Conference rocks::weight_control

829.0. "Boston Globe Article 10-3-1993" by TOLKIN::OSHAUGHNESSY (Let LIFE be your GOAL) Tue Oct 05 1993 15:36

        (I apologize for any typos !!)
        
        Weight loss linked to life change, not diets
        
        By: Richard Saltus  GLOBE STAFF
        
        
        Printed without permission from Boston Globe Sunday October 
        3, 1993
        
        
        Weight-loss experts, disheartened by new figures showing that 
        Americans are growing ever fatter despite the billions of 
        dollars they spend on diets of every kind, are offering a 
        grim bit of advice - think twice about even trying to shed 
        pounds unless you are prepared to make it a lifelong 
        commitment.
        
        It's a bitter pill for the tens of millions of Americans who 
        go on quick weight-loss programs - often with unattainable 
        visions of Julia Roberts or Richard Gere dancing in their 
        heads.
        
        A report published Friday, summing up a National Institutes 
        of Health study carried out in 1992, came close to saying 
        that diets don't work.  With few exceptions, dieters gain 
        back the weight they lose - if not within a year or two, at 
        least within five years.  And the scientists added that they 
        don't know at present which is better - to have lost weight 
        and regained it, or never to have lost it at all.
        
        The report, published in the medical journal Annals of 
        Internal Medicine, comprised the findings of a major NIH 
        study.
        
        One of its chief points was that researchers now realize that 
        obesity is far from a simple matter of eating too much.  
        Rather, it's a complex, chronic medical problem - just as 
        stubborn as, say, high blood pressure - that responds to no 
        single treatment and must be battled day after day, year 
        after year.
        
        It came less than two weeks after the federal Centers for 
        Disease Control said its latest National Health and Nutrition 
        Examination Survey revealed that from 1988 to 1991, there was 
        a striking 8 percent increase in obesity among Americans - 
        rising from 24 percent to 32 percent of men and from 27 
        percent to 35 percent of women.
        
        "To the shock of everyone, with all these billions of dollars 
        spent the problem hasn't gotten better," said Dr. George 
        Blackburn of New England Deaconess Hospital, calling it a 
        sharp setback for the government's Healthy People 2000 goal 
        of a 25 percent reduction in obesity.
        
        Coming at a time when an estimated 44 million Americans are 
        on diets, the figures suggest that, "For one thing, many of 
        those who are most committed to dieting and weight loss are 
        those who don't need to" because they're only marginally 
        overweight, said Dr. Susan Yanovsky of the National Institute 
        of Diabetes and Digestive and Kidney Diseases.
        
        "Secondly, we're still approaching obesity in the wrong way.  
        We're looking at it as something we can provide a quick fix 
        for, and expect it to work," Yanovsky said.  She is the 
        executive secretary of the National Task Force on Prevention 
        and Treatment of Obesity at the institute.
        
        The experts who worked on the study published Friday agreed 
        that there is no quick fix or crash diet that will have 
        long-lasting results.  Moreover, said a consensus statement, 
        experts now know that obesity has many causes - including a 
        relatively strong genetic effect as well as environmental and 
        cultural factors - that make it exceptionally difficult to 
        treat.
        
        "For almost all people, a lifelong commitment to change in 
        lifestyle, behavioral responses, and dietary practices is 
        necessary," said the report.
        
        "We do have to start thinking twice about weight-loss dieting 
        in people who aren't significantly overweight,"  Yanovsky 
        said, and concentrate resources on individuals who are 20 
        percent over the desirable weight for their height - the 
        medical definition of "obese."
        
        Given this harsh prescription, the report said, people should 
        think carefully about the dedication required, and the 
        psychological harm that comes from repeated dies failures, 
        before they undertake a weight-loss program.
        
        Moreover, the goal should be lowering health risks and 
        gaining fitness, not conforming to ideals of beauty.  "For 
        most people, achieving body weights and shapes presented in 
        the media is not a reasonable, appropriate, or achievable 
        goal," the report said, "and thus the failure to do so does 
        not represent a weakness of will power or character."
        
        The NIH report came on the heels of a Boston study that found 
        extremely overweight people - mainly women - had lower family 
        incomes and educational levels and less chance of marrying.  
        The researchers from the Harvard School of Public Health and 
        New England Medical Center said discrimination was the most 
        likely cause of the barriers that fat people encounter.
        
        Also on Friday, three national companies that had been 
        charged with false advertising by the Federal Trade 
        Commission agreed to publicize that most weight loss is 
        temporary, and to disclose statistics on how long dieters 
        maintained their new weights.  Two other companies said they 
        would fight the charges.
        
        Many of the worst practices of commercial diet programs have 
        already been weeded out, said Blackburn, head of the Center 
        for Study of Nutrition and Medicine at the Deaconess.  He 
        added that such programs can be useful - but only if they are 
        a part of a long-term regimen that includes permanently 
        changing the way a person eats and the support of other 
        dieters.
        
        In keeping with the report's advice that only the truly 
        committed should attempt weight loss, Blackburn said people 
        who want to take up the challenge should be "getting 
        themselves 'diet ready.'"
        
        That means, he said:
        
        -  Having a plan that ensures 100 minutes of physical
           activity a week.
        
        -  Being able to stick to a regular eating plan - that is,
           the same foods at the same meals - at least 60 percent 
           of the week.
        
        -  The ability to get a full night's sleep.
        
        -  Most importantly, a group of "like-minded" people who
           support each other's diet efforts.  It is best if the 
           members don't change much.
        
        Blackburn added that no matter what regimen people use to 
        shed pounds, what's most critical to keeping the weight off 
        is eating according to the US Department of Agriculture's 
        "food pyramid" that emphasizes pasta, bread, and fiber; 
        fruits and vegetables; and only small amounts of dairy foods 
        and meats.
        
        "No drug, modified fast, or even surgery can succeed if a 
        person won't adopt a low-fat, high-fiber diet and put on 
        their walking shoes," he said.
        
        
        QUESTIONS TO ASK OF DIET PROGRAMS
        
        If you're thinking of signing up for a weight-loss program, 
        pay no attention to anecdotal "success stories" and 
        advertising claims, says the National Institutes of Health.
        
        Instead ask:
        
        -  Of those who begin the program, what percentage complete
           it ?
        
        -  Of those who complete the program, what percentages lose
           five pounds ?  Ten pounds ?  Twenty pounds ?
        
        -  Of those who lose weight, what percentage have kept the 
           weight off after one year ?  After three years ?  Five
           years ?
        
        -  What percentage suffer adverse medical or psychological
           side effects ?
        
        Ask also about the mix of diet, exercise and behavior 
        modification; the amount of counseling available; and whether 
        the program has professionals who keep in touch with dieters 
        after the weight-loss regimen ends.