The real data behind weight loss research points to a radically different approach to healthy living
April 26th, 2018
I recently received an e-mail from a blog reader:
“My mom passed away last week. She has been on a perpetual diet since before I was born, and has yo-yo’d her whole life, but never became thin. She has been very critical of my decision to focus on my health and stop trying to manipulate my body size. On her deathbed, she told me that she was grateful that I had found a different path, and that as her life came to a close she deeply regretted all the things that she never did because she was waiting to do them until she was thin. Thank you for saving me from the same fate.”
I know that path too well, because it was the path I used to be on myself.
I spent many years of my life trying to become thin, because I was promised that being thin was the key to happiness, health, and all my dreams coming true.
I tried everything — fad diets, lifestyle changes, medically supervised diets, you name it—always with the same results. I lost weight short-term, but then I’d gain it back, often gaining back more than I’d lost.
So, I decided to take a two-part approach. The first part was learning to love and appreciate my body at any size. The second part, I decided, would be to lose weight for my health. Part one will have to be the subject of another article, but once I realized my body was amazing and worthy of respect and good care, I decided to focus on losing the weight.
I studied research methods and statistical analysis in college, but I hadn’t researched any of the diets that I had been on. I decided to start with research. I began a literature review of every study of intentional weight loss that I could find, so that I could find the best diet, the one with the greatest efficacy, in order to set myself up for success.
What I learned was so shocking that I went back through all the studies, thinking I must have missed something or misunderstood. But I hadn’t.
There was not a single study where more than a tiny fraction of people were successful at losing a significant amount of weight long term.
The idea that I could become and stay thin if I just tried hard enough had been sold to me as fact by everyone — from coaches to doctors to random strangers my entire life — and based on the research, there was absolutely no reason to believe it was true.
Furthermore, I learned that weight loss wasn’t even a predictor of health.
Based on what I learned, I took my focus off of losing weight and on getting healthy. I’ll share with you here what I learned, and how I established habits to maximize my health and happiness.
The myth of weight loss and health
How did we get this idea of dieting so wrong?
Well, a great deal of research is funded by the diet companies themselves, and they have a vested interest in people spending time, energy and money (to the tune of $60 billion a year) on weight loss. To get to the the truth, we have to read the research very carefully.
Lucy Aphramor did an extensive look at the issues with weight loss research, but here are some common study tactics that would get a freshman in Research 101 a failing grade:
- Long term research shows that most people are able to lose weight in year one, but the vast majority gain it back (with the majority gaining back more than they lost) within 5 years. Most weight loss studies simply stop tracking progress at 2 years, when participants have gained back some weight, but are still under their original weight. Then they claim that the study was a success. Or they will ignore weight regain and simply draw the conclusion that “all participants lost weight.”
- Many studies have very high dropout rates, which they simply ignore in the results, making the highly questionable assumption that the dropouts had the same “success” rates as participants who completed the study.
- Studies find that the average person loses around 5 pounds. Peer-reviewed research from Weight Watchers found that the average person loses around 5 pounds (Weight Watchers participants lost about 11 pounds) at the end of a year of dieting. I could probably lose 5 pounds with a vigorous session with a loofah. Advertising claims insinuate that their results prove people can lose ten to twenty times that amount by the same methods, with absolutely nothing to back up that claim.
- Some people simply change the goal posts and declare victory. As several weight loss researchers have explained, the Metropolitan Insurance tables originally provided very specific height and weight ratios to achieve a ‘healthy weight’. But people weren’t able to reach those targets, so the amount of weight loss that studies deemed ‘clinically significant’ was changed to 20% of body weight. But again, doctors couldn’t get people to reach that target, so the number was lowered to 10%, then 5%. Now, one can be considered a “successful dieter” for research purposes, despite the fact that they haven’t even dropped a dress size.
The research actually shows that weight loss programs either don’t work at all, or work minimally.
That’s shocking enough. But the thing that really blew my mind?
There has never been a study that looked at formerly fat people who had become thin through dieting, and compared their health outcomes to those who were always thin.
That study simply doesn’t exist.
To say I was shaken to my core would be an understatement.
As someone who believes in research, logic, and math, I was forced to face the fact that there was almost no chance that I would become thin, that further attempts to become thin would most likely result in weight gain, and that there was no guarantee that becoming thinner would make me healthier.
I had been sold a lie. This realization marked the beginning of my journey to focus on my health rather than my weight, but first I would have to give up something that had been present for almost my entire adult life.
What I had to give up is what Kate Harding calls the fantasy of being thin. I had spent all my time imagining the amazing life I was going to have and all the things I was going to do when I was finally thin.
I had been sitting around for years, planning and plotting for the day when my thin body finally arrived. Now it was time to let that fantasy go, and take my fat body out for a spin. It was time to take my “When I’m Thin” list and relabel it the “Do It Now!” list.
What actually improves health?
But then there was the matter of health.
Health isn’t an obligation, a barometer of worthiness, a thing within our control, or a guarantee under any circumstances. The decision of how highly to prioritize health, and the path one chooses to get there are intensely personal. In my case, I did want to prioritize my health.
But if trying to manipulate my body size wasn’t the way, then what was?
I went back to the research and found good news. In every study that took actual habits into consideration, habits were a much better predictor of future health than body size.
Let’s start with Wei et. al. This study looked at the relationship between relative risk of all-cause mortality, and cardio respiratory fitness among men using the (deeply flawed) BMI categories. What it found was that physical fitness—as measured by capacity for exercise on a treadmill—was a strong independent predictor of in reduced mortality from cardiovascular disease…even stronger than ‘normal’ BMI.
That study was one of many cited in Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis by Barry, Vaughn W. et al. that concluded: “Researchers, clinicians, and public health officials should focus on physical activity and fitness-based interventions rather than weight-loss driven approaches to reduce mortality risk.”
Other research points to lifestyle habits as a more important factor than weight loss itself. In one detailed study, Matheson et. al., looked at the impact of four lifestyle habits (5 or more servings of fruits and vegetables daily, exercise more than 12 times per month, alcohol up to 1 drink/day for women and up to 2 drinks/day for men, and no smoking) on health hazard ratio based on BMI categories.
In the below graph, the vertical axis is the health hazard ratio (a lower number represents less risk). The horizontal axis represents the number of lifestyle habits in which subjects engaged.
Each group of three bars represents the subjects’ BMI categories (“normal weight,” “overweight,” and “obese”.) For those who were participating in zero of the habits, there was a large discrepancy among those of different BMI categories (again, correlational and not causational), but when subjects were engaging in even one habit, that discrepancy becomes far less, and when all four of the habits are engaged in, the health hazard ratios are nearly identical regardless of weight.
You may be wondering: if this is true, why do we keep seeing headlines claiming that you can’t be fit and fat?
The reason is, once again, embarrassingly poor studies. Other studies don’t take actual habits into account. They simply look at metabolic numbers at one stage of life, then they look at them again decades later. If larger-bodied people had metabolic numbers that moved into higher risk zones, they claim this proves that people can’t be fat and physically fit. The problem is that without actually taking any habits or behaviors into account, their “conclusions” are beyond spurious.
When I thought about this, it began to make perfect sense. Why were my thin friends being told to eat slow foods and whole foods, while I and my other fat friends were being told to eat frozen Jenny Craig meals, or liquid diets? Why were thin people given medication to control health issues when fat people were asked to risk our lives in dangerous stomach amputation surgeries? Why were the exact same behaviors that were recommended to fat people by doctors considered to be red flags for eating disorders if thin people engaged in them?
All of the evidence—and common sense—is clear: supporting my body means engaging in healthy habits, and letting my body weight settle wherever it settles.
The result has been nothing short of miraculous in my life. I finally felt like my body and I were a well functioning team, my weight stabilized, and I felt healthier and happier than I had ever felt both mentally and physically. I had a ton of time, money and energy to devote to things other than weight loss attempts, and I used it to do things that I had always wanted to do. That includes participating in three National Dance Championships, two marathons, and a Guinness World Record!
How to embrace a health mentality
So how do you make the switch from toxic diet culture to an orientation towards health in your own life?
The first thing you need to accept is that health is a multifaceted concept.
The decisions we make about how highly we prioritize our health, and the resulting path we choose, are intensely personal and are not anybody else’s business unless we choose to make it their business. You decide.
How to set up for any new health habit
When you are making the shift from a diet mentality to a health mentality, there are some basics to start with.
- Start slow: choose one or two small habits to adopt, do those for a few weeks, and once they become part of your daily routine, choose one or two more. For example, you may choose to stop smoking first. That may be enough to focus on; increasing the vegetables in your diet or starting an exercise habit might need to come later.
- Focus on celebrating victories (no matter how small they seem). Be sure to include things in your life that bring you joy—a scientifically proven wayto counteract the depletion that can come from the self-regulation you must do when establishing new habits.
- Go for the “low hanging fruit.” Start with habits that sound like fun to you, and that seem like they will fit easy in your life.
- Try to be additive rather than restrictive where you can. For example, choose to have an extra serving of vegetables, an extra glass of water, or a half hour more of sleep rather than swearing off sugar.
- Avoid taking an all-or-nothing approach. One of the habits that we often pick up through dieting is the idea that “I blew it, so I might as well eat every unhealthy thing I can think of, whether I want it or not, today and then start again tomorrow.” That sets up a lot of disordered thinking around food.
- Try incremental change. Yes, you’ll be healthier if you quit smoking. But if that seems like too much to do right now, remember that you are also healthier for each cigarette you don’t smoke, so try smoking one less cigarette a day, and remember to celebrate that victory.
The good news is that the options for supporting our health are almost endless — which was news to me, because previously the only thing anyone had really talked to me about was losing weight and manipulating my body size.
New habits to consider
There’s an entire universe of good habits that will improve your physical and mental health. If you have been enmeshed in poisonous diet culture, here are some that can especially support your escape:
- Foster the belief that your body is worthy of care. If you and your body are in a dysfunctional relationship, you can start to do a sort of “couples counseling”. Make a list of everything you can think of that your body does for you — breathing, blinking, heartbeat, waving, smiling, hugging, etc. Become conscious of your thoughts about your body—especially judgements. Notice and interrupt negative thoughts and replace them with gratitude for something — anything! — from your list. This practice will completely shift your relationship with your body, but it takes time and repetition. For me, it took about three months. The more I appreciated my body, the more I saw my body as a friend. And the more I saw my body as a friend, the less I was willing to put up with anyone (including me) saying negative things about it. Now, my body and I are a team and I give her nothing less than my full support and loving care.
- One of the most often overlooked aspects of health is strong social connections. If you don’t have a strong social network, consider joining clubs (online or in person) and start to create good connections.
- Sleep is very important to health — both amount and quality. Consider setting aside time for extra sleep, or looking at options for better sleep hygiene.
- Hydration is another way to support your health. It’s also a good habit for practicing incremental increase! All too often we try to go from 0 to 8 glasses of water a day, spend two days mostly in the restroom, and then give up. Just one extra glass of water a day for a week is a great way to start.
- Take a close look at how you are taking care of your mental health. There are several habits and actions you can use to spotlight this form of self-care. This can include taking some time for yourself, meditating, seeing a therapist, taking your meds, or something else.
- Food can definitely be a way of supporting your health. Healthy intake habits include drinking water and eating fruits and vegetables (unless contraindicated by a specific medical condition).
- Food can also be an area fraught with triggers and difficult to break patterns that don’t help or push you back towards diet mentality. Consider getting some support for healthy eating — you might try something like intuitive eating, or finding a weight-neutral dietitian, nutritionist, or health coach. Learn to listen to your body and create a relationship with food that takes into account hunger, satiety, and nutrition, but also social aspects of eating and pleasure.
- Movement is something that can support health, and it doesn’t take a lot. Even a few minutes here and there can have benefits. Most recommendations suggest accumulating 30 minutes of moderate activity per day 5 days a week, or 15 minutes of vigorous activity per week. You can break this up into smaller increments, and if you can’t get all your minutes in, some is still better than none. You can also choose any activity that you like, it all counts — rolling your wheelchair around the block, gardening, dancing around your living room in your underwear, etc. Make it fun!
Creating a new health culture
Over time, I learned how to take good care of my body, rather than trying to shrink it. But I wasn’t done making my full transition from toxic diet culture to fully loving and supporting my body.
That’s because weight-based shame, stigma, bullying, and oppression are real, and they affect my everyday life. They aren’t something that fat people can just overcome with self-confidence and a can-do attitude.
Fat people get hired less and paid less than thin people with the same qualifications, we often receive healthcare that is far inferior because of the weight bias of doctors, we are asked to pay twice as much for the same service (example: transportation from one point to another on a plane) and bullying is rampant.
Throughout my life as a fat person, I had been told that the solution to weight-based oppression and bullying was to become thin. My journey to understanding weight and health led me to the understanding that what I had been told was basically to give my bullies my lunch money and hope they stopped beating me up. That’s not how social justice should ever work.
I realized that fat people have the right to live in fat bodies without shame, stigma, bullying, or oppression regardless of why we’re fat, what the “consequences” of being fat might be, or if we could or even want to become thin. The rights to life, liberty, the pursuit of happiness, and being treated with basic human respect are not, and should not, be size-dependent. The solution to weight-based oppression is ending weight-based oppression—not eradicating fat people.
One question I get asked a lot is, what if I’m wrong? What if my life is shortened by being fat?
Like anyone who respects science, I certainly acknowledge that it’s possible. I also have to acknowledge that nothing is promised — there are healthy and unhealthy people of all shapes and sizes, and there is no weight that I could be that would make me immortal.
Knowing all of that, I can say with confidence that, having lived both diet culture and “Health at Every Size”, I would rather have a shorter life living as I do now than a longer life pursuing thinness. I am confident that I will not be on my deathbed regretting having spent my life pursing thinness instead of pursuing my dreams, and that means everything to me.
Like so many important journeys, my transition from diet and weight loss culture to accepting my body and ultimately becoming a fat activist, was not, and is not, always easy. But it was, and is, absolutely worth it.
If you are looking for resources to support you on a journey away from toxic diet culture and toward actual health, I recommend the following:
- For an extensively researched argument for making the paradigm shit, check out Bacon and Aphramor’s paper Weight Science — Evaluating the Evidence for a Paradigm Shift.
- For resources around Health at Every Size, you can check out this extensive list from Dr. Linda Bacon.
- For general resources around Health at Every Size and Size Acceptance, the Association for Size Diversity and Health provides this list.