Do Diets Fail or Do Dieters Fail?

I got a question from a blog reader that I wanted to talk about:

I have a question! I have non-FA friends who think that most diets don’t work not because of metabolism or anything like that, but because the actual dieter is weak-willed. They think that people regain the weight plus some because they stop doing the diet or attending Weight Watchers or whatever it is they have chosen to do. In contrast, I think that even if one stays on the diet religiously, still metabolism will change and the weight will be regained in the majority of cases. What do you think?

This is basic math.  Studies show that  the vast majority of diets fail.  Even Meme Roth says that the failure rate is around 95%.  Somehow people still believe that it’s because 95% of people just aren’t doing it right.

In truth, there is a lot of research about the physiological changes the body goes through in response to weight loss for the specific goal of weight regain.  An Australian research team studied people who had lost weight in an effort to understand some of these changes. A year after their initial weight loss:

  • A hormone that suppresses hunger and increases metabolism – Leptin – was still lower than normal
  • Ghrelin, nicknamed the “hunger hormone,” was about 20 percent higher
  • Peptide YY, a hormone associated with hunger suppression was abnormally low
  • Participants reported being much more hungry and preoccupied with food then they had prior to losing weight

A year after losing weight these people’s bodies were still biologically different than they had been prior to the weight loss attempt, desperately working to regain the weight – and participants had already regained about 30% of the weight they had lost.  One of the study’s authors characterized it as “A coordinated defense mechanism with multiple components all directed toward making us put on weight.”

So it does appear that the body fights weight loss strongly. There are other studies that show the same things, as well as studies that show genetics play a large part.

What I want to point out is the fact that, regardless of why a treatment doesn’t work, if it fails the vast majority of the time (and has the exact opposite of the intended effect the majority of the time) then there is an problem with the treatment and an issue with meeting the criteria for evidence-based medicine, and that is the situation with dieting.

The thing that blew my mind when I realized it (thanks to the brilliant Deb Burgard) is that the entire basis of prescribing weight loss for greater health is built on a guess.  There is not a single study that shows that people who lose weight have the same health outcomes as people who were never fat, or better outcomes than if they had just engaged in healthy habits and stayed fat.  This whole thing is just a guess – so all the work and money going into figuring out how to make fat people thin so that we can be “healthier” may be a complete waste.

So it’s not just that it doesn’t appear that long-term weight loss is possible for most people – it’s also that, when it comes to health, weight loss may not even be a worthy goal.

What’s ridiculous to me is that it’s not being widely publicized that we have a mountain of evidence that shows that healthy habits are the best chance for healthy bodies of all sizes for those who are interested in that (and there’s no obligation).  Plenty of studies show that people who get 30 minutes of moderate movement 5 days a week get tremendous benefits without weight lossAnother study shows that people who get moderate physical activity, 5 servings of fruits and veggies, drink moderately and don’t smoke have the same health hazard ratios whether they are considered “Normal weight”, “Overweight” or “Obese”.

It’s important to note that our culture’s attachment to weight loss as the path to health is not based on evidence.  It is at best an “everybody knows situation” akin to the time when everybody “knew” that the sun revolved around the Earth (which could be why those of us who are pointing out the evidence are getting told to sit down and shut up faster than they put Galileo under house arrest).  At worst, our attachment to weight loss is a combination of profitability and pride.  The diet industry doesn’t want to give up the over 60 Billion a year it rakes in, doctors are enjoying lucrative weight loss practices, and others just don’t have the guts to admit that they’ve traveled so far down the wrong road and given so much bad advice to so many people.

So why do people who have all of this information keep trying to diet?  I think it has a lot to do with the potential rewards and  everyone’s belief that they can beat the odds.  I was watching a documentary about the Green Beret selection process (I’m a documentary junkie).  They know that 50% of people will fail but every man there is sure that he will beat the odds.  At one point one of the guys is so out of it that they ask him “Do you know where you are” and his answer is, I swear to god,  “hashbrowns”.  But as they drive him away to see a medic he keeps yelling that he’s fine, he can do it. Golda Poretsky at Body Love Wellness wrote a great post about this phenomenon as it pertains to weight loss.  I get e-mails all the time “I don’t agree with you because I’m losing weight right now and I’m just not going to gain it back.”  To which I want to reply “hashbrowns.”

I think a lot of it has to do with the fact that weight loss almost always works short term, but almost always fails long term and the dieting industry has done a great job of taking credit for the first part of a biological reality and blaming dieters for the second part.  I get so many e-mails from people who say “I believe in HAES, but I’m doing [insert diet here] and I’ve lost X pounds so  it’s working!”   There is so much societal reward when people are losing weight that you can get a huge rush and it’s easy to forget that there is a 95% chance that you will be back where you were or even heavier in 5 years.  Of course everyone is the boss of their underpants and I have no problem with people choosing dieting for themselves, but I do not feel comfortable being part of the rush of praise that people who lose weight receive that makes the near-inevitable weight regain that much more crushing so I choose my words very carefully, and I’m certainly not recommending that people do something that nobody can prove is possible for a reason that nobody can prove is valid.

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Published in: on June 12, 2012 at 7:29 am  Comments (31)  

31 CommentsLeave a comment

  1. Oh, I hate it when someone I know loses a bunch of weight and everyone around is praising them up and down. I’m not threatened by their loss (which is what a lot of folks think) but I cringe when I think of the odds of them maintaining that loss for long, and how they have to face all these people later, having regained the weight.

    I refuse to be part of the rush to effusiveness over someone’s wt loss, knowing that the odds are so strong that the weight will come back. I won’t play into that yo-yo mind-game. But at the same time, I don’t like to rain on the parade either, by snarkily pointing out the odds against maintenance. That feels cruel too.

    So I usually don’t comment or I just try to be neutral and change the subject. It’s a difficult position to be in sometimes.

    • I completely agree with you — and I DID lose a whole lot of weight. Thing is, though, I did it entirely for my own reasons and it hasn’t colored my perspective of fat[ter] people. What really gets me about all that effusive praise, BTW, is the assumption that the way I was before the weight loss was inferior to the way I am today, even though I never really changed. I’m the same person I’ve always been and it has infuriated me to the point of my becoming seriously misanthropic how much better I’m treated now than I was treated before I lost the weight.

      BTW, I didn’t go on any faddish diets to lose the weight — I just made lifestyle changes and that’s what did the trick for me. I never wanted to go on a diet, and I think they’re nothing more but huge ripoffs designed to siphon money away from the bank accounts of insecure people. Nor have I experienced any significant health benefits from the weight loss. The only thing I’ve noticed is that I’m no longer pre-diabetic, but I fully attribute that to the fact that I’m living a generally healthier life than I was before. OTOH, the real point of concern for me, my blood pressure, is still a major point of concern for me, to the point where they’re now rotating various combinations of blood pressure medication to see which ones WILL work on me. Oh, and my asthma? Not affected one iota by my weight.

      I consider myself very fortunate in that my primary care physician has never hassled me about my weight and always treated me as a whole patient independent of the numbers on the scale. I also think it’s wonderful that my mom’s primary care physician and nephrologist (her two primary doctors) have also done the same for her (in fact, her nephrologist told her her weight “problems” are most likely due to retention of fluid and to let any doctor who tries to hassle her into losing weight know about what she’s said). I wish more doctors out there were like that.

  2. I was in the military and my husband still is. I recently decided to try to quit the diet yo-yo… and am having a heck of a time deciding what to eat, how to exercise (I have both a bad back and a bum ankle). I wish to be healthy.
    I guess I actually am healthy (blood work and blood pressure good) but the diet and/or exercise mentality for the purpose of losing or maintaining a lower weight than I think my body will “settle” on is so ingrained in my mind!
    Thank you for your blog. I find many words of wisdom and ammo for dealing with situations that may arise (and I dread).

    • Tara, at first it’s awkward to figure out eating and exercise when you first give up dieting, but it gets easier the longer you do it.

    • H Tara,

      It can definitely be tough at first. I remember just thinking – if I’m not eating for points or calories then what am I supposed to eat. You might check out Linda Bacon’s book “Health at Every Size” or Michelle at http://www.Fat Nutritionist.com, and Golda Poretsky at http://www.bodylovewellness.com, if those aren’t the right resources for you they’ll start you on your way. For exercise you might try Jeanette DePatie at http://www.thefatchick.com and Kelly Bliss at http://www.kellybliss.com.If there is anything that I can do to help you can always e-mail me at ragen at danceswithfat dot org.

      Good luck and have fun!!!

      ~Ragen

      ________________________________

      • Thank you all so much!
        Even prior to my first big injury I used diets regularly to ensure that I was below the maximum allowable weight in the military. When I was my most fit (run team, frequent weight lifting) I hovered at 3-5 lbs over my max weight–I’d crash diet for a few days to a week to ensure I was below max weight because body-fat measurements were at best inconsistent and inaccurate.
        After injury I used different diets/ alternative fitness techniques to try to maintain that weight…. then the real yo-yoing began.
        Go back even further and I remember my mother chastising me for my weight in my pre-teen years. This is a lot of ingrained weight consciousness to unravel!
        It’s enlightening to hear that weight is not the factor with which I should be concerned. On some level I think I already knew this… let the research begin!
        Thanks again!
        Tara

    • Our culture has so much disordered habits with eating and exercise, it’s hard to learn to see them for what they are and find healthy behaviors to engage in, especially when you’ve spent years in a weightloss pressure-cooker like the military. Think of it as a skill that you need to learn how to do well. I know that seems weird, that eating and exercising in a way that is healthy for you is a skill that you have to study, learn, and practice in order to do well, but it really is. Be patient with yourself, don’t be afraid to make mistakes, and when you check in with yourself a year from now, I bet you’ll see you’ve changed a lot. Enjoy your new friendship with food and movement. :)

  3. I catch myself thinking stupid thoughts. I have to fly to California in October for a family wedding and I carry all of my weight in my hips. I swear the term saddle bags was created just for me. I think they call it something like extreme pear. At any weight. I have issues sitting in theater seats where the arms don’t raise and stadium seats at the local ball field, so needless to say, I’m terrified of the idea of having to fly across the country trying to squeeze into an 18 inch seat and failing. The worst part is that for one very dark moment, I started thinking that if I started a highly restrictive diet now, I might lose enough to comfortably make it to the wedding and then when I fail in a couple of years, so be it. I still can’t believe I let myself think this way…and even then it won’t solve my issues. When I was in high school and starving myself, my hips were still so wide that i barely fit in some amusement park rides, so what makes me think knowingly putting my body through that much strain would even work, much less be worth the risk? I sincerely wish airlines would consider creating wider seats that can be sold as a single or a double in a pinch. While I hope that might be an option in the future, those accomodations will not be available on my flight in October and even if I buy two seats or whatever other hoops I have to jump through, I’m still going to be hurting all the way to Cali.

    • Jen W–I am so with you. I had three flights for work in three months recently, including an international flight, and I was nervous so far in advance that it was stupid. As it turned out, it was fine. I brought my own belt extender (only needed on some domestic flights) and tried for aisle seats whenever possible. It was uncomfortable sometimes, and I definitely wouldn’t want to do it every day, but my mantra was that it was just one day of my life, and I would never see these people again. :)

  4. I was disabled in an accident, totally unrelated to my size, indeed it mighty have cushioned me somewhat says the neurosurgeon. I have switched from physiotherapy to a personal trainer to improve balance and core strength. I am smaller as a result, either weight loss or muscle tone or more likely a combination of the two. People are driving me crazy saying how wonderful it is that I have “lost weight”. They truly dont get why I am not dancing around in a state of ecstacy about it.

  5. I’ve been lurking for a month or so now, but this issue is one I’d been wondering how to deal with. Thank you for phrasing things so eloquently, as well as providing so many helpful links to other studies and previous posts of yours. Your blog is a treasure I feel like I’ve just found, as is HAES. (Oh, how I wish I’d known about it sooner–how I wish my grandmother had known, and not decided to put me on a diet at 10 years old. I’ve seen pics of myself at that age. I wasn’t even slightly pudgy! I was normal. I don’t entirely blame her though, because she was put through the same societal shaming.)

    I’ve been wanting to shout out your praises to the world. :D But I’ve been reluctant to draw attention to myself for just the reasons this post touches on: the fear that people will just accuse me of not having enough willpower. It’s difficult getting over the “I must lose weight” mindset as well as the dream of one day being thin. But for the first time in many years, I know I’m not bad or weak-willed just because I (like 95% of other people) have been unable to keep off weight and have in fact gained more in the process of cyclic dieting.

    In any case, thank you for being a bright spot in my morning reading. You cheer me up immensely each day, and give that extra boost of motivation to do some activity, even if just a little thing, to work on health rather than thin.

  6. Hi, Ragen

    Diets are the wrong methodology. They fail, not the dieter. My blog has all the links to the most current and detailed research of Dr. Rudolph Leibel and Dr. Michael Rosenbaum. Their extensive research run back and forth many, many times has soundly shown the body has VERY aggressive involuntary responses t( all detailed in my article with video links) to any attempts to lose weight.

    Dieting is “tinkering with the system” and does long term damage that does not go away says Dr. Leibel.

    Dr. Leibel said when it comes to body weight and body fat, our bodies completely have a mind of their own.

    Wishing You Well.

    Raz

  7. One other thing you mentioned today caught my attention:

    “The diet industry doesn’t want to give up the 60 Billion a year it rakes in, doctors are enjoying lucrative weight loss practices, and others just don’t have the guts to admit that they’ve traveled so far down the wrong road and given so much bad advice to so many people.”

    And I thought of this:

    http://www.subversivecopyeditor.com/.a/6a010536d5bba5970c0147e0ff357d970b-800wi

  8. ~tilts head~

    is that last line missing a “not”?

    “I’m certainly recommending”

    • Indeed it was, thank you! So much for my fallback career as a proofreader!

      ~Ragen

      • ~grin~ i would like extra points for reading all the way to the end

        which, is not even a bit hard to do with your excellent posts!

        • You get so many points!

          ~Ragen

          ________________________________

  9. I’m just going to leave this here:

    http://www.nytimes.com/2007/05/08/health/08fat.html?pagewanted=all

    A telling quote from the article:

    “His subjects were prisoners at a nearby state prison who volunteered to gain weight. With great difficulty, they succeeded, increasing their weight by 20 percent to 25 percent. But it took them four to six months, eating as much as they could every day. Some consumed 10,000 calories a day, an amount so incredible that it would be hard to believe, were it not for the fact that there were attendants present at each meal who dutifully recorded everything the men ate.

    Once the men were fat, their metabolisms increased by 50 percent. They needed more than 2,700 calories per square meter of their body surface to stay fat but needed just 1,800 calories per square meter to maintain their normal weight.

    When the study ended, the prisoners had no trouble losing weight. Within months, they were back to normal and effortlessly stayed there.”
    _______________________________________________________

    The thing is, people’s bodies desire homeostasis, and if you try to force them in an extreme one way or the other (including massively overeating), the body will fight it tooth an nail.

    While humans often generally have a metabolic profile that is able to gain some weight easily, unless you have a massive hormonal imbalance or another health issue (including binge eating disorder), the chances of gaining huge amounts of weight in someone who is generally of average size is fairly small.

    I’ve met people who come from families where their relatives are all about around 130 pounds and then they obsess about how “if I ever let myself go, I’d totally be like 400 pounds!” This is fairly unlikely if you do not come from “larger stock” or have the genetic and health components in place to gain that much weight.

    Plus most people have highly distorted views of their bodies. They FEEL that they are “so fat” when in actuality the whole “feeling fat” phenomenon is simply short-hand for their insecurities about their own bodies. I know of women who are 300 pounds and who don’t “feel fat” the way that it is generally meant by the average person (ie: “gross, ugly, unloveable, etc). I’ve met women (like my mom) who are less than 100 pounds who are convinced that because they’re not the same size jeans as in high school that they hugely obese.

    I think that people need to realize that they can’t conflate their body dysmorphia with their actual health or body size. What we need is a body image revolution, not a weight loss revolution.

  10. My New Years resolution for 2012 was to NOT diet. It was wierd at first. I also follow the HAES best I can. I started buying lots of sweets and decided I would eat whatever I wanted. With the sweets in the house, I found I didnt eat as much as I thought. I still have Girl Scout cookies. I eat whatever I make for dinner. I used to make a seperate dinner for me, non fat, etc. I get full before I finish my plate. I am not thinking of food all day and my weight has stablized to within 3 lbs. I am so amazed. I feel good. I really enjoy my sweets when I feel like eating them. I dont obsess. I dont feel like I have to eat all the cookies in one day because tomorrow I diet again. It is a process to change old habits. It does get easier and actually I feel more “natural”. I get hungry, I eat, Im not hungry and I dont eat. I feel like I lost a heavy weight off my shoulders. Forgive the pun.

  11. … because they stop doing the diet or attending Weight Watchers or whatever…

    In addition to everything you’ve mentioned, Ragen, I think it’s worth pointing out that some diets — including some that WW leaders have recommended, including some that doctors have supervised — are neither workable nor safe to maintain long term. Even if it were possible to continue losing weight (or to maintain a “goal weight”) while eating 1000-1200 calories per day — Willpower aside, that wouldn’t be a safe thing for me to do, you know? Not wanting to starve myself doesn’t make me weak-willed.

    • “Not wanting to starve myself doesn’t make me weak-willed.”

      Bravo! Truer words were never spoken!

  12. I believe Meme said in the Interview with Shannon is is “95% of dieters fail, not because they can’t, just because they don’t” so I’m not sure that she is totally on board with you on that.

    “Of course everyone is the boss of their underpants and I have no problem with people choosing dieting for themselves”

    This is why you are one of my favorite opinion bloggers. You are respectful of others. :)

    • Thanks Ashley,

      Meme and I definitely disagree about why dieters fail, the point I was trying to make was that she had at least admitted that 95% of dieters DO fail.

      ~Ragen

      ________________________________

  13. From my days of dieting, which ended about 30 years ago, I remember how dieters would always tell me they had a better diet I should follow. It was confusing and confounding. Back then I tried not to do that to people. These days I do the same. I don’t preach HAES when they talk about their diets. Mostly I say nothing or try to remain neutral or change the subject. I may wait until we are on a non-diet discussion and then mention a few facts about HAES. I also do my best not to comment on a person’s apparent loss or gain of weight. This sometimes prompts other people to ask why I didn’t complement someone for losing weight. I suppose they jump to the conclusion that I am envious. I tell them every person’s body is her own business, and I am not getting involved in her personal business. Seems to shut them up.

  14. That moment in the documentary was probably pretty horrifying, but I find myself thinking the next time I get asked a really basic question that has nothing to do with food, I’m answering ‘hashbrowns’ just to be surreal about it.

    And yeah, totally with you. If something fails 95% of the time no matter how you do it, then it probably just doesn’t work and should be abandoned.

  15. Question for anyone who would care to answer it. Back story: I went to a general practitioner to get medicine and a referral for a counselor to treat my depression. This is the first time I’ve seen a general practitioner as an adult, so he does a general exam, orders a few blood tests for a later date to make sure that all of my levels of everything are normal (they are). Then near the end of the appointment after prescribing medication to start on, he recommends exercise and sunlight to help the depression- so far, so good. Then, while I am still in tears from just describing my psychological symptoms, he also recommends “less white food” and “more lean meat”. I ask him if studies have shown that doing this helps with depression. He gives me a blank stare and says, “No, it’s for your weight.”

    o.0? I’m 22 years old, 6 feet tall, and 240 pounds. My levels are all normal, I came to you for help with depression, AM IN FACT STILL CRYING, and this seems like a good time to tell me to lose weight?

    It seems like a really inappropriate comment to make at a time when I really didn’t have the emotional energy to explain to him about HAES, but he was a nice doctor otherwise, and I don’t know whether this is a big enough reason to change doctors or not. Besides that, how do you respond in that situation? If I do stay as his patient, what can I say to keep this from happening again?

    • I would just say to him, lets deal with __________ for now and we can talk about my weight on another visit. I will make an appointment when I am ready to talk about it with you.

    • Yeah that reminds me of when I went to my doctor years ago when I had depression. I hadn’t yet realized I had it, but I had some concern about my hormone levels after doing some reading on the subject. He completely dismissed my concerns, didn’t question me about symptoms at all(which might have clued him in to the depression–duhh!) and gave me a long weight loss lecture instead. Dickhead. I went out to my car and bawled my eyes out. Thanks, doc! Just to survive, I had to make a conscious decision to let go of my weight, because focusing on it was killing me. He later dropped me for noncompliance, which was the best thing he ever did for me, because I went and found my fabulous gynecologist who referred me to my equally fabulous primary care doctor. They treat me with respect and listen to my concerns, and I feel I can tell them anything and they won’t make me feel like a freak. You have the right to appropriate care. If he pulls that again, you can tell him,”doc, it’s all I can do to deal with this depression. I just don’t have anything in the tank for other stuff. When I’m feeling better I’ll discuss it with you.” If he won’t stop pushing, you may want to drop HIM for noncompliance. Good luck, and keep hanging on.

  16. I so admire the information you put out to help guide me as i flirt with HAES. I say this as I listen to GMA where there are presenting a New Diet…. a surgical procedure called POSE for those who only want to lose 25 to 60 pounds. Good Grief.

    I gave up dieting and weighing about 6 years ago and am so elated with my peace of mind. It took some time before I was truly at peace… but now I can wake each day without thinking about food and what I can eat. I have a healthy diet and exercise modestly and moderately. It’s all good.


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