It doesn't take fifty minutes a day, six times a week, to lose weight. Metabolic reset is best achieved with Tabata-style sprint work: 20 seconds of intensity (whole-body bodyweight exercise, walking, swimming), followed by 10 seconds of rest. Ten-fifteen minutes of this three times a week works wonders. Add 10-15 minutes of stretching or yoga on the alternate days and you have a wonderful basic prescription for weight loss. Weight loss demands both dietary control AND exercise. Each approach, by itself, is partial. But this needs to be combined with meditation, journaling, or counseling to deal with the emotional issues. Self-love and acceptance of our human imperfection can help quite a bit too. Health isn't a place, it's a process, and one we have to address every day.
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Monday, February 22, 2010
Can Overweight Women Trust Their Doctors?
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14 comments:
The implied question seems to be whether overweight women can trust their doctors to give good advice on losing weight. What's the 5 year success rate on your system?
More generally, overweight women in particular should be cautious about trusting their doctors, and so should everyone else.
Overweight women (I don't know about overweight men) are at risk for having all their medical problems attributed to their weight, including serious problems which have other causes.
Furthermore, I've seen enough from people to know that a doctor who listens and thinks (let alone a doctor who knows enough) is rare and precious.
I've recently heard from three people (one fat man, one fat woman, and one thin woman) about needing to be assertive and intelligent with their doctors-- or what what seriously wrong with them would not have been dealt with.
The "system" I use is life change--actually changing eating pattern and life patterns. Virtually 100% of the people who manage to keep weight off use it. The specific pieces of the puzzle (say, the Tabata protocol) is merely about efficient exercise, and can be used to refine the approach.
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I think that obese people are in the position of someone who has an arrow in their back and complains about pain. True, the pain may be something else, but until the most obvious issue is dealt with, it is unreasonable to expect a doctor to look past the arrow to the possibility of a tweaked muscle.
Some relevant links on success rate of weight loss regimes:
1) Diets Don't Work: http://mann.bol.ucla.edu/files/Diets_don't_work.pdf (from UCLA). I'll note that the focus of this one is on the really high failure rate of weight loss programs that only focus on calorie restriction, without exercise; according to this article, people who do this tend to lose weight temporarily and then regain more than they lose.
2) A Consumer Reports evaluation of weight loss regimes (including exercise recommendations), offers more hope:
But it’s not impossible. The Consumer Reports National Research Center’s survey of CR subscribers, published in June 2002, found that 25 percent of respondents who had ever tried to lose weight did shed at least 10 percent of their starting weight and kept it off for a year or more.
(Of course, this still means 75% didn't.)
3) A Consumer Search review of weight loss programs (http://www.consumersearch.com/weight-loss-programs/review).
On the one hand, low though the success rate of weight loss efforts seems to be, it does seem to be higher, if you're exercising as well as watching what you eat, than I get the impression the fat acceptance movement is arguing. (But it looks as if, if you're just restricting calories and not exercising, it might not be worth bothering.)
On the other hand, if I were overweight, given that I wouldn't be any the less vulnerable to all the non-weight-related diseases than skinnier people, I wouldn't want my doctor to be ignoring all those possibilities until I lost enough weight to be in normal range (which might, after all, be never - sometimes even successful lasting weight loss just means getting down from obese to overweight). So it does seem to me that the article's raising a reasonable concern, even if the women involved could also improve their health if they lost weight.
Steve, that's amazingly irresponsible. There are a wide range of reasons for pain, and I've read about a woman who's infected appendix was ignored for months by her doctor because he thought she ought to lose weight.
The level of medical care is sufficiently bad for overweight women (and would be a great deal worse if all doctors took your point of view) that it wouldn't surprise me a bit if the health stats for fat people would be noticeably better if fat and illness weren't conflated.
The fat man that I mentioned? He was losing the ability to walk. It wasn't his weight. He'd been prescribed a drug which was affecting his ability to walk.
This post brings up some concerns. What exactly are you envisioning when you suggest "Tabata-style" work? Using the word "style" here could allow for some approximation in the implementation of the protocol. But even then I have to wonder if the risks for suggesting it for overweight women or overweight men (tacitly or explicitly) do not outweigh the benefits.
The actual Tabata protocol is 20 seconds at 170 percent of Vo2 Max, followed by 10 seconds rest for 7 or 8 intervals. Even in conditioned athletes it can take several weeks to get through the prescribed number of intervals completely without feeling faint. And the results merely show in increases in Aerobic and Anaerobic fitness in these athletes.
Even suggesting interval training, which for someone overweight or under-conditioned and possibly incapable of actual Tabata levels would also seem to be of limited benefit given the higher chance of injury. From the narrow perspective of mere weight loss the approach could appear useful, but no more so than simple resistance training without the intense interval component.
Weight loss is a chemical, emotional, and physical endeavor. It is a subset of a much larger process. Interval training, Tabata or otherwise, for prolonged periods has effects counterproductive to what should be the ultimate goal of obtaining overall health and wellbeing.
My weight stayed low when I was running 35 miles a week. It has gone up since my joints prevented my continuing that. So, I do not believe that one needs to use both diet and exercise, so long as the exercise is sufficient. My appetite seems to have increased since I mostly quit running, not gone down as one might guess.
PT, I don't know how low your exercise level went, but I've found that if I'm completely sedentary, I have a strong impulse towards what I call nervous eating-- it's very clear that I really want the stimulation rather than being hungry. When I'm in that state, I resent feeling too full to want more food because I still want the experience of eating.
I file this under mostly physical rather than mostly emotional.
If you were about 35 when you stopped running, the weight gain could be somewhat coincidental. It seems to be common for men to start gaining weight at that age.
"I think that obese people are in the position of someone who has an arrow in their back and complains about pain. True, the pain may be something else, but until the most obvious issue is dealt with, it is unreasonable to expect a doctor to look past the arrow to the possibility of a tweaked muscle."
An arrow in the back is acute, obesity is chronic.
Obese people are more in the position of someone who's had migraines for years and one day has an bullet in his or her back and complains about pain. True, the pain may be from the migraines yet again, but it's perfectly reasonable to expect a doctor to look past the migraines to the possibility of a bullet.
"Steve, that's amazingly irresponsible. There are a wide range of reasons for pain, and I've read about a woman who's infected appendix was ignored for months by her doctor because he thought she ought to lose weight."
Exactly!
Hi of curse they can truth theire doctor why should they dont trust there doctors?
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The author is absolutely right, and there is no question.
Are you saying that they shouldn't trust their doctors when they tell them to exercise?
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