Why do we call it the “weight loss industry” when what we really get for our time, sacrifice, and money is weight cycling? 19 times out of 20, what we are really purchasing is the experience of weight loss and regain.
Imagine if we called it the “weight cycling industry,” and “weight cycling programs.” Would you participate in Weight Cyclers at work? Buy food from NutriCycle? Hire a trainer from the Biggest Weight Cycler?
As a physician, would you prescribe weight cycling for your patients? As a Human Resources director, would you encourage/incentivize/coerce your employees to embark upon a bracing round of weight cycling this year? As a parent, would you send your child to weight cycling camp?
Because that is what we are doing, folks. Better face the facts: Of 100 people trying to lose weight, the vast majority of people will regain weight. Some significant group – perhaps a third – will gain more weight than they lost. Some tiny number (7? 5? 3?) will maintain their weight loss, and of that group, some number from 0-4 of them will be flirting with, developing, or fortifying an eating disorder. Yes, you read me right. The 1-year prevalence data for adolescents and adults is 2-3% for adolescents and 3-4% for adults – and though it is not impossible to develop an eating disorder without having first dieted, it is the norm to do so. If you read the practices of the people quoted in the Weight Management Registry, a group of several thousand people who have lost at least 30 pounds for at least 1 year, you will see some of the same practices and preoccupations we diagnose in people with eating disorders, including daily weighing, immediate compensation on the occasion of weight gain, logging every bite of food, exercising more than 90 minutes/day, etc. Even people in the Registry regain weight and apparently are allowed to continue being members as long as they once lost 30 pounds and kept it off for a year.
It is an odd requirement, because one year is not rational criterion of “weight maintenance.” Of the few studies that follow people at least 2 years, the 2-5 year range is the critical time period when almost everyone has regained. It is odd that any studies of weight loss shorter than 2 years are published, since all that interesting data in the differences in what happens at 6 months or a year are all wiped out by 2 years anyway. Yet the NIH apparently rarely funds studies – even weight loss studies – for longer than 1 year.
Our tax dollars go to funding study after study of this or that factor which results in faster weight loss, weight loss for more participants, fewer dropouts, etc., all of which becomes moot since almost everyone regains weight shortly after the study ends when no one is watching. In this era of fiscal anxiety, surely it would be a no-brainer to only fund studies that have a follow-up period for all participants of at least 2 years. It seems like a good minimum length for publishing studies in journals as well. And imagine if everyone demanded to see evidence from the weight cycling industry of 2-year follow-up data before they hand over a penny. We would have over $60 BILLION back in our own pockets.
You might be thinking, but I know someone who kept weight off. You might be that person yourself.
And as long as that person is (or you are) not struggling with disordered eating or some other kind of unacceptable drain on your life energy, s/he/you are probably pleased with that outcome. There are certainly times that people lose weight by recovering from an eating disorder, or being more aware of their bodies’ appetite cues, or finding a passion (not a compulsion) for a physical activity, or changing to a less sedentary job, or changing medications, or just feeling more able/willing to feed themselves the kind of fuel their bodies thrive on. Weight loss itself – or weight gain – is not the issue. When people adopt those practices they might lose or gain weight or stabilize their weight. It is the practices that people adopt in the pursuit of weight loss that are the problem, because for the 95 out of 100 people who regain weight during a diet, when the practices are not sustainable they lead to more physical and psychological illness.
The Health at Every Size® model is weight neutral. People using this approach are not pro- or anti-weight loss, but they are mindful that the pursuit of weight loss is usually harmful, unlike the cultivation of sustainable practices that feel life-affirming and support your health. In keeping with the “truth in advertising” theme, the Health at Every Size model does not insist that everyone is healthy at every size, or that anyone anytime is necessarily the size that optimizes their health. “Health” in this context means that whatever size you are, there are practices that will support your health. There are environments that celebrate diversity, free of weight stigma, that will be the healthiest for people of all sizes. Concentrating on those practices and environments are a far better investment than anything the weight cycling industry has to offer.