This is a nice NYT piece on some of the physiology behind the difficulties of maintaining weight loss (“The Fat Trap.”) (Failure rate of diets is typically 85-95%) It profiles a couple who has lost significant weight and spends significant effort trying to maintain that weight. (Scrolling through the pictures of a day in their life is fascinating, and a little sad to me…) Ironically, the author ends the article implying that someday she will try (again) to lose and maintain the loss in spite of the daunting task it is.
It’s worth a read, but here are a ten things I would have liked the author to touch on, or perhaps explore in further articles:
1. If an “underweight” person, or a teen girl did the behaviors that the Bridges do in the article to maintain weight loss, they would qualify for at minimum severely disordered eating, and likely qualify for an eating disorder diagnosis. If the behavior is disordered, and the person does nothing but think about weight and exercises hours a day, is it not an eating disorder? (Obsess about food and calories, weigh every bite, weigh themselves daily…) Are these folks happy? What are the stressors, the social costs of maintaining weight loss? Have they lost friends, hobbies, social networks, a purpose in life, all things that are shown to improve health? A recent metanalysis showed that men and women who lost more than 10% of their body weight actually had higher mortality. Though the design of the study had some flaws, weight loss is not necessarily innocuous, particularly if the psychic toll appears to be so high.
2. No acknowledgment of the data that yo-yo dieting is more harmful than staying at a higher but stable weight. The word needs to get out that dieting can be very harmful.
3. No mention of HAES (Health at Every Size) philosophies. Mounting data shows that adopting healthy behaviors, even without weight loss, improves health. Wouldn’t the author be better served? Wait, she says her health is good, she exercises etc, so this is about image, no?
4. I’d love to know what this costs the couple. They have fancy recumbent bikes, racing bikes, take swim aerobics classes, digital scale, pomegranate seeds, time for 1-2 hours of exercise a day… Is maintaining weight loss, even at this amount of effort, only possible for the wealthy, retired elite? (I note that it is far easier for my daughter’s grandparents to get in their daily work-outs than it is for her parents.) Can anyone who works or is trying to feed a family do this? Maintaining weight loss is their new career.
5. Weight bias. Mrs Bridge says when she was a teen, she dieted on 1400 calories a day, people accused her of lying and how painful that was. My clients tell me this all the time. Their kids are on calorie restriction, but aren’t losing weight fast enough for the nutritionist or MD, who are subtly, or outright accusing the parents of lying, or not keeping track, when in fact they are. The fact that professionals who are recommending diets don’t know or care to inform themselves about the physiology piece is tragic. I’ve been there, the sense on the part of the professional, is “Why don’t they do what I tell them to do,” never, “Why is what I am asking these parents to do failing over and over?”
6. If the hormonal changes that go along with weight loss that try to get the body back to the original weight persist for up to six years, then should any study less than five years get any audience in terms of weight and health? Most studies I read are in weeks to months, perhaps 1-2 years, and rarely follow out to the gold-standard of five years (maybe it should be six?)
7. Does the mindset of deprivation/diet effect hormones significantly? (Remember the Mind over Milkshakes study?) It showed that how we THINK about food, indulgence vs deprivation, effects ghrelin hormome levels (the food in the study was the same…) So, I’d like to see more of an explanation or examination of that possibility. Could the mind’s obsession with weight loss make the body work harder to put the pounds back on?
8. If we are just unraveling this in adults, what the heck happens to young children who are put on diets?? The hormonal milieu is far more complex when you add in growth spurts, not to mention the developing brain and the setting down of neural pathways. If a human body and soul only knows restriction and worry about weight, what are the chances of growing up healthy and happy? (I am seeing more and more infants and young toddlers put on diets…) If dieting changes metabolism, hormones and the make-up of muscle fibers, are these kids building bodies that are even more at risk of unhealthy weight gain– for them? Perhaps their genetic set-point may have been 180 pounds, but with a lifetime of chronic dieting they struggle for decades bouncing around a much higher weight?
9. Genetic testing. Ugh. Of course, in my mind relates to the last two points. First, it seems that the known contributing genes are just beginning to be understood. If we don’t know the whole picture, is it accurate or kind to give someone a prognosis of “low” or “high” risk based on a handful of “known” markers? Second, how does it further mess up one’s trust in one’s body with a “diagnosis.” Might a “low risk” or “high risk” person eat differently based on a perception of risk? And thirdly, if a parent is given a diagnosis of “high risk,” might we see recommendations of dieting from birth or in utero? The default with kids and weight, and adults and weight for that matter is to restrict intake, with pretty predictable results. And, I don’t think it’s too off-base to imagine that in vitro clinics may start adding “fat” genes to the testing list and that whole slippery slope.
10. I’d also like to see a little more about why a significant proportion of dieters overshoot their original weight after a diet. Many do this repeatedly their entire lives, know as weight cycling, which seems to be particularly harmful to health.
What did you think of the article or my points?
P.S, a reader sent this link to me. If you see stuff that you think I might be interested in, please send it my way!