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Recently, the U.S. Preventative Services Task Force recommended that doctors refer all patients with a body mass index of 30 or more to a program designed to promote weight loss. A successful program, according to the panel, combines counseling sessions with concrete weight-loss goals, nutrition advice, and education on setting limits and recognizing barriers to change.  The recommendation was met with mixed reviews from doctors and politicians involved in the healthcare debate. Some cited it as a “long-overdue” prod to physicians while others acknowledged the additional responsibility it would place on doctors who are already facing time and resource constraints.

What the debate skims over, however, and what may be the most important point is not a single study demonstrates the long-term benefits of an intensive weight loss program for health. This oversight is at the crux of the war on obesity and America’s obsession with weight loss.

One of the central misconceptions fueling the task force’s recommendation is that body weight alone is indicative of health. Many studies have indicated that weight, when viewed in conjunction with other lifestyle habits like exercise, is not related to disease or early death except in the morbidly obese. Other studies point out that equal numbers of thin and fat people exhibit unhealthy eating habits and whether or not those habits become externally apparent is largely determined by genetics. To assume all fat people are unhealthy and all thin people are healthy is prejudicial and does a disservice to both groups.

Another misconception is that everyone who is fat must suffer from some form of disordered eating. In reality many people with a BMI above 30 are healthy adults who exhibit moderate eating and exercise habits. Likewise, many people at a “normal” BMI of 18.5 to 24.9 do display maladaptive eating habits. Using BMI alone as the criteria for admission into a free counseling program both sets the stage for further discrimination against fat people and excludes many “normal” weight individuals who might benefit. In short, It is a grave mistake to assume everyone at a “normal” BMI is making healthy choices and everyone above a “normal” BMI is not.

As part of the initiative, doctors are urged to refer obese individuals to programs where weight loss is the primary goal and benchmark for success. There are many problems with this. First, weight loss programs fail for about 95% of dieters and ultimately cause more health problems from the resulting weight cycles. Second, there is not sufficient evidence linking weight loss with improved health outcomes in the long run, which the task force openly admits but appears to dismiss in another classic case of succumbing to popular culture rhetoric about dieting. The task force states that in some cases, programs include exercise sessions. From an evidence-based perspective, this should be priority number one. Research has shown dramatic improvements in health from exercise alone, and obese but fit people are as healthy as fit people falling within the normal BMI criteria. A focus on weight loss over increased physical activity gives people an inaccurate tool for gauging health.

Dr. Jack Der-Sarkissian notes that more than half of all obese patients are never told they need to lose weight, and that’s just “not fair to the patient.” Hmmm…. Let’s talk about what’s really not fair. It’s not fair that doctors assume all fat people have homogenous eating habits and weight loss is the lifesaving miracle panacea. It’s not fair that doctors assume a fat person is automatically unhealthy and on the flip side, a thin person is healthy. It’s not fair that so many medical problems a fat person encounters are attributed to weight with no further investigation. It’s not fair that people at “normal” weights are rarely offered nutritional advice, diagnostic testing, or counseling because they are assumed to be healthy. It’s not fair that so many people with diagnosable eating disorders do not get the treatment they need because they don’t meet certain weight criteria, while the government wants to the foot the bill for every fat person to a enter a weight loss program.

When will health officials come to realize that both physical and mental health are independent of body size and the people who could actually benefit from counseling fall all along the weight continuum.

DIET: that dirty four-lettered word that is so ingrained in our national vocabulary that it’s mention is akin to discussing the weather.

“What’s the forecast for tomorrow?” you ask.

“A high of 1200 calories with a slight chance of deprivation.” How gloomy.

Dieting has become as American as baseball and apple pie, that is, as long as you make it a slice of sugar free, fat free pie.

Yet despite how often we talk about dieting, very few actually succeed in losing weight and keeping it off. So why do we persist? Are we all insane, as a popular quote would suggest?

“The definition of insanity is doing the same thing over and over again and expecting different results.”

Or maybe we’ve been bamboozled by an industry that profits off of our failures, an industry that designs a faulty product and then places the blame on the buyer? Today I challenge you all to embark on a different kind of diet: the anti-diet.  Let go of all your complicated food rules and beliefs about “good” and “bad” foods and begin to trust your body to tell you what it wants and needs.

To provide you with some motivation, I’m counting down the top ten reasons to ditch dieting for good.

10. Dieting wrecks havoc on your metabolism.

Dieting slows the metabolism down tremendously, as the body enters what it assumes to be a period of famine. And while fat people who lose large amounts of weight may look similar to a naturally thin person, their bodies are actually behaving more like that of a starving person. In other words, a fat person who loses weight will not acquire the health characteristics of a naturally thin person. On average, the metabolism slows so that a formerly fat person burns about 24% fewer calories per square meter of their body’s surface area than a naturally thin person. By avoiding diets, you can ensure your metabolism is functioning at its optimal level.

9. Your body produces hormones that fight against weight change.

Your body has a natural set point for weight, largely determined by genetics, at which it feels most comfortable. Deviating much beyond this point triggers a cascade of hormones designed to resist further weight fluctuations. These hormones can stimulate or suppress appetite, decrease or increase metabolism, and encourage or discourage activity. Dieting interferes with the mechanisms that regulate set point and makes it difficult to respond to hormonal cues. Much like a broken gas gauge on a car, dieting makes it difficult to tell when the tank is full or running on empty.

8. Dieting can lead to many psychiatric problems.

Here’s a novel idea: your body, as adept as it is at carefully regulating all your bodily systems, cannot tell the difference between a diet and unintentional starvation. And starvation has been shown to cause a lot of psychological problems. In the classic Minnesota Starvation Study, healthy men were put on 1,600 calorie diets with the intention of losing 25% of their body weight. Over the course of the experiment, the men experienced what head researcher Dr. Ancel Keys came to call “semistarvation neurosis.” They became nervous, anxious, withdrawn and overly critical of their appearance and weight. Many exhibited signs of depression, losing their ambitions, interests, sense of humor, and desire for social interaction. They became obsessed with food and many developed odd food rituals. And to think this all happened on 1,600 calories per day. Many popular diets today prescribe much less!

7. Dieting wastes a lot of time and energy.

As noted by a participant in the Minnesota Starvation Study the act of restricting food “made food the most important thing in one’s life.” Whether your counting calories, weighing out just right portions, or dreaming about all the food you wish you could be eating, dieting can quickly become an all-consuming undertaking, often at the expense of other areas of your life. When we deny ourselves food we enjoy in favor of “healthy” foods we dislike, a lot of time gets spent fantasizing about that forbidden food.

6. Dieting robs a lot of the pleasure from eating and can make for more complicated social situations.

Despite what many popular diets lead you to believe, getting pleasure from food does not make you a hedonistic, weak-willed person. Eating can and should be a pleasurable experience. Think about digging into a big stack of fluffy pancakes on a lazy Sunday morning, eating a slice of cake on your Birthday, or clinking champagne glasses with friends and family on New Years Eve. Food is a part of many of social situations, and when your web of complex food rules keeps you sidelined from digging in with everyone else it can be an isolating experience.

5. 95% of dieters regain the weight and then develop a higher weight set point.

Because of the numerous regulatory checks that your body employs, in the end, dieting is more synonymous with weight gain than weight loss. It slows metabolism, increases the body’s efficiency at getting calories from food, increases appetite, decreases activity levels, lowers your body temperature, breaks down muscle tissue, and increases fat storing enzymes. All these checks ensure you are on the fast track to gaining back any lost weight. And because our bodies are programmed to protect us from weight loss but aren’t too concerned with weight gain, they settle at a slightly higher set point than they were previously at. In other words, the same amount of calories you were once eating to maintain weight X are now how many you need to eat to maintain X+10lbs.

4. Dieting and weight cycling causes a lot of the problems that excess weight is blamed for like heart disease, high blood pressure, high cholesterol, and liver damage.

It’s a classic case of what came first, the chicken or the egg? Many people see a correlation between excess weight and disease and assume weight is the cause, when in reality the relationship isn’t so straightforward. What often underlies conditions like heart disease is the damage done to the body by losing and regaining the same weight over and over again, the same cycling that leads to higher set point weights.

3. You don’t need to diet to maintain your body’s healthy weight.

Too many people are under the impression that without constant vigilance the pounds will keep piling on, when in fact, this is far from the truth. A scientist at the University of Vermont, Ethan Sims, conducted an experiment that was the mirror image of the Minnesota Starvation Study. Instead of looking at the effects of calorie restriction, Sims put men on a calorie dense diet. In order increase their weight by 20% above their natural set point the men had to eat as much as 10,000 calories for up to six months time. Sims discovered that the amount of weight the men should have gained based on a simple calories in versus calories out equation was much more than they actually gained. Their bodies fought hard to maintain their natural set point, and at the conclusion of the study they returned to these weight without effort. Your body knows the weight it is healthiest at and will fight you to maintain that weight. Ironically, you have to diet to NOT maintain your healthy weight. Watch a documentary that puts participants through a similar weight gain experiment here.

2. Being thin does not necessarily make you healthier. Moderate activity and healthy, moderate food choices make you healthier.

Fit, active people are much healthier than sedentary individuals, regardless of weight. In fact, fit obese people are healthier than thin sedentary individuals and just as healthy and thin active individuals. When fat people exercise, they reap all the benefits even without an accompanying weight loss. In other words, losing weight will not make one healthy but exercising will. Several studies also indicate that fostering an active lifestyle increases self-confidence and acceptance while dieting often has the opposite effect. Read more.

1. Dieting is NOT about loving and respecting your body.

How many times have your heard someone say (or said yourself) “I’m trying to lose weight because I want to take care of myself?” While the intention is good, dieting is a misguided attempt at promoting health and well-being. Choosing a healthy, varied diet, staying active, and accepting your body in its present state sends a lot more powerful message if you ask me. You wouldn’t tell your partner or your best friend, “I’d love you more if only you were….(fill in the blanks).” So why do we repeatedly tell ourselves this message by trying to lose weight? Love and respect come from an understanding that I am a complete, whole person as I am.

For a great resource on the research behind these reasons check out Big Liberty’s blog. Or pick up a copy of the book Health at Every Size by Linda Bacon, The Obesity Myth by Paul Campos or Rethinking Thin by Gina Kolata.

I’m minding my own business at the gym the other day, happily meandering around the weight room when one of the “fitness consultants” approaches.

(How bad-ass I imagine I look) Source

“Hey, you’ve been working out here for awhile now, but I don’t think I’ve ever learned your name,” he says casually. Hmmmm, I think to myself, it’s probably because I have no desire for you to know my name. My antisocial, just leave me alone and let me work out in peace attitude starts to surface.

“I’m Dana,” I politely respond stifling my inner bitchiness.

“Hi Dana, I’m Jeff**.” He extends his hand. You really want to shake my hand right now? Can you not see how sweaty I am? I politely shake his hand, intending to end our little exchange and get back to lifting. But Jeff persists, “I can’t help but notice you look like you’re losing some of the definition in your stomach. If you want to set up a session with me I can show you a great workout to tighten that area up.”

I glare at Jeff with my “I can’t believe you just said that, I’m ready to go all psycho on you and rip your head off” eyes. He doesn’t seem phased. I muster up the gumption to interject but Jeff continues.

“A lot of women notice that has they get older (excuse me, when has 27 ever been classified as old?) it’s easier to accumulate fat around the midsection. But if we go over your diet and exercise plan I’m guessing there are some simple changes we can make to keep that from happening.”

Can your diet and exercise plan remove this baby from my midsection? I’m sure that would tighten things up quite a bit you ass. I almost say this out loud, but I decide to let him continue knowing that once I do reveal I am pregnant, not just the fatty he is implying I am, he will feel like an even bigger ass. Sometimes I can be a little evil.

Jeff continues on about the importance of high intensity interval training for fat burning and avoiding sugar because it turns to fat. “Do you want to go downstairs with me for a consultation?” he asks. “We can get some baseline measurements for weight and waist size. Give me four sessions and I’ll bet we can knock a whole inch off your waist and 5lbs off the scale.” Do these aggressive, make you feel like shit tactics really work on most women?

Source

I finally decide to spare Jeff any further humiliation, plus he set himself with that last statement. “Well Jeff,” I say “I don’t think my doctor would approve of me losing 5lbs right now, but if you want to wait until mid July, I’d be more than happy to drop say 6-8lbs all in one day and you can take full credit, although my husband might not like that.” I’m relishing in the confused look on his face. I wait long enough for there be that cinematic, dramatic pause. “Yea, I’m 19 weeks pregnant.”

A flash of understanding crosses his eyes, and I’m expecting him to apologize and wander off to find some other girl with an expanding midsection to torture. But instead Jeff surprises me. “Oh, you didn’t really look pregnant.” He laughs a little too confidently. “In that case, definitely look me up later in the summer and I can help you get off all that baby weight.” I cannot believe this guy. Oh Jeff, yes of course the first thing my former anorexic midsection wants to do after giving birth is come find you to be ridiculed and shamed. It would be the start of such a beautiful relationship.

I desperately search for something snarky to say, but in the end all I can think of is “no thanks,” and I walk away.

The world is full of people like Jeff: well intended but clueless. They make comments that lead you to question your self-worth, your beliefs, and your inherent goodness and beauty. They’re ready with a snap judgment or inappropriate remark that can bring you down even when you’re feeling on top of the world. You can’t avoid them because they’re everywhere. And unfortunately, despite my desire to mark this Jeff with a big, flashing neon sign that read Unintentional Jerk, they don’t come with any warning label or exterior sign of inner thoughtlessness.

The best remedy for a Jeff is to educate and move on. If you’re feeling brazen enough (which I was not at the time) tell him or her that, while you’re too confident to be brought down by their comment, other people not as tough as yourself might find it hurtful. Your advice might register with them, but since I don’t call them “clueless” without reason, it probably won’t. In that case, just walk away. Everyone views the world and the people in it through a unique lens. The way one person sees you does not truthfully reflect who you are as a person. It only reflects who you are through the personal experiences and biases of the person looking. Work on creating the most favorable, forgiving, and loving lens through which to view yourself. In the end, that’s the only perspective that really matters.

In the meantime, if anyone does come up with a good “jerk tagging” system, please let me know. I’ll spearhead the campaign!

**Name has been changed to protect the identity of said fitness consultant (you’ll see why he needs protection in a moment).

The shirt I contemplated buying but decided it wasn’t worth spending $20 to flaunt my insecurity:

Source

In the classic tale of the tortoise and the hare, the slow-going tortoise crosses the finish line ahead of the speedy but arrogant hare. “Slow but steady,” the tortoise says. By adopting that mantra in the race to lose weight, you are not only guaranteeing that you cross the finish with energy to spare and your vital organs in tact (more on that later), you are preventing yourself from having to rerun the same course over and over again.  Approaching weight loss more like a marathon instead of a sprint to one’s goal weight is the ideal way to ensure your body maintains optimal functioning.

One of the prime examples that comes to mind when I think of fast weight loss is the NBC reality show The Biggest Loser. Contestants vie for a chance to win $250,000 by adopting very low calorie diets and engaging in grueling 6-8 hour long workouts (all under doctor supervision of course), all in the hopes of dropping the largest percentage of their body weight and being crowned the Biggest Loser. What the viewing audience doesn’t see is that in addition to the money, every contestant walks away with another prize: a significantly slower metabolism. Maybe they should rename the show the Biggest Metabolic Loser?

In an abstract presented at the most recent Obesity Society Annual Scientific Assembly, Darcy Johannsen and friends reported that by week 6 Biggest Loser participants had lost 13% of their body weight and by week 30, 39%. More interestingly they reported that by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected by their weight loss and by week 30, by 504 more calories. (Source: WeightyMatters)

The term for what is happening is called metabolic adaptation, and under normal circumstances, it’s a great survival mechanism. Back when our ancestors had to go prolonged periods of time without substantial amounts of food, a slowed metabolism ensured survival. Today, when food is bountiful, it’s not quite as useful. What’s interesting to note is that this phenomenon does not occur when weight loss occurs at a rate of 1-2 lbs per a week, the amount recommended by MayoClinic.com medicine specialist Dr. Donald Hensrud.

These results have been replicated in studies with rats. In a laboratory study using rats that are prone to gaining weight (think your average person with a genetic predisposition to obesity), rats on a severely calorie restricted diet showed significant reductions in metabolic rate, measured as both 24-hour energy expenditure and sleeping metabolic rate. Eight weeks after returning to a normal feeding schedule, the metabolic slow-down persisted, thus setting the rats up to regain much of the lost weight. Sound familiar?

In addition to a damaged metabolism, side effects of extreme dieting include dizziness, fatigue, irritability, hair loss, malnutrition, muscle loss, and even in some cases diabetes. On a sufficient number of calories, most adults can get the recommended daily allowance of vitamins and minerals assuming they are choosing carrots over candy 90% of the time. With a sever calorie restriction, however, it is very difficult to get all of the essential nutrients, snowballing into many of the other accompanying problems. Take hair loss for example. Without adequate amounts of protein a condition know as Telogen effluvium, or the loss of more than half the hair on your head, can occur.

Who’s up for skinny and bald? I suppose Brittany Spears pulled it off.

Rapid weight loss can cause major fluctuations in blood sugar levels. A 1996 study in the “Journal of Diabetes and Its Complications” indicates that patients who lost weight very quickly developed diabetes most likely as a result of swings in blood sugar levels and stress hormones.** Additionally, when the body depletes its glycogen (blood sugar) stores it begins to fuel itself by breaking down muscle tissue, not fat. Dr. Linda Bacon points out that yo-yo crash dieting can eventually lead to heart muscle loss. It damages your blood vessels and causes micro tears that create a setup for atherosclerosis and other types of heart disease.

If you are in need of losing weight please consult your doctor or a nutritionist to learn the proper way to go about doing it. Become the tortoise in the race to lose weight and go about it slow and steady. Because in the end, even if you don’t win the race to fit into your bikini come this summer, you’ll win a much better prize: long term health.

**Small sample size and in need of replication. If you find another study that shows similar results I would be interested in hearing about it.

Lose 10lbs in 10 days! Drop the weight while eating whatever you want! Watch the fat instantly melt off! Fit into a smaller size by jumping around on one foot, in the rain, while holding a lemon and chanting “I will be skinny!” Okay so I made that last one up, but is it really any more ridiculous than the others when you think about it?

Fad diets promising miraculous (read impossible) weight loss have been around for decades, circulating through popular culture in a fairly cyclical patter. The Master Cleanse diet developed in the 1930s resurfaced in the 2000s, the Cabbage Soup diet from the 1960s came back during the 1990s, and the diet pill trend from the 1970s, well that one we just can’t seem to shake. So why are well-educated, intelligent women still buying into the empty promises advertised by the latest diet craze?

For starters, as consumer-savvy as the modern woman is, the marketing and sales teams behind the most popular diets are just as savvy. They feed off of frustrated dieter’s desperation to lose weight quickly in a society built around instant gratification. They proliferate false scientific information and disguise pseudoscience as infallible evidence in support of their diets. Take the popular grapefruit diet for example. It purports that grapefruits contain an ingredient that promotes fat burning, however, this claim has never been indicated by any scientific research. Can dieters lose weight on the grapefruit diet? Of course, but not for the publicized reason. The grapefruit diet is nothing more than a low calorie, high protein diet, and weight loss will likely result with or without the addition of the magic grapefruit.

This brings up another reason why so many women buy into the diet’s propaganda: they do work, at least initially. Whether it’s the negative calorie diet, the apple cider vinegar diet, or the cabbage soup diet, most fad diets reduce calorie intake enough to cause weight loss, spawning thousands of testimonials and anecdotal evidence for the diet’s validity. Unfortunately, while those who succeed initially are eager to share their triumphs with the world wide web, most disappear into the background once the diet is no longer working.

Because fad diets recommend such a limited calorie intake and a limited variety of food, they are unsustainable in the long run. Whether it’s food boredom or the body’s survival mechanisms kicking in, fad diets take a physical and mental toll on the dieter. Because the diets do not usually meet the recommended levels of micro or macronutrients, they can lead to hormone imbalances, headaches, digestive problems, fatigue, mental confusion, and even cardiac problems in severe cases. Fad diets are not about teaching healthy lifestyle changes or proper nutrition and exercise habits. The focus is on fast weight loss, no matter how unsafe. And unfortunately, when weight loss occurs that quickly it’s mostly lean muscle mass and water that are lost, not fat.

The fact that people don’t stick with fad diets is not news. If a fad diet actually worked, everyone would be doing it and there wouldn’t be the dozens of diets you see on the market. But just how large is that market? According to the FTC, Americans spend close to $34 billion a year on diet products. In order for the industry to grow that large, industry executives depend on dieters jumping on and off the different bandwagons. In other words, the diet industry wants you to fail. Fad diets create what I’m calling the Weight Loss Rollercoaster or the Vicious Cycle of Weight Loss. It goes something like this: (note the high-quality graphics I came up with in PowerPoint)

People are lured into a new diet with high hopes that this time it will be different. Initial weight loss occurs because of calorie reduction, not the advertised magic cure. The diet becomes unsustainable because the body is deprived. People fall off the dieting wagon with a slowed metabolism and binge impulses resulting from severe restriction. Lost weight is regained plus some more. Feelings of guilt and shame surface because  dieters feel responsible for the failure. And then we are back where we started with people being lured into a new diet with high hopes that this time it will be different. But it wont’ be.

So how do dieting veterans break out of this cycle? At some point you have to admit that there is not a quick fix, a magic pill, or a secret recipe for weight loss. If you are overweight, chances are it took you awhile to get that way, and likewise, it will take you awhile to get the weight off in a healthy way. I believe that the first step to adopting a healthy approach to weight loss is to accept the body you are in right now, perceived flaws and all. Learn to love who you are, nurture a deep respect for what your body can do, and then make small sustainable changes that lead you to a healthier life. Don’t focus on weight loss, fixate on a certain number on the scale or a size of clothes you wish to wear. Concentrate your efforts on being healthier all around and likely weight loss will follow. While this is much easier said then done, if you can take that first step to recognize the limitations of fad diets and put the blame for failure where it belongs (on the industry), you will be one step closer to ending the struggle.

Take it from a former dieting expert, there are usually only two ways a fad diet can end: failure and frustration when you give up, or disordered eating when you succeed.

Have you ever tried a fad diet? What was your experience like?

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