Diets just don’t work for the vast majority of people; they cannot keep the pounds off in the long term. And we’re not talking about just adding exercise to solve the problem either. Health writer for the New York Times, Tara Parker-Pope, explores the real method for keeping it off — and it’s not what most people want to hear.
The new year brings weight-loss resolutions and a bombardment of television ads for various diet programs and exercise equipment to tease Obese America into thinking “anything is possible” in terms of remaking our rotund figures. In a fascinating, but unsurprising piece in the NYT, “The Fat Trap,” Tara Parker-Pope delivers the news most people huffing and puffing in the gym and mixing up shakes in the blender don’t want to hear — you can take off the pounds, but most of us will pack them back on over time.
The formula for weight loss is simple – consume fewer calories and burn more off through exercise, right? But the biological changes that occur for those who carry those extra pounds long enough may simply be too hard to permanently shed. Why? Joseph Proietto, a physician at the University of Melbourne with weight-loss clinic in Australia, decided to take a look at the issue in a study launched in 2009. Fifty obese men and women averaging 200 pounds were started on an extreme low-calorie diet that included Optifast shakes. They lost an average of 30 pounds.
While some dropped out of the program, the remaining patients were placed in maintenance mode, and were provided phone counseling to help them stay on course with suggestions for a healthy diet and maintaining an exercise program. Guess what happened? The pounds slowly crept back on anyway.
After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.
While researchers have known for decades that the body undergoes various metabolic and hormonal changes while it’s losing weight, the Australian team detected something new. A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost.
The idea that diet/starvation mode triggers weight gain over time isn’t particularly novel. It explains why obesity is such a vexing problem:
For years, the advice to the overweight and obese has been that we simply need to eat less and exercise more. While there is truth to this guidance, it fails to take into account that the human body continues to fight against weight loss long after dieting has stopped. This translates into a sobering reality: once we become fat, most of us, despite our best efforts, will probably stay fat.
Of course this news can be seen as a relief for some who are on the diet/exercise yo-yo program of losing and gaining weight, but it doesn’t explain how some people can successfully keep the pounds off (as in 5 years or longer), or those who crash gain and lose weight — think Robert De Niro’s shape-shifting for Raging Bull in 1980. The National Weight Control Registry’s 10,000-person study of weight-loss retention followed people who used myriad diets — liquid fasts, Jenny Craig, Weight Watchers, etc. — and these people definitely fall outside of the norm. Parker-Pope spoke with Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, concedes that the 10,000 people in the registry represent a tiny sliver of the millions who lose weight each year, and most who diet never keep it off as those being tracked have.
“You find these people are incredibly vigilant about maintaining their weight. Years later they are paying attention to every calorie, spending an hour a day on exercise. They never don’t think about their weight.”
Janice Bridge, a registry member who has successfully maintained a 135-pound weight loss for about five years, is a perfect example. “It’s one of the hardest things there is,” she says. “It’s something that has to be focused on every minute. I’m not always thinking about food, but I am always aware of food.
A good deal of the NYT piece is devoted to Bridge’s regimen to stay slim. I have to say it’s pretty disturbing because the unnatural focus on food and exercise is obsessive. It is a maintenance mode that I guarantee most people don’t have time for, and for those who are naturally thin (or even at a stable overweight status), they don’t have to think about much on a daily basis.
- She weighs herself every morning and records the result in a weight diary.
- She carries a scale with her when she travels.
- She weighs all her food portions for meals.
- She looks at the menu to calculate calories every time she goes out to eat
- She avoids anything with sugar or white flour
- She carries a 20-ounce water bottle and fills it five times a day.
- She exercises from 100 to 120 minutes a day, six or seven days a week
Now there’s nothing wrong with any of the above in principle, but in practice, let’s be honest, who has the time and discipline to do this every day for the rest of their lives? And it’s not an exaggeration – Bridge has done this every day for six years with the exception of a 2-week period when she went on “weigh-in free” vacation.
A big caveat — Bridge is an empty-nester and retired; she admits that if she had small kids, a job, and all of the responsibilities that come with that would make her weight maintenance a much more difficult endeavor. As in, she’s not like most of America. Here’s another “success story”:
Lynn Haraldson, a 48-year-old woman who lives in Pittsburgh, reached 300 pounds in 2000. She joined Weight Watchers and managed to take her 5-foot-5 body down to 125 pounds for a brief time. Today, she’s a member of the National Weight Control Registry and maintains about 140 pounds by devoting her life to weight maintenance. She became a vegetarian, writes down what she eats every day, exercises at least five days a week and blogs about the challenges of weight maintenance. A former journalist and antiques dealer, she returned to school for a two-year program on nutrition and health; she plans to become a dietary counselor. She has also come to accept that she can never stop being “hypervigilant” about what she eats. “Everything has to change,” she says. “I’ve been up and down the scale so many times, always thinking I can go back to ‘normal,’ but I had to establish a new normal. People don’t like hearing that it’s not easy.”
‘Hypervigilant.” The level of hypervigilence smells perilously like adopting a socially and medically approved eating disorder.
The bottom line is that for the long-term overweight and obese, this is the price you must pay to remain thin. Note I said long-term. Short-term weight gainers can lose the pounds because they don’t remain overweight for a long period. Rudolph Leibel, an obesity researcher at Columbia University in New York, explained that both Robert De Niro and Morgan Spurlock of “Super-Size Me” (the latter gained weight during the documentary after consuming McDonalds for a month), may have had a couple of factors at play.
Leibel says that whether these temporary pounds became permanent probably depends on a person’s genetic risk for obesity and, perhaps, the length of time a person carried the extra weight before trying to lose it. But researchers don’t know how long it takes for the body to reset itself permanently to a higher weight. The good news is that it doesn’t seem to happen overnight.
So the real problem, if you’re looking at Obese America from the 30,000-foot view is that to avoid the yo-yo dieting and hypervigilant slim maintenance lifestyle, you have to avoid getting fat in the first place, which of course is too late for the vast majority of us. And it’s why the focus on childhood obesity should be a priority, and why it is part of the First Lady’s much-publicized agenda.
There has to be a middle ground where yes, severe obesity needs to be addressed medically, but most overweight people can still improve their health markedly by exercising and eating smarter. It’s just that they may never be thin. With our culture of intense fat-shaming that I don’t see going away any time soon, it makes it difficult for people in this category to feel good about themselves even as they attain great blood pressure/cholesterol/other health stat changes that don’t manifest themselves in a slim figure. We’re a product of our genes, our environment, our incessant food and diet marketing culture — and the biology of dieting — that make weight loss more than just willpower. As Tara Parker-Pope noted, “I may not be ready to fight this battle this month or even this year. But at least I know what I’m up against.”
And that’s the bottom line — if you’re ready to take on the hypervigilant lifestyle in order to remain thin, then go for it.
There are no shortcuts to long-term maintenance of weight loss; it’s time to stop listening to the siren song of quick fix diets, pills, or exercise contraptions. It’s also time to accept that processed food companies will never stop marketing junk food in seductive ways and Bi Food doesn’t care if the American public eats itself to super-sized proportions. We choose what we ingest and how much we exercise, and we have seen the consequences, so addressing health first, rather than solely punish for the extra pounds themselves, requires honesty all around.
Read the whole piece, The Fat Trap.
Just a personal observation — the only “diet” that has ever worked for me over the long term has been the “Pain Diet.” Living with chronic pain has resulted in a gradual weight loss of about 35 lbs over the course of two years. I’ve kept it off without trying or consciously altering my diet — and obviously my exercise (I used to walk about a mile a day) has actually decreased because of fibromylagia and now rheumatoid arthritis. But pain suppresses appetite overall; I can’t recommend that as a weight loss plan.
The sad thing is that people have noticed my weight loss as a positive affair simply because I am thinner — but I’m certainly not healthier. What does that say about our culture?