Tag Archives: statistics

The 1% efficacy rate and weight loss as a prescription

Talk to nearly any person over a size 12 and chances are, they have run into a doctor or medical professional who recommended that their health would improve if they would only lose weight. Whether that person went to a podiatrist for help with their feet or a gyno for a pap smear or an optometrist to get an eye exam, chances are at least one of these medical professionals has stated that the solution for these health woes is that the patient simply lose weight.

Let’s take a look at that prescription for just a moment. Just how likely is it that one of these people is going to lose any kind of significant weight (and keep it off for any period of time)? A recent study, conducted by a team at King’s College suggests that this prescription is pretty unlikely to be successful. For moderately fat people (BMI 30-35) the chances of returning to a “normal weight” (heavy airquotes here) and staying there for a year is one in 124 for women and one in 210 for men. For very fat people (BMI 40-45), the chances drop to 1 in 677 for women and 1 in 1290 for men. The chances for losing only 5% of body fat were greater (one in 10 for women and one in 12 for men) however the majority of these folks gained the weight back within 5 years.

Keep in mind that there is no evidence that this very tiny percentage of people who had lost weight lived any longer or healthier than those who had not lost weight. While there is some correlation of people who have always been thin and certain health benefits, there is virtually no statistical evidence that the microscopically small group of people who manage to maintain a significant amount of weight loss over the long term enjoy any health benefits at all over the people who don’t.

So, can we talk? Can somebody tell me why, exactly, medical professionals are suggesting a “treatment goal” which in the very, very most optimistic scenarios can be achieved by 10 percent of those who try it and on the low end has a less than 1 in 1200 chance of being achieved? And can anybody tell me why we recommend this strategy when there is virtually no evidence that in the rare case it will be achieved it will do any good?

Let’s talk about this in terms of a pill. We tell the patient that they have somewhere between a 10% and a .1% chance of even being able to ingest the pill. And in the long term, so few people are able to keep this pill down long enough to test, that we don’t have really any convincing evidence that the pill does any good at all. The side effects from even trying to take this pill range from frustration to eating disorders to weight gain, to poor nutrition to death. So what on this God’s green earth is the point?

I think it’s time to recognize that weight loss is not a behavior–it’s a condition. And that weight loss as a prescription is probably not worth the paper upon which it is printed.

Love,

Jeanette DePatie AKA The Fat Chick

P.S. Want me to come speak at your school, office, organization or group? Learn more about my speaking at http://www.jeanettedepatie.com.

Is Godzilla Yo-Yo Dieting?

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Japanese fans are up in arms about the new Americanized Godzilla’s hefty size–citing poor diet as cause for the unwelcome change.

The trailers for the newest Godzilla film have hit American shores and has spawned some significant controversy. It appears that Godzilla has come “under fire” not for his acting (which has been notably wooden in the past) but for his BMI. No we are not talking about the Bad Monster Index–where Godzilla holds the undisputed title of King of the Monsters. We are talking about the Body Mass Index. Many are currently arguing that Godzilla is just sporting too much weight on his 350-foot high frame. Using the current BMI, Godzilla could weigh about 750,000 pounds before he hit the dreaded “Obese” category. Godzilla has not been forthcoming about his weight, but many Japanese fans have calculated that the hapless lizard may have stomped out of the “ideal weight” category.

“He’s so fat I laughed,” was one particularly cutting remark found on Japanese forum 2chan. Others have referred to him as “metabozilla”, “marshmallow Godzilla” and even “pudgy and cute”. Some have speculated that Godzilla’s size is due in part to his American diet and sedentary lifestyle. “That’s what happens when all you do is eat Snickers bars,” said one commenter.

Much of this has led to speculation about Godzilla’s diet. He has never been shown on screen eating (although he has ingested a nuclear reactor and seemed to absorb energy from that). He has been seen in comic books eating raw seafood. Most people guess that he lives largely on radiation and sushi.

It seems pretty likely that Godzilla has to eat quite a bit to sustain is 350 foot high body. An African elephant weighs in at about 7,000 pounds and needs to eat about 500 lbs. of plant matter per day to sustain itself. Using that same ratio, Godzilla would need to eat about 50,000 pounds of plant per day. Now the King of Monsters might be able to absorb some of his energy via nuclear radiation. And naturally protein sources like fish are more dense in calories than say, trees. But I ask you, do we really want a creature that needs to eat 10,000 pounds or more of food per day to turn to a protein diet? So far as we know, Godzilla does not eat people, yet. But I don’t know if I want to encourage him.

But Godzilla hasn’t always been svelte. A quick look at his film debut publicity photos in 1954 show a relatively “fluffy” monster with more of a pear-shaped figure.

There is no question that Godzilla has gotten bigger over the years. Traditionally, the giant lizard has grown larger in proportion to the buildings he stomps around. The Godzilla of 1954 was a mere 50 meters tall. The newest Godzilla is over 100 meters tall and noticeably beefier:

But if you look carefully at the creature’s shape, you might notice something very interesting and somewhat familiar. It’s even clearer if you look at this picture here:

Clearly the great monster’s shape has cycled too. He appeared to have shed some pounds in the the MusoGogi period (1964) beefed up considerably in the BioGogi period (1989-91) gone through some sort of radical weight loss program in the Shodaijira period (1998) and bulked back up for his current appearances. Seem familiar to you? Seemed that way to me too. In fact, I think Godzilla is experiencing the most common outcome of trying to stay slim. I think the King of Monsters is weight cycling–probably from yo-yo dieting.

Now there is no way to know for sure. As my good friend Ragen Chastain says, the only thing you can know about a fat person (or monster) by looking at them is your own prejudices about fat people (or giant lizards). But if our good friend Godzilla is experiencing weight cycling, he would certainly be experiencing the same thing that most people who try to lose weight experience. Most people are able to keep some weight off for a while, but the vast majority of folks (90 percent or more) regain the weight they’ve lost and often a little more.

So this leads us to the question of what should be done about Tokyo’s most famous building-stomper. I think if we are seriously going to spill digital ink regarding the size of a fictitious reptile who bangs buses together for fun, we should use this as a truly teachable moment. Let’s talk about what really works in making creatures of all shapes and sizes happier and healthier. I think the first thing we should do, is to stop trying to shame the poor creature. There is ample evidence after all, that shame doesn’t help anybody lose weight. I’m sure the producers at The Biggest Loser are planning epic monster battles between Godzilla and their “Monster Trainers” as we speak. And even though the King of Monsters’ agent is probably taking calls right now from diet companies seeking his endorsement for the new “Monster Weight Loss Formula”, we should probably discourage him from falling into his old habits of dieting and weight cycling.

I recommend the same thing for Godzilla that I recommend for everybody else. He should eat a varied diet including foods that he loves (but not including people). He should engage in joyful and pleasurable physical activities (not too close to major cities). In fact, I think he should try my DVD. He should sleep well. And he should manage his stress (again, hopefully not too close to major metropolitan areas). At 60 years old, Godzilla is showing no signs of slowing. If he follows these simple recommendations, he’s likely to stay happy and healthy for many years to come. Which is good. Because I freakin’ LOVE this guy.

Love,

Jeanette DePatie (AKA The Fat Chick)

CEO: Every BODY Can Exercise.com

What are the odds?

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Hey there! Sorry I haven’t blogged in a few days. I’ve been on the roller coaster and hanging on for dear life. Seems like that’s the way of it, doesn’t it? First you’re on top of the world, and then BOOM, sick in bed with a terrible, nasty, icky head cold.

It’s not like I haven’t taken prophylactic measures. I’ve been taking lots of vitamin C, drinking lots of water, washing my hands raw and all of that good stuff. I’ve been doing my very best to get good sleep and trying my best to manage stress.

Ever since I felt a sniffle, I’ve been rubbing menthol on my feet and sucking a zinc lozenge every few hours and drinking massive quantities of tea.

I’m doing everything that statistics suggest I should to prevent and minimize colds. So why am I still sick?

I got sick because I got sick. No matter how many steps you take, you can stick get sick at any time. Does that mean I shouldn’t have taken those steps to try to minimize my risk and minimize my symptoms? Well no. The steps didn’t have many potentially negative side effects and weren’t too difficult. And they might have worked. And who knows, things might have been worse had I not taken those steps.

But this is the thing about statistics and health. If there’s a 1% chance of getting sick, that means that out of every 100 people, about 1 will get sick. And no matter how many remedies you try, no matter how strong your immune system may be, that one person might be you. And as tempting as it might be to believe you didn’t get sick because of the mouthwash you used, or the special ritual you followed, you might not have gotten sick because of dumb luck.

So as much as we may wish to believe that we are “healthy” because we are virtuous people who eat whole grain cereal and do yoga, I think we need to give at least a passing nod to all the other stuff that goes into it. As Fall Ferguson writes in her post on the ASDAH blog: there are many, many factors that go into whether or not a person is healthy. Doing healthy stuff is just one of those things. So where does this leave us?

We may wish to do stuff that increases our odds of being healthy. How much stuff we are able to do may well be decided by our socioeconomic status or access to good healthcare. How effective those healthy behaviors are may well be decided by our genetic makeup. How much stuff we choose to do is up to each and every one of us. It’s time we give up the notion that being healthy is “virtuous” and being sick is a sign that we are “weak, lazy, undisciplined or unconcerned”. Sometimes we just got sneezed on by the wrong person at the wrong time. There are no guarantees.

So even though I feel tired, and cranky and stuffed up and sneezy and sick, I choose not to bother feeling guilty.

Love,

The Fat Chick

P.S. Still waiting to hear when our Katie Couric episode will air. Will keep you posted! oxoxoxoxox