Do Diets Fail or Do Dieters Fail?

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 95% 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.  Plenty of studies show that people who get 30 minutes of moderate movement 5 days a week get tremendous benefits without weight loss.  Another 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 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.