It is often said that 95 percent of weight loss methods do not work. It’s just, it’s not true. Advances in medical treatment (such as medical knowledge) for obesity and weight loss drugs mean that there are many ways to help people lose weight.
In fact, losing weight is the easy part (relatively speaking). The problem is that when you stop eating or stop taking weight loss pills, the weight comes back.
To be clear, this does not mean that diet and other obesity treatments are useless. Far from it.
In a recent study, published in Lancet Public Healthresearchers followed up on participants five years after participating in a 12-week or 52-week WW program (formerly known as Weight Watchers).
Although, on average, people’s weight went back, some weight loss – about 2 kilograms, on average – was maintained for five years.
Even this short period of weight loss can begin to reduce the risk of diabetes, heart disease and other diseases related to weight. But for people with obesity, and their health care providers, weight regain can be frustrating.
Obesity stigma, which sees weight as a responsibility, means that ‘failure’ of treatment is often seen as personal failure. This is not true. So why does the weight come back?
Your brain doesn’t want you to lose weight
There are several reasons why weight returns. First, our brain hates it when we lose weight. It sees this as diminishing our chances of survival, so it does everything it can to pull your weight down.
When you lose weight, your brain lowers its metabolic rate (the rate at which your body burns calories), making you more efficient. The truth is that, if there are two people of the same weight, one is overweight and the other has lost weight, the latter must eat less food to maintain the same weight.
It appears that a hormone called leptin is responsible for this. One of the main functions of leptin is to tell the brain how much fat you are carrying. When you have too much fat, leptin is also produced. So when you lose weight, your brain senses a drop in leptin.
Interestingly, scientists have shown that if you give enough leptin to trick your brain into thinking you haven’t lost weight, then most of the changes associated with weight loss are reduced. There’s no support for data acquisition yet – but keep an eye out for this.
In addition to these environmental factors, each person with obesity has their own combination of psychological, social, environmental and economic factors that have contributed to their increase. Many of these cannot be resolved during weight loss treatment.
Obese people who have lost weight continue to live in environments where junk, unhealthy foods are widely available, highly recommended, cheap and convenient. People usually like to eat. We celebrate with food, eat food, and use food as comfort and reward. Eating less requires constant thought and a lot of effort.
Behavioral support for obesity, such as commercial group programs or cognitive behavioral therapy, teaches us ways to help us deal with this, but does not prevent it from becoming a problem. Nor will it make our lives easier.
Daily stressors and life events can interfere with the healthy habits that people establish when trying to lose weight, while drugs that work against natural drivers work when they are taken. Surgery also works to overcome natural drivers, but biology also fights.
Untreated medicine
It is unreasonable to expect that a single action will result in weight gain. If we take the example of blood pressure medication, which is very effective, no one is looking to stop the treatment when the blood pressure drops. It might just come back. The same is true of weight loss pills.
Obesity is probably best thought of as a long-term relapse. People with obesity need help and support throughout their lives. Instead of ignoring effective treatments for the sake of weight loss, we need to be honest with people about the treatments they can get and the likelihood of needing continued treatment. After all, chronic diseases require medical treatment.
A common misconception is that obesity is a simple problem: just eat less and move more. Therefore, obese people only need to “sham fat” in order to lose weight. However, fat people are not bad, lazy or bad-mannered; they are fighting their biology and their environment. Being overweight is not a choice.
Amy Ahern, Principal Research Associate, MRC Epidemiology Unit, University of Cambridge and Giles Yeo, Professor of Molecular Neuroendocrinology, MRC Metabolic Diseases Unit, University of Cambridge, University of Cambridge
This article is reprinted from The Conversation under a Creative Commons license. Read the first article.
