Skip to main content

What you thought you knew about obesity is wrong

By Aaron Carroll, Special to CNN
updated 11:20 AM EST, Tue February 5, 2013
 Aaron Carroll says some studies have upended the received wisdom on obesity: There is no one-size-fits-all solution
Aaron Carroll says some studies have upended the received wisdom on obesity: There is no one-size-fits-all solution
STORY HIGHLIGHTS
  • Aaron Carroll: I thought I knew all about obesity; a new study challenges that
  • He says obesity a big problem, but weight loss not as simple as fruits, veggies and no snacks
  • Studies do show that overall, vigorous exercise and watching calories help
  • Carroll: Best tool against obesity is not to get there in first place

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- I've written quite a bit about medical myths, so I'm always a bit skeptical about medical "knowledge." But one thing I, and I'm sure many of you, think we understand is obesity. After all, weight issues crop up in media constantly. Just last night, Gov. Chris Christie was joking about donuts and his weight on The Late Show with David Letterman, and the First Lady's weight is once again a subject of discussion in the Washington Post--even though by any objective standard she's in great shape.

We know how people gain weight, and we think we know how to lose it.

Except a study in this week's New England Journal of Medicine shows us that's just not right. Pretty much everything we "know" about obesity and weight loss is wrong.

Let's start with some things that are true.

More than a third of Americans are obese. Many more are overweight. The Centers for Disease Control and Prevention estimates that obesity-related medical costs were almost $150 billion in 2008, and the cost in health related expensed for an average person who was obese was more than $1,400. This doesn't count the physical, mental or quality-of-life toll that obesity can levy on a person.

Few of us dispute that we need to do something about this problem. There are plenty of experts (present company included) who will tell you what needs to be done. The sad truth, though, is that lots of that advice (even mine) turns out to be mistaken.

Aaron Carroll
Aaron Carroll

I know I've told people that making small, sustained lifestyle changes is the best way to lose weight over time. But it turns out that making such changes, say by deciding to walk a mile every day for five years, results in far less weight loss than you'd expect.

Coca-Cola weighs in on obesity fight

I've lectured people about the importance of physical education in schools, and I've seen countless reports declaring that the decrease in PE nationwide is one of the reasons that more children are obese or overweight today. It turns out that studies don't show that's the case.

My family loves watching "The Biggest Loser." But I've found myself telling my kids again and again that what's shown on TV isn't the best way to lose weight. I tell them that slow and steady works better in the long-run than rapid weight loss. I also tell them that setting unrealistic weight goals can actually sabotage your efforts.

So imagine my shock to discover that what evidence exists in this new study hints towards ambitious goals being a good thing, and that quicker weight loss isn't less likely to be kept off in the long-term.

Bacteria in gut may cause morbid obesity
Coke's new ad campaign targets obesity
FDA expected to approve new diet drug
NYC's controversial move to curb obesity

People will say eating breakfast is a good idea when you're trying to lose weight, because it will keep you from binging later. But studies show that there's no protective effect from eating breakfast at all. People will say that eating more fruits and vegetables is a great way to lose weight. But studies show that, on their own, eating more of them without making other behavioral changes doesn't result in any weight loss. There's no magic to fruits and vegetables.

Eatocracy: Chefs with Issues: Farm-to-table should still be on the table

People will say that snacking in between meals can lead to weight gain. But studies don't show that to be the case either. In general, people compensate for snacking throughout the rest of the day. In other words, it's not necessarily bad to snack outside of usual meal times.

It's all enough to cause one to despair. But just because so much of what we believe is wrong doesn't mean we still can't do something about the issue.

Studies do show that you can absolutely overcome genetic and familial factors to lose weight.

They show that significant physical activity can help with weight loss, and that it has the added bonus of making you healthier in general. Reducing your caloric intake works overall, especially if it's done in a way to change your overall eating habits. Getting the whole family involved is important. And finally, for some, bariatric surgery can result in life-changing outcomes.

Over the past five years, my wife and I have lost quite a bit of weight. I'm down somewhere between 15% to 20% of my high of more than 200 pounds. My wife lost even more, although I'm not going to give you any numbers (I like being married).

Now that I look back, if I'm going to be honest about it, I did it in bursts over a few months here and there, each time gaining back less than I had lost.

7 weight loss myths (sort of) debunked

Each time, I had ambitious goals of 15 pounds or more in two to three months, and each time I really restricted my caloric intake. But I've kept the weight off by radically changing my overall eating habits.

My breakfast consists of just coffee, I eat very light lunches, such as salads, and dinner is usually a healthy home-cooked meal with the family. My wife cooks way more than she used to and is obsessed with finding ways to make meals healthier. I avoid fried foods almost entirely, and I can't remember the last time I ate in a fast food restaurant. I also get to the gym two to three times each week.

I don't tell you this because I think this is what you should do, or because I think it's the key to getting thinner. I tell you this because more and more, I think that the journey to sustained weight loss is a very personal and individual path. Perhaps our problem is we're trying to find a one-size-fits-all solution. I'm not sure that exists.

Lastly, what was left out of this new scientific paper was prevention. The single best way to fight obesity is to avoid it in the first place. That has to start when kids are young, and it's a lifelong journey. But one thing I doubt will ever be proved false is that it's much easier not to gain the weight in the first place than to take it off later.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Aaron Carroll.

ADVERTISEMENT
Part of complete coverage on
updated 3:47 PM EDT, Wed October 1, 2014
Julian Zelizer says Jimmy Carter's message about the need to restore trust in public officials is a vital one, decades after the now 90-year-old he first voiced it
updated 5:56 PM EDT, Wed October 1, 2014
Ford Vox says mistakes and missed opportunities along the line to a diagnosis of Ebola in a Liberian man have put Dallas residents at risk of fatal infection
updated 6:21 PM EDT, Wed October 1, 2014
Pepper Schwartz says California is trying, but its law requiring step-by-step consent is just not the way hot and heavy sex proceeds on college campuses
updated 4:48 PM EDT, Wed October 1, 2014
Mike Downey says long-suffering fans, waiting for good playoff news since 1985, finally get something to cheer about
updated 5:39 PM EDT, Wed October 1, 2014
Steve Israel saysJohn Boehner's Congress and the tea party will be remembered for shutting down government one year ago
updated 2:56 PM EDT, Wed October 1, 2014
Yep. You read the headline right, says Peter Bergen, writing on the new government that stresses national unity
updated 7:12 PM EDT, Wed October 1, 2014
Hong Kong's pro-democracy demonstrators are but the latest freedom group to be abandoned by the Obama administration, says Mike Gonzalez
updated 12:53 PM EDT, Tue September 30, 2014
Jeff Yang calls Ello a wakeup call to Facebook and Twitter, and a sign of hope for fast-rising upstarts Pinterest and Snapchat.
updated 10:23 AM EDT, Wed October 1, 2014
Paul Waldman says the Secret Service should examine its procedures to make sure there are no threats to the White House--but without losing the openness so valuable to democracy
updated 10:55 AM EDT, Wed October 1, 2014
Jesse Williams says the videotape and 911 call that resulted in police gunning down John Crawford at a Walmart reveals the fatal injustice of racial assumptions
updated 7:03 PM EDT, Tue September 30, 2014
Mel Robbins says officials should drop the P.C. pose: The beheading in Oklahoma was not workplace violence. Plenty of evidence shows Alton Nolen was an admirer of ISIS.
updated 3:11 PM EDT, Tue September 30, 2014
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, William Piekos says..
updated 3:11 PM EDT, Tue September 30, 2014
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, writes William Piekos.
updated 10:13 AM EDT, Tue September 30, 2014
As Prime Minister Narendra Modi visits America, Madeleine Albright says a world roiled by conflict needs these two great democracies to commit to moving their partnership forward
updated 10:04 AM EDT, Tue September 30, 2014
John Sutter: Lake Providence, Louisiana, is the parish seat of the "most unequal place in America." And until somewhat recently, the poor side of town was invisible on Google Street View.
updated 9:11 AM EDT, Mon September 29, 2014
Julian Zelizer says in the run up to the 2016 election the party faces divisions on its approach to the U.S.'s place in the world
updated 10:19 AM EDT, Mon September 29, 2014
Ruben Navarrette says Common Core supporters can't devise a new set of standards and then fail to effectively sell it.
updated 9:29 AM EDT, Tue September 30, 2014
Earlier this month, Kenyans commemorated the heinous attack on the Westgate Mall in Nairobi.
updated 2:59 PM EDT, Tue September 30, 2014
David Wheeler says Colorado students are right to protest curriculum changes that downplays civil disobedience.
updated 9:58 PM EDT, Fri September 26, 2014
Sally Kohn says when people click on hacked celebrity photos or ISIS videos, they are encouraging the bad guys.
updated 7:55 AM EDT, Fri September 26, 2014
Loren Bunche says she walked by a homeless man every day and felt bad about it -- until one day she paused to get to know him
updated 9:32 AM EDT, Tue September 30, 2014
ISIS grabs headlines on social media, but hateful speech is no match for moderate voices, says Nadia Oweidat.
updated 8:33 AM EDT, Mon September 29, 2014
A new report counts jihadists fighting globally. The verdict? The threat isn't that big, says Peter Bergen.
updated 5:37 PM EDT, Tue September 23, 2014
Ebola could become the biggest humanitarian disaster in a generation, writes former British Prime Minister Tony Blair
updated 12:58 PM EDT, Fri September 26, 2014
ISIS has shocked the world. But will releasing videos of executions backfire? Four experts give their take.
updated 10:39 AM EDT, Fri September 26, 2014
Eric Holder kicked off his stormy tenure as attorney general with a challenge to the public that set tone for six turbulent years as top law-enforcement officer.
updated 9:09 AM EDT, Fri September 26, 2014
LZ Granderson says Obama was elected as a war-ending change agent, not a leader who would leave behind for his successor new engagement in Iraq and Syria. Is he as disappointed as the rest of us?
updated 5:10 AM EDT, Wed September 24, 2014
Gayle Lemmon says the question now is how to translate all the high-profile feminizing into real gains for women
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT