Getting off weight’s vicious cycle

By Lydia Jade Turner

This article was first published in ABCs The Drum.


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.

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[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.

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