If you read the news reports of a recent UK Study, “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records”, American Journal of Public Health, Fildes et. al., July 16, 2015, and are overweight, you are probably hearing that you should be heading straight to your surgeon and get bariatric surgery since you cannot otherwise get down to a normal weight, and if you do lose the weight, you will never be able to keep it off.  Exhibit 1 that is untrue are my own experiences, so all hope is not lost.

Above is a picture of me from 2008 when I weighed in the 430’s, and had a superobese BMI (much greater than 45, actually in the 60’s), and the adjacent picture is from 2012, when I  weighed in the low 190’s, yet still had a “overweight” BMI of around 26 (an overweight BMI is considered between 25 and 29.9) — more on that classification later. Since 2012, I have kept the weight off, and I never had bariatric surgery, or took any medications, and relied on exercise, better eating habits and behavior modification to achieve and maintain my weight loss.

Before discussing the problems with this survey, and its conclusions, it is important to understand what BMI is, how it is calculated, and what are the problems with BMI.  Body mass index (BMI) is a measure of body fat based on your weight in relation to your height, and applies to most adult men and women aged 20 and over. The formula is as follows: your weight in pounds (multiplied by 703) divided by the square of your height in inches (for metric measurements, it is your weight in kilograms divided by your height in meters squared). BMI does not measure body fat directly, but there is thought to be a correlation between one’s actual body fat and BMI.  Actual body fat can be measured directly by various means, two of the best methods are underwater weighing, and dual-energy X-ray absorptiometry (DXA), with the latter being the gold standard of measurements. What BMI does not take into consideration is one’s bone structure, muscle mass, and weight of your organs. So, if you are an athlete, your BMI calculation can have you believe have a fair degree of fat, and are overweight, whereas you may in fact have a very low amount of body fat, and be perfectly normal.

Example 2, I had a DXA scan, and it showed I had less than 10% body fat, and for my age category, normal body fat is considered between around 22% to 26% — the scan indicated that my bones, organs and muscles themselves weighed 178 lbs.  So for me, BMI is horrible indicator of my body fat. It is also important to note that BMI says nothing about your overall health, but just tries to estimate you body fat based upon your height and weight.

So now that we understand BMI a little better, let’s look at this study. First off, the study admits that “[o]ur research was part of a larger study to evaluate the use of bariatric surgery” and excluded participants who received such surgery. That to me indicates a potential bias (pushing surgery),  and I also found it interesting that the mean age of the male participants was 55 years old. I am now 55, and can tell you it is not easy to maintain a level of exercise and activity, than when I was 50, so I can maintain my weight loss, whereas I would think that for someone in their 20’s, 30’s and 40’s, it would be much easier. Another curiosity of the study is that off all the groups they looked at (simple obese, severe obese, morbid obese, and superobese), the superobese were second best of those groups in obtaining a normal BMI, and the best at obtaining a 5% reduction in body weight. Again, it is important to note that the worst of the groups, the one’s with largest weight problem, seemed to do best, and they are not using surgery.

Here is what I think, if you are already in good shape, it is more difficult to lose weight since your body’s metabolism has adjusted to your level of activity, so it takes a much greater effort to lose those last few pounds. Isn’t that what we have all experienced?

So in conclusion, I firmly believe, contrary to the study, that you can lose and maintain weight loss through exercise, diet, and behavior modification, without the need for surgery, but it takes vigilance. As I have discussed in other blog entries, I constantly monitor my weight every day, and make changes to my food intake and exercise level to make sure I maintain a steady weight. And what the survey does not discuss is the danger and side effects of surgery, and how some patients still cannot maintain their weight loss even after surgery. For me, finding that inner drive to make the changes yourself, rather than relying on surgery, is better way in that you learn good and healthy habits, and it provides you with a sense of achievement which you would not otherwise experience. And to me, this survey’s dismissal of weight management strategies, seemingly in favor of surgery, is just poppycock.