At BodyMatters Australasia we take a proactive approach when it comes to educating the public about matters related to eating disorders and unhealthy weight-loss practices.

Aiming to change the cultural factors that contribute to our global epidemic of eating problems, we work closely with other advocacy organisations, taking both a top-down and grassroots approach to effect change.

As Managing Directors and specialists in eating disorders, both of us have been interviewed and had our work published in a variety of mainstream media including print, radio, and television.

We hope you enjoy our blog, and please do not hesitate to leave commentary should the urge strike - we are always interested to hear your views!

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Best wishes,

Lydia & Sarah xo

Biggest Loser trainer Michelle Bridges claims weight loss ‘success’ is a case of mind over matter.

“[Being a contestant on] The Biggest Loser… is a bit like winning the lottery. You can either spend all the prizemoney and return to your original financial state, or you can invest it wisely and set yourself up for life,” she wrote in her Sunday Life column.

Despite research demonstrating ninety-five per cent of people who lose weight will regain it within two to five years[1], Bridges stuck to her guns.

“…Biggest Loser contestants return to reality with all the tools they need for the best long term outcome.”

Side-stepping the fact that many past contestants have regained the weight or are now weight cycling, Bridges insists weight regain is the fault of the individual.

Bridges can be confident it is the contestants who are to blame, because she knows The Biggest Loser approach works. She knows this – despite no studies to support this view – simply by assuming this is the case.

In an attempt to support her argument, she described a 2004 study [2] misattributing it to a 2008 study conducted by Professor Susan Byrne.

The 2004 study Bridges described looked at the impact of ‘dichotomous’ or ‘black-and-white’ thinking on weight loss.

The findings showed those who began their weight loss journey with unrealistic expectations were more likely to engage in rigid weight loss attempts, setting themselves up to fail. However those with less ‘dichotomous thinking’ were more likely to be content with a modest amount of weight loss and thus kept the weight off for longer.

Bridges concluded that “…long term outcome is likely to be affected by the mindset in which losing weight is approached…”

The problem with this conclusion is that the study did not even qualify as ‘long term’ research. What wasn’t revealed is that the participants were tracked for only one year. It does not make sense to extrapolate data at one year and assume this informs what is likely to happen at five years. That’s just bad science.

Interestingly a more recent study by the same author finding weight loss failure at three years concluded “…it is ethically questionable to claim that psychological treatments for obesity ‘work’ in the absence of data on their longer term effects” [3].

Bridges further reported that studies since the 1960s demonstrate that the few who are able to keep weight off long term, manage to keep only a modest amount off – approximately five to ten per cent of their starting weight.

If Bridges is aware of this research, why does she continue to promote significant and rapid weight loss on The Biggest Loser?

Why does she sell workout DVDs that promise to get you “tight toned and terrific“ when most ‘obese’ people who successfully maintain weight loss will still be… ‘obese’?

Is she not aware of the overwhelming amount of literature demonstrating the harms of weight cycling- a common result of weight loss failure? [4-8]

Bridges signed off with a ‘tip’ informing that those who make sustainable nutrition and lifestyle changes successfully keep the weight off. She finished by telling readers not to diet.

There are undoubtedly benefits to making healthy nutrition and lifestyle choices, whatever one’s size. But Bridges’ claim that this will keep the weight off is simply not supported by research. Biological safeguards often underlie weight resistance.

And isn’t it hypocritical to tell readers not to diet when the entire Biggest Loser show is one extreme diet designed for public entertainment?

Bridges is regularly featured in the SMH health section. She has provided advice on topics ranging from childhood obesity to genetic research.

It seems many Australians are putting in the efforts to improve their health, but knowing who’s advice to trust is proving difficult.

Despite all this focus on weight, what is rarely reported is that several studies demonstrate weight has little impact on health except at statistical extremes [9-11]. In fact those categorized as ‘overweight’ often outlive those in the ‘ideal weight’ category [12].

Due to significant financial conflicts of interest and bias [13, 14], obesity research typically does not account for numerous variables not limited to history of weight cycling, diet pills, stress levels, nutrient intake, socioeconomic factors [15].

Emerging studies show weight cycling – a common side effect of attempting weight loss –may be responsible for some of the problems typically attributed to obesity [16].

Could the solutions prescribed be causing the very problems they are designed to prevent?

Rather than abusing our bodies attempting weight loss solutions that don’t work, we can choose to engage in a process of health. We can choose to engage in life-enhancing physical activity, and balance our nutritional needs with feelings of hunger and satiety.

We can choose to focus on fitness, regardless of whether it brings about weight change. A healthy lifestyle will bring about health improvements, whatever one’s size.

References

[1] ALBERT STUNKARD, M.D.; MAVIS McLAREN-HUME, M.S. (1959). AMA Arch Intern Med, 103(1):79-85. Please note this statistic has been reinforced by numerous clinical studies since 1959 and was recognized at the Australian New Zealand Obesity Society conference 2009 and the International Obesity Summit 2010.
[2] Byrne, S.M., Cooper, Z., & Fairburn, C.G.F. (2004).  Psychological predictors of weight regain in obesity. Behaviour Research and Therapy, 42, 1341-1356.
[3] Byrne, S.M., et. Al., (2010). Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up. Behav Res Ther, 48(8): 706–713.
[4] Wallner S.J., et. al., (2004). Body fat distribution of overweight females with a history of weight cycling. Int J Obes Relat Metab Disord., Sep 28(9):1143-8.
[5] Colditz, G.A., Field, A.E., Manson, J.E., Taylor, C.B., Willett, W.C. (2004). Association of weight change, weight control practices, and weight cycling among women in the Nurses’ Health Study II. Int J Obes Relat Metab Disord., Sep 28(9):1134-42.
[6] Rzehak, P., et.al., (2007). Weight change, weight cycling and mortality in the ERFORT Male Cohort Study. Eur J Epidemiol., 22(10):665-73.
[7] Amigo I., Fernández C. (2007). Effects of diets and their role in weight control. Psychol Health Med., May;12(3):321-7.
[8] Saarni, S.E., et.al., (2006). Weight cycling of athletes and subsequent weight gain in middle age. Int J Obes Nov;30(11):1639-44.
[9] Durazo-Arvizu, R., et al., (1998). Mortality and optimal body mass index in a sample of the US population. American Journal of Epidemiology, 147: p. 739-749.
[10] Flegal, K.M., et al., (2005). Excess deaths associated with underweight, overweight, and obesity. Journal of the American Medical Association, 293(15): p. 1861-7.
[11] Troiano, R., et al. (1996). The relationship between body weight and mortality: A quantitative analysis of combined information. Int J Obes, 20: p. 63-75.
[12] Andres, R., D.C. Muller, and J.D. Sorkin, (1993). Long-term effects of change in body weight on all-cause mortality.  A review. Annals of Internal Medicine, 119: p. 737-743.
[13] Aphramor L (2010). Validity of claims made in weight management research: a narrative review of dietetic articles. Nutrition Journal, 9:30 doi:10.1186/1475-2891-9-30. www.nutritionj.com/content/9/1/30#B36
[14] Bacon L (2008). Health at every size: The surprising truth about your weight. Benbella: USA.
[15] Campos, P., et al., (2005). The epidemiology of overweight and obesity: public health crisis or moral panic? International Journal of Epidemiology.
[16] McFarlin, B.K., & Strohacker, K. (2010). Influence of obesity, physical inactivity, and weight cycling on chronic inflammation. Frontiers in Bioscience E2, 98-104.

Last week The Sydney Morning Herald’s economic writer Jessica Irvine published a piece boasting about her weight loss success. She had lost 19 kilograms in less than a year.

Irvine extolled the virtues of one simple equation: “calories in minus calories out.” Congratulatory messages poured in from readers, with one man so smitten he simply proposed.

“If you are putting on weight, you are failing to balance the books. You are eating too much or not moving enough, or both.” With one strike, Irvine re-enforces harmful myths about eating and weight loss, using her short-term “success” as evidence.

We have been indoctrinated to believe being ‘thinner’ is automatically healthier than being ‘fatter’, and being ‘not-fat’ means we can escape being treated like a second-class citizen.

But what if Irvine’s advice is wrong?

Ninety-five percent of those who attempt weight loss will regain the weight within two to five years. Some suggest it would be more appropriate to rename the weight loss industry the ‘weight cycling industry.’

Either way the weight loss industry worth $60 Billion a year in the US alone has convinced most that failure to keep the weight off is due to individual weakness. It has us believing that weight loss is just about willpower, reflected by Irvine,”…our minds are emotional things, prone to fits of fancy and despair.”

Let’s assume for a moment that this idea about willpower is true. Even for those who comply with a strict weight loss regime, long term studies demonstrate weight regain.

The largest randomized study into weight change with long-term calorie deficit is The Women’s Health Initiative, in which twenty thousand women reported a reduced calorie intake of an average of 360 calories per day. Nearly eight years later, there was an average weight loss of 0.1kg and a 0.3cm increase in average waist circumference. It seems for most, our bodies have physiologically adapted to defend fat.[1]

To use the “calories in calories out” equation effectively, one would eventually have to follow disordered eating patterns as our Basal Metabolic Rate (BMR) responds to reduced caloric intake by slowing down. While the body initially releases weight, the science always catches up. [2-8]

Despite this evidence, many continue on the weight-loss weight-regain cycle. Obesity is so harmful, so the message goes, that one has no choice but to keep trying. To do anything else is framed as “giving up.”

Yet the ineffective solutions prescribed are not even safe. Many will relate to the unintended yet common side effects of weight cycling (which is associated with increased mortality)[9], binge eating, food and body preoccupation [10], to name a few. One doesn’t have to meet the criteria for an eating disorder to have their health significantly compromised.

Perhaps more disturbingly is how quickly the eating disorder mindset has gone mainstream. Children in schools do maths assignments requiring them to count every calorie they consume.

Others count every step with a pedometer.

We have adults on a ‘health kick’ weighing every morsel of food while others skip meals and replace them with liquids. Some are even prescribed diet pills despite their long history of cardiac damage.

The solutions prescribed are the same behaviours we are diagnosing in those with eating disorders. There is no doubt that we have an epidemic in this country. We have an epidemic of unhealthy eating and weight loss behaviours. Too many people are eating highly processed foods and not exercising.

Many are eating past fullness, using food to meet their emotional needs, and many just can’t stop thinking about food. What we have is an epidemic, but it is an epidemic of eating pathology – affecting people of all sizes.

Targeting the ‘overweight’ and pitching weight loss solutions that don’t work and are not safe, does not make sense. Those who are deemed ‘obese’ suffer relentless discrimination, and research shows that any population that is marginalized typically suffers poorer health – also known as ‘status syndrome’ [11]. Weight loss has been pushed for more than forty years, and as a nation we are only getting sicker.

Due to reduced scientific integrity resulting from financial conflicts of interest and prejudice [12, 13], most are not aware that several studies show weight is not an accurate measure of health except at statistical extremes [14-16]. In fact, those categorized as ‘overweight’ often outlive those in their ‘ideal’ weight range [17].

Rather than focusing on weight and harming ourselves in the process, we can choose to focus on health. We can make a choice to engage in life-enhancing physical activity, to balance our nutritional needs with feelings of hunger and satiety, to expand our understanding of health so it reaches beyond the number on the scale.

A shift towards a health-centred paradigm is showing promising results [10, 13]. The health-centred approach recognizes that there are other vital health quantifiers we can rely on, for example, blood pressure, heart rate, blood lipid levels. Fitness has been shown to be the best predictor of health- regardless of size.

Refusing to focus on weight is not about “giving up,” it’s about moving on.

References
[1] Howard BV et al (2006). Low-fat dietary pattern and weight change over seven years: the Women’s Health Initiative Dietary Modification Trial, JAMA, 295:39-49.
[2] Stice, E., et al., Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. Journal of Consulting and Clinical Psychology, 1999. 67: p. 967-974.
[3] Stice, E., K. Presnell, and H. Shaw, (2005). Psychological and Behavioral Risk Factors for Obesity Onset in Adolescent Girls: A Prospective Study. Journal of Consulting and Clinical Psychology, 73(2): p. 195-202.
[4] Coakley, E.H., et al., (1998). Predictors of weight change in men: Results from the Health Professionals Follow-Up Study. International Journal of Obesity and Related Metabolic Disorders, 22: p. 89-96.
[5] Bild, D.E., et al., (1996). Correlates and predictors of weight loss in young adults: The CARDIA study. International Journal of Obesity and Related Metabolic Disorders, 20(1): p. 47-55.
[6] French, S.A., et al., (1994). Predictors of weight change over two years among a population of working adults: The Healthy Worker Project. International Journal of Obesity, 18: p. 145-154.
[7] Korkeila, M., et al., (1999). Weight-loss attempts and risk of major weight gain. American Journal of Clinical Nutrition, 70: p. 965-973.
[8] Shunk, J.A. and L.L. Birch, (2004). Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years. J Am Diet Assoc, 104(7): p. 1120-6.
[9] British Nutrition Foundation (1999). Task Force on Obesity Report. UK Blackwell Science 137.
[10] Bacon L and Aphramor L (2011). Weight science: evaluating the evidence for a paradigm shift, Nutrition Journal , 10:9 doi:10.1186/1475-2891-10-9. www.nutritionj.com/content/10/1/9#B36
[11] Marmot MG (2006). Status syndrome: a challenge to medicine. Journal of the American Medical Association 295(11), 304-1307.
[12] Aphramor L (2010). Validity of claims made in weight management research: a narrative review of dietetic articles. Nutrition Journal, 9:30 doi:10.1186/1475-2891-9-30. www.nutritionj.com/content/9/1/30#B36
[13] Bacon L (2008). Health at every size: The surprising truth about your weight. Benbella: USA.
[14] Durazo-Arvizu, R., et al., (1998). Mortality and optimal body mass index in a sample of the US population. American Journal of Epidemiology, 147: p. 739-749.
[15] Flegal, K.M., et al., (2005). Excess deaths associated with underweight, overweight, and obesity. Journal of the American Medical Association, 293(15): p. 1861-7.
[16] Troiano, R., et al. (1996). The relationship between body weight and mortality: A quantitative analysis of combined information. Int J Obes, 20: p. 63-75.
[17] Andres, R., D.C. Muller, and J.D. Sorkin, (1993). Long-term effects of change in body weight on all-cause mortality. A review. Annals of Internal Medicine, 119: p. 737-743.