Diets do not work

You have had a look at yourself in the mirror and realised that you don’t like what you see. Your doctor has told you that you must lose weight. You have researched Atkins, Detox diet, Banting, Intermittent Fasting and a few others. You are ready to start your diet. Again.

You probably feel that you don’t need to have your resolve weakened by reading a blog espousing that diets don’t work. Worse, a major risk factor for being 5kg heavier in a years time, is to be on a calorie restricting diet now. Dieting results in weight gain.

Diets don’t work. A major risk factor for a net weight gain of  5kg in a year’s time is to be on a calorie restricting diet now

A 2006 study by Helsinki University, Finland, found that athletes who competed in sports that periodically required them to lose weight to compete in their category- men and women who had the grit to be top athletes- were three times more likely to be obese at 60 years of age than other elite sportspeople of the same age.

In the popular American reality show The Biggest Loser, contestants were given intensive input from dieticians, personal trainers and life coaches. Six years after the show ended 70% of the contestants had regained their lost weight (and more).

Even with weight loss surgery- gastric bypass surgery, gastric sleeves, gastric bands and balloons- does not always yield positive results. Initially, patients lose weight and experience an improvement in obesity-related illnesses like diabetes, hypertension and hypercholesterolemia. But five years later, studies show, up to half weight-loss surgery patients experience significant weight gain. (Keep in mind that by the time a patient has weight loss surgery, they have had input from a multidisciplinary team consisting of surgical, psychological and dietary specialists) Due to the poor long-term efficacy of these interventions, health-care funders are refusing to pay for second operations, which carry a higher surgical risk.

I see many patients who are overweight, successful, people pleasing and perfectionistic.These traits seem to create a perfect storm for obesity- and the deep shame that follows at not being able to get on top of this aspect of their lives.

But it’s not about willpower. It’s about neuroscience. We cut calories for a while, lose a bit of weight, and we get the illusion that it is about willpower. But we are fighting biology and evolution. The brain uses metabolic suppression as a powerful tool to keep your weight within a set point range. Drop below that range and the signals for being full after eating decreases. The brain actually changes to notice food and become more responsive food cues- becoming prime bait for “eatertainment” in the process.(https://www.drmarcellestastny.co.za/lets-talk-weight-fat/)

I see this in my practice all the time. Patients go into these vicious cycles of restricting and bingeing. Their metabolisms, which does not want them to starve, slows down so that it’s harder to lose weight. To make matters worse, the human body tends to lose weight in the form of water, muscle and fat, but regain it in the form of fat.

The concept of modern dieting, caloric restriction to lose weight, started in the 19th century. Women have been dieting, and failing at weight loss, for generations. I have a patient who told me that when she first starved herself for a whole day at age 13, she felt proud because she felt that this is what women did. Many of us have a critical soundtrack in our heads relating to food, which started when we observed our mothers berate themselves for failing at one diet or another. Our self-worth is tied into what we eat and don’t eat. Men are not far behind in this way of thinking. Diets don’t work, and we need to wake up to this to end the transgenerational abuse.

Diets are a risk factor for weight gain. They can also be a health risk. Some of the more faddish diets banish certain foods and can result in deficiencies or too little fibre.   Some diets have “supplements” which could be harmful, like ephedrine. Many cost a lot of money. One of the greatest risk factors for triggering Anorexia Nervosa is dieting with a normal BMI.

At the very least dieting takes all the fun out of eating!

References:

• “Why diets make us fat” Sandra Aamodt
• “The fat trap” Tara Parker-Pope, New York Times, December 2011
• “Why you can’t lose weight on a diet” Sandra Aamodt, New York Times, May 2016
• “Weight cycling of athletes and subsequent weight gain in middle age” E Saarni et al, International Journal of Obesity, March 2006