The FastDay Forum

[carorees]

I've just come across this interesting article which discusses the problem of a statistically increased risk of death for people who intentionally lose weight when they were overweight but healthy.

It seems that the lowest risk of death occurs in people who maintain a stable weight even if that stable weight is not within the healthy BMI bracket. The authors suggest that doctors should not be exhorting all their overweight patients to lose weight...only those for whom being overweight has resulted in health problems (mind you this probably applies to the majority of their patients) and that more effort should be made to prevent people from gaining weight (whether after a period of dieting or just generally). This means adopting a way of eating that, not only prevents weight gain but, above all, is sustainable.

For me, it once again highlights the massive importance of MAINTENANCE! I would beg anyone who is considering changing their fasting/eating pattern to break a plateau to ensure that the modification they chose is something they will be able to do FOREVER!

Here are some key quotes from the paper:

Sustained weight loss is achieved by a small percentage of those intending to lose weight. Mortality is lowest in the high-normal and overweight range. The safest body-size trajectory is stable weight with optimization of physical and metabolic fitness. With weight loss there is evidence for lower mortality in those with obesity-related comorbidities. There is also evidence for improved health-related quality of life in obese individuals who lose weight. Weight loss in the healthy obese, however, is associated with increased mortality.

Cross-sectional analyses of healthy populations show, on average and without intervention, a gradual increase in body weight with increasing age, with a gradual slowing of this trend in the fifth to sixth decades. Weight-gain velocity is greatest in men younger than 40 years and in women younger than 50 years. Maximum weight is achieved on average between ages 50 and 69.

...at any given time, 36% of the population is attempting to lose weight, while 64% are taking no action to manage weight. Intervention in the weight trajectory, usually with diet and exercise, leads to weight loss, weight cycling with eventual gain, or weight stability. Remarkably, body-size outcomes are similar whether or not there is intention to lose weight—in both groups over the course of 6 years, 30% remain stable, 37% to 39% lose weight, and 31% to 33% cycle or gain weight.

A 10% weight loss can reduce resting energy expenditure by 15%. The obese individual who has lost this weight must then continue to diet and exercise even to stabilize at the lower weight, otherwise weight cycling occurs, with gradual gain in 80% of those originally attempting weight reduction. The 20% who are successful in maintaining weight loss might not have this marked metabolic compensation, and it might be easier for these individuals to maintain their loss over time.

There is generally little evidence to support weight loss for mortality reduction in healthy subjects older than 60 years. There might be some benefit in the elderly with comorbidities such as osteoarthritis, coronary artery disease, and diabetes. Mortality in this age group has been shown to increase if weight reduction is unintentional, exceeds 5%, or reduces BMI to less than 22 kg/m2.

Because compliance is among the most important variables in weight intervention, and because the change needs to be lifelong, it is important to consult with the patient to craft a strategy that is likely to be followed. Weight loss, however, need not be a prerequisite to better health. Improved physical fitness, reduction of highly metabolically active abdominal fat, and improvement of cardiovascular risk factors can happen equally well at a stable elevated weight with a commitment to healthier food choices and appropriate exercise.

'There is generally little evidence to support weight loss for mortality reduction in healthy subjects older than 60 years. There might be some benefit in the elderly with comorbidities such as osteoarthritis, coronary artery disease, and diabetes. Mortality in this age group has been shown to increase if weight reduction is unintentional, exceeds 5%, or reduces BMI to less than 22 kg/m2.'

Mm, given my age, 65, and low BMI, 19.24, should I worried by this @Carorees?

Ooer really? So at age 60 and weight 70kgs that seems to be it for me then?
:0O

Thanks for that Caroline - though it is utterly alarming. I'll have a good read methinks as it is so disturbing I want to find that it's flawed. The paper has this caveat at its head, and I'll maybe console myself with that:

Statistics show that of those who contract the habit of eating, very few survive.
George Bernard Shaw

One does rather wonder what the paper's author (the delightfully named Dr. Bosomworth) was actually trying to say with that quote?..

My thanks too, Caroline (what would we do without your scientific research background?! )

Having had the message of 'overweight is bad' drummed into me most of my life (as have most of us, I guess), I'm having trouble getting my head around the concept that it may be worse to lose weight and yo-yo (have I got that right?) than to be overweight and keep the weight stable.

But yes, the overall message I took from that was also -
Maintenance, maintenance, maintenance!

And that's where the real challenge will lie!

Goodness, that was not what I expected. I shall take the pragmatic view that if I'm happier at a lighter weight then that has to be better for my mental health than being heavier than I am comfortable with. I don't dispute the findings but I am just going to ignore them as they are not what I want to hear, 'fingers in ears and whistling loudly'. Being happy with what you have, and I am more than happy to have less fat than I had, is the most important thing for me. Thank you Caroline, you are brilliant at finding all these amazing facts for us and I am truly grateful but this one will go straight into my mental recycling facility, ( Boo Hoo not playing now )

Ballerina x

During a recent conversation with my doctor, I said to her that I wouldn't be unhappy if I didn't manage to lose anymore weight. She said that it would be better to stay the weight I was than to try and lose too much and then put weight back on, as yo-yoing was much worse than being slightly overweight.

[carorees]

'There is generally little evidence to support weight loss for mortality reduction in healthy subjects older than 60 years. There might be some benefit in the elderly with comorbidities such as osteoarthritis, coronary artery disease, and diabetes. Mortality in this age group has been shown to increase if weight reduction is unintentional, exceeds 5%, or reduces BMI to less than 22 kg/m2.'

Mm, given my age, 65, and low BMI, 19.24, should I worried by this @Carorees?

No I don't think you need be worried. I presume with your low BMI you are not trying to lose weight just to fast for health? If that is your aim, have you considered just doing one fast per week? Or fast with no calories for 24 hours and then eat however much you want (i.e., more than 500 cal). This should enable you to include fasting into your life but not create a calorie deficit so you would maintain your weight. Also, I don't know your frame size but if you have a light frame then a BMI of 19.24 would be the equivalent to just under 22 for a medium framed person.

For everyone, though, I do think it is worth recognising that it may be better to set a goal weight that is slightly higher than vanity dictates if you are more likely to be able to stabilize at that weight than to strive mightily to attain a target weight and then gradually put weight back on again because the diet is too restrictive.

Also, remember the article is referring to losing weight when you are otherwise healthy. If you have good health reasons to lose weight such as poor glucose tolerance, high cholesterol, high blood pressure, osteoarthritis etc etc, then losing weight will be a good thing, but regaining it will be a bad thing so, again, be careful not to set too low a target weight. If you plateau at say a BMI of 27, think carefully about whether you really need to get down to a BMI of e.g., 22...will it improve your health or will it be a never ending battle to keep that low?

As izzy says, it is an individual decision but knowing that keeping weight stable while being healthy is more important than reaching any particular number on the scales will help you decide what is right for you.

I must admit I wasn't expecting the article from Caroline, more a general comment eg more wrinkles, saggy flesh. Very sensible advice not to set your goal weight too low rather than try to achieve something that isn't sustainable.

And on that basis set smaller goals first and see how it goes? I've set myself a target of minus 17kg and I have a way to go yet - I'm now trying to be more realistic about how quickly it comes off and looking at a smaller loss by year-end then setting the next milestone once I can see that the first milestone is sustainable.

Many thanks for your reply Caroline. You're correct in that I'm not trying to lose weight, just maintain and try 6:1 for the additional health benefits.
According to the charts taking wrist size into account I do have a medium frame by the way!

[carorees]

Yes, Vildekhaya...see how your body responds not only with weight loss but with other health markers. So, pain in the knees if you have OA, blood glucose control if you have diabetes/pre-diabetes, blood pressure etc. If these have normalized/massively improved and you have not reached a BMI below 25 and the fasting is not resulting in weight loss, consider if you could stop where you are before adding another fast day, cutting down calories on feed days etc etc.

Maximum weight is achieved on average between ages 50 and 69.

I love this - makes it sound like something you've really worked for!

As you can see from my stats on the left, I'm now on the borders of the "normal" BMI range. I'd meant to try for a BMI of 23 but I've been thinking for some time that perhaps I should abandon my scales now and just focus on health issues and reducing waist, which is way more than half my height and worries me rather.

So the idea is to continue low-carb 5:2 without calorie counting but eating sensibly and healthily and increase exercise levels. So far so good, but the challenge is going to be not weighing myself several times a week and getting out of the mindset of measuring health through weight.

It sounds pathetic even to me but I don't know if I can wean myself off my weighing scales!

@shachat, get a hoola hoop, and wiggle your way to a slimmer waist.