Tuesday, 10 November 2009

The Hospital

The last post enclosed this quote:
  • Anyone who caught Channel 4’s ‘The Hospital’ will probably never eat carbohydrates again. At one point, the lead doctor in the show – who spends his days fixing gastric bands to supersized patients - belted out an inspired tirade against ‘beige’ foods; crisps, potatoes and bread among other things.
I went in search of the actual program which you can see here. It is quite funny that despite a room full of experts (doctors, surgeons, nutritionists), meeting streams of people who are fat despite dieting and pursuing lots of exercise, they still think it is "calories in vs calories out" and a lack of self discipline that is the problem.

The quote about beige kicks in at 12'30" but even this doctor responsible for this incisive comment seems to believe you can simply restrict calories or increase calories out to lose fat. Hmmm - can these guys prove this approach works? Are they sure that reducing 'calories in' in a complex biological organism will NOT cause a compensatory and involuntary reduction in calories out?

It does sound controversial that a fat person is, at a cellular level, in calorific balance, but they are. If you can't access your fat stores then you can be fat and starving. Starving people will eat. Hunger is a powerful driver. From an evolutionary perspective those that did not respond to this signal died. Simple as.

At 23' comes a really nasty part where the 'experts' just CANNOT believe that at least one of the patients is lying about her diet and exercise (they are accused of lying by the narrator). The whole thing is pushed largely in to the realm of psychology.

Where exercise is found to work there is no conclusion drawn beyond the idea that calories out were increased and so burned off the fat. Such an explanation ignores the consequence of exercise on insulin sensitivity....

The broad advice is to follow our old friend "the balanced diet". N'owt worse than a mistake repeated eh?


theshmaltz said...

I think it was a UK program that aired here in Australia a few months ago called "The Top 10 ways to lose weight" or something like that. Full of the usual malarkey.

One thing that I was really interested in was a case of an obese woman who was asked to keep a food diary of everything she ate for a period of time. The show presented her eating large fruit salads with low-fat yoghurt, small low-fat meals etc etc etc. She would labouriously enter all her food intake into her diary.

At the same time, she was given some substance to drink which apparently could be used to work out actually how many calories she'd consumed by what she pee'ed out.

Upshot of this all, is that after analysing her food diary, the nutritionist worked out the woman was eating about 1500 calories a day, yet the urine testing showed she was actually consuming 3000 calories per day! The nutritionist then basically accused the woman of cheating, and not recording all her food.

Asclepius said...

One of the most tragic things about the 'conventional wisdom' is that people are labelled as weak willed and liars. Criticism falls on the subjects rather than the methods.

You'd think that some of the experts out there would question why 'failure' to lose fat is so common using the conventional approach and why there is supposedly such extreme deception manifesting in otherwise decent people.

For me it is no suprise that an extreme bahaviour like dieting or chronic cardio would lead to other extreme compensatory behaviours.

AT22 said...

And the more you think about it, the more it seems totally ridiculous to believe in the calories in/out idea. I mean, if I'm eating 1800 calories but not losing weight, if I decrease to 1600, could that really make that much difference in the grand scheme of an entire chain of biological systems and allow me to shed 5 pounds of bodyfat?

And just counting calories is ridiculous to begin with -- "that carrot has 13 calories." Really? Couldn't it really have 20 or 7? What about those "100 calorie" packs. Don't you think that is an estimate? Maybe it's 115. If you are counting calories and eat three of those in a day (not unrealistic for a carb-addicted dieter, right?), that is 45 extra calories right there that you never even counted. There are so many problems with thinking that a very black/white version of things is the solution.

Ugh, exhausting.

Asclepius said...

AT22 - I hear ya!

I have blogged before about the madness of running around, day-in, day-out with various counters running in your mind - be they to do with calories, percentages of RDA or 'traffic light' systems of food properties.

To keep all these counters running for one day is hard, but to do it every day of your life (resetting the counters each morning), is all but impossible.

I am also coming around to think the same limitations can apply to exercise and the counting of reps/sets and obsessing over poundages. Clarence bass wrote something approaching this, with the emphasis on 'effort' being critical:

"Resistance (poundage) makes little difference...as long as the last few reps are at or near maximum. Effort, not force, is the controlling factor."

I happen to agree with him and as you'll see from my workouts I always vary reps and sets to try to mimic life's randomness, but the real work always occurs on those last few reps of the last few sets. Those reps are the important ones to me.