Losing Weight—What the Experts Are Reluctant to Tell You – Part 1

Have you ever shed 15 or 25  pounds and, then, over the next year or so, put it all back on? Usually, we blame ourselves.

But, as I reported on HealthBeat in 2008, physicians who treat obese and overweight patients know that only about 5% of us are able to lose weight and keep it off—even in highly controlled experimental settings where patients diet and exercise under a doctors’ supervision. Over two years, 95% of us will put the pounds back on, and in some cases, add more.

A National Institutes of Health (NIH), working group study published in the January 2015 issue of the journal Obesity, confirms that:  “Despite advancements in our understanding of obesity, weight regain after weight loss remains the most substantial problem in obesity treatment – with both the body and the mind conspiring against individual efforts to maintain weight loss.”

                What Randomized Controlled Trials Reveal 

University of Minnesota Psychologist Traci Mann has spent 20 years running an eating lab and, based on her experience, she reports: “Long-term weight loss happens only to the smallest minority of people.”  

Indeed, when she and five other researchers analyzed outcomes for patients in randomized trails where one group dieted, and the other group did not, the studies showed that, after two years, the average patient on a calorie restricted regimen had lost only one kilogram, or about two pounds, while one third to two thirds of dieters had actually regained more weight than they lost. (In many of these trials, the patients not only cut calories, but also exercised.)

What about folks who combine intensive lifestyle changes with drugs designed to help us lose weight? “Studies show that patients on drug therapy lose around 10 percent of their excess weight,” but “the weight loss plateaus after six to eight months,” UCSF’s Medical Center reports. “As patients stop taking the medication, weight gain usually occurs.”

                              Low-Carb vs. Low-Fat Diets 

Does it matter which diets you try?

At one time, most physicians were convinced that fatty foods led to obesity, and a low-fat diet offered the best route to becoming svelte. But in recent years, a growing number of doctors and health advocates have begun to argue that increased consumption of sugar and refined carbohydrates is the most likely explanation for our obesity epidemic. 

Last summer WIRED published an impressive in-depth review of what we do and do not know about whether certain foods will make us fat.

The story notes that that in 2009, “Robert Lustig, a pediatric endocrinologist, rose to national fame after a 2009 lecture in which he called sugar ‘poison’ went viral on YouTube.

 Meanwhile, newer science has undermined the consensus that fat is all that bad for you. A recent meta-analysis published in the Annals of Internal Medicine found no clear evidence that eating saturated fat contributes to cardiovascular disease.”

What about carbs? “In trials, carbohydrate restricted diets almost invariably show significantly better short term weight loss,” WIRED reported, but “over time, the differences converge towards non-significance.”  In other words, the available evidence suggests that over the long term, both low-fat and low-carb diets fail.  

Why Is Losing Weight, and Keeping it Off, So Difficult?

We don’t  know.

The cruel truth is that obesity is an incredibly complicated disease. Physicians and scientists who specialize in studying it acknowledge that medical science still has not yet sliced through the tangle of genetic, metabolic, social, psychological and environmental factors that cause most of us to regain whatever weight we lose.  

The conventional wisdom tells us that shedding fat is simple: just eat fewer calories than you burn. In other words, put less food in your mouth, and exercise more. As the post above reveals (URL) many family doctors and GP’s still believe this. After all it was only two years ago that the American Medical Association acknowledged that obesity is a “disease.” 

(If they didn’t think obesity was a disease, what did they think it was?  I’m afraid that, like many in our culture, deep down, they viewed obesity as a sign of sin.  Actually, two sins: “gluttony” and “sloth.”  My guess it that this is true of doctors who were, themselves, overweight– and felt guilty about it.)

                                    2008—What We Knew Then

Seven years ago, when I first wrote about a PBS documentary titled “Fat: What the Experts Don’t Tell You” I learned that, for most people, the received wisdom doesn’t work. Eating less and moving more does not lead to long-term weight loss.  (Let me add: I highly recommend this film. It is by turns, moving, entertaining, and eye-opening. It will tell you what most of the mainstream media may never reveal about losing weight.)

In the documentary, Harvard’s Dr. Lee Kaplan, head of the Weight Reduction Program at Mass General Hospital, acknowledges that: “Obesity doesn’t seem like a subtle disease. But it is. If something is off kilter by just 1 percent in your system that can lead to a 100- pound weight gain. More than 400 genes are involved in weight regulation. And that doesn’t include the environmental factors.”

In that 2008 post, I also quoted Arthur Frank, medical director of the George Washington University Weight Management Program: “People think that dieting is ‘a matter of choice.’”  In other words, with a little will power, you can simply choose to eat less. But in fact, losing weight requires overcoming powerful brain signals that are working against you. 

Dr. Michael Rosenblaum, a Columbia University researcher who, at the time was working on an NIH-funded study on weight control, explains: “Obesity is the one disease where your body fights the cure. By and large, the body is programmed to help you heal.”   But not in this case.

If you ever have dieted you already know that, once you lose some weight, your metabolism seems to slow down, and stops burning as many calories.  For all your body knows, you are stranded on a desert island, starving to death. So it tries to “save you.” Some argue that this is how the human species has survived.

“We are very efficient biological machines,” says University of Alberta health professor Tim Caulfield, who writes about health misconceptions. “We evolved not to lose weight. We evolved to keep on as much weight as we possibly can.”

But saying that your body fights weight loss does not shed light on the more fundamental question of how and why your metabolism slows—or why you hit a plateau—and ultimately re-gain the weight you lost.

Not everyone believes that this is all about evolution. Some argue that the obesity epidemic has more to do with what we eat today— and how compulsively we diet–See part 2 of this post, below 

13 thoughts on “Losing Weight—What the Experts Are Reluctant to Tell You – Part 1

  1. Diets are a temporary fix. If you want to lose weight permanently, you have to change what you eat permanently.

    • Jerry— At least that’s what we think. Though was I explain in the post, the rigorously controlled studies that might prove that eating fewer carbs
      (while also exercising) would lead to long-term weight loss have not yet been done. But they are beginning

      • It worked for me…at least for 3 1/2 years so far. I lost 50 lbs, lowered my chloresterol, lowered my blood pressure, shrunk the size of my heart, and improved the function of my aortic valve (Now, mild reflux). My cardiologist is thrilled!

  2. Jerry–

    I’m very glad to hear this.

    You may be one of the people the research refers to as
    “Outliers”–the 5% of us who do achieve long-term
    weight loss through cutting calories and exercise.

    Though I also would be interested as to whether you got to your goal by reducing calorie intake–or by changing not how Much you eat, but What you eat.

    I think there is hope that we will discover that low-carb
    diets can really improve health and reduce weight–though we don’t yet have the rigorous trials needed to prove this.

    See my second post on this topic

  3. I changed WHAT I eat. I still eat as much as I want, and I made no change in level or type of exercise I get. My Dr says my body is now at its “natural weight”. It flucuates pound or two depending on how much I eat.

    The weight does not stay on me when I overeat like it use to. I go back to eating “normally” and my weight drops back to “normal”.

    • Jerry–

      This is very interesting.

      As I say in part 2 of this post (here http://www.healthbeatblog.com/2015/02/does-over-eating-make-you-fat-or-do-you-eat-more-because-you-are-fat-part-2-of-obesity-what-the-experts-are-reluctant-to-tell-you/

      Recent research published in JAMA (and elsewhere)
      suggests that if we eat less carbs (and refined sugars) and forget about counting calories, we may be able to shed fat and keep it off.

      Past studies have suggested that, over the long term,
      both low-carb and low-fat diets fail.

      But experts are pointing out that those studies were not very rigorous. Many limitations.

      Now, they are beginning to do long-term, randomized, the tightly controlled trials that may give us answers–in about two years.

      In my own experience, low-carb works best. I’m not trying to lose a huge amount, but taken off 10-12 pounds over the past 2 1/2 years–very slowly–just by watching carbs.

      This may be because I LOVE carbs. Show me a plate of fresh green fettuccine with just a little butter and
      fresh parmesan (and maybe some wild mushrooms) and I will eat it and be tempted to ask for more.
      I just don’t care as much about fat and sugar– I’ll take the fettuccine over chocolate cake any day of the week.

      For me, eating as much fat as I want (& it’s not That much) , avoiding most bread, and having pasta, rice, or potatoes only 3 days a week seems to work. . ..

  4. My wife introduced me to the book “Wheat Belly”. By avoiding breads, processed sugars (soft drinks, cakes, pies) and other processed foods I lost 30 pounds and reduced my blood pressure significantly. My wife had the same results. We eat a lot more fruits, nuts and vegetables.

    • Joe Rager–

      Thats great. AS I point out in this series of posts, I’m hopeful that watching carbs (rather than counting calories) can help more people keep weight off long-term.
      For years, we urged people to cut fat, but there are reasons to suspect that carbs and sugar are the big problem. We just needed better, more rigorous studies to find out for sure.

  5. Maggie it is good to see you posting again.
    I read an article a while back where some researcher said that part of the weight problem is that skinny people do not digest food the same way that fat people do. I don’t know if there is any validity to this but there does seem to be some truth to it. I would guess that it goes back to your genes.

    • Hi John–

      It’s good to be back.

      We know that genetics plays a role in weight gain.

      In fact, hundreds of genes are involved. But we
      don’t know how they regulate weight. To say that skinny people “digest food differently” begs the question (i.e. doesn’t really answer it)

  6. One indication that something is happening that affects the whole population, rather than people simply making bad choices, is the inexorable upward slope of BMI in the US. True, states vary by the percentage of obesity, with a few only sitting at 15% while others are pushing 40%!) but thirty years ago, 15% was at the top. Watching the changes over time, as in this chart from The Economist (http://media.economist.com/images/jpg/FirstGraph.jpg)
    the pattern doesn’t look like outbreaks, but like a single factor affecting the whole country. It doesn’t shift from state to state, or decrease in one while increasing somewhere else.

    My guess would be that two or three large factors are pulling most of the weight (sorry.)

    – diet (sugar and carbs)
    – mood (anxiety, overwork, loss of stability)
    – antibiotics ( it makes cattle fatten faster, so why not us?)
    – not enough sleep and downtime

    Noni

    • Noni

      From what I have read the biggest factor behind the obesity epidemic (nationwide) is that we are far
      more sedentary that we once were.

      At home, we spend more time on computers–less time taking walks or participating in sports.

      This si particularly true of kids. I can remember a time when, if you walked through a suburban neighborhood on a Sunday afternoon, you saw
      kids outside–play-hop-skotch on the front sidewalk,
      playing rag, playing ball in the street, playing basketball in the back yard . . .

      Now, HELICOPTER Parents keep them inside (afraid they will be kidnapped) and the kids are on their computers. . .

      Also, many of our poorer schools do not have
      gyms, gym classes, or good playgrounds and recesses.
      (Recesses used to be twice a day.)

      Helicopter parents also drive kids to school (and everywhere else.) This is terrible for kids. Even if you live in a neighborhood that is less than safe, kids can
      walk to school in groups of two or three (this is what my kids did in NYC).

      And my son always played
      pick-up basketball games in public basketball courts. (Though often he was the only white kid on the court. Here on the upper-west-side of Manhattan
      (a pretty affluent neighborhood) white parents were
      already becoming “helicopter parents”–didn’t want to let kids out of their sight.

      Finally, growing poverty (and inequality) is having a nationwide affect on obesity. The U.S. now has a larger %age of kids living under the poverty level than any other nation in the developed world. A growing percentage go to bed hungry especially near the end of month when food stamps run out.

      Hunger makes you eat more the next time food is available.

      Stress & the lack of fresh fruit, vegetables and fish in
      ghetto grocery stories, along with the lack of safe
      places to exercise all contribute to obesity for both poor children and poor adults.

      Even if parents don’t let their kids eat fast food and soda, the least expensive foods to prepare at home are high-carb–pasta, rice, beans, potatoes . . .

      I don’t know a bout antibiotics. I don’t think that most people get enough antibiotics for it to make a difference in obesity rates nation-wide–but I could be wrong.