On the most common new year's resolution of our time:
I don't have the numbers to back this up, but I would wager that losing weight is the most common new year's resolution across the world. It's seen in the sudden influx of people at the gym starting January (that quickly tapers off by March) and the proliferation of diet packages from cleanses to paleo that are widely promoted around the same time. Though many fail, one might reason that this yearly attempt at lifestyle change might bear fruit, slowly but surely, with the few that succeed, or at the very least the great impetus for change indicated by this worldwide effort might be channeled towards true obesity reduction with the right levers and encouragement. Certainly, as someone who will become a health professional that will have patients within the obese range in the future, I would like to believe that that is all that is needed.
But I don't know if I can.
Riding the New Year zeitgeist around weight loss, Tara Parker-Pope recently wrote an excellent article in the New York Times on the scientific evidence demonstrating how our bodies fight against us in the battle to lose weight. Though clinical trials are naturally limited in only able to follow people a few years, they are suggesting that our biology makes it naturally easy to regain weight after a diet: because the body will tend to "protect" the weight that it has become accustomed to. So, after losing weight, the body will produce more ghrelin and less leptin (thus making you hungrier) and convert more muscle fibers to slow metabolizers (thus lowering your metabolism, so that even when you exercise, you're burning less calories than someone at a stable weight).
Longitudinal data from the National Weight Control Registry -- a nationally collected list of people that were able to lose substantial (more than 30 lbs) weight and keep it off for at least a year -- further underscores just how these factors play out to make weight loss difficult in the real world. Firstly, the numbers are striking: though about 94 million Americans are reportedly trying to lose weight at any time, only about 10,000 people are on this registry. Secondly, to lose weight and keep it off, people on the registry tend to continuously eat far fewer calories and exercise much more than a person who maintains the same weight naturally. Therefore, losing weight isn’t just a matter of going on a diet or going to an exercise boot camp, it’s redefining what you eat on a daily basis and incorporating exercise into your schedule on the long-term, developing a “new normal” lifestyle to support your weight (which your body is still going to consider “abnormal” these studies show, for several years after the fact)
Putting it all together, one cannot help wondering if it is our cultural obsession with being thin that is pathological rather than any national need for weight loss. As many within the obese range have eloquently written, many doctors seem to just look at their BMI's without listening to their exercise plans and what they actually eat every day.
Talking about her annual gynecologist appointment, one patient wrote of her gynecologist:
I was obese, he said, fiddling with the chart that would have told him I had an eating disorder history if he’d bothered to look at it, and I absolutely needed to lose weight... He just asked what kind of exercise I’d been doing, and I rattled it off, and he said “Good!” ... he asked what I ate, but he didn’t wait for an answer.
When the patient pointed out his oversight in not asking how much she actually ate, the doctor responded with exasperation. “There’s no possible way you’re not eating too much.” Except, according to all the existent research on weight loss and weight regain, it is very likely that that patient is not eating too much!
At the very least, as doctors and other health professionals concerned with helping those on the obese range, we need to recognize that at least a third of our patients are likely thinking about weight loss (remember: 30% of Americans are actively trying to lose weight) and that there is much more work needed than just cutting out fast food and walking for twenty minutes a day in order to create any sort of sustainable difference. Taking this a step further, perhaps we need to be focusing as a profession less on weight loss for those that are already obese. Instead, we need to be promoting exercise and healthy eating (without expectation of dramatic weight changes) and engaging in efforts to prevent obesity from occurring altogether.
Photo Credit: Katie Harris on Flickr