Robert A. Regal, Ph.D
Weight Management :
The research and treatment implications
Weight Control - False Promises
We live in a culture that extols the virtue of being thin. The media bombards us with images of thin and fit looking individuals that appear to exemplify all that is physically desirable. Madison Avenue, with the support of most of the medical establishment, has successfully marketed products and programs that all claim to uniquely help anyone achieve their dreams of physical transformation. Diet, exercise, self-control…these, in endless variations on theme, are sold as the keys to success. The problem is that this promise is a lie. Those who maket this lie have made countless millions of dollars. Those who have purchased these lies suffer painful self-loathing, a self-hatred that is borne from the false belief that they have only themselves to blame for their failures to achieve and sustain promised transformational goals.
The Research
Gina Kolata, a senior science/medical writer for the New York Times recently published an excellent book titled, "Rethinking Thin", published by Farrar, Straus & Giroux. The book chronicles the history of weight control methodologies and research from the inception of both. It reviews much of the material I first came across in 1982 after reading Bennet and Gurin’s book, "The Dieter’s Dilemma." In a nutshell, research from twin studies; adoption studies; animal and human studies on starvation and over-eating; decades of controlled and uncontrolled weight loss research and finally, breakthrough research on the role of hormones in regulating weight… all of them confirm the biological/regulatory nature of weight maintenance. The literature on weight loss is filled with variations on the themes of diet and exercise. Nearly all point to initial success. None has ever achieved replicated sustained success. The data clearly indicate that the price one needs to pay for sustaining weight loss beyond the very modest boundaries of a set-point, is to engage in an on-going struggle against a measurably lowered metabolism and a persistent sense of hunger that fosters obsessional thinking (as if starving). It is a choice between vanity and sanity.
Many have argued that health, not vanity, is the real reason for concern regarding obesity. Here again, a review of the research offers little support for this concern. It is ironic to note that careful analyses of the relationship between weight and mortality actually suggest a modest benefit to being moderately overweight. Clearly no one is suggesting that morbid obesity is healthy and that there are no negative health implications for such a condition. The issue is the blame attached to those people and self-loathing they experience partially because of the role society falsely attributes to their behavior. The research proving the intractability of weight control through behavioral means is convincingly convergent. I say this as a psychologist whose practice has been and will remain characterized by the behavioral/cognitive-behavioral wing of clinical psychology. Blood pressure, respiration, heart rate, body temperature…they all can be influenced temporarily by behavioral means…but certainly not sustained in the long run. So it is with weight control, and this should have powerful implications for the way we speak to and treat children as well as adults with regard to concerns about weight. This issue is admittedly complex insofar as it is heavily influenced by social norms and the media. Unfortunately, it is also fueled by “authorities” in medicine, psychology and other allied health disciplines that continue to support the false notion that obesity is controllable through diet and exercise. The corollary being that obesity is caused by the lack of a good diet and insufficient exercise. Blaming the victim is all the more potent when the “scientific” community confirms its support for pseudo-scientific lore. Overweight children, as well as adults, should not feel responsible for an aspect of their appearance that they are no more responsible for than their height or facial contours. How do we help?
It should be the job of treating professionals to help the people understand what the research is telling us. People need to know that body types are essentially biologically determined. Diet and exercise are valuable tools to care for and preserve physical and mental well-being. They cannot offer healthy long-term solutions to significant weight loss. Research will one day reveal healthy biological strategies to manage weight, but that day is not now. For now, self-acceptance should be the goal. Learning how to recognize and fully appreciate the physical, emotional, intellecutal and social capacity of each individual is the appropriate goal of therapy. Patients need to learn how to act assertively and let go of stigmatized barriers that have encouraged withdrawal rather than engagement. Teaching patients to embrace an understanding that happiness is not and never was dependent on a scale, but rather the result of assertively facing life's challenges is where the greatest benefit in therapy lies.Weight Control Fact Sheet
1) In the entire history of weight control research, there are no replicated studies that
report significant long-term weight loss due to any variation of diet and exercise.
2) Nearly all of the clinical research on weight control show that changes in weight due to
diet and exercise eventually return to pre-experimental levels within 6 – 12 months.
3) When healthy normal-weight males were studied for six months under conditions
similar to those of dieting adults (eating 50% fewer calories/day and moderately
increasing their exercise regime), they lost 25% of their weight. However, the
following profound changes in their behavior were observed:
-Subjects could not stop thinking of food and eating.-Food became the topic of their conversations and fantasies.-Subjects often reported vicarious pleasure from watching others eat or from smelling food.-Some of the men hoarded food.-Most of them chewed gum non-stop and had to have a limit of 9 cups of coffee or tea imposed on them.
-Some subjects reported episodes of binge eating. -Those who violated the diet became self-deprecatory. -Some suffered bouts of depression, irritability and mood swings. -Subjects lost interest in sex -Their metabolism dropped to 40% of pre-experimental levels. -Body temperatures dropped and heart rates slowed. When the men were allowed to eat freely for the next phase of the experiment (3 months),
they ate voraciously. One man, for example, ate meals that contained as much as 5 – 6,000
calories. An hour later he would begin to snack. Some subjects consumed 8 – 10,000 calories a day.
Eventually all of the men in the study re-gained their lost weight and with it, a return to emotional and dietary
balance. (Keyes et al., 1950.)
4) When healthy normal-weight males were studied for 200 days to observe the process
and effects of gaining 20 – 25% of their body weight (approx. 20 – 30 lbs.) following
observations were recorded:
-All of the men doubled their normal food intake.-Not all subjects could reach their goal.-Some subjects ate as much as 10,000 calories/day.-Weight retention required an average of extra 2000 calories/day.-Meals became unpleasant and a few would regurgitate after the first food of the day.-Subjects’s metabolism increased by 50% over pre-experimental levels. At the end of the study, the men were allowed to eat freely. They all rapidly lost the
weight they had gained to their pre-experimental levels. (Sims, 1974)
5) Carefully controlled clinical research at Rockefeller University with more than 50
morbidly obese subjects who committed themselves to living at the research institute
for six months achieved weight losses averaging 100 pounds per subject. This
was achieved with a liquid diet of 600 calories per day. Although subjects were
delighted with their results, their behavior and physiology changed. Their bodies
metabolism slowed substantially and they began to act and think like the Keys starvation
subjects. All of the 50 subjects eventually re-gained all of the weight they had lost.
(Hirsh, 2003)
6) Studies of children adopted at birth reveal that adoptees bear no relationship to the
weights of their adoptive parents, and substantial correlations to weights of their biological
parents. (Stunkard et al., 1986)
7) Twin studies comparing the correlations between identical twins reared together versus
identical twins reared apart versus fraternal twins reared together versus fraternal
twins reared apart, revealed that 70% of the variation in people’s weights may be
accounted for by genes. Identical twins had nearly identical BMIs regardless of
whether they were reared together or apart. (Sorensen et al., 1992)
8) Twelve pairs of identical twins ate 1,000 calories a day more than needed to maintain
their natural weight for 100 days. Each subject should have gained 23.3 lbs. in that
time frame given standard calorie conversion formulas. The average weight gain was
18 lbs. with a range of 9.5 – 29 lbs. Identical twins gained identical weights…and in
the same places. At follow-up, all subjects rapidly returned to their pre-experimental
weights. (Bouchard, 1992)
9) Two large federally-funded studies (Caballero et al., 2003 and Nader et al., 1999)
studied the impact of nutritional education, diet, and exercise with randomly assigned
schools in the Southwest (Caballero, 41 schools, N=1704) and in Michigan ,Texas,
Louisiana and California (Nader, 96 schools, N=5,106). Students were in the third
grade when both studies began. Experimental groups in the Caballero study had low-
fat, low-cal, heart-healthy breakfasts and lunches provided by the school. Both studies
exposed experimental groups to programs of nutritional information with hands-on
practice for both students and their families. Experimental groups also received
significant increases in their weekly exercise programs. Both studies ran for 2
years. When tested, children in the experimental groups of both studies clearly
learned what they were taught about diet and exercise. These students were also
eating far less fat and exercising more. Expectations that these effects would
translate into lower weights for the experimental groups were not confirmed.
There were no group differences!!!
References
Books
1) Bennett, W. and Gurin, J., The Dieter’s Dilemma, (New York: Basic Books, 1982)
2) Kolata, G., Rethinking Thin, (New York: Farrar, Straus & Giroux, 2007)
Some Relevant Research Studies
1) Ancel Keyes et al. (1950) The Biology of Human Starvation, 2 Vol. (Minneapolis:
University of Minnesota Press, 1950)
2) Ethan A. H. Sims, “Studies in human hyperphagia”, in George Bray and John Bethune,
Treatment and management of Obesity ( New York, Harper and Row, 1974) p. 29
3) Hirsh, J., “Obesity: Matter over Mind?” Cerebrum: The Dana Forum on Brain Science,
Winter 2003, vol.5, no. 1
4) Stunkard, A. J. et al., “An adoption study of human obesity,” New England Journal
of Medicine, Jan. 23, 1986, vol. 314, pp. 193-1985) Sorensen, T.I.A., Holst, C., and Stunkard, A.J., “Childhood body mass index - Genetic
and familial environmental influences assessed in a longitudinal Aadoption study,” International Journal of Obesity, 1992, vol. 16, pp. 705-7146) Bouchard, C., et al., “ The response to long-term overfeeding in identical twins”, The
New England Journal of Medicine, May 24, 1990, vol. 322, no. 21, pp. 477–482.7) Stunkard, A.J. et.al., “The body-mass index of twins who have been reared apart”,
New England Journal of Medicine, May 24, 1990, vol. 322, no. 21, pp. 483-4878) Caballero, B., et al., “Pathways: A school-based randomized controlled trial for the
prevention of obesity in American Indian schoolchildren,” American Journal of Clinical Nutrition, 2003, vol. 78, no. 3, pp. 1030-1038.9) Nader, P.R., et al., “Three-year maintenance of improved diet and physical activity,”
Archives of Pediatrics and Adolescent Medicine, 1999, vol. 163, pp. 695-704 To contact Dr. Regal: Call 914-347-4797 or e-mail at: Contact@RegalPHD.com
