Panaceia or Hygeia

immunize yourself against the pandemic of lifestyle diseases

DIRECT. More obese liars.

Posted by Colin Rose on July 16, 2008

We have already commented on a similar diet study, A to Z. Again with DIRECT (DIetary RandomizEd Controlled Trial) we have another attempt to prove the Atkins diet is better but is really another demonstration of lying by most overweight and obese people. Any study on diet and energy balance that cannot first demonstrate that the First Law of Thermodynamics is obeyed from self-reported data is totally unreliable and unreproducible and should never be published.

While the data as presented are hard to interpret in terms of detailed energy balance because daily energy intake and expenditure is not reported, as it should have been, the subjects claimed to be doing more exercise and eating less but only lost 10 pounds in two years. The prescribed diets contained 1800kcal for men and 1500kcal for women. These values are close to the basal metabolic rates of these mostly obese people. They should have lost weight continuously and markedly during the trial. Let’s see how much they should have lost if they were reporting accurately. They claimed to be eating about 500 kcal less than baseline per day on all diets. Even doing the same amount of exercise they should have lost about a pound per week (one pound of fat is about 3500 kcal) or about 50 pounds per year or 100 pounds in 2 years. Since they claimed to be doing more exercise they should have lost even more. If they had been telling the truth, most participants should have starved to death well before the end of the study! Ergo, most overweight and obese people lie about food intake and exercise; they tell investigators what the investigators want to hear.

Obesity is and always has been caused by junk food addiction. Until we deal with that, the pandemic of obesity and its terrible consequences will only worsen. Unlike most infectious diseases, there is no vaccine against  addictions. We all must make the right choices as to what we put into our bodies. In developed capitalist democracies resisting the self-destructive temptation to consume all manner of cheap addictive substances or to adopt addictive behaviours readily supplied by highly profitable enterprises is the hardest task we have. And how to deal with it is not taught in medical school.

————————————————————————-

That obese people lie about food intake was proven beyond doubt by a study using doubly-labeled water to measure true energy expenditure. About 65% of these subjects were overweight or obese. They claimed to be eating only about 1500 kcal/day, about 40% less than they actually ate, but were burning 2500. So, they should have had a deficit of 1000 kcal/day and be losing weight dramatically but their weights were stable. Ergo they were “misreporting”, a euphemism for lying.

——————————————————————

Disney World

Is she on a low-fat or low-carb diet?

25 Responses to “DIRECT. More obese liars.”

  1. 646 said

    Helpful Facts

  2. Bee said

    “…should have lost even more”? SHOULD? Are you kidding me? Are you trying to imply that all bodies work exactly the same way and if we all do the same thing, the result will be the same? Riiiiight :eyeroll:

  3. Fat people need to be given a choice: Either put down the fast food or take a bullet. I refuse to contribute my hard-earned tax dollars to pay for lard-arses on Medicare, Social Security, or any other social program. I think extermination would be an excellent over-eating deterrent.

  4. kibblesbits said

    Maybe you should ask for a refund for the tax dollars spent on your education, Johnnypeepers!

  5. Maybe you should ask for a do-over for the botched abortion your mother attempted.

  6. txtechdog said

    The information in this article is flawed. You can’t claim that 1800 or 1500 calories is close to a persons BMR unless you also specify their age, height and weight. When I was obese (370 pounds), my BMR was over 2500 calories and after losing 118 pounds, it is still over 2000. This is because I am 6’5″. Restricting calories too much and/or creating too large of a calorie deficit can slow your metabolism, making it difficult to lose weight. There are also any number of medical conditions, like thyroid imbalances that can impact weight loss. And the claim that all obesity is the result of food addiction is just plain stupid.

    I’m not saying that there aren’t a lot of people out there who are fat because they don’t watch what they eat because I was one of them. But failing to take into account possible medical reasons for obesity and putting out wrong information like the stuff about BMR is wrong.

    I didn’t have a food addiction, I was just lazy and didn’t eat healthy. And your conclusion that all obese people lie about their exercise and food intake is another example of your ignorance. If I had lied about my exercise and intake, I wouldn’t have lost 118 pounds in the past year.

  7. Colin Rose said

    Good for you, Txtechdog. You are a great example of solving the problem by vigilance in lifestyle. No need for a Lap Band or gastric bypass. What made you change? Do you have any suggestions about how to get the two-thirds of the US population that is overweight or obese to do the same?

    I didn’t say ALL obese people lied. But enough do to make it useless to do dietary trials depending upon self-reporting for data acquisition.

    There are very few and rare “medical” reasons for obesity. Anyway they would have been excluded from participation in DIRECT.

    As for BMRs in reference to DIRECT we are talking about average BMR in the study population which would be around those mentioned. The average weight was about 200 lb and the average height probably around 66 inches.

    I guess it depends upon how one defines addiction. Why does anyone eat junk if it isn’t an addiction to sugar, salt and the mouth feel of fat?

  8. [...] In a nutshell http://medicalmyths.wordpress.com/2008/07/16/direct-more-obese-people-lying-about-food-intake/ [...]

  9. elfinugget said

    I agree with your statements about food addiction (and add that most food manufacturers prey on this biological facet)… however, I would put forth that:
    a) everyone requires food, and food causes dopamine levels to fluctuate in everyone (thus everyone is addicted)
    b) “food addiction” doesn’t cause obesity; rather, it’s our bodys’ proclivity to store calories toward times of famine (something all mammals do) that causes obesity.

    Losing weight at even the prescribed “safe” levels (no more than 1-2 pounds per week) causes a spike in ACTH production and cortisol production – a stress response designed to encourage the animal in question (in this case, humans) to focus more on finding food. Increased ACTH production also decreases TSH production, thus lowering the metabolic rate, to preserve fat stores. If these people didn’t have an existing thyroid imbalance, restricting a 200-pound person to less than 1500 kcal per day probably created one. (personally my basal metabolic rate began at 2100kcal/day… after 40 pounds it hasn’t changed that much!)

    There is also no speaking to the general health of the individual before the trial – were they hypertensive type-two-diabetes apple-shaped-body-type obese? If they were, their cortisol levels were likely already imbalanced… sure, not outside “normal”, maybe, but “normal” is just an average, isn’t it?

    Heightened cortisol levels also cause retention of salts, and retention of salts causes retention of WATER. I’d like to point out that salts have no caloric value – something this chart does not answer to at all – you can eat 1500 calories, fine, but if you’re also consuming 5g of salts per day, you’re retaining massive amounts of water (which is … gasp gasp… more dense than fat…) I’d put forth that anyone whose body didn’t change shape might well have been lying… but I’d bet anything that these people dropped SIZES like crazy.

    Before you go around accusing *ANYONE* of lying, why don’t you take a moment to think about the actual metabolic process of “dieting” and calorie restriction? And show us some numbers that correct for height, bone density, actual body volume, and measurements? And show us a chart that indicated how much salt was taken in during the course of a day? And show us a chart that indicates median and mode averages as well, rather than just mean averages? In the meantime, spare us your short-sighted rhetoric.

  10. Colin Rose said

    Ice cream, cheesecake, pop, danishes, chocolate cake, croissants, potato chips, etc. are not essential food any more than cocaine, alcohol and nicotine are essential drugs. They are concocted specifically to appeal to our attraction to sugar, salt and the mouth feel of fat, attractions that kept us alive 4 million years ago but are of no survival value today. Our capitalist democracy is adept at supplying whatever people will pay for even if it kills them. But the consumer votes with his/her money. If no one bought junk “food” it wouldn’t get produced.

    You seem to be trying to find some way to get around the First Law of Thermodynamics. Sorry, but hormones, salt and water retention don’t explain the energy imbalance in self-reported data in DIRECT.

  11. “Maybe you should ask for a do-over for the botched abortion your mother attempted.”

    This may be the best come back i’ve ever heard.

  12. txtechdog said

    Colin, you are implying by your insistence on applying the rule of thermodynamics, that the human body is a perfect system, which it isn’t. And misreporting doesn’t mean they are lying, just that they aren’t accurately measuring everything they eat. Plus given the rules for nutritional labeling in this country, where you can state that something has zero calories when in fact it has 4.99 calories (the rule is that a food manufacturer can round down to the nearest multiple of five), then it is easy to underestimate the number of calories in food, especially since the company is normally going to do everything it can to convince you that something isn’t that bad for you. It is in fact possible within the guidelines for food labeling in this country to state that almost any food has zero calories by specifying tiny “servings” and applying the rule of 5. The fast food industry is especially bad about this. Consider the salads at a place like McDonalds. If you order the chicken salad that is made with the fried chicken, it comes with a full fat dressing, chicken covered in batter and deep fried. On top of this, they add full fat cheese and crutons. So what should be a healthy choice for you to eat turns out to have more calories than one of their burgers (Quarter pounder w/cheese = 510 calories, Premium Caesar Salad with Crispy Chicken and Newman’s Own Creamy Caesar Dressing = 520 calories). And everywhere you turn, the restaurant industry is confronting people with ever bigger portions or “all you can eat”, “never ending pasta bowl”, “never ending bread sticks”, “super buffets” and other crimes against nutrition like the Bloomin’ Onion at Outback (over 1100 calories).

    What I object to most is your characterization of obese people as liars. I have read studies that show that everyone, not just obese people, underestimate their calorie consumption by anywhere between 25 and 200% and overestimate their physical activity by the same amount. Unless you take the time to weigh your food and someone teaches you how to properly keep a food diary, then it doesn’t surprise me in the least that people in the study didn’t record their calories correctly. And the same goes for exercise. Unless you use a heart rate monitor and that monitor is a very good one, then it is likely that any estimates of calories burned by physical activity will be off as well. Don’t put all of the blame on the people who participated in the study. Some could have been lying, but most probably just don’t know how to estimate portions correctly and the people running the study didn’t adequately teach them how before the study started.

    And it is not only medical conditions, which are not as rare as you make them out to be, but medications and other factors that can cause the body to not be a perfect system. Weight loss isn’t an exact science like physics. Every body is different and reacts differently to the stress of dieting.

    You asked how I lost weight. I made up my own diet based on my extensive reading about diet and nutrition with some guidance from my doctor. I kept a food diary and recorded everything I ate or drank for the first 8 months of my diet. And when I say I recorded everything, I mean that I literally measured my food on a food scale. No guesswork or estimation. I also stopped eating fast food. I ate a lot of vegetables, lean proteins, like beans, chicken, turkey and fish, and cut back on the fat in my diet as well, while keeping good fats like olive oil in it. I changed the way I eat completely. I also cut back on refined sugar and simple carbohydrates. Once I lost enough weight to not have constant back and joint pain, I joined a gym and started working out. I am not on some fad diet, perpetrated on the public by companies looking to make a fast buck. And although I have lost a lot of weight, I still want to lose some more, because by BMI standards, I am still overweight.

    As for my reasons, they were primarily that I was sick and tired of feeling sick and tired. I didn’t want to be a fat old man who couldn’t participate in my children’s lives and eventually, my grandchildren’s lives.

    My final word is this. Educating people on the dangers of obesity and exploring some of the underlying causes is a noble undertaking. Blaming fat people, ridiculing them, and ignoring all of the outside influences that lead people to ignore their health is just “fat bashing” and is just as reprehensible in my opinion as gay bashing, racism, or any other form of discrimination. Pointing out the problems with a study is fine, but only blaming the participants, when there is evidence that the study was flawed from conception is not. Put some of the blame where it belongs, on the people who conducted the study without properly instructing the participants and without proper supervision to ensure that their data was accurate.

  13. gkatch22 said

    “If they had been telling the truth, most participants should have starved to death well before the end of the study…”

    Your whole paragraph assumes that baseline metabolism remains constant. Either all the obese lie consistently, or their metabolisms slow down to match the reduced caloric intake, stunting further weight loss.

    I’ve read enough to believe that the latter is more likely true (although maybe some dieters lie/misreport).

    • Colin Rose said

      Gkatch22, please quote a study showing a reduction in basal metabolism on these types of diets sufficient to explain the discrepancy between reported calorie negative balance and actual weight change.

      • gkatch22 said

        I read Taubes’ summary of Ancel Key’s “The Biology of Human Starvation”. That’s a huge book, so I took the summary on faith, but intuitively, it makes sense.

        The take-home message is as follows. When people endure semi-starvation diets (i.e. intake below basal), one would expect a constant reduction in weight – the First Law. But that doesn’t happen. A plateau is eventually reached; people don’t just starve to death or wither away to a point, they adjust to the new level of caloric intake. And when caloric restriction is removed, they regain all the weight and more. This happens whether the patient is lean or obese. One can control calories in, but the body will see to it that calories out is adjusted down.

      • Colin Rose said

        Tell that to survivors of concentration camps. Gary Taubes is an Atkins disciple; insulin is bad, fat is good, etc; it sells books but it’s junk science. Again, please show me some data on BMR on low-cal diets of any sort. At any rate, the diets in DIRECT and A to Z were not below BMR.

  14. gkatch22 said

    Taubes only reported and critiqued the science, same as you, Colin! Can we talk about the science and not shoot the messenger? In any case, we’re talking about Keys’ study, not Taubes. I haven’t read Keys and not about to, the results are well known.

    Your concentration camp point is well taken. Yes, you can starve and/or work a person to death. But we’re talking about calorie restriction and “semi-starvation” diets here, which attempt to reduce weight to normal by restricting intake to something below basal.

    DIRECT “not below BMR”? Two of the three diets were calorie-restricted. They must have been below BMR to get any initial weight loss at all.

    Gary

    P.S. What’s wrong with being an Atkins disciple anyway? I’ve tried such a diet (“paleo” actually) and it really does take off the weight. The only question remaining is are there any lon-term health effects. Ornish is a funny case, because he condemns it, saying your mortgaging your health, but he is also quick to point out that there are no studies.

    • Colin Rose said

      All I ask for is any data showing that 1800 cal/day in men and 1500 in women significantly reduces BMR. Any lifestyle that causes a negative energy balance will reduce weight; “paleo” eliminates junk food, addiction to which is the main cause of obesity. Indeed there are no long-term studies, nor is it likely there will ever be one, but I will go with the one proven to regress atherosclerotic plaque. Nothing else has come close.

      • gkatch22 said

        1. NEJM Volume 332:621-628 March 9, 1995 Number 10: Changes in Energy Expenditure Resulting from Altered Body Weight
        Rudolph L. Leibel, M.D., Michael Rosenbaum, M.D., and Jules Hirsch, M.D.

        2. EFFECT OF CALORIC RESTRICTION ON ENERGY EXPENDITURE IN OBESE PATIENTS, Bray, G.
        The Lancet, Volume 294, Issue 7617, Pages 397-398

        –GK

      • gkatch22 said

        BTW, totally agree with you on the elimination of junk food. We “paleos” just lump a few other things into the junk pile with sugar, like grains ;-)

        I find it astonishing the number of friends I have who claim that life without chocolate or pasta would not be worth living. I kinda miss my pizza and bagels, but I like seeing my abs too much now. I’m 54 now and lean for three years and counting, for the first time in my life. I find it incredible to think that the price for this good health is heart disease.

        Cheers,
        GK

      • Colin Rose said

        The NEJM study was done in a strictly controlled metabolic ward and the calorie intake for the weight loss part was 800 per day, much more severe than DIRECT but even with the reduced thermic effect of food they still lost weight dramatically.

        The Lancet study was similar but even more severe with only 450 cal per day but again they still lost weight. The reduction in the thermic effect of food cannot totally offset the reduction in intake otherwise none of these patients would have lost any weight.

        With an intake of 1800 or 1500 there would be a very small reduction in BMR that would not explain the gross discrepancy between self-reported and observed energy balance seen in DIRECT.

      • Colin Rose said

        What’s wrong with pasta per se. It’s not the pasta but what’s put on it.

        See this story in the NP for proof of the addictive effect of junk food.

        http://www.nationalpost.com/story.html?id=2737117

  15. gkatch22 said

    Funny how opposite we are! You say, “It’s not the pasta but what’s put on it,” and I say, “It’s not what you put on it, it’s the pasta!”

    Let’s call the whole thing off?

    Seriously I just made a short blog post about that study:

    http://gkdietandhealth.blogspot.com/2010/03/fat-gets-blame-again.html

  16. gkatch22 said

    Getting back to your original contention that weight loss should be linear as a function of calorie defecit, that completely ignores the effect of reduction in metabolism. Granted, people could misreport, but the metablolism effect is there nonetheless.

    Interesting in these studies is the absence of a normal-weight control group. As Keys showed in his semi-starvation study, both the obese and the lean respond to calorie reduction in a similar manner. When the restriction is lifted both groups “overeat” and regain their original weights and most often more. But only the fat people are accused of gluttony. If there had been lean people in the DIRECT study, and their weight loss also stalled, would you be ready to call them “skinny liars”?

  17. gkatch22 said

    Hi Colin,

    Here’s a new study supporting your “liar” hypothesis:

    http://www.nature.com/ijo/journal/v34/n3/full/ijo2009251a.html

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