Active Voice: Responding to a NY Times Article That Missed the Point - “To Lose Weight, Eating Less is Far More Important Than Exercising More”

By John M. Jakicic, Ph.D., FACSM

Viewpoints presented in SMB commentaries reflect opinions of the authors and do not necessarily reflect positions or policies of ACSM.

John M. Jakicic, Ph.D., FACSM, is a professor and chair of the Department of Health and Physical Activity at the University of Pittsburgh in Pennsylvania. He also is director of the Physical Activity and Weight Management Research Center at the university. Extensively published and well-funded by NIH research grants, Dr. Jakicic’s specialization relates to health effectiveness of long-term strategies for successful weight loss in overweight populations. A particular focus in his work has been the role of physical activity in these interventions. Dr. Jakicic has served in numerous appointed and elected volunteer positions with ACSM. He currently is the chair of ACSM’s Strategic Health Initiative on Obesity. In the last few years, he also served on the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines – a group of leading health scientists charged with developing and publishing four special reports in 2014 that address lifestyle management of risks for cardiovascular disease and overweight and obesity in adults.

Dr. Jakicic presents this invited commentary in response to an article recently published in the New York Times (NY Times). That article, by Aaron E. Carroll, M.D., was entitled
To Lose Weight, Eating Less is Far More Important Than Exercising More”. The NY Times is one of the foremost news sources in the world, having the largest circulation of any print newspaper in the US and having won more Pulitzer Prizes than any other news source. Therefore, the opinions expressed in the article by Dr, Carroll may influence understandings of a great many. For this reason, SMB is grateful to Dr. Jakicic for sharing an alternative viewpoint in this Active Voice commentary.

Excess body weight, typically termed overweight or obesity, is highly prevalent in the United States. Moreover, this excess body weight is typically associated with many additional negative health consequences that range from metabolic (diabetes, heart disease) to physical (musculoskeletal pain such as back pain, leg pain, etc.) to psychological (depression) to social stigma. Thus, it is imperative that effective treatments and interventions are developed and implemented to have both an initial and sustainable impact on addressing the significant public health problem that is obesity. The article entitled “To Lose Weight, Eating Less is Far More Important Than Exercising More” authored by Aaron E. Carroll that was published on June 15th in the New York Times raises the public health issue of overweight and obesity. Unfortunately, the headline and, additionally, the overall tone of the message contribute to reader misunderstanding regarding how to effectively combat the obesity epidemic in the United States and many other countries throughout the world. The article also further encourages the false notion that one important lifestyle behavior is more important than another — when in fact, for effective weight control, physical activity is just as important as appropriate diet and nutrition.

The challenge for most individuals is not initially losing weight, as most are extremely successful at this phase of weight loss. Rather, the challenge is maximizing the weight loss that is achieved in the early phases of this process (the initial 3-6 months) and then maintaining the weight that is lost. From this perspective, physical activity is very important and contributes an additional 5-7 pounds of weight loss beyond what can be achieved with dieting alone (http://www.ncbi.nlm.nih.gov/pubmed/19127177). Moreover, it is very clear from the scientific literature that physical activity is critically important for maintaining weight loss (http://www.ncbi.nlm.nih.gov/pubmed/19127177, http://www.ncbi.nlm.nih.gov/pubmed/24239920, http://www.ncbi.nlm.nih.gov/pubmed/25376395. And, the process of developing a physically active lifestyle needs to start while one is engaged early on in efforts to reduce by dietary means. Thus, de-emphasizing the importance of physical activity for individuals who are overweight or obese provides incorrect information to the public. The effect is only to further confuse people with regard to how they can best manage their weight and achieve long-term and sustainable success.

Therefore, it is important that all of us, including the media, provide accurate information to the public - information based on the entire breadth of science, rather selective components of the evidence available. The clear and accurate evidence-based message that needs to be consistently provided to the public for weight control and successful long-term and sustainable weight loss is:
  1. Eat foods in the appropriate portion size to meet your nutrition needs, with the quality and composition of the diet consistent with public health guidelines;
  2. Progress to engaging in at least 30 to 60 minutes per day of activity that is similar in intensity to brisk walking (walking as if you need to get somewhere in a hurry) that can be done in bouts of at least 10 minutes at a time; and
  3. When possible, seek opportunities for other household, occupational and lifestyle activity to further increase daily energy expenditure
(http://www.ncbi.nlm.nih.gov/pubmed/24239920,
http://www.ncbi.nlm.nih.gov/pubmed/25376395).

Editorial Note: Dr. Jakicic’s viewpoint derives from his extensive experience leading large-scale interventions that incorporate dietary and physical activity behaviors for weight reduction in overweight adults. One of his recent contributions on these issues (http://www.ncbi.nlm.nih.gov/pubmed/25376395) presents definitive evidence on the unique and notable contribution of structured physical activity to long-term weight loss among overweight adults. Also, he and his colleagues on the ACC/AHA Task Force on Practice Guidelines, after a comprehensive vetting of several hundred published reports from the last decade related to the issues of his commentary, determined that physical activity is a necessary part of effective behavioral interventions for weight reduction. His final recommendations provide us with a clear, concise and up-to-date translation of the scientific evidence on the unique and complementary role that physical activity contributes, along with diet, to achieving and maintaining weight loss and reducing risk factors for cardiometabolic diseases.

ACSM is a global leader in development and advocacy of scientifically-based information relating to sport and exercise. Comprehensive evaluation and accurate translation of this science is a first critical step in this process. Then, a systematic and vigorous advocacy program based on these high-quality information resources, becomes the means for us to improve health and safety through physical activity in our communities. Be assured that ACSM is committed to continuing, even expanding, its development of tools and resources that will help achieve these goals. Look for further updates on this in future issues of SMB! Meanwhile, we encourage ACSM members to communicate with local media on these issues. Contact the ACSM Communications and Media Advocacy office to call attention to similar stories that appear in the national and international media. Finally, share the key points in Dr. Jakicic’s commentary with your colleagues, students, clients and the general public, wherever possible.