I've been following the reactions, and the disappointing part is how predictable they are. How nobody is using it to really stop and think and discuss possible implications, but rather they interpret the findings according to what they already believe. Carefully read, it's actually a quite honest and balanced article. Pretty much the conclusions I've been coming to through blogging and reading: weight loss for the sake of weight loss is counter-productive, but attempts to get healthy (even when they don't lead to weight loss) are always valuable.
The size acceptance, Health at Every Size, and anti-fat-shaming community jumped on the study as vindication, further proof that diets don't work in the long run, and a way to say "see? we were right all along." People in the nutrition and fitness industry found it negative and disturbing because they feel it gives people an excuse not to even try, and it goes against everything they believe (or get paid for). And the many individuals who are trying, who are on a public journey of weight loss on blogs, forums, Facebook, and Twitter, see it as a personal affront to their efforts and want to be the exception to the rule. In essence, everyone is right, and still nobody is.
There is very little evidence of weight loss being maintained beyond 5 years. That's the main point to clarify: we're talking long term maintenance, not success stories of 1 or even 2 years. And as much as we want to believe that it's possible, that we all know someone who has successfully lost a lot of weight and "if they can do it, we can do it," clinging to that belief can give a sense of false hope. Worse, it sets people up for guilt, shame, regret, and loathing if they fail. With such a high probability of regaining the weight, is it right to continue wearing the rose-coloured glasses of denial?
My question is about the research. It sounds to me like the people involved were put on fairly strict diets, in "highly controlled experimental settings." Is it reasonable to expect long-term compliance with something which does not take into account your own sense of control? Think of it like rehab. Detoxing and getting sober within the confines of a facility is often the easiest part for an addict. It is maintaining sobriety in the real world, full of temptations and road blocks and pitfalls, where relapse occurs. It's the same issue I have with shows like Biggest Loser, because they're living on a ranch in isolation and there's external control over what food comes in and out. Contestants spend very little of their time in the real world before the show's finale, and then aren't allowed to talk about how hard it is to maintain habits in a real-life context. What really failed, here? Dr. Yoni Freedhoff asks the question: "does it mean the people in the included trials failed to maintain their interventions, or does it mean that the interventions were too crappy to be sustainable in the first place?"
What this article and study should be is a call to arms to re-examine how we go about weight management. Too often, people are told to lose weight with a simple eat less, move more mantra that just.doesn't.work. That seems to be proven time and again. It's why I hate the concept of a diet. Rather than determining that weight loss is impossible, we need to be looking for better solutions. Different ones than the same-old tried-and-not-true-but-try-again-anyway solutions. Ones which can be sustainable long-term. The catch phrase for this is "lifestyle change" but we need more. Lifestyle change is usually a code word for "diet" when restricting and tracking is involved. True change is bigger than the individual. It's not just about changing your own habits, it's about working to change the society we live in, the sedentary environment which makes movement and exercise something you have to actively seek out instead of being part of a daily routine. It's about changing food industry standards and legislation and what kind of chemical crap gets approval for consumption.
It also highlights just how prevalent fat stigma is, because there is no question in anyone's mind in this article (and others related to it) that obesity is something to be cured. What if we stopped making fat the enemy - as in, looking fat, carrying fat, being over a rather arbitrarily set body weight ideal - what if fat wasn't the worst thing you could be? Would the approach to HEALTH change, then? Would we focus on the whole person and quality of life and not simply on one's size?
The biggest flaw that I see with the article is that "science" covers a lot of bases, which is why everyone is right, and everyone is wrong, when they interpret it in this case. If you tell me that weight loss is biologically impossible, akin to growing taller, that's a pretty different story than if it is psychologically improbable. The studies referred to revolve around human behaviour. Biological findings about the body holding on to fat cells, or mutations in hormones, or increases in ghrelin levels - THOSE are the kinds of findings that could lead to a conclusion of "impossible." It's an example of sloppy writing (or genius, if the point was to generate controversy and outrage).
The article is not without bias, but that doesn't mean that it should be dismissed entirely, as many commenters seem to do. The byline of "no known cure for obesity except surgically shrinking the stomach" should trigger some warning signals in any logical person's head. First of all, treating "obesity" as a disease, as something to be cured, is a fallacy. Obesity describes the amount of fat you have in relation to your height. It does not indicate your health status. The evidence for surgical weight loss success is also pretty negative, spotty at best, and to start with the premise that the only cure is surgery suggests a strong bias by the reporter. She even acknowledges the drawbacks and failures of surgery in the body of the article, yet leads with such a byline about surgery. Red flag.
Nobody is suggesting that we just give up. Read the comments on any of the forums and you'll inevitably find someone saying "this is just an excuse for 'them' to be lazy and stay fat." The biggest point missed is that the health benefits from exercise and trying to eat better still exist, even if the weight never comes off. The focus on "obesity" itself is the red herring, here. Why, why, why do we insist on conflating correlation and causation? We talk about obesity as if the diseases which correlate to it are a given. You are super-fat? You will get diabetes. You will die of a heart attack. No, no, no. The risk factors increase exponentially, but there's not a direct-line connection. It's like smoking. Not every person who smokes gets lung cancer, and not every person who ever had lung cancer was a smoker. The likelihood of a smoker developing cancer is high enough that we associate the two. The difference with obesity is that the fat alone is not what causes various diseases, it's what makes the body's environment ripe for various diseases to occur. You know what helps change that? Fitness. Health. Nutrition. All of which can occur with and within a body that stores extra fat.
So, is weight loss a hopeless endeavour? Not at all. But clearly, in order to have long term success, it takes constant vigilance. I don't see how acknowledging that is negative. You have to be prepared for it. Willpower alone is not going to keep motivation going ten years down the road. There will be ebbs and flows, highs and lows, and the habits developed early on may not continue to work once the body gets used to them. There are some habits which seem consistent in those who have maintained their weight loss: weighing every day, writing down what they eat, and continuing to exercise. Tracking seems especially significant, which means it's something you are constantly thinking about. That makes sense to me. It's when you let down your guard for a moment of complacency that it's easy to slip up, and believe me: it's a slippery slope after that.
Correlation is not causation. Nothing is a done deal.
Improbable is not impossible.
But let's keep our heads out of the sand, and our eyes wide open.
Long-term weight maintenance is an uphill battle, and to pretend otherwise just makes it that much steeper.
- the original article: Obesity research confirms long-term weight loss almost impossible
- Dances with Fat (blog): Seriously, weight loss doesn't work
- Weighty Matters with Dr. Yoni Freedhoff: initial response (Is it really scientifically impossible to keep your weight off?) and follow-up (More on the "Almost Impossible" Feat of Maintaining a Weight Loss)