I’ve complained that studies of weight loss diets have extremely forgiving definitions of “success.” Fatfu, in a terrific post that I only just now read (although it’s almost a year old), has a similar complaint. But she also whips out her calculator and tries to deduce one of Weight Watcher’s best-kept secrets — how many Weight Watchers clients lose weight over the long term?
38,000 people who reached goal weight per year sounds like a lot. But actually it turns out to be a really small number. I found a business article from back then that stated that Weight Watchers had 600,000 attendees in the U.S. in 1993. Divide 38,000 lifetime members per year into 600,000 and my calculator says that each year only about 6% of Weight Watchers members (give or take) reached their goal weight (presumably 94% failed).
Now before you get all impressed with Weight Watcher’s 6% success rate, let’s step back. For one thing, the successful 6% weren’t so fat in the first place. The 2001 study says that most were between a BMI of 25-30 (i.e. “overweight” but not “obese” – to use definitions I find silly). The 2007 abstract says the average starting BMI for that study was 27 – which is well below the average Weight Watchers participant. So in order to achieve goal weight the average lifetime member probably had to lose less than 10 lbs and would have to include a lot of people who had even less to lose. […]
And what about the number we’re really looking for – how many people actually become “normal” weight long-term using Weight Watchers? It turns out only 3.9% of the golden 6% were still at or below goal weight after 5 years. By my calculations that means 3.9%*6.3% = 0.24% or about two out of a thousand Weight Watchers participants who reached goal weight stayed there for more than five years.
More recent numbers from Weight Watchers indicate that the rate might even be as high as 1 in a hundred. But that’s only after five years — and virtually all research on weight loss shows that “success” rates drop year after year. Just how low would the numbers be after seven years, or ten years? As Traci Mann wrote in an excellent American Psychologist article (pdf link) reviewing the evidence on dieting (hat tip to Fatfu):
Second, these losses are not maintained. As noted in one review, “It is only the rate of weight regain, not the fact of weight regain, that appears open to debate” (Garner & Wooley, 1991, p. 740). The more time that elapses between the end of a diet and the follow-up, the more weight is regained. […]
Even in the studies with the longest follow-up times (of four or five years postdiet), the weight regain trajectories did not typically appear to level off (e.g., Hensrud, Weinsier, Darnell, & Hunter, 1994; Kramer, Jeffery, Forster, & Snell, 1989), suggesting that if participants were followed for even longer, their weight would continue to increase. It is important for policymakers to remember that weight regain does not necessarily end when researchers stop following study participants.
Dieting, for 99% or more of the people who try it, does not lead to long-term weight loss. Even the 1% who do lose weight, don’t typically lose enough weight to turn a fat person, into a person of average weight. So why is weight-loss dieting the advice given nearly all fat patients by their doctors?
Here’s something doctors don’t tell their patients: 41% of people who go on diets weigh more a few years after the diet, then they did before they began dieting. ((See page 224 of this article (pdf file). “Eight of the studies reported (or made it possible to compute) the percentage of participants who weighed more at follow-up than before they went on the diet. These rates averaged 41% and ranged from 29%… to 64%…” A few pages later: “From one third to two thirds of participants in diets will weigh more four to five years after the diet ends than they did before the diet began. This conclusion comes from studies that are biased toward showing successful weight loss… The true number may well be significantly higher.”)) Since I’m a blogger, not a scientist, I’ll go ahead and make the irresponsible comparison: Dieting is significantly more likely to cause long-term weight gain than weight loss. That’s a Surgeon General’s warning that should appear on every diet program and product on the market.
“Dieting, for 99% or more of the people who try it, does not lead to long-term weight loss. Even the 1% who do lose weight, don’t typically lose enough weight to turn a fat person, into a person of average weight.”
Weight Watchers is a self-selecting sample though. As in, not everyone who diets joins the Weight Watchers (wether a ‘real’ or perceived need to lose weight – as for example, I don’t have a real need to lose weight at 16 BMI, it doesn’t negatively affect my health).
I’m not sure who or what to blame that makes it so that people gain weight far in excess of what they actually need to get by (energy gained – energy spent should = 0 or near it), so I won’t blame anything.
I totally agree. Except for this statement is wrong and inconsistent:
“By my calculations that means 3.9%*6.3% = 0.24% or about two out of a thousand Weight Watchers participants who reached goal weight stayed there for more than five years.”
Actually, those calculations show that about 4 out of a hundred WW participants WHO REACH THEIR GOAL WEIGHT stay there for more than five years. (You know, the 3.9 percent OF the 6.3% that did reach goal. I’m assuming you are correct about that part.)
And they show that about two out of a thousand WW participants IN GENERAL reach their goal weight and stay there for more than 5 years. (the 0.024 is out of EVERYONE not out of the 6.3 percent that already reached goal.)
You see what i’m saying? That just bugged me. Still grim statistics of course.
There’s a lot of evidence that this kind of failure applies to practically every weight loss method, not just Weight Watchers. Gina Kolata documents a lot of it in Rethinking Thin, including evidence from those who have spent decades researching the genetics of “obesity”. There’s also good evidence that if you do manage to make a fat person stay slim for a while, they don’t have the metabolic profile of a healthy slim person. They have the metabolic profile of a starving person. Weight loss surgery is just enforced malabsorbtion and malnutrition and has its own severe side effects, and long-term, the failure rate becomes closer and closer to non-surgical dieting.
It’s kind of ironic that this weight re-gain is called a ‘failure’ when it is in fact a demonstration of biological success: the human body’s ability to fight famine and stress.
Genetics plays a big role in how much a person weighs. If you have fat parents, fat grandparents, fat uncles/aunts/etc, chances are, you will be fat. Repeated dieting worsens those chances. And don’t even get me started on weight loss surgery. While some people have success with WLS, most don’t get thin (or even to what is considered a “normal” weight) unless they suffer from debilitating complications (and anywhere from 2 to 5 in 100 die from it within 30 days to 1 year of having the surgery). I’ve dieted repeatedly, and never been able to maintain weight loss, and ended up fatter than I would have been had I never dieted. And I know about WLS from personal experience. I had a VBG 11 years ago, lost 70 lbs (and was still considered “morbidly obese” after losing that much weight) and regained 110 lbs when it failed. My doctor wanted me to have it redone (which a friend of mine did, she had 2 VBGs, the second one when her 1st failed, and it killed her at the ripe old age of 43). I’ve been fat for 35 years now, and doctors have been telling me for 35 years that if I don’t lose weight, I’ll be dead in 5 years, in spite of the fact that I’ve never had high blood pressure, never had high cholesterol, and never had high blood sugar, and still don’t. Just goes to show what they know. I’ll stay fat and happy and healthy and probably outlive them all (since my grandparents were all in their 80’s and 90’s when they died, and they were all “overweight” or “obese”).
The fat people that are shown as an example of the “obesity epi-panic” are probably less than 1% of all fat people. Those fat people are the ones held up as the boogieman to scare everyone into compliance with an unattainable “ideal” that is getting thinner and thinner every year. You can say that calories in minus calories out should equal zero and no one should gain weight if they follow that advice, Schala, but the human body is not a closed system and there are way too many variables that affect how many calories a person needs to survive, how many calories they store, where they store them, why they store them, etc. And none of is this is the same for every person. It’s why diets don’t work for the majority of people, never have, never will. The sad thing is that doctors have known this for over 50 years, and diet, diet, diet is still what they will tell a fat person, knowing that it doesn’t work, because health has become conflated with thin. So if you aren’t thin, you can’t possibly be healthy (tell that to all the thin people who die of heart attacks/strokes/cancer/whatever disease, being thin didn’t extend their lives).
To tell you the truth, I don’t know how well WW keeps track of its successes or failures. I’m a lifetime member, and have been for 1 1/2 years. The central headquarters keeps sending me form letters to “come back,” even though I weigh in every month. I’m a success story that they don’t know about, so the bad record keeping could go both ways.
Exaclty as Schala said, nothing and no-one to blame.
This post like it’s original inspiration is great. I’m not sure what difference it will make, there tends to be either denial or an, ‘of course diets don’t work, it’s healthy living/lifestyles, stupid’ response.
People can’t or won’t let this one go, and move on to a better way of achieving weight loss for those who want it, as is perfectly feasible.
That’s what’s so hard to figure out conclusively, why people cling to the idea that weight loss must be pointlessly punitive and unsustainable; what difference does it make if it’s the opposite?
One caveat: Weight gain as a person ages is normal. So a weight loss to desired body weight and then weight gain at no more than typical rates could be considered a success. Whether that success is worth achieving is a different issue, but I’m not sure that demanding an absolutely stable weight is a reasonable definition of “success” in this context.
Dieting doesn’t work. Gotcha.
Sky blue. Gotcha.
I don’t have a real need to lose weight at 16 BMI, it doesn’t negatively affect my health
Arguably you should gain weight. On the population level, people with BMI of less than 18 are more likely to die than those of higher weights (see the NHANES data). However, I would hesitate to recommend that any thin individual try to gain weight, certainly not be any means at any cost (i.e. forcing yourself to eat when you don’t want to…just seems unhealthy overall). I don’t know you or your personal situation, of course, but in general I would suggest that very thin people exercise regularly and be aware of their bone density. Hip fractures can kill and not just in older people. (All assuming that the BMI of 16 is stable: if you lost significant weight recently, particularly if it was unintentional log off and go make an appointment with your doctor NOW. You need to find out what’s wrong.)
I’m not sure who or what to blame that makes it so that people gain weight far in excess of what they actually need to get by
You’re probably wise to blame no one, but being a rasher sort myself, I’m going to make a few suggestions.
1. The economy: People today are more likely to be working multiple jobs than in the past. I’m not sure what percentage of people are working 100+ hours per week, but a fair number seem to be. (Any actual data would be appreciated if anyone has it.) Stress and sleep deprivation are both known to cause weight gain. Maybe one reason people are getting fatter is that they aren’t being given enough time for recreation and sleep. Maybe we ought to be recommending unions as a weight reduction technique rather than weight watchers.
2. Cars: Using public transportation uses a small, but probably significant, amount of energy (walking to bus stop, down stairs to subway, running to catch the train, etc.) If you switch from taking the bus to work to taking a car (and make no other change in your diet or exercise pattern) you might gain 1-2 pounds per year. Doesn’t sound like much but over time can add up.
3. Peer pressure to be thin: If dieting leads to rebound weight gain then pressuring people perceived as overweight to go on a diet is just the wrong thing to do.
I’m not going to claim to have rigorous evidence for any of the above, but I’d seriously like to see someone examine the involvement of the first especially in weight gain. If for no other reason than that I’d love to see the headline, “Minimum wage increased to combat obesity epidemic” someday…Not sure the goal of decreasing obesity is all that important but raising the minimum wage would almost certainly be a good idea.
4. Peer pressure to consume: Almost every social gathering requires some sort of consumption of unhealthy food or drink. Whether it’s a cake to celebrate a birthday, fatty BBQ sausages on the long weekend or a few beers down the pub, our culture constantly demands we consume calories.
100% or more of people who receive medical treatment end up dieing in the long-term. We all have to die sometime right, so why bother trying to improve the short time we have left?
Also, people tend to gain weight over time anyway (average about 1lb/year from the few studies ive flicked through), so some of the weight “regain” is normal not because of the dieting. A lack of a control group in the studies sighted means they cannot be conclusive as to the long term effects.
The human body still had to obey the laws of physics with it’s biochemistry. Have a low enough intake of calories and you will lose weight. Of course the optimum calorie deficiency isn’t usually the same as the minimum intake.
Depsis: Your first point has been true since the dawn of human civilization. Shockingly, we’re social creatures, and we celebrate with eating food together, and always have. The rich did it far more often than the poor, and yet you don’t start blabbing about how Queen Elizabeth I or Louis XIV were fatty fat fatties.
And shockingly, I know people who could stuff themselves silly and never maintain a weight above 105 pounds, whereas unless i literally starve myself I will never ever ever again be skinny. I eat far less than most of the skinny people I know, and here I am a fatty fat fatty. Explain that away (the doctors have, so there’s an actual answer for it verified by multiple lab tests, and hint: it’s NOT diabetes).
Every body is different, period. As long as you eat healthfully for the most part (it is every American’s birthright to gorge themselves on pie at Thanksgiving, for instance) and get a moderate amount of exercise, weight means NOTHING.
@Dianne
Well, yes it’s stable. The only time it went unstable is when I lost 9 lbs in almost 2 weeks (10 days). When the doctor prescribing hormones gave me a dosage 12 times inferior to the previous one (from a high dosage to a minimally low one). A week later I was dizzy, having cramps, and lost 9 lbs (from 108 to 99 lbs). I’m more or less stable at 100 lbs since. I did not regain that loss. I did see another doctor at the time to help me (and replace the incompetent one that got me sick).
I’d probably benefit from gaining weight, if I knew how to. Apparently eating food isn’t cutting it, whatever food that is I’m eating. It would be nice to reach 110 lbs (just short of 18 BMI) or 115 lbs (18.5 BMI). I’m 5’6″ tall by the way.
The human body still had to obey the laws of physics with it’s biochemistry. Have a low enough intake of calories and you will lose weight.
True, but that’s one of those statements like, “All bleeding stops eventually”–it’s true but that doesn’t mean that all ways in which bleeding stops or all ways in which one can lose weight are optimal or healthy (or even compatible with life.)
Suppose you eat a diet which is adequte for you to maintain weight at your current activity level. Suppose further that that diet includes approxmately 350 Calories per day of chocolate. If you cut out the chocolate (and made no other changes in your diet or exercise habits) would you lose 1 pound per 10 days? Probably not. Your body’s metabolism would change so that it used less energy. At the same time, it would upregulate hormones that would “pressure” you to consume more (i.e. make you feel hungrier.) Not even to mention the effects of the loss of the theobromine and related fatigue. And you’d feel stressed, leading to increased corticosteroids and thus increased fat…and in the end no weight loss or at least less than expected. And in the presence of ad lib food, the chances that someone in that situation really doesn’t change their eating habits at all are very low.
So while I don’t think anyone is claiming exemptions from the laws of physics, the human body is complex and thinking of it as a simple black box of calories in and out is not completely accurate.
My metabolism is very fast compared to what I eat, so to gain any measure of weight, I need to eat more than my hunger permits, at every meal, and eat snacks, and eat fatty foods on top. Then maybe I’d gain 1 lbs per week. The problem is our budget (I don’t live alone) can’t afford an overeating scheme like this. We barely get by as it is.
Well, yes. Starve a body long enough and it will loose weight, just like if you hold someone’s head underwater long enough they will drown.
However, bodies have just amazing tricks to maintain fat levels at genetically- and environementally- determined “set points” . . . when I was a Physiology TA we studied recent research that showed that mammals with low fat storage often have mitochondria (the powerhouses in cells) that burn food energy and then WASTE it without using it – litterally leaking it out. Mammals genetically predetermined to store more fat have highly effiecient mitochondria (without energy leaks). Could you “fix” this? Maybe. These leaks are caused by a particular protien in the mitochondrion wall, there’s a good chance that a drug could target these. BUT these cells do this for a particular reason for this genetically-unique mammal. AND the body has multiple other mechanisms to maintain its set-point during starvation (e.g., cortisol levels).
After we read these mitochondria papers in class, the students wrote an essay on the research and we discussed it in class. At the end of the discussions I asked “so, given that this research was done in other mammals besides humans but making reasonable extrapolation, what do you think this research suggests about weight management and attitudes in our culture?” And these University-of-California educated biology students (many of them future doctors and researchers) inevitably came to the conclusion that fat people should control their hedonistic habits! Culture trumps evidence, I guess.
If it is true that there are more overweight children today – as the media keeps telling us – which suggests environmental change, then we should examine what’s going on there, and NOT make assumptions about causation without evidence (e.g., “those kids are just lazy-game-boy-addicted-junk-food-loving slobs” . . . perhaps it’s actually all the hormones in the water and food). We should also *rationally* consider the long-term consequences of this change. Kids are getting taller too, but no one talks about a “height epidemic” . . .
5: Straight up disease. I have a metabolic disorder that makes me gain weight, and makes it nearly impossible for me to lose it. (I can lose it when I become anorexic or bulimic.)
People who are healthy — whose blood pressure and cholesterol levels are good, whose joints can bear their weight, who can live in a 5th floor walk-up and not walk in their door wheezing and red-faced — shouldn’t let their doctors pressure them about their weight. If it doesn’t reduce mobility or health, it’s a meaningless number.
It’s silly to worry about the number on a scale, but the actually important thing the media is telling us is that there are more kids being diagnosed with Type II diabetes and other health conditions related to excess body fat (aka obesity). Much of this may be due to the increased immigration since the 1970s of non-Caucasians to the U.S.
Asians, Africans and Latinos (by Latino I specifically mean people with Native ancestry, not “Hispanic” Caucasians) who adopt the stereotypical American diet suffer worse health effects than Caucasians do because they’re not genetically disposed to a high-protein, high-fat diet. Caucasians who lived in cold climates ate a much meat-heavier diet than people who lived in more temperate climes where grains, vegetables and fruits were more easily accessible.
My mother had this problem when she immigrated from South Asia. When she was raising two small kids essentially by herself, and was coping with feelings of loneliness, isolation, etc., she started eating a lot of American food (pizza, ice cream) that she’d almost never been able to eat before, and even though she wasn’t eating a lot more than the Caucasians around her, the change affected her body much more.
My younger sister worked on a project a few years ago to help educate West African immigrants about the dangers of wholesale adoption of an American diet, and to assist them in maintaining their own food traditions in a foreign country. My older sister has worked with Latino kids on a similar issue. In South Texas they are facing a host of obesity-related health problems because of the switch from their traditional diet (in which fat is relatively rare) to one where McD’s is more affordable and time-efficient than recreating their pre-immigration meals.
We should resist media and even mistaken medical ideas about how people are supposed to look, but we also should be aware that what we eat affects our health and that while some people can be healthy on a certain diet, other people can’t. The aspects of fat advocacy that show how almost any weight can be compatible with health are good for us; the aspects that don’t acknowledge that high body fat does affect insulin receptors are not so good for us.
’d probably benefit from gaining weight, if I knew how to. Apparently eating food isn’t cutting it, whatever food that is I’m eating. It would be nice to reach 110 lbs (just short of 18 BMI) or 115 lbs (18.5 BMI). I’m 5′6″ tall by the way.
So, yeah. You can’t reach a “normal weight” (as defined by BMI charts) by changing your eating. Just like the vast, vast majority of people who are overweight by the same chart.
This is the thing that the “calories in/calories out” people love to ignore. The majority of people who are underweight can’t gain just by eating more, just like the majority of people who are overweight can’t lose just by eating less.
I wish someone would do a controlled study on Seth Roberts’ “Shangri-La Diet”…
PG, there’s a difference between being “pressured” to lose weight and being refused to be treated by doctors because of your weight.
Ali,
Sure, but doctors feel that pressuring you to do unpleasant things that they believe are good for your health is part of the job. (“You need to get your blood drawn.” “No, I hate needles!” “Too bad. Roll up your sleeve.”) A doctor who refuses to treat you because of your weight is, kind of by definition, NOT your doctor and NOT doing his job.
Also, what percentage of doctors actually refuse to treat people because of their weight — i.e., see the number on the chart from the nurse who weighed the patient, and say, “Get out”? I would be surprised if this didn’t violate some laws, insurance regulations or ethical requirements. (For example, a bar on discriminating against patients for a pre-existing condition.) If it does violate any of those, such doctors should be reported and duly punished.
I once had a doctor tell me she wouldn’t treat me unless I agreed to try to lose weight.
And that was messed up, but unless she actually fired you as her patient when you said, “I have tried what you recommended, it is not making me healthier, I won’t do it anymore,” then she was pressuring you, not refusing to treat you. That kind of blackmailing pressure can be just as bad as a refusal to treat, but the former is absolutely legal (First Amendment and physician’s discretion regarding treatment*) whereas the latter seems to be on much shakier ground due to the aforementioned mandates of statutes, regulations and professional ethics. Attorneys, for example, can’t dump clients where that would cause an immediate harm (e.g. dropping a client right before a filing is due, such that there is no way the client pro se or a newly-hired attorney could get it done on time).
* The exception to the legality of pressure is that if the doctor pressures you into doing something that turns out to be bad for you, you can sue in tort for medical malpractice, and if it was really bad and really obviously wrong for the doctor to be pushing, it could be criminal negligence.
The human body still had to obey the laws of physics with it’s biochemistry. Have a low enough intake of calories and you will lose weight.
Yes, yes, yes. People who are trying to gain could conceivably stuff themselves sick 24/7 and gain, and people who are trying to lose could conceivably starve themselves sick 24/7 and lose, BUT THAT WOULDN’T LEAD TO IMPROVED HEALTH FOR EITHER POPULATION.
I’ve had doctors refuse to prescribe me hormones because of alleged (irremediable apparently) ignorance on the subject. Even though they had the power to do so, and considered me suitable for such. It is pretty common. In Quebec province, only 2 endocrinologists accept to treat transsexual patients at all.
There are plenty of studies that demonstrate a link between excess weight and a plethora of serious health problems. I’m not arguing for strict adherence to BMI charts, particularly as there are better things such as waist-to-hip ratio.
Dianne/JupiterPluvius: I’m not arguing the calories in/calories out as a direct approach to dieting. What you eat, along with exercise, is more important than how much. However the notion that it’s ‘impossible’ to lose weight is a cop out that shouldn’t be encouraged.
Sometimes there are so many people that need help, that the best you can do is help those who are prepared to help themselves.
WHR is also flawed. I’d be considered legally male, with a 0.75 WHR when the purported ideal is 0.90 (and above) for males (and 0.70 and above for females).
For the record, though 0.70 is well above Barbie-sque figures (she’s close to 0.50). Archie comics is also guilty of this, with female characters with impossible waists, while male characters all have a flat shape.
PG and others:
Spend as much time as you need at First, Do No Harm to internalize the reality that yes, doctors do refuse non-weight-dependent medical care to patients on the basis of their weight all the time, as well as attributing all kinds of symptoms to weight that are in no way weight-related.
And Despis, when you say:
you are effectively saying that it is OK with you if fat people suffer and die for lack of medical care, and that is a damn lowdown, disgusting, awful thing to do, to decide who should live and prosper and who should suffer and die based on whether or not someone’s body pleases you.
Before you assert
, go read the Obesity Paradox series at Junkfood Science. Here, I’ll give youarticle #1.
No, I’m saying that forcing a doctor to treat a patient who isn’t going to follow their instructions and continue with self destructive behavior is kind of pointless.
The link you provided dealt with a study of the short term survival rates for patients who already had or were suspected of having coronary artery disease. From a general population point of view, it doesn’t address the fact that obesity results in an increased risk of the disease in the first place.
A quote that study: Obesity may confer a short-term survival benefit previously observed in post-MI, post-revascularization, and CHF cohorts, but at the same time might result in worsened long-term outcome; over a prolonged time, acceleration of the underlying cardiovascular disease process by obesity would be expected to become evident.
Desipis,
The post does not say that weight loss is impossible, it states that dieting doesn’t work, spot the difference.
Wow, you are a disgusting person Desipis.
I ride bikes, alot. I’ve ridden more in one summer than most people do in a lifetime. I also do other exercie in addition to biking. I rarely eat fast food and eat meat even less than that. My cholesterol is off the charts low, as well as my blood pressure. I live a mostly stress free life and with the exception of some annoyingly large boobs, i have no (physical) illnesses.
Oh by the way, I’m also just a couple BMI points away from being obese.
Fuck off.
oh and back to that 1st hateful quote again, I didn’t realize that doctors were in the business of letting drunk drivers, drug users, and people who attempt suicide die in their hospitals/offices because they refuse to “help themselves”
ETA: and let’s not forget those pesky cancer patients who refuse chemo. They don’t want to help themselves so best not to treat them at all.
Elusis,
Spend as much time as you need at First, Do No Harm to internalize the reality that yes, doctors do refuse non-weight-dependent medical care to patients on the basis of their weight all the time, as well as attributing all kinds of symptoms to weight that are in no way weight-related.
“All the time” isn’t a very helpful statistic. I can be certain that it’s not a universal practice; my father is a cardiologist, my older sister is chief non-MD administrator in the cardio department of an academic health center, my little sister is in rotations for medical school, and none of them would refuse care to a patient based on weight. (Cardiologists in particular could hardly maintain a practice if they refused patients based on weight.)
People should be naming, shaming and reporting doctors who refuse medical care to patients whom the doctors perceive as fat, and state legislatures should pass laws requiring medical boards to investigate and punish doctors who are accused of refusing to treat patients based on a pre-existing condition. The complaint form at First, Do No Harm is a good start, but to really put the pressure on, they should be maintaining a database of medical professionals — doctors and nurses — who have done this in order to encourage boycotts until those professionals change their behavior. They also should lobby insurance companies to kick doctors out of their network if there are verified incidents in which the doctor refuses care based on a patient’s weight. There are a lot of ways to go after physicians — through the state, through the private sector, through public shaming — who do this.
As for the attribution of symptoms to weight, many doctors are uninformed and/or prejudiced about correlation and causation in obesity and various medical conditions. For example, polycystic ovarian syndrome really does track closely with obesity, but it’s unclear whether the obesity causes PCOS, PCOS causes obesity, or they have a common, as-yet-unknown cause that screws with women’s hormones and thus leads to both obesity and PCOS. But to the average person, PCOS would seem to have absolutely *nothing* to do with obesity — “why would my level of body fat be linked to having cysts?” So it’s not adding to the sum of human knowledge to declare that symptoms that don’t appear to be weight-related therefore cannot be weight-related.
Yeah, I was obese when I rode the bike 3 hours a day, and walked for 1-2 hours a day, and ate about 600 calories a day less than my recommended daily diet amount.
Reason? DISEASE.
How do the calorie in/calorie out people account for those of us who have metabolic disorders? My disease may affect as many as ten percent of women.
Also, Ali, don’t dream of modulating your tone to be civil. You are responding in a perfectly appropriate manner to someone who thinks you and I aren’t worthy of medical help.
Um, I think you’re behind on research about PCoS, PG. Both the cysts and the weight issues are linked to the body being severely confused by insulin. Also, the disease is heritable, so causality seems pretty clear.
Mandolin,
Yes, but insulin resistance may be due to high body fat making insulin receptors less effective. It’s really difficult to tell whether poor receptors simply increase obesity, or if the obesity also can lead to poor receptors — that is, whether it’s a one-way street or a feedback loop. Some people with Type II diabetes are able to get off insulin injections once they change their diet and exercise habits and thereby reduce glucose and waist fat, which implies that they have gotten their insulin receptors working better through lifestyle changes.
Obviously this isn’t effective for everyone; my family all has high cholesterol and my father is borderline diabetic despite good diet, exercise and a “normal” weight (though like most middle-aged men he carries excess fat in his belly) — we just have slightly dysfunctional livers. Disease and disorders account for a lot of obesity and other conditions, but not for all of it. And even those of us with heritable conditions sometimes can ameliorate them. I first discovered I had high cholesterol when I was 11, and my parents put me on a skim milk, no cheesecake, extra time playing sports regime. It got my cholesterol level below 200.
“Yes, but insulin resistance may be due to high body fat making insulin receptors less effective.”
But that is, as I understand it, not what’s going on in PCoS. I am not insulin resistant — if you test my fasting blood, there is no lingering insulin. I still have PCoS.
And anyway, what are you talking about in terms of amelioration? I can ameliorate my disease in terms of exercise and diet to increase my chances of avoiding diabetes.
So, if we’re talking about a goal of improving health qua health, then yes. I can do that. I can ameliorate my disease.
But if we’re talking about weight as, in itself, a bad thing that – again itself – needs amelioration, then no. I – personally – cannot lose much weight without becoming anorexic or bulimic.
It’s a framing problem. If weight is merely a potential signal of something wrong – in my case the PCoS – then I can improve my health while not “improving” my weight. If, on the other hand, we’re going to treat the weight as something bad in and of itself then I – again personally – am screwed.
But look at the different outcomes of these two things. Diet and exercise to lessen chance of diabetes? Outcome: more healthy internal organs. Behaviors engaged in to lose weight? Ignoring the negative implications of those behaviors in and of themselves, even the desired outcome is basically useless- a more socially acceptable body.
Well, I say “basically useless.” Having a socially acceptable body would reduce the social discrimination that I encounter. It would make it easier for me to survive in the world. Which is why I have a tendency toward bulimia and anorexia, and particularly had one when I was still working in the theater — they were a perfectly rational decision to trade my health and emotional stability for advancement in my chosen career.
I once had a doctor tell me she wouldn’t treat me unless I agreed to try to lose weight.
Not ethical, possibly not even legal. On the plus side, you’re probably better off without her. I hope you found someone with better sense to help you with your medical care.
Sometimes there are so many people that need help, that the best you can do is help those who are prepared to help themselves.
Right. Which is why doctors routinely refuse to treat patients who smoke, drink alcohol to excess, use drugs, engage in high risk sexual behaviors…oh, wait. I’ve never heard of anyone being refused medical care or threatened with withdrawl of care because they smoked. And there is no question, no controversy at all about smoking: everyone agrees that it is dangerous. Occasionally, doctors will refuse to perform certain interventions to patients who are drastically non-compliant to the point that that particular intervention will do them no good and may harm them (for example, to get intensive dose chemoradiation in head and neck cancer, you must have a feeding tube in place…otherwise you will die of starvation during the treatment so failure to agree to a PEG means no high dose–curative intent–chemotherapy) but refusal tot treat altogether is, as far as I know anyway, more or less unheardof in any context other than obesity and weight loss. Therefore, a doctor saying that she/he simply will not treat someone at all because of the patient’s weight is most likely just expressing prejudice.
That having been said, there are a number of things that a person can do that can both improve their health and (maybe) decrease their weight: Eating fewer concentrated fats and sugars and more whole grains, increasing exercise (if not injured or already overexercising), reducing stress, and getting chronic medical conditions treated can all improve one’s health. Weight loss is usually minimal even with fairly strict adherence, but ultimately so what?
Mandolin,
But that is, as I understand it, not what’s going on in PCoS. I am not insulin resistant — if you test my fasting blood, there is no lingering insulin. I still have PCoS.
Yes, but there can be multiple presentations of PCOS, and insulin resistance is sufficiently common in people with PCOS that it’s described as a “recognized feature” of PCOS. Also, do you have abnormal glucose tolerance? That’s common among East Asians with PCOS (I don’t know what your genetic background is). I certainly agree that there is a large genetic component in all of this, but heritable isn’t the same as inevitable.
With regard to amelioration, as I stated above, weight is fairly meaningless — the only point at which it’s a medical concern is if it stresses your joints and reduces mobility. That’s why I find BMI so silly and am troubled by the Wii Fit’s emphasis on it — it claims I’m fine while my brother-in-law, who is in much better shape than I am (ridiculously stronger, faster, with greater endurance), is “obese.” However, a high proportion of body fat (the technical meaning of obese) does affect health.
“Weight loss is usually minimal even with fairly strict adherence, but ultimately so what?”
Well, right. I think that’s what the fat activists are arguing. Why even put the weight on the table as a subject of conversation? If one becomes healthier via good diet and exercise, then that’s great. It does not necessarily lead to weight loss. So, screw the weight loss, and focus on the healthier.
Your conclusion does not follow. If 41% gain weight, then somewhere between 0 and 59 percent lose weight, with the complement returning to their original weight and no more. For all you’ve said, it could be 41% gain, 9% return to original, 50% lose weight, which would totally ruin your conclusion that dieting is more likely to cause gain than loss (much less significantly more likely).
And this also obscures by not mentioning the amount of weight lost or gained. If for example it’s:
6% gain more than 5 lb
35% gain 0-5 lb
25% no change
20% lose 0-5 lb
14% lose more than 5 lb
…then that’s a breakdown that argues FOR dieting, yet still consistent with your 41% number. Your statistic cannot be used to draw the conclusions you do without much more information.
And this does not even take into account the “natural” background weight gain that accompanies normal aging, as mentioned upthread.
And of course it’s very potentially misleading to lump all dieters in together. A proper analysis would divide the group into categories according to (a) how much weight they were trying to lose, and (b) whether they successfully lost it before gaining some/all of it back. It’s grossly misleading to lump the person who lost 15 lbs and gained it back with the person who lost 90 and gained it back, much less the person who lost 90 and only gained 20 back, much less the person who was trying to lose 15 but only lost 6 and gained 8 (a net gain).
From the cited study:
And keep in mind, these studies are designed in ways that generally exaggerate how “successful” the diets are at promoting weight loss — for instance, by not counting people who drop out of the study (who seem likelier to be weight gainers than weight losers), or by using very short time periods (often as short as six months or a year).
I don’t think anyone’s lumping in someone who lost 90 and gained 20 with someone who lost and gained 90.
* * *
It’s interesting how pro-diet people never, ever say “some weight gain over time is natural and normal, and shouldn’t be seen as a sign of failure” when criticizing articles that argue that people should be dieting more. Gee, I wonder why that is?
Amp: thanks, that clarifies things a bit. However, it still doesn’t take into account how much the gainers gained vs. how much the losers lost, which is an important figure (as per my edit to my first comment above).
The ideal study — with people randomly assigned to control groups or treatment groups — has not been done. However, there certainly have been studies done comparing non-dieters to dieters, and finding that after controlling for many factors (including age) the dieters gained more weight over time.
Ali:
With the exception of the “no meat” thing it sounds like you were living healthily therefore my comment about the doctor doesn’t refer to people like you.
My comments referred to patients who refused to change their behavior, something which must be observed over time and hence has nothing to do with emergency treatment.
Mandolin:
a)Your base metabolic rate is significantly to different to the basis used for recommendation. Something which is quite likely if you have a metabolic disorder.
b)You over estimated your calorie burn during exercise.
c)You under estimated your calorie intake through food and drink.
d)Your body is storing something other than fat.
The only thing you can gather from those studies is that those who typically chose to diet have less control over their weight.
This thread shows yet again that dieting is about belief, not fact.
The ideal study — with people randomly assigned to control groups or treatment groups — has not been done.
Why not? All you need is a group of people willing to go on a diet or not, depending on which way they are randomized. Of course, one would want to be open about the risks of dieting versus not dieting, to the extent to which they are known, but I don’t see this study as an ethical dilemma.
I have no idea why it hasn’t been done; maybe it has been and I’m just not aware of it.
There was a small study in which people were randomly assigned to either a diet group or a HAES group; I blogged about it here.
Well, I don’t tend to think that the “puts on more weight from when they started” thing is much of an indictment. As much as the young, sexy, 20-something beauty gurus hate to admit it, people tend to put on more weight as they age. So saying “they weigh more after they go off the diet” doesn’t say much.
However, I totally agree that dieting is a loser’s game in general.
I’ve lost 20 pounds since two years ago, and they seem to be staying off. You know how? Vegetarianism, parenting, and biking to work. Lifestyle changes, not just starving myself.
Hey, this post was so interesting I basically wrote a post on my blog about it. If anyone is interested-
http://difficultjane.blogspot.com/2011/02/fat-part-2.html
Also, thank you.
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