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Lying Liars —

December 18, 2013

Weight LossFat HealthFat ScienceExerciseEating DisordersDickweedDiet Talk

Trigger warning: This post is all about weight loss research and the unhealthy lifestyle changes that weight loss gurus promote.

One thing I’ve always found amusing is how in order to be deemed an expert on weight loss (like Maria Kang), you must simply do one thing: lose weight. If you lose 100 pounds and have theDiet Help entrepreneurial spirit, you can open up shop on the internet and start dispensing advice like you’re Lucy from Peanuts.

That’s what the Capitalism is all about, right? If you’ve got the chops, you can make a living by offering goods or services that the public wants or needs. That’s all well and good, but what irritates me is that the fact that these self-ordained experts are assumed to be telling the truth about their lifestyle, regardless of the gaping holes in their story. Setting aside the fact that Kang promotes the idea that a 1,400-calorie diet is a both healthy and a sustainable lifestyle choice, I pointed out that Kang’s claim that she’s a working mom, just like you, is bullshit. But this kind of criticism goes ignored when the mainstream press gives coverage to weight loss gurus.

You may recall about three years back the media went ballistic when Redbook magazine featured an article and photo of Jillian Michaels as a fat teenager, saying that at her heaviest she was 5’2″, 175 pounds. As “proof,” they included the infamous photo of her as a fat teen.

Jillian Michaels Fat

Of her weight struggles as a teen, Michaels said “Oh, my God, it was pure hell.”

Michaels’ “fat” photo isn’t exactly revealing a fat kid. She’s wearing a bulky, dark shirt and her arms are crossed over her stomach. I get the distinct impression that this photo was specifically chosen because it obscured Michaels’ body enough that it’s suggestive of “fat” without actually appearing fat.

And yet, people will talk about how Jillian Michaels went from fat to fit, as though it’s certified fact. Why? Because she said so.

The same goes with the lifestyle choices of Kang and Michaels. They claim that they lead healthy lifestyles and we assume they are right because, after all, they’re thin. Clearly they have the answers and we should heed their advice, as weight loss gurus. But what we don’t see is what goes on behind closed doors. How much does Jillian Michaels actually devote to exercise? How much does she actually eat? She’s crystal clear about what she thinks the contestants on Biggest Loser (TBL) should do. She explains her TBL regimen in a Washington Post interview:

On the show my team does 1 hour of cardio in the morning. Then in the afternoon we do an hour of resistance training as outlined in my book followed by another hour of cardio. Then one more hour of cardio in the evening… We do take Sunday completely off – no exercise whatsoever.

So, in this article, Michaels claims that she has her team do three hours of cardio per day and one hour of resistance training for a total of 24 hours of exercise per week. But as I noted in last year’s Biggest Loser round-up, when contestant Alex can’t meet her expectations on the treadmill, Michaels tells the camera, “Alex works out for two hour segments, three times a day. There is absolutely no way this girl cannot jog at six miles an hour for five minutes on a one incline.” Assuming she still means they take Sunday off, that’s still 36 hours of exercise per week.

Likewise, Michaels says in that same WaPo interview regarding her contestants on the show, “My boys are not on low calorie diets. They are all consuming between 1800 – 2500 cals per day depending on their unique metabolic requirements.” But former TBL contestant Kai Hibbard told Golda Poretsky that they were put on 1,000 to 1,200 calorie diets.

As for her own lifestyle choices, Michaels claims that she eats 2,000 calories per day and works out strenuously two to three hours a week. And in this interview, Michaels claims she goes to the gym three or four times a week.

Here’s what bothers me, though: we take Michaels’ claims at face value. If she says she works out strenuously just three hours a week and eats 2,000 calories a day, we give her the benefit of the doubt and say okay. The same goes for Kang or any other expert: whatever they claim is the lifestyle that allows them to maintain their body, that must be true because look at their body!

And then there’s Health At Every Size® (HAES), which is largely comprised of former dieters who have tried anything and everything there is to try: different caloric levels, different macronutrient combinations, different exercise intensities, different supplements and more. We have the exact same experience that all of the weight loss gurus have with one exception: we either haven’t had the dramatic results or we haven’t maintained the weight loss.

But when people ask us about our experience, the response could not be more different from the response that Michaels and Kang get. If I said, “I followed Jillian Michaels’ book Wow, Look, You’re Not a Fatass Anymore to a T and only lost 15 pounds,” what is the response from Michaels or anyone else? Either you’re lying or you were somehow doing it wrong.

When presented with personal experience of diets having failed or dieters having gained weight back while still on the diet program, weight loss gurus immediately begin their 12-point diagnostic check. They know that the problem is you, not the program they endorse, so they will ask you detailed questions about what you’re eating, how you’re eating, when you’re eating, where you’re eating, what you’re exercise is, how long, how intense, how frequent, how varied. During this diagnostic check they will pinpoint where you went wrong and tell you that if you just do X, Y, and Z, you’ll start losing weight again and be thin again in no time.

This is how weight loss gurus persuade the public that despite overwhelming evidence to the contrary, their system works. If it weren’t for those pathetic people fucking up their instructions, we’d all have tight, toned bodies and type 2 diabetes would be cured.

When diets succeed, the weight loss gurus are truth-tellers, but when diets fail, the dieter who claims strict adherence is a liar.

Nobody ever seems to question whether Michaels might be lying about how much she exercises or how many calories she eats. Perhaps she doesn’t want it to seem like she’s obsessed with exercising or has an eating disorder, so she makes her regimen sound friendlier and easier than it really is. Can any of us know for sure what Jillian Michaels does behind closed doors? Nope. And yet weight loss gurus get to openly doubt the claims of any and all failed dieters because their fat bodies are the proof that they are lying.

This is the very root of skepticism over HAES: former dieters who claim diets don’t work were probably just doing it wrong all along, or else they didn’t try Guru X, Y or Z, who would have set them straight right away.

When I debate HAES skeptics, this inevitably comes up. They want me to show them irrefutable proof that failed dieters aren’t just bad liars. It doesn’t matter if I write an exhaustively-sourced explanation of why calories in/calories out is bullshit, it doesn’t matter if all the obesity experts have lowered expectations to define “clinically significant weight loss” as losing 5%-10% of your starting weight. What matters is that there’s a bunch of people on reddit who post before and after photos of their weight loss success and that failed dieters lie. Period. End of story. No need for further debate.

And yet I continue to debate them. Why? I consider concern trolls a whetstone to sharpen my rhetorical skills and arguments. I especially find it valuable when a concern troll can express their dissent without going all argle bargle on me. Two weeks ago, I posted my response to two studies that declared “fat and fit” dead, and included a lengthy rant about the reddit trolls who I can’t appease, no matter how much evidence I present. All I get back from them is argle bargle, including a Fitness Circlejerk response to this post (note: their infatuation with me is such that they have changed every redditor’s name to “fatchka”… I’m touched, boys).

At one point, a troll claimed he was going to get a copy of the study and prove that I was cherry-picking my studies, that I misinterpreted them, that the study was shit. I was kind of looking forward to an actual analytical response, rather than the argle bargle surrounding it. But as you can see in that thread, OP left us hanging. There would be no brilliant analysis that day.

Fast forward to two days ago and there’s a new question on our /r/AskHAES subreddit from /u/HAESFTW: Is there any evidence that weight regainers are actually following the diet when they regain the weight?

I clicked on it and there’s a brief followup:

If not why do we blame the diet for weight regain?

How is that any different from a freshly tanned person stopping their tanning bed routine and blaming the bed itself for making them pale months/years later ?

It’s a fair question, but a terrible analogy. My co-moderator /u/LesSoldats provided some answers, but HAESFTW wasn’t satisfied. He then points to Linda Bacon’s HAES Manifesto (PDF), in particular, this passage:

Assumption: Anyone who is determined can lose weight and keep it off.

The vast majority of people who try to lose weight regain it, regardless of whether they maintain their diet or exercise program. This occurs in all studies, no matter how many calories or what proportions of fat, protein or carbohydrates are used in the diet, or what types of exercise programs are pursued. Many studies also showthat dieting is a strong predictor of future weight gain.

His complaint is that there is no proof that people who maintain a diet and exercise program will regain the weight, as opposed to the more likely outcome that the dieter has simply stopped following the diet and/or exercise regimen. Again, this is absolutely a fair point, and one that LesSoldats addresses in terms of the psycho-social reasons that diets fail. But that answer is not “evidence” as the main question requests.

As I said in my “fat and fit” myth-busting post, I haven’t done as much data dredging as I have in the past because it’s incredibly time consuming. But because HAESFTW was relatively respectful (compared to most of the argle bargle dissent we get), I decided to delve into the details and respond. It’s a lengthy response that uncovers more resources, more data and more info that sheds light on what we mean when we say diets don’t work. So, I am posting the conversation in its entirety below as a resource for everyone.

The bottom line is, diets don’t fail because failed dieters are liars, but because the only diets that yield substantial, noticeable weight loss in a statistically significant portion of the population are the same diets that are largely unsustainable for many, many reasons. The problem isn’t that you are a lying dieters, it’s that the expectations surrounding diets and weight loss are built on lies, half-truths, insinuations, shitty research and, above all, cults of personality.

This is a long exchange, but worth the effort, I think.

Proving the Unprovable

HAESFTW

Is there any evidence that weight regainers are actually following the diet when they regain the weight?

Atchka!

There are two arguments about why people regain the weight. The first is biological: when you engage in the kind of severe caloric restriction necessary to lose significant amounts of weight (to put a number on it, let’s say 1,600 calories or less), you trigger hormonal changes in your body that push back against that caloric deficit, both physically and emotionally. I explain the response the body has to caloric restriction in this post and go into details about leptin, ghrelin and adaptive thermogenesis. In a nutshell, your body does everything it can to preserve what few calories you’re taking in (particularly when that caloric restriction is coupled with increased exercise). This is the semi-starvation neurosis that is most noticeable in the Minnesota Starvation Experiment (an extreme variation), but the symptoms of which appear in those engaging in the kind of restriction I’m referring to. It’s your body’s way of trying to urge you to find more calories. As a result, most people find that kind of lifestyle unsustainable because of the links between stress and leptin/ghrelin and the effects I explain in that post above. Your tanning analogy is inadequate because there’s no compensatory reaction when you tan, whereby your body urges you to stop tanning, unless you count melanoma. Even then, it’s not something internal that makes tanning itself uncomfortable or unpleasant. It’s an external cue that you’re tanning too much. A better analogy would be if you’re a runner and you push yourself further and further, harder and harder because you believe that if you just work hard enough you’ll be the fastest person on earth. But there are internal cues (soreness, fatigue, injury) that are your body’s ways of telling you to knock it off. You can ignore those cues (and many do) and continue your training regimen, but many people will find the increased regimen unsustainable, then fall back either to their less rigorous habits or quit training all together. So whose fault is it if you don’t keep training at that higher level? In a simplistic sense, you can say the runner. If they just stuck with it, their body may eventually yield the results desired, but something interfered. That “something” is the unsustainability of your goal. If that runner chose smaller, more sustainable goals, then they would have an easier time sticking with their training until they achieve the desired success and are less likely to burnout, get sore or injure themselves.

A key question is: how does the runner benefit from the more or less intense regimen. If the runner’s goal is to be the fastest person in the world, the benefit is largely to the ego. You want to achieve a status that is nice to have, but not necessary. If the runner’s goal is to be healthy, then that more intense regimen is not necessary. There’s no added health benefit of running two miles a day versus five miles a day, thanks to the law of diminishing returns. So, if your goals are more reasonable (health vs. fastest person), the actions necessary to achieve those goals are more likely to be sustainable.

Bringing this back to HAES: the person who wants to be the fastest person on earth is the 400 pound person who wants to be a 180 pound person because they will be more physically attractive (setting aside your belief (I’m assuming here) that going from 400 to 180 is the healthiest option). It’s more of an ego-based goal that requires lifestyle changes that are largely unsustainable. The runner who is seeking health, however, is like the person who makes health their goal, rather than huge amounts of weight loss. I hear you objecting, but here’s the fact: most people who engage in healthy lifestyle changes do not lose huge amounts of weight. Weight loss research defines “clinically significant weight loss” as between 5% and 10% for that very reason. If you read weight loss research, you’ll find a distinct pattern: the lower the calorie intake, the greater amount of weight subjects lose at first, but after one year, there’s no difference between those who eat 800 calories and those who eat 1,600. And those people who eat 1,600 calories aren’t losing huge amounts of weight either. But both groups gradually regain weight. Your original question is whether people who regain are sticking to their diet, but that’s a nearly-impossible study to run. How do you determine which subjects are sticking to their diet and which are “cheating” without performing a Minnesota-style experiment where subjects are essentially imprisoned? The best study I’ve seen, which attempts to account for this is the two-year trial of the Alabama EatRight program. EatRight describes itself this way:

EatRight is a lifestyle-oriented weight control program designed to beat the odds of the weight-loss battle by easing participants into new eating and exercising habits.

Sounds reasonable, right? So, they go through this program, learn to eat energy-dense, healthy foods and exercise more. They all lose some weight after completing the program, then they are followed for the next two years to see how successful they are at maintaining their weight loss.

Subjects were divided into Maintainers (defined as those gaining less than 5% of body weight since completion) and Gainers (those who gained more than 5%). The “successful” Maintainers had a mean starting weight of 199 pounds, ended the program weighing 193 pounds, and two years later weighed 190 pounds. But here’s the striking thing: unadjusted mean intake for maintainers was 1608 calories, whereas calorie intake for gainers was 1,989 calories. So even the most dedicated subjects who stuck with that 1,600 calorie diet for over two years managed to lose just 4.5% of their starting weight.

So an even bigger problem than regaining weight is that we have this grossly unrealistic idea that 3,500 calories = 1 pound. There’s a great study (PDF) by a team from the NIH that actually looked into this belief. They began this way:

This ubiquitous weight-loss rule (also known as the 3500 kcal per pound rule) was derived by estimation of the energy content of weight lost but it ignores dynamic physiological adaptations to altered body weight that lead to changes of both the resting metabolic rate as well as the energy cost of physical activity.

The equation they came up with that aligns with most weight loss research is that for every 10 calories restricted per day, a person will experience one pound of weight change. But there’s a stipulation: half of the weight change will be achieved in about one year and 95% of the weight change in about three years.

Think about that. We’re told to believe that if I restrict 3,500 calories in a week, then I should lose one pound during that week. But this team from the NIH says it’s more like if you restrict 500 calories each day (or 3,500 per week), then you should expect to lose a total of 50 pounds, but the catch is that you will lose 25 pounds after one year and you will reach 48 pounds after three years.

So the way I see it is that people have been given these unrealistic expectations for what caloric restriction achieves. Someone jumps on a 1,600 calorie “EatRight Alabama”-type lifestyle change and only lose 5% after two years, and that 1,600 calorie diet is so miserable due to hormonal responses and/or whatever life changes may occur (as /u/LesSoldats discussed) that they give up those changes, along with whatever metabolic benefits they may have achieved, and regain the weight. This is the runner with the unrealistic expectations.

HAES seeks to reset expectations entirely, focusing on making sustainable lifestyle choices that have demonstrable effects on your health. And you measure “health” not by how much weight you lose, but by how it improves your metabolic indicators. This is the sustainable path of the runner with realistic goals.

To sum up:

tl;dr: We blame the diet because it’s unsustainable for the vast majority of people and the ubiquitous expectations of 3,500 calories per pound lead to inevitable disenchantment with lifestyle changes. Weight regain is incredibly complicated and simply assigning blame to the dieter is inadequate when you look at the totality of evidence.

HAESFTW

If not tanning, how about following a budget. What makes weight loss different than getting out of debt? I think you are propping up a bit of a straw man argument. As if all weight loss efforts need to mirror the Biggest Loser. That’s the equivalent of telling the person trying to get out of debt that they should live in their car to save money. I would agree that intensity is not sustainable and would also back a less aggressive calorie deficit. Someone following a budget is fighting similar internal biological urges as someone on a diet.

http://www.newsweek.com/new-science-behind-your-spending-addiction-68063

So at what point do we vilify financial advisors for advising people in debt to follow a budget?

I don’t understand how you can say the following…

” If you read weight loss research, you’ll find a distinct pattern: the lower the calorie intake, the greater amount of weight subjects lose at first, but after one year, there’s no difference between those who eat 800 calories and those who eat 1,600. And those people who eat 1,600 calories aren’t losing huge amounts of weight either. But both groups gradually regain weight. “

or how Linda Bacon could say the following…

“The vast majority of people who try to lose weight regain it, regardless of whether they maintain their diet or exercise program. This occurs in all studies, no matter how many calories or what proportions of fat, protein or carbohydrates are used in the diet, or what types of exercise programs are pursued.”

Yet at the same tell me that “Your original question is whether people who regain are sticking to their diet, but that’s a nearly-impossible study to run.”

If its impossible to determine whether or not the individuals are sticking to their diet why do you appear to embrace the idea that an individual can eat 800 calories (or apparently even less than that in Ms. Bacon’s case) and still regain weight. How do we know they are actually eating 800 calories?

I couldn’t get the study to open but I found it through here.

http://www.medpagetoday.com/PrimaryCare/Obesity/28204

When people gain weight, their baseline energy needs increase, to keep the extra tissue alive and to move it around. Likewise, when weight is lost, their baseline needs decrease. So when people cut calories below the baseline requirement — thereby triggering weight loss — the gap between their intake and their baseline energy needs begins to shrink. At some point, it may disappear altogether, at which point weight loss stops.

The problem isn’t that a 3500 calories deficit doesn’t roughly equal one pound of fat. It’s that the what started as 3500 deficit in week one will be closer to a 0 deficit in week 104. Fat bodies require more calories than slimmer ones. That’s it.

Atchka!

The budget analogy fails because you can account for all the variables that affect an individual. A financial planner can request enough paperwork that they know exactly how much your income and expenditures are. The human body is not a budget, and individual mileage may vary.

As far as making it the all-or-nothing approach, my point wasn’t that your only options are very low calorie diets or unrestrained gluttony. It’s that the only lifestyle change that produces significant results, defined as an average of 15% after a year, are VLCDs. And if you want me to believe anything you have to say about weight loss, then you’re going to have to show me a study that gets these kind of results without pointing to yourself or some series of photos on reddit. Because it’s anecdotal evidence.

Yes, there are hundreds of thousands of people who lose 50 or 100 or 150 pounds every year, but we don’t consistently learn of their ultimate success or failure after one, two, five years. The successful people are self-selecting, and we never know the true followup rate these amazing success stories. But of those hundreds of thousands of people who achieve their goal of losing 50 pounds or more are a sliver of the millions of people who try and don’t get anywhere near the results we’re talking about. The people who successfully lose weight get to explain how they did it, but for some reason when the people who fail at losing weight explain how they did it, they’re assumed to be liars. The entire premise of your question is that the reason a majority of people fail to lose weight is that they don’t follow the diet, and those who claim they do follow that diet are liars. But whether they are lying or not, their explanation is irrelevant to the argument because they are also anecdotal evidence.

You specifically asked for evidence that proved “weight regainers are actually following the diet when they regain the weight.” So, that rules out me pointing you to the many, many, many people I know who have tried anything and everything from caloric restriction to paleo and not gotten results. They’ve exercised, followed the rules and done everything right, but not had the same experience that the successful people have. This is when the successful people begin their diagnostic check. “Have you tried X? Have you tried Y? Have you tried Z?” This kind of anecdotal evidence that diets don’t work is immediately dismissed. What other evidence is there? If you know of some long-term, peer-reviewed research that is able to reliably monitor the dietary habits of subjects, please share. If not, the evidence you’re asking for is harder to come by because it would be incredibly expensive and difficult for any research team to do a long-term controlled study that actually proves subjects do or do not follow diets when they do not lose much weight.

What this means in terms of your question is that it’s a question with an answer guaranteed not to satisfy you. You want evidence and the closest evidence available is only suggestive of what you’re asking. The only study in existence that answers your question is the Minnesota Starvation Experiment, which only happened due to a remarkable set of circumstances around WWII. But because that evidence doesn’t exist, you feel like this completely negates HAES because we can’t prove an impossible question.

But what we can ask and answer is “What happens when we have subjects follow a particular diet and/or exercise routine after X number of years?” This kind of evidence simply shows us how that diet fares in “normal” life, and the fact that the long-term failure rates of all known weight loss approaches simply means that they either they don’t work for the vast majority of people or that they are unsustainable. Either way, it is clear that advising patients to go down this path over and over and over is not giving the desired results generally.

As far as the caloric deficit being due to fat bodies needing more calories, then the obvious solution is to continuously reduce your caloric intake until you achieve your goal, correct? If that’s the case, then either there is existing evidence out there proving it, or else some lucky research team has a great way to disprove the currently accepted assumptions about long-term weight loss failure.

But here’s the thing: you’re saying that there’s no need to go all Biggest Loser, but then you’re saying that the problem is a 500 calorie deficit stops being effective, implying that greater deficits are needed to lose weight. So clearly you think there is a particular caloric deficit or dietary approach that yields greater results than a VLCD. Find me a single study, long- or short-term that shows better results than 15% average after a year or more, and I will shut down Fierce Fatties for good. Just one, solid, peer-reviewed study that says VLCDs aren’t the most successful.

BTW, VLCDs that are done in studies aren’t a continuous 800-calorie diet. You go through a weight loss phase of several weeks with meal replacements, then wean you back onto real food and give you some healthy nutrition plan for maintenance. The 800 calorie portion is meant to make you lose a significant amount of weight in a short period of time, then maintenance would theoretically keep the weight from coming back on. There are people who do an ongoing VLCD, though that would be close to disordered eating in many respects. More people try to do 1,600-1,800 long-term when trying to lose weight, I would venture to guess. I did a program at our gym where they measured our metabolic rate and gave us a caloric estimate to shoot for in order to lose our goal weight, and that was more forgiving to provide enough calories for being physically active. But none of these programs come even close to matching the short-term results of VLCDs (they all have similar long-term results, though).

This roundup of studies has this great table on long-term research (from 12 weeks to three years) comparing VLCDs and LCDs with maintenance programs. Take your pick of studies. This three-year (open source, even) is a good one that compares VLCDs and LCDs with and without exercise. Here’s how that study describes the setup:

The participants were premenopausal women with a mean body mass index of 34.0 kg/m(2). Eighty-two participants were randomized to this study; 74 participated in the follow-up assessment. A 12-week weight reduction by mostly a very-low-energy diet [one week LCD, eight weeks VLCD, three weeks LCD] was followed by a 40-week maintenance program randomized in 3 groups: a control group with no increase in habitual exercise and with counseling on diet and relapse prevention; a walk-1 group, with a walking program targeted to expend 4.2 MJ/wk [1,000 calories] and diet counseling; and a walk-2 group, with a walking program of 8.4 MJ/wk [2,000 calories] and diet counseling. Random permuted blocks within strata were used, with weight loss (in 3 classes) as the stratifying factor. After the intervention, the subjects were followed up for 2 years.

Here are the specifics about the maintenance program, since this is the key to long-term success:

The intensity of walking exercise was set at 50% to 60% of individual heart rate reserve (maximal minus resting heart rate) added to resting heart rate. The calculation of the weekly walking time needed to cover the target energy expenditure during walking was based on a linear regression of heart rate vs oxygen consumption during a maximal exercise test (uphill treadmill walking). The time was calculated as the target energy expenditure divided by the energy expenditure (kilojoules per minute) during the exercise test corresponding to the target heart rate zone. On the average, the walk-1 subjects were prescribed to walk 2 to 3 hours weekly, and the walk-2 subjects, 4 to 6 hours weekly. The subjects used a heart rate monitor (Polar Edge; Polar Electro Oy, Kempele, Finland) during the walking sessions. One weekly walking session was supervised.

All subjects participated in weekly meetings in small groups throughout the maintenance program, conducted by an exercise instructor. All subjects were instructed to follow a low-fat diet, and they received educational material monthly. As a part of their homework, they were asked to monitor high-risk situations for overeating. Problems in diet and prevention of relapses were discussed in the meetings.

Can they prove that all the subjects followed their instructions? Nope. But they can prove what happens when you prescribe this kind of long-term lifestyle change to a particular group of people.

The results? (SW: starting weight; EW: ending weight; EoS: End of Study) * Control: SW – 203 pounds; EW – 176 (13%); EoS – 198 (2%) * 1,000 calorie expenditure: SW – 203 pounds; EW – 172 (15%); EoS – 185 (9%) * 2,000 calorie expenditure: SW – 203 pounds; EW – 172 (15%); EoS – 193 (5%)

If you don’t like the fact that these are the best questions that research scientists can ask, then I suggest you find a way to fund a better study. Otherwise I find it pretty laughable that you think the lack of evidence proving fat people aren’t liars means that HAES is invalid. HAES is a sustainable, long-term approach to health that is proven to help people (especially lifelong dieters) improve their metabolic health. If you don’t like it, don’t do it, but stop acting like you have the all the answers because you and the Dudebro Society of Reddit have awesome before and after photos. Peer-reviewed research or it didn’t happen.

HAESFTW

The budget analogy fails because you can account for all the variables that affect an individual. A financial planner can request enough paperwork that they know exactly how much your income and expenditures are. The human body is not a budget, and individual mileage may vary.

No you can’t. People get sick. Hours get cut. Bonuses missed. Things break down. Prices raise. Shit happens. Many a budget has been broken by the unexpected.

As far as making it the all-or-nothing approach, my point wasn’t that your only options are very low calorie diets or unrestrained gluttony. It’s that the only lifestyle change that produces significant results, defined as an average of 15% after a year, are VLCDs. And if you want me to believe anything you have to say about weight loss, then you’re going to have to show me a study that gets these kind of results without pointing to yourself or some series of photos on reddit. Because it’s anecdotal evidence.

“Independent of the macro composition of your diet, a net negative energy balance (consuming less calories than your body needs) is alone responsible for weight loss.”

http://examine.com/faq/what-should-i-eat-for-weight-loss.html

“For the purpose of this article, ‘Starvation Mode’ is defined as a concept where your metabolic rate declines during the process of caloric restriction or weight loss to such a degree that further weight loss becomes impossible or weight gain occurs.”

Starvation mode, according to the above definition, is for all practical intents and purposes a myth.

http://examine.com/faq/how-do-i-stay-out-of-starvation-mode.html

The cited studies are at the bottom. There is about 20 of them combined for both articles.

Yes, there are hundreds of thousands of people who lose 50 or 100 or 150 pounds every year, but we don’t consistently learn of their ultimate success or failure after one, two, five years. The successful people are self-selecting, and we never know the true followup rate these amazing success stories. But of those hundreds of thousands of people who achieve their goal of losing 50 pounds or more are a sliver of the millions of people who try and don’t get anywhere near the results we’re talking about. The people who successfully lose weight get to explain how they did it, but for some reason when the people who fail at losing weight explain how they did it, they’re assumed to be liars. The entire premise of your question is that the reason a majority of people fail to lose weight is that they don’t follow the diet, and those who claim they do follow that diet are liars. But whether they are lying or not, their explanation is irrelevant to the argument because they are also anecdotal evidence.

You specifically asked for evidence that proved “weight regainers are actually following the diet when they regain the weight.” So, that rules out me pointing you to the many, many, many people I know who have tried anything and everything from caloric restriction to paleo and not gotten results. They’ve exercised, followed the rules and done everything right, but not had the same experience that the successful people have. This is when the successful people begin their diagnostic check. “Have you tried X? Have you tried Y? Have you tried Z?” This kind of anecdotal evidence that diets don’t work is immediately dismissed. What other evidence is there? If you know of some long-term, peer-reviewed research that is able to reliably monitor the dietary habits of subjects, please share. If not, the evidence you’re asking for is harder to come by because it would be incredibly expensive and difficult for any research team to do a long-term controlled study that actually proves subjects do or do not follow diets when they do not lose much weight.

What this means in terms of your question is that it’s a question with an answer guaranteed not to satisfy you. You want evidence and the closest evidence available is only suggestive of what you’re asking. The only study in existence that answers your question is the Minnesota Starvation Experiment, which only happened due to a remarkable set of circumstances around WWII. But because that evidence doesn’t exist, you feel like this completely negates HAES because we can’t prove an impossible question.

The premise of my argument is that Linda Bacon claims that people put on fat even while being compliant with a calorie restricted diet combined with exercise.

“The vast majority of people who try to lose weight regain it, regardless of whether they maintain their diet or exercise program. This occurs in all studies, no matter how many calories or what proportions of fat, protein or carbohydrates are used in the diet, or what types of exercise programs are pursued.”

I find that premise hard to believe. So I asked for evidence supporting that position. Is she not a prominent figure of the HAES community?

But what we can ask and answer is “What happens when we have subjects follow a particular diet and/or exercise routine after X number of years?” This kind of evidence simply shows us how that diet fares in “normal” life, and the fact that the long-term failure rates of all known weight loss approaches simply means that they either they don’t work for the vast majority of people or that they are unsustainable. Either way, it is clear that advising patients to go down this path over and over and over is not giving the desired results generally.

As far as the caloric deficit being due to fat bodies needing more calories, then the obvious solution is to continuously reduce your caloric intake until you achieve your goal, correct? If that’s the case, then either there is existing evidence out there proving it, or else some lucky research team has a great way to disprove the currently accepted assumptions about long-term weight loss failure.

*You do not understand my point. A 500 a day deficit is still good for about a 1 pound a week loss. But the calorie count that produces a 500 a day deficit isn’t the same as it was 50 pounds ago. A 2500 calorie figure may be good to lose a pound a week to start off with but maybe 52 weeks later that number gradually falls down to 2000. To lose a pound a week the deficit *

http://examine.com/faq/how-do-i-calculate-my-metabolism.html

But here’s the thing: you’re saying that there’s no need to go all Biggest Loser, but then you’re saying that the problem is a 500 calorie deficit stops being effective, implying that greater deficits are needed to lose weight. So clearly you think there is a particular caloric deficit or dietary approach that yields greater results than a VLCD. Find me a single study, long- or short-term that shows better results than 15% average after a year or more, and I will shut down Fierce Fatties for good. Just one, solid, peer-reviewed study that says VLCDs aren’t the most successful.

I never said a 500 calorie deficit stops being effective. The problem is the deficit gets smaller and smaller if the patient doesn’t adjust their calorie targets as they lose weight.

Can they prove that all the subjects followed their instructions? Nope. But they can prove what happens when you prescribe this kind of long-term lifestyle change to a particular group of people.

The results? (SW: starting weight; EW: ending weight; EoS: End of Study) * Control: SW – 203 pounds; EW – 176 (13%); EoS – 198 (2%) * 1,000 calorie expenditure: SW – 203 pounds; EW – 172 (15%); EoS – 185 (9%) * 2,000 calorie expenditure: SW – 203 pounds; EW – 172 (15%); EoS – 193 (5%)

You are right that this doesn’t tell us anything about whether or not the individuals involved followed the instructions.

If you don’t like the fact that these are the best questions that research scientists can ask, then I suggest you find a way to fund a better study. Otherwise I find it pretty laughable that you think the lack of evidence proving fat people aren’t liars means that HAES is invalid. HAES is a sustainable, long-term approach to health that is proven to help people (especially lifelong dieters) improve their metabolic health. If you don’t like it, don’t do it, but stop acting like you have the all the answers because you and the Dudebro Society of Reddit have awesome before and after photos. Peer-reviewed research or it didn’t happen.

I honestly have no idea where you are getting the idea that I’m asking for “fat people to prove they are not liars.” I’m asking for evidence of weight regain despite complying with the calorie restriction and exercise as described by Linda Bacon. Why is the burden of ” peer reviewed” proof on me to disprove the inexplicable statements made by a prominent HAES figurehead? Shouldn’t she have the proof before making those statements?

Atchka!

First of all, thank you for the link to that Examine site. I thought it seemed hokey at first (I’m skeptical of supplements as healthcare), but that first link has a great rundown of studies comparing macronutrient theories, and many are open source, which makes me happy. I will be combing through these studies in the coming weeks to see what they have to say.

But did you even read that first summary? The ones that actually provide weight loss data in the summaries are as follows:

  • Both the high-carbohydrate and high-protein groups lost weight (-2.2+/-0.9 kg [-4.8+/-2.0 pounds], -2.5+/-1.6 kg [5.5+/-3.5 pounds], respectively, P Diet composition did not affect the magnitude of weight loss
  • Overall, weight loss of 5.2 [11.4 pounds] +/- 1.8 kg [4.0 pounds] was achieved independently of diet composition.
  • Weight loss was 7.3 +/- 0.3 [16.0 +/- 0.7 pounds] kg with both diets.
  • Overall weight loss was 6.2 (SD 7.3) kg [13.7 pounds] (P < 0.01 for time with no diet effect.
  • Weight loss (7.9 [17.4 pounds] +/- 0.5 kg [1.1 pounds]) and total fat loss (6.9 [15.2 pounds] +/- 0.4 kg [0.9 pounds]) did not differ between diet groups.
  • All interventions reduced weight (DO 8.9 +/- 1.6%, DA 10.6 +/- 1.7%, and DC 8.7 +/- 1.7%; P < 0.001) with no difference between treatments (P = 0.7, time x treatment).

Yes, all of these studies show that caloric reduction is the factor responsible for weight loss, not macronutrient balance (a point I strongly agree with, but wasn’t sure if you support a particular macro theories). However, they also show that the caloric reduction induced by either low fat or low carb approaches still results in insignificant losses.

Of the 18 studies cited, only two are “long-term.” I put it in quotes because study 10 has a follow-up of 52 weeks and study 13 has a follow-up of 68 weeks, which is not really long-term, when you compare them to similar studies out there that follow subjects for 2-5 years. But it’s what you gave me to work with, so let’s analyze it.

Recall that I said it’s nearly impossible to create a study that observes long-term dietary habits of subjects and the effects on weight. Well, many of the studies in this collection do just that: observe subjects in a strictly-controlled hospital setting, where calorie intake and expenditure is rigorously measured. But when you look at how the studies are designed, you immediately see the shortcomings. The two long-term studies don’t take place in a controlled setting, while the 16 studies that are more tightly controlled are also incredibly brief and observe a small number of subjects. For instance, Study 4 follows 13 subjects for 8 weeks in a hospital setting. This is incredibly informative and valuable data (which is why I plan to read it later), but it still doesn’t answer your original question. But what they do answer is how woefully inadequate our claims of diet efficacy are. Even in those controlled settings, when intake and expenditure is strictly controlled and it comes closest to recreating your budget analogy, the results still show that the human body is not a bank account.

The human body is a dynamic system with metabolic inconsistencies that we cannot easily account for on an individual basis. When you say that budgets are similar because “People get sick. Hours get cut. Bonuses missed. Things break down. Prices raise.” All of those things can still be accounted for. If I get sick, if my hours are cut, if my bonus is missed, if prices are raised, there is quantifiable data that my accountant can adjust to know the precise effect it will have on my budget. I work for an auditing firm, I know just how effective financial oversight is, even with all the unpredictable variables that can change budgetary restraints. But the human body is not like that in the least. Even if you measure food out, we know that calorie estimates are guesses at best. If food calories were the same as a businesses expenditures, it would be like having a supplier who says, “Our widgets cost you $500 each, but when we actually bill you we’re going to charge you unpredictable rates depending on market variables… this week I may charge you $495 for a widget and next week I’ll charge $508.” This is not how financial systems work. Prices are set because stability is vital to Capitalism. The human body does not have that luxury.

The response I’m sure you have is, “Well, just eat less” as Marion Nestle says in that NPR article I link to. Okay, but you take this advice and apply it to your budget analogy, that’s like telling a person “Just spend less” to avoid budget pitfalls. Yeah, on the surface that’s common sense. But in reality, that’s not how it works. As you say:

You do not understand my point. A 500 a day deficit is still good for about a 1 pound a week loss. But the calorie count that produces a 500 a day deficit isn’t the same as it was 50 pounds ago. A 2500 calorie figure may be good to lose a pound a week to start off with but maybe 52 weeks later that number gradually falls down to 2000. To lose a pound a week the deficit.

This isn’t just telling people to spend less money or eat less food. This is telling people that over time they need to eat less and less and less food to continue losing weight at a steady rate. This is like telling a person they need to spend less and less money to stay on budget (which is sadly true in the current state of our economy, where wages have been stagnant for decades). Your claim is that a fat person who eats 3,000 calories per day should just cut back to 2,500 calories per day, and when they plateau, it’s a sign that the deficit isn’t enough, so they must reduce to 2,000 calories per day. But what happens when they plateau at 2,000 calories per day? Ah, yes, we go down to 1,500 calories per day. And this is the “solution” to dieting, despite there being any evidence that this approach is either (a) successful at producing continued, steady weight loss in a representative population and (b) sustainable for most people. So, you are the one making claims of efficacy with zero evidence to back up those claims. Again, if you have proof otherwise, please share it.

Which brings me to your final statement: ” I’m asking for evidence of weight regain despite complying with the calorie restriction and exercise as described by Linda Bacon.” The evidence you seek is in the personal experience of the former dieters who have experienced what Bacon describes and have switched to HAES because it’s a more sustainable approach. Ask any former dieter and they will provide you detailed anecdotal evidence of what Bacon describes. But this anecdotal evidence is not sufficient to you. You want peer-reviewed research which does not, and cannot, exist.

So, what this argument ultimately comes down to this: One group says, “We have proof that weight loss works” and points to a cohort of people who provide anecdotal evidence that caloric deficits results in the desired result of significant, long-term weight loss. Then another says, “We have proof that the vast majority of people who try to lose weight regain it, regardless of whether they maintain their diet or exercise program” and points to a cohort of people who provide anecdotal evidence of that.

What you are doing is saying “Give me evidence that latter group is right,” but refuse to admit that the former group is also lacking evidence that they are right. You claim that simply adjusting your caloric intake downward when you no longer lose weight is the solution to weight loss that we are overlooking, but you have zero evidence to back that up. Meanwhile, I’ve provided reams of research, both here and over the years on my blog, that any and all weight loss regimens are ultimate failures, and you’ve deemed that inadequate because it doesn’t magically monitor the eating habits of subjects for years at a time. But even the studies you provide that do strictly monitor dietary intake during the period when your caloric deficit is less affected by body composition prove that our bodies are not machines and that weight loss is far more difficult and complicated than a budget.

Bacon’s assertions are based on a combination of data on the long-term success rate of any and all diets AND on the personal, anecdotal evidence that individual dieters have shared with her, with me and with anyone who will listen. By comparison, you don’t have any evidence that diets work in the long-term, only that personal, anecdotal evidence that if you try hard enough, have enough willpower, follow Plan Z from Outer Space, you will succeed in losing 100 pounds like Mr. Reddit. So, which group is really making the inexplicable statements?

UPDATE

If you’re interested, HAESFTW went full Auschwitz with his argument. He’s now claiming that Linda Bacon thinks you cannot starve people into emaciation. He is a fucking doorknob and not worth another minute of anyone’s time.

21 Comments leave one →
  1. December 18, 2013 2:41 pm

    Reblogged this on Sly Fawkes and commented:
    I used to be one of those people who went to the gym for 3+ hours at a time. I was also bulimic to varying degrees. I was miserable.
    Nobody can maintain this sort of workout schedule if they have an actual job and a family. I was neglecting my son to try and get rid of my horrible, horrible baby weight. This, not the fact that I wasn’t able to maintain this kind of an exercise schedule, is what I should have been ashamed of.

  2. vesta44 permalink
    December 18, 2013 4:52 pm

    I love how anecdotal evidence is acceptable when it proves the point one side says is so (diets work to make fat people permanently thin), but that anecdotal evidence is not acceptable when it disproves that same point (diets don’t work to make fat people permanently thin). You can’t have it your way, peeps – either you accept anecdotal evidence in both cases, or you don’t accept it at all.

    • December 19, 2013 8:59 pm

      I don’t believe diets work to make people permanently thin. I believe calorie restricted diet resulting in a caloric deficit results in weight loss for as long as it is followed. That’s what the studies show.

  3. December 18, 2013 5:08 pm

    All I know is the stupid diets do not work. People think it’s insane that someone as fat as me does not diet. I am just not interested. It has failed so often it’s not funny. If I eat too little food I am cold. I’ve lost more weight then Julian weighs right now. [technically 160 has been kept off-irony huh?] but I’m still very fat. I am tired of them shoving things down fat people’s throats that simply do not work. I consider calories a myth, which I know puts me in mega-outliner land. The human body does not work like a car.

    http://fivehundredpoundpeeps.blogspot.com/2012/11/are-calories-themselves-myth.html

  4. Kala permalink
    December 18, 2013 6:27 pm

    I love the attitude where folks are like: “But, but, but! If only the researchers (specialists in a field I’m not an expert in) ran the study just as I think it should be run, only then would the conclusions that I already believe to be true be substantiated.” Isn’t that a convenient set of logic?

    HAESFTW just knows, truly knows, that these diets are effective, and when those researchers finally get around to forgoing all practicality and medical ethics, and run that magical trillion dollar study where they can pinpoint exactly what a large group of people eats and does every day for years, he’ll be proven right. Science just needs to catch up to /r/keto, what trailblazers they are.

    • December 19, 2013 9:18 am

      Since you clearly need a personal tutorial, here’s an invitation: spend a week with me, and eat exactly what I eat during that time. I am a thin person at present, but I am genetically inclined toward fatness. My daily intake is somewhere between 600-800 calories. After you have spent a week with that degree of curtailment it is just possible that you will reconsider your attitudes and beliefs. And, at the same time, I can offer you some gentle correction as to judgments against others in a more general sense. http://ireport.cnn.com/docs/DOC-968195

      • December 19, 2013 9:23 am

        Oops. That was intended for the troll. My invitation to him is genuine. He can reach me through FaceBook.

        • December 19, 2013 8:56 pm

          I’m not a troll, but I think you should get your metabolism measured by a doctor. At 5 foot 11, 155 pounds 55-60 years of age most calculators estimate your BMR at >1500. So if you are consuming less than half of that daily and not losing fat then either the calculators are incredibly inaccurate, your reported calorie intake is inaccurate or your metabolism is drastically different than the general population.

  5. vesta44 permalink
    December 18, 2013 11:46 pm

    WTF?!? Why on earth would he think that Linda Bacon thinks people can’t be starved into emaciation? Does he think he’s psychic, that he can read the minds of people he’s never met and that aren’t even in close proximity to him? What a bonehead.

    • December 19, 2013 8:45 pm

      Hi everyone…. I’m HAESFTW

      I don’t profess to be a mindreader but Ms. Bacon seems to believe the majority of people regain weight despite following their calorie restricted diet and exercise program.

      “The vast majority of people who try to lose weight regain it, regardless of whether they maintain their diet or exercise program. This occurs in all studies, no matter how many calories or what proportions of fat, protein or carbohydrates are used in the diet, or what types of exercise programs are pursued.”

      “Prisoners in the camp received meals three times a day: morning, noon, and evening. Factors influencing the nutritional value of the food included the official nutritional norms in the Nazi concentration camps. In practice, Auschwitz prisoners with less physically demanding labor assignments received approximately 1,300 calories per day, while those engaged in hard labor received approximately 1,700. ”

      http://www.jewishvirtuallibrary.org/jsource/Holocaust/auconditions.html

      The prisoners were forced to be on a calorie restricted diet and do strenuous exercise. Yet they didn’t regain weight as we would expect if Linda Bacon’s assumptions were correct. Instead they continued to lose more and more fat and starved to death. Why is that?

      • December 19, 2013 10:39 pm

        You were banned from AskHAES for this nonsense and you won’t last long here if this is your argument. This is an idiotic argument. You’re comparing prisoners and free-living populations. You’re comparing the duress and indignity of concentration camps to people reducing caloric content and going to the gym. I’ve allowed these comments to pass, but you’re on a short leash. You demonstrate a basic failure to comprehend fundamental concepts of research (“Why don’t they just round up a bunch of fat people and observe them for two years with their unlimited funding to study the eating habits of fatties?”, let alone the results of the research you’re citing.

        I’m done trying to explain these basic concepts and having you come back with the exact same question, reworded. And I’m not going to let you continue to exploit the Holocaust for your idiotic analogies, when you won’t even acknowledge the findings of the research that did take place following the Dutch, including the fact that their offspring had significantly higher rates of obesity compared to the generation before or after them. As everyone can read above, I exhaustively explained why people regain weight on diets. I can’t write it any simpler. So, if you’re just here to beat a dead horse, you can see yourself out.

        Peace,
        Shannon

        • December 19, 2013 11:00 pm

          I’m comparing their biology. Their metabolism.

          Is their any peer reviewed research that suggests that caloric deficits forced on individuals impacts weight gain or loss differently than self imposed caloric deficits?

          I do think it would be a good idea to study individuals who report to have regained weight despite maintaining their reduced calorie diet and exercise habits. If that true their weight regain at a caloric deficit could be observed in an environment in which caloric intake is better controlled. I don’t know why the study would have two years long nor why it be any more expensive than any other study.

          I don’t know what the relevance of higher obesity rates of the offspring during times of famine has to do with what I’ve been talking about. But I acknowledge it. :shrug:

  6. December 19, 2013 6:58 am

    He went full Auschwitz. You never go full Auschwitz.

    But seriously, a lot of interesting data came out of engaging with this guy, so that’s something. Thanks for choosing to share it with us!

  7. Mich permalink
    December 20, 2013 10:26 pm

    This was looooong. To add to the physiological effects of caloric restriction and starvation, during the Holocaust, all the women lost their periods, and no babies were born. This was discussed in the film “Will you Steal a Pencil for Me?”. This agrees with the Minnesota experiment, and what we know from animal studies/observations: they become temporarily sterile.

    To claim though, that starvation doesn’t lead to emaciation, is false, as the camp survivors were all emaciated, and their refeeding took decades.

    • December 23, 2013 11:21 am

      Sorry for the length, but complex issues sometimes require complex discussions. But, yes, if you imprison someone, then starve them and force hard labor on them, they will lose weight. There are also the prison studies which show the same thing happens with over-feeding. Adjusting caloric intake moves weight, but not nearly as significantly or consistently as we’re led to believe.

      Peace,
      Shannon

  8. Anti-HAES permalink
    December 23, 2013 10:46 am

    All I see is more body policing from the HAES people. If I want to go on a diet, it’s my right to do so. If I want to do exercise, it’s my right to do so. My body, my decisions. No matter how hard you try, no matter how hard you tantrum… you will never get me. My body is mine, and mine alone.

    • December 23, 2013 11:17 am

      Alright, I’m allowing this comment through, but be warned, you’re also on a short leash because the troll force is strong with this one.

      How is this body policing? If you want to go on a diet, go on a diet. Is anyone telling you that you have to follow HAES? Are fat people holding you hostage, prying your eyes open Clockwork Orange-style and forcing you to read this blog? Have I personally said that people who choose to diet should be shamed and ostracized? Have I said that people who choose to lose weight are terrible people? Where exactly is this “body policing” you speak of? Because as far as I can tell, this post is entirely about the science behind weight loss, coupled with the fact that failed dieters are treated like mobile lab experiments that society gets to judge. So please, enlighten me: where’s the policing?

      Peace,
      Shannon

    • December 24, 2013 12:18 am

      “Body policing from the HAES people?”
      Do you not understand the words “health at EVERY size?”
      Which would include whatever size you are.
      There are no campaigns to shame people away from dieting. There are plenty to shame people into dieting.
      Larger people live every day being shamed for their body type.
      Please…go away. Far away.

      • December 28, 2013 8:12 pm

        Apparently, yours or my own refusal to diet = Oppressing someone else who wants to diet.

        Some fun, eh?

  9. vesta44 permalink
    December 23, 2013 3:08 pm

    I get the feeling that people who diet and exercise in order to change their bodies do not like it when they’re told what the chances are of them being able to maintain that change forever. They’ve drunk society’s Kool-Aid, they’ve swallowed the lies of the diet industry, and they believe, and that’s enough for them. Trying to enlighten them as to their actual chances of success isn’t going to work, and is seen by them as “body-policing” – they think we’re telling them that they can’t diet and exercise, when what we’re actually saying is “Your body, your choice, but good luck with that, come back in 5 years and tell us how successful you’ve been.” Notice how many of those people never come back and report on their “success”? They’re screaming “I can’t hear you – la-la-la-la” with their fingers stuck firmly in their ears.

    • December 24, 2013 12:22 am

      I stopped exercising for several years even though I actually enjoy it because it never led to weight loss. When I started doing it again, I had a minor weight loss of about 25 pounds. However, the dosage of my thyroid medicine had also been increased at that time, so who knows? I didn’t care, because I didn’t start exercising again to lose weight. I started doing it to increase qualities such as flexibility and stamina, which it has.
      Exercising for weight loss tends to fail for most people, and drive them away from exercise, which is generally a health-promoting activity. Again, the anti-fat establishment shoots themselves in the foot.

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