Tuesday, April 27, 2010

Diet and exercise don't work?

In the Atlantic, Marc Ambinder wrote:Stigma might be more bearable—an unpleasant way station on the path to a thinner, healthier life—if diet and exercise, the most prescribed solutions to obesity, worked. But they don’t. Qualification: if you eat less and exercise more, you’ll lose weight. But the chances that you’ll stick with that regimen are slim, and the chances that you’ll regain the weight, and then some, are quite high. A systematic review of weight-loss programs, by Thomas A. Wadden and Adam Gilden Tsai of the University of Pennsylvania, found that the evidence that commercial and self-help weight-loss programs work is “suboptimal.” People who diet often regain more weight than they lose.

I can think of two counter examples. A friend of mine at work was diagnosed with a heart problem. It was exacerbated by a sedentary lifestyle, and his doctor wanted to immediately put him on drugs. He said, "Wait, wait. Can I solve this with a lifestyle change? Change my diet and exercise?" His doctor replied, "That doesn't work. Statistically, nobody sticks with such regiments." My friend wasn't willing to give up, however, and told the doctor, "Let me try it for a month. If that doesn't work you can put me on drugs." This guy went from zero exercise to biking to work 4-5 days a week, hiking and running with his kids on weekends, and started cutting his portion sizes and eating more greens. A month later, his doctor pronounced him completely fit, and at little risk from his cardiovascular disease. Six months later, he was still going strong, and still biking to work nearly every day. Note that if this same man had lived outside California, he probably wouldn't be able to bike through the entire winter. If he had even lived in San Francisco, his bike probably would have gotten stolen within that time period.

Example two: In 2005, I was diagnosed with osteopenia. My doctor immediately put me on a regiment of calcium and vitamin D supplements, and I embarked on a program of hiking and weight lifting, that I continue to this day (it's been 5 years). My bones are back to normal, even though doctors and others were incredulous at the improvement.

The lesson, perhaps, is that if you're a Google engineer, all these rules of thumb about lifestyle changes not working? They're probably inapplicable to you. The question in my mind is: Is there an easy way to predict what kind of persons do well with this kind of diet/exercise regime, and what kinds of persons don't?
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