It’s not the diet. It’s YOU.

From a discussion of celebrity endorsements of diet plans comes this gem from Nutrisystem exec Stacie Mullen:

“The dieting public understands that the dieter has a responsibility to comply with the program,” said Ms. Mullen, adding that if the dieter fails, “I don’t think the public blames the program the dieter was on.”

And from Zalmi Duchman of the Fresh Diet:

“If they don’t do good on it, it doesn’t mean the product doesn’t work,” Mr. Duchman said. “It just means that they’re not sticking to it.”

This perception really helps diet companies stay in business.  I’m sure diet programs REALLY don’t like this:

Reviews of the scientific literature on dieting (e.g., Garner & Wooley, 1991; Jeffery et al., 2000; Perri & Fuller, 1995) generally draw two conclusions about diets. First, diets do lead to short-term weight loss. One summary of diet studies from the 1970s to the mid-1990s found that these weight loss programs consistently resulted in participants losing an average of 5%–10% of their weight (Perri & Fuller, 1995). Second, these losses are not maintained. As noted in one review, “It is only the rate of weight regain, not the fact of weight regain, that appears open to debate” (Garner & Wooley, 1991, p. 740)
Traci Mann et al [emphasis added]

Most dieters regain their lost weight. It’s not that “they didn’t stay with the program.”  It’s that most dieters regain. Period.  The few who maintain significant weight loss long-term are a very small minority.   But as long as they trumpet “Anyone can lose weight!  Just pay us!” they can drown out the downer research that shows how unproven and full of lies their programs are.

US Obesity Rates Level Off Again?

Oh, not again.  Still.  They’ve been level for years, but this time the Journal of the American Medical Association noticed. There’s discussion as to why, such as “people are getting healthier”.  Given how dieters often gain weight in the long term, I thought this perspective a bit more realistic:

Dr. Ludwig said the plateau might just suggest that “we’ve reached a biological limit” to how obese people could get. When people eat more, he said, at first they gain weight; then a growing share of the calories go “into maintaining and moving around that excess tissue,” he continued, so that “a population doesn’t keep getting heavier and heavier indefinitely.”

That’s not what my mother told me.  She was convinced that if I wasn’t actively dieting I would continue to gain weight for the rest of my life.  Yet when I finally quit dieting my weight … leveled off.  Huh.

Furthermore, Dr. Ludwig said, “it could be that most of the people who are genetically susceptible, or susceptible for psychological or behavioral reasons, have already become obese.”

Gee, y’think?

Things to Read

This is kind of a mishmash ;)

If you’ve seen comments about “dickwolves” and PAX and wondered what it was about, JetWolf has a nice summary.

Author Seanan McGuire addressed why fixing the US healthcare system is so terribly, terribly important this week.  Seanan has discussed why she needs health insurance here and here.

Seanan’s new CD, Wicked Girls, is available for ordering at CDBaby.

Alternet has a well-done piece by Judith Matz on “Why dieting makes you fatter”.  It references Linda Bacon’s Health At Every Size study, Traci Mann’s survey of diet studies, and other research.   If you’ve been into fat acceptance a while it’s mostly things you know, but it’s good to see getting wider play.  It might also be a useful “FA 101” piece.

A 3-part Q&A with Linda Bacon is over at PyschCentral, too.

Ragen at Dances With Fat has a great post on respecting others’ choices while discussing Fat Acceptance and HAES.

Anything else?

On Fat and Eating

From Hanne Blank:

Truth is, it is totally possible to be a fat person eating “healthy” and “sustainable” and “locavore” and “balanced” and “nutritious” and “organic.”  This fat I have on my hips here?  That’s some locally-grown, sustainable, artisanally crafted, homemade fat, right there, practically glowing with seventeen kinds of early 21st-century middle-class white American foodie pride.

From Lesley at Two Whole Cakes:

[M]any behaviors seen as damaging and dangerous in thin people are outright encouraged in fat people. The specific example above is purging, but the sentiment is the same for many disordered eating patterns. Fat people are often supported in hating their bodies, in starving themselves, in engaging in unsafe exercise and in seeking out weight loss by any means necessary. A thin person who does these things is considered mentally ill. A fat person who does these things is redeemed by them. This is why our culture has no concept of a fat person who also has an eating disorder. If you’re fat, it’s not an ED — it’s a lifestyle change.

Quote of the Day: Healthcare Providers and Expectations

From an article on healthcare providers stigmatizing fat patients:

Healthcare providers also need to readjust their expectations. Getting individuals who are obese down to a normal weight isn’t realistic: Research shows that most people can’t expect to lose more than 10% of their body weight and, more important, to maintain the weight loss over time. Instead of viewing that as a treatment failure and growing discouraged with patients, doctors and nurses need to recognize that even relatively small changes in weight represent real progress and can have very important implications for health.

I’ve written before that the US National Institutes of Health (NIH) guidelines for treating obesity recommends a 10% weight loss goal.  Not to diet down to “normal weight”, or even to just “overweight”.   Ten percent.    I also noted that I never had a medical professional (or parent or teacher) be satisfied with a 10% weight loss.   I was still fat, so obviously 10% wasn’t enough.

Just to be clear? If a 10% weight loss puts you in the “normal weight” category, you weren’t in the “obese” category.

Most readers know I disagree with the emphasis on weight loss; not only are most losses not  maintained in the long term, but dieting is associated with long-term weight gain.   I do believe in bodily autonomy, though, and that those who choose to diet should use resources like the NIH guidelines and the observations of others who are maintaining losses to maximize their chances.  And I get angry that someone could work hard to lose 10% of their body weight, could work hard to maintain that loss, and still have a healthcare provider berate them for being fat.  Or refuse to treat them, just because they’re fat.

Skip the fat shaming.  It doesn’t help anyone.

(Checking out Health At Every Size doesn’t hurt either.)

Dieting Changes How Bodies React To Stress?

At least that’s what seems to happen in mice.  As summarized in US News and World Report,

Shaving calories triggers molecular changes in the brain that make mice more susceptible to stress and binge eating long after the diet ends, researchers report in the Dec. 1 Journal of Neuroscience. The finding could explain part of the yo-yo dieting phenomenon, in which people repeatedly diet and lose weight but then subsequently regain even more than they lost.

Researchers found that the dieting mice were more stressed than the non-dieting mice.  They also found that even after ending the “diet” and regaining the weight, the former-dieting mice were more susceptible to stress than the non-dieters.

The team traced lower activity of the gene that makes CRF to a chemical modification called DNA methylation.  DNA methylation and other modifications to genes help to regulate gene activity. Dieting mice had lower levels of methylated DNA near the gene for CRF than did animals that continued on the high-fat diet or ones that ate as much regular chow as they wanted. This change was essentially locked in for the dieting mice. It did not increase even two months after the diet ended—a long time in the life of a mouse, and equivalent to years, maybe even decades, for a person.

Researchers mildly stressed the mice for a week with things like damp bedding, cage swaps or putting a marble in the cage—mice are not big fans of change—so that the animals didn’t know what was coming next. Under this mild, but chronic, stress the former dieters snarfed down far more of the high-fat food than the nondieters. And the ex-dieters also had higher levels of hormones that prompt eating.

I DID find it rather eye-rolling that the article suggests that “dieters may need to cut stress as well as calories”, given that being fat is itself stressful.  And, of course, it remains to be seen how much of this applies to humans.  But this may help explain the mechanisms by which dieters so often regain the lost weight.

Abstract is here.

Meridia (sibutramine) being removed from the US market

From CNN:

Abbott Laboratories has agreed to take its obesity drug Meridia (sibutramine) off the market, the U.S. Food and Drug Administration announced Friday.

The company voluntarily withdrew the drug because clinical trial studies showed there was an increased risk of heart attacks and strokes in people who used the drug. […]

Approved in 1997 for weight loss, the original data on the drug showed that people who took Meridia lost at least 5 percent more of their body weight than people who were on a placebo and relied on diet and exercise alone.

The FDA requested the company withdraw the drug, after reviewing data from a follow-up study known as the Sibutramine Cardiovascular Outcomes Trial (SCOUT ). It showed there was a 16 percent increase in the risk of serious heart events, including non-fatal heart attack, non-fatal stroke, and death, in a group of patients given Meridia as opposed to others given a placebo.

Hopefully the increased risk of heart attacks and strokes will return to normal if the drug is discontinued.

Things to Read

From Marianne Kirby at The Rotund:

FA represents a long chain of people coming to the realization that the diet roller coaster is, to mix my metaphors, a sucker bet. The diet industry – when you get down to the bare, capitalist bones of it – has quite a lot of profit to be made from making people, especially women, feel awful about their bodies and their weight. If we all felt awesome about ourselves, they would go out of business.

From Nudemuse on some recent posts about fat and feminism:

[T]here seems to be some gap in a lot of feminist thought when it comes to granting fat women the same agency they might give to a woman who wants to do something else with her body.
No one likes being told, hey you might enjoy bread but you can’t have any because I think it would be best for you.

Now, I don’t know about you folks but my first reaction to that kind of condescension is to say, oh really, okay fuck you.

Maybe people with this mind set are trying to come from a loving place. If you are trying to come from a loving place think about it this way; if it was your life your body how would you feel about some stranger telling you what’s good for you in this manner? If it would upset you, don’t fucking say it.

And April at Round is a Shape on setting a boundary with her mother:

One phrase that I uttered early on in the day when my mother started to bemoan the fact that she was so hungry (after an early morning and only a granola bar she was feeling guilty for daring to feel famished by noon after driving 1.5 hours to see us!) and relay her guilt about going for a piece of bread or another pierogi: “This home is free of food judgments”.  And, happily, this was the last of self-recriminations that we really heard or voiced all day.


Another HAES Quote

This quote on Health At Every Size is from Michelle, aka The Fat Nutritionist.  Links within the quote were added by me.

[D]ieting purports to make all people lose weight, permanently. Because 80-95% of the people who engage in it do not lose weight permanently, dieting fails as an intervention. It fails to achieve its stated directive, and it also doesn’t seem to help people permanently pick up healthier eating/moving behaviours.

Whereas HAES does not purport to do *anything* to a person’s weight. It purports to encourage healthier eating and moving. And while only a few people might lose weight, just like in dieting, HAES succeeds as an intervention — because the goal was to engage in healthier behaviours, not to lose weight, in the first place. Evidence has shown (in Linda Bacon’s study) that HAES does actually succeed in getting people to adopt healthier eating and moving behaviours that stick around for the long-term.

I realize that this is not always an either-or.  But for many fat people, it’s assumed that either you are actively trying to lose weight through eating “better” or eating less or exercising more … and the weight not coming off, or not staying off, is then a reason to quit the healthy behaviors.

Thanks Frances at Corpulent for linking to Michelle’s post on Health At Every Size.

FDA Advisory Panel Recommends NOT Approving Qnexa

In an update, the FDA advisory panel reviewing the weight-loss drug Qnexa has voted to reject it.

The final FDA decision will not be issued until October, but the advisory panel’s decision is usually key to their decision.

In a 10-6 vote, a Food and Drug Administration advisory panel said they were concerned that Qnexa was too experimental. […] Approving the drug would be “a huge public health experiment,” said panelist Elaine Morrato of University of Colorado.

[…] Vivus is seeking FDA’s green light to sell Qnexa to adults to use once a day to slim down in it hopes could become the first prescription diet drug in a decade. The company told advisers its pill offers a safe option for shedding pounds and improving their health.

There is little doubt the drug works, but panelists said potential side effects such as depression, memory loss, increased heart rate and birth defects are a worry.

Panelists were also concerned since patients may take Qnexa for years but Vivus only studied it for about 12 months.

Qnexa is a combination of phentermine and topiramate aka Topamax.  I also posted about the drug a few days ago.

New Diet Drug: Qnexa

Patients on the highest dose of Qnexa lost an average of 8.9 percent of their weight after adjusting for the effects of a placebo. More than 60 percent of patients on middle and high doses lost at least 5 percent of their weight, compared with 20 percent for those getting a placebo.
NY Times

Recall that the National Institutes of Health states that a “8-15% weight loss is often observed” from dieting.  So losing an average of 8.9% doesn’t seem all that to me. It is enough for the FDA to consider it an effective weight loss treatment, though, because the FDA requirements are:

[A] drug will be considered effective if at least one of the following criteria is satisfied after one year of treatment:

  1. The difference in mean weight loss between the active-product and placebo-treated groups is at least 5 percent and the difference is statistically significant
  2. The proportion of subjects who lose greater than or equal to 5 percent of baseline body weight in the active-product group is at least 35 percent, is approximately double the proportion in the placebo-treated group, and the difference between groups is statistically significant

5% of baseline weight on average over a placebo.  For a 200lb person, that’s 10lbs. That’s what’s required to be an effective weight loss drug.

I think that says something pretty damning about the supposed ease of weight loss.

Meanwhile, the risks of Qnexa include suicidal thoughts, problems with thinking, birth defects, speeding heart rates and acid buildup.   I wouldn’t want to risk taking it.

Does this sound worth it to you?   Or do you figure it’s at least better than Alli?

More info: FDA review (PDF)

7/15 Update: FDA panel rejects Vivus weight-loss drug Qnexa

Expectations (and Risks) of Weight Loss

Lots of folks have been quoting the new paper in the International Journal of Obesity

Weight loss of 15% or more from maximum body weight is associated with increased risk of death from all causes among overweight men and among women regardless of maximum BMI.

“Associate”, here, appears to mean “correlate”.   The 15% piqued my interest because it echoed this bit* from The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, from the US National Institutes of Health (NIH) guidelines on “obesity treatment”:

Obese individuals typically want to lose 2 to 3 times the 8 to 15 percent often observed and are disappointed when they do not.  (p32)**

Correlation does not necessarily mean causation, but this leads me to wonder whether, on average, a more than 15% loss requires more extensive changes to diet and exercise, that in turn can result in more muscle loss and other damage?    Nobody knows.  It’s not clear whether the correlation is a strong one (3000% more likely?) or a weak one (100% more likely?) or if it will actually mean anything in the end.   But I do think we should focus more on health than on weight.

I also note they did find one group where weight loss reduced risk of cardiovascular disease:  obese men who lost between 5% and 15% of their max weight.  I also note that reducing risk of cardiovascular disease can be done by increasing exercise and other such changes, without focusing on weight loss.

*Posted about here.

**For convenience, I’m using PDF page numbers, which can be entered into the PDF viewer to go directly to the page in question.  These do not map to the printed page numbering.

Weight Loss Expectations: NIH vs Popular Thought

What expectations do people have when they start a weight loss program?  The Fantasy of Being Thin is very common, and usually isn’t about being less fat.  It’s about being THIN.

So this blurb from The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, from the US National Institutes of Health (NIH) guidelines on “obesity treatment” actually came as a bit of sanity to me:

“How much weight does the patient expect to lose? What other benefits does he or she anticipate?” Obese individuals typically want to lose 2 to 3 times the 8 to 15 percent often observed and are disappointed when they do not.  (p32)*

First, note that offhand reference to “the 8 to 15 percent [weight loss] often observed”.   That sounds like the authors have reviewed weight loss research and consider 8-15% pretty common.**

Second, this is also in line with the recommended initial weight-loss goal of 10% of “baseline weight”.  (p29)   For someone who weighs 250lbs, that’s 25lbs.  For me, it’s 40lbs.  The NIH recommended weight loss goal is NOT to diet into the “normal weight” range or “overweight” range.   Let’s highlight that, shall we?

NIH recommended weight loss goal: 10% of “baseline” weight.

This is a revelation to me.

I’ve lost 10% of my baseline weight many, many times in my life.  I’ve never had a parent, teacher, or medical professional congratulate me for it.   The closest I ever got was being told to “keep it up”.   Because 10% is not enough. Because I was still fat.  If losing 10% of your current weight would get you into the “normal weight” range, you’re not very fat.  (Of course, most people who are fat aren’t very fat.)

Let me set this off, too, because it’s important: If losing 10% of your current weight would get you into the “normal weight” range, you’re not  in the “obese weight”range.  You might already be in the “normal” range, or possibly the “overweight” range. 

News flash: The WW and Jenny Craig ads and TV shows extolling how someone went from 330lbs to “normal weight” and imply that anyone else can do the same?  The parents / doctors / nurses / trainers / therapists / weight loss counselors who casually tell people to  “drop the weight”?   Are not in line with NIH guidelines for the treatment of obesity.

The Practical Guide also includes this gem:

After a patient has achieved the targeted weight loss, the combined modalities of therapy (dietary therapy, physical activity, and behavior therapy) must be continued indefinitely; otherwise, excess weight will likely be regained. (p34)

Hear that?  It’s not “transition to a maintenance diet”.  It’s “continue indefinitely”.  Of course even that doesn’t usually work long-term, but at least they’re not pretending that you can end your diet. Unlike some doctors/teachers/parents/gym employees I could name….

I also noted that their section on “physical activity” has no suggestions for when the patient is already exercising the recommended amount — because apparently that’s impossible.

Oh, and the The Practical Guide actually doesn’t recommend weight loss for those in the “overweight” category unless one has an “obesity-related illness” (p35). (Oddly enough, many obese people don’t have “obesity-related” illnesses either.  But I digress….)

*For convenience, I’m using PDF page numbers, which can be entered into the PDF viewer to go directly to the page in question.  These do not map to the printed page numbering.

**As noted elsewhere: “Reviews of the scientific literature on dieting (e.g., Garner & Wooley, 1991; Jeffery et al., 2000; Perri&Fuller, 1995) generally draw two conclusions about diets.  First, diets do lead to short-term weight loss.  One summary of diet studies from the 1970s to the mid-1990s found that these weight loss programs consistently resulted in participants losing an average of 5%–10% of their weight (Perri&Fuller,1995).  Second, these losses are not maintained.”

Additional: Searching for “reasonable expectations of weight loss NIH” brings up lots of interesting results, such as “What is a reasonable weight loss? Patients’ expectations and evaluations of obesity treatment outcomes.

Today’s Logic Fail

Researchers found that kids who have higher BMIs tend to do a little worse on treadmill tests than thinner kids…if they’re from “lower- or middle-income neighborhoods.”   The difference goes away if they’re from the more affluent neighborhoods.

Lead researcher Dr. Tajinder P. Singh, of Children’s Hospital Boston, speculates that

[K]ids from affluent neighborhoods have healthier lifestyles — better diets, more opportunities for exercise — so that even if they are overweight, they may be in good health.

Singh also points out that BMI just measures height and weight, and so it could be the more affluent kids have more muscle mass.  I recall that muscle mass can depend on genetics, but it’s also greatly influenced by exercise.   Ah!

So, logically speaking, does Singh then suggest that perhaps lower- to middle-income children could benefit from more opportunities to exercise?

Singh said they suggest that lower- to middle-income children stand to gain the most from losing excess weight.

Not exercise.

Even though they’re doing treadmill fitness tests, which are … exercise.

Measuring response to … exercise.

A response that improves with … exercise.

Gee.  If  ALL the kids from poorer neighborhoods had averaged lesser cardio fitness, would he have suggested they should move to the better neighborhood?

Why Don’t I Diet?

Simple: There isn’t a proven, permanent method of weight loss that works for all (or even most) people.

Yes, most dieters lose 5-10% of their body weight in the first few months.  They then regain some or all in the long term.   This has been shown by a number of studies, including studies run by diet companies. (PDF)  Depending on how long dieters are tracked after the study, usually 1/3 to 2/3 end up regaining all they lost, plus more.

So the real question isn’t, “Should I lose weight?” The real question is, “Would a small, possibly temporary weight loss be worth it to me, and how much do I think I will regain?  Do I think I will sustain a net loss, or will this just result in me weighing even more than I do now?”

I’m not saying people may not decide to go for it, and there are people who essentially “win the lottery” and both achieve and maintain a huge weight loss. But it’s not as simple as “Oh, I’m going to lose weight now”.

In my case, I also have a proven history; every diet has resulted in me weighingmore than when I started.  Every one.  In fact, my weight gain as an adult has ALL been related to either clinical depression or dieting.  Sobering?  Yes.  But that is my history and ignoring it won’t magically make diets work any better.

Thanks to Elizabeth Patch for sharing this great poster!

Further Reading:

  • Health at Every Size: New Hope for Obese Americans?, by Marcia Wood, published in the March 2006 issue of Agricultural Research magazine.  Highlights a 1-year study with 1-year followup comparing HAES with dieting.  The dieters lost weight initially but gained it all back by the 2-year mark.
  • Health at Every Size: The Surprising Truth about Your Weight by Linda Bacon, PhD.  Very readable discussion of healthy living and intuitive eating, but also discusses the research on dieting (and how it fails) in detail.  About Linda Bacon -o-   Book Website -o- Available on -o- My review is here.