Do 95% of Dieters Really Fail?

Thanks to reader Marie for the questions that spawned this blog.  She asked:

I’m curious about the 95% figure. As far as I’ve read, that is based on some outdated and likely not valid research. I hope you understand I’m not attacking you, but it’s a statistic I see that you use often here and one that many of the nutritionists that I work with dispute. And I know I shouldn’t rely on anecdotal evidence, but I know several people personally (including myself) who have lost weight and kept it off. Now, the people who have kept it off have done it sensibly with healthy food and exercise. Others I’ve known who relied on more gimmicky approaches have regained. Here’s an article I’ve read.

http://www.nytimes.com/1999/05/25/health/95-regain-lost-weight-or-do-they.html

Thanks for the thoughtful, non-attacking question Maria.  Here is my answer.

First, my take on the article:

They say “…The true failure rate could be much better, or much worse, he said. ”The fact is that we just don’t know.”

They say that the number is based on a 1959 study conducted by Dr. Albert Stunkard and Mavis McLaren-Hume in which 95 of 100 participants failed.  But then admit “Since the 1959 study, though, the statistic has been reinforced by most other clinical studies, which also showed people with discouraging results.”  Studies like this one which is a 55 year study.  They conclude that “Dieting has it’s own benefits…People who try to lose weight tend to eat better and exercise more, leading to increased fitness and lower blood pressure”.  That, to me, is practically an endorsement of the Health at Every Size Paradigm since you can have the better eating and exercising without a side of failure and body shame.

At any rate, this statistic has a long history and was acknowledged at both the New Zealand Obesity Society conference in 2009 and again at the inaugural International Obesity Summit in 2010.

They are not questioning the 95% statistic based on any scientific study, but upon the anecdotal evidence of the National Weight Control Registry.  This is a voluntary registry of dieters who have lost at least 30 pounds and maintained that for a year. The article claims that “Judging by their accounts, it is entirely possible for people without the resources to hire personal trainers and chefs to accomplish permanent weight loss.” And that’s where it goes off the rails for me.

According to their website:

There are currently more than five thousand members of the National Weight Control Registry, all of whom have lost significant amounts of weight and kept it off. These members lost the weight in a variety of ways and for a variety of reasons. Some have lost 30 pounds, some 130 pounds. Some have kept the weight off for one year, some for decades. What they all have in common, though, is a commitment to successful weight loss maintenance.

Ok, first of all, “more than 5,000″.  Let’s say that they have 6,000 members, just to give them the benefit of the doubt.  My research showed that between 45 million and 80 million Americans go on a diet every year.  I’ll round down to 40 million just to be sure..  The registry started in 1994 and has 6,000 success stories.  Using our extremely low estimate, since 1994, there were 660,000,000 attempts at dieting (including people who tried more than once).  So if we are going to use the registry to prove weight loss success, it shows a failure rate of 99.991%.  That’s not necessarily accurate of course because the registry relies on self-reporting.  It’s possible that there are 32,994,000 people who successfully lost weight but didn’t report it to the registry.  If that’s the case then the 95% failure rate holds true.  If there are more than 32,994,000 who successfully lost weight but didn’t report it then the failure rate would be less. Or maybe when they said “more than 5,000″ they actually meant 33 million.

As it stands, based on estimates that favor them: 660,000,000 diet attempts.  6,000 successes and 659,994,000 failures.  What I’m trying to say here is that the registry is no help in proving the efficacy of dieting because it utterly lacks statistical significance and relies completely on self-reporting –  in addition to under-reporting, some of those “success stories” could have regained their weight but not reported it. Also, the numbers are singularly unimpressive.  Were I these two doctors, who make their living selling weight loss, I would not be waving these numbers around.

What these scientists are trying to say is that by studying the .009% of dieters who have succeeded they can find the secret to dieting successfully. That’s like studying Powerball winners to see the best way to become a hundred millionaire.  On a side note, studies show that more than 50% of “overweight” people and more than 30% of “obese” people are metabolically healthy, but very few people seem to be studying us to see how they can make other overweight and obese people healthy. Why do we value .009% over 50% or 30%?

Maybe it’s because the Registry is run by two doctors who make their living selling weight loss and is predominantly funded by pharmaceutical and diet companies whose bottom lines depend upon people believing that they can lose weight.  Conflict of interest?  You decide.

Moving on.  In order to talk about success or failure we first have to define them.  Weight Watchers once claimed success when a study showed that participants lost around about 10 pounds in six months and kept off half of that for two years.  Karren Miller-Kovach, chief scientific officer of Weight Watchers International at the time said: “It’s nice to see this validation of what we’ve been doing.”

Validation? Seriously?  Lady, they lost 5 pounds in two years.  I’m reasonably certain that I could lose 5 pounds in two years just by exfoliating semi-regularly.  If Weight Watchers (or any weight loss company) was so successful then you probably wouldn’t be required to put “Results not typical” on every one of your ads, you know what I’m saying?

At any rate, to me success would have to be based on the diet industry’s own definition:  Getting people into the “normal bmi” range. But that raises the question – if 95% of people who are 5 pounds over the “normal” range are “successful”, does it follow scientifically that 95% of people who are 200 pounds over would be successful by the same means? This is a trickier question than it sounds.

For me the bottom line is that even if a study did prove that some form of weight loss had success based on the diet industry’s definition, that would only be the start of the discussion.  What are the risks?  What happens to the people who don’t succeed? Are these people actually healthier, or are they just smaller?  And for me the big question is “What’s the point”.  I researched and chose Health at Every Size for a Reason.  I already love my body and I’m healthy and Health at Every Size has given me everything I’ve ever wanted so I don’t need another path to health.

The reason I believe that diets fail 95% of the time is that there isn’t a single statistically significant study that shows otherwise.  If you know of one, I’m open to reading it. (Note that I am not including weight loss surgery in this because when the side effects include death and lifelong misery, I think that’s a game changer.)  The reason that I repeat the statistic here often is because I think that we’re being lied to.

If your doctor told you that she was going to prescribe you a medicine that worked for Sally, but that she was legally required to say that Sally’s results weren’t typical, that you probably wouldn’t experience Sally’s results, and then told you that it was more likely to leave you less healthy than more healthy would you take it?  If Viagra failed 95% of the time would we blame guys for not trying hard enough or would we say that the medicine didn’t work?

It’s time to tell the truth:  The Emperor has no weight loss.

For more research on this subject, check out this post.

Published in: on June 28, 2011 at 5:37 am  Comments (54)  

54 CommentsLeave a comment

  1. Thanks for this blog! I got so angry when I read that stupid newspaper article that just tells (fat) people all over again that it’s a matter of willpower to lose weight. Yeah, right. I wonder how it can then be explained how any fat person (who clearly must lack discipline) still manages to have a successful career, run his/her own business and achieve important personal goals. All without willpower?! Relating willpower with weight loss is one of the things that annoys me most in all the diet industry induced brain washing BS.
    If Weight Watchers (or any other international diet corporation) would be successful in making people thin, they wouldn’t be noted on the *** stock market, they’d be out of business.

    • Exactly! They are not really in the business of weight loss assistance, they are in the business of body shaming. Their approach does not work long term, but making people hate themselves for having the “wrong” body does work. People hate themselves for “failing” at a diet, so they keep coming back for more abuse.

  2. Great post! I was rejected from the NWCR — I lost 60 pounds about 10 years ago, but, because my body did what bodies do and tried to get back to the state it was used to, I regained 20 of it for a while. So, I don’t count as a maintainer, even though I now weigh 57 pounds less than I did at my largest, and I’ve never weighed more than ((my 1999 weight) – 40) since 2006. Anyway, sorry for mentioning weight loss but I just wanted to give you the example to back up that they’re pretty kooky about who they “sample”.

    And for those who would tell you that if I can do it it means anyone can do it, the ONLY reason I can maintain this weight is that I am single and have no conflicting pressures on me. In my time outside of work I can exercise and police my diet to my heart’s content without having to worry about a family and their needs. But if I, say, get into a relationship with someone who expects to put some demands on my free time rather than just waving at my back as I go out running, my weight drifts back up. It is NOT easy and trivial. I’m trying to get my head into a HAES space because I doubt it’s realistic to think I can live like this forever.

  3. I think it’s important to note that there is also a big difference between “going on a diet” and “losing weight.” The two are not mutually exclusive!! I am a psychologist who works at a residential center for women with eating disorders, and I state that to note that my next statement comes from both personal and professional experience.

    My experience personally (and what I’ve witness professionally) is that when you start taking care of your body as a part of yourself that deserves respect and you treat it well, your body will respond great and, ultimately, find what is referred to as a “set point.” That set point is different for every single person who walks the planet and, for many, it falls outside of their “BMI Range” or whatever.

    And, as for my personal definition of treating my body well? Moving because I love it, strength training because it enables me to understand the strength I have in a way I often try to neglect, and eating a whole variety of foods while simultaneously trying to follow my personal ethics (that happy animals make for happy meat, and since happy meat is considerably more expensive, my diet ends up being very veg & fish based with only extra meat- NOT because meat is bad for you at ALL, just because for myself and my personal ethos [which does not need to be anyone else's ethos], I don’t do commercial beef or chicken). The drastic change that occurred in my life when I started respecting my body did, yes, result in weight loss- but never to the extent that I was in my BMI range; just to the point that I’m healthy and happy.

    And, once that shift occurred, I never (ever) dieted. Now before I respected myself, I dieted in a variety of ways, and guess what? I got to be included in that 95% “failure” rate. And I’ll tell you, it was not THAT which improved my self-esteem & self-respect!!

    Regan, I adore your blog. I link it often and get universally positive feedback from, especially, my other friends in the ED-treatment profession. Thanks for fighting for HAES!!

  4. So, in other words, conjecture and assumptions. The statistic may be close to the truth, or maybe not even close. Nobody has that data. The weight loss industry does a thriving business, and most of their methods are crap. I don’t know anybody who’s done any of them and managed to maintain, though I do know plenty of people who have lost and maintained, figuring out their own path. I doubt they’ve heard of the NWCR.

  5. This is an important blog post to share when we’re talking about the National Weight Control Registry, too: Weight-Loss Maintenance: The Job Description

    http://justmaintaining.com/2010/09/30/weight-loss-maintenance-the-job-description/

    and also this one:
    The Unfairness of Weight-Loss Maintenance:

    http://justmaintaining.com/2010/09/29/hello-world/

  6. Of all the people I have known who have lost weight and largely kept it off over time, and whose weight loss was NOT caused by a health problem, they have generally not been obese to start with. For example, one lady I know was plump but not fat, her circumstances meant that she attended a lot of fancy formal dinners with rich sauces and pudding etc. She started to ask for the food without the sauces, and had lighter puddings or no puddings, and she started to exercise. She lost the plumpness and is now probably within normal BMI range, and has stayed that way for several years now. But really, what she did is pretty much HAES. Another one I know of still goes to her slimming club every single week, and follows the restrictive diet every singel day and spends a lot of time at the gym, despite reaching her goal weight years and years ago. Body shape has become a huge life project.

    The number of times I have heard people, mainly youngish women, say that this new diet/slimming club/regime etc is definitely going to work and they are going to keep the weight off because “this time they are really determined” – these women lose it and then gain more back than they lost

  7. I have a friend who gained 65 pounds because of a pregnancy. She then lost it and has, no surprise here, kept it off. One time she told me that famous, “I did it, so I KNOW you can too!” line. Heh. Sure. Your 65 pounds gained during pregnancy, when you’re naturally thin to begin with, is TOTALLY similar to my 150 pounds – fat since I hit puberty – dealing with metabolic issues self.

    I don’t get it. Is it too much to ask that people just leave me alone to deal with my health the way I need to? Apparently.

    • I lost weight during my pregnancy, weighed about 7 ibs just before delivering my daughters than when I fell pregnant. I loose weight on the pill as well. We are all different!

    • I heard a great quote that describes this mentality: “Acting like she hit a triple when she was born on third.” I’m not a sports person but even I get the meaning – don’t take credit for being thin when you were born with a body that has a propensity to be that way in the first place. I’ve heard many people go on about how they are thin because they eat right/exercise but the reality is that they have never been fat and probably couldn’t be even if they tried hard. Drives me batty too.

      • “Acting like she hit a triple when she was born on third.” –I LOVE this; thank you!

      • I love this, I’ll be adopting it into my lexicon.

        ~Ragen

      • I am so using that quote.

      • I believe that’s derived from the great Governor Ann Richards talking about George Bush – “born on third base; thinks he hit a triple” was how she described him.

  8. I think that research saying 95% of diets fail themselves fail to look at why people diet. Example: say your BMI was 40, you’d be told to lose weight by your doctor, right? But, as you say, it is possible to live a healthy and happy life with a BMI of 40. So, say you think “Ok, I’ll go on a diet” and you do, but you don’t enjoy it and don’t feel benefits and you were happier before? You gonna stick to that diet? No. You’ve “failed”.

    Say you want to diet because you want to look like the young, tall, skinny, white cis women in Vogue etc. You go on your diet. You think, “wait: do I *need* to look like the young, tall, skinny, white cis women in Vogue?” You decide you don’t. You’ve “failed”.

    There’s a ton of examples with the same conclusion: you go on a diet because you’re either supposed to look like the Vogue set or you’re supposed to have a BMI of between 20 – 25 because it’s healthy. You decide you’re healthy as you are with your BMI of 25+? You’ve failed.

    That’s one example of why I don’t take the 95% failure stuff seriously: it won’t take into account those who made the decision not to diet.

    And what of those who *do* fail? I read somewhere in Elle magazine that a lot of women (if you will find it helpful I’ll dig out the article, I kept it) want to lose half a stone. That, as you say, those 5lbs, are pretty much nothing. Furthermore, the lighter you are the harder it is to lose weight (lord knows, I know). Those diets might fail. Some people’s bodies want to be a certain weight. My body wants to be 150lbs and I am forcing it down to 117 and I can tell you for sure it does not want to do that. Right now it is point-blank refusing to let me out of the 130s. If I give up now, and I’m underweight already, I have failed.

    So, it’s complex. That’s what I’m saying :)

    Also – one of your commenters say the weight losing business is all about fat-shaming. I agree. Like, if I ever say “diet” on twitter I get a butt-load of spam telling me what I need to do to look good. Man, if they cared about my health they’d be telling me to gain weight pronto. Weight losing businesses exploit the fact that most women want to diet or feel they ought to.

    • great comment! That was my point too, none of these studies can consider all the factors and thereby are not accurate. So I don’t think its right for either side (for or against dieting) to use the 95% stat. because its bull. We should all do what will make us happy. If we want to attempt to lower our weight (for what ever reason), we shouldn’t have people telling us “but it will never work, you are doomed to fail, 95% of all diets fail.” Just like other people shouldn’t go around using the stat to say “95% of all typical diets fail because you aren’t doing it right, try this instead.” We are all different, and we have our own truths, our own right and wrongs and our own experiencies.

  9. I’d love to have accurate statistics on “weight-loss recidivism ” (sounds like going back to prison), because it is always good to know the truth. However, I don’t like the way the Times is holding up The National Weight Control Registry as proof that people don’t regain weight at such a high percentage as commonlly believed. I’d like to see real data, please, rather than ancedotal self-reporting.

    Yes, I can see how it would be “incredibly easy” to find success stories when they are self-reported. I’m not saying that those who lost weight are liars. Only that they might not be so willing to self-report when they regained considering the emotional high stakes involved for many in being “good” for having lost weight. Actual factual data might be a little more convincing albeit more difficult to obtain. :)

    • Replying to myself… a little too close to talking to myself. ;)

      I guess I need to wait till a little later in the day before posting. I just noticed that this article is from 1999. I would think that if there were anything to their findings that there would be lots of fresher articles pointing to the success rates reflected in the National Weight Control Registry.

  10. The most honest maintainers (check out Debra’s Just Maintaining, one of my favourite blogs, along with yours) say straight out that maintaining is a thankless slog, requiring at least a certain amount of obsession (sometimes a lot!). It also requires enough time to be a part-time to full-time job in of itself.

    And then there’s the exercise component of maintaining. Lord knows, I am all for enjoyable physical activity, but maintainers often keep up a punishing schedule of workouts just to stay more or less at the same weight. As someone who came to disability fairly young, I have to wonder about these people, many of whom pound the pavement (and their joints!!) to the point where they are no longer able to get their bodies to cooperate and…woops…the pounds start coming back on.

    More and more, I am coming to the conclusion that we *do* have a set point and there is no true way to bring it down–it can only be held down forcibly, unnaturally and with great effort (both physical and psychological). On the other hand, people who gain weight easily (and I know people who really can’t) can also nudge their set point higher, mainly through dieting (yo-yo, anyone?). For women, hormones and menopause also have an effect on weight (up, up and away!).

    Even if the success rate for dieting were to be 20%, rather than the 5% commonly cited, it still wouldn’t be something to jump up and down about. Especially if it still meant what it means today: unrelenting, teeth-gritting slogging, with no time off for good behaviour and not even necessarily any health benefits…just a get out of jail free card protecting you against fat prejudice.

    Am I jaded? You betcha.

    • there is research to suggest that running is actually good your joints. I won’t post them here, its pretty easy to google them. Counterintuitive, I know, but there it is. I have seen this first hand. I was beginning to have knee pain, now that I run 20 miles a week (on pavement), no pain anywhere.

    • “just a get out of jail free card protecting you against fat prejudice”

      Thinking about it that way was very helpful for me. I had an eating disorder, then scaled back to “mainstream” dieting, then “dieting lite”, then “I’ll never diet again, but hard-core exercise will make me thin!”

      I remember being in a particularly punishing exercise class and thinking “there is nothing wrong with my body. the problem is with how other people treat me. I’m doing this because I want thin privilege”.

      Once I really accepted that, I quickly decided that that wasn’t a good enough to treat myself like dirt.

      • GAH. I always seem to leave one word out of my comments. I meant to say “wasn’t a good enough REASON to treat myself like dirt”.

      • Word. I’ve been there; you just get sick of playing the game. Time to take the ball and bat and go home. But then you have to come up with an identity besides “thin”, which is an entirely different ballgame.

    • who the hell wants to be “obsessed” with first losing weight and then maintaining the loss? especially if the stats behind Healthy At Every Size are true (not saying that i think they’re misleading or anything like that, i’m just still wrapping my brain around them). i guess for some people, it’s worth it. i don’t personally get that at all.
      i recently read this quote (paraphrasing slightly): “it’s not the years in your life, it’s the life in your years.” even if everything Big Weight Loss says about being fat is true, i’m still not sure that the hunger, the endless obsession, the constant vigilance around food and drive to types of exercise you don’t like, are all worth it. i guess it’s easy to say that when you’re young and pretty healthy (aside from type 1 diabetes, and of course being fat, if that is “unhealthy” to you).

  11. I love science with Ragen! Thanks for this great article.

    My husband is a “maintainer.” But he runs and works out every single day–he actually works out twice a day because his evening routine is lifting weights and other exercises. He also eats mainly vegetables.

    I admire his dedication, but I also really wish he would relax sometimes….

    xo Susie

  12. The problem is that people can define diet and failure however they want and if you truly buy into the diet mentality, you will always fail. It’s set up that way.

  13. Sometimes I feel like printing out your blog posts and pinning them to my shirts. It would make life so much easier. I would just have to point.

  14. thank you for this! a great article to reference or link to when in the midst of a battle with troll invasions. I also like to link to your “the problem with proving it” post :)

  15. I totally agree with you, as I had been the same weight/height since about 13-14 years old.

    When I lost an astonishing 80lbs a few years ago, everyone kept asking me what my “secret” was. The depressing part is had I actually taken the hour to explain the obsessive calorie-counting, the daily gym visits(I would get home after 11pm, and have to wake up for work at 5am), the 4 or so hours outside running around with the children I looked after(okay this part was actually fun), the hard party drugs that enabled me to dance for 6+ hours every Friday and Saturday, and not eat at all during the weekend, AND the countless sessions of fat-shaming myself in the mirror…I think people would still be impressed. Thin at any cost. No one really cares about the health.

    When I told my new(shitty) doctor that I had lost significant weight in the past but gained it all back, his suggestion was Weight Watchers. I almost laughed aloud. When he saw I wasn’t having that suggestion, he put a “supportive” arm on my shoulder and conspiratorially said, “You know I can definitely help you get a bariatric procedure, which will be your quickest path to health. You just let me know!” This was on my first visit to this doctor, where he also sent me for diabetes testing immediately. Honestly, I went home and cried.

    • Ooops, sorry, this response was supposed to be directed at NewMe’s post.

  16. The definition of success is returning people to normal BMI and letting them stay there.

    calorie restriction breaks its own principles that is weight expended is weight gone. We know if we spend £50/$30 or whatever, its spent, it doesn’t restore itself of its own accord.

    Clearly there is a flaw in the theory. It shouldn’t even be necessary, because you should just lower your intake and that should be that, no plans, no regimes, no diaries etc.,

    • Also, some people like myself are what I call “dietproof”, that is their system reacts in such an extreme way, very quickly indeed-I’m talking starting immediately, that it is not a question of dedication or commitment that is lacking, it is simply physiologically and psychologically untennable.

      Funnily enough, I can fast, I just cannot diet.

      I’d really like that acknowledged.

  17. I did Weight Watchers seven times and lost about 125 pounds, but at age 41 I’m pretty much right back where I started. Are they counting me a seven successes?

    Kinda blows your mind, doesn’t it?

    • Actually, yes. That’s one of the big controversies about Weight Watchers. They count you as a success after you lose 10% of your body weight but if you gain it back they start the count over again. More than a little bit crazy I think.
      ~Ragen

    • Weight Watchers must have changed a lot. When I was four or five years old, my grandma used to take me to Weight Watchers meetings with her. Everyone got weighed and cheered for losing weight, or forgiven and comforted for gaining. Then they had a sermon – I mean, a motivational talk – and then we went to Ponderosa, which was my favorite part of the whole routine because they had a hot bar. My kindergarten-aged self would stuff myself with chicken wings, potatoes, and fruit without anyone yelling at me and listen to the ladies gossip. It was just like church without having to wear a dress. I wonder why the diet cult mentality didn’t sink in until I was a teenager?

  18. Hah! “The Emperor has no weight loss”, I am stealing this and incorporating it into my vocabulary now.
    Love it.

  19. Thank you for printing my post. I’m glad it inspired you to write this blog. I hope I haven’t offended anyone.

    That’s not the only article I’ve read, and as I’ve mentioned, I work with nutritionists (at a college though) who aren’t hung up on weight or BMI or anything. I really enjoyed reading your reply.

    I think I’m worried myself about being in the 95%. I guess I’m hoping that I won’t regain weight or, more importantly, actually MOST importantly, not fall back into some terrible habits I had (more on that in a minute!). I’m not hoping that I don’t regain because I have fat hate or anything or because I want to fit some ideal, but I was obese (after spending most of my life being lighter). I felt tired and sluggish and unhappy. I feel more comfortable and vibrant and happy since I’ve lost weight. Even my skin and things look better. I believe I was unhealthy, and my blood pressure was up and my gallbladder came out this past winter. I was anorexic and bulimic in high school and college, and then just a plain binge eater after that. I needed to fix my eating habits and get exercise, so I did.

    I’m not doing anything gimmicky. I could never not eat carbs as a life-long vegetarian (who’s done it for animals not weight loss), and I hate Weight Watchers and all the crappy food it advocates. There’s also no way I’d ever eat powdered packets of food! I read a great book that advocates a balance of four meals a day of whole foods (produce, whole grains, healthy oils, protein) and I feel terrific. I haven’t had a binge in six months. I can’t remember a time before that when I didn’t binge.

    I’m not doing anything punishing to my body, just working out with weights and using the elliptical and taking long walks and swimming. These are all things I love, and I’d stopped doing them. I imagine doing the exercise again is what’s making me feel better, and not the weight loss. I am amazed that my body works so beautifully, and I think that’s what’s most important.

    This blog makes me think a lot. What I’m thinking right now as I reread what I wrote is that I’m going to keep what I’m doing. I’m going to keep eating whole food and exercising, but not because I want to lose weight. I am going to do it because it makes me feel fantastic, and my body, no matter what size it is, deserves that.

    • Thank you so much for the original comment and this one. I didn’t meant to imply that it was the only article or to discount your discussions with nutritionists. I apologize if it seemed like that. I just chose to talk about the article because it was the only complete information. I think what’s important for people to understand is that your experience is completely valid, but is not everyone’s experience. Some people who are obese are also partaking in unhealthy behaviors, but not all of us are. I love your last paragraph. That’s sort of the whole point of my blog – I believe that if I want to be healthy, my best chance at doing that is to practice healthy habits and my body will work itself out I think that if my body gets smaller its just a side effect of the healthy behaviors – not so much that being smaller is necessarily healthier. Either way, I’m glad that you’ve found a path to health and I support you in whatever you choose. I’m glad to have your perspective here. Thank you so much!

      ~Ragen

  20. Thanks again, Ragen!

  21. Hmmm. I note that the registry’s view of success seems rather generous. After all, what’s 30 lbs to someone who weighs, say, 300? Some contestants on biggest loser lose that much in a couple weeks. If you only have 30 lbs to lose, you’re probably just at the upper end of your setpoint. And keeping it off for a year? I wouldn’t consider that a success, you’re not suddenly insured against weight gain after a year. Logically, most of us would consider true weightloss success to be the achievement of thinness (or at least a “normal” bmi) and stay thin for the rest of our lives. But of course this registry is not about logic, it’s about lowering the bar to entice us to jump over it (and spend lots of money in the process).

  22. Having lost a lot of weight accidentally (through illness) and wanting to keep it off, I’ve been immersed in weight research recently. My conclusion is that this is very poorly understood area and I shouldn’t either panic or be complacent, based on what’s known.

    There are some things known for certain. One is that foetuses and very young children exposed to famine will become obese when food becomes available again.

    Another is that most people’s bodies will rebound quickly if forced to undergo rapid weight loss. Dr Sharma’s blog has had some very good posts about why it’s virtually impossible to keep significant weight off, and the way the body will work against you to put the weight back on.

    It’s also apparent that at certain BMI – different for everybody – the body begins to change its metabolism, in ways that are poorly understood. At this point, significant weight loss seems to become difficult, if not impossible.

    However… I live in a small European town that has lots of retirees, who as children underwent famines and food shortages as a result of WWII. According to the research, they should all be quite big now, but they’re not. They’re slender. So the environment seems to play a significant role as well. An environment where meat isn’t full of growth hormones etc may produce different results in the population when compared to an population fed on industrial food.

    What I have come to believe is that (1) we don’t really know very much and (2) we place too much emphasis on personal responsibility, when the reality is that individuals are affected by food and built environments beyond their control.

    Unfortunately, it’s going to be very difficult to get at the truth, because the whole debate is toxic, thanks to all the moralising and shame.

  23. I’m new to the blog, and I have really been enjoying it! I just wanted to let you know that there are people out there studying the metabolically healthy obese (in fact, one of my colleagues just had a paper accepted… the reference should be up on pubmed soon)!

    • Hi Jessica,

      Welcome! That makes me so unbelievably happy and I will keep a lookout for her work. (Feel free to keep us updated if you would like and I’ll definitely be excited to blog about it.)

      ~Ragen

  24. Great post, Ragen! I love it when you pound on the science!

    I think there are few things more empowering as a participant in the modern social conversation than knowing how to find, read, and understand original research. Speaking from experience working in the sciences, science reporting, and popular health media, most health reporting in popular media is like the game “Telephone”–the information researchers start out with is NOT the information normal readers get.

    Even though it’s a long-ass read, it occurs to me that folks might find it valuable to know these dozen or so steps that almost every piece of “health news” in the popular media has gone through before it gets to them. (Caveat–this isn’t an exhaustive description, just a very typical process):

    1. Original research is done by scientists who
    *May or may not have the money or time to do high quality research, so their results may have major methodological failings or be otherwise statistically uncertain
    *May or may not have personal biases, (such as sexism, racism, or sizeism) that affect their methods, perceptions of their outcomes, and reporting
    *May or may not have been paid by a corporation to “prove” something that will make them money, thereby either consciously or unconsciously biasing the methods and findings
    *May or may not have hand-picked their data so that only the results they want are reported and the ones they didn’t want never come to light

    2. The original research findings are written up into a research paper by a scientist or scientists who
    *May or may not understand how to write (and design graphics) accurately
    *May or may not have personal biases, (such as sexism, racism, or sizeism) that affect their perceptions of the research findings
    *May or may not have access to all the research findings
    *May or may not have to submit their work to a corporate marketing person, university editor, or other gatekeeper whose boss has a major financial stake in the outcomes of the study

    3. The original research paper is finalized into a format that includes an abstract–a one or two paragraph summary of the paper that glosses over nearly all the paper, including almost all the problems that limit the validity and certainty of the data.

    4. The scientists submit the original research paper to scientific journals in hopes of it being published. It is provisionally accepted for publication by editors who
    *May or may not have a financial stake in certain findings being promoted or suppressed
    *May or may have enough specialized knowledge in the particular research field to really understand or interpret the findings

    5. The research paper is sent to approximately 1 to 5 “anonymous” scientific reviewers who
    *May or may have enough specialized knowledge in the particular research field to really understand or interpret the findings
    *May or may not have a financial stake in certain findings being promoted or suppressed
    *Ostensibly don’t know who wrote the paper, but may or may not, based on their knowledge of the field
    *Ostensibly will be anonymous to the writers, but who may or may not be, based on their writing style, known opinions in the field, etc.
    *May or may not have personal biases, (such as sexism, racism, or sizeism) that affect their perceptions of the research paper

    6. The reviewers approve or deny the paper for publication or request changes to the paper before the paper can be further considered.

    7. If the paper needs changes, the author/s make changes based on the reviewers’ comments or say why they won’t make specific changes. Repeat as needed.

    8. The article is accepted for publication, then edited by the scientific journal’s staff who
    *Almost certainly will not fact-check the article
    *Make changes that the authors won’t see until after publication
    *Probably don’t have a science degree, or scientific training
    *Probably don’t have enough specialized knowledge in the particular research field to really understand or interpret the findings

    9. The article is published by the scientific journal on its website, and/or print edition and may be published to reference sites such as PubMed.gov. From there, it may or may not be noticed by editors of professional magazines (“lite,” or business-oriented magazines for clinicians), editors of higher-end popular media (NY Times, etc.), editors of specialized media (Wired, etc.), all of whom
    *Almost certainly will not fact-check the original article and probably won’t even read the whole thing
    *Probably don’t have a science degree or scientific training
    *Probably don’t have enough specialized knowledge of the particular research field to really understand or interpret the findings

    10. The editors will assign the story to a journalist who
    *Almost certainly will not fact-check the research paper
    *Probably doesn’t have a science degree or scientific training
    *Probably doesn’t have enough specialized knowledge of the particular research field to really understand or interpret the findings
    *Won’t read the entire research article
    *Probably has no training in science writing, and so is likely to distort the meaning of the findings and sensationalize them, such as calling a small study with very uncertain outcomes “proof of a major new finding”
    *May or may not interview a scientist on the original research team and if she does, may or may not edit any quotes so that they distort what the interviewee meant

    11. The journalist turns the story in to editors who
    *May or may not fact-check the article the journalist wrote to see if it correlates to the research paper or if any quotes are actually what the interviewee said or meant
    *Probably don’t have a science degree or scientific training
    *Probably don’t have enough specialized knowledge of the particular research field to really understand or interpret the original research paper
    *Probably have no training in science writing, and so are likely to edit the story to sensationalize it a little more, further distorting the meaning of the findings
    *May write up a sensationalized headline, such as “Does Sunscreen Cause Cancer?”

    12. The article is published in a higher-end news outlet’s website, where it is noticed and rewritten/paraphrased by editors of news aggregators, such as Yahoo! News and MSNBC.com, bloggers, and editors and journalists who write for non-health-related outlets, such as People and fashion sites. They
    *Almost certainly will not fact-check their article against the research, and if they do, will almost certainly read only the abstract
    *Probably don’t have a science degree or scientific training
    *Probably don’t have knowledge of the particular research field
    *Probably have no training in science writing
    *Almost certainly will introduce even more distortions into what the previous untrained journalists wrote
    *Will almost certainly write up an even more sensationalized headline, such as “Sunscreen Causes Cancer” or “Is Your Sunscreen Killing You?”

    And that’s when it gets to you.

    Most universities have basic classes that are an introduction to understanding empirical research, and I really recommend that people take one if they have any chance. For me, it’s been life-changing.

    In fact, I helped save a life using these skills–a good friend was using a nutrition-based cancer protocol that sounded great and incredibly successful in literature produced by the people who were selling it. By reading original research, I found that it had an approximately 0% success rate–that is, it was universally fatal to use it. He’s alive and in total remission now, no thanks to those fucking vultures, but not until he let his tumor grow by over 1000% and metastasize to Stage 3 while waiting for the miracle cure promised by cheap science writing to take effect.

    • (Wild applause, both for the clear explanation, and for saving a life!)

      • Morgan, is it ok if I copy and paste this into note on my Facebook (and credit you)? I have friends that post news reporting of studies all the time as gospel truth (examples: a recent article that says wheat and sugar make people stupid, or an article that says spanking leads to mental illness). You have laid out the process of constructing and publishing studies very well, so well that I want to share. I would remove the mention of your friend’s cancer, if you prefer.

  25. I just found the blog and I love it, love the message you’re putting out there, and I hate for this to be my first post here… but your statistics are kind of messed up. You’re saying that 660 million people dieted in the US since 1994, but the current US population is 310 million, presumably because some of the people who dieted in 1995 also dieted in 1994.

    I don’t know how to calculate how many Americans actually have dieted in the past 17 years, but maybe you could reframe it in terms of person-years? It would work as 660m person-years spent dieting. Or, if person-time metrics feel too awkward, you could phrase it as 660m diets, where each year spent dieting counts as a separate diet for simplicity’s sake. Either way, the success rate is vanishingly small, but having a number of American dieters that is greater than the number of Americans detracts attention from that fact.

    On a non-statistical note, I’ve always wondered how many of the maintainers in the registry are actually people like me, who gained weight due to a medical condition and then lost it when their health improved. I had a seizure disorder as a child and gained a lot of weight because of the meds. When I outgrew my seizures and went off the meds I lost 60 pounds and have “kept it off” for 8 years now. I’m technically eligible for the NWCR even though I’ve never successfully dieted.

    A few of my relatives try to use me as proof that diets work, which is frustrating since it’s really the opposite. I didn’t change my diet or activity level, I just removed an external factor that had artificially altered my weight setpoint. If anything, my experience is evidence that our bodies know what size they want to be and will return to that size whenever possible.

  26. Maybe I should have summed it up this way (Boyfriend dubbed this “headlination”):

    1. “In a survey of 165 stage 2 male renal cancer patients between the ages of 50 and 75, those who self-reported using zinc-based sunscreen at least three times annually during the period 1990 to 2000 showed an 18% increase in mortality risk over a five year period. Patients were recruited from the Detroit Cancer Center by physician referral. Study limitations: self-reporting bias, ten-year gap in recall period, no information regarding how staging or diagnosis was determined, no control group, no information on other sunscreen ingredients, sunscreen brands, or confounding factors such as patient diet, blood levels, pollutant exposure, etc.

    2-8. “Pilot Study Indicates Correlation Between Increased Mortality Risk and Zinc-Based Sunblock Exposure in Elderly Male Renal Cancer Patients”

    9. “Pilot Study Indicates Correlation Between Increased Mortality Risk and Sunblock Exposure in Renal Cancer Patients”

    10. “Sunblock Linked to Early Cancer Deaths”

    11. “Ditch the Sunblock–It May Save Your Life!”

    • Awesome example! Thank you!

  27. What strikes me as very interesting about the article linled to is that the two members of the National Weight Control Registry who were interviewed said that before their successful weight loss and maintenance they had eaten the way that society thinks all fat people eat – large amounts of processed junk food – and did not exercise at all. I wonder how many of the other NWCR success stories are the same? That would mean that the NWCR is proving that people who eat “too much” (for their metabolism) and don’t exercise will gain weight, and if they then eat healthily and exercise their weight will normalise back to its set point.

  28. The data suggests more than one thing.
    When most people hear a statistic on how few adults gain fluency in an additional language (as adults) they often jump to the conclusion that the adult brain cannot pick up languages as a child’s brain can.
    That is one possible interpretation, and requires that we assume that the few adults who do learn new languages to fluency have abnormal brains.
    But I think we go straight to that conclusion because we’re confounding ‘can possibly’ and ‘will actually.’
    It’s equally possible that all adults are capable of learning new languages to the point of fluency, but that language learning programs aren’t designed to create fluency, or because fluency isn’t a priority to most language learners.

    Of course most people assume they can control their body even when its difficult, but resign themselves to assumed and perhaps fictional ‘facts of nature’ when it comes to challenging their brain. I wish it were the opposite.

  29. The data I know of about bariatric surgery says that people generally gain the weight back, too. A lot of folks who get it regain their weight, just a lot slower than dieters. There are many studies about it going on right now to measure how well it works long-term. The pouch in the stomach can be stretched out to its original size over time (with the exception of lap band surgery). The cost for the individual is so high if this turns out to be true. They didn’t even get what they were promised by the surgery.

  30. First time reader of your blog here just reading through all your posts at work (and can I just say I love it already)

    Anyway I don’t have much to add to the discussion considering you’ve covered it more than adequately already yourself but I wanted to say that I absolutely lost my shit at this: “I’m reasonably certain that I could lose 5 pounds in two years just by exfoliating semi-regularly”. Funniest sentence I’ve read all day, thanks for the giggle. You rock!


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