The Tipping Point

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You probably heard about Gina Kolata’s piece in the New York Times earlier this month detailing commonplace weight regain among Biggest Loser competitors, but you may have missed Dr. Sandra Aamodt’s excellent follow-up piece in which the neuroscientist shares research showing just how unlikely long-term weight loss is for any of us, not just the show’s former contestants.

While this information might be news to some of us, data showing commonplace weight regain among people who attempt to lose it has been available for quite a while, yet it has not garnered much mainstream attention despite years of efforts from researchers, advocacy groups, activists, and practitioners around the world, including myself.

Regardless of what our goals are, nobody wants to hear that they are probably unattainable, which partially explains why the myth of weight loss has survived. Unfortunately, yet understandably, people are reluctant to listen when receiving a message they do not want to hear.

The problem, however, runs deeper. The notion that we can lose weight and keep it off if only we try hard enough has taken on “everybody knows” status. We hear it in our fitness centers, around the proverbial office water cooler, up in the bleachers at Little League games, and at spring cookouts. The message is so commonplace that we do not stop to question its validity.

Doctors, dietitians, and other healthcare practitioners can inadvertently contribute to the mess. We are human and vulnerable to the same “everybody knows” paradigm too, and sometimes we take treatment guidelines at face value without looking into them for ourselves.

Lump the green version of myself in there as well. I shake my head with embarrassment and shame at some of the advice I doled out early in my career before I knew better, and I wish my profession as a whole would get up to speed.

We see the “success stories,” the people in our lives who were able to lose weight and keep it off, at least so far. The Massachusetts State Lottery website features pictures and stories of its recent million-dollar winners, but their enticing smiles do not change the reality that the most likely outcome of buying a ticket is financial loss.

Children observe their parents looking critically in the mirror, associating guilt and virtue with eating and exercise behaviors, and oscillating between rigid restriction and binges. The torch of dieting and weight obsession passes to the next generation.

If the myth of weight loss dies, so do the $60,000,000,000-per-year diet industry and the privilege enjoyed by the thin in a culture thick with fat shaming and weight stigma. They keep the fantasy alive and have plenty of incentive to make sure we continue to feel bad about ourselves.

Cognitive dissonance is a powerful force to overcome, not just for laymen, but for everyone. Given the strong headwind, I am pleased to see this information finally receiving the widespread attention it so desperately needs.

Ms. Kolata and Dr. Aamodt certainly deserve credit for their parts, but so does everybody who has ever made an effort to get the word out – practitioners and researchers who risked career suicide, activists for whom death threats are a daily way of life, and patients who have stood up and demanded evidence-based care – as they have also contributed to what I hope is finally the tipping point.

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