The stigma surrounding obesity is strong and pervasive, giving rise to a multibillion-dollar industry preying on "get thin quick" schemes, drugs, supplements and crash diets or cleanses. Up to 95 percent of people who lose weight will regain it within a year, often with an added 5-10 percent of weight on top of it.¹ So, what is the point of even bothering with weight loss? Our patients' health, of course!

Does Being Overweight Actually Cause Health Problems?

The evidence is overwhelmingly to the contrary: extra weight does not cause health problems.² Obesity is correlated with some poor health outcomes, but there is no research to support that it actually causes said health outcomes. In fact, more accurately, the distribution of weight on our body has more of an effect on our health than total weight. Studies point to excess abdominal and visceral fat as an indicator of decreased health outcomes, not total weight, actually pointing to "normal" BMI persons with excess visceral fat as being the most susceptible to poor health outcomes, not overweight people in general.³

Dieting Might kill You Faster

Sounds extreme, right? The act of dieting and restricting caloric intake contributes to a cascade of effects in the body, upregulating the hormone ghrelin, which increases hunger; increasing cortisol levels, which promotes the body to hold on to fat; and also contributing to decreased telomere length and integrity.⁴

Since telomeres are an essential component to the aging process, this tells us dieting might actually make us age more quickly. And if diets often fail and we regain weight, this means we are going to be continually subjecting ourselves to this type of stressed state.

If we try to lose weight too quickly, our body prefers to break down muscle tissue instead of fat, so extreme diets that promote quick weight loss may have success with decreasing weight, but that number isn't just fat – it's often mostly water and lean muscle mass, which is quite counterproductive to the intention of weight loss. This process also leads to smooth muscle breakdown like heart tissue, increasing susceptibility to infections, increased blood pressure and decreased bone density.⁵

Restrictive dieting will almost certainly cause the experience of shame in a dieter, which is shown to contribute to eating disorders or disordered eating tendencies; and poor mental health outcomes in general.⁶ So, why do we keep doing this to ourselves?

Willpower Is a Myth

Often we blame ourselves for being too weak willed to stick to a diet or program: It's not that the plan was too hard or didn't fit our lifestyle, it was that we failed at it. But willpower isn't something we actually have control over; willpower is also our self discipline and it's a finite resource. We need this to be able to perform cognitive tasks, to live our lives and think critically.

But once we're out for the day, we're out; it's thought that this might be why dieters often binge at the end of the day after having a "perfect" food day. Studies also show that dieting can lead to cognitive decline and reduction in our ability to problem solve.⁸

We Have Less Control Over Our Weight Than We Think

There's a commonly held belief that people who are obese are just simply unmotivated or lazy; it's their fault their body is too heavy. This idea turns out to be anything but true when it comes down to research on the matter. Twin studies tell us that a person's weight is 70 percent determined by genetics, with the remainder attributed to lifestyle and other factors. For perspective, your height is 80 percent determined by your genetics, meaning our weight is essentially no more in our control than our height is.

Our bodies tend to follow our genetics and have a set weight range they prefer to be at: roughly 20-30 lbs. It is ideal to live at the low end of this range; however, pushing ourselves outside of this range can prove near impossible in either direction.⁷

What Does Affect Our Health?

Simply put: our lifestyle. It's not the number on the scale that matters so much as what we are doing day in and day out. Exercise has been shown to have beneficial effects on our health metrics. Compared to dieting alone, people who exercised had improved changes in health metrics, whereas dieters lost weight, but had no changes in their health metrics.⁹

Eating whole foods, getting adequate nutrition, vegetables, fruits, good sleep, improving digestion, processing stress and emotions in healthy ways and moving our bodies are all proven ways to improve our health. And most importantly, these are processes we have control over. We can choose to exercise or eat a salad; we don't get to choose the number on the scale. And since the number on the scale isn't an actual indicator of health, our focus really needs to turn to these other choices for improving our health.

How to Help Our Patients

I find it helpful to take the time to truly gauge a patient's desires, history and motivation before suggesting any dietary or lifestyle changes. It's incredibly important to help our patients heal and return to a state of balance and awareness when it comes to their relationship with food and exercise.

Instead of restrictions, I focus on what they can add, instead of take away. This may look like adding in more vegetables, focusing on getting adequate protein or taking up a form of movement that gives them joy. There is also a strong element of coaching around expectations, and if there is any intentional weight loss at all, it needs to be done slowly so it can be sustainable and truly create a suitable lifestyle for the patient. If the means we use to attain a result are unsustainable, the results will be unsustainable.

References

1. "Statistics on Weight Discrimination: A Waste of Talent." Council on Size and Weight Discrimination: http://cswd.org/statistics-2.
2. Mann T. Secrets From the Eating Lab. Harper-Wave, 2017.
3. Coutinho T, et al. Central obesity and survival in subject with coronary artery disease. J Am Coll Cardiol,  2011 May 10;57(19):1877-86.
4. Kiefer A, et al. Dietary restraint and telomere length in pre and post menopausal women. Psychosom Med, 2008 Oct 1;70(8):845-49.
5. Sapolsky R. Why Zebras Don't Get Ulcers, 3rd Edition. Holt Paperbacks, 2004.
6. Stice E. Risk and maintenance factors of eating pathology: a meta analytic review. Psychol Bullet, September 2002;128(5):825-48.
7. Stunkard AJ, et al. The body mass index of twins who have been reared apart. New Engl J Med, 1990;322:1483-87.
8. Eighty-three separate studies cited in Hagger MS, et al. Ego depletion: is the active self a limited resource? J Personality Social Psychol, 1998;74(5):1252-65.
9. Wiklund P, et al. Metabolic response to 6 week aerobic exercise training and dieting in previously sedentary overweight and obese pre-menopausal women: a randomised trial. J Sports Health Sci, June 2014;3(3):217-24.

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