With regard to Dieting and Weight Issues, it is becoming clearly evident  that the members of the Medical Profession, including those who are part of the Scientific Community, are greatly in need of a REALITY CHECK.  A Reality Check is something which shows you that the real situation is different from what you believed or hoped. 

What is considered as "conventional wisdom" is that :

Most people burn X number of calories, and if they reduce that X number by 500 calories per day, in one week they will lose one fat pound (3500 calories = 1 fat pound). 

Therefore after doing this for 10 weeks, they will lose 10 pounds. Because they are now 10 pounds lighter, they will burn slightly less than the X number of calories their body needed before their weight-loss, and they can then easily eat that new X calorie number and maintain that weight loss.

This process can be continued indefinitely, and by following through, it will result in the body's loss of all "excess weight", and thereafter, will result in the body's maintenance of that "ideal weight" .  As a result of this people will become Thin and Healthy. 

At the bottom of this article, I give more detail about this numbers issue, but the POINT IS that while following this Basic Process gives short-term weight loss results, only a very few people ever achieve long-term weight loss results.  

Certainly, the REAL SITUATION Here is DIFFERENT from what the Medical Profession, the Scientific Community, and the General Public, BELIEVES or HOPES it to be.

DietHobby contains several articles about the dubious connection between being "Healthy" and being "Thin".  Also, some good points are made in the article below:

How Can You Say Weight Loss Doesn't Work? 

                By Ragen Chastain of danceswithfat

This is one of the most common questions that I get.  For people who've been steeped in diet culture - even if they've personally had the experiences of short term weight loss, long term weight regain, and yo yo dieting - have a hard time believe that successful long-term weight loss is something that almost never happens.  

That's certainly how I felt when I first started to read through the research.  I had a really difficult time believing that the idea that I could, and should, become thin to be healthy, - which was promoted and sold to me more aggressively than any other concept or product in my life, - was not only not based on research, but actually directly contraindicated by it.

The issue here is two-fold. 

First even if we believed that weight loss would improve health (though Mann and Tomiyama 2013 suggests that it doesn't), there isn't a single study in existence where more than a tiny fraction of people were able to achieve long term weight loss using any method. 

Statistically the most common outcome of intentional weight loss attempts (whether they are "diets" or "lifestyle changes" or any thing else that is an attempt to manipulate body size through diet and/or exercise) is weight regain.  

The thing that seems to cause the most confusion is that almost everyone loses weight short term, and we mistakenly believe that if we can lose weight short term, then we can lose weight long term, and maintain that weight loss.

The truth is that the vast majority of people regain their weight, and the majority gain more than they lost (see Mann and Tomiyama 2007).  So even if we think that being fat is a problem, given the current research, recommending weight loss is the worst advice we can give. 

Weight loss simply does not meet the ethical requirements of evidence based medicine, since we don't have any evidence that suggests that it will work for more than a tiny percentage of people; and we don't have any evidence that is able to link decreased weight to better health, controlling for behaviors. In fact when people decrease weight without changing behavior, (as in the case of liposuction for example) we don't see changes in health.

In fact, what we see over and over is that when people change their behavior, their health often improves, and often they lose weight short term. We then inexplicably credit the weight loss with the improved health, rather than crediting the behaviors. 

When studies control for behavior, we find that people of different sizes with the same behaviors have the same health hazard ratios and risks of all cause mortality. (See Wei et al, Matheson et. al, and the Cooper Institute Longitudinal Studies to start.)

We have no evidence that supports a weight loss intervention either for change in body size or a change in health; but we have a great deal of evidence for increased health through behaviors, regardless of starting weight or weight change associated with the behaviors. 

So, the ethics of evidence-based medicine require that we prescribe healthy behaviors to those interested in improving their health; or that if we give a weight loss intervention, we practice informed consent and let them know that almost everyone who attempts that intervention has the exact opposite of the intended result; and that we have no evidence that, even if the person is in the tiny minority who succeed, their health will be improved.

We should also be very clear that neither health nor healthy habits are an obligation - nobody owes anybody health or healthy habits by any definition.  Everyone gets to choose how they prioritize their health and what path they want to take to get there.  Also, regardless of habits, health is never guaranteed and never entirely within our control.  Finally health is not a barometer of worthiness, and our health isn't anybody else's business unless we make it their business.

People are allowed to disagree with this, but let's not pretend that disbelief, however indignant or authentic or well meaning, is the same thing as evidence-based conclusions. 

The idea of weight loss creating health is what I call a Galileo Issue - it's widely believed, fervently supported, it's heresy to suggest that it's not true, and yet it is not supported by evidence. We have to start basing our interventions on evidence over "everyone knows" if we hope to actually give people accurate information.

For links to research studies cited, see the original article at danceswithfat. 

 Warning:  Math Ahead 

Now, . . . more about the body's X numbers that I mentioned above. 

Various mathematical formulas exist which provide information on what the actual X number of calories (BMR or RMR) that any one person's body uses daily. The Harris-Benedict, and Mifflin, are the most commonly used.

The X numbers provided by these formulas are based on statistical AVERAGES.  An AVERAGE is a level that is typical of a group; a middle point between extremes.

There are many online calculators for BMR or RMR.  I've listed several here at DietHobby under RESOURCES, Links, Helpful Tools. 

People who faithfully follow the above-stated process which I talked about at the beginning of this article, … but who do not achieve the "expected" weight-loss or maintenance-of-weight-loss results  … are judged to (1) be lying about their eating compliance, or (2) have the body of an "Outlier".

An OUTLIER is someone who stands apart from others of his or her group.

 In Statistics, an Outlier is an observation that is distant from other observations. In most larger samplings of data, some data points will be further away from the sample mean (the average) than what is deemed reasonable.  

How far away from the group must one be to be considered an Outlier? There is no rigid mathematical definition, and what constitutes an Outlier is ultimately a SUBJECTIVE exercise, a judgment call by the researcher. 

A small number of Outliers is to be expected, and is not due to any unusual condition. However, sometimes, all Outlier data is totally excluded from the data that is used to determine the AVERAGE.

Outliers can arise due to errors made in the study, OR Outliers could be the result of a flaw in the assumed theory, calling for further investigation by the researchers.  Additionally, the presence some Outliers indicate that the causative mechanism for the data might be different at extreme ends. 

 I've learned that Medical Professionals tend to totally ignore the information that I try to provide about my personal weight-loss and maintenance experience, even though this involves 10 years of detailed records involving my daily food input data, and my daily scale weights.  They simply will not accept the low calorie number that I have to continually eat in order to maintain my weight-loss, and they find that my continual upward calorie creep upwards -- despite my low-calorie eating -- to be either unbelievable, or totally abnormal.  

The standard response is that I am either untruthful or mistaken about my food intake.  If I am insistent about my accuracy, then I am told that I must be an "Outlier", that the way my body behaves is not normal. 

I now suspect that the way my body behaves with food IS far more normal than experts have led me to believe. However, it IS true that my weight-loss and maintenance of weight-loss RESULTS are not "Typical", because I am one of that very tiny percentage who has lost an enormous amount of weight, and has now kept it off for more than 8 years.  

It has taken me an enormous amount of vigilance and effort to achieve this. For more, see: Running DOWN the UP Escalator. 

Research studies on the subject of misinformation show that:  

When information doesn’t square with someone’s prior beliefs,

Not all false information goes on to become a false belief -- meaning: a lasting state of incorrect knowledge -- and not all false beliefs are difficult to correct.

For example astronomy. If you were asked to explain the relationship between the Earth and the Sun, you might do so incorrectly, and a friend who understands astronomy might correct you. No big deal, you simply change your belief.

But in the time of Galileo, the view of the Earth-sun relationship was tied closely to ideas of the nature of the world, the self, and religion. If Galileo tried to correct your belief, the process wouldn't be as simple.

The crucial difference between then and now, is the IMPORTANCE of the Misperception.
 When there's no immediate threat to our understanding of the world, we change our beliefs. Problems occur when that change contradicts something we hold as important.

False beliefs stem from issues closely tied to our conception of self. False beliefs, it turns out have a great deal to do with self-identity; What kind of person am I, and what kind of person do I want to be? This self-identity issue affects all ideologies.

Facts and evidence simply aren't that effective, given how selectively they are processed and interpreted.   Strongly held beliefs continue to influence judgment, despite correction attempts … even with a supposedly conscious awareness of what is happening.

When someone believes something strongly,  new information isn't going to change their mind.  
 They will simply disregard that information. 

Learning this truth has helped me avoid many issue-related arguments.  
I have finally come to realize  that when someone strongly holds a belief that has clearly been proven to be incorrect, trying to get them to change their mind is a waste of my time.  I can choose to share information if the opportunity arises, but if that information is rejected, its best to simply walk away.

I am now I'm now in my 9th year of maintaining a "normal" weight after a large weight-loss.

Accomplishing this has been incredibly hard, and, even after all these years, this task is not getting any easier for me.
See: Running DOWN the UP Escalator.

The Truth about weight-loss and maintaining weight-loss isn't something that we're EVER going to hear from Marketing Interests … (which includes most doctors and nutritionists) … however, Facing it, Understanding it, and Accepting it, can be very helpful.

Below is a recent CBS news article discussing this issue.

Obesity research confirms long-term weight-loss almost impossible. 
                          by Kelly Crowe, CBS news 6-4-14

There's a disturbing truth that is emerging from the science of obesity. After years of study, it's becoming apparent that it's nearly impossible to permanently lose weight.

As incredible as it sounds, that's what the evidence is showing. For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear. "It couldn't be easier to see," she says. "Long-term weight loss happens to only the smallest minority of people."

We all think we know someone in that rare group. They become the legends — the friend of a friend, the brother-in-law, the neighbor — the ones who really did it.

But if we check back after five or 10 years, there's a good chance they will have put the weight back on. Only about five per cent of people who try to lose weight ultimately succeed, according to the research. Those people are the outliers, but we cling to their stories as proof that losing weight is possible.

"Those kinds of stories really keep the myth alive," says University of Alberta professor Tim Caulfield, who researches and writes about health misconceptions. "You have this confirmation bias going on where people point to these very specific examples as if it's proof. But in fact those are really exceptions."

Our biology taunts us, by making short-term weight loss fairly easy. But the weight creeps back, usually after about a year, and it keeps coming back until the original weight is regained or worse.

This has been tested in randomized controlled trials where people have been separated into groups and given intense exercise and nutrition counseling.

Even in those highly controlled experimental settings, the results show only minor sustained weight loss.

When Traci Mann analyzed all of the randomized control trials on long-term weight loss, she discovered that after two years the average amount lost was only one kilogram, or about two pounds, from the original weight.

Tiptoeing around the truth

So if most scientists know that we can't eat ourselves thin, that the lost weight will ultimately bounce back, why don't they say so?

Tim Caulfield says his fellow obesity academics tend to tiptoe around the truth. "You go to these meetings and you talk to researchers, you get a sense there is almost a political correctness around it, that we don't want this message to get out there," he said.

"You'll be in a room with very knowledgeable individuals, and everyone in the room will know what the data says and still the message doesn't seem to get out."

In part, that's because it's such a harsh message. "You have to be careful about the stigmatizing nature of that kind of image," Caulfield says. "That's one of the reasons why this myth of weight loss lives on."

Health experts are also afraid people will abandon all efforts to exercise and eat a nutritious diet — behavior that is important for health and longevity — even if it doesn't result in much weight loss.

Traci Mann says the emphasis should be on measuring health, not weight. "You should still eat right, you should still exercise, doing healthy stuff is still healthy," she said. "It just doesn't make you thin."

We are biological machines

But eating right to improve health alone isn't a strong motivator. The research shows that most people are willing to exercise and limit caloric intake if it means they will look better. But if they find out their weight probably won't change much, they tend to lose motivation.

That raises another troubling question. If diets don't result in weight loss, what does? At this point the grim answer seems to be that there is no known cure for obesity, except perhaps surgically shrinking the stomach. 

Research suggests bariatric surgery can induce weight loss in the extremely obese, improving health and quality of life at the same time. But most people will still be obese after the surgery. Plus, there are risky side effects, and many will end up gaining some of that weight back.

If you listen closely you will notice that obesity specialists are quietly adjusting the message through a subtle change in language.

These days they're talking about weight maintenance or "weight management" rather than "weight loss."

It's a shift in emphasis that reflects the emerging reality. Just last week the headlines announced the world is fatter than it has ever been, with 2.1 billion people now overweight or obese, based on an analysis published in the online issue of the British medical journal The Lancet.

Researchers are divided about why weight gain seems to be irreversible, probably a combination of biological and social forces. "The fundamental reason," Caulfield says, "is that we are very efficient biological machines. We evolved not to lose weight. We evolved to keep on as much weight as we possibly can."

Lost in all of the noise about dieting and obesity is the difficult concept of prevention, of not putting weight on in the first place.

The Lancet study warned that more than one in five kids in developed countries are now overweight or obese. Statistics Canada says close to a third of Canadian kids under 17 are overweight or obese. And in a world flooded with food, with enormous economic interest in keeping people eating that food, what is required to turn this ship around is daunting.

"An appropriate rebalancing of the primal needs of humans with food availability is essential," University of Oxford epidemiologist Klim McPherson wrote in a Lancet commentary following last week's study. But to do that, he suggested, "would entail curtailing many aspects of production and marketing for food industries."

Perhaps, though, the emerging scientific reality should also be made clear, so we can navigate this obesogenic world armed with the stark truth — that we are held hostage to our biology, which is adapted to gain weight, an old evolutionary advantage that has become a dangerous metabolic liability. 

Dr. Yoni Freedhoff, whose new book, The Diet Fix is featured here in DietHobby's BookTalk section, made this comment about the above-quoted article:

 

I think what makes maintaining weight loss seem "almost impossible" are the goal posts society has generally set to measure success. 

 

No doubt, if the goal set is losing every last ounce of weight that some stupid chart says you're supposed to lose then the descriptor "almost impossible" may well be fair. 

On the other hand, if the goal is to cultivate the healthiest life that you can honestly enjoy, subtotal losses, often with significant concomitant health improvements, are definitely within your reach. 

Ragen Chastain of DanceswithFat says: 

If you read the comments on the article, you’ll see that many people subscribe to the magical power of semantics.  If you attempt intentional weight loss, but instead of dieting you call it a lifestyle change, they claim you won’t gain your weight back.  This is the second to the last stop on the denial train, at the final stop people just close their eyes, stick their fingers in their ears, and scream LA LA LA! 

Studies have shown that when people diet, their bodies change biologically for the express purpose or regaining and maintaining weight,

.... but it really doesn’t matter at this point why weight loss fails almost all the time.  The fact that it does means that weight loss does not meet the criteria of evidence based medicine.  If a prescription fails almost all the time, often having the exact opposite of the intended result, (and especially when that happens consistently for more than 50 years,) the solution is not to keep prescribing that intervention and tell people to try harder.

This is the world that diet culture built. Doctors, diet companies, internet commenters, people’s mamas and everyone else have been telling us that being thin is the only path to health and that if healthy habits don’t make us thinner than they won’t make us healthier.  Society says that the only “good” body is a thin body. Now we find that if healthy habits don’t make us thinner we “tend to lose motivation.”  I forget, what’s the word that means the opposite of “shocking”?

The solution is to stop worrying if the truth is “stigmatizing” and start telling the truth early and often.  Telling the truth with the same veracity that people post anti-fat, pro weightloss diatribes in the comment sections of every article that exists on the internet.

Public health should be about making as much true information and as many options as possible available to the public, and then letting people make their own decisions.

Health is not an obligation, a barometer of worthiness, or completely within our control. Each of us gets to choose how highly we prioritize our health and the path that we want to take to get there and those decisions can also be impacted by forces outside of our control.

The other part of the solution is to stop stigmatizing fat people. The article waxes tragic about the fact that fat people are unlikely to get thin, but the truth is we have no idea what our health would be like if fat people weren’t faced by constant stigma.  We have no idea what our health would be like if fat people stopped feeding our bodies less fuel than they need to survive in the hopes that they will eat themselves and become smaller (aka weight loss). Since statistically the best way to gain weight is to diet, we don’t know what our society body size distribution would look like if we stopped doing it. Maybe if enough people refuse to perpetuate the lie of weight loss and start telling the truth, we can find out.

My own view is, that just because something is hard, doesn't mean it is impossible.  

Losing weight is hard.
Maintaining weight-loss is hard.  
Being fat is hard.  
Choose your hard.
  

Each of us needs to decide for ourselves, whether or not we want to attempt to "climb the weight-loss mountain", and, if so, what individual path will work best for us personally.