7/27 - practus interuptus

DocHoliday said:

The major genetic causes of obesity tend to come with obvious mental disabilities, so we can skip those for now. Individuals have been found with these disorders with normal intelligence though so genetic screens for these would be last on my list if nothing else hit.

Hormone levels would be next, specially cortisol and thyroid hormones. These can cause one to be overweight but in no way would explain obesity by themselves. Diet and exercise would still contribute partially.

The list goes on briefly (there just aren't many legitimate other causes of obesity that diet and exercise doesn't fix) but we would get into 'things I will rarely see in my career' territory. These include a tiny number psychiatric disorders (even these are just a failing of diet really), lipid metabolism errors (exceedingly rare and would have been diagnosed very early), etc.

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"The major genetic causes of obesity tend to come with obvious mental disabilities"
Please explain this one. Do you mean obesity due to a genetic disposition obviously
comes with genetic disposition to some sort of mental disability?
If so what are some of these mental disabilities?

RayClay said:

Glycemic load is what counts and most fruits and vegetables are fine given their vitamin content etc. Eat the skin of fruits and potatoes.

http://www.health.harvard.edu/newsweek/Glycemic_index_and_glycemic_load_for_100_foods.htm

Eat whole foods and whole grains, grill, steam and otherwise avoid frying. Use Olive oil or other healthy oils.

You can fill up at every meal and lose weight, and, more importantly, be healthy. Mrs. Dash products kick ass, especially the chicken grilling rub.

Great guide to healthy foods and preparation.

http://whfoods.org/

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Thanks for the link - i've bookmarked it.

JR4 said:

No I do not realize that and neither do you.
When have you done extensive research on this topic, seen thousands of patients, conducted advance research using the latest equipment to analyze blood work, been able to track the level of the many
hormones involved and had the knowledge to understand how these hormones interact with each other
and had access to detailed daily activities of the patients whose blood work you analyzed?

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And you have?

How do you explain the millions of dieters who have some success losing weight then hit a barrier, the
so called "plateau"( many give up when this happens ). "Extreme minority"? Bull

Click to expand...

Its very simple actually. They are overweight because of a lifetime of poor eating habits, mostly because they eat for pleasure (we all do at some level). They attempt to modify that behavior, stick to it for awhile and then revert to the eating habits they have lived their whole life with. Its not that hard to understand.

If you are so sure you know what you are talking about you should open a diet center and help these
millions of people who are sincerely trying to lose weight and failing, who lose some weight but hit
a plateau at some point. Maybe you can convince them to just hang in there only an
"Extreme minority" can't overcome the plateau.

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Overeating is epidemic in this country. You keep making up these millions of people who eat healthy, burn more calories than they consume and gain weight, as if saying it makes it true.

Now genetics may have some role but I'm not sure about what that is other than I have notice in my
life time overweight parents often have children who are overweight.

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Children are fed by their parents.

Now that could be due to
life style but it could also have to do with some genetic disposition in the metabolic system.

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But that is simply conjecture.

But even if genetics is involved, once a better science is known about the problems in the metabolic
processes, there maybe treatments to make metabolism work better even for people with such
genetic issues. That day is coming and I bet 10 years from now endocrinologist will be able to
help people who really want to lose weight. There will always be gluttons who eat for pleasure
but for those who are really trying to lose weight a better day is coming.

Click to expand...

I think you are finally getting in the vicinity of making sense. People are overweight because they overeat. Half of the calorie in, calorie out formula is metabolism. If science can figure out a way to speed up metabolism artificially, then the people who cannot commit to a lifestyle that will result in not being overweight can have a drug or a program that will artificially enhance the calorie burning so they do not have to eat less or exercise more.

Finally, you seem to divide overweight people into 2 groups, one of which you think are making every effort possible and sticking to a strict regimen of healthy eating. That just isn't the case. I have no doubt there are many overweight people who give it their best effort, but they fail because they have more calories in than calories out. They probably try really hard, but they either lack the motivation to exercise, or the CONSISTENT commitment to not eat the wrong foods.
The guy who eats well all day, follows his prescribed dietary plan, is too busy to exercise every day, and then rewards all of his effort with and ice cream sundae (or 4 cookies or a half a bag of chips) fits your description of trying and wanting to lose weight, but he is NOT sticking to his plan at all (while rationalizing that he is) and those deviations are exactly what puts the caloires in over the calories out.

JR4 said:

"The major genetic causes of obesity tend to come with obvious mental disabilities"
Please explain this one. Do you mean obesity due to a genetic disposition obviously
comes with genetic disposition to some sort of mental disability?
If so what are some of these mental disabilities?

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I think I wasn't clear. There's a difference between genetically predisposed to obesity (which means it is easy to gain weight) and genetic disorders that CAUSE obesity - meaning they are definitely the absolute reason the patient is obese and not a lack of diet/exercise. The former is uncommon. The latter is very rare.

Of genetic CAUSES for obesity (patient can truthfully say "I did everything you asked, nothing works), many are accompanied with other developmental problems including mental disability. It's something that is typically diagnosed very early in the patients life.

I can't say I remember each and every individual one (or even most of them), but a more common example is Prader-Willi. But it's not going to be the reason your honestly dieting and exercising patient can't lose weight since it will almost certainly be diagnosed before the patient presents to you.

AndyJohnson said:

Its very simple actually. They are overweight because of a lifetime of poor eating habits, mostly because they eat for pleasure (we all do at some level). They attempt to modify that behavior, stick to it for awhile and then revert to the eating habits they have lived their whole life with. Its not that hard to understand.

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I'm sure glad science doesn't make such simplistic assertions. Your statements are so full of
erroneous assumptions that I do not want to respond with correction. You just seem to make
up stuff that fits your viewpoint of the world. I believe you have no concept of how hard it
is for obese people to lose weight. Your simplistic point of view is so unfair to many of these
people. Many of them suffer mental anguish because of people like you who do not understand
but cast degrading remarks on their inability to stay on a diet , have no will power and are all
just willful over eaters satisfying their pleasure centers. They know how you feel when you
come face to face and you don't even have to say a word.

Overeating is epidemic in this country. You keep making up these millions of people who eat healthy, burn more calories than they consume and gain weight, as if saying it makes it true.

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The only example I gave of someone who fits the"burn more calories than they consume and gain weight"
scenario was the Kate example which is documented.
What I did say was millions try to lose weight on diets and many reach a plateau. (not gain or lose weight)

I think you are finally getting in the vicinity of making sense. People are overweight because they overeat. Half of the calorie in, calorie out formula is metabolism. If science can figure out a way to speed up metabolism artificially, then the people who cannot commit to a lifestyle that will result in not being overweight can have a drug or a program that will artificially enhance the calorie burning so they do not have to eat less or exercise more.

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No that is not what I meant. Increasing Metabolism is NOT the answer. Getting metabolism to function
normally is!
When this happens many obese people who have tried to maintain a healthy diet and exercise and failed
will be able to try again and this time succeed.

Andy, I am not going to respond to any more of your posts on this topic. It's just a waste of my time.
Continue to make your simplistic false assertions without any deep understanding of all the factors involved
if you wish.
I have just tried to share new science about obesity with people on this forum and have given references
to that new science. I hope if someone here has a weight problem, it will encourage them to read more
about it and maybe lead to real help with this difficult problem.

JR4 said:

No I do not realize that and neither do you.
When have you done extensive research on this topic, seen thousands of patients, conducted advance research using the latest equipment to analyze blood work, been able to track the level of the many
hormones involved and had the knowledge to understand how these hormones interact with each other
and had access to detailed daily activities of the patients whose blood work you analyzed?

How do you explain the millions of dieters who have some success losing weight then hit a barrier, the
so called "plateau"( many give up when this happens ). "Extreme minority"? Bull

If you are so sure you know what you are talking about you should open a diet center and help these
millions of people who are sincerely trying to lose weight and failing, who lose some weight but hit
a plateau at some point. Maybe you can convince them to just hang in there only an
"Extreme minority" can't overcome the plateau.

Now genetics may have some role but I'm not sure about what that is other than I have notice in my
life time overweight parents often have children who are overweight. Now that could be due to
life style but it could also have to do with some genetic disposition in the metabolic system.
But even if genetics is involved, once a better science is known about the problems in the metabolic
processes, there maybe treatments to make metabolism work better even for people with such
genetic issues. That day is coming and I bet 10 years from now endocrinologist will be able to
help people who really want to lose weight. There will always be gluttons who eat for pleasure
but for those who are really trying to lose weight a better day is coming.

Click to expand...

I've lost 60 pounds. So I know exactly how hard it can be. And I also know that motivation is key. I've tried to loose weight and fail because I wasn't motivated. Like milions of people who fail because they aren't motivated enough and cheat on the diet(The majority of those who fail).

I've hit that plateu several times where I'm not gaining or loosing weight on my diet. That's because I've hit the weight I should have with that diet. If you want to loose more weight then you have to start eat even less or work out more.

People like you just want an excuse so they can say that they tried as hard as they could. But they can't loose weight. So they might as well go back to their unhealthy food.

Children with fat parents are fat because the parents eat to much(which is why they are fat). Which probably means that the parents don't know about eating the right amount of food(portion control), so they give their kids to much food.

It's a lifestyle choice in the majority of cases. Not bad metabolism. Some may absolutely have below average metabolism. But then they can't eat for 2 people. If the milions of obese people in America or europe actually followed a good diet all the way through then they wouldn't be obese anymore. If they eat what one person should eat then they wouldn't be so big and they wouldn't be hungry. Or they can, like you, blaim their problems on something they can't control and continue to eat large unhealthy meals and be obese.

no point to continue argue with you as you just ant to say that something else is to blame. I'm out from this thread

JR4 said:

I'm sure glad science doesn't make such simplistic assertions.

Click to expand...

A lot of science is based on the simple answer is the correct one.
Are you seriously telling me that if an overweight person consults a doctor about their weight, the first advice won't be to reduce eating and increase exercise?

Your statements are so full of
erroneous assumptions that I do not want to respond with correction.

Click to expand...

The saving face way to admit you are wrong I suppose.

You just seem to make
up stuff that fits your viewpoint of the world. I believe you have no concept of how hard it
is for obese people to lose weight.

Click to expand...

I have a very good understanding of that. The problem you have is that instead of empowering them to make life changes, your approach tells them its ok to be overweight because its not their fault, and does them no good, unless they are one of the stark minority who actually eat and exercise properly and have a medical condition.

Your simplistic point of view is so unfair to many of these
people. Many of them suffer mental anguish because of people like you who do not understand
but cast degrading remarks on their inability to stay on a diet , have no will power and are all
just willful over eaters satisfying their pleasure centers. They know how you feel when you
come face to face and you don't even have to say a word.

Click to expand...

Clearly you feel that overweight people are lesser people than you and that they have something to be ashamed of. That is too bad. I guarantee you there has never been a person in the world who suffered mental anguish over my understanding of why people are overweight.
Frankly many overweight people are overweight by choice. Of course they wish they were not overweight but the prospect of limiting what they eat or exercising is less attractive than being overweight. I weigh more than I wish I did myself. But I am comfortable with my lifestyle and diet and exercise choices resulting in the body I have more than I would be making additional sacrifices to weigh less. Every person is somewhere along that scale. It is wrong of you to act as if an overweight person is broken, or that they should be ashamed when someone points out they choose to eat more than they should. Hopefully you can come to stop looking down on overweight people to the point you think it is horrific to think they choose to be that way.

The only example I gave of someone who fits the"burn more calories than they consume and gain weight"
scenario was the Kate example which is documented.
What I did say was millions try to lose weight on diets and many reach a plateau. (not gain or lose weight)

Click to expand...

This has been your whole argument. You have said 'millions and millions of people' follow proper diet and exercise regimens and can't lose weight. That is simply inarguable wrong.

No that is not what I meant. Increasing Metabolism is NOT the answer. Getting metabolism to function
normally is!

Click to expand...

I know its not what you meant, I corrected it for you.

When this happens many obese people who have tried to maintain a healthy diet and exercise and failed
will be able to try again and this time succeed.

Click to expand...

Not if they don't stick to the regimen, or go back to their old ways, which is why they are where they are.
I agree there are a miniscule percentage of people who have medical issues that prevent them from losing weight. I have all along. You are taking this vast minority and trying to claim it is a majority, which is where you are off the rails.

Andy, I am not going to respond to any more of your posts on this topic. It's just a waste of my time.

Click to expand...

Thats a better approach than having read a book, misunderstanding it, and posting stuff that is ridiculous, so I concur.

Continue to make your simplistic false assertions without any deep understanding of all the factors involved
if you wish.
I have just tried to share new science about obesity with people on this forum and have given references
to that new science. I hope if someone here has a weight problem, it will encourage them to read more
about it and maybe lead to real help with this difficult problem.

Click to expand...

And I would hope that the few people who have these medical conditions get treatment, and the majority of overweight people are not enabled by this excuse that you want to give them, and proceed to lifestyle changes that will help them, if they wish.

DocHoliday said:

I do know jack. Here it is: for every 99 patients who are obese that come into our school clinic, only 1 can blame it on genetics.

That's not to say everyone does blame it on genetics. To their credit, a fair amount of patients know their eating habits are to blame but yet an infuriating percentage of them continue to get hostile when confronted about it.

Provide people rationalization for their poor choices and they will rationalize away. There is no point debating metabolic disorders as a significant factor when doing so helps delude the 99%.

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No. You don't. And you've clearly shown that. You're a damn med student who THINKS he knows stuff but has next to ZERO real life experience. And your continued comments prove that. Do yourself and all your patients a favor and stop judging people when you don't know jack about them. Here's a fun fact for you. For my instance, it IS genetics. It's why I couldn't get my Triglygerides below 212 despite being on a low carb diet for over 6 months and taking the meds as prescribed and excercising for 30-60 mins 5 times a week.

There are so many different things that can cause weight gain/obesity that ARE from genetics it's absurd. Such as Clinical Depression. Metabolic Disorders. Type 1/2 Diabetes (some cases, but not all). Lymphatic disorders. For you to sit there and say that 99 out of 100 are not genetics is just foolish when you consider all the different things that are caused by genetics..

DaBruinz said:

No. You don't. And you've clearly shown that. You're a damn med student who THINKS he knows stuff but has next to ZERO real life experience. And your continued comments prove that. Do yourself and all your patients a favor and stop judging people when you don't know jack about them. Here's a fun fact for you. For my instance, it IS genetics. It's why I couldn't get my Triglygerides below 212 despite being on a low carb diet for over 6 months and taking the meds as prescribed and excercising for 30-60 mins 5 times a week.

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In your case it may be genetics. But in most people, it's a poor adherence to the diet. Your anecdote really says nothing except you are one of the rare few.

There are so many different things that can cause weight gain/obesity that ARE from genetics it's absurd.

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No, there really aren't. There are genetic factors that can make it easy to gain and hard to lose but vanishingly few are a primary reason a patient is obese.

Such as Clinical Depression. Metabolic Disorders. Type 1/2 Diabetes (some cases, but not all). Lymphatic disorders.

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Clinical depression INCIDENCE is partially influenced by genetics. It is not a genetic disorder and any weight gain is a secondary symptom. The patient must still exercise and adhere to diet to lose weight.

Lymphatic and metabolic disorders are exceedingly rare and only a portion of them cause obesity.

Type 2 diabetes incidence is also influenced by genetics. It is NOT a genetic disorder. Of all the disorders you listed this one responds by fat the best to diet and exercise.

For you to sit there and say that 99 out of 100 are not genetics is just foolish when you consider all the different things that are caused by genetics..

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Man, our genetic makeup must have really took a turn for the worse in the past 50 years. All of human history we've been fine until now, when our genes spontaneously turned to crap.

Did the advent of high calorie foods make it easier for poor eating habits to = obesity? Undoubtably. But in the end, there is only one solution for most people:

You guessed it - diet and exercise.

Back to your own diet: do you think your doctor will say "oh DaBruinz, your Triglycerides aren't responding. You can quit that diet and exercise - it's your genetics as you can't do squat about it."

Nope. Expect more diet modifications.

Thoughts and prayers going out to Kate. Stay strong, K.

DocHoliday said:

In your case it may be genetics. But in most people, it's a poor adherence to the diet. Your anecdote really says nothing except you are one of the rare few.



No, there really aren't. There are genetic factors that can make it easy to gain and hard to lose but vanishingly few are a primary reason a patient is obese.



Clinical depression INCIDENCE is partially influenced by genetics. It is not a genetic disorder and any weight gain is a secondary symptom. The patient must still exercise and adhere to diet to lose weight.

Lymphatic and metabolic disorders are exceedingly rare and only a portion of them cause obesity.

Type 2 diabetes incidence is also influenced by genetics. It is NOT a genetic disorder. Of all the disorders you listed this one responds by fat the best to diet and exercise.



Man, our genetic makeup must have really took a turn for the worse in the past 50 years. All of human history we've been fine until now, when our genes spontaneously turned to crap.

Did the advent of high calorie foods make it easier for poor eating habits to = obesity? Undoubtably. But in the end, there is only one solution for most people:

You guessed it - diet and exercise.

Click to expand...

I think the point trying to be argued in this thread is that overweight people aren't to blame for being overweight because they have obstacles.
I was thinking we were discussing how they lose weight not what issues they have that make it difficult.
For some reason stating that the way to lose weight is to burn more calories than you consume has resulted in being perceived as inconsiderate and unfeeling.

Still never ceases to amaze me how angry people get when someone has a different opinion than they do.

DaBruinz said:

No. You don't. And you've clearly shown that. You're a damn med student who THINKS he knows stuff but has next to ZERO real life experience. And your continued comments prove that. Do yourself and all your patients a favor and stop judging people when you don't know jack about them. Here's a fun fact for you. For my instance, it IS genetics. It's why I couldn't get my Triglygerides below 212 despite being on a low carb diet for over 6 months and taking the meds as prescribed and excercising for 30-60 mins 5 times a week.

.

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Cholesterol is certainly a hereditary issue. But that isn't what this discussion was about as cholesterol levels are not impediments to not being able to lose weight by burning more calories than you consume.

AndyJohnson said:

I think the point trying to be argued in this thread is that overweight people aren't to blame for being overweight because they have obstacles.
I was thinking we were discussing how they lose weight not what issues they have that make it difficult.
For some reason stating that the way to lose weight is to burn more calories than you consume has resulted in being perceived as inconsiderate and unfeeling.

Still never ceases to amaze me how angry people get when someone has a different opinion than they do.

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One thing I will say though, diet is far, far more important than exercise. (Still should do both).

Walking is good for you, but if you're overweight walking isn't going to do much if you're still putting down 3000+ cals. Way too easy to walk - hell, run for 30 minutes and basically eat back all the calories lost in 5 minutes.

DocHoliday said:

One thing I will say though, diet is far, far more important than exercise. (Still should do both).

Walking is good for you, but if you're overweight walking isn't going to do much if you're still putting down 3000+ cals. Way too easy to walk - hell, run for 30 minutes and basically eat back all the calories lost in 5 minutes.

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Absolutely, but its not so cut and dried. My doctor tells people to ignore the exercise end, because he doesn't like how people do just what you are saying, use exercise as the excuse to not eat well.
However, at least for many people, there are tangential benefits to exercise, not the least which is that if I go to the gym every day to lose weight I am in the frame of mind that I will eat less, or better, in order to support it. As you start feeling healthier because of the exercise (regardless of weight if you are sedentary you are more tired, and more easily tired out) you don't want to screw it up.
The part that really hasn't been brought up here is the psychological factors. People drown their sorrows in food. There is a phrase 'comfort food' that helps to explain why people cannot control calorie intake as easily as they wish.
At one point I went on a healthy diet at the same time I quit smoking cold turkey, since I knew there is often weight gain associated with quitting smoking. I had an awakening and realized I could never smoke again (or not at least until my kids were grown) so there was no question I was done smoking. (Also pertinent to the conversations in this thread, I had tried to quit 50 times before, even sometimes for a couple of years and failed. Once I had the right reason, its been 7 years since I smoked and I never will. All of the failures were simply a lack of the value of quitting meaning more than the enjoyment of smoking.) In any event, when I did this I also decided to give up coffee, which I probably drank 5 cups a day of at the time. That was somewhat because I knew I should cut back but mostly because it would give me the added determination of proving to myself I could do something so difficult and made me less inclined to cheat on any of the 3. I lost 40 lbs, quit coffee for over a year (never intended to permanently stop) and have not thought about smoking since.

DocHoliday said:

One thing I will say though, diet is far, far more important than exercise. (Still should do both).

Walking is good for you, but if you're overweight walking isn't going to do much if you're still putting down 3000+ cals. Way too easy to walk - hell, run for 30 minutes and basically eat back all the calories lost in 5 minutes.

Click to expand...

Agree completely. I see so many people gain weight when they exercise because they think they "deserve" to eat more since they're working hard. The truth is exercising doesn't normally burn that many calories and they're very easy to replace. That's especially true of long, slow (low intensity) exercise routines.

Patjew said:

Agree completely. I see so many people gain weight when they exercise because they think they "deserve" to eat more since they're working hard. The truth is exercising doesn't normally burn that many calories and they're very easy to replace. That's especially true of long, slow (low intensity) exercise routines.

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When I was in my 20s I lived in a town where the thing to do was play in a softball league (fastpitch) in the summer and a basketball league in the winter.
Being involved in athletics all my life, it seemed like a good way to replace some of the excersize I would get going to practice most days of the year.
The problem was that after the games, we would spend the next 5 hours at the bar drinking more beer than you could work off playing 7 days a week.

AndyJohnson said:

When I was in my 20s I lived in a town where the thing to do was play in a softball league (fastpitch) in the summer and a basketball league in the winter.
Being involved in athletics all my life, it seemed like a good way to replace some of the excersize I would get going to practice most days of the year.
The problem was that after the games, we would spend the next 5 hours at the bar drinking more beer than you could work off playing 7 days a week.

Click to expand...

That sounds like a blast. I want to do that now!

DocHoliday said:

....

Did the advent of high calorie foods make it easier for poor eating habits to = obesity? Undoubtably. But in the end, there is only one solution for most people:

You guessed it - diet and exercise.

Back to your own diet: do you think your doctor will say "oh DaBruinz, your Triglycerides aren't responding. You can quit that diet and exercise - it's your genetics as you can't do squat about it."

Nope. Expect more diet modifications.

Click to expand...

Doc, Maybe your current medical studies have NOT caught up with people who have challenged the
old "eat less - exercise more" to fight obesity Rx, which is backed up by solid evidence and research.

Here is a good start to get you up to speed.
11 Experts Demolish the “Calories-In-Calories-Out” (CICO) Model of Obesity" (IE: Eat Less - Exercise More)


I love this quote ( it is so true)
“A friend of mine once said “The problem with explaining complicated systems to the layman is this: it’s easy to simplify a concept to the point that that it’s no longer true.”
...
The concept of the “calorie”, as applied to nutrition, is an oversimplification so extreme as to be untrue in practice"


If you search the internet for "problem with calories in calories out:
you'll get a ton more.

Patjew said:

Thoughts and prayers going out to Kate. Stay strong, K.

Click to expand...

I sent her a 30 pack of Budweiser and 6 boxes of Cheezits.

JR4 said:

Doc, Maybe your current medical studies have NOT caught up with people who have challenged the
old "eat less - exercise more" to fight obesity Rx, which is backed up by solid evidence and research.

Here is a good start to get you up to speed.
11 Experts Demolish the “Calories-In-Calories-Out” (CICO) Model of Obesity" (IE: Eat Less - Exercise More)


I love this quote ( it is so true)
“A friend of mine once said “The problem with explaining complicated systems to the layman is this: it’s easy to simplify a concept to the point that that it’s no longer true.”
...
The concept of the “calorie”, as applied to nutrition, is an oversimplification so extreme as to be untrue in practice"


If you search the internet for "problem with calories in calories out:
you'll get a ton more.

Click to expand...

There is no doubt that 2000 calories if vegetables, lean meat, and nuts is different than 2000 calories of cheese, soda, and bacon.

But:

1.) Adhering to a healthy, proportioned diet is still the solution even if what patients were eating was the problem instead of how much.

2.) Most patients are still eating too much, not just the wrong food.

Calorie in, calorie out may not be strict reality but the fact it isn't perfect isn't the reason people aren't losing weight.

Unless ****ty food becomes more expensive it's just going to take the sheer force of will to eat better and less.

By the way, the genetic mice really has no bearing on human patient populations since our genotypes have not significantly changed since the obesity epidemic began.