CBC: Obesity research confirms long-term weight loss almost impossible

The CBC has an article on what obesity research shows.

After years of study, it’s becoming apparent that it’s nearly impossible to permanently lose weight.

I’m not sure that’s news, but go on.

 For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear. … “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.

When Traci Mann analyzed all of the randomized control trials on long-term weight loss, she discovered that after two years the average amount lost was only one kilogram, or about two pounds, from the original weight.

FYI, a PDF of Traci Mann’s study is here.  Most people — up to two thirds — regained all the weight they had lost, PLUS more.  Oh, and several studies indicated that dieting was actually a consistent predictor of future weight gain.

(File under: Things they don’t tell 8-yr-olds when putting them on their first diet.)

I was a bit puzzled at:

But eating right to improve health alone isn’t a strong motivator. The research shows that most people are willing to exercise and limit caloric intake if it means they will look better. But if they find out their weight probably won’t change much, they tend to lose motivation.

Is this a reference to (please choose one):

  1. People who improved their nutrition in an effort to lose weight and who stopped when weight loss slowed or stopped?
  2. That people are only willing to improve their nutrition if the carrot is “weight loss” and not “health”?

Because (let’s face it) option 1 is a classic bait-and-switch, and I know how demotivating that is to experience.

Mom/Teacher/Doctor:   “You should do this! You’ll lose weight!”
Me: *Does it*
Mom/Teacher/Doctor: “Why aren’t you losing [more] weight?  Oh dear. You’re probably healthier now!  So keep it up — maybe you’ll lose more!”
Me: *Sudden intense desire to commit matricide.*

I do love that the CBC quoted Traci Mann on what to do about this:

 Traci Mann says the emphasis should be on measuring health, not weight. “You should still eat right, you should still exercise, doing healthy stuff is still healthy,” she said. “It just doesn’t make you thin.”

And yes, that sounds like Health At Every Size®.

Exercising for Strength

[Please avoid if references to calorie counting, restriction, or binge eating is a problem. This also goes for most of the links.]

Lately I’ve been reading two very different blogs for their exercise content.

One is Shaunta Grimes’ Tumblr, where she’s discussing her “100 Day Experiment” with Health At Every Size®.  Shaunta had begun her weight-accepting journey years before, but still counted calories and tried not go above 1800. Unfortunately she’d end up binging periodically.  During the 100 Day Experiement, Shaunta began eating at least what her body needs,  getting enough sleep, and exercising in slowly increasing amounts.  Shaunta began with exercising 10 minutes a day and has since added swimming & weight lifting.  Shaunta is thrilled to have more energy, be sleeping better, have less edema, and be stronger. She also hasn’t been binging. She has lost a small amount of weight but remains above 350lbs.

The other is 300 Pounds Down. Holly, the author, had weight-loss surgery in 2011 at 417lbs.  She’s lost 200lbs at the moment and intends to lose more (hence the name of the blog).  Holly began exercising for 30 seconds, increasing 30 seconds a day, working up to walking 5 miles a day.  An injury sidelined her walking, and then she began lifting weights with Crossfit.

Obviously these are two very different narratives.  But: both women began exercising while weighing over 350lbs. (Kinda like me.) Both began very gradually and increased slowly but steadily. (Yup.) Both women are getting stronger — and delighting in that fact! (Yup…)  Both have more energy.  Both are happier.  And both are encouraging me to continue my own exercise efforts.

I support bodily autonomy, including the right for each person to decide whether to exercise. I choose to exercise for my own selfish reasons. I support others in making their own choices. Both of these blogs have helped me to reflect on my own experiences with exercise and on my own victories, like “lifting 40lb boxes” and “better at carrying things upstairs”.

(And yes, I’m aware that Shaunta & Holly have very different blogs!!!  Shaunta, like myself, is a HAES proponent;  Holly has weight loss as a primary goal.  Shaunta is  deliberately eating more than she had before; Holly is deliberately eating much less & differently than before.)

Green Tea Extracts

I’ve written before that our society tends to push weight loss “pros” and not mention “cons”.  Here’s a “con” you may not be familiar with.

There are many products to help people lose weight (if only temporarily).   Some “fat burning” supplements contain green tea extracts, which in high doses can be toxic to the liver.

 The investigators looked at 845 patients with severe, drug-induced liver damage who were treated at hospitals in the network from 2004 to 2012. It focused only on cases where the investigators ruled out other causes and blamed a drug or a supplement with a high degree of certainty.

When the network began tracking liver injuries in 2004, supplements accounted for 7 percent of the 115 severe cases. But the percentage has steadily risen, reaching 20 percent of the 313 cases recorded from 2010 to 2012.

Those patients included dozens of young men who were sickened by bodybuilding supplements.  […]

A second trend emerged […in…] patients with liver injuries linked to herbal pills and powders. Two-thirds were middle-aged women, on average 48 years old, who often used the supplements to lose weight or increase energy. Nearly a dozen of those patients required liver transplants, and three died.

Not all supplements are dangerous, of course. But this is part of why I get leery of gyms and personal trainers who push pills and powders — and anything with “lose weight fast” in the title.

Quote of the Day: Hunger, Food, and Self-acceptance

[Discusses calorie counts, reference to dieting/WLS]

I work with Michelle, The Fat Nutritionist, and she’s changed my entire life and my entire relationship with food. I was talking to her about hating myself for eating more often than I “should” […] She said my body requires more calories than I’m able to consume in one sitting . That my 350 pound body requires more calories to function than someone who is, say, 200 pounds. That’s why I eat more often…I need more nutrients and calories than my stomach is capable of holding at any one time. Blew. My. Mind. I just thought, well I’m clearly eating too much […]

We’re told so often that we’re supposed to eat 1,200 calories a day. The end. No flexibility. No matter how much you weigh, no matter how hard you work. 1,200 calories. That’s what I learned as a child and I’ve held on to that – even when I know, logically, that it’s complete and utter bullshit. Even dieting sites tell me I should be eating 2,500+ calories just to function. When you’ve believed your entire life that 1,200 calories is your goal, giving yourself permission to eat twice that amount is terrifying. I don’t trust my body. I don’t trust my hunger. How can I? Look where that left me.

What Michelle teaches me is to learn to accept that my body knows best. My body knows what it needs from me. And even after ignoring and disbelieving that for 30 years, I can teach myself to slowly start listening to the things my body tells me. I can permit my body to eat what it needs and wants, whether that’s a candy bar or a bucket of greens. I can give myself permission to eat. I can eat without judgment or fear or shame.

The food mantra I’ve come up with and repeat to myself when I eat: My food choices are valid. I’m allowed to eat this.

— From Heidi at Attack of the Sugar Monster, in discussing learning to eat more intuitively.   (Warning: Linked page includes discussion of weight loss surgery, eating disorders, and purging.)

I don’t try to count the calories in my food;I know the human body isn’t a bomb calorimeter. But I learned, young, that I “eat too much” (because otherwise I wouldn’t be fat) and was urged to diet (even though dieting isn’t necessarily about being healthy).  Heidi’s framing of this, of learning to trust her body, is really helpful to me.

I am also a fan of The Fat Nutritionist, though I haven’t worked with Michelle one-on-one myself.


Mod note: I keep this a space to discuss life & fat acceptance without focus on weight loss. I realize that quoting from this post of Heidi’s  may seem to open up the door to discuss weight loss here. NOPE. If you want to talk about it, please take it elsewhere.

Yes, I have done some reading on weight loss surgery and am not interested.  I believe in body autonomy and letting each person make their own choices about their own body — including weight loss — even though choosing not to diet is considered wrong by society.

Why I Think Declaring Obesity A Disease is Harmful

It’s inaccurate:

It distracts from the real issues:

It’s a win for the weight cycling industry

Unfortunately, what’s good for the weight cycling industry isn’t necessarily good for patients: 

There is a Change.org petition on this – I’ve signed, have you?

Around the web

Image courtesy of Rudd image gallery.

Image courtesy of Rudd image gallery.

A useful discussion of how to say the right thing to someone in hospital (or other bad situation.)

Christianity Today wonders if antidepressants keep people from God.  Fred Clark at Slacktivist responds:

No pious jackasses sit around pondering “Should Christians Take Insulin?” No insufferably holier-than-thou idiots pretend it would be deeply spiritual if they said, “Rattlesnake anti-venom can help, but it can also hinder our reliance on Christ.” Or “An emergency appendectomy may sometimes be beneficial, but only if we’re careful not to allow it to overshadow our true savior.”

Obesity Panacea debunks the latest “Paying people to lose weight is the ticket!” study, noting that the weight was regained during the 3-month follow-up:

Over the course of the 4 month intervention individuals in the incentive groups earned an average of approximately $300, in contrast to $0 awarded to those in the control group. Interestingly, the average weight loss achieved by those receiving a financial incentive was significantly greater as compared to that of the control group (13-14lbs vs. 4 lbs, respectively). Furthermore, only 10% of individuals in the control group versus approximately 50% of those in the incentive groups achieved the target weight-loss of 16lbs.

However, during a subsequent 3-month follow-up, study participants gained back much of the lost weight after the cessation of the financial incentives – a finding which is common to most, if not all, weight-loss intervention studies.

[…]

[I]ts a cute and gimmicky approach to providing incentive for weight loss, and the idea makes for great headlines (as recently illustrated). I’m sure financial incentives can work for some, but this is no obesity panacea.

(emphasis added)

At ASDAH’s HAES Blog, Fall Ferguson has an interesting question about the opportunity cost of society’s obsession with weight & thinness:

[W]hat do we forego as a society when we allocate precious social, economic, cognitive, emotional, and physiological resources toward pursuing and maintaining our weight-based paradigm of health?

Some of the damages discussed are to public health, proper health care for many thin and fat people, productivity, fun, creativity, self-esteem, and happiness.  I know many who’ve found that abandoning weight loss efforts provided more time and energy for LIFE, such as school and work.  (In our current culture, it can also mean accepting difference.)  But it’s worth thinking about: What could be accomplished if we weren’t wasting so much effort on weight?

Weight Loss Myths

Shakesville posted about this Gina Kolata NY Times piece already, but I wanted to highlight this:

David B. Allison, who directs the Nutrition Obesity Research Center at the University of Alabama at Birmingham […] sought to establish what is known to be unequivocally true about obesity and weight loss.

His first thought was that, of course, weighing oneself daily helped control weight. He checked for the conclusive studies he knew must exist. They did not.

“My goodness, after 50-plus years of studying obesity in earnest and all the public wringing of hands, why don’t we know this answer?” Dr. Allison asked. “What’s striking is how easy it would be to check. Take a couple of thousand people and randomly assign them to weigh themselves every day or not.”

Yet it has not been done.

And, in the meantime, you have parents, doctors, families, and friends advising people to follow these myths. You have weight-loss companies making money from these myths.  And they don’t work. Or, they work for some people. Or, they work temporarily before all the weight comes back (plus more).  Feel like hitting one of the lying liars who lie and mislead people into putting all that time and energy and work and money into eventually gaining even more weight yet?

From Allison’s study abstract: 

Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information.

What sort of myths?  Back to Gina Kolata, here’s some weight loss ideas that have been proven to not work, yet are commonly preached to people everywhere:

  • Small things make a big difference. Walking a mile a day can lead to a loss of more than 50 pounds in five years.
  • Set a realistic goal to lose a modest amount.
  • People who are too ambitious will get frustrated and give up.
  • You have to be mentally ready to diet or you will never succeed.
  • Slow and steady is the way to lose. If you lose weight too fast you will lose less in the long run.

Kolata also highlights some ideas that have not yet been proven true OR false:

  • Habits in childhood set the stage for the rest of life.
  • Add lots of fruits and vegetables to your diet to lose weight or not gain as much.
  • Yo-yo diets lead to increased death rates.
  • People who snack gain weight and get fat.
  • If you add bike paths, jogging trails, sidewalks and parks, people will not be as fat.

…and yet, again, these are in diet books, diet programs, and in the last, calls to change how cities are laid out.  (Not to say that bike paths, jogging trails, sidewalks or parks are bad. Just that they won’t automagically make people thin.)

Why is this?  Doctors believe that being fat is terribly, horribly bad.  They want to give people something concrete to do.  And, often, doctors aren’t educated about nutrition or obesity research.  We end up with these myths being repeated over and over, endlessly, and people blame themselves when they don’t work or don’t work long-term. Or they figure it probably works for most people, just not me.   Even the list of “Facts – Good Evidence to Support”, which starts with “Heredity is important but is not destiny”, makes me wonder how much of it suffers from the “must hold out hope of weight loss!” bias.  Especially when the article notes that losing 10% of their weight is typical, and very few lose more.

Overall, the NEJM paper is a call to improve the research.  Even so, they’re not tackling the big “weight loss improves health” idea, or how much of its support comes from short-term studies that include exercise as a component (and never mind that exercise can improve health on its own, independent of weight loss).  Even the reference to most weight loss being in the 10% range will likely not burst the FOBT.

As Liss notes, “What a different culture it would be if fat people weren’t a problem to be solved.

Conflating Dieting with Eating Healthy

[Feel free to skip if you don’t want to think about dieting right now.]

Image courtesy of the Rudd Center Image Gallery

Image courtesy of the Rudd Center Image Gallery

It’s January and there is the usual plethora of diet commercials extolling weight loss. Google “dieting” and up comes Special K’s “Healthy Eating Plan”!

That said, it is a bit refreshing to see someone write:

As a lifelong dieter, let me tell you from experience: A diet need have nothing to do with “eating healthy.”

[…] It’s possible to lose weight by eating more healthily. But losing weight and eating more healthily can also be two totally different goals.

The cultural conflation of “eating healthy” and “dieting” has a lot of built-in assumptions.

There’s certainly more (and I haven’t even gotten into all the debate over what “healthy eating” means).

One result of the end-of-year crunch at work is that I haven’t been eating lunch regularly.  I’m going to work on permission to eat what I want, and eating at regular intervals.  But I am still avoiding diet commercials.

Americans Are Fatter Than They Think!

I tweeted this, but I’m just not sure how to fully express the snark this deserves, so I thought y’all might want to give it a try.

See, a study has discovered that…drumroll…BMI can be inaccurate!!!!  Really!!!  You might be fat and not know it!!!  (eeek!)  And since most people who are “overweight or obese” aren’t actually very fat, increasing the number of people who think they need to lose weight can increase customers for the weight cycling industry.

….

I keep thinking I’m missing something here.  Got anything else?

Ripping off the Yay! Scale

For years, Marilyn Wann has created and sold Yay! scales, used them in anti-diet activism, and written about them online and in her book FAT!SO? : Because You Don’t Have to Apologize for Your Size. Others have mentioned Yay! Scales in books as well, including Health At Every Size.

Now Kellogg’s is using a very similar scale to sell their “Special K Challenge”. According to The New York Times:

In a new commercial, women in Times Square reluctantly agree to get on scales in public, then are pleasantly surprised when, instead of numbers, the scales display words including satisfaction, pizazz, confidence and moxie.

The commercial, part of campaign by the Chicago office of Leo Burnett, part of the Publicis Groupe, will be introduced on Jan. 2, high season for weight-loss companies.

“We’re trying to change the conversation from one that’s always focused about deprivation to one that’s focused on motivation,” said Doug VanDeVelde, senior vice president for cereal marketing at Kellogg.

Let me get this straight.

The entire point of a Yay! Scale is that you get compliments instead of a number.

Because the number isn’t important.

Because so many people in this society measure their worth by their weight.

Because it’s about changing the conversation. 

It’s about yanking away that all-important number and suggesting other things might be more important than weight.

It’s about making people smile instead of feeling judged.

It’s about changing the focus to life instead of weight. It’s about getting a life instead of yet another a diet.

And here’s Kellogg’s acting like they invented a scale that gives compliments, only it’s to encourage dieting.   Maybe no one at Kellogg’s knew about the Yay! Scale, but … you know what the first hit Google gives me on “scale compliments”?  A post about … a Yay! Scale.

Remember when Weight Watchers ads claimed that diets don’t work (because somehow Weight Watchers isn’t a diet)?   It’s co-opting the language of fat acceptance, but twisting it to support dieting.

Weight Cycling Industry

From Deb Burgard comes this amazing post on weight cycling:

Why do we call it the “weight loss industry” when what we really get for our time, sacrifice, and money is weight cycling? 19 times out of 20, what we are really purchasing is the experience of weight loss and regain.

Imagine if we called it the “weight cycling industry,” and “weight cycling programs.”  Would you participate in Weight Cyclers at work?  Buy food from NutriCycle?  Hire a trainer from the Biggest Weight Cycler?  […]

Because that is what we are doing, folks.   Better face the facts:  Of 100 people trying to lose weight, the vast majority of people will regain weight. Some significant group – perhaps a third – will gain more weight than they lost.  Some tiny number (7? 5? 3?)  will maintain their weight loss, and of that group, some number from 0-4 of them will be flirting with, developing, or fortifying an eating disorder.

People ask me why I don’t diet anymore.  I don’t lose weight “for good” — my weight goes down in the short term  and up in the long term, ending up weighing more than when I started.   So yeah, “weight cycling” is more descriptive than “weight loss”.

And yet, people ask, “what about health“?  As Deb points out in the same post:

It is the practices that people adopt in the pursuit of weight loss that are the problem, because for the 95 out of 100 people who regain weight during a diet, when the practices are not sustainable they lead to more physical and psychological illness.

The Health at Every Size® model is weight neutral.  People using this approach are not pro- or anti-weight loss, but they are mindful that the pursuit of weight loss is usually harmful, unlike the cultivation of sustainable practices that feel life-affirming and support your health.   In keeping with the “truth in advertising” theme, the Health at Every Size model does not insist that everyone is healthy at every size, or that anyone anytime is necessarily the size that optimizes their health.  “Health” in this context means that whatever size you are, there are practices that will support your health.

As I’ve written before, I don’t consider myself perfectly fit.  But I refuse to frame exercise or healthy eating or getting enough sleep as “something I’m doing for weight loss”.  What matters is the effect is has on me.  Getting enough sleep makes me feel good.  Lifting weights makes me feel strong.  Walking increases my endurance.  That’s why I’m doing it.

It’s not the diet. It’s YOU.

From a discussion of celebrity endorsements of diet plans comes this gem from Nutrisystem exec Stacie Mullen:

“The dieting public understands that the dieter has a responsibility to comply with the program,” said Ms. Mullen, adding that if the dieter fails, “I don’t think the public blames the program the dieter was on.”

And from Zalmi Duchman of the Fresh Diet:

“If they don’t do good on it, it doesn’t mean the product doesn’t work,” Mr. Duchman said. “It just means that they’re not sticking to it.”

This perception really helps diet companies stay in business.  I’m sure diet programs REALLY don’t like this:

Reviews of the scientific literature on dieting (e.g., Garner & Wooley, 1991; Jeffery et al., 2000; Perri & Fuller, 1995) generally draw two conclusions about diets. First, diets do lead to short-term weight loss. One summary of diet studies from the 1970s to the mid-1990s found that these weight loss programs consistently resulted in participants losing an average of 5%–10% of their weight (Perri & Fuller, 1995). Second, these losses are not maintained. As noted in one review, “It is only the rate of weight regain, not the fact of weight regain, that appears open to debate” (Garner & Wooley, 1991, p. 740)
Traci Mann et al [emphasis added]

Most dieters regain their lost weight. It’s not that “they didn’t stay with the program.”  It’s that most dieters regain. Period.  The few who maintain significant weight loss long-term are a very small minority.   But as long as they trumpet “Anyone can lose weight!  Just pay us!” they can drown out the downer research that shows how unproven and full of lies their programs are.

US Obesity Rates Level Off Again?

Oh, not again.  Still.  They’ve been level for years, but this time the Journal of the American Medical Association noticed. There’s discussion as to why, such as “people are getting healthier”.  Given how dieters often gain weight in the long term, I thought this perspective a bit more realistic:

Dr. Ludwig said the plateau might just suggest that “we’ve reached a biological limit” to how obese people could get. When people eat more, he said, at first they gain weight; then a growing share of the calories go “into maintaining and moving around that excess tissue,” he continued, so that “a population doesn’t keep getting heavier and heavier indefinitely.”

That’s not what my mother told me.  She was convinced that if I wasn’t actively dieting I would continue to gain weight for the rest of my life.  Yet when I finally quit dieting my weight … leveled off.  Huh.

Furthermore, Dr. Ludwig said, “it could be that most of the people who are genetically susceptible, or susceptible for psychological or behavioral reasons, have already become obese.”

Gee, y’think?

Things to Read

This is kind of a mishmash ;)

If you’ve seen comments about “dickwolves” and PAX and wondered what it was about, JetWolf has a nice summary.

Author Seanan McGuire addressed why fixing the US healthcare system is so terribly, terribly important this week.  Seanan has discussed why she needs health insurance here and here.

Seanan’s new CD, Wicked Girls, is available for ordering at CDBaby.

Alternet has a well-done piece by Judith Matz on “Why dieting makes you fatter”.  It references Linda Bacon’s Health At Every Size study, Traci Mann’s survey of diet studies, and other research.   If you’ve been into fat acceptance a while it’s mostly things you know, but it’s good to see getting wider play.  It might also be a useful “FA 101″ piece.

A 3-part Q&A with Linda Bacon is over at PyschCentral, too.

Ragen at Dances With Fat has a great post on respecting others’ choices while discussing Fat Acceptance and HAES.

Anything else?