Author Topic: Wansink.  (Read 6890 times)

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Offline CarbShark

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Wansink.
« Reply #165 on: October 28, 2018, 11:24:11 AM »
In case anybody wants an antidote to Bachfiend's grave misunderstanding:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630467/

Quote
Obesity (Silver Spring). 2013 Mar;21(3):E219-28. doi: 10.1002/oby.20145.

Aerobic exercise alone results in clinically significant weight loss for men and
women: midwest exercise trial 2.


Donnelly JE(1), Honas JJ, Smith BK, Mayo MS, Gibson CA, Sullivan DK, Lee J,
Herrmann SD, Lambourne K, Washburn RA.

Author information:
(1)Department of Internal Medicine, Cardiovascular Research Institute, The
University of Kansas Medical Center, Kansas, USA.

Exercise is recommended by public health agencies for weight management; however,
the role of exercise is generally considered secondary to energy restriction. Few
studies exist that have verified completion of exercise, measured the energy
expenditure of exercise, and prescribed exercise with equivalent energy
expenditure across individuals and genders.OBJECTIVE: The objective of this study
was to evaluate aerobic exercise, without energy restriction, on weight loss in
sedentary overweight and obese men and women.
DESIGN AND METHODS: This investigation was a randomized, controlled, efficacy
trial in 141 overweight and obese participants (body mass index, 31.0 ± 4.6
kg/m(2) ; age 22.6 ± 3.9 years). Participants were randomized (2:2:1 ratio) to
exercise at either 400 kcal/session or 600 kcal/session or to a nonexercise
control. Exercise was supervised, 5 days/week, for 10 months. All participants
were instructed to maintain usual ad libitum diets. Because of the efficacy
design, completion of ≥90% of exercise sessions was an a priori definition of per
protocol, and these participants were included in the analysis.
RESULTS: Weight loss from baseline to 10 months for the 400 and 600 kcal/session
groups was 3.9 ± 4.9 kg (4.3%) and 5.2 ± 5.6 kg (5.7%), respectively, compared
with weight gain for controls of 0.5 ± 3.5 kg (0.5%) (P < 0.05). Differences for
weight loss from baseline to 10 months between the exercise groups and
differences between men and women within groups were not statistically
significant.
CONCLUSIONS: Supervised exercise, with equivalent energy expenditure, results in
clinically significant weight loss with no significant difference between men and
women.

Copyright 2012 The Obesity Society.

DOI: 10.1002/oby.20145
PMCID: PMC3630467
PMID: 23592678  [Indexed for MEDLINE]

The one quibble I have with this study is they only measure those who followed the program and ignored the dropouts (34%) or anyone who didn’t do 90% of the program.

The approach for diet trials is nearly always “intent to treat” meaning the dropouts and any who didn’t follow the protocol are counted.




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Offline jt512

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Re: Wansink.
« Reply #166 on: October 28, 2018, 11:37:15 AM »
In case anybody wants an antidote to Bachfiend's grave misunderstanding:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630467/

Quote
Obesity (Silver Spring). 2013 Mar;21(3):E219-28. doi: 10.1002/oby.20145.

Aerobic exercise alone results in clinically significant weight loss for men and
women: midwest exercise trial 2.


Donnelly JE(1), Honas JJ, Smith BK, Mayo MS, Gibson CA, Sullivan DK, Lee J,
Herrmann SD, Lambourne K, Washburn RA.

Author information:
(1)Department of Internal Medicine, Cardiovascular Research Institute, The
University of Kansas Medical Center, Kansas, USA.

Exercise is recommended by public health agencies for weight management; however,
the role of exercise is generally considered secondary to energy restriction. Few
studies exist that have verified completion of exercise, measured the energy
expenditure of exercise, and prescribed exercise with equivalent energy
expenditure across individuals and genders.OBJECTIVE: The objective of this study
was to evaluate aerobic exercise, without energy restriction, on weight loss in
sedentary overweight and obese men and women.
DESIGN AND METHODS: This investigation was a randomized, controlled, efficacy
trial in 141 overweight and obese participants (body mass index, 31.0 ± 4.6
kg/m(2) ; age 22.6 ± 3.9 years). Participants were randomized (2:2:1 ratio) to
exercise at either 400 kcal/session or 600 kcal/session or to a nonexercise
control. Exercise was supervised, 5 days/week, for 10 months. All participants
were instructed to maintain usual ad libitum diets. Because of the efficacy
design, completion of ≥90% of exercise sessions was an a priori definition of per
protocol, and these participants were included in the analysis.
RESULTS: Weight loss from baseline to 10 months for the 400 and 600 kcal/session
groups was 3.9 ± 4.9 kg (4.3%) and 5.2 ± 5.6 kg (5.7%), respectively, compared
with weight gain for controls of 0.5 ± 3.5 kg (0.5%) (P < 0.05). Differences for
weight loss from baseline to 10 months between the exercise groups and
differences between men and women within groups were not statistically
significant.
CONCLUSIONS: Supervised exercise, with equivalent energy expenditure, results in
clinically significant weight loss with no significant difference between men and
women.

Copyright 2012 The Obesity Society.

DOI: 10.1002/oby.20145
PMCID: PMC3630467
PMID: 23592678  [Indexed for MEDLINE]

The one quibble I have with this study is they only measure those who followed the program and ignored the dropouts (34%) or anyone who didn’t do 90% of the program.

The approach for diet trials is nearly always “intent to treat” meaning the dropouts and any who didn’t follow the protocol are counted.

They explain in the paper that that was a design decision.  The study aimed to answer the question, what is the effect of exercise per se on body weight, as opposed to the question, what is the effect of an exercise prescription.  The latter would measure  the net effect of exercise per se and compliance.  Both questions are important.
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Offline CarbShark

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Wansink.
« Reply #167 on: October 28, 2018, 12:33:27 PM »
Any reason they couldn’t also include an intent to treat analysis?

For that matter any reason why diet trials can’t also include per protocol analyses?

It seems since both are measuring the same outcomes (weightloss/fat loss) they should provide results that can be directly compared.

All this proves that it’s possible for some to Lose weight with exercise alone. It doesn’t show that exercise-based weight loss programs would work.


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Offline jt512

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Re: Wansink.
« Reply #168 on: October 28, 2018, 12:59:03 PM »

All this proves that it’s possible for some to Lose weight with exercise alone. It doesn’t show that exercise-based weight loss programs would work.


It shows that regular aerobic exercise causes significant loss of body fat with no loss of lean body mass.  That's important to establish, don't you think?  Compliance with an exercise program is an important question as well, of course.  I find it is interesting (and somewhat surprising) that nearly two-thirds of the subjects complied for the full 10 months.
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Offline bachfiend

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Re: Wansink.
« Reply #169 on: October 28, 2018, 04:44:53 PM »
In case anybody wants an antidote to Bachfiend's grave misunderstanding:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630467/

Quote
Obesity (Silver Spring). 2013 Mar;21(3):E219-28. doi: 10.1002/oby.20145.

Aerobic exercise alone results in clinically significant weight loss for men and
women: midwest exercise trial 2.


Donnelly JE(1), Honas JJ, Smith BK, Mayo MS, Gibson CA, Sullivan DK, Lee J,
Herrmann SD, Lambourne K, Washburn RA.

Author information:
(1)Department of Internal Medicine, Cardiovascular Research Institute, The
University of Kansas Medical Center, Kansas, USA.

Exercise is recommended by public health agencies for weight management; however,
the role of exercise is generally considered secondary to energy restriction. Few
studies exist that have verified completion of exercise, measured the energy
expenditure of exercise, and prescribed exercise with equivalent energy
expenditure across individuals and genders.OBJECTIVE: The objective of this study
was to evaluate aerobic exercise, without energy restriction, on weight loss in
sedentary overweight and obese men and women.
DESIGN AND METHODS: This investigation was a randomized, controlled, efficacy
trial in 141 overweight and obese participants (body mass index, 31.0 ± 4.6
kg/m(2) ; age 22.6 ± 3.9 years). Participants were randomized (2:2:1 ratio) to
exercise at either 400 kcal/session or 600 kcal/session or to a nonexercise
control. Exercise was supervised, 5 days/week, for 10 months. All participants
were instructed to maintain usual ad libitum diets. Because of the efficacy
design, completion of ≥90% of exercise sessions was an a priori definition of per
protocol, and these participants were included in the analysis.
RESULTS: Weight loss from baseline to 10 months for the 400 and 600 kcal/session
groups was 3.9 ± 4.9 kg (4.3%) and 5.2 ± 5.6 kg (5.7%), respectively, compared
with weight gain for controls of 0.5 ± 3.5 kg (0.5%) (P < 0.05). Differences for
weight loss from baseline to 10 months between the exercise groups and
differences between men and women within groups were not statistically
significant.
CONCLUSIONS: Supervised exercise, with equivalent energy expenditure, results in
clinically significant weight loss with no significant difference between men and
women.

Copyright © 2012 The Obesity Society.

DOI: 10.1002/oby.20145
PMCID: PMC3630467
PMID: 23592678  [Indexed for MEDLINE]

5 kg weight loss in 10 months isn’t very much or very significant.  It’s only 0.5 kg a month or 0.125 kg a week in the participants who managed to complete the program (the modest aim of 0.5 kg weight loss a week with dietary restriction should be achievable).

There’s also very limited information on dietary intake.  It just states that it was looked at (they were fed 5 days a week in a university  cafeteria) and had post-eating recall of food eaten elsewhere, and there was so significant difference in kcal intake per day between the groups, but no further information.  Recording dietary intake is notoriously inaccurate.  Did the study groups really not restrict their dietary intake at other times, which would explain their not very large weight loss over 10 months?

And as the authors note, the results from other studies on exercise in weight loss are very mixed, with some showing no significant benefit.  One study doesn’t mean much.

And it’s not a very good study anyway.  For a study published in 2018 purporting to be examining increasing energy expenditure without changing energy intake as a means of causing weight loss, I find it extraordinary that they didn’t actually measure total energy intake.  It should have been easy enough to do double-labelled water measurements to determine what the exercise program was doing to total daily energy expenditure.  And I still find it odd that they didn’t report detailed energy intake.

The only ‘measurement’ of energy expenditure is the 400 or 600 kcal exercise sessions on a treadmill - based on heart rate monitoring.  I’m a little sceptical about energy expenditure from heart rate monitoring - I do 90’ cardio with 30’ on a treadmill (the other 60’ from a crosstrainer and a stationary bike) and on a ‘good’ day according to the heart rate monitor I manage 550 kcals - and the male participants on 600 kcal sessions were supposed to achieve it in 60’?
« Last Edit: October 28, 2018, 07:07:41 PM by bachfiend »
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Offline bachfiend

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Re: Wansink.
« Reply #170 on: October 28, 2018, 11:23:45 PM »
In case anybody wants an antidote to Bachfiend's grave misunderstanding:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630467/

Quote
Obesity (Silver Spring). 2013 Mar;21(3):E219-28. doi: 10.1002/oby.20145.

Aerobic exercise alone results in clinically significant weight loss for men and
women: midwest exercise trial 2.


Donnelly JE(1), Honas JJ, Smith BK, Mayo MS, Gibson CA, Sullivan DK, Lee J,
Herrmann SD, Lambourne K, Washburn RA.

Author information:
(1)Department of Internal Medicine, Cardiovascular Research Institute, The
University of Kansas Medical Center, Kansas, USA.

Exercise is recommended by public health agencies for weight management; however,
the role of exercise is generally considered secondary to energy restriction. Few
studies exist that have verified completion of exercise, measured the energy
expenditure of exercise, and prescribed exercise with equivalent energy
expenditure across individuals and genders.OBJECTIVE: The objective of this study
was to evaluate aerobic exercise, without energy restriction, on weight loss in
sedentary overweight and obese men and women.
DESIGN AND METHODS: This investigation was a randomized, controlled, efficacy
trial in 141 overweight and obese participants (body mass index, 31.0 ± 4.6
kg/m(2) ; age 22.6 ± 3.9 years). Participants were randomized (2:2:1 ratio) to
exercise at either 400 kcal/session or 600 kcal/session or to a nonexercise
control. Exercise was supervised, 5 days/week, for 10 months. All participants
were instructed to maintain usual ad libitum diets. Because of the efficacy
design, completion of ≥90% of exercise sessions was an a priori definition of per
protocol, and these participants were included in the analysis.
RESULTS: Weight loss from baseline to 10 months for the 400 and 600 kcal/session
groups was 3.9 ± 4.9 kg (4.3%) and 5.2 ± 5.6 kg (5.7%), respectively, compared
with weight gain for controls of 0.5 ± 3.5 kg (0.5%) (P < 0.05). Differences for
weight loss from baseline to 10 months between the exercise groups and
differences between men and women within groups were not statistically
significant.
CONCLUSIONS: Supervised exercise, with equivalent energy expenditure, results in
clinically significant weight loss with no significant difference between men and
women.

Copyright © 2012 The Obesity Society.

DOI: 10.1002/oby.20145
PMCID: PMC3630467
PMID: 23592678  [Indexed for MEDLINE]

5 kg weight loss in 10 months isn’t very much or very significant.  It’s only 0.5 kg a month or 0.125 kg a week in the participants who managed to complete the program (the modest aim of 0.5 kg weight loss a week with dietary restriction should be achievable).

There’s also very limited information on dietary intake.  It just states that it was looked at (they were fed 5 days a week in a university  cafeteria) and had post-eating recall of food eaten elsewhere, and there was so significant difference in kcal intake per day between the groups, but no further information.  Recording dietary intake is notoriously inaccurate.  Did the study groups really not restrict their dietary intake at other times, which would explain their not very large weight loss over 10 months?

And as the authors note, the results from other studies on exercise in weight loss are very mixed, with some showing no significant benefit.  One study doesn’t mean much.

And it’s not a very good study anyway.  For a study published in 2013 purporting to be examining increasing energy expenditure without changing energy intake as a means of causing weight loss, I find it extraordinary that they didn’t actually measure total energy intake.  It should have been easy enough to do double-labelled water measurements to determine what the exercise program was doing to total daily energy expenditure.  And I still find it odd that they didn’t report detailed energy intake.

The only ‘measurement’ of energy expenditure is the 400 or 600 kcal exercise sessions on a treadmill - based on heart rate monitoring.  I’m a little sceptical about energy expenditure from heart rate monitoring - I do 90’ cardio with 30’ on a treadmill (the other 60’ from a crosstrainer and a stationary bike) and on a ‘good’ day according to the heart rate monitor I manage 550 kcals - and the male participants on 600 kcal sessions were supposed to achieve it in 60’?

And if the male participants on 600 kcal per session were doing that 5 times a week for 10 months, they should have lost 15 kg.  And all they managed was 5 kg.  It’s a small reward for a lot of effort.  It’s like investing $3000 to receive $1000 in return.  Would the participants continue the program past the 10 months?  Would they continue to lose rather modest amounts of weight, plateau or just regain the weight?

A weight loss of 5 kg in 10 months is only an imbalance between energy intake and expenditure of 120 kcals per day.  It would only take a small underreporting of food intake prior to the study to give the false impression that energy intake was unchanged, whereas it could be that food intake did actually decrease during the study.

And the authors think that exercise should be ‘prescribed’ for weight loss (as if it’s something unpleasant - exercise should be enjoyable).  What would be the response of someone being advised to use a treadmill 5 times a week for 10 months in order to lose an average of 5 kg, with no information as to whether they’d continue to lose the weight at the same rate if they continued, or that they wouldn’t promptly put the weight back on if they stopped?


« Last Edit: October 29, 2018, 02:23:58 PM by bachfiend »
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Offline bachfiend

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Re: Wansink.
« Reply #171 on: October 30, 2018, 03:44:57 PM »
Other studies looking at the role of exercise in weight loss have reported either no loss or modest losses in body weight and body fat.

I’d call a 5 kg loss in body weight after 10 months with 5 one hour sessions on a treadmill per week very, very modest. 

jt hasn’t bothered defending the study despite claiming that it’s virtually a slamdunk against my ‘misunderstanding.’  It’s a very poor study.

I’m not claiming that exercise shouldn’t be encouraged.  Exercise has many benefits, including being enjoyable (if done right) and making the person feel good (ditto).
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