I think the first time I had heard of the success of dieting (or lack thereof) was in Tracy Mann’s book “Secrets from the Dieting Lab”. Tracy is (was?) a researcher/professor here at the University of Minnesota. The book quoted a study a while back with some pretty strict parameters of what success meant and it showed that 3% of all people actually succeed at dieting. I believe the parameters were, met a weight goal and kept that weight off for a relatively long time period, which, while limiting, is sort of the goal for most people.
Now those statistics are starting to get some push back, maybe rightly so from some people in the dieting business. Their point of view seems to be something like this, “success is relative, if someone loses a lot of weight and keeps it off it doesn’t need to have this extreme bar to be successful”.
I think I agree with that.
That said, modern dieting has holes you can drive a truck through.
I follow a lot of people in health and fitness and right now weight loss medication is becoming VERY hot. Even to the point where bariatric surgery might become optional. Which is great for obesity clients that are desperate for help but there is one issue that I really struggle with there…..
In the case of bariatric surgery your stomach is often “sleeved” off to shrink the size of your stomach so that you eat fewer calories. Weight loss medication does something similar but without the surgery and once again, some people have exhausted every possible option they need these tools.
Whether or not everyone is “exhausting” all of their options can be up for debate but, by and large, there are some positives and negatives. Having excessive weight on your body can and often is a health hazard.
Here is my issue. Clients ARE NOT being counseled properly about what is happening to their body and what the potential outcomes will be, let me give you an example:
Client is 350 pounds, I believe the success rate of bariatric surgery is around 20%. That means that the person (on average) lands at 280, which is likely a significant change for them from a health perspective.
Here is what we know about dieting: the more you do it, the worse it gets, that’s one of the reasons why people resort to such an extreme option. Often, they have dieted their way to this extreme problem yo yo’ing back and forth. Not everyone but for a lot of people this is a risk. Opting for more and more extreme options as they go. The other part that isn’t as well known is the more extreme you do it, it seems to multiply the negatives.
When you have surgery you barely are able to eat or you take medicine for the same result you are in effect opting for the nuclear option, so I need to be clear here, some people need this and it can be helpful for those people from a relative standpoint.
But 280 isn’t the goal they have in their head, they often want to go all the way to an even lower weight.
It’s like a trump card, once you use it, it’s really difficult to get back.
My criticism is simply this, if you are a weight loss doctor, there needs to be a VERY strict counseling paradigm for what the expectations will be once it’s all done. Like I said, losing 70 pounds for someone that is 350 pounds is likely a game changer from a health perspective.
But if that is the end of the road, what's next? (because people aren’t trying to be 280 pounds even though it might be healthier)
I will tell you what’s next because this is the part of the story I see. Often these populations resort to extreme exercise to get to a further calorie deficit and struggle. If you are eating 500 calories where do you go? Where do you even get the energy to WANT to exercise like that?
With bariatric patients they often struggle to get in enough food to even try and kick start their metabolism. With weight loss medication you can at least get off the medication but when you take away the reason someone lost 70 pounds there will almost always be some weight gain and frankly, when you use the nuclear option the chances of things going back to normal in terms of your metabolism and further weight loss is not good.
There NEEDS to be more honesty in this regard.
The other part that is important is that there needs to be after care and for most people that means counseling. The conditions that contributed to obesity are likely still there.
And guess what, that doctor sending you weight loss medication in the mail doesn’t often have a referral network for counselors set up.
Here is why I chose the most extreme example to make this point about the success and failure of dieting.
It’s all relative, the people that are saying “it’s unfair to judge us like this” are basically saying “we aren’t responsible for the mess we are creating”.
And I am saying they are. If you aren’t OVERLY honest about the outcomes and how difficult it is AFTER the dieting period is done you aren’t telling the majority of the story.
Part of the reason they aren’t telling that story is because the overriding belief is that people should be under-eating most of their lives.
I am saying that is causing more problems than it solves. YES, some people need extreme interventions to get back their health, it is literally a life or death option.
But for the majority of people FOOD WILL TAKE THEM MUCH FARTHER if they can extend the timeline strategically maintaining their metabolism along the way.
And if it sounds like I am being critical of weight loss doctors I am a bit, there needs to be more in terms of after care and expectation.
Who I am really criticizing here is the diet industry in general that paints this picture that they have some different way of doing it that is somehow a game changer.
The only different thing about dieting in a very long time is us. What we are saying is that dieting has to be viewed as a strategic option that is used minimally where periods of food come back. Long periods that allow the body and metabolism to heal.
That the answer to dieting is not dieting all the damn time.
There is this meme meant to shame dieters that there are more people lining up for weight loss medication than there are people lining up for lifestyle interventions.
Whether it’s normal dieting or extreme options the narrative being sold is that “this is what will fix you” without a whole lot of honesty about what “fixing you” means.
And then people waste YEARS upon years of their life chasing the wrong rainbow. I am not saying personal responsibility shouldn’t be mentioned, it should but once again there is a deep lack of understanding of all of this that isn’t being taught.
It reminds me of the saying, “if you are a hammer everything looks like a nail” and for the diet industry, everything keeps looking like a bigger and bigger nail.
It might be time to expand our tool box.
Even the programs that reverse don’t do a good job because they cave to the fear of their clients or they let AI (artificial intelligence) do the work.