Re: CR versus exercise for weight loss

December 31, 2004

Hi Folks:

WARNING: RANT FOLLOWS.

These exercise advocates drive me nuts! I agree that a certain

minimum amount of exercise is *absolutely* essential, and that beyond

that amount further gains will be derived from more exercise, but

with diminishing returns and necessitating increased

(disadvantageous) caloric intake. But take a look at this quote

from the 'study' below - ESPECIALLY the last sentance:

" In the few studies that directly compare the effectiveness

of diet versus exercise as weight loss methods, the influence

of exercise alone compared with diet alone is modest,

with an average reduction of approximately 5 kg for

exercise versus 17.5 kg for diet after 3 months to 1 year

of treatment. It is important to note that the energy

deficit imposed by diet in these studies was far greater than

that imposed by exercise, explaining the reports of greater

weight loss achieved by diet than exercise. "

My answer is: " well ***of course*** the influence of exercise is

smaller than that of diet. It could not be any other way. And

raising the issue as if it is important is ridiculous. "

Compare what the couch potatoes that these types of study are aimed

at, must do to lose one pound of weight a week, either: A) purely

via exercise, or purely by reduced caloric intake.

EXERCISE:

Most of these people have only one way to exercise and that is walk.

If they are lucky they might be able to maintain a speed of three

mph, at which rate they will need to walk about 70 miles to burn off

one pound of weight. So to burn off one pound via exercise in a week

they will need to walk TEN MILES A DAY EVERY DAY OF EACH WEEK.

CALORIC RESTRICTION:

In order to reduce weight by the same one pound in a week via diet

they would need to consume 3500 less calories per week. That is 500

fewer calories per day.

Now please, if there is any soul out there who believes they would

find it easier to walk ten miles a day every day, than to eat 500

calories less a day, please raise your hand and say so.

Over the years, since about age ten, I have been no slouch in the

exercise department. But for me walking ten miles a day (that means

walking non-stop for 3 hours and 20 minutes EVERY day of the week)

would be enormously more difficult/inconvenient than refraining from

stuffing the extra 500 calories down my throat.

And for those who just cannot manage the required caloric restraint,

I would say they do not need a nutritionist, they need a

psychiatrist. We all know that humans are naturally addicted to food

and would much prefer to eat more rather than less. Our ancestors

would not have survived extreme climatic conditions had they not

eaten as much as they could when food was plentiful. But while we

all find it difficult to restrict intake, to ignore the clear

evidence of harm caused to health by over-eating when there is no

prospect there will ever be a food shortage is plain nuts, in my

opinion, hence the need for the psychiatrist.

So for those here, if any, who have so far been unable to resist

swallowing five plates of dessert whenever possible, I suggest 'get a

grip'.

'Studies' like this one seem to me to just pander to the view that no

one should ever be expected to be able to restrict their food

intake. Therefore something else, or someone else, should be found

to blame. Once again, isn't it about time people started to

place 'blame' squarely where it ought to be placed .............

on individual responsibility for one's actions?

Restriction of caloric intake will always be a far greater

contributor to weight loss than exercise, unless you are prepared to

devote fully half of all your spare time to the latter.

Thanks Al, it is good to be kept informed about the latest propaganda

the non-restrictors have dreamed up to evade personal responsibility.

Rodney.

PS: Two rants from me on this issue is taking up more than enough

space here. So I will try to refrain from future tirades on the same

subject. But it would be a lot easier if those who refuse to

restrict would likewise be kind enough to stop making endless excuses.

--- In , " old542000 " <apater@m...>

wrote:

>

> Hi All,

>

> We exercise moderately and CR. However, the

> combination may more extensively reduce weight.

>

> http://tinyurl.com/4axhz data is used to show

> the figure of the prominent effects of reduced

> exercise but unchanged diet on obesity. This

> may appear to downplay the role of diet, but the

> remainder of the article does not reduce the

> importance of a reduced calorie diet.

>

> It should be emphasized that the exercise

> accompanying CR is moderate. This may

> be beneficial in terms of compensating the

> loss of muscle tissue and bone loss.

>

> The pdf is available for the not in Medline below.

>

> ACSM'S HEALTH & FITNESS J, 8 (5) SEPT/OCT 2004 9-14

> Which Is More Effective For Maintaining A Healthy Body

> Weight: Diet or Exercise?

> S. Pescatello, Stella Lucia Volpe, .

>

> Bottom Line

> In the few studies that directly compare the

> effectiveness of diet versus exercise as weight loss

> methods, the influence of exercise alone compared with

> diet alone is modest. However, the energy deficit

> imposed by diet in these studies was far greater than

> that imposed by exercise. Current evidence indicates

> that when diet and exercise are used in combination,

> 30 minutes/day of moderate intensity physical activity

> coupled with caloric (500 to 1,000 kcal/day) and fat

> (less than 30% of total energy intake) restriction are

> sufficient for weight loss and associated health benefits.

> For successful long-term weight loss maintenance,

> even greater amounts of lifestyle physical activity are

> recommended that should be supported by multimodal

> strategies that include the following: 1) community-wide

> campaigns, 2) point-of-contact strategies, 3)

> comprehensive lifestyle modification programs, 4) social

> support interventions in community settings, and

> 5) environmental supports and access combined with

> informational outreach activities.

>

> Learning Objective

> To discuss the merits of diet, exercise, or both for achieving

> and maintaining a healthy body weight.

>

> Key words: Nutrition, Obesity, Physical Activity, Weight

> Loss, Weight Management.

>

> Approximately 97 million people in the United States

> are overweight or obese (1), and the World Health

> Organization has declared obesity a ``global

> epidemic'' (2). The routine recommendations given to

> people who have excess weight are to increase exercise levels

> and reduce energy intake. Yet the millions of Americans

> who try to exercise more and eat less often fail to lose their

> excess weight, and even fewer sustain their original weight

> loss (3). Hence, as a nation, America continues to get

> heavier.

> The purpose of this article is to deliberate the relative

> importance of diet and exercise as strategies for maintaining

> a healthy body weight. We acknowledge that both

> strategies are essential to achieve this goal. Nonetheless, this

> article is formatted as a debate in which the authors take

> the position that diet or exercise makes the more significant

> contribution to the obesity epidemic and its resolution

> via attainment and maintenance of a healthy body weight

> (this information was first presented as a Socratic debate at

> the 2002 Annual Meeting of the New England Chapter

> of ACSM, Providence, RI). Our intent with this format is

> to challenge health and fitness professionals to ``think

> out of the box'' regarding approaches that they can use to

> enable overweight and obese clientele to achieve and

> maintain a healthy body weight. To reinforce this message,

> we will conclude by presenting the recommendations of

> the American Dietetic Association (ADA) (4), ACSM (5),

> and the Institute of Medicine (IOM) (6) for successful

> long-term weight loss maintenance.

> The Diet Perspective

> Obese individuals try many approaches to lose weight,

> including fad diets, exercise machines, and supplements,

> some of which can be harmful. The risks associated with

> fad diets and supplements often outweigh any benefits.

> Thus it is a challenge for nutritionists and exercise

> professionals to help people lose weight and then maintain

> their weight loss, as it is for the many individuals

> attempting to accomplish these goals. The etiology of

> overweight and obesity is multifactorial; however, being

> in a positive energy balance is the underlying cause, and

> the one in which practitioners in the health related

> fields can have significant impact. It is imperative that

> individuals make dietary changes to lose weight or prevent

> weight regain because it is overeating that has made a

> significant contribution to the obesity epidemic.

> Diet and a Healthy Body Weight

> H. Lantz, Ph.D., et al. (7) reported that significant weight

> loss was maintained after a 4-year hypo-energetic diet and

> behavioral program in obese men and women (n = 113).

> The study participants did not have any type of

> obesity-related surgery, were not taking any medications

> for weight loss, and did not participate in a regular exercise

> program. On average, they lost 6 to 8 kg. Further, those

> who completed the 4-year program (n = 55) maintained a

> 3 kg weight loss for 8 years after completion of the program.

> In the Women's Health Trial: Feasibility Study in

> Minority Populations (8), a long-term, low-fat, dietary

> intervention resulted in significant decreases in body weight

> without any major efforts to reduce energy among older

> white, African-American, and Hispanic women. Unlike

> Dr. Lantz et al. (7), these researchers found that major

> alterations in body weight occurred with minor changes

> in diet. Diets of this type are a more practical approach

> for weight loss in free-living populations.

> Diet not only plays a major role in weight loss but also

> positively impacts blood lipids and glucose. S. Ash, Ph.D.,

> et al. (9) determined the efficacy of three different types

> of dietary treatment for weight management and blood

> glucose control in 51 overweight men with type 2 diabetes

> mellitus. Their study was a 12-week intervention that

> included three iso-energetic dietary groups: 1) intermittent

> energy restriction, 2) pre-portioned meals, and 3)

> self-selected meals. Each group had weekly contact with a

> registered dietitian. For all groups, the 12-week dietary

> intervention resulted in a mean decrease in energy intake

> (564 ± 665 kcal/day) and significant declines in body weight

> (6.4 ± 4.6 kg), waist circumference (8.1 ± 4.6 cm),

> percentage body fat (1.9 ± 1.5%), glycosylated hemoglobin

> levels (HbA1c; a measure of long-term glucose control,

> 1.0 ± 1.4%), and triglycerides (0.3 ± 0.6 mmol/L).

> Unfortunately, of the 27 individuals who returned for the

> 18-month follow-up visit, none of these improvements in

> body composition or metabolic health was maintained.

> The authors concluded that an energy intake of

> approximately 1,400 to 1,700 kcal/day was effective in

> attaining a 6% weight loss and improving glucose control

> in men with type 2 diabetes mellitus. Dr. Ash et al. (9)

> proposed ``it was the intensive weekly contact with a

> health professional in combination with moderate energy

> restriction that facilitated the successful short term

> results seen.''

> In summary:

> Obesity has become a ``global epidemic,'' and the

> increased consumption of energy has made a major

> contribution to this epidemic. For example, during

> 1971 through 2000, average energy intake significantly

> increased (P < 0.01) from 2,450 kcal/day to

> 2,618 kcal/day (10).

> If individuals can change their dietary intake slightly by

> decreasing energy intake or fat intake, prevention of

> weight gain or weight loss will be achieved.

> There will be even greater rates of prevention of weight

> gain with diet if some type of behavioral support system

> is made available.

> The Physical Activity Perspective

> Diets are synonymous with restricted energy intake and

> skipped meals to ``voluntarily'' lose weight. Diets are seldom

> voluntary and represent temporary short-term solutions

> to being overweight, so it is not surprising that they have

> failed as an approach to reverse the obesity epidemic. This

> portion of our deliberation presents the physical activity

> perspective because it is the critical component for

> long-term weight loss maintenance. Specifically, the physical

> activity position conveys the significant contribution

> physical inactivity has made to the global obesity epidemic

> and its essential role in achieving and maintaining a healthy

> body weight.

> Adults lose weight when they decrease or reduce energy

> intake and dietary fat content through diet and/or increase

> energy expenditure through physical activity. Paradoxically,

> decreases in caloric and fat intake have occurred along

> side dramatic increases in the prevalence of obesity over the

> past 25 years in the United States (11) and industrialized

> countries worldwide (12). For example, in the United

> Kingdom, the prevalence of obesity increased more than

> 150% between 1980 and 1995, while energy and fat intake

> decreased over this same time period (Figure) (12). The

> occurrence of escalating rates of obesity in the presence

> of reduced energy and fat intake suggests declining energy

> expenditure (as illustrated by the surrogate measures

> of physical inactivity, e.g., television viewing and car

> ownership, in the Figure) is the primary culprit for the

> rising prevalence of overweight and obesity in industrialized

> societies worldwide.

> Physical Activity and a Healthy Body Weight

> More than two thirds of Americans are overweight, and

> not so coincidentally, approximately the same numbers of

> Americans do not exercise regularly. A viable public health

> strategy to thwart the obesity epidemic is to improve the

> health of those with excess weight through increased

> physical activity (1, 3, 4, 13). Physical activity results in

> numerous health benefits with or without weight loss. These

> benefits include less abdominal fat, lower blood pressure, an

> improved blood lipid-lipoprotein profile, enhanced insulin

> action, and protection from cardiovascular and all-cause

> mortality even in the presence of overweight and obesity.

> For these reasons, the ADA (4), ACSM (5), IOM (6),

> and others (13) recommend habitual physical activity as

> primary therapy for those who are overweight because

> of its documented long-term success in achieving and

> maintaining healthier body weights.

> In the few studies that directly compare the effectiveness

> of diet versus exercise as weight loss methods, the influence

> of exercise alone compared with diet alone is modest,

> with an average reduction of approximately 5 kg for

> exercise versus 17.5 kg for diet after 3 months to 1 year

> of treatment (14). It is important to note that the energy

> deficit imposed by diet in these studies was far greater than

> that imposed by exercise, explaining the reports of greater

> weight loss achieved by diet than exercise. R. Ross, Ph.D.,

> and coworkers (14) conducted one of the few controlled

> studies wherein the energy deficits induced by diet and

> exercise were carefully matched in obese, sedentary,

> middle-aged men. The men were randomly assigned to

> one of four groups: control, diet-induced weight loss,

> exercise-induced weight loss (daily walking for 60 minutes

> at 70% of maximal heart rate), and exercise without weight

> loss. The negative energy balance induced by diet and/or

> exercise was matched in the three experimental groups to be

> 700 kcal/day for 3 months. The diet- and exercise-induced

> weight loss groups lost similar amounts of weight (7.5 kg)

> and decreases in abdominal fat. Despite decreases in body

> weight, skeletal muscle was preserved in the exercise-induced

> weight loss group, whereas it was reduced in the

> diet-induced weight loss group. Thus, when the energy

> deficits induced by diet and exercise are comparable as

> they were in the study by Dr. Ross et al. (14), the two

> interventions produce similar weight loss amounts, and

> the composition of the weight loss is healthier when

> induced by exercise rather than diet.

> An important development in the field of exercise

> science has been the realization that the quantity of

> physical activity needed for health benefit is different

> from the amount needed for successful weight loss

> maintenance (4, 5, 6, 13). To better clarify the amount

> of exercise necessary for long-term weight loss,

> Jakicic, Ph.D., FACSM, et al. (15) compared the effects

> of varying durations and intensities of exercise on weight

> loss after 12 months of treatment in overweight and

> obese, sedentary, middle-aged women. Volunteers

> were randomized into one of four groups: vigorous

> intensity/high duration (200 minutes/week);

> moderate intensity/high duration (300 minutes/week);

> moderate intensity/moderate duration (200 minutes/week);

> and vigorous intensity/moderate duration (150 minutes/

> week). The women also were provided with a behavioral

> weight loss intervention consisting of a reduction in energy

> intake to 1,200 to 1,500 kcal/day and fat intake between

> 20% to 30% of total energy intake. All groups lost weight

> ranging from 6.3 to 8.9 kg with no differences between the

> groups. A noteworthy finding was that the women who

> reported exercising more than 200 minutes/week or more

> than 40 minutes/day lost more weight than the women

> who stated that they exercised between 150 and 199

> minutes/week or 30 to 39 minutes/day, 11.6 vs 8.5 kg,

> respectively. These findings indicated that 30 minutes/day

> of moderate intensity physical activity is sufficient for

> weight loss and associated health benefits when caloric

> intake is restricted; however, greater amounts of exercise

> combined with caloric restriction will result in additional

> benefit for those willing and able to do so.

> The work of Dr. Jakicic et al. (15) and others (5)

> indicates that sizeable amounts of daily energy expenditure

> are needed to successfully maintain weight loss, defined

> at losing 10% of initial body weight and maintaining this

> weight loss for a minimum of 1 year. To achieve these

> large amounts of daily energy expenditure, individual and

> population-based strategies must be instituted to foster an

> environment conducive to ample amounts of lifestyle

> physical activity. Such strategies recommended by the

> Task Force on Community Preventive Services (16)

> include the following: 1) community-wide campaigns,

> 2) point-of-contact strategies such as posting signs

> near elevators and escalators encouraging stair use, 3)

> comprehensive behavior modification programs, 4) social

> support interventions in community settings, and 5) creation

> of enhanced access to physical activity sites combined with

> informational outreach activities.

> In summary:

> Physical inactivity has made a significant contribution

> to the obesity epidemic.

> Physical activity is essential for the long-term

> maintenance of a healthy body weight.

> Despite this knowledge, the majority of Americans

> remain overweight because of their sedentary lifestyles, so

> strategies should be instituted to foster an environment

> conducive to ample amounts of lifestyle physical activity.

> Treatment Recommendations

> Individuals will lose weight when they reduce dietary

> energy and fat intake and/or engage in greater amounts

> of lifestyle physical activity. We acknowledge that to

> successfully reverse the obesity epidemic, multimodal

> approaches are necessary that combine diet and exercise

> alterations based upon sound behavioral science theory.

> J.O. Hill, Ph.D., and colleagues (13) recently proposed

> that if energy balance was lowered by 100 kcal/day, weight

> gain in the general population could be averted. They

> suggested that people can simply exercise (e.g., walk)

> 15 minutes more per day (which is approximately 1 mile of

> walking) and/or eat a few less bites at each meal to achieve

> this energy deficit. These recommendations imply having

> simple behavioral targets for the prevention of weight gain

> are key in the treatment of overweight and obesity.

> Despite this optimistic public health solution to reversing

> the obesity epidemic, evidence indicates that on an

> individual basis more intensive, multidimensional

> interventions are required. A multidisciplinary approach

> for successful weight loss management recommends the

> following steps (4, 17):

> 1. Identify a reasonable weight goal.

> 2. Prevent additional weight gain.

> 3. Participate in a program that helps with weight loss

> through healthy eating (as opposed to restrictive dieting)

> and adequate levels of physical activity.

> 4. Learn how to prevent relapses.

> 5. In certain cases, accept an overweight or obese physique

> while still encouraging daily exercise and consumption

> of a healthy diet.

> ACSM (5) also contends that a combination of diet

> and exercise is the key to weight loss and the prevention

> of weight gain. ACSM's recommendations for overweight

> and obese adults are to

> Reduce body weight by 5% to 10% of initial body weight

> with a sustained weight loss of more than 10% of initial

> body weight to maximize long-term health benefits.

> Progressively increase physical activity levels to at least

> 150 minutes (2.5 hours) of moderate intensity physical

> activity per week, and when possible progress to 200 to

> 300 minutes (3.3 to 5 hours) per week or more than

> 2,000 kcal of energy expenditure.

> Reduce current levels of energy intake by 500 to 1,000

> kcal/day combined with a decrease in dietary fat of

> less than 30% of total energy intake. Thereafter, an

> individualized plan of energy intake should be formulated

> in combination with a low fat diet (less than 30% of

> total energy intake) to prevent weight regain.

> Incorporate resistance training into a weight loss program

> to improve strength and function; however, it may not

> significantly prevent the loss of fat-free mass associated

> with a weight loss program.

> Consistent with ACSM recommendations are the

> recent recommendations of the Institute of Medicine that

> advise adults (and children) to engage in 60 minutes of

> moderately intense physical activity daily to maintain

> normal healthy body weight (BMI 18.5 to 25 kg/m2).

> This recommendation includes everything a person does

> beyond sleeping and breathing or all activities that contribute

> to an active lifestyle such as walking the dog and taking

> the stairs versus the elevator or lifestyle physical activity.

> Conclusions

> In summary, the debate on what approach is most successful

> for attainment and maintenance of a healthy body weight

> continues because neither diet nor exercise alone appears to

> be a clear winner in this regard. Current evidence indicates

> that when diet and exercise are used in combination,

> 30 minutes/day of moderate intensity physical activity

> coupled with caloric restriction are sufficient for weight loss.

> For successful long-term weight loss maintenance, even

> greater amounts of lifestyle physical activity are

> recommended that should be supported by multimodal

> strategies that include the following: 1) community-wide

> campaigns, 2) point-of-contact strategies, 3) comprehensive

> lifestyle modification programs, 4) social support

> interventions in community settings, and 5) environmental

> supports and access combined with informational

> outreach activities.

>

> Cheers, Alan Pater

December 31, 2004

Hah! My wife runs marathons and averages 10 miles a day running, and

that's before breakfast!

Chaque un a son gout!

On Fri, 31 Dec 2004 04:35:28 -0000, Rodney <perspect1111@...> wrote:

>

> Hi Folks:

>

> WARNING: RANT FOLLOWS.

>

> These exercise advocates drive me nuts! I agree that a certain

> minimum amount of exercise is *absolutely* essential, and that beyond

> that amount further gains will be derived from more exercise, but

> with diminishing returns and necessitating increased

> (disadvantageous) caloric intake. But take a look at this quote

> from the 'study' below - ESPECIALLY the last sentance:

>

> " In the few studies that directly compare the effectiveness

> of diet versus exercise as weight loss methods, the influence

> of exercise alone compared with diet alone is modest,

> with an average reduction of approximately 5 kg for

> exercise versus 17.5 kg for diet after 3 months to 1 year

> of treatment. It is important to note that the energy

> deficit imposed by diet in these studies was far greater than

> that imposed by exercise, explaining the reports of greater

> weight loss achieved by diet than exercise. "

>

> My answer is: " well ***of course*** the influence of exercise is

> smaller than that of diet. It could not be any other way. And

> raising the issue as if it is important is ridiculous. "

>

> Compare what the couch potatoes that these types of study are aimed

> at, must do to lose one pound of weight a week, either: A) purely

> via exercise, or purely by reduced caloric intake.

>

> EXERCISE:

>

> Most of these people have only one way to exercise and that is walk.

> If they are lucky they might be able to maintain a speed of three

> mph, at which rate they will need to walk about 70 miles to burn off

> one pound of weight. So to burn off one pound via exercise in a week

> they will need to walk TEN MILES A DAY EVERY DAY OF EACH WEEK.

>

> CALORIC RESTRICTION:

>

> In order to reduce weight by the same one pound in a week via diet

> they would need to consume 3500 less calories per week. That is 500

> fewer calories per day.

>

> Now please, if there is any soul out there who believes they would

> find it easier to walk ten miles a day every day, than to eat 500

> calories less a day, please raise your hand and say so.

>

> Over the years, since about age ten, I have been no slouch in the

> exercise department. But for me walking ten miles a day (that means

> walking non-stop for 3 hours and 20 minutes EVERY day of the week)

> would be enormously more difficult/inconvenient than refraining from

> stuffing the extra 500 calories down my throat.

>

> And for those who just cannot manage the required caloric restraint,

> I would say they do not need a nutritionist, they need a

> psychiatrist. We all know that humans are naturally addicted to food

> and would much prefer to eat more rather than less. Our ancestors

> would not have survived extreme climatic conditions had they not

> eaten as much as they could when food was plentiful. But while we

> all find it difficult to restrict intake, to ignore the clear

> evidence of harm caused to health by over-eating when there is no

> prospect there will ever be a food shortage is plain nuts, in my

> opinion, hence the need for the psychiatrist.

>

> So for those here, if any, who have so far been unable to resist

> swallowing five plates of dessert whenever possible, I suggest 'get a

> grip'.

>

> 'Studies' like this one seem to me to just pander to the view that no

> one should ever be expected to be able to restrict their food

> intake. Therefore something else, or someone else, should be found

> to blame. Once again, isn't it about time people started to

> place 'blame' squarely where it ought to be placed .............

> on individual responsibility for one's actions?

>

> Restriction of caloric intake will always be a far greater

> contributor to weight loss than exercise, unless you are prepared to

> devote fully half of all your spare time to the latter.

>

> Thanks Al, it is good to be kept informed about the latest propaganda

> the non-restrictors have dreamed up to evade personal responsibility.

>

> Rodney.

>

> PS: Two rants from me on this issue is taking up more than enough

> space here. So I will try to refrain from future tirades on the same

> subject. But it would be a lot easier if those who refuse to

> restrict would likewise be kind enough to stop making endless excuses.

>

> >

> > Hi All,

> >

> > We exercise moderately and CR. However, the

> > combination may more extensively reduce weight.

> >

> > http://tinyurl.com/4axhz data is used to show

> > the figure of the prominent effects of reduced

> > exercise but unchanged diet on obesity. This

> > may appear to downplay the role of diet, but the

> > remainder of the article does not reduce the

> > importance of a reduced calorie diet.

> >

> > It should be emphasized that the exercise

> > accompanying CR is moderate. This may

> > be beneficial in terms of compensating the

> > loss of muscle tissue and bone loss.

> >

> > The pdf is available for the not in Medline below.

> >

> > ACSM'S HEALTH & FITNESS J, 8 (5) SEPT/OCT 2004 9-14

> > Which Is More Effective For Maintaining A Healthy Body

> > Weight: Diet or Exercise?

> > S. Pescatello, Stella Lucia Volpe, .

> >

> > Bottom Line

> > In the few studies that directly compare the

> > effectiveness of diet versus exercise as weight loss

> > methods, the influence of exercise alone compared with

> > diet alone is modest. However, the energy deficit

> > imposed by diet in these studies was far greater than

> > that imposed by exercise. Current evidence indicates

> > that when diet and exercise are used in combination,

> > 30 minutes/day of moderate intensity physical activity

> > coupled with caloric (500 to 1,000 kcal/day) and fat

> > (less than 30% of total energy intake) restriction are

> > sufficient for weight loss and associated health benefits.

> > For successful long-term weight loss maintenance,

> > even greater amounts of lifestyle physical activity are

> > recommended that should be supported by multimodal

> > strategies that include the following: 1) community-wide

> > campaigns, 2) point-of-contact strategies, 3)

> > comprehensive lifestyle modification programs, 4) social

> > support interventions in community settings, and

> > 5) environmental supports and access combined with

> > informational outreach activities.

> >

> > Learning Objective

> > To discuss the merits of diet, exercise, or both for achieving

> > and maintaining a healthy body weight.

> >

> > Key words: Nutrition, Obesity, Physical Activity, Weight

> > Loss, Weight Management.

> >

> > Approximately 97 million people in the United States

> > are overweight or obese (1), and the World Health

> > Organization has declared obesity a ``global

> > epidemic'' (2). The routine recommendations given to

> > people who have excess weight are to increase exercise levels

> > and reduce energy intake. Yet the millions of Americans

> > who try to exercise more and eat less often fail to lose their

> > excess weight, and even fewer sustain their original weight

> > loss (3). Hence, as a nation, America continues to get

> > heavier.

> > The purpose of this article is to deliberate the relative

> > importance of diet and exercise as strategies for maintaining

> > a healthy body weight. We acknowledge that both

> > strategies are essential to achieve this goal. Nonetheless, this

> > article is formatted as a debate in which the authors take

> > the position that diet or exercise makes the more significant

> > contribution to the obesity epidemic and its resolution

> > via attainment and maintenance of a healthy body weight

> > (this information was first presented as a Socratic debate at

> > the 2002 Annual Meeting of the New England Chapter

> > of ACSM, Providence, RI). Our intent with this format is

> > to challenge health and fitness professionals to ``think

> > out of the box'' regarding approaches that they can use to

> > enable overweight and obese clientele to achieve and

> > maintain a healthy body weight. To reinforce this message,

> > we will conclude by presenting the recommendations of

> > the American Dietetic Association (ADA) (4), ACSM (5),

> > and the Institute of Medicine (IOM) (6) for successful

> > long-term weight loss maintenance.

> > The Diet Perspective

> > Obese individuals try many approaches to lose weight,

> > including fad diets, exercise machines, and supplements,

> > some of which can be harmful. The risks associated with

> > fad diets and supplements often outweigh any benefits.

> > Thus it is a challenge for nutritionists and exercise

> > professionals to help people lose weight and then maintain

> > their weight loss, as it is for the many individuals

> > attempting to accomplish these goals. The etiology of

> > overweight and obesity is multifactorial; however, being

> > in a positive energy balance is the underlying cause, and

> > the one in which practitioners in the health related

> > fields can have significant impact. It is imperative that

> > individuals make dietary changes to lose weight or prevent

> > weight regain because it is overeating that has made a

> > significant contribution to the obesity epidemic.

> > Diet and a Healthy Body Weight

> > H. Lantz, Ph.D., et al. (7) reported that significant weight

> > loss was maintained after a 4-year hypo-energetic diet and

> > behavioral program in obese men and women (n = 113).

> > The study participants did not have any type of

> > obesity-related surgery, were not taking any medications

> > for weight loss, and did not participate in a regular exercise

> > program. On average, they lost 6 to 8 kg. Further, those

> > who completed the 4-year program (n = 55) maintained a

> > 3 kg weight loss for 8 years after completion of the program.

> > In the Women's Health Trial: Feasibility Study in

> > Minority Populations (8), a long-term, low-fat, dietary

> > intervention resulted in significant decreases in body weight

> > without any major efforts to reduce energy among older

> > white, African-American, and Hispanic women. Unlike

> > Dr. Lantz et al. (7), these researchers found that major

> > alterations in body weight occurred with minor changes

> > in diet. Diets of this type are a more practical approach

> > for weight loss in free-living populations.

> > Diet not only plays a major role in weight loss but also

> > positively impacts blood lipids and glucose. S. Ash, Ph.D.,

> > et al. (9) determined the efficacy of three different types

> > of dietary treatment for weight management and blood

> > glucose control in 51 overweight men with type 2 diabetes

> > mellitus. Their study was a 12-week intervention that

> > included three iso-energetic dietary groups: 1) intermittent

> > energy restriction, 2) pre-portioned meals, and 3)

> > self-selected meals. Each group had weekly contact with a

> > registered dietitian. For all groups, the 12-week dietary

> > intervention resulted in a mean decrease in energy intake

> > (564 ± 665 kcal/day) and significant declines in body weight

> > (6.4 ± 4.6 kg), waist circumference (8.1 ± 4.6 cm),

> > percentage body fat (1.9 ± 1.5%), glycosylated hemoglobin

> > levels (HbA1c; a measure of long-term glucose control,

> > 1.0 ± 1.4%), and triglycerides (0.3 ± 0.6 mmol/L).

> > Unfortunately, of the 27 individuals who returned for the

> > 18-month follow-up visit, none of these improvements in

> > body composition or metabolic health was maintained.

> > The authors concluded that an energy intake of

> > approximately 1,400 to 1,700 kcal/day was effective in

> > attaining a 6% weight loss and improving glucose control

> > in men with type 2 diabetes mellitus. Dr. Ash et al. (9)

> > proposed ``it was the intensive weekly contact with a

> > health professional in combination with moderate energy

> > restriction that facilitated the successful short term

> > results seen.''

> > In summary:

> > Obesity has become a ``global epidemic,'' and the

> > increased consumption of energy has made a major

> > contribution to this epidemic. For example, during

> > 1971 through 2000, average energy intake significantly

> > increased (P < 0.01) from 2,450 kcal/day to

> > 2,618 kcal/day (10).

> > If individuals can change their dietary intake slightly by

> > decreasing energy intake or fat intake, prevention of

> > weight gain or weight loss will be achieved.

> > There will be even greater rates of prevention of weight

> > gain with diet if some type of behavioral support system

> > is made available.

> > The Physical Activity Perspective

> > Diets are synonymous with restricted energy intake and

> > skipped meals to ``voluntarily'' lose weight. Diets are seldom

> > voluntary and represent temporary short-term solutions

> > to being overweight, so it is not surprising that they have

> > failed as an approach to reverse the obesity epidemic. This

> > portion of our deliberation presents the physical activity

> > perspective because it is the critical component for

> > long-term weight loss maintenance. Specifically, the physical

> > activity position conveys the significant contribution

> > physical inactivity has made to the global obesity epidemic

> > and its essential role in achieving and maintaining a healthy

> > body weight.

> > Adults lose weight when they decrease or reduce energy

> > intake and dietary fat content through diet and/or increase

> > energy expenditure through physical activity. Paradoxically,

> > decreases in caloric and fat intake have occurred along

> > side dramatic increases in the prevalence of obesity over the

> > past 25 years in the United States (11) and industrialized

> > countries worldwide (12). For example, in the United

> > Kingdom, the prevalence of obesity increased more than

> > 150% between 1980 and 1995, while energy and fat intake

> > decreased over this same time period (Figure) (12). The

> > occurrence of escalating rates of obesity in the presence

> > of reduced energy and fat intake suggests declining energy

> > expenditure (as illustrated by the surrogate measures

> > of physical inactivity, e.g., television viewing and car

> > ownership, in the Figure) is the primary culprit for the

> > rising prevalence of overweight and obesity in industrialized

> > societies worldwide.

> > Physical Activity and a Healthy Body Weight

> > More than two thirds of Americans are overweight, and

> > not so coincidentally, approximately the same numbers of

> > Americans do not exercise regularly. A viable public health

> > strategy to thwart the obesity epidemic is to improve the

> > health of those with excess weight through increased

> > physical activity (1, 3, 4, 13). Physical activity results in

> > numerous health benefits with or without weight loss. These

> > benefits include less abdominal fat, lower blood pressure, an

> > improved blood lipid-lipoprotein profile, enhanced insulin

> > action, and protection from cardiovascular and all-cause

> > mortality even in the presence of overweight and obesity.

> > For these reasons, the ADA (4), ACSM (5), IOM (6),

> > and others (13) recommend habitual physical activity as

> > primary therapy for those who are overweight because

> > of its documented long-term success in achieving and

> > maintaining healthier body weights.

> > In the few studies that directly compare the effectiveness

> > of diet versus exercise as weight loss methods, the influence

> > of exercise alone compared with diet alone is modest,

> > with an average reduction of approximately 5 kg for

> > exercise versus 17.5 kg for diet after 3 months to 1 year

> > of treatment (14). It is important to note that the energy

> > deficit imposed by diet in these studies was far greater than

> > that imposed by exercise, explaining the reports of greater

> > weight loss achieved by diet than exercise. R. Ross, Ph.D.,

> > and coworkers (14) conducted one of the few controlled

> > studies wherein the energy deficits induced by diet and

> > exercise were carefully matched in obese, sedentary,

> > middle-aged men. The men were randomly assigned to

> > one of four groups: control, diet-induced weight loss,

> > exercise-induced weight loss (daily walking for 60 minutes

> > at 70% of maximal heart rate), and exercise without weight

> > loss. The negative energy balance induced by diet and/or

> > exercise was matched in the three experimental groups to be

> > 700 kcal/day for 3 months. The diet- and exercise-induced

> > weight loss groups lost similar amounts of weight (7.5 kg)

> > and decreases in abdominal fat. Despite decreases in body

> > weight, skeletal muscle was preserved in the exercise-induced

> > weight loss group, whereas it was reduced in the

> > diet-induced weight loss group. Thus, when the energy

> > deficits induced by diet and exercise are comparable as

> > they were in the study by Dr. Ross et al. (14), the two

> > interventions produce similar weight loss amounts, and

> > the composition of the weight loss is healthier when

> > induced by exercise rather than diet.

> > An important development in the field of exercise

> > science has been the realization that the quantity of

> > physical activity needed for health benefit is different

> > from the amount needed for successful weight loss

> > maintenance (4, 5, 6, 13). To better clarify the amount

> > of exercise necessary for long-term weight loss,

> > Jakicic, Ph.D., FACSM, et al. (15) compared the effects

> > of varying durations and intensities of exercise on weight

> > loss after 12 months of treatment in overweight and

> > obese, sedentary, middle-aged women. Volunteers

> > were randomized into one of four groups: vigorous

> > intensity/high duration (200 minutes/week);

> > moderate intensity/high duration (300 minutes/week);

> > moderate intensity/moderate duration (200 minutes/week);

> > and vigorous intensity/moderate duration (150 minutes/

> > week). The women also were provided with a behavioral

> > weight loss intervention consisting of a reduction in energy

> > intake to 1,200 to 1,500 kcal/day and fat intake between

> > 20% to 30% of total energy intake. All groups lost weight

> > ranging from 6.3 to 8.9 kg with no differences between the

> > groups. A noteworthy finding was that the women who

> > reported exercising more than 200 minutes/week or more

> > than 40 minutes/day lost more weight than the women

> > who stated that they exercised between 150 and 199

> > minutes/week or 30 to 39 minutes/day, 11.6 vs 8.5 kg,

> > respectively. These findings indicated that 30 minutes/day

> > of moderate intensity physical activity is sufficient for

> > weight loss and associated health benefits when caloric

> > intake is restricted; however, greater amounts of exercise

> > combined with caloric restriction will result in additional

> > benefit for those willing and able to do so.

> > The work of Dr. Jakicic et al. (15) and others (5)

> > indicates that sizeable amounts of daily energy expenditure

> > are needed to successfully maintain weight loss, defined

> > at losing 10% of initial body weight and maintaining this

> > weight loss for a minimum of 1 year. To achieve these

> > large amounts of daily energy expenditure, individual and

> > population-based strategies must be instituted to foster an

> > environment conducive to ample amounts of lifestyle

> > physical activity. Such strategies recommended by the

> > Task Force on Community Preventive Services (16)

> > include the following: 1) community-wide campaigns,

> > 2) point-of-contact strategies such as posting signs

> > near elevators and escalators encouraging stair use, 3)

> > comprehensive behavior modification programs, 4) social

> > support interventions in community settings, and 5) creation

> > of enhanced access to physical activity sites combined with

> > informational outreach activities.

> > In summary:

> > Physical inactivity has made a significant contribution

> > to the obesity epidemic.

> > Physical activity is essential for the long-term

> > maintenance of a healthy body weight.

> > Despite this knowledge, the majority of Americans

> > remain overweight because of their sedentary lifestyles, so

> > strategies should be instituted to foster an environment

> > conducive to ample amounts of lifestyle physical activity.

> > Treatment Recommendations

> > Individuals will lose weight when they reduce dietary

> > energy and fat intake and/or engage in greater amounts

> > of lifestyle physical activity. We acknowledge that to

> > successfully reverse the obesity epidemic, multimodal

> > approaches are necessary that combine diet and exercise

> > alterations based upon sound behavioral science theory.

> > J.O. Hill, Ph.D., and colleagues (13) recently proposed

> > that if energy balance was lowered by 100 kcal/day, weight

> > gain in the general population could be averted. They

> > suggested that people can simply exercise (e.g., walk)

> > 15 minutes more per day (which is approximately 1 mile of

> > walking) and/or eat a few less bites at each meal to achieve

> > this energy deficit. These recommendations imply having

> > simple behavioral targets for the prevention of weight gain

> > are key in the treatment of overweight and obesity.

> > Despite this optimistic public health solution to reversing

> > the obesity epidemic, evidence indicates that on an

> > individual basis more intensive, multidimensional

> > interventions are required. A multidisciplinary approach

> > for successful weight loss management recommends the

> > following steps (4, 17):

> > 1. Identify a reasonable weight goal.

> > 2. Prevent additional weight gain.

> > 3. Participate in a program that helps with weight loss

> > through healthy eating (as opposed to restrictive dieting)

> > and adequate levels of physical activity.

> > 4. Learn how to prevent relapses.

> > 5. In certain cases, accept an overweight or obese physique

> > while still encouraging daily exercise and consumption

> > of a healthy diet.

> > ACSM (5) also contends that a combination of diet

> > and exercise is the key to weight loss and the prevention

> > of weight gain. ACSM's recommendations for overweight

> > and obese adults are to

> > Reduce body weight by 5% to 10% of initial body weight

> > with a sustained weight loss of more than 10% of initial

> > body weight to maximize long-term health benefits.

> > Progressively increase physical activity levels to at least

> > 150 minutes (2.5 hours) of moderate intensity physical

> > activity per week, and when possible progress to 200 to

> > 300 minutes (3.3 to 5 hours) per week or more than

> > 2,000 kcal of energy expenditure.

> > Reduce current levels of energy intake by 500 to 1,000

> > kcal/day combined with a decrease in dietary fat of

> > less than 30% of total energy intake. Thereafter, an

> > individualized plan of energy intake should be formulated

> > in combination with a low fat diet (less than 30% of

> > total energy intake) to prevent weight regain.

> > Incorporate resistance training into a weight loss program

> > to improve strength and function; however, it may not

> > significantly prevent the loss of fat-free mass associated

> > with a weight loss program.

> > Consistent with ACSM recommendations are the

> > recent recommendations of the Institute of Medicine that

> > advise adults (and children) to engage in 60 minutes of

> > moderately intense physical activity daily to maintain

> > normal healthy body weight (BMI 18.5 to 25 kg/m2).

> > This recommendation includes everything a person does

> > beyond sleeping and breathing or all activities that contribute

> > to an active lifestyle such as walking the dog and taking

> > the stairs versus the elevator or lifestyle physical activity.

> > Conclusions

> > In summary, the debate on what approach is most successful

> > for attainment and maintenance of a healthy body weight

> > continues because neither diet nor exercise alone appears to

> > be a clear winner in this regard. Current evidence indicates

> > that when diet and exercise are used in combination,

> > 30 minutes/day of moderate intensity physical activity

> > coupled with caloric restriction are sufficient for weight loss.

> > For successful long-term weight loss maintenance, even

> > greater amounts of lifestyle physical activity are

> > recommended that should be supported by multimodal

> > strategies that include the following: 1) community-wide

> > campaigns, 2) point-of-contact strategies, 3) comprehensive

> > lifestyle modification programs, 4) social support

> > interventions in community settings, and 5) environmental

> > supports and access combined with informational

> > outreach activities.

> >

> > Cheers, Alan Pater

>

December 31, 2004

Bad French, sorry (should be Chaqu'un a son gout), je croix.

On Fri, 31 Dec 2004 09:25:43 -0500, Dowling

<christopher.a.dowling@...> wrote:

> Hah! My wife runs marathons and averages 10 miles a day running, and

> that's before breakfast!

>

> Chaque un a son gout!

>

> On Fri, 31 Dec 2004 04:35:28 -0000, Rodney <perspect1111@...> wrote:

> >

> > Hi Folks:

> >

> > WARNING: RANT FOLLOWS.

> >

> > These exercise advocates drive me nuts! I agree that a certain

> > minimum amount of exercise is *absolutely* essential, and that beyond

> > that amount further gains will be derived from more exercise, but

> > with diminishing returns and necessitating increased

> > (disadvantageous) caloric intake. But take a look at this quote

> > from the 'study' below - ESPECIALLY the last sentance:

> >

> > " In the few studies that directly compare the effectiveness

> > of diet versus exercise as weight loss methods, the influence

> > of exercise alone compared with diet alone is modest,

> > with an average reduction of approximately 5 kg for

> > exercise versus 17.5 kg for diet after 3 months to 1 year

> > of treatment. It is important to note that the energy

> > deficit imposed by diet in these studies was far greater than

> > that imposed by exercise, explaining the reports of greater

> > weight loss achieved by diet than exercise. "

> >

> > My answer is: " well ***of course*** the influence of exercise is

> > smaller than that of diet. It could not be any other way. And

> > raising the issue as if it is important is ridiculous. "

> >

> > Compare what the couch potatoes that these types of study are aimed

> > at, must do to lose one pound of weight a week, either: A) purely

> > via exercise, or purely by reduced caloric intake.

> >

> > EXERCISE:

> >

> > Most of these people have only one way to exercise and that is walk.

> > If they are lucky they might be able to maintain a speed of three

> > mph, at which rate they will need to walk about 70 miles to burn off

> > one pound of weight. So to burn off one pound via exercise in a week

> > they will need to walk TEN MILES A DAY EVERY DAY OF EACH WEEK.

> >

> > CALORIC RESTRICTION:

> >

> > In order to reduce weight by the same one pound in a week via diet

> > they would need to consume 3500 less calories per week. That is 500

> > fewer calories per day.

> >

> > Now please, if there is any soul out there who believes they would

> > find it easier to walk ten miles a day every day, than to eat 500

> > calories less a day, please raise your hand and say so.

> >

> > Over the years, since about age ten, I have been no slouch in the

> > exercise department. But for me walking ten miles a day (that means

> > walking non-stop for 3 hours and 20 minutes EVERY day of the week)

> > would be enormously more difficult/inconvenient than refraining from

> > stuffing the extra 500 calories down my throat.

> >

> > And for those who just cannot manage the required caloric restraint,

> > I would say they do not need a nutritionist, they need a

> > psychiatrist. We all know that humans are naturally addicted to food

> > and would much prefer to eat more rather than less. Our ancestors

> > would not have survived extreme climatic conditions had they not

> > eaten as much as they could when food was plentiful. But while we

> > all find it difficult to restrict intake, to ignore the clear

> > evidence of harm caused to health by over-eating when there is no

> > prospect there will ever be a food shortage is plain nuts, in my

> > opinion, hence the need for the psychiatrist.

> >

> > So for those here, if any, who have so far been unable to resist

> > swallowing five plates of dessert whenever possible, I suggest 'get a

> > grip'.

> >

> > 'Studies' like this one seem to me to just pander to the view that no

> > one should ever be expected to be able to restrict their food

> > intake. Therefore something else, or someone else, should be found

> > to blame. Once again, isn't it about time people started to

> > place 'blame' squarely where it ought to be placed .............

> > on individual responsibility for one's actions?

> >

> > Restriction of caloric intake will always be a far greater

> > contributor to weight loss than exercise, unless you are prepared to

> > devote fully half of all your spare time to the latter.

> >

> > Thanks Al, it is good to be kept informed about the latest propaganda

> > the non-restrictors have dreamed up to evade personal responsibility.

> >

> > Rodney.

> >

> > PS: Two rants from me on this issue is taking up more than enough

> > space here. So I will try to refrain from future tirades on the same

> > subject. But it would be a lot easier if those who refuse to

> > restrict would likewise be kind enough to stop making endless excuses.

> >

> > >

> > > Hi All,

> > >

> > > We exercise moderately and CR. However, the

> > > combination may more extensively reduce weight.

> > >

> > > http://tinyurl.com/4axhz data is used to show

> > > the figure of the prominent effects of reduced

> > > exercise but unchanged diet on obesity. This

> > > may appear to downplay the role of diet, but the

> > > remainder of the article does not reduce the

> > > importance of a reduced calorie diet.

> > >

> > > It should be emphasized that the exercise

> > > accompanying CR is moderate. This may

> > > be beneficial in terms of compensating the

> > > loss of muscle tissue and bone loss.

> > >

> > > The pdf is available for the not in Medline below.

> > >

> > > ACSM'S HEALTH & FITNESS J, 8 (5) SEPT/OCT 2004 9-14

> > > Which Is More Effective For Maintaining A Healthy Body

> > > Weight: Diet or Exercise?

> > > S. Pescatello, Stella Lucia Volpe, .

> > >

> > > Bottom Line

> > > In the few studies that directly compare the

> > > effectiveness of diet versus exercise as weight loss

> > > methods, the influence of exercise alone compared with

> > > diet alone is modest. However, the energy deficit

> > > imposed by diet in these studies was far greater than

> > > that imposed by exercise. Current evidence indicates

> > > that when diet and exercise are used in combination,

> > > 30 minutes/day of moderate intensity physical activity

> > > coupled with caloric (500 to 1,000 kcal/day) and fat

> > > (less than 30% of total energy intake) restriction are

> > > sufficient for weight loss and associated health benefits.

> > > For successful long-term weight loss maintenance,

> > > even greater amounts of lifestyle physical activity are

> > > recommended that should be supported by multimodal

> > > strategies that include the following: 1) community-wide

> > > campaigns, 2) point-of-contact strategies, 3)

> > > comprehensive lifestyle modification programs, 4) social

> > > support interventions in community settings, and

> > > 5) environmental supports and access combined with

> > > informational outreach activities.

> > >

> > > Learning Objective

> > > To discuss the merits of diet, exercise, or both for achieving

> > > and maintaining a healthy body weight.

> > >

> > > Key words: Nutrition, Obesity, Physical Activity, Weight

> > > Loss, Weight Management.

> > >

> > > Approximately 97 million people in the United States

> > > are overweight or obese (1), and the World Health

> > > Organization has declared obesity a ``global

> > > epidemic'' (2). The routine recommendations given to

> > > people who have excess weight are to increase exercise levels

> > > and reduce energy intake. Yet the millions of Americans

> > > who try to exercise more and eat less often fail to lose their

> > > excess weight, and even fewer sustain their original weight

> > > loss (3). Hence, as a nation, America continues to get

> > > heavier.

> > > The purpose of this article is to deliberate the relative

> > > importance of diet and exercise as strategies for maintaining

> > > a healthy body weight. We acknowledge that both

> > > strategies are essential to achieve this goal. Nonetheless, this

> > > article is formatted as a debate in which the authors take

> > > the position that diet or exercise makes the more significant

> > > contribution to the obesity epidemic and its resolution

> > > via attainment and maintenance of a healthy body weight

> > > (this information was first presented as a Socratic debate at

> > > the 2002 Annual Meeting of the New England Chapter

> > > of ACSM, Providence, RI). Our intent with this format is

> > > to challenge health and fitness professionals to ``think

> > > out of the box'' regarding approaches that they can use to

> > > enable overweight and obese clientele to achieve and

> > > maintain a healthy body weight. To reinforce this message,

> > > we will conclude by presenting the recommendations of

> > > the American Dietetic Association (ADA) (4), ACSM (5),

> > > and the Institute of Medicine (IOM) (6) for successful

> > > long-term weight loss maintenance.

> > > The Diet Perspective

> > > Obese individuals try many approaches to lose weight,

> > > including fad diets, exercise machines, and supplements,

> > > some of which can be harmful. The risks associated with

> > > fad diets and supplements often outweigh any benefits.

> > > Thus it is a challenge for nutritionists and exercise

> > > professionals to help people lose weight and then maintain

> > > their weight loss, as it is for the many individuals

> > > attempting to accomplish these goals. The etiology of

> > > overweight and obesity is multifactorial; however, being

> > > in a positive energy balance is the underlying cause, and

> > > the one in which practitioners in the health related

> > > fields can have significant impact. It is imperative that

> > > individuals make dietary changes to lose weight or prevent

> > > weight regain because it is overeating that has made a

> > > significant contribution to the obesity epidemic.

> > > Diet and a Healthy Body Weight

> > > H. Lantz, Ph.D., et al. (7) reported that significant weight

> > > loss was maintained after a 4-year hypo-energetic diet and

> > > behavioral program in obese men and women (n = 113).

> > > The study participants did not have any type of

> > > obesity-related surgery, were not taking any medications

> > > for weight loss, and did not participate in a regular exercise

> > > program. On average, they lost 6 to 8 kg. Further, those

> > > who completed the 4-year program (n = 55) maintained a

> > > 3 kg weight loss for 8 years after completion of the program.

> > > In the Women's Health Trial: Feasibility Study in

> > > Minority Populations (8), a long-term, low-fat, dietary

> > > intervention resulted in significant decreases in body weight

> > > without any major efforts to reduce energy among older

> > > white, African-American, and Hispanic women. Unlike

> > > Dr. Lantz et al. (7), these researchers found that major

> > > alterations in body weight occurred with minor changes

> > > in diet. Diets of this type are a more practical approach

> > > for weight loss in free-living populations.

> > > Diet not only plays a major role in weight loss but also

> > > positively impacts blood lipids and glucose. S. Ash, Ph.D.,

> > > et al. (9) determined the efficacy of three different types

> > > of dietary treatment for weight management and blood

> > > glucose control in 51 overweight men with type 2 diabetes

> > > mellitus. Their study was a 12-week intervention that

> > > included three iso-energetic dietary groups: 1) intermittent

> > > energy restriction, 2) pre-portioned meals, and 3)

> > > self-selected meals. Each group had weekly contact with a

> > > registered dietitian. For all groups, the 12-week dietary

> > > intervention resulted in a mean decrease in energy intake

> > > (564 ± 665 kcal/day) and significant declines in body weight

> > > (6.4 ± 4.6 kg), waist circumference (8.1 ± 4.6 cm),

> > > percentage body fat (1.9 ± 1.5%), glycosylated hemoglobin

> > > levels (HbA1c; a measure of long-term glucose control,

> > > 1.0 ± 1.4%), and triglycerides (0.3 ± 0.6 mmol/L).

> > > Unfortunately, of the 27 individuals who returned for the

> > > 18-month follow-up visit, none of these improvements in

> > > body composition or metabolic health was maintained.

> > > The authors concluded that an energy intake of

> > > approximately 1,400 to 1,700 kcal/day was effective in

> > > attaining a 6% weight loss and improving glucose control

> > > in men with type 2 diabetes mellitus. Dr. Ash et al. (9)

> > > proposed ``it was the intensive weekly contact with a

> > > health professional in combination with moderate energy

> > > restriction that facilitated the successful short term

> > > results seen.''

> > > In summary:

> > > Obesity has become a ``global epidemic,'' and the

> > > increased consumption of energy has made a major

> > > contribution to this epidemic. For example, during

> > > 1971 through 2000, average energy intake significantly

> > > increased (P < 0.01) from 2,450 kcal/day to

> > > 2,618 kcal/day (10).

> > > If individuals can change their dietary intake slightly by

> > > decreasing energy intake or fat intake, prevention of

> > > weight gain or weight loss will be achieved.

> > > There will be even greater rates of prevention of weight

> > > gain with diet if some type of behavioral support system

> > > is made available.

> > > The Physical Activity Perspective

> > > Diets are synonymous with restricted energy intake and

> > > skipped meals to ``voluntarily'' lose weight. Diets are seldom

> > > voluntary and represent temporary short-term solutions

> > > to being overweight, so it is not surprising that they have

> > > failed as an approach to reverse the obesity epidemic. This

> > > portion of our deliberation presents the physical activity

> > > perspective because it is the critical component for

> > > long-term weight loss maintenance. Specifically, the physical

> > > activity position conveys the significant contribution

> > > physical inactivity has made to the global obesity epidemic

> > > and its essential role in achieving and maintaining a healthy

> > > body weight.

> > > Adults lose weight when they decrease or reduce energy

> > > intake and dietary fat content through diet and/or increase

> > > energy expenditure through physical activity. Paradoxically,

> > > decreases in caloric and fat intake have occurred along

> > > side dramatic increases in the prevalence of obesity over the

> > > past 25 years in the United States (11) and industrialized

> > > countries worldwide (12). For example, in the United

> > > Kingdom, the prevalence of obesity increased more than

> > > 150% between 1980 and 1995, while energy and fat intake

> > > decreased over this same time period (Figure) (12). The

> > > occurrence of escalating rates of obesity in the presence

> > > of reduced energy and fat intake suggests declining energy

> > > expenditure (as illustrated by the surrogate measures

> > > of physical inactivity, e.g., television viewing and car

> > > ownership, in the Figure) is the primary culprit for the

> > > rising prevalence of overweight and obesity in industrialized

> > > societies worldwide.

> > > Physical Activity and a Healthy Body Weight

> > > More than two thirds of Americans are overweight, and

> > > not so coincidentally, approximately the same numbers of

> > > Americans do not exercise regularly. A viable public health

> > > strategy to thwart the obesity epidemic is to improve the

> > > health of those with excess weight through increased

> > > physical activity (1, 3, 4, 13). Physical activity results in

> > > numerous health benefits with or without weight loss. These

> > > benefits include less abdominal fat, lower blood pressure, an

> > > improved blood lipid-lipoprotein profile, enhanced insulin

> > > action, and protection from cardiovascular and all-cause

> > > mortality even in the presence of overweight and obesity.

> > > For these reasons, the ADA (4), ACSM (5), IOM (6),

> > > and others (13) recommend habitual physical activity as

> > > primary therapy for those who are overweight because

> > > of its documented long-term success in achieving and

> > > maintaining healthier body weights.

> > > In the few studies that directly compare the effectiveness

> > > of diet versus exercise as weight loss methods, the influence

> > > of exercise alone compared with diet alone is modest,

> > > with an average reduction of approximately 5 kg for

> > > exercise versus 17.5 kg for diet after 3 months to 1 year

> > > of treatment (14). It is important to note that the energy

> > > deficit imposed by diet in these studies was far greater than

> > > that imposed by exercise, explaining the reports of greater

> > > weight loss achieved by diet than exercise. R. Ross, Ph.D.,

> > > and coworkers (14) conducted one of the few controlled

> > > studies wherein the energy deficits induced by diet and

> > > exercise were carefully matched in obese, sedentary,

> > > middle-aged men. The men were randomly assigned to

> > > one of four groups: control, diet-induced weight loss,

> > > exercise-induced weight loss (daily walking for 60 minutes

> > > at 70% of maximal heart rate), and exercise without weight

> > > loss. The negative energy balance induced by diet and/or

> > > exercise was matched in the three experimental groups to be

> > > 700 kcal/day for 3 months. The diet- and exercise-induced

> > > weight loss groups lost similar amounts of weight (7.5 kg)

> > > and decreases in abdominal fat. Despite decreases in body

> > > weight, skeletal muscle was preserved in the exercise-induced

> > > weight loss group, whereas it was reduced in the

> > > diet-induced weight loss group. Thus, when the energy

> > > deficits induced by diet and exercise are comparable as

> > > they were in the study by Dr. Ross et al. (14), the two

> > > interventions produce similar weight loss amounts, and

> > > the composition of the weight loss is healthier when

> > > induced by exercise rather than diet.

> > > An important development in the field of exercise

> > > science has been the realization that the quantity of

> > > physical activity needed for health benefit is different

> > > from the amount needed for successful weight loss

> > > maintenance (4, 5, 6, 13). To better clarify the amount

> > > of exercise necessary for long-term weight loss,

> > > Jakicic, Ph.D., FACSM, et al. (15) compared the effects

> > > of varying durations and intensities of exercise on weight

> > > loss after 12 months of treatment in overweight and

> > > obese, sedentary, middle-aged women. Volunteers

> > > were randomized into one of four groups: vigorous

> > > intensity/high duration (200 minutes/week);

> > > moderate intensity/high duration (300 minutes/week);

> > > moderate intensity/moderate duration (200 minutes/week);

> > > and vigorous intensity/moderate duration (150 minutes/

> > > week). The women also were provided with a behavioral

> > > weight loss intervention consisting of a reduction in energy

> > > intake to 1,200 to 1,500 kcal/day and fat intake between

> > > 20% to 30% of total energy intake. All groups lost weight

> > > ranging from 6.3 to 8.9 kg with no differences between the

> > > groups. A noteworthy finding was that the women who

> > > reported exercising more than 200 minutes/week or more

> > > than 40 minutes/day lost more weight than the women

> > > who stated that they exercised between 150 and 199

> > > minutes/week or 30 to 39 minutes/day, 11.6 vs 8.5 kg,

> > > respectively. These findings indicated that 30 minutes/day

> > > of moderate intensity physical activity is sufficient for

> > > weight loss and associated health benefits when caloric

> > > intake is restricted; however, greater amounts of exercise

> > > combined with caloric restriction will result in additional

> > > benefit for those willing and able to do so.

> > > The work of Dr. Jakicic et al. (15) and others (5)

> > > indicates that sizeable amounts of daily energy expenditure

> > > are needed to successfully maintain weight loss, defined

> > > at losing 10% of initial body weight and maintaining this

> > > weight loss for a minimum of 1 year. To achieve these

> > > large amounts of daily energy expenditure, individual and

> > > population-based strategies must be instituted to foster an

> > > environment conducive to ample amounts of lifestyle

> > > physical activity. Such strategies recommended by the

> > > Task Force on Community Preventive Services (16)

> > > include the following: 1) community-wide campaigns,

> > > 2) point-of-contact strategies such as posting signs

> > > near elevators and escalators encouraging stair use, 3)

> > > comprehensive behavior modification programs, 4) social

> > > support interventions in community settings, and 5) creation

> > > of enhanced access to physical activity sites combined with

> > > informational outreach activities.

> > > In summary:

> > > Physical inactivity has made a significant contribution

> > > to the obesity epidemic.

> > > Physical activity is essential for the long-term

> > > maintenance of a healthy body weight.

> > > Despite this knowledge, the majority of Americans

> > > remain overweight because of their sedentary lifestyles, so

> > > strategies should be instituted to foster an environment

> > > conducive to ample amounts of lifestyle physical activity.

> > > Treatment Recommendations

> > > Individuals will lose weight when they reduce dietary

> > > energy and fat intake and/or engage in greater amounts

> > > of lifestyle physical activity. We acknowledge that to

> > > successfully reverse the obesity epidemic, multimodal

> > > approaches are necessary that combine diet and exercise

> > > alterations based upon sound behavioral science theory.

> > > J.O. Hill, Ph.D., and colleagues (13) recently proposed

> > > that if energy balance was lowered by 100 kcal/day, weight

> > > gain in the general population could be averted. They

> > > suggested that people can simply exercise (e.g., walk)

> > > 15 minutes more per day (which is approximately 1 mile of

> > > walking) and/or eat a few less bites at each meal to achieve

> > > this energy deficit. These recommendations imply having

> > > simple behavioral targets for the prevention of weight gain

> > > are key in the treatment of overweight and obesity.

> > > Despite this optimistic public health solution to reversing

> > > the obesity epidemic, evidence indicates that on an

> > > individual basis more intensive, multidimensional

> > > interventions are required. A multidisciplinary approach

> > > for successful weight loss management recommends the

> > > following steps (4, 17):

> > > 1. Identify a reasonable weight goal.

> > > 2. Prevent additional weight gain.

> > > 3. Participate in a program that helps with weight loss

> > > through healthy eating (as opposed to restrictive dieting)

> > > and adequate levels of physical activity.

> > > 4. Learn how to prevent relapses.

> > > 5. In certain cases, accept an overweight or obese physique

> > > while still encouraging daily exercise and consumption

> > > of a healthy diet.

> > > ACSM (5) also contends that a combination of diet

> > > and exercise is the key to weight loss and the prevention

> > > of weight gain. ACSM's recommendations for overweight

> > > and obese adults are to

> > > Reduce body weight by 5% to 10% of initial body weight

> > > with a sustained weight loss of more than 10% of initial

> > > body weight to maximize long-term health benefits.

> > > Progressively increase physical activity levels to at least

> > > 150 minutes (2.5 hours) of moderate intensity physical

> > > activity per week, and when possible progress to 200 to

> > > 300 minutes (3.3 to 5 hours) per week or more than

> > > 2,000 kcal of energy expenditure.

> > > Reduce current levels of energy intake by 500 to 1,000

> > > kcal/day combined with a decrease in dietary fat of

> > > less than 30% of total energy intake. Thereafter, an

> > > individualized plan of energy intake should be formulated

> > > in combination with a low fat diet (less than 30% of

> > > total energy intake) to prevent weight regain.

> > > Incorporate resistance training into a weight loss program

> > > to improve strength and function; however, it may not

> > > significantly prevent the loss of fat-free mass associated

> > > with a weight loss program.

> > > Consistent with ACSM recommendations are the

> > > recent recommendations of the Institute of Medicine that

> > > advise adults (and children) to engage in 60 minutes of

> > > moderately intense physical activity daily to maintain

> > > normal healthy body weight (BMI 18.5 to 25 kg/m2).

> > > This recommendation includes everything a person does

> > > beyond sleeping and breathing or all activities that contribute

> > > to an active lifestyle such as walking the dog and taking

> > > the stairs versus the elevator or lifestyle physical activity.

> > > Conclusions

> > > In summary, the debate on what approach is most successful

> > > for attainment and maintenance of a healthy body weight

> > > continues because neither diet nor exercise alone appears to

> > > be a clear winner in this regard. Current evidence indicates

> > > that when diet and exercise are used in combination,

> > > 30 minutes/day of moderate intensity physical activity

> > > coupled with caloric restriction are sufficient for weight loss.

> > > For successful long-term weight loss maintenance, even

> > > greater amounts of lifestyle physical activity are

> > > recommended that should be supported by multimodal

> > > strategies that include the following: 1) community-wide

> > > campaigns, 2) point-of-contact strategies, 3) comprehensive

> > > lifestyle modification programs, 4) social support

> > > interventions in community settings, and 5) environmental

> > > supports and access combined with informational

> > > outreach activities.

> > >

> > > Cheers, Alan Pater

> >

December 31, 2004

Hi :

Thank you for that vote on behalf of your wife. (Very) good for her.

So, so far we have one out of six billion who prefer the ten miles of

exercise daily. Let's see how many others we can find ; ^ )))