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Friday 20 June 2014

Obesity research confirms long-term weight loss almost impossible

No known cure for obesity except surgically shrinking the stomach


There's a disturbing truth that is emerging from the science of obesity. After years of study, it's becoming apparent that it's nearly impossible to permanently lose weight.
As incredible as it sounds, that's what the evidence is showing. For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear. "It couldn't be easier to see," she says. "Long-term weight loss happens to only the smallest minority of people."
We all think we know someone in that rare group. They become the legends — the friend of a friend, the brother-in-law, the neighbour — the ones who really did it.
But if we check back after five or 10 years, there's a good chance they will have put the weight back on. Only about five per cent of people who try to lose weight ultimately succeed, according to the research. Those people are the outliers, but we cling to their stories as proof that losing weight is possible.
"Those kinds of stories really keep the myth alive," says University of Alberta professor Tim Caulfield, who researches and writes about health misconceptions. "You have this confirmation bias going on where people point to these very specific examples as if it's proof. But in fact those are really exceptions."
Our biology taunts us, by making short-term weight loss fairly easy. But the weight creeps back, usually after about a year, and it keeps coming back until the original weight is regained or worse.
This has been tested in randomized controlled trials where people have been separated into groups and given intense exercise and nutrition counselling.
Even in those highly controlled experimental settings, the results show only minor sustained weight loss.
When Traci Mann analyzed all of the randomized control trials on long-term weight loss, she discovered that after two years the average amount lost was only one kilogram, or about two pounds, from the original weight.

Tiptoeing around the truth

So if most scientists know that we can't eat ourselves thin, that the lost weight will ultimately bounce back, why don't they say so?
Tim Caulfield says his fellow obesity academics tend to tiptoe around the truth. "You go to these meetings and you talk to researchers, you get a sense there is almost a political correctness around it, that we don't want this message to get out there," he said.
"You'll be in a room with very knowledgeable individuals, and everyone in the room will know what the data says and still the message doesn't seem to get out." In part, that's because it's such a harsh message. "You have to be careful about the stigmatizing nature of that kind of image," Caulfield says. "That's one of the reasons why this myth of weight loss lives on."
Health experts are also afraid people will abandon all efforts to exercise and eat a nutritious diet — behaviour that is important for health and longevity — even if it doesn't result in much weight loss.
Traci Mann says the emphasis should be on measuring health, not weight. "You should still eat right, you should still exercise, doing healthy stuff is still healthy," she said. "It just doesn't make you thin."

We are biological machines

But eating right to improve health alone isn't a strong motivator. The research shows that most people are willing to exercise and limit caloric intake if it means they will look better. But if they find out their weight probably won't change much, they tend to lose motivation.
That raises another troubling question. If diets don't result in weight loss, what does? At this point the grim answer seems to be that there is no known cure for obesity, except perhaps surgically shrinking the stomach. 
Research suggests bariatric surgery can induce weight loss in the extremely obese, improving health and quality of life at the same time. But most people will still be obese after the surgery. Plus, there are risky side effects, and many will end up gaining some of that weight back.
If you listen closely you will notice that obesity specialists are quietly adjusting the message through a subtle change in language.
These days they're talking about weight maintenance or "weight management" rather than "weight loss."
It's a shift in emphasis that reflects the emerging reality. Just last week the headlines announced the world is fatter than it has ever been, with 2.1 billion people now overweight or obese, based on an analysis published in the online issue of the British medical journal The Lancet.
Researchers are divided about why weight gain seems to be irreversible, probably a combination of biological and social forces. "The fundamental reason," Caulfield says, "is that we are very efficient biological machines. We evolved not to lose weight. We evolved to keep on as much weight as we possibly can."
Lost in all of the noise about dieting and obesity is the difficult concept of prevention, of not putting weight on in the first place.
The Lancet study warned that more than one in five kids in developed countries are now overweight or obese. Statistics Canada says close to a third of Canadian kids under 17 are overweight or obese. And in a world flooded with food, with enormous economic interest in keeping people eating that food, what is required to turn this ship around is daunting.
"An appropriate rebalancing of the primal needs of humans with food availability is essential," University of Oxford epidemiologist Klim McPherson wrote in a Lancet commentary following last week's study. But to do that, he suggested, "would entail curtailing many aspects of production and marketing for food industries."
Perhaps, though, the emerging scientific reality should also be made clear, so we can navigate this obesogenic world armed with the stark truth — that we are held hostage to our biology, which is adapted to gain weight, an old evolutionary advantage that has become a dangerous metabolic liability.
Graham

17 comments:

Brittany said...

Keeping the weight off is very hard, like you talked about in the article. Many people exercise and eat healthy and diet as they lose weight. But when they reach the goal weight they stop and that is when the weight comes back. The need to hold onto their motivation and continue eating healthy and exercises. When a goal is reached a person should stop worrying about the scale and focus on continuing to be healthy. I like how you mentioned prevention of having the extra weight in the first place. If parents start there kids eating healthy young it will just be a lifestyle to them instead of a diet they start later in life. Thanks for the article.

Galina L. said...

People actually know, but have trouble to believe. Do you remember we all were discussing the article in a NY times by Tara Parker-Pope, their own health writer

http://www.slate.com/blogs/xx_factor/2011/12/29/the_new_york_times_magazine_the_fat_trap_and_the_impossibility_of_lasting_weight_loss.html ?

My GP told me he stopped telling people to loose weight because he read too many papers about such attempts being useless.
It is just cruel to suggest to someone that he/she should only choose the right diet strategy and the obesity would be resolved. I think the people who choose a LC diet have easier life diet-wise, but it also will not guarantee a permanent weight-loss to everyone, especially when a lot of weight has to come off. Fortunately, I have never been in a need of a substantial weight-loss, but it was so hard for me to loose mere 30 lbs, that I have an endless compassion to the people who are fat-trapped.

Larcana said...

I agree with Galina, I used to think fat people were slothful...not anymore! I advocate for LC diet to help control appetite and inflammation.
If that's all we can get...well...

OldTech said...

This story does not explain the rise of obesity since the 80's. Growing up in the 50's and 60's I do not remember seeing anyone who was obese. So why was the biological forces not at work before the 80's?

Gwen said...

Honest to god, they'll do or say ANYTHING except give up grains and sugar, won't they?

I haven't run across a single individual yet who gave up grains and sugar and didn't keep all of the excess weight off. It's not rocket science, it's simply accepting the reality that grains and sugar are NOT good for us. In any form. Most people don't have the guts to 'go there.'

Galina L. said...

OldTech,
It is hard to loose weight permanently for the people after they got significantly obese. Since most people in 80-s were not obese on the first place, they didn't have a chance to come across biological forces which keep people fat after they got fat.
There are several reasons why obesity is so wide-spread problem right now. My personal opinion is that the regular dieting and the modern exercise advice make people fatter together with other factors. I think so because I witnessed the difference between my mom and grandma who were very similar genetically and had the same body type, but my mom was an accomplished athlete in her youth, than dieted regularly and kept exercise routine all her life. At the age of 75 she was fatter (but had better blood pressure and pulse) than her mom at the same age and who was just slightly plump all her adult life. My grandma recently died from Alzheimer at 92 years old. They both were never affected by a modern food industry . My mom is on a LC diet now.

JasmineJohend said...

I agree with Gwen, if the doctors keep handing out diet sheets to patients with the current food pyramid we are all set to fail. I've kept the weight off for 3 years by sticking to VLC. In the past I have allowed myself junky no brake carbs in moderation during Christmas and it set off cravings for more, I started to regain and had pains in my joints. So for me it's all about abstinence forever, including Christmas, birthdays. You have be firm with the carb pushers as well "only a little bit won't hurt". Better to tell them you are allergic, or are concerned about the welfare of the field mice being trampled during harvesting of wheat and sugar cane.Don't tell them you are doing it for health reasons or you will be lectured for your "bad diet" from lack of carbs.

amicuscuriae said...

The difficulty I have with Graham's quotes from articles related to dietary issues is that there is never any editorial comment. Is this article being quoted approvingly? Derisorily? Who knows. Gwen interprets the quoted passage as an argument in favour of avoiding grains and sugar. Fine, but the passage contains no basis for such an interpretation. It's actually saying that whatever diet you follow to lose weight, be it paleo, Atkins, LCHF or whatever, it won't work. The author appears to be saying that if you, for example, became obese because your diet consisted entirely of chocolate eclairs and crisps, there is no point changing to any type of diet supposedly promoting weight-loss, as you'll pile all the weight back on (and maybe more) sooner or later. You might as well (according to this reasoning) stick to the chocolate eclairs and crisps (at least if weight-loss, rather than general health benefits, is your only aim). I'm not saying I agree with the author, of course. A LCHF diet is working for me so far and (despite this doom-laden article), I remain optimistic that it'll continue to do so in the long term.

Galina L. said...

I can tell from my experience that for loosing weight, especially at the beginning, I had to follow less strict diet than the one I follow now to keep my weight stable, and eventually I a reached a weight-loss plateau, luckily for me at already appropriate size. I experienced the effect of biological forces which fight to keep the amount of fat stable. I have read testimonials of many people on the internet who stalled way sooner than they aimed for, some still in the obese category, and I participate mostly in the LC blogs. Yes, LCarbing makes a big difference, but there is no guarantee for everyone to solve obesity even on a LC diet.

Unknown said...

My bet is that all the "outliers" who keep the weight off are people following real food diets. I'm only very low carb because I'm diabetic and need to control my BG - but if I didn't, I'd be happy to add non-processed food carbs like sweet potato to my diet.

I'd love to know the percentage of processed food being eaten by the people who regain the weight.

Galina L. said...

No, Indy, eating not-processed food is not the recipe for being thin, unfortunately.

Unknown said...

You can control your weight loss by use isagenix Australia product . it is really good for weight loss .

JasmineJohend said...

Despite my low body weight, VLC and daily exercise my blood sugars are still in the high range (not diabetic but not as low as one would expect). I've been told it could be cortisol disregulation (cortisol is driving my sugars up) and I should add some carbs in, such as sweet potato. Anyone been in this position or have any ideas?

Galina L. said...

Jasmine, you may read what is listed as the topics of the Physiological Insulin Resistance blog posts on the Hyperlipid blog.

Wiflib said...

So, my eight stone weight loss that I've maintained for over six years is hard to maintain? I don't bloody think so. Start eating low-carb and stay low-carb and you've cracked it.

I'm going to die very old and very thin.

Lowcarb team member said...

OldTech said...
This story does not explain the rise of obesity since the 80's. Growing up in the 50's and 60's I do not remember seeing anyone who was obese. So why was the biological forces not at work before the 80's?

Same here when I was a child in the 50's obesity was rare, for the few that were overweight cutting back on carbs not fat was the order of the day.

Cheers
Graham

Lowcarb team member said...

Wiflib said...
So, my eight stone weight loss that I've maintained for over six years is hard to maintain? I don't bloody think so. Start eating low-carb and stay low-carb and you've cracked it.

I'm not having any of that Libby, you know very well that Ally, phoenix, jopar et al stated that low-carb was unsustainable and would lead to dire consequences how dare you prove them wrong.

I'm going to die very old and very thin.

What you on about I'm already very old and thin and I'm still here.

Cheers
Graham