Hi, everyone. It’s Ali from Ok2BeFat. And it’s time for another episode of the Fat Activism Basics.
In this video I will be discussing weight and weight loss. I will also be using the words “obesity” and “overweight” in the context of discussing and quoting scientific studies, even though these are not words I would normally use.
This is The Failure of Dieting
When fat activists point out that fat people are routinely discriminated against in our culture, the inevitable response is — well, if you don’t like being discriminated against, why don’t you just lose weight?
Now. Is it really ok to harm an entire group of people just because you don’t like what they look like? I would say extremely no. And not only no, but that it’s an wildly unethical position to take in the first place.
I object to the entire framing of the issue that fat people should somehow have to prove to the people who hate us that we don’t deserve to be hated. It’s not my job to prove to you that I’m a person.
To even agree to debate my humanity is to lose, because I would have to agree that fat haters have any right to pass judgment on me.
I absolutely reject that idea. I will never agree to a framing that positions me as less than human or as somehow having to prove my humanity to anyone.
So why do a video about diets in the first place?
Because a lot of fat people who are being subjected to fatphobia think that their mistreatment is their own fault. That if they could just do it right, just this once, everything will change.
People are wasting their time, effort, and money on a lie. A lie that harms them and steals from them, not just money but time.
The lie that with enough effort a fat person can be turned into a thin one. A lie that tells them their pain is their own fault.
That lie must be fought, pulled out at the root and exposed. Because no matter how the weight loss industry tries to dance around the fact — diets don’t work. No matter how hard you try to rebrand them as lifestyle changes — diets don’t work.
Every single fat activist can tell you — 95% of diets fail over time. And what we generally mean by that is that 95% of people who lose over 20 pounds will regain it within 5 years. Almost always, dieters will not only regain the weight they have lost, they’ll end up at a higher weight than before they even began.
So where does this 95% number come from? In her book “Losing It”, Laura Fraser points towards a study from 1959 by Dr. Albert Stunkard at the University of Pennsylvania medical school.
Dr. Stunkard undertook a review of the studies into weight loss available at that time, going back thirty years to 1938. He criticized the conclusions of almost all the available research. These studies had skewed their own results by excluding people who quit before the end of the research period or people who were otherwise considered non compliant.
Dr. Stunkard argued that if someone drops out of a weight loss program, that the program should be considered a failure for that person. Which seems pretty sensible. If you quit in the middle of a test, it generally counts as a failure everywhere that isn’t diet research.
There were already hundreds of studies on weight loss in 1958, but when Dr. Stunkard applied his more stringent standards to the available data, only 8 studies made the cut. Not 8 percent. 8 total.
Stunkard’s standards are —
Number 1 — Studies must be conducted in a clinical setting and not rely on self-reporting.
Number 2 — Everyone who starts a weight loss program should be counted as a participant when calculating final results.
People who drop out should count as having failed the program.
And Number 3 — Studies must conduct long term follow-up to see if people actually maintain any weight they lost.
We know that weight regain occurs over time, so a study that doesn’t follow its subjects for a clinically significant number of years is not giving an honest account of how attempts at weight loss act on the body.
Of the 8 studies left, Dr. Stunkard found that only 4% of what he called “grossly overweight” people lost as much as 40 pounds. And of the patients who had lost weight, after 2 years, only 2% of them had kept it off.
We haven’t seen any research since 1958 that contradicts these original findings. Most of the studies into weight loss still do not pass the original Stunkard test.
Does it make sense for doctors, scientists, and governments around the world to insist that people can lose weight permanently when the topic has barely even been properly studied?
Most scientific disciplines would require actual proof to make the kinds of sweeping statements we see people making about weight loss every single day.
In 2007, Traci Mann, a professor of psychology at UCLA, published a study called “Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer”.
Mann reviewed the research on the effectiveness of calorie restricting diets. At that time, Medicare policy had just been revised to pay for “effective treatments” of obesity. This change was a major windfall for the weight loss industry, which could now count on a new and extremely lucrative income source, the United States government.
Mann’s 2007 review of the research into dieting shows that “one third to two thirds of dieters regain more weight than they lost on their diets”.
Mann also found that even these dismal numbers are most likely underestimating the potential weight regain of dieters over time, due to methodological problems that bias the studies towards a more successful view of weight loss maintenance than is actually warranted.
Mann suggests that if dieters were followed for longer than the longest studies, that weight regain might be even worse.
Mann’s discussion of the problems with the research in 2007 lines up pretty well with Stunkard’s conclusions in 1959.
-The lack of follow up over a significant enough period of time, when it is known that weight regain over time is THE critical issue when it comes to the effectiveness of any weight loss method.
-The lack of rigorous clinical trials with a real control group. Especially the problem of selectively including and excluding study participants with an eye towards influencing the outcome of the study overall.
Mann highlights a study from 1995 where the authors reported excluding two of the study participants from the final results because “inclusion of the two patients strongly skewed the results against weight loss maintenance”.
Participants are also regularly excluded from the final results of weight loss studies for either not losing enough weight during the initial study or for quitting completely or dropping out of the follow ups. Drop outs are regularly not counted at all, instead of counted against the effectiveness of the weight loss method, which they should be.
So if the generally accepted number of weight loss success stories is only 5% — even though if we are really basing the numbers on Dr. Stunkard’s 1959 research, it really should be 2% and not 5% — what happens when we talk about really really fat people?
Not just the 25 pounds every thin person is dieting for, but the people who would have to lose 100 or 200 pounds or more to meet their BMI chart requirements.
How successful is weight loss for those people — the ones everyone pretends to be so concerned about?
You would be hard pressed indeed to find a single fat person who doesn’t know all about dieting and who hasn’t tried it themselves. If it was truly so easy to make a fat person into a thin one, permanently — why do fat people continue to exist?
It’s not usually for the lack of trying to become thin — the world is made into such a painful place for fat people, there’s barely a one of us who hasn’t tried (and tried more than once) to escape into the promise of thinness.
At least one study has put the likelihood of very fat people achieving a BMI under 25 at a less than 1% probability. A BMI of 25 is where the overweight category currently begins.
The “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records” study used medical data from the UK to follow 278,982 people from November 1, 2004 to October 31, 2014, and showed a likelihood of reaching and maintaining a BMI under 25 for the highest weight group at 1 in 608 probability for women, which is a 0.1644% likelihood of success. And for men it was 1 in 362, which is a 0.2476% likelihood of a successful diet.
It seems like to me that giving dieting even a 5% chance of working is giving it too much credit.
We are constantly subjected to all sorts of wild claims about how healthy it is for people to lose weight, when it hasn’t in any way been proven that it is even possible for people to lose and maintain weight loss.
So while we’re here… IS it healthy for people to lose weight?
Paul Campos lays out the problem with dieting as a health recommendation really clearly in The Obesity Myth.
“More Americans than ever are dieting: On any given day, approximately 70 million adults are dieting to lose weight, and another 45 million are dieting to maintain their current weight. These percentages have tripled over the course of the last generation. And the result? Americans weigh on average 15 pounds more than they did 20 years ago.”
Campos also notes that millions of Americans are consistently trying to lose about 25 pounds, often on the advice of their doctors. Even though the research on yo-yo dieting is clear that repeatedly losing and gaining weight shows an increase in mortality rates.
Glenn Gaesser discusses this research in Big Fat Lies, citing the “Exercise Intensity and Longevity in Men: The Harvard Alumni Health Study”. Men who had dieted showed nearly double rates of type 2 diabetes, high blood pressure and heart disease as their classmates who had never tried to lose weight.
Higher rates of heart disease have been found also in the Multiple Risk Factor Intervention Trial and the Framington Heart Study.
And okay, you may say — haven’t you picked apart the idea of mortality rates as overblown in a prior video? Are mortality rates important, or not?
And I would say… which mortality rates?
If argument is that the epidemiological comparisons that are used to show mortality rates are a valid and an important scientific measurement for individual people, then what about the same types of mortality rate studies that show that people who weigh more live longer?
What about the studies that show that repeatedly trying to lose weight, regaining it and trying to lose it again — that this never ending loop of dieting is linked to increased mortality and disease rates?
Somehow those studies and those mortality rates just disappear when the topic of fat people is brought up.
Either studies showing mortality rates are important and can be relied upon, and we should dig into them and see what they actually say. Or they aren’t reliable and we should treat them with skepticism in ALL cases, including in the ones that seem to condemn fat people.
So which is it?
I am personally inclined to distrust studies of mortality rates unless the discrepancies are very large and hard to attribute to anything else. In the case of fat people versus thin people, we are talking about really small differences. Please see the BMI part 3 video for a further discussion of how the statistics regarding these studies can be manipulated.
But if we are going to use mortality and disease rates as a way to determine what is considered risky behavior, as so many people want to do, then surely trying to lose weight must be a heavier risk than just being fat.
I have to say, I find it extremely callous and cruel the ways people use these studies against fat people. Shaming the subjects of a study for dying is extremely gross and it’s wrong.
Shoving links of these studies at fat activists and screaming that we’re going to die is pretty ugly behavior. Also… you’re going to die too. Just fyi.
But let’s say you don’t want to rely solely on epidemiology. I certainly don’t.
What other evidence do I have of the danger of weight cycling?
How about multiple animal studies?
In the 1950s and 1960s, researchers conducted a number of animal trials of what we now call yo-yo dieting or weight cycling and found damage to blood vessels and the heart. The animal evidence, replicated in different experiments and among different types of animals, repeatedly shows that a period of restricted food followed by a period of expanded calorie intake produces high blood pressure and blood vessel damage.
But what about case studies of humans, you may ask? Well, in 1944, our friend Dr. Ancel Keys conducted the research into famine known as the Minnesota Starvation Experiment. In this experiment, 32 men were put on a low calorie diet for 24 weeks. During the re-feeding stage, the scientists noticed that many of the men seemed to be in danger of congestive heart failure, with 1 man needing to be hospitalized for severe heart problems.
32 people not a big enough case study? I agree. Let’s take a look at the survivors of the Nazi siege of Leningrad in World War 2.
From September 1941 to January 1942, the Nazi forces cut off the food supply to the city, putting the entire population on a starvation diet. In 1943, Russian doctors examined 10 thousand people who had survived and found that the amount of high blood pressure in the population had increased by between 100 and 400 percent, depending on the age of the subject.
And by 1944, the rate of blood vessel damage seen in autopsies in a Leningrad hospital had gone from less than 6 percent to 55 percent.
Glenn Gaesser notes, “If just a single cycle of losing and gaining weight can strain the cardiovascular system and damage blood vessels, what happens when a onetime episode becomes a recurrent pattern? More damage.”
And now is the time where someone inevitably sends me that article from The New York Times from 1999. It’s called “95% Regain Lost Weight. Or Do They?”. Because when you google for something like “95% of diets fail debunk”, this article is the first thing that comes up, after a couple of results that reference it.
So let’s talk about the claims in this article. I encourage you to go read it yourself. There’s a link to the article in the source notes below.
And now when someone inevitably dumps a link to it in the comments, we’ll both know that they didn’t bother to watch through to the end of the video.
The New York Times article is an argument that the Stunkard standards are too strict. Except it doesn’t really even make that argument openly, as it relies on noting that Dr. Stunkard did clinical trials on only 100 people, but does nothing to mention his survey of the entire available body of research.
The researchers quoted in the article try to discredit the Stunkard study as not credible due to a small sample size, without mentioning that he had reviewed and rejected the majority of the available dieting research for being not scientifically rigorous.
I feel that this omission is deliberately misleading, as it boils down the Stunkard study to one clinical trial, rather than acknowledging the larger critique of the majority of research into dieting as incomplete and deceptive.
So if the Stunkard standards are too strict, what are these researchers proposing instead? The National Weight Control Registry, a collection of self-reported information about weight loss.
If you are willing to say that you have lost 30 pounds for the duration of a year, you too can be counted as a success story by the National Weight Control Registry, a project that the article notes is funded by “financing from drug companies and other sources”. What other sources? I don’t know. I sent an email to them to ask, but I haven’t heard back.
Now, it should go without saying that self reporting is not a better way to scientifically track weight loss over time than a clinical trial. It’s a worse way, we all know that, right? Because there’s no way to double check people’s self reported figures, when if you had them in a clinical environment, researchers would be taking their own measurements and not relying on self-reporting.
Additionally, a single year is not enough time to label a weight loss attempt as a success. If dieting works so well that fat people can be made thin for the entire rest of their lives, as people love to claim — then we should easily be able to see successful diets in their second and third decades. But we don’t see that.
We see outliers and we see people repeatedly losing and gaining weight, which has been proven by science to be more dangerous than just being fat.
In her article in the Journal of Nutrition Education and Behavior called “The National Weight Control Registry: A Critique”, Joanne Ikeda points all this out and more. She mentions an article by the Registry researchers in 2003 which shows that even among the so-called success stories represented by the 2,400 Registry participants included in one of their studies, that 72% had already regained weight from when they had first registered.
And 23% of the participants who were mailed a follow up survey did not return it. Those people should count against the figures as failing their weight loss maintenance, and yet the Registry researchers do not count them at all. Because the Registry is completely based on self-reporting, we can only track the weight regain of the people who are willing to admit it.
And then we have the totality of the numbers themselves.
To quote from the Ikeda article —
“…using conservative estimates of the prevalence of dieting for weight loss in the United States, it appears that 44% of women and 29% of men are dieting at any one point in time. The US census current population estimates for men and women over the age of 18 years are 100 million 994 thousand and 108 million 133 thousand, respectively. Using these figures, it appears that there are 76 million 800 thousand people dieting.
If 5% of them are successful at permanent weight loss, approximately 3 million 800 thousand people will be eligible for enrollment in the (registry). According to the (registry) Web site, there are currently 4 thousand people enrolled. So the researchers can demonstrate a “success rate” of 0.001%, which is not even close to the dismal 5% estimate cited in the scientific literature.”
The National Weight Control Registry is a joke. It proves nothing, except that when it comes to dieting, people are willing to engage in all manner of special pleading that diets do work and for everyone, when that’s not at all what the real science shows.
Not when it is subjected to rigorous scientific standards.
Dieting doesn’t work. That’s simply a fact.
And that’s the end of the Failure of Dieting.
Please see the notes for a list of the sources I consulted for this series.
All my love and thanks to all the fat activists around the world — past, present and future — who are doing such amazing and fantastic work.
And thank you to all my supporters on Patreon — you make it all possible, and I love you for that!!
You can support my work on Patreon at patreon.com slash Ok2BeFat or you can make a one time donation at ko-fi.com slash Bad Fatty Ali
See you again soon!
Losing It by Laura Fraser
“The Results of Treatment for Obesity- A Review of the Literature and Report of a Series” by Albert Stunkard, M.D.; January 1959, The Journal of American Medical Association
“Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer” by Traci Mann, A. Janet Tomiyama, Erika Westling, Ann-Marie Lew, Barbra Samuels, and Jason Chatman, University of California, Los Angeles
The Obesity Myth by Paul Campos
Big Fat Lies by Glenn A. Gaesser, PhD
“Exercise Intensity and Longevity in Men: The Harvard Alumni Health Study” by I-Min Lee, MBBS, ScD; Chung-cheng Hsieh, ScD; Ralph S. Paffenbarger Jr, MD, DrPH; Journal of American Medical Association, April 19, 1995
“Diet-induced hypertension and cardiovascular lesions in mice.” By G. T. Smith-Vaniz, A. D. Ashburn, and W. L. Williams; Yale Journal of Biology & Medicine, October 1970
“Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records.” By Alison Fildes, PhD, Judith Charlton, MSc, Caroline Rudisill, PhD, Peter Littlejohns, MD, A. Toby Prevost, PhD, and Martin C. Gulliford, FFPH, MA; American Journal of Public Health; September 2015
“95% Regain Lost Weight. Or Do They?” By Jane Fritsch, The New York Times, May 25, 1999
The National Weight Control Registry- http://www.nwcr.ws/
“The National Weight Control Registry:A Critique” by JOANNE IKEDA, MA, ; NANCY K. AMY, PHD ; PAUL ERNSBERGER, PHD ; GLENN A. GAESSER, PHD ; FRANCIE M. BERG, MS ; CLAUDIA A. CLARK, PHD ; ELLEN S. PARHAM, PHD, RD, LD, LCPC ; PAULA PETERS, PHD; Journal of Nutrition Education and Behavior, July–August, 2005 Volume 37, Issue 4, Pages 203–205