Diets Don’t Work

(Photo from Fat From the Side submitted by fiercefattyflavor who says, “On the runway modeling Size Queen designs.  If you told me in high school that my fat, beautiful ass could do these things, I would have rolled my eyes.  But I’m so happy to be walking the road of body acceptance, and doing all the things I never thought I could.”)

When you talk about fat-discrimination, like I did a few posts back, there’s usually someone around to shout out the common rebuttal – that while you shouldn’t discriminate against something that someone can’t change, fat people are fat because of their own damn fault, and if they don’t like it they can simply lose weight. That’s the undercurrent to most fat-hate. It’s the great big justification for it all – you’re fat by choice, which means not only are you this horrible thing called fat, it’s all your fault, which is even more horrible and unfathomable.

So this is an idea I want to explore really thoroughly. I’m sure you’re all familiar with it, but let’s state the claim outright. The idea goes something like this: If you’re fat, all you need to do is eat less (or differently), and then you will be thinner. It’s so basic! Calories are energy, and we store our excess energy as fat. If we eat fewer calories (or burn more calories), our weight will go down. Calories in! Calories out!

There are all kinds of suggestions about how to go about this and more diets than I could possibly list, but the gist is the same. You wouldn’t be so fat if only you would put down the fucking cheeseburger. It’s so obvious, that thin people cannot grasp why we fatties can’t get on board. It’s so obvious that fat people can’t figure out why they themselves can’t get on board.

But if it’s SO obvious and SO simple, then it should be SO true, don’t you think? So let’s look at what science has to say about this so obvious thing.

LOTS of researchers have looked into whether or not dieting works to treat obesity, since Medicare guidelines provide funding for obesity treatments that work. There’s lots of data I was able to look at. Looking at scores of studies over the years, the first finding is that dieting works. Sort of. Dieters in weight-loss programs lose an average of 5-10% of their body weight.

The first problem with this is the small numbers. I weight 225 pounds and am obese. If I lost 10% of my weight, I would weigh 203 pounds and be obese. Anyone who talks about a weight-loss program as a solution to the “obesity problem” is talking out their ass. In one study, participants lost 6-10 pounds. In another, they averaged a 4 pound loss. When someone touts a weight-loss program as “working”, is that the amount of loss you have in mind? In another study, there was no difference from the control group after three years.

This New York Times article talks about two large studies that show no weight-loss results. In one, women followed a low-fat diet for 8 years with no change in their weight. In another 8 year study, researchers did all those things people say we should do to fight childhood obesity rid the world of fat children: expand PE, serve nutritious cafeteria food with less fat, teach students about nutrition and exercise, and get the parents involved. These changes also didn’t lead to weight loss.

Even when dieters show small losses, those losses tend not to stick around. The main thing that changes across the studies is the rate of regain. One study says 90% of dieters gain back their weight within a year. Another study says 95% gain it back in 2-3 years. Another study says only 3% keep it off. And most of these dieters gain back MORE than they lost. One study shows that two year later, 23% gained back more than they had lost. When followed for more than 2 years, 83% gained more than they had lost.

According to Traci Mann, UCLA associate professor of psychology and lead author of a study looking at 31 studies on diets:

“We concluded most of them would have been better off not going on the diet at all. Their weight would be pretty much the same, and their bodies would not suffer the wear and tear from losing weight and gaining it all back. Diets do not lead to sustained weight loss or health benefits for the majority of people.”

So what about exercise instead? A British study followed 200 children over 3 years, monitoring fat and exercise levels and found that varying levels of physical activity did not lead to changes in fatness. How about people doing one hour of aerobic exercise, 6 days a week, for a year? Their weight loss averaged 3-4 pounds. A whole year! In one 6 month study, people doing 50 minutes of exercise 5 days a week lost the same as those using diet alone. Other studies that looked at programs combining diet and exercise found that the losses were slightly better than with diet alone, but still not very impressive, and you’re still likely to gain it back.

I looked at study after study, charts, graphs, numbers. I did the math, I read the conclusions, over and over again. Diets don’t work. People generally do NOT lose weight and keep it off.

It’s hard to state this strongly enough, and I’m going to keep repeating it as I go forward, it’s a really important message:

Diets. Don’t. Work.

(Edited to add: I don’t post most of the hateful comments I get on this post. If your comment is one of those, I’ve added a new page where you can bring your arguments – The Fat Backtalk Zone. If I won’t publish your comment here, there’s a possibility I’ll post it and reply over there.)

Comments

  1. That is some really impressive research, and good on you for getting into the nutty gritty of it. I myself never had to worry about weight growing up and never had a problem till I broke out with eczema in my late twenties and was put on a high dose of steroids did I even know what it was to worry about it. Now that i have been trying to lose some weight I can’t. I was wondering about diets but kinda saw a lot of them as being unhealthy in one way or another, or just hard to stick to. My Aunt has struggled with weight loss all her life but Weight Watchers really has done well for her, but I think that is kind of a life change it’s not something you go on and then off.

    • Weight Watchers is also a diet. It’s pretty much just calorie restriction.

      • Maybe we should change the statement to, “Intentional, long-term weight reduction doesn’t work (for the vast majority of people).” That way we could avoid the topic of whether a given weight loss plan is or is not a diet.

        • I agree, I understand it is a diet, but moreover I think it’s a lifestyle choice. I have know more than just my aunt to have success with weight watchers. I think it helps people change the way they look at things and use calculations. Some people have different ways of rationalizing with them selves and when they make it a calculation its harded to rationalize.

          • The statement remains true: “Intentional, long-term weight reduction doesn’t work (for the vast majority of people).” And that includes Weight Watchers. Here is a good article discussing what it means to be “successful” on Weight Watchers.

            http://fatfu.wordpress.com/2008/01/24/weight-watchers/

            If the people you know are truly successful at losing a large amount of weight and keeping it off for more than a few years, kudos to them. They have achieved something very rare. But the things you’re saying, about “lifestyle choice” and so on, perpetuate the false idea that such a thing is generally achievable by most people. It does not appear to be so.

            • “Lifestyle choice” is completely meaningless in this context. It just means “diet”. And the “rationalizing” that you mention is some kind of code for “fails to be on the right diet”. Fuck that.

              • It would be a lifestyle choice for me to count how many times I blink in a day, and attempt to reduce that number by about 10%. I suppose I could do it, but I would have to spend an inordinate amount of time focused on blinking, counting blinks, restricting blinks when I felt the need to blink, beating myself up when I accidentally blink and then my whole life would be about blinking. That’s not a lifestyle I really want for myself, thanks.

                • Brilliant!

                  • I see what you guys are saying and I think I came across the wrong way. I was by no means trying to say that what you guys are saying isn’t true. I agree with all that has been said.

                    My aunt had to lose weight because of diabetes she started the diet three years ago and has done really well, lost a ton of weight and has kept it off. She exercises regularly with a trainer, cooks food the weight watchers way (whatever that means) I am glad it is working for her and hope that she doesn’t fall victim to statistics.

                    It is unfortunate that there is no right answer on how to lose weight and diet so to speak. Are there any ways that have been found to be more productive and sustaining than Diets?

                    • Are there any ways that have been found to be more productive and sustaining than Diets?

                      Some diets are more effective at others than helping people “lose weight and keep it off.” However, none of them are very consistently effective. “More effective” might mean that 6% of people “succeed” instead of 4%. “Lose weight” might mean a reduction of 5-10% of body weight (which still leaves most obese people obese). “Keep it off” might mean that you’re not back at your starting weight in a year or two. I don’t think that most people would say that a 4-6% success rate, given a quite generous definition of “success” is very encouraging. It’s my understanding that, of the various weight loss methods out there, Weight Watchers is one of the more successful, for what that’s worth.

                      But I think you’re missing the point–which, to be fair, I know what posts Issa is going to write, but hasn’t posted yet, and I believe that this point is coming in a later one. The point that I think you’re missing is that the focus on weight loss, itself, is the problem. The question should not be, “what is the best way to lose weight,” because losing weight is actually a proxy for all sorts of other values like health, attractiveness, mobility, athletic ability, and so on. We should be focusing on how to achieve those values, not weight loss.

                    • “My aunt had to lose weight because of diabetes she started the diet three years ago and has done really well, lost a ton of weight and has kept it off.”

                      This is the kind of sentence I don’t want to see repeated here. As I write more about fat acceptance, I’m going to have to make a decision about whether/how to moderate comments, because it’s so hard for people not to say things like this over and over again. It is 100% irrelevant what happened to your aunt. Even if it is true that your aunt used to have a BMI over 25, now has a BMI under 25, achieved that primarily through diet and exercise, will not regain that weight within 5 years, and isn’t engaging in disordered/obsessive eating habits to do so, then that makes her a statistical outlier, and it’s aggressive and mean to bring her up in discussions about weight loss. I know this isn’t unique to you; everyone seems to have a story like this that they cling to, because we want so desperately to believe that thinness is possible, but that’s only because we’ve been sold so aggressively sold the idea that thinness is required. I’ll get around to arguing that thinness isn’t required, but for this post I’m focusing on how it’s not even all that possible. “Success” anecdotes don’t change that, and they don’t belong here.

  2. I admit you are likely right and this is all true. But personally I am not at a place where I can accept it. I sort of have to believe that if I really try I can lose weight and that I am just fat because I am not really trying. Trying really hard worked before and then I stopped and I got fat again. Like, I can lose weight anytime, I just don’t want to right now. Yes, I know it is sounds dumb.

    • I know just what you mean. As long as losing weight is something we think is in your grasp, then we can assure ourselves that weight loss is right around the corner. It’s a thing that so many people really, really want that it’s really hard to think about it just not being possible. The good news is that you can come around to a place where you don’t want to lose weight because you are happy about yourself exactly as you are. But I know that isn’t easy.

    • You say that trying really hard worked, but that’s kind of the point. If you try really hard, you can lose weight. If you try really hard, you can hold your breath too, or not urinate. Eventually, your biological imperative will overwhelm your will. The problem is that, when it comes to food, that is framed as a personal failing. It’s not. Don’t hate yourself for not being able to hold your breath or your bladder indefinitely. Don’t hate yourself for not being able to hold your appetite either.

  3. This is great writing Issa!
    Its a sensitive subject for me as well.
    I once was in a hotel with my mom and we were laughing at this magazine that was showcasing diets of the last 20 years and between my mom and I we had tried nearly every one of them. Including the Dolly Parton Cabbage Diet. (for real my mom did that for a bit.)

    My mom was anorexic growing up, and still has some body dismophia issues she struggles with, she’s a size 10, and not obese. She was on weightwatchers while I grew up and swore by it. I have tried that, and everything else.

    I’m strangely having to work with a program in Chattanooga right now called “Step 1 Healthy Kids/ Healthy Families” – who is partnering with our urban farm non profit. The goal is to fight “childhood obesity”.

    anywho- I guess the question is- What does work? million dollar question. I am currently going to the gym every day again, and enjoyed reading your blog while i ate my lunch of chicken fingers and salad. <3 thank you!

    • I have so many more posts on this subject where I will offer up lots more research, but let me just throw a couple of questions out there and I promise to get around to covering them in depth in future posts.

      “Healthy Kids/ Healthy Families”…fight “childhood obesity

      Healthy kids sounds like a great goal. What does it have to do with obesity? Can’t we just talk about and work towards health without also trying to make people skinnier?

      What does work?

      To do what? Make people skinnier? Is that a good goal to be striving for? Does it have any benefits? Any drawbacks?

      Weight loss is sort of universally accepted as a Good Thing, but that doesn’t mean that it is.

      Also, on “childhood obesity”, every time you see that phrase, mentally replace it with “fat kids” instead, and see how it changes your view of the rhetoric. Why are we trying to fight fat kids? Is anything that we’re doing to combat fat kids actually good for fat kids?

      • Thank you for phrasing “childhood obesity” that way. I’m a public health student and every time we talk about prevention of childhood obesity (especially in the wake of the new Strong4Life ads in Georgia), I cringe a little bit.

        • OMG the Strong 4 Life billboards are horrible. They are gigantic signs that say, “Hate fat kids!” I don’t know how an organization like Children’s Healthcare for Atlanta can’t see that the whole campaign is hateful and despicable.

    • What does work?

      It’s important to define what you mean by “work.” It’s true that, if you reduce calories enough, you will lose weight. Lock a person in a room and don’t feed them, and they will starve to death. At the end, they will weigh less than they did when they started. This is the premise that people rely on when they say, “just burn more calories than you take in, and you’ll lose weight.” Well, it’s true, but it’s also pretty bleak. I doubt we could call enforced starvation “working.” But starvation is what’s happening when you intentionally reduce calories to induce weight loss–and that’s not conjecture on my part; there’s science behind that. This is the foundation of the claim that “diets don’t work.” Because, you can’t really claim that a weight loss method that requires you to enter a state of semi-starvation is “working” in any meaningful sense of the word.

      From this perspective, it’s not surprising that very, very few people manage to lose a significant amount of weight and keep it off over the long term. It’s not surprising if you re-word that sentence as, “very, very few people are capable of entering a state of semi-starvation and then voluntarily maintaining it for years or decades.” Shocker!

      To boil your question about “what works” down, I think you would have to ask, “what is capable of causing weight loss without causing the body to enter a state of semi-starvation?” The answer appears to be: nothing that we know of. That doesn’t mean that there isn’t something out there, but it doesn’t seem to have been discovered yet. But, as Issa points out, the focus here is entirely wrong. The question should not be, “what works to cause weight loss,” but, “what works to increase overall health, or quality of life, or healthy self-image?” Thinness is used in our culture as a proxy for all of these things. It’s not.

  4. It seems to me that we should be concentrating our efforts and $$$ into instilling healthy habits into our children, and trying to prevent them become obese in the first place. Big parts of the problem come from the way we grow/raise our food, the way our infrastructure is set up for car travel, and the prevalence of junk and fast foods. Basically, our entire American culture is making us fatter.

    • Let me reword your comment slightly.

      “We should be concentrating our efforts and $$$ into instilling healthy habits into our children. The way we grow/raise our food, the way our infrastructure is set up for car travel, and the prevalence of junk and fast foods…Basically, our entire American culture is unhealthy.”

      If I word it like that, I 100% agree. Politically, emotionally, where I put my money, things I think we should take a hard look at, I completely agree!

      This phrase is a problem, though – “instilling healthy habits into our children, and trying to prevent them become obese in the first place” – because it connects together two things that we don’t know go together. We don’t know all of the reasons why some people are fatter than other people (except that it’s 70% genetic), and we don’t know what things (if any) will prevent people from becoming fatter. To top it off, we don’t know if we should try to prevent people from being fatter!

      As near as I can tell, though, there’s no reason not to focus on making sure people have healthy foods and inspiring people to move around more often. We can do that without throwing weight loss into the mix.

      • Speaking of 70% genetic… whenever I wonder about the state of my [waist-less? boobie? fat?] body, I look at this picture: http://www.facebook.com/photo.php?fbid=27164125286&l=4527a7098d — these are three of my four biological grandparents…my paternal grandfather and my two grandmothers. Look at those trunks! Look at those boobies! I laugh at the stories my mom told me of my one grandmother putting on a belt and catching her nipples in it and not even really being bothered by it. I come from a loooong line of ‘husky’ waist-less people, and I come by it VERY honestly. I love these pictures of my grandparents. They remind me of who I am and ALSO, these pictures were all taken before the advent of frankenfood, which just goes to show you… they were fat BEFORE the ‘epidemic’. LOL

        • Awesome pictures! I love old pictures that involve more-than-skinny people because a lot of people think fatness is a new invention. I like looking at the old black-and-whites pointing, “See! Fat person! Ooh! There’s one!” I’m a dork. :-)

          • LOL Feel free to use any of those photos for your fat-people-with-heads projects. All my grandparents are dead, so I’m sure it will be fine. LOL

            • Awesome! I will! My next fat post is going to touch on genetics, so it’ll be perfect to include your ancestors!

              • TEE HEE! I’m honoured!

                • I’m looking forward to the genetics post. I am also hoping that either as a part of the genetics post or a separate one, that you might address health choices vs dieting.

                  I have a rather strong opinion about healthy=skinny, and diet to be skinny vs losing weight as a result of *other* health choices. (for the record, I don’t think that a person’s weight is a good indicator of their current health status. Much like I don’t feel that what a person eats is a good indicator of why they may or may not be fat.)

                  • You bring up so much here that I hope to cover in one way or another in the future. That thinness doesn’t equal health, that weight isn’t a good indicator of health at all, that what you eat doesn’t prove why you’re fat. So much to cover! :-)

                    • Oh yeah, there is a bundle there… and I have more. I really really want to get in deep with the health aspect of it with you. :) Simply put, I am fat AND I am unhealthy. I am not unhealthy because I am fat, but I just *might* be fat because I am unhealthy. Between making some serious food modifications and the new medication for diabetes (was just recently diagnosed,) my weight is changing. The big thing about this though, is that not just my weight is changing. All sorts of other things about my health are changing along with it. I wasn’t looking to alter my weight. I accepted my fat rolls and smoosh ages ago, but I was looking to alter my health. But that is me…I have also been severely skinny AND unhealthy. So what is the base equation. It’s not being fat. For me, fat is a symptom of something else…at least that is where this all is leading. But I am fat, I accept that… and thankfully, so do a lot of other beautiful people in my life. :)

                      Just to touch on one other tidbit, one of the things that frustrates me most about “dieting and exercise” is that no one focuses on inches lost, it’s all about the lbs. If you are someone who is active or exercising, no one ever reminds you that muscle weighs more than fat. So, if one is only looking at pounds lost as an indicator of successful weight loss, they will get frustrated and disappointed pretty quickly with their results. I think this is one of the biggest reasons for “failure.”

  5. Have you looked into any of these studies, I mean this one is on snails not people, but the theory is sound.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448757/

    The general idea is that recent (like last few generations) environmental pressures affect people who are not actually under those pressures. For example, you notice how wealthy white people are thin? Our system likes to say stuff like “because they exercise, because they eat high quality food, because they eat less”, but poor people are heavy “Because they eat bad food and don’t exercise”
    But this sort of theory says that people who come from families that have been well off for a long time have bodies that plan to be feed and have all their needs meet. Those bodies don’t store up for hard times.
    Where as people who are just a few generations from poverty have bodies that prepare for possible starvation situations.

    So for example both lines of my family were poor and did not get good food. As a child I did not get regular access to good food. But since I was about 8 I have. If things go well and I have kids they will have a good food, often. Their kids will, and in a few generations my offspring will be the “I can eat anything and not gain a pound” type. But no matter what I do, I will never be like that.

    • I was bringing this up specifically about childhood obesity. Feeding a kid well, teaching healthy food habits and getting them out in the fresh air are all great ideas, these things should happen. But some kids will still be fat, there might really be nothing that can be done about this. Being fat might be as much a part of this kid as skin color or height. Those posters shaming kids who are fat make me so angry.

      • I have seen some information looking at the correlation between stress and weight, which sounds similar. The correlation between poverty and obesity in the US is an area really ripe for more research.

        Those billboards make me angry, too. Some part of me wants to assume that they have their hearts in the right place… but I just can’t, because the billboards are so fucking hateful. The latest one I’ve seen, from NYC, is a tragedy of fat-hate and ableism all together.

        • That ad is so inappropriate. Like saying “well you gave your self diabetes, so it is all your fault. I bet you if you could go back you would rather have your leg then a large coke”

          Like all the crap people are saying about Paula Dean right now. I have seen so many people on the internet this last few days taking pleasure in her illness.

      • Kitty wrote:

        I admit you are likely right and this is all true. But personally I am not at a place where I can accept it. I sort of have to believe that if I really try I can lose weight and that I am just fat because I am not really trying.

        Then she wrote:

        But some kids will still be fat, there might really be nothing that can be done about this.

        I think you’re right the second time, and I wish you could apply the same compassion you feel for these kids to yourself. You deserve it.

  6. I am of the firm opinion that one of the major causes of *eating disorders* is that American culture is fixated on three major things:

    1) Fear of fat. As a culture, we are so horrified by the idea of fat that it winds up consuming a large part of our thought processes and we obsess on it. This obsession is obviously unhealthy.

    2) Food trauma. Food trauma is every time anyone has been bullied by family, friends, coworkers, a doctor, or some medical study about what they may and may not put in their mouths. I’ve heard statements like “you have to try three bites before you’re allowed to say you don’t like it”, I know people who have been beaten for refusing to eat food they find revolting, I was once married to someone who was deeply indoctrinated that he was required to full his plate, and then eat it all.

    If I have the right to tell you that you MUST eat something, that’s not far off from telling you whose genitals you must place in your mouth. I find that disturbing.

    3) Betty Crocker. Well, more accurately, the entire “food in a box” industry, which is designed to be quick, easy, not require any real knowledge of cooking or ingredients, and contains tons of fillers that we normally wouldn’t use if we were cooking for ourselves. Fast Food can be lumped in here, too.

    There’s other factors too, of course, but that’s my comment sized precis about WTF is wrong with “diets” in America. We don’t need diets. We need to eat healthy, get up from our chairs, couches, and computers once in a while (I plead guilty to that one!) and focus on our bodies being in good functional working order. Nowhere in that does “fat or thin” really enter into it.

    • “If I have the right to tell you that you MUST eat something, that’s not far off from telling you whose genitals you must place in your mouth. I find that disturbing.”

      Exactly. Well stated.

  7. I’m a member of the National Weight Control Registry, which is trying to figure out what does work for weight loss maintenance. I’m hoping something useful comes out of it, but in the meantime I think Healthy At Every Size is a great concept. I know I’m not moving enough, and that I feel better when I do.

    I was reading through the US News ranking of Best Diets and their kudos go out to DASH, which is not designed for weight loss. Reading up on DASH reminded me that I eat too much salty processed foods and don’t move enough. As a result I have twin goals for the next month.

    While the evidence says calorie restriction does not work long term, eating fruits and veggies and being active are pretty universally good advice.

    • While the evidence says calorie restriction does not work long term, eating fruits and veggies and being active are pretty universally good advice.

      I think you’re onto something here. It’s really a shame that so many people adopt what are otherwise generally healthy eating and exercise habits, then abandon them when they fail to produce weight loss. There are all sorts of benefits to eating healthy food and exercising more, and it’s too bad that so many people miss out on those benefits because all they’re focused on is weight loss.

  8. I just got done looking over Issa’s shoulder at all the ignorant comments that she isn’t going to approve. Apparently, someone linked to this post somewhere and now all the haters are coming out of the wood-work.

    It’s obviously pointless to respond to these people, but I am struck by one thing: how the commenters seem to have not really actually read the article. Issa links to many studies that directly refute the haters’ claims (all you have to do is eat less, eat healthy, etc…) and yet the haters seem to, as usual, totally ignore this.

    That is the essence of bigotry: to hold onto a hateful and belief about a class of people without regard for facts.

  9. For any of you rude, angry people from the other night who are still following along with comments on this post, I have now posted a rebuttal of sorts at These are the Fat FAQs.

    I still won’t approve any comments that are hateful, but if you have anything to add or questions to ask, please ask them over there, and let’s see if we can have a meaningful discussion.

  10. If calorie restriction doesn’t work, then why does bariatric surgery work?

    I lost 100 lbs in 2006 without surgery. I have kept the weight off.

    • You tell me. What are some of the key differences between someone who has had bariatric surgery and someone who is restricting their diet by choice? What are the differences in their bodies? What are the differences in the options available to them?

      • The key difference, as far as I can tell, is that one (bariatric) is physically limited from taking in calories and the other (diet) is choosing to restrict calories.

        I conclude from this that the problem with low calorie diets is one of willpower and not metabolism.

        Can you suggest another difference that explains why bariatric surgery tends to work and low calorie diets tend not to?

        • There are lots of situations where a person is physically prevented from getting enough calories: a prisoner situation, an illness that prevents you from keeping food down, etc. I couldn’t eat for a couple of days following my c-section. Bariatric surgery is another one. The shape and function of the body is surgically altered, with this prevention of getting calories as the sole purpose of the procedure. If a person fails to behave as if they’re an abused prisoner, a person with a violent intestinal illness, someone who’s just had surgery, or someone who’s had their stomach permanently altered… that’s “willpower”? That word doesn’t really do it for me. If I try to take a third fewer breaths than I normally do it’s not a failure of “willpower” when I say “fuck that shit” and go back to getting enough oxygen. It’s just my body (brain, hormones, various signals and systems) working and taking care of me. No one is arguing that calorie restriction doesn’t “work”. Prisoners who are underfed will eventually lose weight. People in famine conditions will lose weight. SOME people who are willing to literally devote the rest of their lives to their weight loss can do so. That’s not a realistic meaning of “work” for most people.

        • Considering the death rates and the numerous side-effects of bariatric surgery, and we’re having a discussion about ‘health’, does this seem like a healthy choice to make?

          Just to emphasise this point a little more, because it’s extremely important to understand what we’re talking about when we discuss bariatric surgery, I’ll quote Linda Bacon:

          early 3% of the patients died after
          the first year and 6.4% at the end of the fourth year. Of those who had surgery in 1995 and had at least 9 years of follow-up, 13.0% had died. Of those who had the surgery in 1996 and 8 years of follow-up, 15.8% had died, and of those who had surgery in 1997 with 7 years of follow-up, 10.5% had died. Sandy Swarzc, on the Junk-food Science blog, compared these rates to the U.S. National Center for Health Statistics of the Centers for Disease Control and Prevention data, matching Americans of the same age and BMI and concludes: “By best estimates, bariatric surgeries likely increase the actual mortality risks for these patients by 7-fold in the first year and by 363% to 250% the first four years.”

          You can read more of that Here.

          Maybe, yes, bariatric surgery works. Maybe for some people it also has helped them in some way, and maybe people are happy for it. But should we realistically be offering up this surgery as a HEALTHY alternative to fatness? Considering the risks to your life, and the whole platitude of side-effects (which you can read about in the linked PDF above), I honestly cannot fathom why anyone would argue that this would be a good idea; that is even before taking into account that it has been shown that people still tend to regain any lost weight, even after they’ve had their stomachs butchered.

          But surely… That must be a lack of will-power, right?

  11. I wonder if Issa or any of the commenters can school me a little more in The Science of Fat. I will always be fat, but I get fatter when life events not of my choosing pin me to a chair for months or years–an awful cubicle job, a major injury, etc. When things change and allow me more time and energy, I make an extra effort to get active again, I rebuild lost muscle, and I get back to what I consider my typical level of fatness, where I’m more comfortable. My perception is I have a fat “set point” and a zone of “extra” fat above that. (My “set point” is still obese by BMI measures, so this isn’t just cultural standards speaking through me!) My life-circumstances-imposed “extra” fat seems to abandon me in response to ordinary movement and diet, while the rest of my fat is quite attached to me. Now, I’ve never been able to go more than one or two years without a chair-entrapment period, so I’ve never been able to discern whether I regained extra weight because of my activity-inhibiting life experiences, or whether it would’ve come back anyway. So my hypothetical question is, if I could get through the next 5 years without a trapped-in-a-chair life change, does the research say that my weight would still creep up again, given that I’m at a level of activity and feeding that are comfortable, and not an unsustainable diet/exercise program? I guess I’m really asking whether there’s anything valid in the old set point concept, since this article suggests that our set point seems to be the highest weight we ever reach, and to which we will always return. Thanks for any thoughts/references/links!

  12. It seems to me that the idea of a diet is a temporary thing. I always looked at food and weight loss as a lifestyle change. I jokingly say “there goes my lifestyle change” when I eat something that my peers would describe as fattening.

    I think that there is more to it than just food an exercise though… Such as childhood abuse… (some scary stuff):
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2609903/
    http://www.jaacap.com/article/S0890-8567%2809%2962619-8/abstract
    http://onlinelibrary.wiley.com/doi/10.1038/oby.2001.40/full
    http://www.ajpmonline.org/article/S0749-3797%2807%2900155-9/abstract

  13. Thank-you for writing all this up. Sometimes I feel like I know these things but having them all laid out in one place really puts it in perspective. I’ve been going through all your fat-acceptance posts, and the other day I just started crying because I was thinking ‘You mean I CAN allow myself not to feel ashamed of this body?’. Which was embarrassing. But totally cathartic.

  14. While I agree that it won’t help you lose weight, I just hope you aren’t discouraging regular exercise and healthy eating with this. It doesn’t help people lose weight but it is still good for your heart and joints to go for a run or lift some weights ever now and then. Fat and thin people(especially thin people because they tend to do it less)need to move around. The plaque on your arteries has little to do with how you look in a swimsuit.

    • I’m not encouraging or discouraging exercise and healthy eating. I do mention in some other posts that they are good for you regardless of your weight.

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