STRUGGLING ???

It seems like we are constantly inundated with a veritable avalanche of organizations and individuals promising that they can help us lose weight (123 million responses to struggling with weight the last time I Googled it!). If you are struggling with weight-related concerns, how can you make an informed, intelligent decision about which way to turn? Here are some important issues you might consider addressing to help you navigate the waters.

First, What Does the Weight-loss Research Say? 

We have nearly 40 years of consistent and conclusive research from scores if not hundreds of studies on which to ground this discussion. Whether it be commercial programs, medically supervised or hospital-based interventions or worksite wellness initiatives, the outcomes are strikingly similar:

1. Many people lose weight during the programs.
2. Most people gain their weight back after the programs are over.
3. 1/3 to 2/3 of participants end up weighing more than when they started.
4. The weight cycling that occurs may be detrimental to their health.

I have been following this research for more than 3 decades and as far as I know there are no exceptions. If you know of one, please feel free to send it to me.

Of course, there are also a wide variety of programs offered by an even wider variety of individuals (more on this shortly) on social media and elsewhere. Unfortunately, there is very little data on such offerings as these professionals have neither the time nor the inclination to follow up on long-term outcomes.

How Can You Tell If the Claims Being Made Are Valid?

Any program claiming that they have produced results that differ significantly from the 4 conclusions above should be viewed with significant skepticism. Remember, those four conclusions have been reached over and over and over again for the past 4 decades with amazing consistency. And although most of the individuals marketing their weight loss services in the written or social media will claim they have been “successful,” it seems highly unlikely that their outcomes will be better than the more labor and resource intensive programs investigated in the literature.

In any case, whether from commercial, medical or individually provided programs, here are some claims for which to be on the lookout.

• Claims about numbers of pounds lost. This can be either individual people (so and so lost 60 pounds) or groups such as community members or employees (a certain department lost a total of 620 pounds).

Remember: How much weight is lost is not particularly relevant as many people lose weight in most programs. The important outcome is how many people keep the weight off after the program ends. Be especially on the lookout for claims of "maintenance." If people are still actively participating in a program, it is not maintenance.

• Claims that Guarantee A Certain Amount of Weight Loss. A typical statement might say – “Guaranteed to lose up to 18 pounds in the first month or your money back.”

Remember: First, more than 4 pounds a week is not a safe amount of weight loss for which to strive. Most health organizations suggest a maximum of 1-2 pounds a week. More importantly, note the words “up to” in the guarantee. This is not a guarantee that you will lose 18 pounds or anything close, it is a guarantee that you will lose “up to” that amount. So, if at the end of the first month you have only lost half a pound, you would have satisfied the guarantee, as ½ pound does indeed fit the qualification of being “up to” 18 pounds.

• Claims that Intuitive/Mindful Eating Can be Used for Weight Loss.  It is not unusual, especially for health coaches and health educators to claim that mindful eating can be a good way to begin a weight loss program. Years ago, this was true for some nutrition professionals as well, but nowadays most real experts in this space would never make this claim.

Remember: Mindful/Intuitive eating is about paying attention to internal cues of hunger, appetite and satiety to guide what and how you are eating. Guiding personal eating habits in conjunction with numbers on a scale does not qualify as an internal signal!

• Claims that some foods have magical qualities: These are foods that can supposedly rev up your metabolism, burn belly fat, or boost your immune system. Sometimes they are even referred to as superfoods that can cure or prevent disease.

Remember: While a well-balanced diet can be good for your health, these kinds of claims about individual foods have little scientific support. As David Stukus, Assistant Professor of Pediatrics in the Section of Allergy/Immunology at Nationwide Children's Hospital put it: “If someone out there is offering a miracle cure or other treatment that sounds too good to be true, then it is.” As for superfoods, they are about as real as superheroes!

• Claims focusing on “clean eating.” This movement started out as an approach that encouraged eating fresh, minimally processed, nutrient dense foods cooked from scratch (a laudable proposal although realistically probably not within the grasp of most people on the planet).

However: the movement has morphed into a hodgepodge of unscientific and potentially dangerous diet promotions and practices.

• Claims based on “before and after” pictures. Programs and individual practitioners alike often rely on this marketing tool to sell their interventions. You have seen the before pictures of people, often looking quite disheveled before and then amazing (and thin of course) after.

Remember: Anecdotes are not science. What matters is not - did anyone lose weight and keep it off? What matters is - what percentage of people who were treated did and what percentage regained their weight after the program ended. Furthermore, there is no way to assess the veracity of the claims by looking at these pictures

What Can You Glean from The Type of Professional Offering the Services? It is probably not a great idea to pay too much attention to a friend or family member when it comes to getting direction on what to do about weight-related struggles. While they may mean well, this is a complex, nuanced space and every person is different. But what about health professionals? Some suggestions follow:

• Doctors, Nurses, PA’s, Nurse Practitioners, etc. – With some possible exceptions, most of these professionals will not have a whole lot more training and experience with weight struggles (except perhaps their own) than do you or your friends and family. They might be decent sources for some general nutrition information, (eat more fruits and vegetables for example) but they have neither the time nor the expertise to do the work that it takes to be helpful and do no harm.
• Exercise physiologists, personal trainers, physical therapists – The same can be said for these professionals. Although physical activity is an important piece of the pie when it comes to health, without a lot of background and experience in nutrition and working in the trenches with people around weight, the training these people have is simply not sufficient. I can attest to the fact that my master's degree in Exercise Physiology included minimal nutrition training.
• Health Educators and Health Coaches – It is not difficult to find these folks, offering weight-loss services on Facebook, LinkedIn and elsewhere. Again, unless they have extensive training and experience outside their degrees, it is unlikely they have the expertise to do this work. For example, I have a Ph.D. in Health Education, but without the training and experiences acquired from my master’s degree in Human Nutrition, I would be ill prepared to do this work. Similarly, health coaches are very unlikely to have the expertise. Look at their resumes or ask them about any relevant training or experience they may have. Be especially skeptical of exaggerated claims of weight loss successes – “I have helped so many people lose weight over the years’” or “I know what the research says, but my client’s experiences are different.”
• Nutritionists – Caveat Emptor here for sure, as anyone can call themselves a nutritionist regardless of their training or lack thereof. Beware of nutrition certifications, some of which can be bought after taking a brief online training and an open book test.
• Psychologists, Social Workers, Counselors – Depending on their training, these professionals can be helpful, particularly for those who struggle with disordered eating or eating disorders. For the best outcomes, most of the time you will want to pair this person with an appropriately trained nutrition professional.       
• Nutrition journalists and researchers -  Although many of these people are not health professionals, their research often does a good job of summarizing the relevant literature. They may discover for example that populations that eat a certain way seem to have less “overweight” and “obesity.” However, without the training and experience to translate that information into real human life situations, how helpful are their discoveries really going to be? 
• Diet and Weight Loss Book Authors – Anyone who writes a diet book suggesting that they have discovered the secret to successful weight loss should be viewed with extreme skepticism. These authors range from celebrities with no credentials whatsoever to medical doctors with long strings of initials after their names. There are hundreds if not thousands of these books! The bottom line for all of them is that unless they have data to support their claims (which they don’t) they should probably be ignored. Be especially wary of book covers using the words – "sensible," "easy," "quick," "painless," and "scientifically proven."      

What About Nutritionists and Dietitians – Speaking of nutrition professionals, those who are usually best trained and have the most experience helping people with weight-related struggles are dietitians. Dietitians have at least a bachelor’s degree in human nutrition and significant experience working in the trenches with people. Some nutrition professionals who have a master’s degree in human nutrition but who have not completed a dietetic internship may also be helpful. Remember again that anyone can use the title of nutritionist.

It is critically important to remember that, just as with any professional, not every dietitian or appropriately trained and experienced nutrition professional will be right for your needs. Aside from having the proper training and experience, they must be someone who makes you feel safe and understands that although they may be the subject matter expert, you are the expert in the room when it comes to you. What you are looking for is a guide not a lecturer or a manager.

And perhaps most importantly, because the focus on weight loss has been demonstrated consistently and conclusively over many decades to be ineffective and often iatrogenic, you will want to make sure that the nutrition professional you choose is supportive of and well versed in approaches that are health- rather than weight-centered. Some professionals will use the term "non-diet," although you can be more certain of their perspective if they talk about Health at Every Size. You can learn more about this approach here.

Rhymes with “Boom.”

Let’s see how you might proceed to determine if a specific offering is something in which you might be interested. One of the newest weight-loss programs I have seen advertised on TV has the title of NOOM. The TV ads are interesting. Rather than before and after pictures, they just show individuals who claim to have had a successful experience with the program. These individuals, in stark contrast to most weight-loss marketing don’t look like celebrities and are not bone thin.

The individuals don’t say how much they have lost, just that they have tried numerous diets in the past and found this program to be different - helpful and relatively easy to follow. The TV piece invites the listener to try NOOM and “keep the weight off for good!” Pretty slick really, although one of the participants claims that she tried everything including cutting out bread and pasta - "for a day." I am not sure how that made it through editorial cuts but…

So, we have a new diet program with a cute name, rather unique marketing and suggestions of successful long-term weight loss. What is a potential buyer to do?

When you visit the website, sign up and download the app, (that’s right, this can all be done on your phone) they have you answer a bunch of demographic questions and then they develop an individualized plan based on your answers – gender, height and weight, desired “ideal weight” health behaviors and so on. You are connected with a coach who then guides you through the process. They claim it is not a diet (of course) and yet they utilize an antiquated red light, green light process of categorizing foods, another failed diet approach that was originally created through the auspices of the now totally discredited Biggest Loser Program.

All quite slick, especially perhaps for millennials (they are particularly targeting younger people who like and are good at doing mobile stuff). But the question is, what does the research say? Here is where the rubber hits the road. They claim that the research demonstrates successful long-term weight loss. There are several studies cited, although they don’t make it easy to find them on the website. I Googled 2 of the studies and they were available online.

Remember that what we are looking for are results that differ from those of the plethora of studies over the past 4 decades that we described above. Without going into great detail about each each study, it is not that difficult to determine their validity. Here is what I found.

The first study was reported by CNBC along with the claim that:

“Scientific evidence supports the finding that mobile apps can be effective in the fight against obesity.”

While this sounds promising, the authors of the study, published in September of 2016 and entitled Mobile Apps for Weight Management: A Scoping Review, concluded something quite different saying:

“The overall conclusions advanced in this review are that despite the high accessibility of mobile apps for weight management, the quality of their content and functionality remains poor.”

Hmmm…

The second study, published in May of 2018 followed up on a previous study that involved the use of the NOOM app in conjunction with the Diabetes Prevention Program. The whole process was quite intensive with lots of moving parts. The important point is that the authors of the article claim successful long-term weight loss with use of the app, and NOOM cites this on their website as proof of that reality. Without going into a lot of detail, what you need to know is that, for the so-called “maintenance phase” of this intervention, we are talking about a total of 32 participants! Furthermore, the "maintenance phase" was not really maintenance, as they were still participating in a less intense version of the intervention. Oh yes – and if you read all the way down to the bottom of the paper - there is one more thing:

All authors were employed by Noom, Inc, and received a salary and stock options. AM and MW (authors) hold a patent pending (3492.004US1) with Noom, Inc.

OOPS!

Take Home

Not everyone has the time to download, read and explore in detail the validity of the research claims made by weight loss promoters. For those who want to read further about how to do this, here is a free, downloadable white paper than can help.

It is the responsibility of those promoting weight loss interventions to be honest and upfront about the most likely outcomes and potential dangers of their offerings, just as it is with any medical intervention. To date no program or intervention has been shown to be helpful for more than a small percentage of participants, and there are potential significant, negative physical and psychological consequences to repeated weight loss and regain, which is what happens to the vast majority of participants. 

Until such time as this is no longer the case, all weight loss offerings by any organization or individual should be accompanied by the following declaration:

"Research shows that the vast majority of people who participate in weight loss programs will eventually gain their weight back after the program ends. Many will also gain back more than they lose. The weight cycling that occurs with repeated participation in weight loss programs may have negative effects on their health"

Anything less is simply unethical, flying in the face of standard medical procedure which requires that patients be fully informed before deciding on any medical intervention.

Take care and I hope you find this helpful – Dr. Jon