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why keeping weight off is so hard: article and my thirst for more

Posted by on Dec 29, 2011 in Blog Posts | 16 comments

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!

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16 Comments

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  1. Sarah

    I remember at least 10 or 15 years ago reading a short article in a mainstream magazine (maybe Reader’s Digest) about a study comparing weight loss through diet and exercise. Three different groups were put on either a diet, an exercise plan or both. The diet and exercise group showed the most weight loss, the diet only group had the second most weight loss and the exercise only group had the least weight loss… but the exercise only group were the only ones who had not regained the weight a year later. The conclusion was that any kind of deprivation-based diet will be ultimately ineffective but if people find a form of exercise they enjoy, they will continue to do it.

    • katja

      yes, I think once you feel deprived, it’s game over, unless you are willing to be like the Bridges (not to mention have the time and money…)

  2. George

    Your points are interesting, but you offer no solutions to the epidemic that is obesity in America. You especially offer no solutions to the pandemic that appears to be child-hood obesity in this country, especially amongst lower income brackets. Ultimately, it seems to me, if children have acquired poor eating habits and poor relations with food, then the sooner they are divested of those habits, the better for their long-term health. Finally, there’s a background tone in your article that suggests a hostility to image as a rasson detre for weight loss (as opposed to just health). It’s cool to dream of the day when fat children are not made fun of in schools and when obese adults are not discriminated against. However, until that day arrives, image will retain its vitality in our culture and many others. For this reason, I’m not at all sure wanting a more appealing image (obviously within reasonable bounds) is a bad thing. In fact, I’ve found it quite liberating to look nicer after having, myself, recently lost 55 lbs or so.

    • katja

      George,
      I do offer many solutions, but scattered throughout the blog. Feel free to flip through old posts. I don’t judge anyone for wanting to lose weight, I am an American woman, and therefor not immune to the desire for the beauty idea, and have dieted and exercised for weight loss in my twenties. What I have found is that when I made the switch to eating based on what I was hungry for, including permission for formerly forbidden foods, I am happier, I weigh actually a little less than when I was being more “conscious,” I find that a six pack of soda lasts for a few weeks, and I often don’t finish a whole can, I can now have tortilla chips in the house and they last weeks, not hours. I exercise because it helps my back, and my energy and sleep, and health, far better motivators what weight loss, which rarely happens and leads to a feeling of defeat and “why bother?” I find ways to move my body that are fun, like going to an indoor trampoline center with my child, or reading while on the stationary bike or walking around the lake with my family when it’s 40 degrees in December in Minnesota. I feed myself and my family balanced and regular and yummy meals and snacks including ice-cream, regular cheese, chips etc, and I enjoy cooking. I also have “good” genes, and don’t gain weight easily, like some do (remember the twin study from the article…) I have time, money, job flexibility, access to great food and a stove and fridge that work…
      All this work Americans do to get skinnier, in my reading and experience is a major part of why we are fatter as a nation. Diets reliably lead to weight gain over time. Restricting kids leads to kids who are food preoccupied, binging and are over time, heavier. I agree that kids need to feel good about food and their bodies.
      I don’t care if someone wants to lose weight for looks. I just think it’s still not likely to work. Whether it’s image, “health” or cash (and there have been studies offering LOTS of cash for weight loss, doesn’t work either) diets don’t work.
      As for kids who are bullied needing to lose weight to stop the bullying, or the same for adults experiencing work bias, that’s pretty sad. There have always and will always be fat kids and adults (biology.) Are there more of them today? Sure. Why not help kids and work towards a culture of size acceptance. Just like we wouldn’t accept a child being taunted for skin color, children of different heights and weights should be accepted.
      In my reading and experience, folks struggle with weight primarily because they have tried to be thinner, they try to be “good” or skip breakfast, they are then ravenous. (Read old posts for more detail.) Poverty, food insecurity, stress, poor sleep, poor access to a variety of foods… all play a role.
      I wish you luck, and hope you are happy and healthy. I hope you are in the 5-10% of those who are able to maintain weight loss. Let me know in five years.

    • Emgee

      Congratulations, George, on losing 55+ lbs., I know how much work it is, as I once lost over 60 lbs. myself. Now let’s wait at least 5 years to see how you’re doing, as 85-90% regain most, all or more weight (as have I, despite exercising 5-7 days/week). Oh, and God knows my mom tried, as she had me dieting at age 9. As for the fat kids, might I suggest that YOUR background tone tells me that you have never been poor, nor have you worked with poor kids or their families, as I have. For example, $312 per month for a family of 3 doesn’t go very far, and it buys a whole lot more macaroni and cheese than it does lean meats, fresh fruits and vegetables. And it STILL may not last til the end of the month, meaning you may get what’s available at a food pantry, which also lacks fresh fruits and vegetables. And you may not have sufficient storage for leftovers, so your mom may tell you to eat up all your holiday meal at one sitting (til your tummy hurts), cause there’s no room in the frig and leftovers would have to be thrown away, and we can’t afford to waste food. You may get sent to the principal’s office for stealing the yummy snacks in your friend’s lunch, that you can’t have. You may not get to stay after school to participate in the exercise program, because bus service doesn’t run to where you live, in subsidized housing. Poor eating habits? You bet. Poor relations with food? Undoubtedly–it’s called survival mode. Childhood obesity is a social justice, class issue as well. And then we want to send home a nasty note to mom saying my BMI is too high and I’m fat? Yeah, that’ll help. I LOVE Michelle Obama, but her “Fight Childhood Obesity” campaign is a lot like Nancy Reagan’s “Just say no” war on drugs. Doesn’t get it. I support healthy eating and exercise programs for ALL kids. Those skinny kids playing video games all day may not be any healthier than their chubby friends. Bravo, Katja. And good luck, George.

      • Kirsten

        Thank you Emgee, for replying to George, as you were able to put more eloquent words into play than I would have been able to. George is clearly someone who stumbled onto this one post in a blog that is FULL of ideas, solutions, suggestions, tips, advice, and other extremely useful information, but chose to form and voice an opinion based on one small facet rather than look at all the wonderful resources Katja has provided.

        Katja, I think all of your points and questions are valid, and I too long to know why studies are not done over long term (2 years on average, but never longer than 5…and rarely so) and how prepubescent dieting can really mess up a persons entire self (physically, mentally and spiritually) before they are even fully formed.

        It’s a viscious and unnecessary cycle.

        • katja

          Thank you both Emgee and Kirsten. A few thoughts on why the studies aren’t longer. 1) the people doing the studies want to show their intervention works, so a shorter study time will show more of an effect 2) it is REALLY hard to do longterm studies. It takes a huge effort to recruit, study and follow-up. Being in a study can be a hassle, and people move, relovate, get bored and…3) the drop out rates in dieting studies tends to be pretty high. one thing I love seeing in the HAES studies is that the dropout rates for the health focused group, i.e those who aren’t dieting, are far lower than in the dieting group. This suggests to me that the HAES interventions are more likely to succeed since people don’t quit. This point is often glossed over in study conclusions. They use an “intention to treat” statistics tool to deal with the analysis, but people drop out for many reasons, one of which is dieting stinks…

  3. E

    A few thoughts:

    That couple is only smiling in the initial photo–the one BEFORE all the weight loss. Could just be coincidence, but I wonder if they were happier.

    I appreciated that the article demonstrated the true cost of keeping weight off, because I bet a lot of readers who are not invested in this issue have no idea. However, I felt that it wasn’t very thoroughly researched…I mean, there are other studies done before the ones she mentions that show similar results, and yet she just says that “more studies will have to be done”, as if those were the first.

    • katja

      I agree. There is a lot of evidence out there that supports this stuff going back decades. When I met with a high-up at a local major insurance company, they were talking about a study they did comparing very low calorie diets, and I was like, “Really? Is that even ethical to do any more??? There is ample evidence that the liquid VLCL are more harm than good, and yet we need another study to prove it? Think of the lasting damage those folks endure…”

      • Kate

        I may have said this before on this site, but I went on a liquid VLCD and the results were mentally and physically devastating. I developed severe and chronic psoriasis and psoriatic arthritis, which has forever altered my life. I realize I can’t scientifically prove the diet and the psoriasis are linked, but I never had any even a patch of psoriasis before the diet, nor does any one in my family history have psoriasis.

        Ironically, I was trying to lose weight so I’d be healthier. Now my monthly meds run about $2000 (they’ve been higher) and I see three different doctors 4 times a year. I also regained the very little weight I lost and a lot more. (The regain happened at an unfortunate time of when my thyroid stopped working and I stopped smoking, so the regain was massive.)

        • katja

          I am so sorry that happened. I think VLCL diets are awful, and harmful. I would not be surprised if that even triggered a chronic illness…

  4. Nicole

    Good questions all, Katja, and I am particularly interested as I know you are in the effects on kids. I started dieting at age seven and was on WW by nine. I never lost weight permanently, despite intense parental support (and I would classify it as “support”, because they worked very hard to make it seem “normal” and not about me) and medical pressure. Watching my son now, I can surmise that if I could have just been left alone to grow, I would have had a better outcome. Instead, I weight cycled for almost three decades and ended up extremely fat. I really don’t think I would be as big as I am now if I would not have dieted.

    I will protect my kids from this madness and let them grow, even though all the “conventional wisdom” says otherwise. I am grateful that, at least for now, my son does not appear fat and that my daughter is actually on the small/light end of the growth charts. It makes their lives easier. But if that changes, I will continue to defend them from anyone who makes wrongheaded assumptions and tries to put them on a futile and dangerous path.

    • katja

      Nicole,
      I’m sorry you weren’t trusted as a child, and sorry your parents didn’t have better information. It sounds like they so wanted the best for you. The parents I see who struggle with this issue so want to do what is right, and they are doing what they are told by the “experts!” Your kids are lucky they have you!

  5. Helen Musselman

    That article is interesting but as you point out, still seems to miss connecting the dots to reach the conclusion that weight loss isn’t going to happen for most (working, non-wealthy, non-obsessed) people.

  6. Alexie

    I thought this was a great article that was obviously a big surprise to many readers (as per the comments). She could have spun it off in all sorts of different directions, from weight stigma to HAES, except the article was on one topic: how hard it is to lose weight. I’m betting she gets a book contract out of this, given the intense interest the article has generated, so it will be interesting to see whether all these other issues are covered.

    As someone who’s intensely interested in this research, I would also like to see more info on some of the questions you’ve raised. For me, the big gaping hole is that all the weight loss and tracking experiments have been done on people who were put on a very low calorie diet. That’s such an unnatural diet, that I don’t think it’s any surprise that it unleashes a big physiological response. But would the same physiological response happen to people who had simply shaved off a few excess calories here and there, stepped up the exercise, perhaps eaten better quality foods and been prepared to lose weight very slowly? And why do these studies never track anybody long term?

    The most interesting thing I’ve learned from reading fat studies is discovering how little is actually known about the physiology of adipose tissue – and yet everyone’s an expert on weight, it seems!

    • katja

      Alexie, that was my concern with the metanalysis, it didn’t break down how people lost weight. Perhaps someone who improved health behaviors and lost weight over a few years would enjoy better health vs the deprivation-based typical diet. I can’t believe doing studies on VLCL diets are even allowed anymore. unethical if you ask me…