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In 2020, Helen Pluckrose and I had an online debate over if dieting works. During this debate, I said “Not a single weight-loss model – including long term approaches – has ever been shown to work in a peer-reviewed controlled clinical study.” Helen responded:
It simply isn’t possible that people ate fewer calories than they burned and got fat or that got slim and then ate the same number of calories that they burned and got fat. Fat needs to be built or maintained with calories.
To which I replied:
Of course if someone eats little enough, they will lose weight. And if they keep eating little enough forever – which may require eating even less than when the diet began, as their body attempts to regain the weight – they can keep the weight off.
In this extremely superficial sense, it’s true that all fat people can diet their way to no longer being fat.
But that’s sidestepping the real question: Can a typical human voluntarily reduce food intake enough to cause a large loss of weight, not just for a few months or years, but for a lifetime? Not just in theory, but in practice? Study after study has shown that the overwhelming majority of us cannot.
Helen’s argument is one I’ve seen made at least a hundred times – albeit almost always far less politely said. (“So you’re saying the fat acceptance movement are idiots who don’t believe in the first law of thermodynamics” is a more typical way they put it.)
But rudely or politely put, it’s the same miscommunication – when fat acceptance folks say “diets don’t work,” we mean that our brains won’t allow us to diet forever, but they think we’re talking about physics.
When I encounter the same argument over and over, I often wish I just had something I could paste in that explains it, rather than having to explain it over and over. I’m hoping this cartoon will be useful, for me and for other fat acceptance folks, in exactly that way.
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The challenge and the fun in drawing this was, as you’d expect, the sequence of expressions from panel four through panel eight, showing the character’s increasingly desperate attempt to hold her breathe. It’s so nice being a cartooney cartoonist; I think it would be harder for someone with a realistic drawing style to pull off.
The challenge in writing this strip was fitting it all in! I edited again and again, trying to cut the words down while maintaining clarity and – hopefully – not draining the dialog of all personality and life. I still ended up having to do panels with as many as 30 words, which is both not many words at all and more words than I’d prefer to use. (To give you a sense of how not-long 30 words is, the sentence “I still ended up having to do panels with as many as 30 words, which is both not many words at all and more words than I’d prefer to use” is 30 words long).
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TRANSCRIPT OF CARTOON
This cartoon has nine panels, arranged in a three by three grid. The cartoon has two characters. The first character is a fat woman with a pixie haircut and glasses, wearing a polka dot shirt and a skirt. Let’s call her “DOT.”
(I don’t know if I’ve EVER seen anyone in real life wear a polka-dot shirt, but Bill Watterson sometimes drew adult characters in polka-dot shirts, and as longtime readers know it’s my firm opinion that if Watterson did it then it by definition is good cartooning).
The second character is a thin character with curly hair, wearing a button-up shirt with large black buttons. Let’s call her CURLY.
PANEL 1
Dot has her hands raised – open hands facing inward, a tiny bit above elbow height, which is so much the go-to for cartoonists trying to show a character explaining something that the cartoonist Joe Matt once drew this pose with a caption arrow pointing towards the hands saying “Good ol’ explaining hands.” Curly is cheerful and smiling, and holding one hand out with palm down in a dismissive gesture.
DOT: DIETS DON’T WORK! Studies show that for nearly everyone the weight comes back.
CURLY: Nonsense! Eat less and you’ll lose weight! That’s physics!
PANEL 2
Dot continues explaining, now using a pointing finger, while Curly eagerly leans forward, hands clasping each other, and her eyes replaced with dollar signs.
DOT: While I reply, could you hold your breath? I’ll pay you $1000 if you do it till you faint!
CURLY: $1000? Okay!
PANEL 3
Dot continues explaining; Curly is holding her breath and looking confident.
DOT: Physics says you can do it… if you don’t breathe in, oxygen can’t get to your system, and you’ll pass out.
PANEL 4
A close-up of Curly, still smiling, with her cheeks puffed out, but her eyes are widening. Dot speaks from off-panel for this and the following three panels.
DOT: But this is about biology, not physics. Right now, your brain is sending chemical signals to your body saying “inhale!”
PANEL 5
Curly is still smiling, but she’s obviously straining a bit to keep holding her breath.
DOT: The same thing happens when you diet. The brain thinks you’re starving and sends out signals saying “you’re hungry! EAT!” It’ll send those signals for years if it has to.
PANEL 6
Curly isn’t smiling and doesn’t look confident. She’s still holding her breath, but has balled her hands into fists and is trembling.
DOT: The brain also releases hormones to make your body hold onto more fat. we evolved that way to get through famines.
PANEL 7
Curly has her hands on her cheeks now, and is trembling a lot more, and her eyes are huge and almost popping out.
DOT: And a tiny fraction of people lose weight forever! But for most people, no matter how much willpower they’ve got, eventually…
PANEL 8
In the foreground, Dot looks – let’s face it – a bit smug as she smiles. The panel is mainly taken up by Curly, who has opened her mouth hugely and is gasping. A huge sound effect, drawn so that the letters are converging towards Curly’s open mouth, says “GASP.”
PANEL 9
Dot is back to explaining hands, but with one forefinger pointed up. Curly has turned her back on Dot, arms folded, and has a sour grapes expression.
DOT: THAT’S biology! See my point?
CURLY: Screw THIS! I’m getting a lung bypass!
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But Barry, our bodies won’t allow indefinite weight suppression via calorie restriction either.
1) When people reduce their calories to produce weight loss, their metabolism typically re-sets itself lower and lower, to the point that people can start to re-gain weight while maintaining the same calorie restriction. There are many fat people whose food intake is identical to people who are dangerously underweight from severe anorexia, but who remain fat (and are often encouraged to continue the restricting behavior).
2) People who have bariatric surgery often do not go from “fat” to “thin.” Even though they’re physically incapable of eating more than a few teaspoons of food at a time, and actively experiencing malnutrition, they more typically go from “fat” to “slightly less fat.”
3) We’re seeing this with the semiaglutides (Ozempic, etc.) as well. There is a period of somewhat rapid weight loss, which then levels out and plateaus, and by less than two years, people even start to re-gain.
So it’s not just about “willpower” or “brains” or whatever, which may leave people who are anti-fat with the conviction that fat people need to be “helped” by surgery or medication. The mitochondria of human cells work in mysterious ways, and are exceptionally, exceptionally good at “violating the laws of physics” (which I’m sure they don’t do; human metabolism is just far more complex than a bomb calorimeter) and holding onto body mass in the face of calorie restriction, whether behavioral, mechanical, or otherwise.
Hey, Elusis!
I agree with all of that; it was just more than I could reasonably fit in this cartoon. :-)
Just don’t tell the gender criticals!
But seriously, great page.
Do you know how Pluckrose is doing now? IIRC, she was saying that she would lose weight and that she would have no problem reaching and maintaining a weight that she wanted because it was just physics. My prediction is that it didn’t work out the way she was expecting/hoping/pretending to herself.
Thank you! :-D
I haven’t seen a recent photo of her. My impression is that over the course of her life she’s lost and regained multiple times, but it’s not the sort of thing I’d question her about, so I’m not sure.
Yeah, it’s not really something that one can ask a person. Especially since the answer is almost certainly that she lost and regained the weight. Because you’re right: our biology is not made to allow us to starve in the midst of plenty indefinitely.
I lost 100 pounds 16 years ago, and have kept it pretty much all off since, never gaining it back. Mix of exercise and eating less (especially high carb items).
And no, it doesn’t involve starving. Or anything like it. It’s a false choice to claim that the only 2 choices are starving or eating too much. Indeed, because of insulin spikes after eating (especially carbs) make you feel more hungry.
That being said, I would never urge antone to lose weight unless required for health purposes. And definitely exercise a lot ..
Here’s the thin, Jon: Your results are not typical. We know that 95% or more fail to keep weight off. So you’re in the lucky 5%; I’m genuinely glad for you!
But that doesn’t mean that anyone could do the same as you. That doesn’t mean that you’re a better or more willful person than those who don’t keep weight off. I hope you’re clear on that.
This is perfect! Yes, if you do the thing that most people don’t have the willpower to do, with your body actively working to prevent you, for long enough, you’ll get the result, but that doesn’t make the thing any more possible.
It also doesn’t mean the thing is *safe* and won’t kill you. When I was still bothering to argue on Twitter, Barry and I both got into it with someone who was extremely dismissive that I noted that long-term dieting can in fact kill you. (I would be super unsurprised if *a lot* of mortality attributed to being fat is actually caused by dieting. If a fat person on an extremely low calorie diet dies of a heart attack, nobody’s going to blame the diet.)
I’ve also lost some weight (less than 100 lbs) by going low carb, although the weight loss was a byproduct of keeping my blood sugar happy.
It’s a way of eating that results in weight loss for a lot of people, but still a pretty small minority of those who try it. It’s also tricky to eat low carb *and* avoid excess saturated fat and trans fat *and* eat enough to feel satisfied without either making a lot of things from scratch or spending a lot on low carb substitutes. I have the luxury of being able to buy things like Catalina Crunch and Rebel Ice Cream, which are *a lot* more expensive than their high carb counterparts, and I still don’t find it easy to stay fed while following a low-carb diet.
I honestly have no clue as to what’s right here, but there are lots of studies that very low-calorie diets over longer periods of time can slow aging and lead to longer life.
https://www.nbcnews.com/health/health-news/calorie-restricted-diet-may-slow-aging-healthy-adults-science-shows-rcna69562
https://www.science.org/content/article/why-eating-less-means-living-longer
… etc.
I don’t want to spam the board, but if you type “long-term low-calorie diet long life” or the like into Google, you get lots of different references to studies.
I don’t know what’s true, but it is an interesting question.
The data on caloric restriction and longevity/health in humans is mixed at best. In the end, it doesn’t matter, since most people can’t do it.
With regards to dieting, it is 1) the yo-yoing that is a huge health problem and 2) really hard for most people to do caloric restriction while maintaining good nutrient levels without professional help. Eating a poor quality low calorie diet is definitely bad for health.
Karen: I don’t think it’s as clear-cut as some people believe.
From your first link:
So even some experts in the field have doubts.
Unsurprisingly, the study itself is more modest about its findings than NBC reported:
They optimistically hope that those small effects will have larger benefits down the road, but that’s not something they actually tested.
From a different paper about the same study:
Regarding that “very intensive behavioral intervention”: It began with a solid month of all meals being prepared by the study for the subjects. The first six months included “intensive group and individual behavioral counseling sessions once a week,” and there were regular check-ins for the remainder of the study. Under those kind of interventions, I can easily believe that weight cycling – dropping off and on diets – wasn’t a significant problem with this group for the two years of the study. But I don’t think it’s realistic to think those results are maintainable over the long term in real-life conditions. Also, their subjects were all non-depressed people in great health (no one who was regularly taking medication was included in the study group), which again, I’m not sure how generalizable that is to a general population.
My point is, the “calorie restriction increases [some bio markings which we associate with an increase in] lifespan” evidence, while real, isn’t nearly as certain as the media reports claim, and in practice can’t necessarily be generalized from study conditions to real life.
: Can a typical human voluntarily reduce food intake enough to cause a large loss of weight, not just for a few months or years, but for a lifetime? Not just in theory, but in practice? Study after study has shown that the overwhelming majority of us cannot.
Incorrect. The majority of Americans can’t.
Humans in the rest of the world just have a different biology. (Or don’t glorify being fat.)
Are you saying that American citizens are biologically distinct from the rest of humanity?
The idea that Americans “glorify being fat” is completely disconnected from reality.
I’m unaware of any peer-reviewed studies showing that weight loss diets are any more successful anyplace on earth. Please provide some citations; here’s info on what kind of study I’m looking for.