85 Chapter 9 – The‘ exercise causes weight loss’ myth You ' ve reached middle age when all you exercise is caution. Unknown Of course I have played outdoor games. I once played dominoes in an open air cafe in Paris. Oscar Wilde You have to stay in shape. My grandmother started walking five miles a day when she was 60. She ' s 97 today and we don ' t know where the hell she is. Ellen DeGeneres We spoke earlier about how we doctors can be a patronizing lot, and no more so than when we blithely tell an overweight person,‘ You should really get out and exercise more’. It’ s bad enough that we are stating the bleeding obvious – pretty much all of us could benefit from more exercise – but what’ s worse is when we are patronizing and wrong. In this chapter I am going to bring you the research on the role of exercise in weight loss and you will be surprised to find that the evidence for its effectiveness is not very impressive. The big issue here is that doctors and dietitians will tell you to eat healthier food and exercise more as if they are equally important when this is far, far from the case. I am going to show you that while exercise is important for general wellbeing, cardiovascular fitness and stress management, it is not a big player in losing weight. This is of critical importance because weight loss requires precious effort. When 80 % of people eventually abandon their weight loss attempt because they find it is too hard, it is critical that