There are many good-hearted doctors who recommend weight loss to their patients even though they know that long-term success is a long shot. Empirical research says that ninety-seven percent of dieters will fail to maintain their losses for five years, and many will weigh more than before they lost weight. Lest you think I’m making this up, here are some studies:
- Kramer, et. al.
- Stalonas, et. al.
- Graham, et. al.
- The classic that got everyone thinking, Stunkard and McLaren-Hume
While these studies are a bit old, they remain valid. They’ve withstood the test of time and prove we’ve known this uncomfortable truth for a while.
Survey research is a little more forgiving than empirical. According to a recent study published by scientists at the National Weight Control Registry, 20 percent of maintainers are successful, if you define success as maintaining a 10 percent loss for one year. That’s success? I wouldn’t feel successful if I’d gained back all my weight, but waited till day 366 to begin the process. Nor would I feel successful with a mere 10 percent loss all together.
My favorite Meta analysis of long-range dieting failure is a 2007 study by UCLA. Medicare asked the scientists to conduct an overview of diet research and come back with a recommendation on which programs should be eligible for reimbursement, if prescribed by a medical doctor. The scientists’ conclusion? None.
And yet, doctors still prescribe weight loss thinking, what’s the harm in trying? The harm is compromised immune function, gallstones and increased risk of coronary death. There is another danger that is harder to study, and that is medical AWOL caused by shame and depression. How many patients simply “go missing” from their doctors after losing a lot of weight followed by the humiliating process of regaining it all? The UCLA study points out that attrition in diet studies is common and high, but not computed in any standard way. Moreover, attrition is often marginalized to make dieting look more successful long-term. (p. 226)
If diet studies commonly have people go missing, how many doctors are also experiencing this kind of attrition and not recognizing it? Anecdotal stories are widely available on First, Do No Harm and other size acceptance websites and blogs. We also know that fat people who haven’t yo-yo dieted avoid doctors and participate in fewer health screenings and visits. Many people have suggested that this is for fear of judgment and “the weight-loss lecture.” So, returning to our original question: what’s the harm? Even if none of the other health risks were an issue, avoiding doctors, clearly, puts people’s health at risk.
A doctor should never blithely suggest or prescribe weight loss. If a patient is asking for help losing weight, the doctor should evaluate whether that patient has in place all the resources necessary to maintain losses. Both the doctor and the patient need to understand that weight loss is easier than maintenance, which is a permanent part-time job with no vacations and an unfair boss. Most patients would be better advised to improve their health – eat a wholesome, less toxic diet and exercise frequently – without the expectation of weight loss and the complications of maintenance that will follow. If the patient insists on dieting, the doctor should make clear that he or she will be supportive regardless of the outcome. Moreover, if the doctor does not have time to mentor the patient through loss and maintenance, then a careful referral is in order. While there are bazillions of doctors who will help people lose weight, precious few understand the complexity of maintenance and continue to work with their patients in the years after the weight is lost. I, personally, know of only one. Her approach to maintenance is a little different from mine in the particulars, but we agree on its enormous challenge. She assures me there are a few endocrinologists and other doctors who understand this too.
If your doctor needs to consider these thoughts, please feel free to forward this link.