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Being Skinny in a Fat World

Wednesday 11 December 2013, 11:52AM

By Dr Neil Averis

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Multisporters are nearly always slim and often bordering on underweight as they become more competitive and energy expenditure rises with training.

Many struggle to eat enough to maintain their exercise levels and this is a common cause of under-performance.

Also they usually wish to shed any excess fat especially in the disciplines of running and cycling as every kilo is another kilo to carry.

Because of this it is easy to give advice to our less athletic friends who may well be overweight but have not embraced sport to the degree most readers of this article have.

This advice is not always taken well so you need to be careful of the accuracy of what you say given weight loss is very difficult for an increasing proportion of our society.

Few are going to quickly, or even eventually embrace the multisporters or triathletes focus, so for most with obesity another route must be taken.

For all that, I do get sick of being told that I’m too skinny where in fact the person pointing this out usually could stand to lose some weight!

It is also worth recognizing that from a health point of view a fit overweight person is on average healthier than a thin unfit person and that the thin unfit ones tend to get away without social criticism!

A recent review article in the NEJM (New England journal of Medicine) entitled Myths, Presumptions, and Facts about Obesity, made interesting reading as it analysed what is known about weight loss and what is myth or assumed.

Seven ideas about weight loss were examined and studies reviewed and although many seem reasonable none could be proven with any certainty on studies to date.

If you are in a situation to give advice it is probably better to be accurate or give none!

1 “Small sustained changes in energy intake or expenditure will produce large long term weight changes”, seems obvious but longer term studies show only small initial weight changes as the body seems to compensate for the new situation and readjusts itself to maintain weight after an initial loss. To maintain a steady weight loss either calorie reduction and or exercise levels need to be progressively increased.

2 “Setting realistic goals for weight loss is important, because otherwise patients will become frustrated and lose less weight.” Again this seems reasonable but there is no evidence that goal setting is helpful.

3 “Large, rapid weight loss is associated with poorer long term weight loss outcomes, compared with slow, gradual weight loss.” Again not true, it seems weight loss is weight loss.

4 “It is important to assess the stage of change or diet readiness in order to help patients who request weight loss treatment.” Studies showed “readiness” did not affect outcome of those in weight loss regimes and was not useful in predicting success.

5 “Physical education classes, in their current form, play an important role in reducing or preventing childhood obesity.” Even studies looking at schools with an increased focus on school PE did not seem to make any difference to obesity rates.

6 “Breast feeding is protective against obesity”. Initial WHO studies showing a protective effect on obesity in those children of breast feeding mothers have not been upheld in later studies. However there are many other positive reasons to encourage breast feeding and it may well assist in weight loss in the nursing mother.

7 “A bout of sexual activity burns 100 to 300kcal for each participant.” Given a 70kg man & 6 minutes of sexual activity this would cause a 21kcal energy expenditure, or only 14 more kcal than TV watching, and no, doing both together doesn’t add more to energy use!


The weight loss issue is a big one and has no simple answers, it may be calories in calories out, but in reality loosing weight is complex and difficult and offering advice to others is as fraught as giving advice to others on child discipline.

Exercise and the lifestyle that goes with it are not something that those unused to exercise can grasp easily.

Those with no history of exercise really do struggle with the sensations that accompany moderately hard exercise and often find the experience frightening and difficult.

Injuries are also likely to derail many attempts to exercise and with pounding activities in the overweight such as jogging, are almost inevitable.

Dietary advice and calorie restriction are probably more effective for initial weight loss & I suspect increasing exercise should be an adjunct only, at least in the initial phase.

Some may respond to a challenge of entering an event that is well outside their comfort zone and that experience can be life changing if successful but I suspect the failures are more common & more devastating but much less publicised.

Obesity is almost always an emotional as well as physical condition, no one wishes to be obese and society is very judgmental of those overweight.

Those adults who are overweight are always aware and don’t need to be told, the answer may seem simple to the athlete but if asked for advice or support, offer it with care and consideration.