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"Do not allow the body to attain extreme thinness
for that too is treacherous, but bring it only to a condition
that will naturally continue unchanged, whatever that may be."
Hippocrates, circa 400 BC
Summary of Major Points
with selected references
A. A singular focus on fat/weight
loss for medicinal reasons is counterproductive and may be harmful
to health:
- Most epidemiological studies on weight change indicate
that weight loss and weight cycling are associated with increased
mortality rates.
- Intentional weight loss may reduce mortality rates in
overweight persons with comorbidities, but the reduced death
rates appear to be unrelated to the magnitude of weight loss;
intentional weight in overweight persons without comorbidities
does not reduce mortality rates and may actually increase them.
- Certain popular low-carbohydrate, low-calories diets may
increase risks for heart disease despite weight loss.
- Chronic weight cycling may increase risk of coronary heart
disease and certain cancers (breast; renal).
- Risk of pharmacotherapy may outweigh any benefits.
Andres, R., D.C. Muller and J.D. Sorkin. Long-term effects of
change in body weight on all-cause mortality: A review. Ann.
Int. Med. 119:737-743, 1993.
- Brozek, J., C.B. Chapman, and A. Keys. Drastic food restriction:
Effect on cardiovascular dynamics in normotensive and hypertensive
conditions. J. A.N.A. 137: 1569-1574, 1984.
- Connolly, H.M., J.L. Crary M.D. McGoon, D.D. Hensrud, B.S.
Edwards, W.D. Edwards, and H.V Schaff. Valvular heart disease
associated with fenfluramine-phentermine. N. Engl. J. Med. 337:581-588,
1997.
- Djuric, Z., L.K. Heilburn, M.S. Simon, et al.: Levels of
5-hydroxymethyl-2’-deoxyuridine in DNA from blood as marker
of breast cancer. Cancer 77:691-696, 1996.
- Ernsberger, P. and P. Haskew. Rethinking Obesity: An Alternative
View of its Health Implications. New York: Human Sciences Press,
1987.
- Ernsberger, P., R.J. Koletsky, J.S. Baskin, and L.A. Collins.
Consequences of weight cycling in obese spontaneously hypertensive
rats. Am. J. Physiol. 270 (Regulatory Intergrative Comp. Physiol.
39):R864-872, 1996.
- Hamm, P., R.B. Shekelle, and J. Stamler. Large fluctuations
in body weight during young adulthood and twenty-five year risk
of coronary health in men. Am. J. Epidemiol. 129:312-318, 1989.
- Harris, T.B., R Ballard-Barbasch, J. Madans, D.M. Makuc,
and J.J. Feldman. Overweight, weight loss and risk of coronary
heart disease in older women: The NHAMES I Epidemiolgic Follow-up
Study. Am. J. Epidemio. 137: 1318-1327, 1993.
- Hembrough, F.B and D.H. Riedesel. Mechanical behavior change
in a major artery after a series of starvation-feeding episodes.
Am.J. Physiol. 219:742-746, 1970.
- Higgins, M., R.D’Agostino, W. Kannel, and J. Cobb. Benefits
and adverse effects of weight loss. Observations from the Framingham
Study. Ann. Int. Med. 119: 758-763, 1993.
- Holbrook, T.L., E. Barrett-Connor, and D.L. Wingard. The
association of lifetime weight and weight control patterns with
diabetes among men and women in an adult community, Int. J. Obes.
13:723-729, 1989.
- La Rosa, J.C. A.G. Fry, R. Muesing, and D.R. Rosing. Effects
of high-protein, low-carbohydrate dieting on plasma lipoproteins
and body weiht. J.Am. Diet. Assoc. 77:264-270, 1980.
- Lee, I.-M., and R.S. Paffenbarger. Change in body weight
and longevity. A 27-year follow-up of middle-aged men. J.A.M>A>
268:2045-2049, 1992.
- Lindblad, P., A. Wolk, R. Bergstrom, I. Persson, and H.=O
Adami. The role of obesity and weight fluctuations in the etiology
of renal cell cancer: a population-based case-control study.
Cancer Epidemiol. Biomarkers Pre. 3:631-639, 1994.
- Lissner, L., P.M. Odell, R.B. D’Agostino, J.S. Stokes
III, B.E. Kreger, A.J. Belanger, and K.D. Brownell, Variability
of body weight and health outcomes in the Framingham population,
N. Engl. J. Med. 324: 1839-1844, 1991.
- McCann, U.D., L.S. Seiden, L.J. Rubin, and G.A. Ricaurte.
Brain Serotonin neutrotoxicity and primary pulmonary hypertension
from fenfluramine and dexfenfluramine. A systematic review of
the evidence. J.A.M.A. 278:666-672, 1997.
- Pamak, E.R., D.F. Williamson, M.K. Serdula, J. Madans, J.C.
Kleinman and T.E. Byers. Weight loss and mortality in a national
cohort of adults. Am. J. Epidemiol 136: 686-697, 1992.
- Pamak, E.R., D. F Williamson, M.K. Serdula, J. Madans, and
T.E. Byers. Weight loss and subsequent death in a cohort of U.S.
adults. Ann Int. Med. 119:744-748, 1993.
- Phinney, S.D. Weight cycling and cardiovascular risk in obese
men and women. Am. J. Clin. Nutr. 56:781, 1992.
- Public Health Service Publication No. 1485. Obesity and Health.
Washington, D.C.: U.S. Government Printing Office, 1996, p. 40.
- Ricman, R., N. Mitchell, J. Dingman, and J.E. Dalen. Changes
in serum cholesterol during the Stillman Diet, J.A.M.A. 228:54-58,
1974.
- Smith, G.S., J.L. Smith, M.S. Mameesh, J. Simon and B.C.
Johnson. Hypertension and cardiovascular abnormalities in starved-refed
swine. J.Nutrition 82: 173-182, 1964.
- Smith-Vaniz, G.T., A.D. Ashburn, and W.L. Williams. Diet-induced
hypertension and cardiovascular lesions in mice. Yale J. Biol.
Med. 43: 61-69, 1970.
- Tagliaferro, A.R., A.M. Ronan, L.D. Meeker, H.J Thompson,
A.L. Scott and D. Sinha. Cyclic food restriction alters substrate
utilization and abolishes protection from mammary carcinogenesis
in female rats. J. Nutr. 126: 1398-1405, 1996.
- Tang, A.B. Nishimura K.Y., and S.D. Phinney. Preferential
reduction in adipose alphalinolenic acid (18:3n-3) during very
low calorie dieting despite supplementation with 18:3n-3. Lipids
28: 987-93, 1993.
- Technology Assessment Conference Panel. Methods for voluntary
weight loss and control: Technology Assessment Conference Statement.
Ann. Int. Med. 116: 942-949, 1992.
- Uhley, V.E., M.A. Pellizzon, A.M. Buison, F. Guo, Z. Djuric,
and K.-L.C. Jen. Chronic weight cycling increases oxidtive DNA
damage levels in mammary glands of female rats fed a high-fat
diet. Nutr. Cancer 29: 55-59, 1997.
- Wilhelmj, C.M., A.J. Carnazzo, and H.H. McCarthy. Effects
of fasting and realimentation with diets high in carbohydrate
or protein on blood pressur and heart rate of sympathectomized
dogs. Am. J. Physiol. 191: 103-107, 1957.
- Williamson, D.F., E. Pamuk, M. Thun, D. Flancers, T. Byers,
and C. Heath. Prospective study of intentional weight loss and
mortality in never-smoking overweight US white women aged 40-64
years, Am. J. Epidemiol. 141: 1128-1141, 1995.
B. Most overweight / obesity cormorbidities
can be improved / normalized independently of weight loss:
- Improvement in blood pressure, serum lipids/lipoproteins,
glucose tolerance and insulin sensitivity can be achieved independently
of weight loss, thereby suggesting that overweight/obesity are
not the primary underlying causes of these metabolic/ cardiovascular
disorders.
- Overweight/obese men and women who are physically fit
and active have lower death rates than thin men and women who
are unfit and sedentary, indicating that fitness is more important
than thinnes in terms of health and longevity.
- "Fat" and "fit" are not mutually exclusive
terms
- "Metabolically fit" and health bodies come in
all shapes and sizes.
- Appel, L.J., T.J. Moore, E. Obarzanek, et al. A clinical
trial of the effects of dietary patterns on blood pressure. N.
Engl. J. Med. 336: 1117-24, 1997.
- Barlow, C.E., H.W. Kohl, III, L.W. Gibbons, and S.N. Blair.
Physical fitness, mortality and obesity. Int. J. Obes. 19 (Suppl
4): S41-44, 1995.
- Barnard, R.J. Effects of life-style modification on serum
lipids. Arch. Int. Med. 151:1389-1394, 1991.
- Barnard, R.J. and SJ Wen. Exercise and diet in the prevention
and control of the metabolic syndrome. Sports Med 18: 218-228,
1994.
- Barnard, RJ, T Jung, and SB Inkeles. Diet and exercise in
the treatment of NIDDM. The need for early emphasis. Diabetes
Care 17:1469-1472, 1994.
- Barnard, R.J., EJ Ugianskis, D A Martin and SB Inkeles. Role
of diet and exercise in the management of hyperinsulinemia and
associated atherosclerotic risk factors. Am J Cardiol 69:440-444,
1992.
- Blair S.N., H.K. Kohn III, C.E. Barlow, R.S. Paffenbarger,
L.W. Gibbons, and C.A. Macera. Changes in physical fitness and
all-cause mortality. A prospective study and health and unhealthy
men. J.A. M.a. 273: 1093-1098, 1995.
- Blankenhorn, D.H., R.L. Johnson, W.J. Mack, H.A. El Zein,
and L.I. Vailas. The influence of diet on the appearance of new
lesions in human coronary arteries. H.A. MA. 263: 1646-1652,
1990.
- De Lorferll, M., S. Renaud, N Mamelle, et al. Mediterranean
alpha-linolenic acis-rich diet in secondary prevention of coronary
health disease. Lancet 343: 1454-1459, 1994.
- Ehnholm, C., J.K. Huttenen, P. Pietinen, et al. Effect of
diet on serum lipproteins in a population with a high risk of
coronary heart disease. N. Engl. J. Med 307: 850-855, 1982.
- Krotkiewski, M, K Mandroukas, L Sjostrom, L Sullivan, H Wetterqvist
and P Bjorntorp. Effects of long-term physical training on body
fat, metabolism, and blood pressure in obesity. Metabolism 28:
650-658, 1979.
- Lamarche B., J.-P. Despres, M.-C. Pouliot, et al. Is body
fat loss a determinant factor in the improvement of carbohydrate
and lipid metabolism following aerobic exercise training in obese
women? Metabolism 41: 1249-1256, 1992.
- Leserman, J., E.M. Stuart, M.E. Mamish, J.P. Deckro, R.J.
Beckman, R. Friedman, and H. Benson. Nonpharmacologic intervention
for hypertension: long-term follow-up. J. Cardiopulmonary Rehabil.
9: 316-324, 1989.
- Mcginnes, J.M., and W.H. Foege. Actual causes of death in
the United States, J.A.MA. 270: 2207-12, 1993.
- Paffenbarger, R.S., R.T. Hyde, A.L. Wing, I._M Lee, D.L.
Jung, and J.B Kampert. The association of changes in physcial-activity
level and other lifestyle characteristics with mortality among
men. N.Engl. J. Med. 328:538-5454, 1993.
- Tremblay, A., Despres J.-P., Pouliot M.-C, et al. Normalization
of the metabolic profile in obese women by exercise and low fat
diet. Med. Sci. Sports Exerc. 23: 1326-1331, 1991.
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