of us who have committed to living in a state of weight-loss maintenance for as long as we are able and have submitted our names to the registry, the NWCR comes to represent many things.  It is our annual call-to-account.  Its presence hangs with us, not like a cloud, an itch, a funny smell or any kind of bad thing, but like the periodic recollection of a smart but nosy sister who lives in a distant city, and with whom we only touch base once a year.  She is guaranteed to ask about our weight – sometimes she grills us at length – and she’ll judge us, gently, if we’ve regained, so we anticipate our meetings with her with mixed feelings – angst, indignation, smugness, humility.   

I can’t say I’ve ever turned down a specific piece of my mother-in-law’s pie because of the NWCR.  I’ve never “prepared” for the arrival of the form by dieting or ramping up my exercise.  I pretty much continue with life as usual, but I have a sense of her always, and I’m sure she affects me.  This is pathetic to admit, but I probably think about the NWCR as much as I think about my own breathing sisters, who each live more than 100 miles away in different cities.  And I gotta give the NWCR credit, she may have all kinds of opinions about my weight, but she hasn’t lifted an eyebrow with regard to my housekeeping (or told me I should hold a garage sale).

In addition to being the nosy sister in Rhode Island, for those of us on her rolls, the NWCR is an affirmation (once all the cheering for our weight loss has long gone silent).  

Perhaps I’m being overly bold and should speak only for myself.  For me, she is affirmation.  I know many (most?) other Read the rest of this entry »

Thoughts on Science, Optimism and Bias

In Weight-Loss Maintenance on January 7, 2011 at 12:46 pm

Happy New Year!  Hope you all had lovely holidays.  It’s good to be back at the blog, and back on the internet, for that matter.  (Long story involving words like #!%^&$!#!!, and a whole lotta bad Karma directed at AT&T.)

Between holiday adventures and internet mayhem, I managed to slip in a post about one of my weight maintenance peccadilloes – my ability to measure fluid in ounces using my gulp mechanism.  I must admit that when I get that personal, I do feel a bit self-conscious and self-indulgent, but I think it’s instructive – for me, mostly, but also for others who participate in the fray.  We broke into a lovely discussion about the admirable pursuit of goals, and when that pursuit crosses an invisible line and becomes something less noble.  I don’t think we reached any conclusions, but I came away recommitted to the idea that I should NEVER suggest, “if I can do this anyone can.”  Even if it’s true that anyone CAN do what I do, maybe not everyone should.  One person’s pursuit of a goal may be, in all likelihood, another person’s gateway to disorder.

Somehow, in the comments, RNegade was possessed to share a couple of science-related links.  (Whew!)  My favorite was this New Yorker article by Jonah Lehrer on the “Decline Effect” that happens to our sense of scientific certainty.   This “Decline Effect” is part of a larger problem with bias in science that misshapes our understanding of a variety of social and medical issues.  I put the phrase in quotes, because, as Lehrer notes, “This phenomenon doesn’t yet have an official name, but it’s occurring across a wide range of fields, from psychology to ecology. In the field of medicine, the phenomenon seems extremely widespread . . .”   

As I understand it, the “Decline Effect” happens when the scientific method, and all its noble precepts, leads a scientist (or team) to discover a statistically significant anomaly, Read the rest of this entry »