[Preamble: After the conference I am about to discuss came to an end, I sought and received permission from the organizers to use their slides in my blog. The only stipulation was that I had to credit the authors, most of whom I disagree with strongly, and this requirement gave me pause. While I may not see eye to eye with these doctors, I respect them enough as colleagues not to publicly embarrass them by name. The internet is an unnecessarily harsh place sometimes. Everything I am about to say is in the spirit of constructive criticism, not trolling, and I can make my points without calling anybody out. When it comes down to it, all of us are on the same team. Or at least we should be.]
Last year’s Cardiometabolic Health Congress spurred a wide range of reactions, the vast majority of which were various permutations of anger or disgust. Despite such unpleasantries, I returned for the Congress’s 2015 edition late last month. Self-flaggelation is not my thing, but if we do not venture out of our own circles and challenge our biases and beliefs by listening and talking with people who hold different points of view, then we risk deluding ourselves and repeating the same messages back and forth among people who already share our stance.
During an early break between presentations, I took a walk through the exhibit hall to see which vendors were in attendance and approached one weight-loss company that advertises, “The [company name omitted] was developed by doctors and is clinically proven to be safe and effective for weight loss.” Pretty much any kind of restriction will lead to short-term weight loss, so I always find it interesting when companies act like their program is unique in this way. According to the company representative working the table, he told me the people who go through their program consume between 800 and 1,300 calories per day.
Let’s put this calorie intake in perspective. According to the Food and Agriculture Organization of the United Nations, Somalians consumed an average of just under 1,700 calories per day per person between 1999 and 2001, which made the citizens of this east African nation some of the most undernourished in the world during that time. The situation in Somalia continues to be so dire that in fiscal year 2015, the United Nations World Food Program, with help from countries including the United States, delivered 40,680 metric tons of emergency food assistance to the people of Somalia.
Think about that. American dieters who follow this “safe” weight-loss program consume a level of nutrition so inadequate that if they were eating this little and living in a different region of the world, the United Nations would be sending cargo ships full of food to help them. When is Bob Geldof going to organize a star-studded benefit concert for dieters?
The diet program’s marketing material advertises, “And once you’ve reached your goals, [company name omitted] support continues with our Healthy Living Program, where you’ll learn how to transition and maintain your new, healthier weight for the long term.” Where is the evidence to support this claim? It only took the gentlest of pushes for the rep to concede he had none.
We do, however, have plenty of evidence to the contrary, including, but not limited to, the starvation study Ancel Keys conducted in 1944. After consuming approximately 1,570 calories per day (which, just to hammer home the point, is more than people on this diet program are afforded) for an extended period of time, the subjects, according to Judith Matz and Ellen Frankel, “. . . engaged in binge eating for weeks yet continued to feel ravenous. They overate frequently, sometimes to the point of becoming ill, yet they continued to feel intense hunger. The men quickly regained the lost weight as fat. Most of the subjects lost the muscle tone they enjoyed before the experiment began, and some of the men added more pounds than their pre-diet weight. Only after weight was restored did the men’s energy and emotional stability return.”
Data presented throughout the conference reinforced the long-term failure of diets as well. Among the slides are nine graphs showing data from various weight-loss attempts and they all depict the same pattern: sharp initial weight loss followed by slow and steady weight regain. A couple of the presenters discussed the hormonal and neurological survival mechanisms that kick in to promote weight regain after the body has experienced a period of restriction.
The discussion of these data and physiological reactions represented what I consider a noteworthy shift since last year’s conference. In 2014, very similar graphs were shown as well, but back then the weight-loss attempts were presented as successful because the end points were lower than baseline, even if the studies were short term and the trajectory of weight regain was still going up at the time of the study’s conclusion. This time, presenters were more forthcoming about the dismal results of weight-loss interventions.
Of course, that did not prevent them from hosting a vendor who sells weight-loss programs, nor did it keep some presenters from going into detail about lifestyle interventions that would supposedly lead to weight loss. The height of irony was at the end of a long day of discussing how diets do not work, the last presenter stepped to the podium and offered a how-to tutorial on dieting: measuring portions, daily weigh-ins, using apps that track calories, etc.
Not only did she recommend Weight Watchers, which in itself was as funny as it was horrifying, but she also cheerfully offered a list of “Plans that may be effective short-term (≤2 years) for weight loss,” including low-carbohydrate, low-fat calorie restricted, Mediterranean, vegan, vegetarian, and Dietary Approaches to Stop Hypertension (DASH), without any mention of what happens beyond two years. Did she think we would not notice such a glaring omission?
She also included a slide depicting a large polar bear trying to fit into a tiny igloo with the caption, “When it comes to management of obesity, one size does not fit all. Keep trying . . . and eventually you will find the perfect fit.” On what is she basing this claim? We saw no evidence presented whatsoever that any current methods of weight loss work in the long term except for a small fraction of individuals.
Presenting these behaviors and diets as the key to long-term weight loss makes no sense, not when so many other people perform the same actions without achieving similar success, as evidenced by, among other indicators, the multitude of graphs and data they just showed us. The lottery crowns new millionaires every single day, but that does not mean your financial advisor is giving you sound, ethical, evidence-based advice if he suggests you take your life savings and invest in Powerball tickets.