Thursday, March 25, 2010

Weight ain't about exercise.


Not sure how many more posts will have the same title but yet another study has come out that suggests exercise doesn't have a tremendous impact on weight.

This study, out of Harvard, tracked 34,000 women for 13 years and monitored their weight and their exercising.

Only 13% of the women didn't gain weight over the course of those 13 years and those women began the study at a healthy weight and exercised on average an hour a day.

For women who began the study overweight, no amount of exercise was sufficient to prevent weight gain.

The lessons to be learned?

1. Intake, not output, is what has got us into this mess.
2. If you are part of the nearly 2/3rds of the population who's overweight or obese exercise alone is not likely to help you maintain your weight let alone help you to lose it.
3. If you've got a healthy weight and don't want to gain you'll have to do a ridiculous amount of daily exercise.

and most importantly,

4. The more research that gets published failing to show causal benefit to exercise on weight loss the more difficult it'll be to promote exercise.

What I mean by that statement above is that each and every time studies like this are splashed around the newspapers and blogosphere it diminishes the absolute importance of exercise. That's just plain bad because exercise is likely the second most important determinant of health (nutrition being the first).

To me it seems the story on exercise is very clear - it's absolutely crucial for health, in extreme quantities it's helpful for maintaining weight, and it's really, really lousy as an exclusive modality for weight loss.

Bottom line? I would love to see more studies funded to demonstrate the health benefits of exercise and less studies funded that ultimately serve only to dissuade people from bothering to exercise in the first place by having outcomes that are extremely, predictably, disappointing.

I-Min Lee, Luc Djoussé, Howard D. Sesso, Lu Wang, & Julie E. Buring (2010). Physical Activity and Weight Gain Prevention Journal of the American Medical Association, 303 (12), 1173-1179

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13 comments:

  1. This comment is in two parts, I had so much to say.

    Part 1

    Oh, this stuff both is and isn't so hard to communicate about.
    First off, exercise is important. Period. No matter where you are on the weight spectrum, unless several certified, credentialed medical professionals have told you in no uncertain terms that you need to stay completely still, you need to exercise. Our bodies require movement. Being sedentary is really bad for you. No matter what impact exercise has on your weight (it might even cause the number on the scale to -- gasp -- go up!) it probably the one most important thing you can do to maintain health. And, it can be pleasurable and fun and social and interesting and there are many ways to get it and for goodness sake, do it already!

    When talking about weight, though, I think saying it's all about the inputs isn't accurate, either. It's about finding the right balance, which can be very, very hard in this environment. The food and movement culture in the U.S. is toxic, for the most part, but in a "slow exposure" way most of the time, like smog more than like a toxic cloud released from a chemical production facility. And fighting smog is expensive and requires battling corporate interests and individual behaviors. Government intervention in air quality has been essential (as it has in water quality, too). So unless we change the environment, telling people that it's all about the inputs is like telling people that they must wear expensive, uncomfortable masks in order to breathe the "public air" or to stay indoors in conditioned environments that not everyone can afford or has access to. Skillpower can only get your so far.

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  2. Part 2

    I'll use myself as an example. I'm a short person -- just over five feet tall. My body is very anabolic -- I gain weight (muscle and/or fat) incredibly well, pretty much on anything more than about 1,600 calories per day -- and this is with at least 30 minutes of moderate exercise most days. My ancestors likely found this to be an advantage, they required fewer calories and were able to work hard. Sure, they probably didn't live past 40 for most of the past millenium, but they reproduced and made more short, muscular people who stored calories easily when food was more plentiful and were able to augment the meager supplies when food was scarce with their own tissue, at least long enough to reproduce. No gangly 6-footers who required 3,000 calories a day in my gene pool, as far as I can tell.
    So for me to basically balance all of what comprises survival these days (work, parenting, life, etc) -- I need to eat far less than what my body is telling me to. And far less than my environment stimulates me to. How can I do that -- it's like being in an oxygen rich environment and being told "breath less deeply" -- it's not impossible, but it's also not something that ever becomes a habit, it always requires conscious effort. Is that effort worth it? Maybe. But only if my quality of life in the here an now is improved. And not improved because people like me better if I'm not as fat, because that's tinged with sadness and pain and hatred, not relief, for me.
    For many people who grew up fat (or thinking they were) their kid brains absorbed the message that being fat meant that they were less valuable than people who aren't fat. Your mission might be to help people manage their weight, but their jobs is to manage their overall life. Including fighting against that horrible time-bomb of a thought planted in their brain that they are somehow just naturally "less than" because of a body that, through no fault of their own, stores calories better than other bodies do. The "input is everything" message ignores the innate differences in metabolism that some bodies have. I think it's better to strive for the best balance -- that is, if a person is doing "everything right" with regard to eating and exercise and their weight stabilizes at a high spot, maybe that's just what is. In which case, getting as much exercise as they can enjoy is great. As is eating the food with the best nutrtion payoff for the least calories they can enjoy.
    Compared to most people even a hundred years ago, I'm not sure I buy the idea that we are worse off. I am concerned about health disparities around access to healthy food and physical activity, just like I am around air quality or water quality. But I don't think focusing primarily on individual responsibility for inputs is the best way to go. We need to align environment, intrinsic motivation and human needs, and behavioral science.
    Respectfully,
    WellRoundedType2

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  3. Wellrounded,

    Thanks for the thoughtful comments.

    You and I both agree for certain on your very spot on conclusion,

    "We need to align environment, intrinsic motivation and human needs, and behavioral science"

    Exercise is indeed important period and should be promoted heavily.

    Weight?

    To see a major societal change will indeed take major environmental overhauls.

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  4. I too would like to see research on exercise take the direction you suggest. For years I've been saying exercise is therapeutic, which it really is. An avalanche of studies in this regard would be great.

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  5. http://www.theglobeandmail.com/life/health/60-minutes-a-day-the-key-to-fending-off-pounds/article1510315/

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  6. Sadly, I agree with you that the types of studies that are being done and published are not helpful for the cause of exercise. Having maintained a 204 pound loss now (through natural means, no surgery) for over 3 years, I can tell you that exercise was a critical component to my weight loss story.

    I agree that the calories burned did not equate to even a small portion of that weight loss on an empirical scale. I was exercising in a formal class only 3 days a week, augmented by walking my dogs for extended periods of times every day. If I was burning more than 350 calories on my aerobics class days, and maybe 150 to 200 on dog walking days alone, I'd be surprised. The biggest change for me was in the way I ate.

    However, these studies always seem to ignore such obvious points. A large amount of my problem before losing weight was extreme depression. Exercise has an immediate and long lasting effect on this issue. It also mitigated a lot of the stress I was experiencing both in the workplace and at home.

    Also, as my abilities in the gym, and my ability to first keep up with my dogs and then actually be able to out last them on our walks became obvious, my self esteem increased (separate than the depression), and that bled into other parts of my new healthier lifestyle. "If I can do this, i can eat better too."

    Many people do very well with individual exercise programs. I am not one of them. I absolutely need a class where people like me and expect me to show up (and call me if I don't), and the group mentality with a bent towards healthy living was yet another significant influence.

    So it saddens me that all the studies seem to focus on the calories in / calories out aspect of weight loss only, and because you can't really burn enough calories in exercise to make a significant dent, they discount it's importance.

    One last comment. Exercise is critical for me at weight maintenance. Those calories burned in physical activity allow me to eat junk food on an occasional basis without weight ramification.

    I'm glad that you still push the benefits of exercise even in the face of obvious facts borne out by the studies, but facts that don't take the entire picture into account. That is, we're not just machines that are ruled by numbers, but emotional creatures who respond to all sorts of stimuli - both positive and negative - in the face of living a healthy lifestyle.

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  7. Thanks for the very thoughtful comment Laura.

    In my books exercise's role is one of general health and of healthy thoughts and attitudes and I think your comment captures exactly what that can mean to a person despite the fact the calories it burns aren't much to write home about and it exemplifies why despite my blogging somewhat incessantly that it's not about exercise, we insist on it as part of our program.

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  8. Anonymous3:24 pm

    My Name is Nathalie and
    I have a confession to do => I AM Selfish :o)

    I do sport because I love IT.
    Yes the benefit, but when I practice sport it IS time JUST for “ME”…

    2 hours ago I was at my Pilates course, I was FOR 1 HOUR concentrated every part of my mind on my breath…. THAT is Selfish…. lol

    Now, I'm completely ready to give my mind to what ever reclaim it....

    Some time, as a researchers we looking so hard....We forget to “quantify” pleasure, happiness, and the sense of balance that sport can offer to anyone who dares to try.

    I practice sport because I LOVE the way I fell after. Yé!

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  9. I just finished reading about this study on another site and I have to say I was very surprised by your interpretation of the findings. I am of healthy weight, and to me it is excellent news that I only need to move my lazy body vigorously for one hour in every 24 to avoid gaining weight. It seems shocking to me that you would suggest one hour of exercise is a lot to expect from people. For me, this would equate to walking to work (20 minutes each way) plus two or three hours of other exercise (gardening, heavy housework, gym, etc.) each week. The rest of the time I can sit on my backside. What's the problem?

    Of course, for people that need to lose weight, both diet and exercise need to change. This is very hard to do and it's why it's so important to avoid weight gain in the first place.

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  10. I agree with your original post, Yoni. This is a change in my thinking over the last three years. Exercise contributes perhaps a maximum of 10% to weight-loss efforts.

    -Steve

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  11. Anonymous9:25 am

    This is my first time on this blog and I like the subtitle, so I'll explore it some more.

    As a long time runner (over 25 years), from the start, it has never been about weight.When I first went from sloth to runner, I lost a big of weight, but the benefits both physical and mental far outweighed the side-effect of weight loss. I only wish the two would become separated in the mass consciousness as they are in mine. It's gotten so even Runners' World, to which I used to subscribe, now features a weight loss feature in EVERY ISSUE- I know this by seeing the cover in stores, as I have stopped buying the magazine once the focus shifted so much to weight loss. I enjoy running and being active in other ways so much that I hate to even tag it with the off-putting term "exercise". And maybe that's what we need. Change the focus by changing the spin - it works for politicians. Dont' say "you must exercise!". Say instead "get yourself moving, get the blood flowing, you'll be surprised how good it feels".

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  12. dwayne9:23 am

    I hate using anecdotal stories to justify a conclusion, and I know they don't trump good studies, but ...

    I'm a male, just under 5 feet 8. I had always been pretty athletic and exercised fairly regularly (gym, cardio and lifting, mostly). But by the time I hit 30, I noticed my weight creeping up into the 165 range.

    The I got hooked on ultimate frisbee. Played twice a week to start, and within a couple of months, without even trying -- and I believe without changing my diet or other exercise habits -- dropped 15-17 pounds.

    And I wasn't *that* overweight to begin with.

    I'm now 42 and I weigh in the mid-150s. Whenever other obligations (or injuries) curtail my frisbee schedule, my weight creeps up. When I get back into it, my weight gradually drops to an equilibrium in the low 150s.

    Now, maybe the issue is the definition of exercise. I played with a guy who wore a pedometer for a tournament, which tallied 17 miles after a day of play. Tournaments are grueling, all-day affairs (usually two days), but even an evening of pickup is 1 to 2 hours of interval training. Maybe that's beyond the normal definition of "exercise," I don't know.

    I've also noticed that exercise like this does seem to suppress my appetite a bit. I eat on a regular schedule and don't snack, so I don't *think* that has affected my diet much, but I can't say it has had zero effect.

    But I'm in complete agreement with you that if exercise is seen as a silver bullet, it's a setup for failure and backlash if it doesn't result in magical weight loss -- especially if what the subject is calling exercise is something moderate.

    And the benefits apart from weight loss are so powerful and varied that it's a really bad thing to turn people off from it.

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  13. Anonymous11:33 am

    Well,sure,if you pig out,you probably need to spend 1/2 of your life at the gym to lose pounds.

    But,why, burning even a modest 150 calories per day through exercise ,if your diet is reasonable,can do a pretty good job at mantaining a healthy weight IMO.

    Physical activity and its calorie burning effect can totally play a role in weight loss.Running around all day or doing hard labour would probably grant you 250-500 more calories burned daily depending.

    It's people's ignorance and misconceptions that are the problem,as always : they feel that because they sweated and got their heart rate up for 15 minutes,they can have a huge-ass burger.They don't know their numbers.

    So,exercise is overrated in its part in weight loss,and caloric intake underrated.But with the correct information one gives things their proper dimension,and therefore can use the tools available to their advantage.


    Pretty awesome blog,btw.Nice to see honesty and sharp humor in a softer than ever,politically 'correct' society.

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