Odds of a severely obese woman becoming “normal” weight: 1 in 677. For men, 1 in 1290.


[Image from Jes Baker’s awesome “Empower All Bodies” project.]

Another reason it just makes more sense to encourage fat people to love our bodies, rather than teaching fat people to hate our bodies until we attain “normal” weight:

The chance of an obese person attaining normal body weight is 1 in 210 for men and 1 in 124 for women, increasing to 1 in 1,290 for men and 1 in 677 for women with severe obesity, according to a study of UK health records led by King’s College London. The findings, published in the American Journal of Public Health, suggest that current weight management programmes focused on dieting and exercise are not effective in tackling obesity at population level.

The research, funded by the National Institute for Health Research (NIHR), tracked the weight of 278,982 participants (129,194 men and 149,788) women using electronic health records from 2004 to 2014. The study looked at the probability of obese patients attaining normal weight or a 5% reduction in body weight; patients who received bariatric surgery were excluded from the study. A minimum of three body mass index (BMI) records per patient was used to estimate weight changes.

The annual chance of obese patients achieving five per cent weight loss was 1 in 12 for men and 1 in 10 for women. For those people who achieved five per cent weight loss, 53 per cent regained this weight within two years and 78 percent had regained the weight within five years. […]

Weight cycling, with both increases and decreases in body weight, was also observed in more than a third of patients. The study concludes that current obesity treatments are failing to achieve sustained weight loss for the majority of obese patients.

And those “success” numbers include some patients who lost weight involuntarily due to health problems.

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Another couple of fat-related research links, while I’m posting about this:

A 2009 article in Nutrition Research Review, “A review and meta-analysis of the effect of weight loss on all-cause mortality risk,” examined whether otherwise healthy obese people live longer if they lose weight.

It is less clear whether weight loss benefits longevity and hence whether weight reduction is justified as a prime goal for all individuals who are overweight (normally defined as BMI>25 kg/m2). The purpose of the present review was to examine the evidence base for recommending weight loss by diet and lifestyle change as a means of prolonging life. … There was no evidence for weight loss conferring either benefit or risk among healthy obese. In conclusion, the available evidence does not support solely advising overweight or obese individuals who are otherwise healthy to lose weight as a means of prolonging life. Other aspects of a healthy lifestyle, especially exercise and dietary quality, should be considered.

And another study looked at the link between perceived anti-fat discrimination and mortality:

The researchers were curious whether there would be a correlation between weight discrimination and an increased risk of mortality once you controlled for other factors that might also be associated with a heightened risk of dying — things like depressive symptoms and body-mass index, for example. Sure enough, that’s what they found — controlling for other factors reduced but did not eliminate a statistically significant link between weight discrimination and early death: All else being equal, respondents who said they felt like they’d been discriminated against on the basis of their weight were about 31 percent more likely to have died.

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10 Responses to Odds of a severely obese woman becoming “normal” weight: 1 in 677. For men, 1 in 1290.

  1. 1
    shirt says:

    I, white male, +65, have lost 20 lbs. in less than 6 months. Just stopped drinking beer at home. I was motivated by my cardiologist who wouldn’t operate until I lost 10 lbs.. What was a Hobson’s choice became my choice after seeing how successful it worked.

    BTW the stenting was gloriously successful.

  2. 2
    Ampersand says:

    I’m genuinely glad that the stenting was successful. And since you seem to think the weight loss was a good thing, I hope you keep it off, or lose more if that’s what you want.

    But… a six-month loss isn’t really meaningful, in terms of what these studies have found. Because the question is, how many people keep the weight off long-term? (If I recall correctly, the study this post is about followed people for up to nine years.)

  3. 3
    Nancy Lebovitz says:

    shirt, the other relevant detail is that losing 20 pounds isn’t close to the amount needed to lose to move from severely obese to “normal” weight.

  4. 4
    shirt says:

    All of that is spot on. But I’ll continue to look for wining strategies like that. Now that I’m stented I suspect the next strategy is exercise, then diet. My overweight status is the result of careless self-indulgence. That needs to change to careful limited indulgences. In that regard I am fortunate for I have known many people who are just big and can’t do anything about it.

  5. 5
    Pesho says:

    You do not become severely obese without a reason. As I grew up, I knew exactly two fat people.

    One had a medical problem, it took twenty years for her to get it treated, and she is no longer fat.

    The other had a server overeating problem. I knew him in the Army, no instructor could get leverage on him. He was constantly getting caught trying to sneak out to get food, he tried bribing people for food, he started smashing his head in the bars when he was locked up, and… he ended up in the kitchen. We all thought he was eating more than his share, but he was a good cook, and I, personally, bought his line that by being careful and skilled, he was saving more than he was inhaling. I have lost touch with him, mostly because I couldn’t remember his name when I was looking up my mates from the army. Hard to find someone when you are looking for The Pregnant One.

    We had almost NO fat people in Bulgaria at the time. Now, the country is jostling for first place in Europe by obesity. The genetics did not change. The lifestyles, the access to good food and exercise facilities, the national health care, the education, the acceptance… those did.

    Since my daughter was born, I have put on seven pounds. Now that it’s 72 outside and I take her out in the stroller, I’m sure my weight will stop going up. To go down, I’ll have to make an effort. But seven pounds is chickenshit. Once I got injured, and put on 25 pounds before I realized what was going on (I went from swimming and kayaking 30 hours a week to having to roll on my stomach to get up) It was much harder to take that weight down, mostly because being out of shape made it unenjoyable to be physically active. If I had been in worse shape, if I had not been living 50 meters from my kayak, if I had lacked free time, or if I had had a social life at the time, who knows whether I would have regained my shape.

    All this is to say that I know, not believe, know that it is trivial for healthy people with time and resources to vary their weight within 20 pounds or so. But unless you change the way you live, and eliminate what made you gain the weight in the first place, of course, no diet or exercise will work.

    And if you do not have luxury of dedicating time, or the means to dedicate resources, or the access to food and facilities… no amount of self-control or peer-pressure will help. If anything, the last two will end up as self-hatred and torture.

    By the way, I do not interact with any overweight people in my day to day life. None. Two of my friends got together with women who were overweight, but they are no longer even slightly so. One friend had a fat sister, she grew out of it. One coworker was obese, he got some kind of surgery, and three years later, he is still keeping the weight off. But he also got divorced, eats according to a chart, and spends a lot of his time hiking and boating.

    Like most things in life, it’s all about resources.

  6. 6
    Elusis says:

    You do not become severely obese without a reason.

    Well this is going to be great news from my mother’s perspective, but I’m going to really have a heck of a time replacing my entire wardrobe. At least I’ll have a good range of shopping options though.

  7. 7
    Charles S says:

    I think the figures in the first paper are kind of weird, because the population the statistics refer to are all people in a particular BMI range with 3 or more BMI measurements, not people in that BMI range who were specifically attempting to reduce their weight in a given year (as far as I could make sense of the study description, I may just be severely misreading). Roughly 1 in 10 obese people in the study lost 5 % of their weight each year, but there is no information on what percentage of obese people in the study were actively attempting to lose weight per year.

  8. 8
    Ampersand says:


    This was a concern of mine, too – clearly it’s a big limitation of this study. But I still thought the study was worth sharing because of the large population sample and reliability of the measurements (i.e., doctor reported rather than self-reported). For what it’s worth, here’s what the study says about this question (footnotes to citations omitted):

    It was not possible to evaluate intentionality of weight loss. Previous studies have reported that the majority of obese individuals would like to lose weight and that a large proportion is actively attempting to reduce their weight, so a relatively high level of intentionality among obese participants may be assumed.

    Additionally, monitoring BMI among obese patients in primary care has been shown to predict treatment positively. Patients in this study were required to have a minimum of 3 BMI measurements recorded, suggesting that an inflated proportion of patients in this sample may have been involved in and interested in weight management interventions. Nevertheless, we acknowledge that unintentional weight loss was also included and might result from physical disorders such as cancer or psychological concerns such as bereavement. […]

    The relatively high levels of comorbidity seen in obese compared with normal weight patients would also likely result in more regular consultations and more frequent recording of BMI. However it is possible that patients from all BMI categories with 3 or more BMI measurements recorded over the 9-year study period represent a biased, less healthy sample compared with the general population. If this is the case, then unintentional weight loss, along with comorbidities contributing to weight gain such as mobility impairment, may have influenced BMI changes disproportionately in our sample.

  9. 9
    VK says:

    It’s also worth noting that the NHS and UK governement have an active policy of encouraging all overweight patients to increase exercise, diet, enter weight loss programs etc: while it may not be a realistic assessment of the absolute best people can do the lose weight, it is a good assessment of how the social policy in the UK of encouraging people to lose weight is going (ans: not good!)

  10. 10
    closetpuritan says:

    @Charles S: About a quarter of Americans are trying to lose weight at any given time–so, a minority of the people, but not nearly as small a minority as the people who actually lost 5% of their weight, let alone achieved normal weight. I couldn’t find stats by BMI category, though I know that in the past, studies have found that larger people are more likely to diet/engage in restricted eating patterns.

    @Pesho: I don’t think I would call going from being active 30 hours a week to being not at all active “trivial”. I guess you’re saying “trivial IF you have the resources”, but even among people with high SES that we’d generally think of as having a lot of resources, few people have that kind of time to spend swimming and kayaking, and few people are starting at a level as absolutely sedentary as you were during your injury.

    Still, set point theory predicts that most people’s set point weight is about a 30 lb range, so I think you’re basically correct–changing your weight by 50 lbs is entirely different undertaking than changing your weight by 20 lbs.

    The “obesity epidemic” is certainly not caused by a change in genes, but that doesn’t mean that which people gain weight/how much they gain isn’t affected by genes. (I wrote about this more extensively here.) To take an extreme example, leptin-insensitive people and animals (the pound mouse) are always hungry. If there’s more food around, they’ll be able to gain more weight. Someone who’s on the other extreme and gets full very easily will gain little/no weight. It would be a mistake for such a person to assume their lack of weight gain was due to greater effort or strength of character, yet many people do assume that. And given the existence of of leptin insensitivity, I’m open to the idea of less-extreme biological differences in how satiety is experienced leading to less-extreme differences in calorie consumption and BMI–such differences are only “something wrong” in a very definitional way–we’ve defined certain BMIs as wrong, so biological differences that lead to those BMIs are wrong.