Wednesday, December 28, 2011

The Mind Trap - Paradigms Re-Found

I'm actually pretty encouraged in some ways by Tara Parker-Pope's blog post today on the New York Times website. She writes about the incredible difficulty of maintaining permanent, significant weight loss through dieting or any other mechanism, and about new and existing research showing that dieting, in particular, changes people's metabolism to the point where regaining the weight is nearly a mathematical certainty.

One weight-loss doctor finally decided to try and figure out why his patients just seemed inevitably to regain weight after being on his starvation diet of 500 calories per day for eight weeks. ("special shakes called Optifast and two cups of low-starch vegetables, totaling just 500 to 550 calories a day for eight weeks" - how could anyone fail to keep weight off after realizing how satisfying that could be?)

Anyone who has felt a diet transform herself (or himself) into a food-obsessed, irrational wreck can attest to the fact that your body and brain get messed up by the process.
A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. For instance, a gastric hormone called ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. Another hormone associated with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels. It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.
Almost resisting the temptation to say "Well DUH," I read on. Ms. Parker-Pope comes to the conclusion that I have reached myself in the last little while. "This translates into a sobering reality: once we become fat, most of us, despite our best efforts, will probably stay fat." Right! So this is the end of page 1 of an 8-page post. What more could you possibly say for 7 pages? How about: "So quit being mean to yourself and/or other fatties and focus on being healthy and happy in the body you have"? Would that be too simple?

Apparently. Ms. Parker-Pope brings out some really good stuff, some studies showing that some people seem genetically inclined to put on weight more easily and retain it more stubbornly. And then she gets into the National Weight Control Registry, an organization which I hold to be more than a little insidious. The NWCR purports to show that long-term weight loss maintenance is possible. Many researchers and people with common sense believe it shows the opposite. The NWCR has a few thousand "success stories" in its roster. Here's what Health At Every Size (HAES) researcher and writer Linda Bacon has to say:
First, the data they gathered is hardly long term: It includes individuals who have maintained a thirty-pound weight loss for one year or more. Studies show that two-thirds of weight regain happens within two years, and at five years all the weight has been regained.So some of the individuals in the NWCR registry haven’t even made it past these danger points. And even among this elite group, 72 percent are regaining!*
Ms. Parker-Pope then interviews a woman who lost a lot of weight and has kept it off for years. This woman's regimen includes minutely detailed food and weight journaling; constant weighing and measuring of every mouthful (she knows, for example, that lettuce is about 5 calories per cup); researching menus and performing calorie calculations before any meal outside the house; avoiding all foods with white flour and sugar; and exercising 100-120 minutes a day. “It’s one of the hardest things there is,” she told the Times. “It’s something that has to be focused on every minute. I’m not always thinking about food, but I am always aware of food.”

I find that "I'm not always thinking about food, but I am always aware of food" has just the faintest odor of semantic self-delusion to it. Hey, if that's how she wants to live, that's how she can live. But I sure as shit don't want anyone telling me that her way is the only way to achieve health just because it has reduced her body weight. What the interviews with NWCR survivors tell me is that the people who keep large amounts of weight off long term are obsessing in a way that would be unhealthy for me if I were doing it.

Ms. Parker-Pope clearly gets a hint of this too: "Just talking to Bridge about the effort required to maintain her weight is exhausting," she writes. And then there's this great, great sentence:"If anything, the emerging science of weight loss teaches us that perhaps we should rethink our biases about people who are overweight." YES! YES, YES! YES! Tara Parker-Pope, it's not your fault you haven't been able to keep weight off despite repeated attempts.

Tara is still bummed, though: "In most modern cultures, even if you are healthy — in my case, my cholesterol and blood pressure are low and I have an extraordinarily healthy heart — to be fat is to be perceived as weak-willed and lazy. It’s also just embarrassing." Well, it's only embarrassing if there is widespread social stigma and you also agree to be stigmatized. How 'bout we work to eliminate the social stigma instead of buying into it?

But no. 'Cause here's how Tara Parker-Pope ends her post:
"And even though all the evidence suggests that it’s going to be very, very difficult for me to reduce my weight permanently, I’m surprisingly optimistic. I may not be ready to fight this battle this month or even this year. But at least I know what I’m up against."

Here's the thing, Tara - and I think we can be on first-name terms now because we're talking about some deep-down stuff here - you are healthy according to your metabolic indicators. You are a writer for the New York Times, the most prestigious newspaper in the United States. I infer from your writing that you have a family of your own. You state that you enjoy exercising for 30-40 minutes at a time, which experts are finding is the single most important thing you can control for your health. You might have an awesome life! How about you get ready to fight a different battle in 2012? How about battling to spread the word that people can be just fine without losing weight at all? How about posting a pic of yourself so that the world can see that a widely-read, respected health writer isn't thin? I'll get behind that.

Meanwhile, thanks for sharing some good research.

*Bacon, Linda (2010-02-02). Health At Every Size: The Surprising Truth About Your Weight (p. 145). Perseus Books Group. Kindle Edition.


  1. Have you seen this web site:

    The author is a doctor specializing in treating obesity and even he says diets don't work! In fact, he has an entire article where he states that all medically-supervised weight loss attempts should be proceeded by the warning that trying to lose weight may actually make you FATTER and should be engaged in with caution.

    The fact that Tara ends her article with "But I am optimistic" says to me that society's belief that weight management is simply a matter of willpower is so deeply ingrained that even scientific research won't budge it. She's got some major cognitive dissonance going on.

  2. Thank you so much for writing this. Dr. Linda Bacon referred me to your sit, and I'm thrilled she did. I agree wholeheartedly with what Mac Madame said about the cognitive dissonance. The desire to be thin in our society is so ingrained that even knowing what we know about weight loss doesn't diminish the longing for many people. Until the way fat people are treated in our society changes, self-acceptance will continue to be elusive for many people.
    Thank you for your work and your words, they are important! Warmly, Dr. Deah,

  3. Great review of this article Jayne!

  4. Great discussion of the article! Just wish folks would focus on health rather than dress size

  5. Jayne, the more you, and I, and everyone else can write and read about messages like these, the more we can change the collective conscious. This society has a twisted preoccupation with weight and now that I have a daughter, I feel like I need to do something about that. Thanks for this.

  6. I read the NYT article and it was long. I enjoyed your commentary. Nobody should be obsessed with weight,define themselves based on their weight or be criticized for it. On the other hand, if someone is unhappy or uncomfortable with their weight and wants to change it, that's their choice too. Tara's bloodwork is normal, for others modest weight loss can improve blood markers. If someone wants to be the spokesperson for being heavy and happy- great but why should Tara have to do that if she feels otherwise? Just my 2 cents and I am a nutritionist (say what you will).

  7. I don't think I want her to post a picture of herself. I got 10 bucks that says she's not really all that "fat."

  8. Jayne - First off, I'm a huge fan. I've blogged about your book and how it inspired me to do triathlons. Second, I too had a strong response the Fat Trap article, but in a different way than yours. I hope you check it out.

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  10. Good post!I accidentally found your site on the internet, I am going to be coming back here yet again.Triathlon