A Response to ‘Why You Can’t Lose Weight on a Diet

TED 2013

Sandra Aamodt, who on the surface has a good TED talk, an upcoming book, based on this TED talk and recently wrote this piece in the New York Times condemning ‘dieting,’ has a PhD in Neuroscience.

She’s smarter than me, but unfortunately this doesn’t make her any less susceptible to human bias. Namely that her own experience is right, and thus others are wrong.

“Three and a half years ago I made one the best decisions of my life. I gave up dieting, stopped worrying about my weight and learned to eat mindfully. Now I eat whenever I’m hungry and I’ve lost 10 lbs!

Paraphrased, but close enough…

“This is me when I’m 13 when I went on my first diet and for the next three decades I was on and off various diets. No matter what I tried, the weight always came back.

In a nutshell; I tried ‘dieting’ for 30 years, was unsuccessful because the weight always came back and then I learned how to do this thing called mindful eating, lost ten pounds, feel great, and I’ve kept it off for 3 years.

Is this not “dieting,” simply called by another name?

Mindful eating.

This might be a bit of a semantic argument but there are some giant holes here worth discussing because I’ve been fielding questions about this article very recently and her TED talk for years. It’s been trumpeted as justification for not having to make changes to diet to achieve success. Unfortunately you have to make changes to your diet (or exercise regime) to lose 10 lbs, or learn to defy the laws of physics.

In other words…IMPOSSIBLE…

Mindful eating is great, I’ve taught many components of it to various clients for years now, depending on perceived need. However, like any other form of dieting, it takes some time to learn (3+ months in most cases) and acquire the skill of recognizing actual hunger sensations, sitting with them, adjusting to them.

The entirety of the TED talk and the NYT’s piece hinges on this very important concept (well and another faulty one I’ll get to at the bottom):

Eat When You’re Hungry

This would be fine, assuming a person has good skill in identifying true hunger. Sadly in today’s modern era, we don’t eat just because we’re hungry. Confused hunger signals are often part of a person’s problem with food intake in the first place.

Learning how to recognize when you are truly hungry requires diligent practice, as much as say, ‘learning how to maintain your weight after dieting…’

The truth being that this is one of many potential skills, or combinations of skills that people who eat hypo calorically (i.e. dieting) for a little while to lose weight, must later employ to maintain that weight loss, among others.

It can work, to be sure, but it’s no more effective than telling people to count calories or any number of other “methods” that can be used to create a hypocaloric energy balance that results in weight loss over time.

In the basic sense of the word it’s all ‘dieting.’

Almost all existing research into weight loss signals an undeniable truth:

Without practice in weight management after a phase of weight loss, you’re probably doomed to dieting failure in the long-term.

A tiny little factoid, most popular fad diets miss when they’re selling ‘lose 10 lbs this month!’ or ‘28 days to shredded abs!’

Which is to say, you can lose weight on pretty much any diet provided it leads to a negative energy balance.

Keeping that weight off on the other hand…is an entirely different story…

It takes practice identifying when you’re really hungry, compared to just bored, and most people in the developed world are just frankly bad at it. About as bad as they are at estimating how many calories they take in a day or expend in a day. Which explains why calorie counting often fails as a method too.

The reality of modern living is that human beings are primed to eat for old survival reasons and food is now in abundance. Storing fat is good for the famine that won’t come in 2016.

We eat for social reasons. We eat out of boredom. We eat out of guilt (for not adhering to diets!). We eat when we’re sad, frustrated, anxious, etc... We’re primed to eat more when we’re tired. We eat more when we’re drinking alcohol. We eat more when the plates are big or drink more when the glasses are wide.

We’re primed to eat by advertising, time of day, the time it takes to actually feel full (20 min…), the satiability of our previous meal(s) and a whole host of other reasons that are not real hunger.

Telling people to just eat when they are hungry, is just like telling people to ‘eat less and exercise more.’ Or as James Fell likes to phrase it more accurately, “it’s like telling a person in crushing poverty to just spend less and earn more.

There is no actionable concept here worth hanging onto for the overwhelming majority, despite good intentions, because most people simply don’t know what real hunger feels like. You have to experience a process of deliberate practice that takes it much further and much deeper than a catch-phrase.

Realistically speaking she probably knows deep down that ‘just eat when you’re hungry’ is a tricky thing and maybe her book will expand upon this. From her piece in the NYT’s:

“When dieters’ weight drops below it [set-point — I’ll discuss this below], they not only burn fewer calories but also produce more hunger-inducing hormones…”

Basically hunger increases when in a negative energy balance and negative energy balance is the fundamental requirement for fat loss. So if I simply rely on my hunger cues, I’m likely to eat more food than I might necessarily need if I’m eating in a deficit. That is despite my doing it intentionally with a diet or unintentionally with another method.

I can easily overeat just eating when I’m hungry, particularly if I’m not aware of other skills that can help me manage it. Hopefully now you’re starting to see the mix of skills that are required for long-term weight maintenance.

You can certainly take the slow, indirect, skill based approach, as I typically recommend — my blog is Skill Based Fitness after all. However, this still won’t make it necessarily better or worse than ‘dieting,’ it’s just a different way to go in the sense that the deficit is often smaller, more indirectly manipulated and the skills required for maintenance are well learned during the process.

I’d note here that contrary to conventional wisdom, and even my own general practice, there is actually a strong indication that people who experience greater initial weight loss might actually keep it off better than slower counterparts.

To quote one review:

“…weight loss intervention studies showing that a greater initial weight loss, usually achieved in the first 2–4 weeks of treatment, is associated with a better long-term outcome, i.e. a sustained weight loss 1–5 years later.”

Now this isn’t always the case. The caveat here that eludes most crash/fad/trendy diets, is that the skills I’m mentioning here (including mindful eating as a skill) must still be learned in the long term, no matter the pace you choose. The main advantage of losing more weight in the first month is probably associated with adherence and enhanced motivation for the months that follow.

Also, an initially quick approach might not be appropriate for people with morphed body perceptions, obsessive personalities or simply a lack of desire to learn these skills.

If those skills are not learned, then absolutely faster initial weight loss is often associated more heavily with faster weight regain. This makes the crash diets generally a bad idea, but not necessarily ‘dieting’ in the common sense of the word.

Being is a slight deficit achieved indirectly until becoming weight stable, after learning how to effectively manage your hunger, is still a form of dieting. This can be a better approach because low deficits have less of an impact on hunger-related hormones.

Namely, the body isn’t going, “DAMN I’m losing all this body fat, I need to slow my metabolic rate right back!

This approach of gradually learning how your hunger works, and learning to stop being so self-critical of your own weight works pretty well for a lot of people, provided they take the time to learn the requisite skills.

In the absence of those skills, telling people to just eat when they are hungry is bad advice.

It’s not that diets don’t work, it’s that bad diets don’t work.

The Pedantic Argument

In common vernacular, I’m familiar with the concept of dieting implying something you go on to lose weight — and sometimes it’s for gaining weight, or other reasons.

Most people are.

However, diet also means the average food consumed over a period of time by an organism. If diets don’t work, how do people eat?

It appears to me that the main argument of this talk, NYT piece and probably the book is a matter of semantics. In the sense that you’re encouraging people to abandon the idea of going on a diet. In other words, taking back what diet historically has meant.

Going on a diet for most folks conjures up imagery of stone cold willpower, skipped meals, bland tasteless food, tiny unsatisfying portions and a slew of other disheartening mental imagery.

In this I agree, the terminology might benefit from being referred to differently. I’m not sure that terminology should become intuitive or mindful eating; both of which can be equally misleading. A change, no matter what you want to call it, must be made.

I prefer calling it Skill Based Eating, but that’s just me…

The word ‘diet’ today, implies a short-term process that by definition will stop some day. This perception has dire psychological and often physical consequences in the long-term. It results in a lack of maintenance skills.

If you have been trying many bad fad diets for 30 years, of course, that kind of ‘dieting’ doesn’t work, but like so many things, that’s because you’ve been doing it wrong. Not because you’re dieting.

If you create an energy surplus then a person will gain weight, despite the method. If it’s a negative energy balance, then a person will lose weight. Those are just facts.

It matters not whether that is done directly or indirectly. What matters in the long-term is how prepared an individual is to deal with maintenance. Mindful eating might address this better than other dieting strategies, though it tends not to be as good a method initially for creating the deficit; Thus may not provide strong initial motivation. It does make people less neurotic and orthorexic about the process.

It’s only one of many potential skills that can be viewed as essential (depending on the person) for effective maintenance coming off a diet:

  • Learning how to quickly gauge your consumption and adjust consequent meals (portion control).
  • Learning how to choose meals that provide better satiation and thus less overall hunger (for instance more protein and more vegetables…)
  • Cooking (and controlling the content of your food)
  • Learning how to track changes and adjust accordingly.
  • Learning to avoid hunger cues not directly related to real hunger (not leaving desirable foods in plain sight, or having them in the house…)
  • Learning how to manage other parts of the process like sleep, and stress management
  • Exercise (marvelously effective for weight maintenance!)
  • Learning how to avoid environments that lead to increased intakes (fast food restaurants, certain work environments, etc…)
  • And many more…

In other cases, the problem with dieting is directly related to unrealistic expectations of the commitment long-term and what result can be maintained. It’s just incredibly difficult to maintain low levels of body fat consistently without good genes, incredible skillsets and incredible diligence.

Yes, that’s something many in the dieting industry won’t tell people as they try to sell them six-pack abs. If you’re being sold something that sounds too good to be true, it probably is.

Ultimately this comes down to body image issues (not dieting specifically) and self-esteem that again I agree are incredibly important to address and be concerned about. You said it yourself,

“I didn’t need a diet, I needed a fashion consultant.”

As near as I can tell you are not overweight, and the photo you threw up was not overweight, it was your perception of how you looked that influenced your dieting spree cycles. That’s a psychological problem, not a dieting one.

How do we help people create a better internalized view of themselves in the face of brutal advertising and social pressures? These stressors can often result in overeating and a self-fulfilling cycle of behaviors.

Can you learn good weight maintenance skills after 30 years of trial and error learning? Seems plausible…

Equally plausible is that without that previous experience, you may not have eventually found the current success.

What other skills did you acquire in the timeframe that don’t appear obvious?

At the end of the day, everyone has their journey.

Different people will find different methods work, that hasn’t and won’t change. The ultimate mechanism will remain the same (negative energy balance), but the approach to creating that can change. I believe strongly that helping people discover methods that work for them, out of the many options, is more critical than nearly anything else. Adherence to any diet is the most important consideration.

It’s not that diets make us fat — though certainly the Standard American Diet is making the entire world fatter — it’s that we’re not doing them well enough to make them succeed.

I think what you effectively mean to say is:

Stop relying on gimmicky crappy short-term diet solutions that don’t teach you any skills on how to manage your weight. Stop viewing your diet as something you go on for a short time. Learn to love your body just a little bit more.

On that I can definitely agree…

I do however find that protesting or bashing the idea of ‘diets’ sends the wrong message. Some kind of change has to occur in a person’s diet, and ideally long-term, or the desirable result can never occur. We surely have to change the dialogue, or this message is akin to eat less, exercise more, but discouraging change to a person’s diet can’t be the answer. It has to happen.

Set Point “Theory”

I was going to end on that note but there is a propagation in both the TED talk and the NYT’s piece, of an old theory in weight loss science that to this date remains unproven and most likely improbable. Yes, this model explains the biological aspects of energy balance from a neuroscience perspective, but it fails miserably to explain the significant environmental and social influences on obesity; In addition to food intake and physical activity.

Beyond that, it’s still only a theory, and needs to be taken with a grain of salt. The absolutist notion that body weight is somehow genetically pre-determined by the brain is a bit of stretch to say the least and is hotly contested.

In the 90’s, it was thought that genetic information would be the key to unlocking a slew of problems. Once the genome was mapped, however, we now know that there are very few instances where a single gene is truly the cause of anything. Genes are not hardcoded and not subject to change or influence from other genes. It’s sparked an entirely new field of study called Epigenetics — or the study of how environment influence genes.

Yes, it’s a bit of a buzzword these days but that doesn’t mean it isn’t valid and it’s changed how many scientists think about such absolute ideas like set-point theory.

Weight is not hardcoded and is heavily influenced by environment.

What’s more likely that our setpoints have somehow dramatically increased only in the last 50 years? Or that our food environment and eating/exercise behaviors have led to generally higher average human weight than at any point in history?

Much newer and complete models have been established to address the obvious effects of environmental and social implications that affect weight.

Conveniently ignored in the article and the talk is any discussion of equally valid theories of weight settling, that typically account for environmental influence.

A great paper that I feel may be excluded from your upcoming book can be found here discussing the various models. There is no shortage of theory here.

I realize writing about conflicting points of view doesn’t bode well for book sales, but you can’t just take the one view that supports your experience and roll with it, while discounting the others.

Nobody with even the slightest look at the literature, including myself, would argue that the body doesn’t fight to achieve homeostasis. If you start losing weight, the literature tells us that resting metabolism drops to compensate. The bigger the energy deficit, the larger the metabolic change.

The same has been shown in reverse; Metabolism will increase during overfeeding, which, explains why you’re not guaranteed to gain 2 lbs of fat in one day if you eat 7000 kcal above your required intake.

There are many unanswered questions about how this happens, but we’ve certainly all but ruled out set point theory as the sole factor. Yes, it’s easier to gain, than to lose because…well…SURVIVAL…

The more fat you have, the longer you can go without food.

Set point theory (SPT) defies logical reasoning, as non-surgical bariatric obesity doctor Yoni Freedhoff pointed out way back in 2007:

“People regain their weight as they regain their old lifestyles.”

It’s a nice thought to bring a questionably controlled ‘Biggest Loser Study’ into the mix to support this view, but it goes against an existing large body of research that doesn’t lend support to that view. Particularly what has been seen in more heavily controlled settings such as that of Rudolph Leibel, and his metabolic ward work on the very same subject.

His work showed mostly only minor changes in resting metabolic rate by contrast, when weight stable. You have to look at the data as a whole. Perhaps if you have a very large amount of weight to lose the effects are greater, but for most people, it won’t be. There are numerous strategies as well for managing this process well along the way, like refeed periods, diet breaks, using smaller deficits, resistance training, etc…etc…

All those people in the National Weight Loss Registry are not anomalies; They are proof that you create a deficit; Learn the requisite maintenance skills as they apply to you and your situation; Track, adapt the plan over time and keep at it.

It reveals that everyone has to go through their own process to some extent, depending on your starting point and numerous other factors. Maybe it takes 3 years, or 5 years, maybe for some it’s 30.

It’s a process that takes some time, but your weight isn’t written in the stars, it can be changed. Telling people all about SPT doesn’t exactly help them with motivation. It makes the process seem hopeless. People need hope to find success.

If SPT was really a thing, how do you explain maintaining your current weight at less than it was previously?