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Well intentioned lies, doctors, and the diet industry: If weight loss is impossible, then what?

Recently the CBC repeated news many of us know to be true, that significant long term weight loss is so difficult, so rare, that it counts as near impossible.  I thought the piece was pretty well-researched and well-argued and while I have quibbles and questions here and there, frankly I sometimes I find news of this sort a relief. I’m going to write a part two with quibbles and questions but for now, let’s take this news at face value.

You can find this news depressing or liberating. Personally I’m opting for the latter and I’ll say more about why later.

See Research confirms long term weight loss almost impossible.

As incredible as it sounds, that’s what the evidence is showing. For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear. “It couldn’t be easier to see,” she says. “Long-term weight loss happens to only the smallest minority of people.”

We all think we know someone in that rare group. They become the legends — the friend of a friend, the brother-in-law, the neighbour — the ones who really did it.

But if we check back after five or 10 years, there’s a good chance they will have put the weight back on. Only about five per cent of people who try to lose weight ultimately succeed, according to the research. Those people are the outliers, but we cling to their stories as proof that losing weight is possible.

“Those kinds of stories really keep the myth alive,” says University of Alberta professor Tim Caulfield, who researches and writes about health misconceptions. “You have this confirmation bias going on where people point to these very specific examples as if it’s proof. But in fact those are really exceptions.”

Our biology taunts us, by making short-term weight loss fairly easy. But the weight creeps back, usually after about a year, and it keeps coming back until the original weight is regained or worse.

This has been tested in randomized controlled trials where people have been separated into groups and given intense exercise and nutrition counselling.

Even in those highly controlled experimental settings, the results show only minor sustained weight loss.

So that’s the “news,” scare quotes because it’s not new news.

See The Fat Trap, the New York Times in 2011, or The Obesity Era in Aeon Magazine in 2013. (The obesity era article raises the puzzle of fat animals, as humans aren’t the only animals getting bigger. See also I’m not fat, I’m fluffy: The puzzle of animal obesity.)

My favourite though is Gina Kolata’s 2007 book Rethinking Thin: The New Science of Weight Loss–and the Myths and Realities of Dieting. She’s a terrific writer and I highly recommend her book. Kolata is another New York Times science reporter and so this isn’t exactly fringe stuff.

So let’s get back to supposing this gloomy/liberating view is right. Two things immediately follow.

First, doctors shouldn’t prescribe weight loss to overweight/obese patients, especially not without mentioning the long term likely effect. Would we recommend any other treatment with these odds of success? Medical professionals should spend more time emphasizing weight maintenance. Second, especially if you’re a normal weight or overweight person, the last thing you should try to do is lose weight. That looks like a clear fast train to getting fatter.

Here’s the more interesting question, if doctors know this, why don’t they act on it? Here is my guess at an answer. Doctors hate problems they can’t solve. I saw that when they were dealing with a family member with incurable illness. They want to hold out hope.

So that’s part of it. Doctors are also human and reason as everyone does. The simple mathematical model of “eat less, move more” seems obviously true. Weight loss looks like just simple math plus will power. How could it go wrong?

Finally, doctors also know that healthy eating does matter and so too does exercise. Indeed a recent study in the British Journal of Sports Medicine concluded that  for women and heart health exercise matters more than any other factor including obesity. (See Study: Exercise Trumps Body Weight When It Comes To Women and Heart Health.) Doctors fear that without the promise of weight loss, no one would be motivated to eat well and stay physically active. As the article about the impossibility of weight loss says, “Health experts are also afraid people will abandon all efforts to exercise and eat a nutritious diet — behaviour that is important for health and longevity — even if it doesn’t result in much weight loss.”

But I worry that this reasoning gets it exactly wrong. People aren’t idiots. Tell them to exercise and eat well in order to lose weight. What happens if they don’t lose weight? They’ll quit exercising and quit eating well. That’s because you told them to do it to lose weight. And clearly it wasn’t working so why stick with it?

Also, think about the thin people. They need to eat well and exercise too. But if weight loss is given as the main reason to do so, why would they? They’re already thin after all. See How equating being fat with being out of shape hurts thin people too.

Moving past doctors, what about the weight loss industry? Weight loss companies are ethically bankrupt–see my past post on Weight Watchers, I hate you Weight Watchers–and ought to be shunned. They’re in business to sell the impossible dream. If you fail, it’s your fault. Weight Watchers always says that people who attend the meetings lose weight. That’s because those who don’t lose weight sensibly make the decision to quit.

Is there another way? What about companies like Precision Nutrition (see my take on them Precision Nutrition’s Lean Eating Program: A Year in Review) and dietary approaches like Intuitive Eating?

We haven’t tried Go Kaleo’s approach but it also seems to fall into this category. As a commentator on our Facebook page put it, “Her idea seems to be that our focus on ridiculously low calories when dieting pushes people toward a complete lack of ability to see how many calories they’re actually eating (If not all the way into Binge Eating Disorder) See”

These approaches focus on process and habits rather than results. It’s all about the journey.

Okay, but what about results? Does focusing on the process get you where you want to go?

My suspicion, and it’s just a suspicion, is that these approaches don’t fare much better in terms of weight results but that they do help people have a better, healthier relationship with their food and bodies.

Why the suspicion?

First, they don’t track results. Since I left Precision Nutrition’s Lean Eating program there’s been no follow up to find out how weight maintenance is going. I’ve gained weight back but they don’t know that I suspect they don’t want to know that. When I did the program I met lots of people doing it a second, third, or fourth time. Each said, “This time, I’ll do it right.” But that reminded me a bit of Weight Watchers with its high rate of recidivism.

Second, if they had good news in terms of weight loss results they’d share it. Loudly and from the rooftops. Not a single weight loss company shares honest to goodness statistics about their results. You can assume, I think, pretty safely that if there was good news, we’d all hear about it.

Ragen Chastain of Dances With Fat puts it pretty bluntly talking about the CBC piece:

“If you read the comments on the article, which I don’t recommend, you’ll see that many people subscribe to the magical power of semantics. If you attempt intentional weight loss, but instead of dieting you call it a lifestyle change, they claim you won’t gain your weight back. This is the second to the last stop on the denial train, at the final stop people just close their eyes, stick their fingers in their ears, and scream LALALA! “

So why do I find all this liberating rather than depressing?

It removes an impossible goal.

You can move because it feels good and it’s good for you. You can eat because it tastes good, helps fuel your activity, and makes you happy and  healthy.

You can join Tracy in stepping off the scale.

You can love your body the way it is now.

Now go play! Enjoy!

Image: Misty grassy spot in a forest Jonas Nilsson Lee, Unsplash

9 thoughts on “Well intentioned lies, doctors, and the diet industry: If weight loss is impossible, then what?

  1. Great post, and thank you for all the links you provided for additional reading. I have been mulling over this study too–and do not believe only “a few rare” people can maintain a healthy size. Notice I didn’t say weight. The thing about weight? it fluctuates all the time! I’m beginning to think that if people knew and accepted this (and as you said, step off the scale!), because that measure is meaningless, there would be fewer knee-jerk reactions to thinking we all need to be on a diet half our lives. There definitely needs to be more teaching on how-to maintain–including the fact that you can still be maintaining even if the scale goes up and down 10 times a week. I have been trying to figure this out for about 5 years–and it is hard but I can’t be one of those rare few–this can be done by more people. We need to get that message out. Do you want to be old and decrepit when you are 80? Keep doing what you are doing and you will be. Eating well and exercising every day, learning about balance and flexibility and good food for cognitive functioning will help you live better for longer. I’m motivated by that. It’s not about the weight. This study although interesting worries me, because people might just give up thinking they just can’t do it. They can. They just have to choose it. As you can see, I could go on and on about this one! Anyway, thank you for the post!

  2. Very thoroughly done– thanks, Sam! I’ve fought with my internist about these issues for years, and am on the verge of switching doctors, as I get no support no matter what I do (lose weight, gain weight, xc ski, cycle, whatever). One thing that deserves more research by medical/pub health/obesity folks is this: populations with type 2 diabetes, high blood pressure, cholesterol or triglycerides, etc. have shown a massive benefit in those clinical markers from a 5-10% body weight loss. Some bariatric surgeons have both done research on this and have adjusted their recommendations for weight loss targets for those who are BOTH very heavy AND have these clinical markers. Some of the initial results are promising, but I’m not aware of super-successful long-term studies looking both at weight loss and tracking these markers in these populations.

    This is just a pub health wonky comment, and not in any way an objection to your post. But it does add fuel to your fire here– the human metabolic landscape is very complex, and the myopic view “weight loss good, adherence to BMI scale good, no weight loss bad” ignores virtually all the research we have to date.

  3. Robin, why can’t you be one of the lucky few? Why think that healthy size is what’s important rather than healthy behaviors? Most of what you’re saying is about habits and behaviors, not size.

    I think one of the important messages to get out is that it’s better to be healthy than a particular size/weight. I find the Edmonton Obesity Staging System to be really helpful: If one is fit, obesity (via BMI) doesn’t predict mortality.

    Sam, I think your suspicion is probably right. *sigh*

  4. Great post. Lots to think about. I think there is a deep collective denial about the terrible longterm maintenance stats.

  5. I hadn’t seen this article yet and I’m glad I found it here. You always have a very open and accepting perspective that is both funny and informative. As a personal trainer I try to tell people that they need to like what they’re doing and do it for themselves and to feel good. It’s not all about being a certain shape or size. IT’S ABOUT LIFE!

  6. This confirms a lot of my own thoughts on the matter. I will admit to feeling excited and proud when I see the scale numbers go down, but I also don’t beat myself up too much when they go up, because they’ve hovered in the same 10-15 lb range for the past decade, even with all the “lifestyle” changes I’ve made. What I’ve been focusing more on is body fat composition and increasing muscle. I’ll be happy to be the weight I am as long as it’s more muscle and less fat, and that’s my goal. That’s a goal I know I can achieve, because I am capable of doing the work to build muscle, and I’m not capable of the extreme dieting required to burn fat without much physical activity.

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