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Archive for June, 2011|Monthly archive page

Katarina Borer: My First Impressions of her Recent Work

In Weight-Loss Maintenance on June 30, 2011 at 3:04 pm

It’s taking time, but I am working my way through a study, an article and a commentary surrounding some recent work by Dr. Katarina Borer and colleagues on endocrine, appetite and exercise.  

I believe I mentioned that Dr. Borer contacted me in response to my Open Letter to Weight Management Scientists.  I may have also mentioned that she said my postings were, ahem, interesting and remarkably well informed for a person who is not actively engaged in research. I am digging deep to find my inner objective scientist who would not be moved by such flattery.

I am working my way through these pieces simultaneously because they are based on the same trials, but they present two sets of conclusions.  The first set may be found in the study itself, entitled Appetite Responds to Changes in Meal Content, Whereas Ghrelin, Leptin and Insulin Track Changes in Energy Availability and was published in July 2009 in The Journal of Clinical Endocrinology and Metabolism.  To give credit where due, her co-scientists are Elizabeth Wuorinen, Kimberly Ku and Charles Burant, not that those names are meaningful to me.  Actually, very few of the names in this line of research are meaningful to me . . . yet. 

The way I read a study or article is to turn first to the footnotes to get an idea of the bricks that form the foundation for the work or thought at hand.  I screen through the lens of my own evaluation system to determine what biases are present.  Mostly, in the past, I have read studies that are solely obesity focused, and, whether they admit to it or not, most scientists in this area come with one or more biases.  Some feel that obesity is a medical and social ill that must be reversed or cured, and their research is colored by that view – it may prevent them from seeing certain options.  Some of these scientists have accepted support from commercial interests – diet companies, foundations associated with pharmaceutical companies, and the like, and that makes their work horribly suspect.  Others who publish in this realm are testing the “Health at Every Size” paradigm, or, more accurately, are Hell bent on proving the efficacy of that model, and that limits their view.  In any event, I often can see a study or article’s self-imposed limitations in its footnotes.  Certain names pop up together over and over, and they indicate a point of view.

I don’t have a grasp of such biases and limitations in the world of endocrine and exercise.  In this world, obesity and weight loss are sometimes the focus, but often just confounding factors. With the exception of Cummings et. al., who produced a Ghrelin study that I happened upon by accident, I recognized no one.  I am, therefore, trusting that these are all sterling people, and none is a “scientist for sale.”  Feel free to correct me if I’m wrong. Read the rest of this entry »

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More Thoughts on Endocrine

In Weight-Loss Maintenance on June 20, 2011 at 9:53 am

It’s useless to try to persuade me to be uninterested in endocrine.  If your interests lie elsewhere, I forgive you for skipping my entries on the topic.

First the news:  I heard from Katarina Borer, author of Exercise Endocrinology

As a lay person, it’s hard to know what qualifies as a respected source on a particular topic.  What I know is that in terms of textbooks, it’s the first that pops up when you do searches on Google, Yahoo or Bing using the terms “exercise endocrine.”  It gets Google’s top honors, in that it appears in the number one position, above articles from clearly “popular” sources, such as bodybuilding.com.  Moreover, two other articles from Katarina Borer appear in top ten slots.  That’s my confession.   I have accepted this woman’s qualifications on the basis of her Google Quotient.  She, of course, rose even higher in my esteem when she contacted me by email, and attached three articles for my review (two in which she was lead author, one a commentary on one of the other pieces).  She attained nearly saint status by paying me a compliment, “I found your postings interesting and remarkably well-informed for a person who is not actively engaged in research.”

There.  Confessions dispensed.  I will, sometime soon, review those articles, but they will require time to digest.  I have read each one’s first two paragraphs, and it is apparent to me that I will need to read these articles when my intellectual cylinders are all firing properly and I am under the influence of a precise dose of caffeine.  (Too little and I don’t make important, rapid mental connections; too much and I start cleaning my house instead.)

Several things emerged in the comments on my last post that gave me “Eureka” twinges:  

  1. That other people experience “eat impulses” and at least one commenter feels relieved to have language to describe them.   Our vocabulary, clearly, is constrained by having only two words to describe the sensations that precede eating:  hunger and appetite.  With dozens of hormones, peptides, proteins and the like, reacting in hundreds or thousands of combinations with our individual gene profiles and contributing to our metabolic processes, it seems a bit silly to me that we reduce the entire process to two, singular tense, words.  Moreover, the limits imposed by these two words have created a perfect Petri dish for fomenting the social discord we size acceptance proponents know as weight bias and the oppressors are happy to use in a “war on obesity.”  To wit:  “If you don’t eat when you’re hungry, obviously you’re simply responding to appetite, you out-of-control schmuck, and we, society, will judge you harshly for that if it results in a larger body than we find pleasing.  Hmmmmph!  (We’ll leave you alone or even venerate you if you can eat sans hunger and remain trim.)” Read the rest of this entry »

An Open Letter to Weight-Management Scientists

In Weight-Loss Maintenance on June 15, 2011 at 1:22 pm

Dear Scientist Friends:

Consider this a personal invitation to test a theory, especially if your area of expertise is endocrine and/or you have a personal interest in exercise physiology and weight management.  (Er, and if you’re just one of my regular blog readers, please eaves drop on this letter.)

For several years, I have been synthesizing scientific information and personal experience as a radical weight-loss maintainer, and I would appreciate an experiment designed to better test the relationship between exercise and endocrine, especially those dicey signals that I believe cause most people to regain lost weight – the imbalance of leptin and ghrelin, PYY3-36 and aghouti related protein.  If you know of an experiment that has already explored this relationship, then please provide me a link.  (Disclaimer, as a lay person, my knowledge is embarrassingly limited.  I have not yet read Katarina Borer’s book on Exercise Endocrinology, or any other scholarly text, so maybe I’m naive, but if we do know all that we could know on this topic, it sure hasn’t made it into the mainstream marketplace of ideas.) 

It has occurred to me that there are different kinds of “hunger.”  Those of us who maintain radical weight losses have pretty much mastered how to quell insulin-triggered hunger and vacuous (empty stomach) hunger using macronutrient management.  In short, we use carbs (such as bananas or dark chocolate) to quell immediate, sharp (vacuous) hunger, and we use proteins and fats to keep sneaky insulin-triggered hunger at bay.  But this is not the full story.  If it were, more than 3% of people would be successful at maintaining radical weight loss for five years, the depressing figure that empirical research suggests.

According to the National Weight Control Registry (which could also be called the 3% Club), where I am listed as a participant, 90% of us exercise on average one hour per day.  This finding is one of the most dramatic commonalities among us, more so than eating breakfast (78%), regular weighing (75%) or limiting our TV viewing (62%).  In fact, the only two characteristics that are more common than the hour of exercise are that we have restricted our food (98%) and increased our exercise from our fat days (94%).  (It should hardly come as a surprise that one hour daily represents an increase for most people!) 

Learned people debate the value of exercise compared to food restriction in losing or maintaining weight, assuming that  exercise is a function of energy balance – calories expended v. calories consumed.  Energy balance, however, is not a simple equation, and I think exercise serves an additional, more important, function beyond expending energy.  I think we need to know more about its effect on endocrine.  Read the rest of this entry »

The Plate

In Weight-Loss Maintenance on June 6, 2011 at 11:01 am

It’s the topic of the day (or recent bygone days) at many blogs and websites:  The new US dietary guidelines replacing the old Pyramid, aka “My Plate.”

Knowing full well that I’m howling in the wind, I just blasted off the following missive to the “Contact Us” email address.

Warning to my size acceptance friends, restriction talk, could be triggering.  I also apologize for using the “O” word.  Had to consider my audience, and “fat” wouldn’t fly with them.

No Salutation.  Email address is Support@cnpp.usda.gov

Thank you for your hard work to date.  Here are suggestions for the new plate, which is better than the pyramid, but still inaccurate.  I hope you will integrate them into a new improved plate in the future:

1.  Refined grains have no place on the plate, they should be off the placemat in a distant place (that may look like an ice cream stand or some such) called “now and then treats.” 

2.  Replace the “grains” category with “nutritious starches.” Corn, legumes and baked potatoes are better switched out with the whole grains, not with the green leafies, etc.

3. Change the Dairy glass to “Dairy or Alternative” and link to your alternative section.

I’m not an RD, but I am an eight-year radical weight-loss maintainer (27% of my body’s highest established weight), which is probably more rare.  I think most RDs would agree with my adjustments to your plate. The milling and baking industry and dairy farmers might have a bone to pick, but you serve the broader citizenry, yes?

Regarding your weight-loss advice:  it is outdated and based in the cultural mythology that weight loss is routinely permanent.  Empirical science does not support this.  You would do more to promote health if you shared that weight maintenance is noble, challenging and rare enough in itself.  Most adults over 30 gain 1 to 2 pounds per year.  Preventing that would be helpful.  People should live joyfully most of the time, eat healthfully most of the time (following the revised plate I’m suggesting), exercise most days, then treasure the body that happens, regardless of its BMI category.  Read the rest of this entry »

Let Us Name the Enemy

In Weight-Loss Maintenance on June 3, 2011 at 6:32 am

In the forums over at Big Fat Blog, there’s a discussion going on about the 15 South Florida OB/Gyns (out of 105 that the Sun Sentinel surveyed) who limit their practices to women who weigh less than 200 pounds (and additional practices that set other, slightly higher weight limits, 250 lbs., e.g.). 

Dr. Yoni Freedhoff has also blogged on this news,  which is proving itself worthy enough for west-coast coverage

The offending doctors claim they’re discriminating because their equipment or exam tables are inadequate and that fat patients are at higher risk for complications and should go to specialists. 

Many of the voices chiming in, both at Dr. Freedhoff’s site and BFB are jumping on the blame-the-lawyers bandwagon.  In other words, the enemy is our litigious society.  Doctors are afraid of lawsuits.  This makes me uncomfortable.  We common citizens should think HARD before throwing away our legal protections.  Conflict alert:  I am married to a lawyer.  I’m also the daughter of a lawyer, and the sister of a lawyer, and sister-in-law of a lawyer.  My family is lousy with lawyers. Though I am not one myself, I am fond of lawyers.  Even if I wasn’t, however, I think this blame-the-lawyers thing wouldn’t pass the smell test.

For one thing, the assault on “frivolous lawsuits”  strikes me as overblown, exaggerated and wrong-headed as the “war on obesity.”   The Duke Law Review has the best summary I could find of the “frivolous lawsuit” scare, and it makes a measured argument for how exaggerated it is.  Brief summary:  Those cases that are, indeed, frivolous are rare but over-reported in the news media, simply because they are more interesting than the millions of run-of-the-mill claims that get settled every day.  Moreover, often these cases are oversimplified in the mainstream media (imagine that!) and outright misrepresented by insurance spokespeople and the like who benefit by portraying them as “frivolous,” when a closer examination of the facts would reveal otherwise. 

Frivolous claims are not some great industry for legit or competent attorneys, because judges already have the power to throw out “frivolous” cases and even issue $anction$ against the attorneys who file them.  Some pro-business legislators have suggested that attorney’s “game the system” by filing frivolous cases on the notion that corporations will “settle” in order to avoid going to court.  That’s ridiculous and backwards.  Corporations keep their attorneys on retainer, so it’s no additional cost to them to go to court.  More often, corporations (including insurance companies) routinely deny claims, even when legit, because they know how difficult and expensive the claim will be for a lone citizen.  A claimant has a hard enough time securing an attorney for a good but marginal case; finding an attorney stupid enough to take a “frivolous” case and risk a judge’s $anction is enormously difficult.  Finally, if a claim does make it to a jury and receive what sounds like an extreme or “frivolous” judgment, often an appeals judge later lowers the award, but this fact never becomes part of the story that creates a particular case’s urban legend. Read the rest of this entry »