Why diets don’t work.

Most diets seem to succeed in the short-term, and fail in the long-term. This is not a new, or even particularly controversial, observation among researchers:

“There are two indisputable facts regarding dietary treatment of obesity. The first is that virtually all programs appear to be able to demonstrate moderate success in promoting at least some short-term weight loss. The second is that there is virtually no evidence that clinically significant weight loss can be maintained over the long-term by the vast majority of people.”

-Confronting the failure of behavioral and dietary treatments for obesity, Garner & Wooley, 1991

“Although weight loss can usually be achieved through dietary restriction and/or increased physical activity, the overwhelming majority of people regain the weight that they have lost over the long-term.”

-The Defence of Body Weight: A physiological basis for weight regain after weight loss, Sumithran & Proietto, 2013

“Of course, we can all endorse the call for a healthier lifestyle, but we must be realistic about what it can and cannot accomplish – including that it is not by itself an effective approach to long-term obesity treatment.”

-An Inconvenient Truth about Obesity, Schwartz, 2012

More in-depth analysis of the failure rate of dieting can wait for another post. The question I’m asking here is, if diets fail for some proportion of people, which they indisputably do, why is that? What is the reason? What are the specific mechanisms at work?

The usual assumption among non-researchers about why diets fail is that when a dieter regains weight, it must be because they stopped dieting, which is in turn attributed to things like not having enough willpower, personal and moral failure, gluttony and laziness, or being too ignorant to know better.

These are assumptions which reflect the mythology of our culture: that anyone, if they try hard enough, can be anything they want — and therefore that weight is entirely a choice, a product of effort and moral character. This story centres the individual, their behaviour, their character traits, and their moral attributes as the cause of fatness in the first place, and the reason why weight is regained following a diet.

But these explanations are not satisfactory to me, nor, as you will see, are they reflected in the scientific literature.

To explore other answers, I haphazardly gathered peer-reviewed articles, spanning a range of more than 30 years, that investigated or discussed the various reasons why weight loss produced by dieting is not maintained long-term.

Here is what they theorize about why diets fail.

1. Behavioural relapse, a.k.a. “going off the diet”

The earlier papers on the failure of dieting focused on behavioural factors, since dieting was, at the time, a relatively new and exciting behavioural intervention for “obesity.” (By the mid-20th century, dieting as a popular pastime was not new, but as a subject of medical research, it was still fairly novel.) Researchers assumed that when someone could not sustain weight loss, it must’ve been due to a breakdown in their new behaviours — people must have gone back to eating more and moving less, just as is popularly assumed.

However, the researchers tended not to lean so heavily on moral explanations for this relapse. One study suggested that the fault lay with lack of scholarly attention to the maintenance phase of behavioural change in designing weight loss plans. This was further complicated by the fact that no one can avoid eating entirely, which makes dieting quite different from other behavioural interventions like smoking cessation programs and abstinence from alcohol.

Alongside this were proposed cultural and commercial pressures to eat, especially calorie-rich and highly palatable foods. There also appeared to be few natural rewards provided by dieting once the intervention phase ended — apparently nothing, not even thinness, feels as good as food tastes.

The researchers were not very optimistic about the usefulness of dieting if it only resulted in regaining weight. An illuminating quote from the conclusion of one paper:

“Research on humans suggests that the deleterious effects of obesity are exerted primarily during periods of weight gain…Its medical consequences may be unfortunate enough that if people cannot maintain weight loss, they would be better off not trying to lose weight!”

-Behavior Modification in the Treatment of Obesity: The problem of maintaining weight loss, Stunkard & Penick, 1979

Another paper suggested that culprits for the breakdown of dieting behaviours were negative moods, emotional stress, social pressures to eat more, as well feelings of intense hunger that prompted overeating. But an interesting quote from this same article hints of more than purely behavioural factors:

“The obvious reason for weight regain after weight loss treatment is that participants return to inappropriate eating and exercise habits. These habits need not be as bad as pretreatment habits to cause regain, because metabolic factors may make it easier to regain after a period of dietary restriction…The pattern of relapse and regain appears to be the result of a war between the will and physiologic demands over which self-control appears relatively powerless.”

-Why Treatments for Obesity Don’t Last, Goodrick & Foreyt, 1991

So even in cases where behavioural relapse were implicated, researchers seemed to acknowledge that other factors contributed to that relapse (like stress, biological and cultural pressures to eat, and increased hunger), or to the weight regain itself (metabolic changes.)

2. Lowered energy expenditure

Reduced calorie intake and weight loss, it turns out, cause some interesting changes to the body that result in expending fewer calories. In animal studies, changes include decreased body temperature, less spontaneous activity, and lowered resting metabolic rate (the amount of energy the body uses while at rest.)

Reduced total energy expenditure and, possibly, lowered resting metabolic rate after diet-induced weight loss have also been observed in humans. (Conversely, humans who gain weight above their baseline weight through eating have been observed to have an increased resting metabolic rate.)

A person who gains weight would be expected to expend more energy just due to their increased body mass, thus requiring more energy to physically move and biologically maintain it. The same, but in reverse, is true for someone who loses weight – less energy is required to maintain a smaller body.

But the changes in energy expenditure resulting from dieting have been described as “disproportionate,” meaning that they were greater than the changes expected for the amount of weight gain or loss, indicating that some compensatory mechanism meant to restore preferred weight may exist.

In other words, a person who lost weight to reach 150 lbs. may expend fewer calories just existing than someone who has always weighed 150 lbs. And someone who purposely gained weight to reach 150 lbs. may use more calories to maintain their weight than the person who has always weighed 150 lbs.

However, other studies of weight loss in humans have not demonstrated the effect of lowered resting metabolic rate, which leaves the question open.

A nod to weight diversity from the last study linked:

“Body weight in adults is remarkably stable for long periods of time. In the Framingham Study the body weight of the average adult increased by only 10 percent over a 20-year period. Such a fine balance is evidence of the presence of regulatory systems for body weight. Whatever the mechanism (or mechanisms), the weight at which regulation occurs differs from one person to another, and these differences are almost certainly due in part to genetic and developmental influences.”

-Changes in Energy Expenditure Resulting from Altered Body Weight, Leibel, Rosenbaum, and Hirsch, 1995

3. Fat storage and insulin sensitivity

Another physiological change produced by weight loss is increased insulin sensitivity. This is generally considered a good thing, but it may also leave people vulnerable to weight regain. We may need to go back to a little high school biology to cover this one adequately.

Insulin is a hormone that the pancreas releases into your bloodstream. Insulin’s main life goal is to act like a key that allows glucose, also flowing through your bloodstream, into your cells, which then use the glucose for energy.

When a person’s cells become resistant to insulin, the glucose can’t get into the cells — it then builds up in the blood, eventually causing high blood sugar. Meanwhile, the cells switch to using fat for fuel.

With weight loss, cells become more sensitive to insulin, which allows glucose to enter the cell once more. Those cells use that glucose, and the fat that would otherwise be used for energy is directed back into storage, which may spell weight gain.

Experimental research in humans has indeed demonstrated that increased insulin sensitivity following weight loss from dieting predicts the amount of weight the person will eventually regain. The researchers are careful to point out that increased insulin sensitivity, alone, is not enough to cause weight regain, but in combination with lowered energy expenditure (see above) and increased food intake (see below), it certainly helps.

From this same paper:

“Following weight reduction, there is a 95% failure rate for obese individuals to stay weight-reduced more than 4 years (5). After obese subjects undergo weight reduction, metabolism shifts to favor weight regain…These metabolic phenomena result in the shunting of lipid fuels away from oxidation in muscle to storage in adipose tissue, and in the setting of positive energy balance, increases in body weight and percent body fat occur.”

-Weight Regain Following Sustained Weight Reduction is Predicted by Relative Insulin Sensitivity, Yost, Jensen, and Eckel, 1995

4. Increased appetite

During and after weight loss, levels of several hormones involved in appetite regulation change significantly.

Hormones that promote feelings of fullness and inhibit food intake (including leptin, peptide YY, GLP-1, cholecystokinin, and amylin) are decreased with weight loss. Meanwhile, ghrelin, a hormone that stimulates hunger, is increased, along with reported food preoccupation and appetite.

Again, these responses may indicate the existence of a regulatory mechanism intended to restore preferred body weight:

“Taken together, these findings indicate that in obese persons who have lost weight, multiple compensatory mechanisms [encourage] weight gain…Furthermore, the activation of this coordinated response in people who remain obese after weight loss supports the view that there is an elevated body-weight set point in obese persons and that efforts to reduce weight below this point are vigorously resisted.”

-Long-Term Persistence of Hormonal Adaptations to Weight Loss, Sumithran et al., 2011

In addition to feeling hungrier, weight-reduced people show a stronger preference for high-calorie (high sugar and high fat) foods. There are also changes in brain activity patterns indicating that weight-reduced people are more responsive to food rewards, while brain areas associated with controlling one’s food intake are less active.

The hypothalamus, a part of the brain that may act as a “brake” on the homeostatic tendency toward weight gain, shows decreased activity in people who have lost weight, which affects both food foraging behaviour and metabolism to favour eating more and regaining weight.

5. Genetic predisposition to gain weight

It has long been understood that body weight has a significant genetic component.

Research in pairs of identical twins shows that there is also a significant genetic component to weight loss, including how much and what type of fat is lost, and the rate of fat burning relative to use of glucose for energy.

On the other side of the coin, population studies of twins have shown an association between dieting attempts and subsequent weight gain, which probably reflects a pre-existing tendency to gain weight that is powerful enough to counteract weight loss attempts.

From that study:

“The poor success in weight maintenance after dieting predisposes individuals to the vicious cycle of frequent dieting attempts and weight regain. The relation between weight cycling and subsequent weight gain is well described in the literature. Part of the weight gain occurring in young adults may be regarded as physiologic, and is likely to occur independently of attempts to lose weight.”

-Weight-loss attempts and risk of major weight gain: a prospective study in Finnish adults, Korkeila et al., 1999

Another study using twin data indicates that some of the weight gain may also be due to dieting itself, independent of genetics.

break50

As you can see, moral explanations for weight regain leave a lot to be desired. They reflect lazy thinking. A person’s drive to eat, combined with their tendency to regain lost weight, is clearly more dependent on physiology than on moral corruption, or even simple ignorance.

Biology drives behaviour. It also primes the body to most efficiently exploit that behaviour. What is often interpreted as weakness of will and greediness by our culture is actually the result of a complex orchestration of genetic, homeostatic, metabolic, hormonal, and neurological processes influencing us to eat, restore lost weight, and ultimately survive.

And a final quote:

“…metabolic conditions after weight loss may not be the same as they were prior to gaining the weight in the first place. Instead of working in our favor to prevent weight gain, biology becomes one of the driving pressures that underlie weight regain.”

-Biology’s response to dieting: the impetus for weight regain, MacLean et al., 2011

If you’ve ever regained weight after a diet, you are in very good company. Most dieters regain the weight. You are not lazy, stupid, or greedy. You did not fail — on the contrary, your body worked hard to save you.

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95 Comments

  1. Posted November 19, 2013 at 10:40 pm | Permalink

    You took my next post right out from under me–and it’s so well done!
    I’ll add that the latest evidence to support your argument is on what’s called weight suppression–the difference between one’s highest BMI and current weight–which increases tendency toward binge eating and leads to weight regain. So even if you remain obese–let’s say you lost 50 lbs and remain out of the norm by those awful charts, the degree of weight suppression impacts subsequent weight gain.
    And further, gain weight and you increase fat cells; lose weight, and those cells remain, just waiting.
    But I do believe there’s hope.
    I should pull a post together by the end of the week. So stay tuned!
    Lori Lieberman, RD, MPH, CDE, LDN

    • Posted November 20, 2013 at 5:25 pm | Permalink

      Hi Lori,

      When you write it, could you please send me the link, or post it here. I’m using some of these posts for a size-acceptance research study. axm583 at bham dot ac dot uk.

      Thanks,

      Angela (Never Diet Again UK)

  2. Mich
    Posted November 20, 2013 at 12:49 am | Permalink

    Most of these article quotes were solely concerned with fat people, and made no mention of similar happenings in thin people. Thin people also diet/restrict, and must surely undergo the same biological things.

    • Neeva
      Posted November 20, 2013 at 3:29 am | Permalink

      They do. At least my experience after weight loss dieting fits the description: obsession with food, increased drive to eat, easier weight gain than before. Getting cold more often and getting fatigued more easily after exercise could also be attributed to dieting.
      I was barely in the overweight category of the bmi chart and moved barely in the “normal” category.

      • Adele
        Posted November 20, 2013 at 7:50 am | Permalink

        This has been my experience as well. Although I’m not obese, I am overweight. Every diet/restriction attempt to lose weight to normal BMI has resulted in increased drive to eat, easier weight gain and increased fatigue. Often I felt tormented by how hungry I felt.

        For me, it seemed to follow a pattern: I’d restrict (following a healthy planned diet) with exercise. My hunger would be manageable. I’d lose weight slowly — way more slowly than the “experts” say one should expect given the intervention. After a time (months and sometimes a year or so) the weight loss would stop even though I was still in a restricted state. Then the increased urges to eat would start. Sometimes they would be overwhelming. Personally, I never had the drive to eat “forbidden” or “play” foods, I just wanted more regular food. I didn’t want the dang potato chips, I wanted a balanced meal but in a size/amount which led to eventual weight regain. My appetite became a torment to me. Dieting does that. Even that “healthy” diet everyone raves about, the one Jennifer Hudson did. Yeah, that one. Maintenance is a NIGHTMARE. Does not work.

    • Dee M.
      Posted November 20, 2013 at 5:50 am | Permalink

      It works the same way with thin people. In fact, it’s a major reason why thin people become fat. I have an aunt who started dieting at 140 pounds and has gained over 100 pounds over the decades due to the effects that Michelle has discussed here. She was never fat until she started dieting, and then she got heavier in the rebound after each diet. When she started dieting, I was 40 or 50 pounds heavier than her. In the years she was dieting, I didn’t restrict my eating. I am now at least 50 pounds lighter than her.

      • rsher
        Posted November 22, 2013 at 9:53 pm | Permalink

        story of my life. and i mean my entire life. skinny kid put on prophylactic diet pills aged 8. sent to first fat camp at 145 lbs and 5’7″ at 13, again at 15, again at 16. a year on the duke rice diet at 19. electro-shock therapy diet at 22.

        there’s more – but NO MORE. when a medic suggests losing weight i tell them i can’t afford to gain another pound.

        i am strong, healthy, some possibly weight-related weakness in ankles and a knee. but after all these years, that’s not so bad.

        what has worked without effort? a month in greece, no tv, lots of walking and swimming…. no hunger, no stress, no harsh judgements….

        yeah. weight. mother nature’s little puzzle.

    • Posted November 20, 2013 at 11:03 pm | Permalink

      They absolutely do. They are no different, not special!

  3. Angela
    Posted November 20, 2013 at 4:30 am | Permalink

    Nice article, though it leaves me wondering whether it matters how the weight is lost.
    In the article the focus is on weight loss through dieting.
    So it leaves me to wonder that if I would start eating better, rather than focusing on losing weight, and I would lose weight as a side effect of that. Would that have the same consequences?
    (I mean for example, in my case eating dinner consistently instead of snacking all evening long. Making sure I get some vegetables and meat in my system. And not telling myself I can’t eat snacks)

    • Posted November 20, 2013 at 1:17 pm | Permalink

      Speaking purely anecdotally, I have seen people achieve impressive and lasting results by implementing lifestyle changes when their overweight was clearly linked to unhealthy lifestyle. While this isn’t as widespread as the popular media would have us believe, there IS a subset of people who are not “naturally” fat but who gain weight because they eat a lot of junk and don’t exercise. In those cases — again just a small subset of all “overweight”/”obese” individuals — a simple resolution to eat more vegetables, cut out “trigger” foods or practise simple moderation while also building moderate exercise into the daily routine can help the person find a new “set weight” that is significantly lower than their peak weight. By no means am I suggesting that such people have an obligation to make these lifestyle changes — I’m just saying that I’ve known people who did it, purely for their own benefit, and were very happy with the results, mostly not because of being thinner but because they felt much healthier and had better skin/less arthritis/etc. when eating nicer food and walking a mile or two every day, or whatever.

      The problem is that lots and lots of people are ALREADY eating fresh, healthy food and getting some reasonable amount of exercise, and they’re fat because that’s the size their bodies are. It’s not fair to expect those people — whether the cause of their body size is hormonal, genetic, dieting-related, or just plain unknown — to starve themselves or work out 2 hours a day just so they can conform to some specious social construction of attractiveness. Anyone who’s ever been really hungry knows that it’s hard to focus on much of anything else when your body is crying out for sustenance. There is no earthly reason why anyone should put themselves through that on a daily, permanent basis just to please a bunch of judgmental strangers. Nor is it in any way reasonable to expect fat people to give up all of their free time to exercising while thin people get to spend their leisure hours however they want. (I write this as a thin person who spends a LOT of time lying down on the couch and surfing the Interwebs, often while eating chocolate. I strongly believe that we should be working for a world where EVERYONE has both the resources and the perceived “right” to do the same, if they want.)

      • TG
        Posted November 21, 2013 at 6:27 pm | Permalink

        THIS is my husband to a T. He lays off physical activity, and drinks a bunch of soda, he gains weight. He stopped with soda, got a more physical job, he lost a ton of weight. Now he’s drinking soda again, and the inches are creeping back up. What he has to do to maintain is MINIMAL. Cos he doesn’t just have a single serving of soda a few times a week, he does a whole two letre in a day. Meanwhile, no matter WHAT I do, what “bad habit” I cut out, how MANY bad habits I cut out, etc. my weight goes UP instead of down (I have not dieted in several years, just tried to eat healthier). Every time I go to the doctor, I’ve added another pound or two to the scale. It’s distressing I don’t want to be THIN, I just have a certain amount of fatness that I am comfortable with, in that it doesn’t limit my personal mobility, and that’s all I really wanna get back to. I was holding there for years. And now that was sixty pounds ago.

        • Agnes
          Posted November 21, 2013 at 10:39 pm | Permalink

          I was going to say that I have seen that, too, but almost always in men.

      • Posted November 22, 2013 at 1:56 pm | Permalink

        This describes me perfectly. I cannot maintain a “normal” BMI, but I did not return to my highest weight either, which I reached when eating very poorly and not exercising at all. So I went from size 24 to size 8 and I maintain at size 16, with regular exercise and a nutrient-dense vegetarian whole foods diet that I enjoy. Making peace with size 16 was the hard part.

  4. Jane
    Posted November 20, 2013 at 10:08 am | Permalink

    One of the best diet books I ever read addressed this issue (Dr. George Blackburn; “Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off”). He advocated for slow weight loss, losing only 10% of your weight at a time, and then maintaining that weight for a minimum of 6 months before trying to lose another 10%. All this in the name of trying to reset your body’s weight set point before trying to lose more weight.

    As you described, the body wants to remain the same, has a remarkable ability to stay the same over time, will resist changes, and will fight to undo changes – homeostasis.

  5. scarlet
    Posted November 20, 2013 at 10:33 am | Permalink

    I never had any issues with my weight until I decided to try dieting for fun. I was a young teen and weighed more than my mother, but, as I was six inches taller as well as much larger-framed, that was natural. I went to a diet center with my mother, was weighed and measured, and told to lose 15-25 pounds. My waist measurement as recorded by the diet lady was 25 inches, and I was within a few inches of six feet tall. My mom thought I was chubby because I lacked the delicate bone structure that ran in her family and found no fault with the advice. So I was told that I could lose that 15-25 pounds, despite being a child and not overweight. I went on a brief low-calorie diet, failed to lose any weight, but was never able to return to normal patterns of eating. I’m now well into my thirties. I’ve restricted food since that first diet. I was always either watching calories or fat grams. I was refusing to eat sugar, or white flour, or any wheat products. I became vegetarian and remained strictly so for over 20 years. My reckoning should have been a pregnancy in which I could not gain weight, but I still persisted in my low-calorie, low-fat, low-protein, high-carb diet. I wasn’t eating junk food or drinking soda so everything must be okay. Plus, doctors confirmed I should avoid those “nasty” saturated fats, that meat had nothing my body really needed, and that low-calorie was the ideal. For many years, I ate under my basal metabolic rate and thought that was normal. After all, as a vegetarian avoiding fatty foods, it was the only way not to overload on carbs. I’ve gone through life always thinking I needed to lose that 15-30 pounds, even when I was actually very thin. I had my real wake-up call about a year ago, when I finally had to realize that a damaged metabolism was causing me to gain even on a very low-calorie diet, that all the work I was putting into exercise never allowed me to gain muscle, that I was intermittently fighting hormonal breakouts, my fingernails were ragged, my eyelashes had started thinning, and that blood tests revealed serious dietary deficiencies despite the praise I was getting for my low cholesterol. Still, I decided to try the diet recommended by my doctor. I was told to reduce animal products to a level as close to vegan as possible, to avoid carbs, and to rely on green vegetables for my protein. I stuck with this for a few months, lost 6-8 pounds the first week and nothing thereafter. Obviously, I lost only water weight and possibly some lean mass. But I gradually started to realize how ridiculous the advice was. I was being told to go on a low-fat, low-carb diet, and extremely low-calorie diet. And even at the hefty weight that merited a doctor-advised diet, I am a size 12-14 at 5’1o, and my build remains narrow-waisted. Too big? Well, perhaps. But it’s still smaller than many, and I’d already cut just about everything from my diet.

    It was my bafflement at the advice I was getting that led me to keep searching for answers. I began to read about traditional diets, and I discovered how flimsy the evidence against saturated fat and properly-raised animal foods really are. I re-evaluated my diet, added grass-fed butter and other natural fats, and instantly dropped several pounds. I found I was able to maintain the lower weight without restricting for a period of about six months, but now I am back up a few pounds again, though still slightly lighter than when I started all this. Scale weight doesn’t matter very much to me, but it does to my doctor, and I am at a natural disadvantage on the BMI, as I am tall, hourglass, and large-framed. So, I’m at this stasis. I’m just trying to figure out what works for my body and how I can get through life without the restricting mindset the first diet triggered in me. I still restrict, but only items I consider processed or junk foods. I realize some would still deem that orthorexic, and it may be. But I am finally eating adequate fat, calories, and protein, and even if I am not losing much weight, I sure as heck am not gaining despite eating much more fat and moderately more calories than before. I have decades worth of metabolic damage that needs to heal, and I suspect I’m either going to need to tell my doctor off or find a new one, as she scolded me for drinking a daily glass of whole, grass-fed milk last time I was in the office. I was also again told to avoid cheese, to minimize meat, and to keep my diet low in carbohydrates. Sometimes I feel like I am getting advice from an anorexic, and I can’t help but notice I have better body composition than the doctor blithely giving this advice.

    I wish more doctors would pay attention to why diets don’t work. I’m pretty sure if I had never gone on a diet, I could have avoided years of malnutrition and eventual “overweight” status.

    • Posted November 20, 2013 at 5:40 pm | Permalink

      I related so much to your comment! I have also discovered the benefits of a more traditional diet but it has not resulted in bringing me to the “normal” weight range. My only goal is real optimal health for me. I do think that I’d be healthier if I shed a few more pounds (I won’t deny that!) but that is not the end game. I am hoping that in time I can heal the metabolic damage I’ve done and settle someplace comfortable for me, which I am sure will still be way above what society “says” it should be.

      If your doctor is constantly encouraging unhealthy behaviors and it’s nagging at you, I encourage you to find one that more closely aligns with your beliefs. Mine is almost as bad, but I only go for acute things and totally disregard everything else :) I went to one listed on the “Paleo Physicians Network” and she was much better, but far away and I have an HMO she’s not a part of. I will stick with the HMO doc officially, but go to the other one if I need anything lifestyle related. It’s sad how broken the whole system is. We truly need to advocate for ourselves and not believe someone must know what they’re talking about because they went to medical school. I have great respect for doctors but they do not know everything, nor can they. That is why they specialize and unless they’ve gone for a nutrition degree (and don’t get me started on what is taught THERE), they have not learned much of anything about how we should eat.

      All of that is to say to trust your own judgment and be your own best expert. You are on the right track and I wish you the best of luck in taking great care of yourself. You deserve it!

    • Sarah
      Posted November 21, 2013 at 12:46 am | Permalink

      I don’t like what your doctor told you either. I think western medicine does more harm than good. I would encourage you to follow “the paleo mama” on facebook. She also has a blog with loads of helpful information. She’s not way out there crazy paleo. She’s realistic and trying to live as holistically as she can. It’s about eating healthy whole foods with real fats and no crap.

  6. Christina
    Posted November 20, 2013 at 11:44 am | Permalink

    Wonderful post, hopefully will get widely shared. In the very small percent of people who are able to lose weight and keep it off, it has been reported that sustainable, non-starvation approaches are usually taken. An example would be making substitutions to more satisfying choices (ie. protein and fibre at meals, eating regularly to avoid getting too hungry), and lower calorie choices such as higher amounts of fruits and vegetables. If you don’t feel good while eating a certain way it will never be helpful in the long run.

    • Adele
      Posted November 20, 2013 at 2:34 pm | Permalink

      With all due respect, I’d venture to say they’re are plenty of people who employed those methods and made those healthful choices and still regained. You can still regain even when opting for fruits, vegetables, higher protein and high fiber foods, even when you home cook your meals, and even when processed foods are avoided.

      • Adele
        Posted November 20, 2013 at 2:36 pm | Permalink

        Excuse the error in the first sentence. It should read there are, not they’re are.

  7. Ambimom
    Posted November 20, 2013 at 12:41 pm | Permalink

    Would somebody puh-lease show this to the First Lady! She’s inadvertently begun a campaign to stigmatize a brand new generation of children into all kinds of grief because she doesn’t understand these facts. Our food supply is tainted with growth hormones and antibiotics in our livestock. Surely this must account for early onset puberty and childhood obesity. The proponderance of high fructose corn syrup in packaged and processed school lunch programs must play a role in childhood diabetes. Peter Attia, M.D. theorizes that obesity is a symptom asking, “What I want to know is, WHY did he eat more calories than he burned? If we don’t understand this point, how can we treat this condition?”

    • Posted November 20, 2013 at 11:07 pm | Permalink

      The AED- academy for eating disorders, has reached out to Michelle and she has also met with some leaders in the binge eating disorder field. Hopefully, change wile come.

  8. Triona
    Posted November 20, 2013 at 12:41 pm | Permalink

    Great article.

    I actually lost fat while pregnant (I carry my weight on my bum and thighs so it was obvious) and would have lost weight due to ‘morning’ sickness had I not had a growing baby in me balancing out the weight. I have put on significant weight since having my daughter, some of which i attribute to surviving sleep deprivation, but I wonder after reading this if some of the other things you mention could also be at play? I wasn’t intentionally dieting but my food was dramatically restricted, while my body was also under the stress of growing a baby…. I am now back to my pre-pregnancy diet and level of activity (plus the added games of chase etc.), as well as sleeping through the night again, and am about 15lbs heavier than before.

    One thing I know for sure after reading this is I won’t be dieting to try and lose the extra weight! Thanks :)

    • Posted November 20, 2013 at 1:25 pm | Permalink

      A lot of women also put on weight while nursing (paradoxical though this may seem). I don’t know if that specifically applies to you, but I am absolutely convinced that the hormonal changes surrounding pregnancy and childbirth have a huge impact on weight gain/loss, regardless of what one eats. During both my pregnancies I gained massive amounts of weight in the 1st trimester despite not eating all that much more (I ate an extra bowl of cereal a day, but that would have been more than counterbalanced by all the chocolate I suddenly wasn’t eating as a result of mysteriously losing my lifelong sweet tooth. In any case, a bowl of cereal is only about 300 calories, not nearly enough to cause weight gain of 10 lbs in 2 months). I also hung onto the weight for the first 6 months after giving birth despite nursing, returning o exercise, etc. Then at around the 1 year postpartum mark, without making any lifestyle changes at all, I suddenly lost 10 lbs in a few weeks — the same 10 lbs I gained so quickly at the beginning of the pregnancy! In conclusion, “calories in calories out” is bullsh*t and fails to take account of the mysterious hormonal shenanigans going on inside your body. Definitely don’t diet, especially if you’re nursing — just ride it out and see where your postpartum body wants to take you! And congratulations on the little one :)

      • sannanina
        Posted November 20, 2013 at 4:11 pm | Permalink

        I might be totally off in this case, but in general I think it is also worth noting that weight gain does not always equal body fat gain (or even lean body mass gain). There are plenty of women, for example, who gain and lose quite a bit of weight during the different phases of their menstrual cycle, and as far as I know, that weight is mostly due to water retention.

        • Mich
          Posted November 21, 2013 at 1:15 pm | Permalink

          Here, here!

          During my cycle, I have to pee loads during the blood phase.

  9. Nof
    Posted November 20, 2013 at 2:44 pm | Permalink

    “apparently nothing, not even thinness, feels as good as food tastes.”

    I want to hug you for that well-placed crack. I laughed so hard I forgot to read the rest of the article for a while. If I never see that stupid quote again, it will be too soon.

  10. Sarah
    Posted November 20, 2013 at 8:12 pm | Permalink

    I’m curious where people who have had bariatric surgery fit into this. I know even with surgery many people gain weight back but I had a lap-band procedure four years ago and have lost about 70 pounds that I’ve managed to keep off. There is no way I could’ve lost the weight without surgery. I just didn’t have the willpower. I haven’t lost any weight in the last year but I haven’t gained any back. I still have about 50 pounds to go before I’m at my “goal weight” but that might not be realistic for my body. Obviously severe calorie restriction leads to weight loss but I certainly don’t starve myself. I actually eat way more than I “should” according to my surgeon but my lap-band does help me achieve a feeling of fullness much faster than before. But I also have changed my eating habits a lot since surgery. I didn’t get to my pre-surgery weight by eating healthy. I ate a ton. And most of it was processed crap. I hardly think I became the size I was because my genetics said that’s how big I should be. I think if a person is eating healthy (meaning mostly unprocessed foods, not a ton of sugar, eating healthy fats) and eating to the point of content (not overeating) and exercising, then whatever size they are is their intended size.

    • Posted November 20, 2013 at 8:54 pm | Permalink

      What I saw in the research was that people with weight loss surgery (not sure if gastric banding was included) kept weight off better, but some weight regain was still quite common.

  11. Cierra
    Posted November 22, 2013 at 3:58 pm | Permalink

    So if diets and exercise doesn’t work, then what will?

    • Chairman Meow
      Posted November 23, 2013 at 5:34 am | Permalink

      Self-acceptance.

    • Cath of Canberra
      Posted November 24, 2013 at 10:54 pm | Permalink

      Work for what? Define the problem that you are trying to solve first.

      Is it health? For most people, in general, health is improved by getting some exercise; sleeping well; eating plenty of fruit & veg & legumes & whole grains; drinking only in moderation; and not smoking. (And yes, for specific conditions, and specific people, some of these don’t apply or may be impossible.)

  12. Posted November 23, 2013 at 12:12 am | Permalink

    The saddest thing about dieting is the effect it has on people’s minds: they often feel miserable, weak, obsessed with food and having to deal with frankly inhumane cravings and hunger pangs. The way the body adapts to keep one from starving is so wonderfuly complex and powerful that’d be really nuts to talk about “willpower” in this context.

    However, I still think that weight loss should be a goal for some people who are at risk for diseases such as type 2 diabetes. To these people, suffering from all the huge side-effects of caloric restriction may still be better than having to deal with severe diabetes, for instance. But I reckon these people can only succeed if they have the financial, social and emotional resources to do so, which are not at all easy to come by.

    • rsher
      Posted November 30, 2013 at 10:53 pm | Permalink

      simplified….

      i have hovered near the type 2 diabetes blood sugar levels more than once.

      every single time i’ve brought my numbers back down with lots and lots of walking….

      brown fat (hdl cholesterol) comes from exercise and helps keep blood sugar in check. white fat (ldl cholesterol) is bad for you – enough hdl and you are in “good shape”, so to speak.

  13. April
    Posted November 24, 2013 at 11:39 am | Permalink

    Does that mean there’s no hope then? I don’t actually want to be *thin* (well, it’d be nice, but I’m being realistic), but I’d like to be comfortable. I am definitely not comfortable now. There was a time in my life where I *almost* started to like my body—even though I was still plainly in the “overweight” BMI category (5’1″ at 160 lbs). I’d like to get back to that point, which was 55 pounds ago. But it seems so hopeless.
    I’m afraid that I’ve damaged my body so much in dieting over the years since then that it’s irreparable. I wish I could have stayed at 160, and I should have, except I went off my birth control pills and that threw everything in my body out of whack for some inexplicable reason. The doctors don’t know? I gained 40 pounds in less than 6 months without a really significant change to my routine. Nobody can tell me why. Going back on the pill didn’t fix it.
    And after dieting to TRY to get rid of those pounds, I’ve gained much more. Now I’m 55 pounds above where I was almost within reach of feeling okay about my body, and all seems hopeless.

    • Posted November 25, 2013 at 11:35 am | Permalink

      You’re the second person in comments to refer to this idea (that this means there is “no hope” for losing weight), so I want to address that.

      Just a gentle reminder: this post is not actually about the success/failure rate of dieting. It’s only about the mechanisms that cause regain in the people susceptible to regain. The secondary message from the research is that, unfortunately, those people are the majority. I know that to many people that is a really depressing message, but I want to challenge you to stay away from black-and-white thinking here. Some proportion of people do lose weight, and maybe they even keep it off long-term. I’ve heard estimates from researchers of anywhere between 2-20%, depending on how “success” is defined. Sometimes it means keeping off the majority of the weight lost for greater than 5 years, and sometimes it means keeping off a 10% loss from starting weight for a year. I need to do another post on this.

      However, my point here is that some people will diet, will lose weight, and quite possibly they will keep it off for longer than 5 years. No, it may not be very many people, but I do not want to deny that those people exist. They do. Probably most of us know one person like this. It doesn’t change the fact that they are somewhat anomalous, but it’s important not to get into all-or-nothing thinking on this topic.

      I also don’t want to give people false hope, however. That is how the diet industry keeps making $60 billion a year in the U.S. – by advertising those few successes as though they are the norm. My best guess is that, to figure out if you’re one of those people who can keep weight off, look at your own history with weight loss. If you have repeatedly lost weight and regained it, then probably not. If you’ve never attempted to lose weight, then it’s anyone’s guess. You won’t really know until you try — but there are risks to trying that you should be aware of. Some of them are listed above, but there are even graver ones like the risk of triggering an underlying eating disorder, and possibly doing damage to your cardiovascular health through weight cycling. Attempting to lose weight through diet/exercise is really not a decision that should be made lightly, even though we treat it like a hobby in our culture. It is, however, still a choice, and only you can make it.

      Lastly, the idea of long-term weight loss being a rare outcome is not the same thing as there being “no hope” in a general sense. In fact, it can be the opening up of a lot of hope – for other things. Maybe even things you THOUGHT you could only get by losing weight. Giving up repeated, failed attempts to lose weight gives you back a lot of energy and time and mental real estate to live your life. It also doesn’t mean giving up exercise, or giving up eating well, if you value those things, or giving up pursuing the things in life (relationships, a career, creative pursuits, etc.) that hold meaning for you. It only means stepping off the merry-go-round to nowhere and finding out which direction to walk instead. Walking may be slower than riding a fiberglass horse, it may be less exciting and drama-filled than the continual up-and-down cycle of new diets, but it will eventually get you somewhere.

      • Nof
        Posted November 25, 2013 at 11:49 am | Permalink

        The Fantasy of Being Thin might be helpful to those having trouble accepting that they may not be able to diet to a permanently smaller body.

        • Triona
          Posted November 26, 2013 at 10:58 am | Permalink

          Thanks for this!

    • KellyK
      Posted November 25, 2013 at 4:42 pm | Permalink

      I would second everything Michele said, and I love the merry-go-round analogy.

      I had a similar weight gain in a similar period of time, and it is stressful, and it does suck. I was fortunate in that mine was hypothyroid, and my weight stabilized when I went on synthroid.

      I hope that if you also have some underlying metabolic wackiness going on, that your doctors can get it straightened out soon. Not that that will necessarily result in losing what you’ve gained, though it might, but stabilizing is a good thing in and of itself.

  14. Posted November 24, 2013 at 7:02 pm | Permalink

    Just a repair on what I wrote above: “Should be a goal” = “If the person feels like the cost/benefit balance tilts in favor of weight loss”. I guess there’s no universal rule.

    Today I was having lunch with my fiancée’s family and her mother told us about a friend who was given a 600 kcal/day diet plan by her endocrinologist. The lady is 5’6″ and weights about 195 pounds. I immediatly looked at my fiancée and thought: “What the fuck, is the doctor trying to kill the lady by starvation?”.

    And then my fiancée (she’s a fat nutrionist too – by silly BMI standards!) told me that here in Brazil – I don’t know how it works in Canada or in the U.S – this has become a serious problem: doctors who have no formal degree in dietetics or nutritional sciences feel free to prescribe the most restrictive diets to patients. Now, how seriously fucked up is that? This is so serious, this is so dangerous, and yet I’m told that the government agencies turn a blind eye to it because when it comes to mistreat fat people by torturing them with mad diets, there’s no bounds to what one can do!

    That really enraged me. Prescribing such a diet to a basically healthy obese patient in order to achieve weight loss should be a crime, really. I asked my fiancée’s mother if her friend suffered from some unlikely illness which made this kind of restriction advisable, and the answer was obviously no – the one and only goal of the diet was achieving weight loss and all the alleged benefits consequent to it.

    I just replied that I thought that was really cruel and that weight in and of itself is not a sign of poor health. I know this from experience, as I’m quite thin and yet have many health issues.

    And I even ask myself whether the very idea of dieting came from the doctor. Given how fucked up things seem to be in this area, it might well have.

    • Mich
      Posted November 26, 2013 at 1:59 am | Permalink

      That’s scary. Some doctors in Canada also prescribe weight loss and low-cal for anything.

    • Barlow
      Posted December 19, 2013 at 7:12 am | Permalink

      A starvation diet would not be okay if she had been a fat person either.

    • jenn2hi
      Posted January 12, 2014 at 11:54 pm | Permalink

      When I was 19 and needed breast reduction surgery, at about 190 lbs, 5’3″, the doctor said that insurance required I lose 50 lbs first. I blame her for the start of my weight-cycling life, and also think she was lying to pawn the blame on insurance companies (since it was an immediate answer and not one as a result of a phone call). But whatever. That was 20 years ago, and I stopped the weight-cycling madness about 7 years ago.

  15. Posted November 25, 2013 at 9:57 am | Permalink

    Thank you for this post! I wish more professionals would look at this research and understand the reasons why diets fail. I’m finishing the new book Wellness, not Weight right now that talks about HAES, and it’s fantastic to read the research and different ways to think about weight.

  16. Posted November 26, 2013 at 6:11 am | Permalink

    On the theme of “is there any hope for me?” – I do believe there’s more hope for all of us – because if your weight is not a reflection of your willpower, character or moral fiber, then there’s no reason left to feel bad about your body.

    Except for stigma, of course, which is what body-positivity is all about. If size does not reflect your worth, then your worth is not up for debate.

    And even health status/threat of sickness against a non-compliant body isn’t a reason to feel bad about yourself. Our fears are exploited in the name of health – “if only I’d been more obedient, I might not have gotten sick” – or maybe you would have anyway. Really, so much is in the hands of God/chaos.

    Chaos, that bastard. We really are all in the same boat here. We will all one day get sick – if we’re not already, and the way to learn how to cope with that isn’t to bury our heads in the sand and just try to delay it for as long as is humanly possible. When a thing is inevitable (death, taxes), putting it off doesn’t make it easier to manage when it one day arrives. And my capacity to avoid the inevitable is not what I am going to judge the ‘success or failure’ of my life upon.

    So the body is not a reflection of morality (controversial a statement as that might be these days). We should not feel bad about ourselves for being human and mortal, but we can, if we want, try to develop coping skills and talk about issues and try to prepare for and accept the fact that one day we’re going to die.

    I don’t mean to be morbid, it does not detract from life to talk about death, but it does detract from life, I believe, to live in fear of it, and sickness, and to buy into delusion and prejudice. “If only I had done what I was told… by the people who were trying to exploit my insecurities for money…? Wait a minute!”

    They dress it up as empowerment, but it is not empowering to bury your head in the sand, to do what you’re told in the name of personal development, to believe that you need to be changed, to be made thinner, better, to escape the threat of disease.

    I figure, knowing that we are mortal and trying to accept our bodies ‘warts and all’ means we can become free to live our own lives, and there is much hope and peace in that. Freedom. You don’t need to be thin or fat – it’s a whole other thing. You don’t need to be chained to their wheel.

    Such a great post! Thank you so much.

    • Posted November 26, 2013 at 7:35 am | Permalink

      Beautifully put Chris.

    • Nof
      Posted November 26, 2013 at 9:10 am | Permalink

      I’d like to subscribe to your newsletter, please.

      Very eloquent. “They dress it up as empowerment” indeed.

      • Posted November 26, 2013 at 10:27 am | Permalink

        Read his blog, it is awesome.

        • Nof
          Posted November 26, 2013 at 10:36 am | Permalink

          I did not realize he had a blog so THANK YOU.

          I always forget that you can click on names.

        • Posted November 26, 2013 at 6:46 pm | Permalink

          Thanks Michelle! :)

        • Posted November 26, 2013 at 6:46 pm | Permalink

          And thanks everyone, for your kind words.

          • Mich
            Posted November 27, 2013 at 12:02 am | Permalink

            Awesome post, and you’re totally right about them exploiting our insecurities for monetary gain.

    • Posted November 26, 2013 at 6:15 pm | Permalink

      “So the body is not a reflection of morality (controversial a statement as that might be these days). We should not feel bad about ourselves for being human and mortal, but we can, if we want, try to develop coping skills and talk about issues and try to prepare for and accept the fact that one day we’re going to die.”

      Well put. : ) And in a time where there are people willing to destroy their bodies – that is, themselves! – in order to blow up a building or a school in the name of a life which is supposed to happen outside and beyond our mortal earthly bodies, isn’t it awkward that we should be telling the obese to basically obliterate themselves, their bodies, their identities, their apetites and desires in order to achieve some ideal of pure health and beauty?

      There’s too much death impulse in our world already. We really don’t need these crazy and punishing diets.

      P.S 1: I’m not at all speaking against the concept of an afterlife.
      P.S 2: I have nothing against people who diet. The people I care the most for have spent a good part of their lives following some kind of diet!!

  17. Elodie
    Posted November 26, 2013 at 12:25 pm | Permalink

    Someone in discussions about this often pops up with an anecdote about their brother or cousin or aunt three times removed, and how that person lost weight and kept it off (though usually it’s only been about six months), so everyone should be able to. I rarely see anyone give the other side, which is also anecdotal, but here’s what I’ve seen:

    Everyone I know who has dieted has ended up gaining a massive amount of weight after about three years at most. Every single one. Then they’ll lose a little bit again, maybe get down to nearly their pre-diet weight, then gain even more. Over and over and over again. As far as I can tell, the absolutely best way to gain a lot of weight is to go on a diet. And these people are not weak-willed spineless no-willpower having horrible terrible people. These are people with willpower and abilities in general that regularly amaze me.

    • rsher
      Posted November 30, 2013 at 11:07 pm | Permalink

      my experience exactly…

      i was a skinny/normal 8 when given my first “prophylactic” diet pills. food was restricted for me (not my brothers – who have all grown up skinny) – i was sent to fat camp – sent to the duke rice diet (350 cals a day for months) – tried electroshock therapy – the “diets don’t work” method –

      which all in all have caused me to gain about 140 lbs.

      dieting works if you wan to to gain weight. it works really really well.

  18. G
    Posted November 26, 2013 at 12:36 pm | Permalink

    I wonder if the same physiological changes occur in people who lose weight strictly through exercise, without any food restriction.

    For me, changing my lifestyle from sedentary to active while giving up restriction led to a ~10% weight loss. My weight has been stable for a few years now (though still fat). My appetite fluctuates based on my activity level and I work to trust it but I do wonder about weight “creeping back on” since that was my experience every time I dieted and lost weight. (The activity would still be worth it, though!)

    I suspect my metabolism is higher now, rather than lower like post-dieting… #anecdata

    • rsher
      Posted November 30, 2013 at 11:02 pm | Permalink

      movement is the answer – and not insane over-exercising – just getting back into life. walking, swimming, dancing….

  19. Posted November 30, 2013 at 10:21 pm | Permalink

    I had a “friend” (well I thought she was tell me today “you brought enough food for an army”. We had shared a table at a craft sale trying to sell our photography and I’d brought lunch, which consisted of an apple, banana, sandwich, some taco chips and a granola bar. She must have seen the look on my face as I closed my lunch bag and said “oh I was just joking.” Yeah, right.

  20. Posted December 1, 2013 at 3:04 am | Permalink

    Diets are not the answer, long term sustainable lifestyle changes are. I was watching a video of Geneen Roth at a conference a while back and to explain the cycle of weight loss and regain for dieters she said “For every diet there is an equal and greater binge”. It really hit home for me. When you spend so much time intentionally depriving & restricting yourself, your body is keeping track and you’ll over eat if you do it for too long. Eating for the sake of fueling our bodies so we feel and function well is really the only way to get out of a bad cycle of dieting.

    • sannanina
      Posted December 2, 2013 at 9:23 am | Permalink

      Okay, I hope this does not come across as confrontational. However, what do you mean by “sustainable life-style changes are the answer”? The answer to what? To weight-loss that can be maintained in the long term? To health? If it is weight loss, what kind of weight loss? 5% of body weight? 10%? Or a weight loss big enough to make a “morbidly obese” person… well, if not “normal”, than let’s say “overweight” according to BMI? And what is a sustainable life-lifestyle change? Cutting out soda? Exercising/moving 20-30 minutes each day? Or things like eating extremely low carb six days a week and “cheating” on the seventh day, exercising 1 1/2 hour minimum a day, etc.? Also, sustainable under what circumstances? While working full time and raising a child as a single parent? While being depressed? While being on the road six days a week?

      I don’t think there is much (or any) evidence that life-style changes (in the areas movement/exercise and nutrition) lead to sustainable weight loss in all or most people. Plus, I do not believe that it is possible to go from “morbidly obese” to… well, if not “normal” than let’s say overweight through a sustainable life-style change for the vast majority of people. And I do not think that there is data that life style changes circumvent any of the mechanisms usually triggered by weight loss. I do not claim to know all the literature, though, so if you have sources on that I would appreciate it if you could share them. Plus, it really, really depends how you define a sustainable life style change. After all, Weight Watchers also claims that they are not a diet…

      On the other hand, I regained more than I originally lost after my last “real” diet, and I have lost that weight again. But I only was at my highest weight for a few months. And while I have been relatively weight stable without much effort for the last three years, I do not know if I will eventually regain. What I do know is that I am still very much “morbidly obese”, though, and that any try to make further changes leads to hunger (and in my case also anxiety) and overeating a few days down the road – and I am not talking about huge things here but rather things like consciously limiting sweets, consistently stopping at the lower end of the satisfaction continuum (i.e., when I am not really hungry anymore, but still quite far away from stuffed). I also think that a person who has been at a stable though high weight for a long time before losing weight is potentially in a very different situation than I am. The same would probably be true for someone who gained weight due to taking certain medications etc.

      • Posted December 2, 2013 at 1:23 pm | Permalink

        Hi sannanina, no, you’re not coming off as confrontational, just curious/questioning. :) It’s a passionate & frustrating subject!

        What I mean by “sustainable life changes” is that good health and weight loss only happens (and lasts) when we make permanent changes to our lives, not just changes (diets) that we intend to only do until the weight comes off or until we feel better. “Diets” are not permanent changes. We make permanent change over time – they don’t happen overnight. I too have lost large amounts of weight and gained it back. It’s a horrible feeling, one that I know very well!

        “Lifestyle changes” that help people lose weight/get healthier long term are things like:

        -getting adequate sleep
        -daily movement (doesn’t have to be fancy, but consistency is important)
        -reduction of processed food & increase of vegetables/whole foods in their diet
        -changed perspectives (stop beating yourself up about a missed workout or a piece of occasional pie, viewing food as fuel & not the enemy)
        -a support network (friends, family, coworkers & health professionals)
        -motivation from within that is about more than just fitting in to a certain dress size (for better health, less pain, a longer life, to have more energy etc)
        -learning to listen to what makes your body feel good and what makes it not feel good (a lot of us have forgotten how-we don’t even feel the signals our bodies are telling us anymore)

        “Sustainable” in that these habits become a part of your life and just something you do after a while without even thinking about it. Calorie counting, zero carb and daily insanity workouts are probably not sustainable for most people. Sure, you can do it for 6 months or a year, but what about 15 years down the road? It has to become a part of your life – whether you are a single mom or depressed or anything else. The reason these habits fit in is because they become normal life – like brushing your teeth! Granted, depression is a whole other ballgame that makes it hard to do anything, including normal daily activities – something that needs medical treatment before weight loss can be properly addressed. For the others, time is important here. You can’t make lifestyle changes in a week or a month. Ever been a smoker trying to quit? Similar thing – it takes time and effort to make it permanent, to figure out what you can do forever.

        As to whether permanent lifestyle changes can help morbidly obese people lose weight or maintain weight loss, for long term weight loss, I think yes. To get started, is a more extreme method needed? Probably. That would depend on the particular person’s health and needs. Our habits are very much ingrained in us and a very morbidly obese person may not have the convenience of time to focus on creating permanent lifestyle changes but it certainly could be something that was worked in as they made progress, preferably under the guidance of their doctor or another health professional.

        Here’s a couple of resources:
        http://jama.jamanetwork.com/article.aspx?articleid=1730520
        http://healthfinder.gov/News/Article.aspx?id=671089
        http://onlinelibrary.wiley.com/doi/10.1111/mcn.12103/abstract

        I hope that explains my perspective a little.

        • LadyTL
          Posted December 6, 2013 at 1:50 am | Permalink

          I think the big problem with your list is many items on that are out of our control or not attainable.

          -getting adequate sleep: depends on work and life situation and in many cases health issues

          -daily movement (doesn’t have to be fancy, but consistency is important): depends again on work and time and life unless you are including the many 5 minutes we spend walking and move just in life and also still can depend on health issues

          -reduction of processed food & increase of vegetables/whole foods in their diet: once again depends on income and health issues, certain food types can be out of price ranges for people and other “good” foods can make people sick

          -changed perspectives (stop beating yourself up about a missed workout or a piece of occasional pie, viewing food as fuel & not the enemy): not so easily changed due to near contant outside forces saying the opposite and mental health issues can impede as well

          -a support network (friends, family, coworkers & health professionals): Yeah…no. Given rampant documented medical biases and not everyone has good family and friends…

          -motivation from within that is about more than just fitting in to a certain dress size (for better health, less pain, a longer life, to have more energy etc): see the issues about changing your perspective

          Also, what if someone doesn’t need to lose weight? There is a blind assumption it would be better for everyone to lose weight to a certain number with no evidence to support that idea.

          I get flack from doctors all the time for me to lose weight but I live healthy, am not impeded in any way by my health and by every objective health marker, have no negative effects of my weight even after a decade of being “obese”.

          • sannanina
            Posted December 6, 2013 at 10:18 am | Permalink

            Not just that – but those things also do not always lead to weight loss. And they rarely lead to weight loss of more than a few pounds. (Which does not mean that they are not worthwhile things to do, of course.)

            Sorry, I do not have time to write a longer reply right now…

  21. Ardus Nathila
    Posted December 2, 2013 at 5:54 pm | Permalink

    Very interesting, glad I stumbled upon your blog :)

    At the risk of being called a heretic in this circle, there are a couple of things that jumped out at me.

    In your post on not being a dietician, you mention that you are a person of science, one who believes that sound study can provide a framework to reach a desired outcome. What confuses me is that the studies you link are either incomplete or lack repeatability and monitored controls (subject reporting is unreliable). If it’s not predictably repeatable, it’s not sound science. That and controls, of which are not strongly present in the linked studies, form the basis of science.

    “Diets don’t work” is gross oversimplification of a topic in its infancy of study. All of the topics you covered, while valuable, work in concert with the seemingly simplistic rule that governs weight gain, that being cal in/cal out. Whether it’s Frank Sacks at Harvard or the countless others, this is the only indisputable truth that has been shown to be repeatable.

    I know the immediate reaction will be to cite all of the relevant topics you covered. That rule, cal in/cal out, does not contradict any of the findings of the studies you link. Yes, genetics play a role in how our bodies intake, use, and expend energy. Yes, those who lose weight tend to have an increased level of desire for foods from their past, their learned behaviour. Yes, when you decrease weight, you decrease expended energy. Yes, different sources of calories are utilized by the body differently, often depending on the individual based on a variety of factors. All of those points are valid, but they work in concert with the one rule. If someone wishes to maintain, lose, or gain weight, they can do so once they understand their bodies ability to process and expend energy. If they fail to adjust their intake to their new level of expenditure, they will gain the weight back. It seems simple, I know, but it is relatively simple.

    There is needed differentiation that seems to not be addressed here: “weight” vs. “fat”. What the linked studies, and your final thoughts. fail to do is differentiate between the two:

    “If you’ve ever regained weight after a diet, you are in very good company. Most dieters regain the weight. You are not lazy, stupid, or greedy. You did not fail — on the contrary, your body worked hard to save you”

    If we have a biologically ideal weight, and many incomplete studies have shown promising reason to believe so, that does not necessarily mean that we have a biologically ideal amount of fat. People diet to lose fat, not weight. Weight can be replaced without gaining back the previously disproportionate amount of fat. Lose ten pounds of fat, replace it with 8 pounds of muscle and 2 pounds of fat.

    When I made the choice, and it is a choice, to change my body composition I used a simple calorically restrictive diet, combined with moderate and routine exercise, to lose close to 10% of my body weight. Since then, I have regained every single pound. The difference being that 85% of that weight was muscle, and not the fat I lost. I have no desire to lose any more “weight”, because my composition is improved. I can also now intake many more calories than I could with my past body composition. It has been 10 years. It’s not impossible, it takes a resounding amount of commitment and effort, and it’s certainly not for everyone. Be comfortable with yourself is a great lesson, and incredibly important for everyone’s mental health. However, if you wish to make changes, you need to understand that there will be challenges and disappointment along the way.

    I think articles like these are designed to lessen the hurt, the hopelessness, felt by those who felt that have failed,and that support is needed to help them refocus and re-evaluate their goals. That is great. It is another thing to promote ideas that give them absolutely zero hope, because, as this article seems to suggest, you are what you are and nothing will change that. For that reason I consider this line of thought to be quite destructive, regardless of the intent.

    • Mich
      Posted December 2, 2013 at 8:48 pm | Permalink

      Dieting has been around for more than 4000 yrs, so yes, the studies are repeatable, and they do it the same way it’s been done since the beginning.

      If it really is just calories in/out, then how come twins who come from fat parents and are raised by thin adoptive parents, not become the weights of their thin “new” parents? Queen Victoria had an eating disorder but it didn’t make thin! Was she just chowing down on cheeseburgers or some other villainous food item? What about Churchill?

      • Normann Cohn
        Posted December 3, 2013 at 7:17 am | Permalink

        I guess Ardus Nathila’s post is basically correct, but also trivial. I mean: of course it’s about calories in and calories out. However, thinking that either side of this equation is perfectly under our – or anyone’s – control isn’t supported by most serious scientific studies I know of.

        He talks about body composition. Well, gaining mostly fat free mass was his body’s response to the refeeding; there’s absolutely no reason whatsoever to suppose that other bodies will react in the same way. The most rigorous and accomplished overfeeding experiments have repeatedly demonstrated that people on the same calorie surplus differ not only in the amount of weight they gain, but also in the fat-to-fat-free mass ratio. Just recently I was reading Diaz’s classic overfeeding study (http://www.ncbi.nlm.nih.gov/pubmed/1414963)and it struk me how people on the same diet could respond so differently – while for some the ratio was 20% fat-free mass and 80% fat, for others it was 40% and 60%, respectively. If I remember correctly, there was even a subject whose weight gain consisted of about 90% fat!

        As for the calories in/out, there’s a huge number of factors determing it – structured exercising is just a small part of the story. Basic stress and anxiety, family and professional life, spontaneous physical activities like fidgeting, gut microbiota, exposure to toxins, mood swings and, of course, genetics all play a role in determing actual energy intake and expenditure.

        Not to mention that most people can’t really chose the food and activity environment they live in, nor can they simply let go of their stressful and sedentery 12-hour work schedule, for instance.

        So it IS about calories in and calories out. But saying that means basically nothing, at least to me. And what worries me is that by focusing on the personal choice framework, which surely plays a role in all this, we may neglect the structural problems of social inequality and inadequate access to healthy food and physical activity environments.

        Last but not least, we may also neglect the questions of tolerance and acceptance, as being overweight or obese is surely not a health issue for many people who are already quite active and eat pretty normally; the issue for these people is fat shaming and stigma, not physical health.

        I guess the poster above can consider himself very affortunate to be able to alter his body composition so radically on choice. For many people, including thin people like me who can hardly gain much muscle despite regular weight training, it doesn’t work that way.

        • Posted December 3, 2013 at 1:28 pm | Permalink

          I wonder if that commenter has ever studied the energostatic hypothesis and fuel partitioning. (To be clear, I am only learning about it still, but it seems to have a lot of explanatory power for some of the seemingly paradoxical phenomena around energy intake/expenditure and fat storage.)

          The difficulties in measuring dietary intake are pretty well known in all nutrition research, sadly.

          I don’t really feel like getting into a long comment war about this. I’d rather save my wrists and energy for another blog post, but I think it is a fair critique and they are questions worth asking. But everyone else can feel free to chime in and let me know what they think.

          • Posted December 7, 2013 at 3:14 am | Permalink

            I’m under the impression that the first law of thermodynamics is difficult to apply to a human; the idea that the total energy in an isolated system always remains constant falls apart a bit, because I’m not sure the human body qualifies as an isolated system.

            But here’s the disclaimer: I’m not sure about posting this link, because it’s written aggressively and it’s not an area in which I know much – it really isn’t – and I don’t know if this article would be for everyone, but I found it rather thought-provoking.

            “The idea that a calorie is a calorie actually violates the laws of physics”

            Here’s the link: http://articles.elitefts.com/nutrition/logic-does-not-apply-iii-a-calorie-is-a-calorie/

  22. Ambimom
    Posted December 3, 2013 at 2:10 pm | Permalink

    Forgive my ignorance but I don’t recognize a gender in the name, Ardus Nathila, but I presume that the commenter is male. Despite a presumption that his/her experience is universal, there is demonstrable evidence over many studies that the physiological differences between male and female bodies plays an equally significant role in the effect of diet on weight loss.

    This fact of human biology is doubly cruel culturally, because women pay a much greater price for being fat than men.

    This cannot be emphasized enough. How many advertisements for diet products are aimed at men? The preponderance of Dr. Oz’s audience members are — women; same for Weight Watcher’s classes and Lean Cuisine commercials. The fat stigma is borne primarily by women, regardless of health.

    This culture is vested in a lot of magical thinking, especially about this subject. What is most galling is that most physicians are vested in this very same magical thinking. No matter what ails you, if you are a fat woman, they’ll tell you to go on a diet; and depending on their hospital affiliation, they’ll insist on bariatric surgery being the answer. Of course, it’s not the answer. Far from it.

    Someday, somehow someone will find the answer. In the meantime, I will continue taking an exercise class 4 days a week; refuse all processed foods (except an occasional kosher hot dog); substitute agave for sugar; and eat more fresh fruit and vegetables.

    • B
      Posted January 18, 2014 at 1:26 pm | Permalink

      It’s so true about doctor’s blaming other conditions on your weight. It took years for me to get a diagnosis of Fibromyalgia, even though I’ve had symptoms since I was a child. Oh, I should add, a child who was “normal” weight. Weight gain didn’t cause it to get worse, becoming an adult with more responsibilities did. But of course even with the diagnosis I still get told, “oh and you should also try to lose some weight.” Thanks.

  23. Lauren Bouffard
    Posted December 15, 2013 at 5:16 pm | Permalink

    This is a horrible article. It basically gives people am excuse to not eat healthy and continue to be overweight. Saying someone genetically predisposed to bring overweight is junk science. There is no gene found like down syndrome or Huntington’s disease. I’m sorry you feel over weight people are not treated right but encouraging them to continue to be unhealthy is wrong so that healthy people end up paying for everything
    I have no idea how many obese patients Ive cared for over the years on disability claiming they can’t work. If someone had taught them the importance of a healthy diet, discipline, and physical activity they could work. You say they show a preference for high calorie food and sweets well so do I but I control my urges!

    • Posted December 16, 2013 at 9:24 am | Permalink

      There does not need to be a single gene linked to a particular trait in order for that trait to still be considered highly heritable. Twin studies are certainly not junk science. You sound scared and confused.

    • sannanina
      Posted December 16, 2013 at 11:10 am | Permalink

      Oh dear. Okay, first of all, you are aware that not every trait is the result of one single gene, right? A number of traits are caused by multiple genes – this is not at all unusual (see http://en.wikipedia.org/wiki/Genetic_disorder). And for a trait such as weight/percentage of body fat, where you have a continuum and not separate categories, it is actually quite unlikely that you can trace it back to one gene. Do you also believe that height is not (partially) genetic? Because you cannot trace that back to one single gene, either.

      Also, it would be great if you could state the definition of junk science that you use. And cite some sources that support your claims (and state why they are not junk science.)

      Oh, also, Down’s syndrome is NOT an example of a condition caused by a mutation in a single gene. People with Down Syndrome have three instead of two copies of chromosome 21 (or have two whole copies of chromose 21, and one “partial copy” that got attached to another chromosome). In other words, they have three (instead of two) versions of a number of genes. See http://en.wikipedia.org/wiki/Down_Syndrome

    • rsher
      Posted December 16, 2013 at 11:28 am | Permalink

      Interesting. What was your training in weight problems and control, or are you self-taught? Using common sense maybe?

  24. Posted December 16, 2013 at 3:36 pm | Permalink

    I think for any diet to work one has to have self-discipline. I’ve known people who tried several different kinds of diets and succeeded. They succeeded because they kept to the diet and had the self-discipline to do so. And I’ve known several people who continuously try different diets, and none of the diets work for them. The reason is because they don’t stick to the diet for any length of time, become quickly impatient cause they don’t see instant results or because they just don’t resist temptations and keep eating junk food and things that go against the diet plan. I don’t think any diet can work unless a person exercises self-discipline and sticktoitness. And that’s the way it is, I’m sad to say!

    Patrick P. Stafford
    Creeklife Supporter
    marcelproust37@hotmail.com
    http://www.creeklife.com

    • rsher
      Posted December 16, 2013 at 5:29 pm | Permalink

      So, Patrick, your expertise is…. you “have friends who….” I’m sure you’ve read up on the subject, have followed your friends weight history for decades, know all the science.

      Yours is the simplistic opinion that keeps so many dieting and ultimately gaining more and more weight.

      You don’t have the problem, so you can’t imagine that there might be things you don’t know.

    • rsher
      Posted December 16, 2013 at 5:35 pm | Permalink

      But most of all, Patrick, if it isn’t your problem, if you have no deep knowledge, if you have nothing helpful to add, perhaps you could leave this subject alone.

      Address something that pertains to you, cheap potshots not appreciated, nor are they original.

      None of your business.

    • Posted December 16, 2013 at 5:44 pm | Permalink

      Wow

      Such logic

      Many discipline

      Very sticktoitness

    • sannanina
      Posted December 16, 2013 at 5:57 pm | Permalink

      I don’t think any diet can work unless a person exercises self-discipline and sticktoitness.

      You know, I actually agree with this. The (few) people who successfully maintain a (large) weight loss probably do have very high levels of self-discipline on average. It requires a lot self-discipline to literally work against your own body, eat less than you are hungry for, etc, for years and years. (You might actually be interested in this account of weight maintenance: http://justmaintaining.com. The author says that maintaining her weight loss is basically a half-time job for her.)

      The thing with self-discipline/self-control, though, is that it is a limited resource (i.e., your self-control might be used up by other things than dieting). Yes, you can increase self-control by “training”, but there is a limit to that possibility. Furthermore, constantly working against the inclinations of your body often isn’t particularly healthy, even though it can be very functional in reaching goals in the short term. Lastly, most people who say that dieting requires self-control seem to imply that thin people have that kind of control. But thin people do not necessarily diet – in fact, the thin people I know usually eat what they are hungry for and stop when they are full. Some might diet from time to time, but nearly none of them is on constant very restrictive diet as it is required by most formerly fat people. For a (mentally and physically) healthy human being eating according to hunger cues usually doesn’t require self-control.

      Then there are of course people who diligently stick to diets for quite a while – months, sometimes years. But then the physiological backlash (increased hunger, decreased metabolism) becomes so strong that they cannot keep it up any longer. Those people actually have demonstrated quite a bit of self-control by sticking to a diet for as long as they did, yet they are often treated (and see themselves) as lacking in self- control in comparison to thin people.

      Finally, there are people who stick to quite restrictive diets and STILL start regaining weight at some point or at least stop losing weight long before they have reached their “goal weight”. Self-control can help you deal with one part of the equation – hunger. It will not speed up your metabolism.

      • sannanina
        Posted December 16, 2013 at 6:06 pm | Permalink

        Okay, the first sentence was supposed to be a quote… sorry.

      • Posted December 16, 2013 at 9:14 pm | Permalink

        Yes, part of the problem is that people overestimate how much work it is for naturally thin people and/or underestimate how much work it is for formerly fat people.

        And they don’t question whether all that work is worth it (in part, because they underestimate how much work it is). I’ve used the metaphor before of having a pony. Yeah, it might be nice to have a pony if I didn’t have to actually take care of it and exercise it every day and muck the stall and pay for it to be boarded or pay property taxes on the land for it, etc., etc.

        Or I could keep my house really, really clean if I treated that like a part-time job and just put in enough effort and willpower and bought enough cleaning products… but it looks like it’s not worth it to me, because there’s a bunch of dog hair in the corners of the house right now, and the sheets haven’t been changed in a couple weeks.

        I can put in a smaller amount of effort and get my house clean enough. I can follow HAES and get what I consider a healthy body, and while it may not conform to our current beauty ideal, I’m okay with that. I consider radical weight loss attempts to be a sort of heroic measure, one that I’m not interested in pursuing.

        • Posted December 16, 2013 at 10:01 pm | Permalink

          Your guys’ responses are so much more mature than mine.

          • Posted December 16, 2013 at 10:21 pm | Permalink

            But I adore your sarcasm!

            “Many discipline”.

            I dislike how people apply discipline to eating. I used to do it. But eating is not what discipline should be applied to – eating is about care – it is a perversion of discipline when you use it to police your own oppression. It ‘should’ be a tool to serve your liberation – ie. I use discipline these days to stop me from dieting, to stop me from succumbing to all that garbage, not to ensure my compliance and subjugation.

            Discipline enables me to protect that which is valuable and fragile – my sense of self-worth – in a world where that is really the thing most at risk of harm. If you’re going to use that tool, use it for good, not evil :)

          • sannanina
            Posted December 17, 2013 at 8:11 am | Permalink

            Your first comment actually made me think of this poem by the brilliant Pattie Thomas (for anyone who hasn’t read it it yet, her book Taking Up Space is really good, the poem is from the book):

            The Doctor’s Office

            Condescension
            drips from his lips.

            “You need to take in less calories
            than you expend,” he says
            in slow, elementary tones.

            No questions about what I want.

            I guess I am just not the one to ask.

            All I can think to say is
            “‘Fewer.’
            You mean to say,
            ‘You need to take in fewer calories . . . ’”

            I, of course,
            say nothing.

          • Posted December 17, 2013 at 5:39 pm | Permalink

            Hahaha, that’s brilliant.

          • Posted December 17, 2013 at 8:50 am | Permalink

            That’s a good poem.

            I use my self-discipline to not pick on people’s grammar even when they kinda deserve it. (See Lauren Bouffard’s comment, for example.) Most of the time.

          • sannanina
            Posted December 17, 2013 at 11:45 am | Permalink

            As someone who does tend to be quite nervous about the grammatical (and other) errors she makes I thank you for your restraint ;)

            What gets me, though, is the (often unspoken) assumption that I must be stupid and/or deluded when I decide not to diet anymore, and when I argue that diets really are not the answer to making (most) fat people thin. People have all the right in the world to make different decisions for themselves and to hold different opinions.

            I do actually get uneasy and feel triggered when people tell me that they think that dieting is swell idea – no matter how polite they are when expressing that opinion, but that has to do with my personal history and it is my responsibility to deal with that, not theirs. So – fine, argue against my opinion all that you want, as long as you respect me and as long as you consider at least briefly that I might have a point.

            But if you want me to take you serious it would be nice if you would give me the same courtesy. Which entails actually listening to the points I make and to think about them as well as looking – at least briefly – at the data that I use to support my opinion before deciding that it is nonsense. (And Patrick, if you are still reading… I am sorry to say that your comment doesn’t look like you did any thinking about Michelle’s post before writing replying to it. The same holds true for Lauren’s comment.)

  25. Cath of Canberra
    Posted December 17, 2013 at 9:38 pm | Permalink

    I’ve had some success with new medical people (who I’ve seen a lot of recently) by saying “I’m fine with my weight: fat is way better than suicidal”. It takes them aback and stops them in their weight-loss speech tracks. It’s clearly literally true, and directly applicable to me, as my weight has been very constant. I gained weight in 2 very clear 15 kg batches – once when I went on antidepressants in 1995 and the second time when I went on a different variety of antidepressants in 2007.

    • rsher
      Posted December 18, 2013 at 2:28 am | Permalink

      i, too maintained my same high weight – and have for the past 20 or so years. it varies by about 15 lbs lower but never higher. i never weigh myself. the funny thing is that whenever i get congratulations from medical personnel on “losing weight” my weight immediately shoots back up.

      psychological indeed! whose body is it anyway?

      and why do people find it permissible to make comments on my body? very tempted to make comments on the doctor’s body. maybe comment on his poor eyesight that requires glasses, his receeding hairline; make suggestions that he get laser eye surgery, hair plugs….

      but then i realize that i need him on my side. harrrumph. oh well.

    • Triona
      Posted December 18, 2013 at 7:56 am | Permalink

      That is one thing that blows my mind with the medical profession and society at large – nobody seems to talk about food and mental health! I don’t take anti-depressants anymore, but I very much manage my brain chemistry with food – A LOT of really healthy food. For me it is absolutely the difference between being fat and sane or thin and full of anxiety, paranoia and depression. My brain needs food. But of course our society doesn’t want a bunch of clear thinking empowered women in it….

    • Posted December 20, 2013 at 10:49 am | Permalink

      I know this feeling well. For me, it’s either being fat or having disordered eating and body dysmorphia. I’ll take fat any day, thanks.

  26. Leslie
    Posted December 21, 2013 at 4:27 pm | Permalink

    Thank you so much for this post. My family of origin is incredibly fat-phobic. I find it hard to deal with the crap when I’m at home for the holidays, and today this post helped me to have handy scientific articles to back up the arguments I put forth in the face of their diatribes regarding laziness etc. The science doesn’t really sway them, but it makes me feel I’m doing my best, and I can at least hope it will plant a seed in their minds. And if nothing else, I always know I can come here to detox from all of that. :) So, thank you!

  27. rsher
    Posted December 21, 2013 at 9:08 pm | Permalink
  28. B
    Posted January 18, 2014 at 12:54 pm | Permalink

    I just recently, after a year and a half, regained all the weight I had lost on Weight Watchers. I felt terrible that I couldn’t get myself “back in the groove”. My weight regain began after a vacation, where I knew it would be impossible to stay on the diet. I had already lost 20lbs and thought if I gained a little that wouldn’t be too bad. I’d have a week off and I’d get right back. I gained 6lbs that week, and was never able to truly do the diet again.

    The weight gain was originally from a medication that was notorious for rapid weight gain, that my doctor decided was not important to tell me or warn me about. I was eating so much, and one month later, I was 30lbs heavier. I was already overweight to begin with, and was trying to lose weight prior, so this realization was horrifying.

    I just want to say thank you. My regrets, taking the medication, going on that vacation, have all been slowly driving me insane. I feel bad when I eat a snack while watching a movie, and feel worse when I deprive myself of it, constantly thinking “no, you don’t need it, stop”. Thank you for your words, your research, and your perspective.

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