Dieting for weight loss usually fails over the long-term
Weight cycling may harm your health
Are you on a diet to lose weight? If so, you’ve got lots of company. In the US, the prevalence of women dieting to lose weight increased from 14 percent in 1950-1966 to 57 percent in 2003-2008. For men, the prevalence increased 7 to 40 percent. Even the proportion of normal weight women who dieted to lose weight increased from 37 percent in the mid-1900s to 46 percent in the 2003-2008. For men, the prevalence rose from 11 and 20 percent. Increases in dieting span the age spectrum.
Data from the Cross National Student Health Survey from eastern and western Europe showed that 20 percent of women students with normal weight body-mass index values (average BMI = 20) considered themselves as “a little too fat” or “too fat.” For women with average BMI values of 22.5 (still in the normal range), the proportion of women who thought of themselves as “a little too fat” or “too fat” jumped to 60 percent. Even nine-year old children understand the term “dieting.” Older Americans succumb to the lure of dieting. Data from the 2003-2008 wave of the National Health and Nutrition Examination Survey showed that 70 percent of women and 59 percent of men over age 55 wanted to lose weight. Unfortunately, older people who lose weight are susceptible to losing muscle along with fat, leaving them at higher risk of sarcopenia.
These data reflect relentless messaging from the media and pressures from parents and peers for women to achieve a slender body and for men to have a muscular body. Alas, the constant and ubiquitous environmental pressure to be slim or buff leads to cycles of weight loss and gain – weight cycling. About 25 percent of Americans report weight cycling. Studies that investigated the health effects of weight cycling for people with obesity are mixed. However, some studies do suggest that weight cycling for normal weight and younger persons predicts higher risk of cardiometabolic diseases. Given that weight cycling is shifting toward younger ages, the prevalence of cardiovascular disease may rise in the coming decades.
Ironically, a focus on weight loss usually doesn’t lead to sustained weight loss or result in healthier people. To the contrary, weight focus may have adverse unintended consequences including body dissatisfaction and preoccupation, stigmatization, poor self-esteem, binge eating, and weight cycling. Researchers Linda Bacon and Lucy Aphramor propose a weight-inclusive path, namely embracing the concept of Health At Every Size (HAES).
The basic idea is to shift the paradigm from weight loss to better health by promoting healthy lifestyle behaviors for people regardless of their size. Weight loss arising from embracing better health behaviors may or may not occur. Key tenants of HAES include 1) body acceptance, 2) reliance on internal cues, such as hunger and satiety, to limit eating, and 3) physical activity of any kind, not just structured exercise with rigid goals. From public and personal health standpoints, focusing on weight loss makes little sense. Rather, helping people accept their bodies as they are, learning how to use bodily signals to manage eating, and embracing other healthy lifestyle choices will likely lead to better physical and mental health.
The prevalence of obesity has increased markedly in recent decades and is projected to include almost 50 percent of Americans by 2030. Plus, obesity predicts increased risks of cardiovascular disease and other ills. The typical strategy to avoid or resolve obesity is to lose weight. However, as noted above, weight-loss is difficult to sustain over the long-haul. Researchers Glen Gaesse and Siddhartha Angadi propose still another strategy, namely improved cardiorespiratory fitness (CRF) through increased physical activity. The rationale for doing so rests of five points: 1) increased mortality risk predicted by obesity declines or disappears with moderate to high CRF, 2) most cardiovascular markers improve with better CRF without weight loss and to a degree comparable to that observed with weight loss, 3) weight loss is not consistently associated with reduced mortality risk, 4) improved CRF or physical activity consistently predicts greater reduction in mortality risk than intentional weight loss, and 5) weight cycling may lead to adverse health outcomes.
In his new book, Metabolical, nutrition researcher Robert Lustig proposes a third alternative to dieting, namely eating Real Food. It’s a pretty simple concept: Greatly limit or eliminate ultra-processed foods in your life. Shy away from sodas, pizza, salty and sugary snacks, and other junk foods, and embrace vegetables, fruits, and beans with a smattering of dairy products and unprocessed meat.
This is not to say that making a life commitment to either eating more mindfully, or ramping up physical activity, or eating Real Food is necessarily easy for those with obesity (or for anyone else for that matter). Yet, if people with obesity (or overweight) focus their attention on eating more mindfully, or improving their cardiorespiratory fitness, or eating Real Food, they will likely realize major health benefits – even if they don’t lose any weight. In addition, embracing these alternatives to dieting directs attention to a highly desirable good (better eating, higher fitness) rather than a bad to be eliminated (obesity or overweight). Instead of dieting, make better lifestyle choices to improve your health and well-being.