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The Need for Further Research

January 11th, 2012

In the United States, between 300,000 and 400,000 deaths per year and millions of cases of illness are attributable to obesity. Treatment of obesity, regardless of the method of treatment used, requires some degree of semi-starvation. The irony lies, first, in the fact that much of the scientific information so far acquired about the physiology of weight loss is not being used to guide treatment. Moreover, the scientific information needed to develop a more rational protocol for therapeutic weight loss is, at best, being acquired very slowly. The result of this neglect is that treatment of America’s most common, expensive, and lethal nutritional problem is not yet a science and—what is more—shows little sign of becoming a science.

While the future of obesity treatment is uncertain, we have made many advances in the last few decades. We now know that obesity is a complex and chronic problem of energy regulation. This problem, while complex and influenced by many biological and behavioral factors, requires sustained lifestyle change. The public is constantly bombarded by messages about quick fixes. The typical messages include variations of “Eat all you want and still lose weight,” and “Exercise without moving.” The consumer should be wary of the many carefully packaged and marketed “special diet” plans that imply a proven or scientific formula, but have no sound scientific basis. There are no quick fixes when it comes to weight loss.

While we await further guidance, I note several points. First, individuals who are not very obese (BMI <30 kg/m2) should never follow a very-low-calorie diet. Second, obese individuals who rapidly lose excess fat should decrease their energy (calorie) deficit progressively as the weight-loss regimen continues. Third, limit weight loss to a rate compatible with acceptable composition (i.e., 75 percent fat and 25 percent fat-free mass). A useful guideline is to limit the rate of weight loss to 1 percent of body weight per week (e.g., 300-pound person would limit weight loss to three pounds per week).

Theodore B. VanItallie, M.D., is Professor Emeritus of Medicine at Columbia University. He has played a major role as a clinical researcher and teacher in the areas of metabolism, nutrition, and obesity. In 1975, he founded and became the first Director of the Obesity Research Center at St. Luke’s-Roosevelt Hospital Center.

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