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 https://gokaleo.com/stop-dieting/.”

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!