Just to put that number in perspective for you, an improvement rate of 5% is significantly lower than the typical rate of improvement for virtually any other attempted behavioral change. There really isn’t any statistically significant difference between no intervention at all and medical weight loss plans. It might as well be a placebo. The bottom line is that people who are really, really, really motivated to lose weight will probably succeed regardless of the tools they have at their disposal. That is true for quitting smoking, sobering up, or pretty much any other behavioral change people want to make.
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And that is why it’s foolish to say that this weight control methodology “does not work.” People who make that claim are painting with a brush that’s large enough to cover the state of Texas.
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Gestalt and Hamlet aren’t even really disagreeing, I don’t think. It’s like the tale of the blind monks and the elephant… everyone has a different piece of the elephant and is thus describing it differently, but if you would all put your pieces together you’d have the whole elephant.
The ‘‘whole elephant’’ as I see it, is this. Weight gain is a very pernicious* behavioral problem*. Unfortunately as a society we tend to associate behaviors with moral judgment instead of acknowledging how profoundly environment and genetics and so on influence behavior. That’s part of the reason there’s such a stigma against being fat.
It’s also part of the reason overweight people resist acknowledging that they have a behavioral problem. Because that implies that it’s their ‘‘fault’’ that they are overweight and therefore worthy of derision. But the reality is not so simple. Obesity is statistically correlated with mental illness as well as poverty - in fact, a recent study found that people who lived with food insecurity - not knowing where their next meal would come from or when they would next eat - were fatter compared to the general population. This is because the most logical option when you only get to eat once a day is to eat as many calories as possible for the cheapest amount of money possible. Also, we know that the longer someone goes without eating, the more calories they are likely to consume. Therefore it makes at least some level of sense that people can be both hungry and obese. In the extremely impoverished area my agency serves (the poorest census tract in the state of Pennsylvania) the obesity rate is hovering near 50% in adults and 40% in children.
So mental illness and poverty are just two confounding factors, but there are plenty more. It would be easy to say that people are fat because they are lazy, and yet, Americans work more hours than most other developed countries and we work more hours than we ever have in recent history. I therefore don’t buy the idea that Americans as a whole are getting lazier and this explains our fatness.
And yet… and yet… we’re still dealing with a behavioral problem. Whether it’s because of lack of access to healthy foods or being overworked or being addicted to food, the bottom line is people are taking in too many calories and burning too few. If we could lock everyone in a cage and feed them nutrition pills like in the Jetsons, they’d lose weight. The problem is where free will comes into play - the choices people make that keep them fat. That is the reality.
But the other reality is that we don’t really understand why it’s so hard for the majority of people to change their eating behavior. We have hints - like the study that indicated rats were willing to work harder for sugar, fat, and salt than they were for cocaine - but we have failed to really come up with a specific intervention that facilitates the long-term behavioral change that leads to weight-loss.
The answer to treatment, as I see it, is how do we address the behavior? One roudabout way is through cognition - and there are some promising results in clinical trials using cognitive therapy for weight-loss. In one Swedish trial the majority of participants using cognitive therapy had actually continued to lose weight at one year post follow-up. I am currently trying out this method myself, as a person who has been maintaining a 40 pound weight loss for some years now but still has 20 or so to lose. I have gained and lost the same damn 15 pounds about four times in the last two years.
The problem isn’t that I ‘‘don’t know how’’ to lose weight - I absolutely know how - plan out my meals every day, count calories, exercise regularly, etc. - the problem is sustaining those changes in the long term. The problem is how I react to stressful events with depression and feeling overwhelmed and the occasional downright apathy that sabotages those efforts. The problem is when I come home absolutely exhausted and starving and convince myself that I MUST EAT NOW and don’t have time to cook. The problem is when I get so down I can barely move off the couch much less contemplate a 3 mile run. These are absolutely behavioral problems I must address, but they are clearly changes I have yet to achieve despite an impressive personal history of making behavioral changes in the face of enormous obstacles.
What this book claims to do is get at the heart of all those breaking points and prevent little lapses from spiraling out of control. It’s also about adjusting your expectations for how quickly you will lose weight and how to respond when progress stalls, as one of the key problem with losing weight is that it becomes significantly less reinforcing after the first few weeks and the rate of weight loss begins to slow. It’s about changing the way you think about eating and food. I have all these Response Cards written up to respond to sabotaging thoughts and hunger and cravings. I’ve done all these exercises – one required me to skip lunch deliberately just so I could learn to tolerate the feeling of hunger and learn that it’s not an emergency. One required me to deliberately serve myself more food than I could eat and then once I finished my allotted portion, throw out the rest. One of the cards is supposed to say ‘‘Oh Well, I may not like this but it’s what I have to do to lose weight.’’ I just wrote ‘‘Tough Shit’’ on my card because that’s more my style.
I’m a pretty smart person, but these techniques were not at all intuitive to me.
So yes, obviously, eating less and exercising more works for weight-loss. But it’s a tad disingenuous to imply that means we’ve come up with a wonderful solution for our nation’s obesity problem. Obviously some people are great at losing weight, but the vast majority of us need concrete tools and resources to get over these hurdles.