A Fresh Start?

                                                       
A fresh start?

Recently I've been thinking about the concept of a "fresh start" as it relates to dieting, weight-loss, and maintenance of weight-loss.

My own belief is that every diet works for someone, and every possible type of eating is actually a diet… including all of the intuitive eating, "non-diets" etc. Just SAYING it isn't a diet, doesn't change it's nature. As far as I'm concerned, despite all of the factors like total amount eaten, timing of eating, or micronutrients eaten, if it's food, and if it goes into one's body, it's some type of diet.

Most people begin each new weight-loss diet, "healthy" diet, or new food plan, with some emotional energy, hope, and enthusiasm. Over time, Reality intrudes, and that energy grows dim, and sometimes fades away. At that point, many of these people "take a break" from their diet, or food plan, and return to their former eating habits. This break can be for a short time or a long time, but almost all of them will eventually decide to again alter their ongoing way of eating, telling themselves they are getting "a fresh start".

My personal choice, at present, is to change maintenance food plans frequently…but without allowing any "free" space for overeating, between plans. For the past 8 years I've recorded all of my food every day into a computer software program, no matter what food, how much food, or when that food was eaten. This has been my bottom line consistency factor.

My take is that there needs to be a balance between consistency, patience, endurance, and effort and keeping our daily experiences from getting "stale". "Stale" is the opposite of "fresh", and means tasteless or unpalatable from age; tedious from familiarity, or impaired in vigor or effectiveness.

Although we all share common factors as human beings, each of us is an individual, with genetic, cultural, and behavioral history differences. Weight-loss is hard for almost every overweight or obese person, and maintenance is even harder yet.

The science behind why we weigh what we weigh is hugely complicated. The number of physiological factors governing our ability to maintain, lose or gain weight is staggering. Leptin, leptin resistence, ghrelin, insulin, insulin resistence, and a whole host of other chemicals and chemical reactions in our bodies come into play.

Here's an interesting article I recently read in Big Fat Facts, written by a long-time weight-loss maintainer that talks about the tremendous problems involved in success with losing and maintaining weight.

The Truth About Long-Term Diet Success

An oft-quoted but rarely cited statistic is that diets fail 95 percent of the time. That figure dates back to a 1959 study of 100 people. The study was conducted by Dr. Albert Stunkard, now a researcher with the University of Pennsylvania, and Mavis McLaren-Hume. It concluded that "(m)ost obese persons will not stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it." It was a brazen statement at the time, when doctors and other experts thought that treating obesity was as simple as handing a patient a "plan," and it was likely accurate. It may still be accurate, though we do not know.

Two 1992 reports from the National Institutes of Health have been quoted as corroborating this 95 percent failure rate. The executive statement of one report asserts: "Data show that many individuals regain one-third to two-thirds of intentionally lost weight within 1 year and regain the rest of the weight within 5 years." While this report stops short of stating a figure, it has been used in support of the 95 percent assertion because it references several studies with different but dismal results, some even worse than 5 percent success:

Kramer and colleagues (1989) found that less than 3 percent of subjects were at or below posttreatment weight on all followup visits.  Other researchers have documented similar findings (Graham et al., 1983; Stalanos et al., 1984). With respect to obesity treatment in adolescents, Rees (1990) reported that 85 to 95 percent of patients regain at least as much weight as they lost and Stalonas and colleagues (1984) found evidence that patients regain even more weight than the initial weight lost.

This NIH report also references the analysis of David Garner and Susan Wooley, a 51-page review of diet research and diet failure, that has also been used to support the 95 percent claim and concludes there is no "scientific justification for the continued use of dietary treatments of obesity. . . . Most participants regain the weight lost. The inevitability of this result is often obscured by the use of follow-up periods insufficient to capture the later phases of weight regain."

Many have marginalized the 95 percent figure, but few scientists have challenged it directly with original research or analysis, and that is likely because few are so motivated. The wise people who tell us that "diets don't work" have no interest in finding a different figure. This one proves their point sufficiently. The researchers funded by the pharmaceutical industries want a low benchmark to beat when they finally find the "wonder pill" that will reverse obesity in, say, 12 percent of the population as opposed to 5 percent. They'll tout it as "more than twice as effective as conventional dieting." The people who run the commercial diet programs are not interested in learning that the real rate of success might be 8% or 10%, which might mirror their own success rates compared to that 5% figure.

 The researchers at the National Weight Control Registry (a project dedicated to documenting diet success stories) have recently challenged the 5 percent figure, but they have done so by redefining "success" modestly  as "intentionally losing 10 percent of initial body weight and maintaining that loss for at least a year." They assert (though they stop short of saying they have proven) that under this new definition, the "success" rate is probably closer to 20 percent.

We must conclude that we don't know the long-term success and failure rates of diets, but what we do know is depressing. Do we really embrace the idea that just one year of maintaining 10% weight loss is success? (We would want to ask a "successful" dieter who has regained all her weight plus ten pounds, and who started that humiliating process on day 366 or shortly thereafter.) Moreover, regardless of how diet "success" is defined, even the most cynical researchers, who support weight-loss dieting for health or social purposes, agree that diets fail at least 80 or 90 percent of the time.

This fuzzy problem has implications for both scientists and everyday citizens. For scientists there is an implied challenge to define "success" using fair language that average citizens would embrace if they were to achieve it, and then test that definition and give us a real number to work with. For everyday citizens, even lacking a solid number, the knowledge that diets do "fail," by even the weakest definition, 80 percent of the time or more begs a question: would we board an airplane that had only a 20 percent chance of landing safely?