A few weeks ago I had tweeted for a patient who maintains 19% weight loss for 2 years, which has been successful in maintaining a diary of food and monitoring calories, as well as integrating protein with every meal and snack.
The point of my tweet was a simple push to those who want to claim that calories do not count or that measurement can not help (such as The Economist for example, whose recent article entitled Calorie Death was the main reason I'm annoyed about tweet) and those who claim that the only way to lose weight is their way (these days are usually #keto or #lchf).
Many folks were weighted with their success stories, and some pointed out the National Weight Control Registry (where more than 10,000 registrars kept an average of £ 70 for 5.5 years). But others did not.
Instead, they claimed that 95% of the diets failed, that the weight loss industry was predatory (to a large extent there is no argument there) and invited the people who achieved "unicorns".
Unicorns. Not people. Mythical creatures.
And the emphasis is of course clear. Prolonged weight loss is impossible. Those who succeed are not human, or to succeed they employ superhuman efforts, sometimes even described as disrupted food and / or that those who succeed must be unhappy. Therefore, the effort is futile and those who offer help (like me, to be clear, I am the medical director of a behavioral weight management center) are unethical and motivated by greed (despite the obvious irony that those who explicitly advocate programs weight loss target the same population of people and regularly charge a lot of money for their services).
But boy, there is definitely a heck of many unicorn roaming around for something that is supposed to fail 95% of the time. The 2010 systematic review found that one year later, 30% of the participants had a weight loss of ≥ 10%, 25% between 5% and 9.9% and 40% ≤4.9%. In the LOOK AHEAD study, 8.3% later, 50.3% of the intensive lifestyle intervention group and 35.7% of the usual care group maintained losses of ≥5%, while 26.9% of the intensive group and 17 , 2% of the usual care group retaining losses ≥10%. Here is the DIRECT trial, where the average weight loss in 2 years was 7.5%, while 24% of the participants had a loss of more than 22 kg. And in the recent study DIETFITS study the average weight loss of all participants was 5%, with over 25% of participants losing more than 10% of their weight.
(And for an interesting experiment of thought, beware this thread by Kevin Bass claiming that even if the 95% failure rate was true, these results would be better than the vast majority of medical treatments currently available for other chronic illnesses)
Where does this figure come from 95%? I could imagine it is true if the mouthpiece for successful weight loss was total weight loss and achieving a so-called "healthy"or"normal"BMI, but it would be just as good a punch that would be suitable for the Boston Running Marathon, where the vast majority of marathon runners will never run fast enough to be able to run Boston, the method being taken to lose weight is the misery that causes overly restrictive diets, they are not people who do not support them, is that their diets fail to help them (which, with complete revelation, is the basis of my book The Fix Diet).
As for what a champion needs, it is certainly not a failure. Considering the medical benefits of weight loss as well as the actual weight of the impact that often has on the quality of life (especially at its ends), what we collectively need is to embrace a multitude of treatments (including ethical behavior and weight management programs and greater access to them) along with more effective drugs. What can at the same time defend is the removal of responsibility from the debate on weight, combating weight bias and stigma, recognizing that a person does not need to have a so-called "healthy"or"normal"The BMI does not measure the presence or absence of health or measure the way of life, respecting the rights of people to have no interest in losing weight or changing their lifestyle, that there is value in changing behaviors around food and the ability, losing as a consequence, and recognizing that the intentionally changing lifestyle in the name of health reflects a huge amount of privileges that many people simply do not own.
Taking into account the elements, we may be able to stop with the useless, inhuman and misleading speech of the unicorn, and while we are at it, stop telling everyone that failure is a preliminary conclusion.