Woman becomes obese after fecal transplant from overweight donor
upi.com
upi.com
So, when I read:
> the woman received a fecal transplant from her overweight but healthy daughter, via colonoscopy
I cringed. There are three things wrong with that. First: you don't need to use a relative, because fecal transplants don't have risk of rejection. Second, you wouldn't use a donor who's overweight. And third, it's normally done with a swallowed capsule, not with a colonoscopy, which adds risk and unpleasantness for no reason.
(Edit: The primary source says "With the occurrence of weight gain after FMT in this case, it is now our policy to use nonobese donors for FMT. The untoward consequences of using nonideal FMT donors are important, because patients may prefer to use a family member rather than an unrelated or unknown stool donor due to the perception that these sources are safer.")
Why did that make you cringe in particular?
Why? These transplants are so new and cutting edge that we don't know if taking from an obese person will be a bad or good thing, anecdotes like this might help us form an educated opinion, but it is too early to say for sure.
You certainly cannot say for sure if that was a mistake because few know that really...
Taking fecal matter from someone who is overweight stacking the probabilities away from your favour.
As always, science doesn't happen via "Eureka!" but by "Well that's strange...".
> This has been found to work for weight loss; you give a normal-weight donor's microbiome to an overweight person, and they lose weight a significant fraction of the time.
Do you have cite for this? I think there is some circumstantial evidence on this, but it's far from settled.
Weight loss is rarely the primary goal of FMT and its efficacy in that realm remains unproven. Nowhere did the article imply that any of the things that made you "cringe" are necessary. And oral administration isn't objectively better than the alternatives, nor is it always an option since many people understandably find the idea of swallowing a "poop pill" rather repulsive.
Well, doesn't this case demonstrate that FMT can be used to have an effect on weight, albeit in the negative sense? So something is going on here, and while the science is unproven, it sure seems like this incident demonstrates that it has promise.
Luckily there has been a rapid uptake in FMT and we'll have good correlational data sooner rather than later.
He didn't say it was the primary goal. In fact, the way I read it it was a side effect.
Perhaps the patient opted for the colonoscopy the avoid the "unpleasantness" of swallowing a capsule of fecal matter. It may not taste like shit, but you know it is.
Later I learned that cow-dung was used for fuel in some of the poorer places on earth.
I always assumed there must be some calories left in stool; and that this seeming-dogma about 'calories in calories out' was completely ignoring what could be a huge amount of calories getting shat out (or not).
That said, the study of gut flora is just starting. Here's a summary of <Nature Article I read a while ago but can't seem to find> : When raising sterile mice (no bacterial whatsoever) they tend to do pretty badly. Low body mass, overactive immune system, etc. Taking these mice and then doing fecal transplants (method is for sure 'icky') from obese PEOPLE and thing PEOPLE (totally strange), the mice tend to be obese or thin. Now, they then just cage sterile mice NEAR transplanted mice, and see the same thing, the flora just waft over and find a home. Then they cage sterile mice near thin and obese mice at the same time. The sterile mice get obese, rarely thin, and NOT in-between, it's all or nothing. Flora, this one article I once read states, come in flavors (real icky ones) that like to be in certain relations to each other. Why the mice tended to get obese is strange, and needs more funding.
Real cool stuff, I guess, but then you get to be known as the 'rat poop eating' labs. So there is a detriment to the research.
One possible situation is that she was eating poorly but didn't gain weight due to diarrhea and when she had healthy stool she gained the weight. Also, 'fatty has no-self control' is a way to stifle opposition to your opinion. Ther is no need for that. The laws of physics apply to all people. Burn more calories than you take in, you lose weight. Clearly there will be factors that determine how many calories you burn (perhaps someone burns them much slower than the average person), but as far as I've read magic isn't real yet. The laws of the universe still apply to everyone. I've yet to see anyone eat well and exercise and not maintain a healthy weight. Ever. Not once.
So I'd take that "overweight" indicator with a grain of salt. If this woman is on the tall side or has broad shoulders and hips, that BMI of 26 could mean she appears athletic or even skinny, and she can certainly be healthy with that misleading number.
tldr: have an upvote for agreement.
BMI is pretty accurate most of the time unless you're an athlete. Women putting on far less muscle on average than men, it's far more likely that she was actually overweight...
This means that tall people will tend to have higher BMIs all things being equal and short people lower BMIs. Which actually suggests that the woman might have been overweight if she was only 5'1" despite what her BMI said.
My understanding is that BMI doesn't "assume" anything about what weight "should" do, its instead a measure which has been empirically shown to have a useful (though rather loose) correlation to risks related to various health conditions, particularly cardiovascular conditions. (Mostly, AIUI, it serves as a proxy for a host of other measures, which together are more accurate but more involved to gather.)
The cube-of-height scaling you refer to is what you would expect if taller people were exactly like smaller people but linearly scaled equally in all dimensions -- but that's neither empirically what taller people are built like nor are taller people whose weight relates to that of shorter people that way on average as healthy in the areas BMI is used a risk measure for as the shorter people.
Yes they do. Ever consider this possibility?
Your body is immensely complex, can rid itself of toxins, pathogens, and other invaders ... but is not able to discard excess calories it doesn't need? To the point of making you sick and immobile?
That makes sense to you? That our body doesn't have a regulation mechanism?
Or perhaps it's more likely that it works in some people and is broken in others. Yes, starving yourself will always work. So will increasing exertion. But so will fixing that regulation mechanism. Just because we don't know how is hardly enough reason to discard the possibility.
Umm.... You are aware that this state of a ton of food being very easy to procure is a recent development right? For a vast majority of the body's evolution food as very rare which resulted in being able to conserve energy optimally being ideal. Evolution is a sum of the entire species past, why are you thinking it makes sense for the body to self regulate its self to a six pack?
Yes, your body can purge itself of toxins. But despite this, intake toxins faster than your body can purge itself of them, those toxins will still cause damage. Why should this not apply to the body's energy regulation mechanisms as well?
It is entirely possible that by consuming poor quality food (rotten, junk, infested with parasites/chemicals/etc.) the regulation mechanism is overwhelmed or broken.
It is also possible it's through a genetic defect. An environmental toxin. A virus or bacteria. A bazillion other alternatives that our level science cannot detect or explain.
My point is that when you see an obese person, the response shouldn't be lazy/stupid/eat less/diet/exercise more. It should be sick/needs research/treatment.
Simple over-eating should be 100% regulated by our bodies and the excess material discarded. It should NOT be a problem. But it IS. Something is poisoning us. Rather than blaming the sick, we should find out WHAT that is.
>That makes sense to you? That our body doesn't have a regulation mechanism?
It's so new of a concept, that evolution hasn't had to select for it for more than a few generations, while 99.9999999% of your evolution has favored gathering as many calories as possible.
We're a social species with status playing a substantial role. It's far more likely some were starving and others were extremely well fed. Same as today. That would mean there was plenty of selective pressure over millions of years. Look at other primates for evidence.
We have never been more than some tens of millions until relatively now. So, there was more than plenty of food for all of us.
In fact, if there's one thing where we have had no time for any evolutive adaptation, is our current population size.
I too had never, ever met an overweight person who ate well and exercised. Not even once! Until I did meet one. Your anecdotal absence of proof is not proof of absence. The vast majority of overweight people may eat poorly and not exercise, but that doesn't exclude other possibilities.
In my case, I eat junk food and lead a sedentary lifestyle, and yet I'm lean and muscular. Care to explain?
No, as I said, I met an overweight person who consistently ate well and exercised (a college roommate). I have no idea how many calories they burned.
By comparison, I ate much more and exercised much less and had very low body fat. Again, I have no idea how many calories I burned.
And that's exactly point. That is to say, given the tremendous variation in almost every aspect of human physiology, is it plausible that there exist outliers whose bodies burn calories at markedly different rates? I don't know, but without more evidence, I'm hesitant to declare it impossible.
Typically when I'm told this either by people wanting to lose or people wanting to gain I just ask them to write down everything they eat for week. Guess what we learn at the end of the week? They really had no clue what they were eating. The skinny people were barely crossing 1500 cals and the overweight people were 2500-3000 and had zero idea. The other fun fact here is that food wise both of those are not very far away. A couple sweets or sugary sodas each day and you can easily cross over.
While there are likely exceptions and extremes (thyroid issues), the vast majority have zero clue about how much they really eat. This is why things like Weight Watchers work so well for many people. You get X points/day. Foods are worth differing amounts of points and when you hit zero stop. People quickly learn what foods are 'free' (veggies, most fruit) and load up on those and then plan the non-free foods to maximize taste/fullness/whatever.
Wrong. Exercise burns calories, but also promotes muscle formation. Forming muscle, pound per pound, takes less calories than burning fat produces. So you can have a calorie deficit while gaining more weight in muscle than is lost in fat.
Depending on exercise patterns, precise nutrition, and other factors, a calorie deficit can result in:
Weight loss and decrease in body fat % (net weight loss disproportionately from fat), Weight loss with no change in body fat %, Weight loss and increase in body fat % (weight loss from disproportionately from muscle), Weight gain and decrease in body fat % (weight loss from fat offset by greater weight gain in muscle.)
(I don't think there is any way for a calorie deficit to result in weight gain and increase in body fat % simultaneously, but I may be overlooking something.)
Additionally, changes in absorption, metabolic efficiency, and other factors can make what is assumed to be a calorie surplus based on food/exercise logs into a deficit or vice versa; both the "in" and "out" side of calories in vs. calories out are, absent a lot of detailed measurement most people aren't undergoing even in inpatient medical settings, a lot more approximate and have a lot more bundled assumptions than people tend to think.
Just eat less, conservation of energy man. Science YO! argument is essentially the abstinence solution for STDs.
Normal people aren't a healthy weight because they sit there and resist hunger all day. Their body keeps it in check.
Finding out why obese people don't keep their diet in check would be a huge help in fighting obesity.
Don't get me wrong, I'm sure for a lot people poor impulse control is part of it, but it clearly isn't the whole story.
Please show me the documentation because nearly everything I have read is to the contrary. More specifically I am interested if there are cases where someone eats less than their TDEE and doesn't lose weight or a case where eating at TDEE is unhealthy for some reason.
TDEE (Total Daily Energy Expenditure) = BMR + Energy expended in a day.
It is very clear concept. Have the self control to master the mental elements and eat less calories than your TDEE and you lose weight. My question do you have research/evidence that disputes this? In my opinion as long as the truth is that being overweight is caused by eating more food than you need, the mentality of "fatty has no self control" is reasonable.
It was certainly true of me 40lbs ago.
The only people using "TDEE" are sketchy fitness websites. There is no wikipedia article on the term, and no legitimate medical or scientific sources.
Some studies have used the abbreviation TEE but even then saying BMR would have been clearer and is a well recognised medical term/abbreviation.
The first thing I did was Google TDEE, the first half dozen results are small gyms, or tiny fitness calculators. If you want people not to question your terminology then use more standard terminology.
> My question do you have research/evidence that disputes this?
Do you have evidence that all of weight loss can be boiled down to "just self-control more?" There have been literally hundreds of studies spanning at least 40 years, few if any have found that the key to fighting addictions is just to "self-control more" otherwise we wouldn't have tons of alcoholics, drug addicts, obese people, and so on...
Maybe you should go work at a drug rehab clinic some time. Just keep saying to people "just learn to self control!" and see how far that gets you...
> In my opinion as long as the truth is that being overweight is cause be eating more food than you need to "fatty has no self control" holds true.
And your opinion ignores 40 years of psychological research into addiction. Congratulations to you.
Umm I never made a claim, you did and I asked you to back it up. You haven't even tried to do this instead you got defensive and launched personal attacks. So I'll take that as no you have no evidence to support your opinion. What evidence is there that being overweight is not an issue of regulating (this is the self control part) your caloric intake?
Also I didn't make a single personal attack. However you have (calling me "condescending"). See we can both play the victim card.
There's something about working your ass off everyday for an hour with resistance and cardio that works.
Everyone I have ever known or seen that went to actual bootcamp loses dramatic weight too, whether be army or marines.
Yes there might be exceptions for some with rare illnesses, but let's not throw out good common sense because of a small percentage of people.
I'm assuming you mean TV show. I doubt you know a great many people that go on an "exercise style bootcamp" personally...
> Everyone I have ever known or seen that went to actual bootcamp loses dramatic weight too, whether be army or marines.
Indeed because in basic training you don't get to pick your own meals and you're also limited to a set number of meals a day. Anyone would lose weight if someone else was controlling exactly what they could eat.
> here's something about working your ass off everyday for an hour with resistance and cardio that works.
Also the fact you think exercise contributes to significant weight loss (as opposed to diet changes, which do) suggest that you may not be very well informed in general.
An hour of cardio is one Big Mac worth of calories. It is insignificant.
They offer a bootcamp program at my office. I have a friend who is a personal trainer. I have relatives who have done bootcamp exercise programs. I drive by one of these every day and see people flipping tires.
> Indeed because in basic training you don't get to pick your own meals and you're also limited to a set number of meals a day. Anyone would lose weight if someone else was controlling exactly what they could eat.
You've obviously never trained hard for anything. At some point you can't consume enough calories to counter the metabolism jump from the hard-core training.
> An hour of cardio is one Big Mac worth of calories. It is insignificant.
That's why I said "cardio and resistance", which you conveniently left off. Yes an hour on a stationary bike does very little, but an hour of intense physical exertion daily will transform a person.
I've seen people lose weight, I've seen people not. Most people I've seen do it for the first time lose weight, but most of those who choose to do it and are doing it for the first time are otherwise-healthy people with high body fat.
> Everyone I have ever known or seen that went to actual bootcamp loses dramatic weight too, whether be army or marines.
Everyone I knew at the time they went to military boot camp gained weight; lost body fat though.
In addition, the group of people that are aware that this type of service is available, and that can afford to take multiple days off work to go to a bootcamp exercise program and pay for the program, is a unique portion of the human population with significant commonalities in genetic markers, cultural backgrounds, and many other areas. Their accomplishments should not be used as an indicator for all of humanity (and of course neither should the events described in the original article).
For the person below who asked for references: Unfortunately I don't keep a file of research on obesity because I don't have the problem myself. So I can't directly point to the things I remember reading. But that is also why I started my comment with "I believe".
Since the scientific evidence for a variety of metabolic conditions, etc., contributing to obesity has been overwhelming for a long time without dispelling the popularity of this attitude, I'm going to say the correct answer is "people who are emotionally attached to the idea of 'fatty has no self-control' will continue to ignore the scientific evidence."
While some forms of obesity have been linked to physical health and or genetic factors, even if you discount that the remaining research has suggested it is a mental health disorder not that dissimilar from e.g. alcoholism, exercise addiction, sex addiction, drug addiction, smoking, and so on.
Essentially food causes pleasure centres in the brain to fire, these make people feel less depressed, tired, or just happier in general. So food is often used to treat depression, which unfortunately as the person gains weight can cause both tiredness, lethargy, and depression to grow, so they need even more food to fight it (rinse, repeat).
But all this won't change perception, because perception isn't about facts. For example, homophobes don't hate gay people for any logical reason that you can fight with facts and evidence, it is deeper than that. You have to deal with the core of their hate, which is often self-hate, or fear.
Ultimately these are people picking on others with a mental health issue. It only makes the depression worse. But they rationalise their bullying as "helping" (even if there is evidence that it hurts, not helps), but really this all comes from a core of self-hate or fear, rather than any logical part.
Type-2 diabetes is a disease. One which has both genetic factors (e.g. some families get it more than other families) and non-genetic factors (e.g. unhealthy food consumption, heavy sugary food consumption).
Food addiction is a mental health issue that causes people to over-consume foods. These foods are often chosen to give the best "buzz" (so often high in sugar, high in salt, etc).
Having a food addiction, if untreated, could increase a person's likelihood of getting type-2 diabetes. In the same way that having a heroin addiction could increase someone's likelihood of having a stroke or heart attack.
Please excuse my lack of reading comprehension today.
The research on alcohol, drug, and other addictions seems to indicate that they are physical health disorders -- often with substantial genetic contributions -- and, in fact, the entire idea of separate "mental health disorders" and "physical health disorders" relies on mind being somehow not a product of the physical state of the body, which, while it certainly connects to beliefs of many popular religions (e.g., concerning the soul), doesn't appear to have any scientific basis at all.
Addiction may be more physically/genetically based than we currently realise.
1. Obesity is unhealthy (i.e. persisting in obesity is self-destructive)
2. Obesity is obvious (i.e. ignorance of your obesity is not an excuse)
3. Obesity is treatable (whether from a mental-health angle or otherwise)
I'm honestly not sure what the mental-health roots of obesity has to do with anything. It may be hard to quit smoking, that doesn't stop me from correctly judging that people who smoke are engaging in a self-destructive behavior. It may take professional help for some people to stop gambling, but I'm still going to judge harshly the parent who gambles away money that should be spent on their children. I would not humor the excuses of an obese person who fails to get help anymore than I would humor the excuses of someone who broke their arm but refuses to get it fixed.
Persisting in a smoking addiction (condition) is as bad as persisting in obesity (condition.)
Regularly smoking (action) is as bad as regularly eating too much (action.)
Edit: It is because in both cases, persisting in the condition requires the action.
People may remain obese while actively choosing to take action to address that condition. It is a mistake to equate remaining obese with persisting in anything.
Also, as I mentioned before, remaining obese requires that someone continue to overeat. In discussions like this, people often harp on this point: if someone wants to lose weight, they need to eat fewer calories. Full stop; it is not an over-generalization or inaccurate point. I view people who bring up mental health issues and differences in metabolism as part of the problem, rather than the solution. It is though they are deliberately trying to make the weight loss process seem more complicated than it really is. I am fully willing to admit that people have differences in metabolism such that some need to eat less than others. I know that mental health issues might need to be treated in order to make it easier for someone to stick to a diet. Neither of these things change the fact that persisting in obesity implies that someone is continuing to eat too much.
We could make the exact same arguments about smoking. You might say that people don't have access to the info they need to quit. I am saying that the very simple way to quit is to smoke less (i.e. not at all.) It is true that there may be unique impediments in each person's quitting process, but I have no doubt that simply by listening to their doctor, they can overcoming them.
Obviously people eat too much. But knowing that does not help them stop eating too much. Most people do not like being overweight; many overweight people are miserable because of their excess weight. Society is judgemental about obesity. Job prospects are worse. Life expectancy is worse. Being obese is expensive. There are so many negatives to being obese, and the answer is a simple "eat less" - so why does that simple answer fail for so many people?
imho the article is awful. There was 1 case study and it happened by accident. The title is just giving another excuse to people who are struggling with self-discipline.
There's nothing inherently wrong with being fat, sometimes people prefer to focus on other things. However, if you want to change, I have the duty to encourage you toward a healthier path. Sugar coating things – i.e. "you can do nothing about it" – doesn't help.
The article spends considerable time talking about the donors, and the rigorous screening process to make sure the donated bacteria are good ones. Obviously, that procedure wasn't followed in this particular incident.
Worth a read!
http://www.newyorker.com/magazine/2014/12/01/excrement-exper...
Please be careful not to read too much into one data point.
> Correlation doesn't imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing 'look over there'.
There seems to be enough evidence that it's not unreasonable to believe your weight is strongly influenced by your gut bacteria.
How is this possible? If they were supplying her with a certain amount of calories per day, she absolutely HAD to lose weight. Unless she was snacking, in which case the whole mystery is solved.
It's weird how people talk about calories in/calories out as if they have a way to measure the second half of the equation.
But more practically, monitoring heart rate is a decent proxy, after calibrating...
Altered metabolism that allowed her to pull more nutrients from her food or store them easier?