Help Clients to Trade Suffering, Sacrifice and Struggle in Dieting for the Skills of Organization, Planning and Thoughtfulness.
The following is an excerpt from the new book The Diet Fix: Why Diets Fail and How to Make Yours Work (Crown 2014) by renowned obesity expert and clinician Yoni Freedhoff, MD. It has been edited and reprinted with permission from the publisher.
Whether it was Rita Mae Brown or Albert Einstein who first said it, the quote “Insanity is doing the same thing over and over again and expecting different results” might just as well have been written to describe society’s past few hundred years of weight loss efforts.
From the famous “milk cure” of the early 1800s, when dieters traveled deep into the Swiss Alps for the privilege of being assigned their own personal cow whose freshly milked udders provided their sole source of sustenance for 7–14 days, to William Banting’s blockbuster 1864 bestseller Letter on Corpulence, to the 1970s 700-calorie Scarsdale Diet, grapefruit diets and cabbage soup diets, there has been no shortage of traumatic weight loss plans over the years.
The modern day isn’t much different; for every ridiculous diet that falls out of favor, a new ridiculous diet is born. While all of them have markedly different calorie control, they all share a common theme: In order to lose weight, you have to suffer. There is an underlying belief that success resides in white-knuckling willpower, in undereating, overexercising and somehow learning to like it. These ideas are echoed not just by individuals but by the media, the entertainment industry, and even our public health officials and allied health professionals.
Before trying to fix all the things wrong with dieting, it’s important to discuss (1) society’s most common dieting myths, which in turn perpetuate recurrent traumatic dieting; and (2) the one myth that rules all of these myths and binds them together. It is likely that your clients struggle with many, if not all, of these myths. Perhaps having some insight into each myth may equip you to better help with their challenges.
Myth: People Lack Willpower
I hear all the time, not only from thin folks who just don’t understand weight management, but even from folks who have themselves struggled with their weight for decades, that the reason people struggle is that they lack willpower— they just can’t resist temptation.
Dieting is not about willpower. If it were about will power or about just wanting it badly enough, the world would be skinny. Successful weight management is about change and beliefs.
In terms of change, the world is a very different place from what it was just 50 years ago, and there are many things impacting a person’s weight: cheap and convenient calories, constant stress and long, sedentary work days, among many other factors. It’s a different world now, and the default in this world is weight gain; simple, brute-force willpower doesn’t stand a chance.
In my opinion, dieting has proved to be a tremendous failure over the years. But from all angles, we are taught to believe the opposite: that diets work and it’s we who fail. And beliefs matter. But couldn’t it be that the fault for our never-ending dieting failures doesn’t lie with us as individuals, but rather with how we approach dieting as a whole? A paradigm shift was needed for ancient astronomers to realize that the true nature of the world around them was a round, rather than a flat, earth. If we’re going to make sense and success of dieting, diets need a new underlying belief, an integral part of which must include rejecting the notion that willpower is enough to see us through.
Myth: Weight and Health Are Mutually Inclusive or Exclusive
Another mistaken belief that permeates weight loss lore is that people simply cannot be considered healthy unless their weight or body mass index reaches some specific number. While there’s no doubt that at the extremes of weight there is definitively attributable risk, there is also no doubt that the risks of weight as a singular measure of the presence or absence of health have been markedly over-blown by both society and medicine.
Some studies have even suggested that beyond the age of 65 the healthiest body weights are statistically in the medically overweight range (a body mass index between 25 and 30) and that mild degrees of medical obesity are in fact no riskier than possessing a “normal” body weight (Flicker et al. 2010).
Keep two things in mind: (1) Weight doesn’t exist in a vacuum, and (2) health has a great many variables. There are studies that demonstrate that even with moderate obesity, eating a healthful diet and exercising regularly mitigates the vast majority of risk that had been attributable to weight (Kuk et al. 2011). The notion that you can be healthy only if your weight is ideal, or if your BMI ranges between 22 and 25, is flawed. Health is far too complex to be boiled down to a number on a scale. How do you think the mistaken belief that a person can’t possibly be healthy at a BMI of 35 affects the person who has reduced his BMI from 45 to 35? It leads him to feel like a failure, and it might even lead him to give up entirely and regain the lost weight.
So how does a person lose weight in this day and age, when it would certainly seem that the default is to gain, the environment is toxic, and the deck is conclusively stacked against us? According to the founding director of Yale University’s Prevention Research Center, David Katz, MD, MPH, it’s not about developing willpower—it’s about cultivating skillpower.
The good news is that the skills required aren’t the classic triad of suffering, sacrifice and struggle. The skills required are organization, planning and thoughtfulness. With these skills, not only is it possible to experience permanent weight loss, but also—and perhaps more important—it’s possible to enjoy a normal, healthy and friendly relationship with food. While it does take time to master, skillpower gets easier with time. The more practice a person has with any particular skill, the better that person will get at it, and the more naturally it will come.
Myth: Dieting, by Definition, Must Be Difficult
Whoever thinks that successful weight management is about suffering doesn’t understand human nature. We are not built to suffer. In fact, humans spend untold effort trying to minimize personal suffering. Yet dieting has always classically been about some combination of undereating or overexercising, and both of those approaches invariably involve suffering.
Suffering does more damage than simply making weight management difficult to sustain. Believing oneself to be a failure as a consequence of being unable to suffer is a terrifically self-destructive and traumatic burden that, in turn, challenges each successive weight management effort. Truly, for weight management to last a lifetime, it cannot be a difficult process. Starting a weight management effort believing you’re going to need to suffer to succeed almost certainly guarantees that you won’t.
In their book Switch: How to Change Things When Change Is Hard, Chip and Dan Heath explain that in order to effect long-term change, we need to improve the path we take to get to where we want to go. If the goal is long-term weight management, instead of becoming entrenched in suffering—a path that is undeniably difficult—we need to focus on ways to make living with less food or fewer calories easier. Individuals who succeed in maintaining weight loss may well be more thoughtful about food and fitness, but—most important—they have found a way to be more thoughtful. For them, that improved path and mindset no longer qualify as suffering.
Myth: Fitness Is More Important Than Food for Weight Loss
While there’s likely no behavior more important to over-all health than exercise, in the real world exercise doesn’t drive weight loss.
Have you ever eaten anything “because you exercised”? An extra portion? A higher-calorie choice? A reward for your hard work? Or have you ever been hungrier because you exercised? And once you start eating in response to your exercise, exercise’s weight benefits quickly disappear. Exercise has a tremendous impact on us psychologically and physiologically, and in regard to weight management, those impacts are both for better and for worse.
While exercise may lead us to unknowingly consume more calories as a reward for our exertion than the calories we burned exercising in the first place, there’s no doubt that exercise does us many tremendously good services; and it’s no myth that exercise helps us keep weight off. Exercise has a powerful impact on our mood and our sleep and, in my experience, markedly bolsters healthy living attitudes as a whole. It’s likely these indirect or less tangible benefits that lead to weight management’s most unfair paradox: While exercise alone is unlikely in the real world to lead to any dramatic weight loss, we know that without exercise we’re far more likely to regain whatever weight we’ve lost. Exercise is a strong commonality found among the National Weight Control Registry’s weight loss masters. When all is said and done, most folks suggest that dietary choices are responsible for 70%–80% of a person’s weight, while fitness covers the remaining 20%–30%.
I don’t know about you, but if I had a final exam where the questions were to be weighted 70%–80% in favor of one semester’s material, I’m pretty sure that’s the semester that would get the vast majority of my study time and attention. To put this another way: It’s far easier to lose weight in your kitchen than it is to lose weight in your gym.
Myth: Cheat Days Make Dieting Easier
Cheat days make sense on paper. If 86% of your week (6 of 7 days) is great, you’ve earned that day off. Right? What about just a meal off?
It would still be a bad plan, but let’s go through the why with some numbers. There are 21 formal meals a week. What if 95% of them (20 of 21) were perfect? And I mean really perfect—homemade, from scratch, with loads of fruits and vegetables and perfect calorie control? Unfortunately, living in our modern food environment even a single “cheat” meal—a purposely indulgent, pay-no-attention, write-off meal—has the caloric potential to erase nearly an entire week of exceptionally careful choices.
Here’s how: I remember watching an episode of a weight loss reality show. In it, contestants dined at a fancy restaurant—the kind with the big plates and the small portions. The challenge involved guesstimating the calories in their ordered meals. One contestant ordered a beet salad, followed by a fish fillet plated on vegetables over a bed of what looked like couscous or brown rice. Total calories for her meal consisting of undeniably healthy ingredients? Over 2,000—and that didn’t include any wine, dessert or predinner bread.
Even if that undeniably healthy-sounding combination were your cheat meal (and chances are your cheat meal would be far more indulgent), and you also decided to have a glass of wine and share a dessert, your singular cheat meal could easily lead you to consume 2,000 more calories than you burned that day.
Let’s put that in perspective: If you were aiming to lose 1.5 pounds weekly, over half your week might be spent just working off the surplus from that one, single meal. If you were aiming for a 1-pound weekly loss, there went 5 days’ worth of effort. If you were just trying to maintain your weight, one indulgent cheat meal a week could lead to a 15 to 30-pound annual gain!
Have a full-fledged cheat day rather than just a cheat meal, and you can almost certainly kiss your entire week of weight loss good-bye.
But there are graver risks to cheat days than simply excess calories. Every time you decide to “cheat,” what you’re doing is making it easier to do so again and again. What might start out as a weekly cheat meal may expand to a full-fledged cheat day, to weeklong cheat vacations, to stressful-time cheat months, and finally to an all-you-can-cheat lifestyle.
Of course, if you are feeling compelled to cheat, there are certainly other things wrong. Feeling the need to cheat means that you’re living with an overly restrictive lifestyle. The belief that using food for reasons other than fuel is cheating can derail even the most sincere dieter. We don’t eat purely for sustenance. Food isn’t simply fuel. The roles of food as a pleasure, a comfort and a social pillar are part of the very fabric of the human condition, and if it’s cheating to be human, well, that’s a big problem.
Myth: Some Foods Simply Must Be Forbidden
At my office, I regularly write actual prescriptions for chocolate, chips, cookies, ice cream, cake and the like.
While that may strike you as odd, the notion that a person is going to successfully and permanently avoid a particular food—especially a highly palatable, physiologically or psychologically rewarding one—is ridiculous. Inevitably, regardless of a person’s dietary or weight management desires, a situation will arise where even if it’s “forbidden,” a danger food is going to get eaten. Whether it’s a consequence of emotion, fatigue, stress, celebration, injury or vacation, people know that eventually their forbidden foods are (at least temporarily) not always going to be forbidden.
Chocolate, ice cream, cake, chips, pizza, peanut butter, Chinese food—we all have foods we struggle to control ourselves around. For many, the strategy to deal with danger foods is to blindly restrict them.
To navigate this world’s dietary indulgences, a person needs to learn to switch gears from being blindly restrictive to being thoughtfully reductive. Asking questions like “Is it worth the calories?” and “What’s the smallest amount of [insert forbidden food here] that I need to be happy?” can go a long way toward tempering forbidden food-related weight management failure.
Myth: Carbs, Fats, Sugar, Fructose (etc.) Are the Enemies
Popular diets seem to travel in waves. The 1990s were the low-fat decade. Next came the low-carb decade. Next maybe it will be the low-fructose or gluten-free decade. It seems that traumatic dieters are always given different foods on which to blame their weight issues.
But here’s the thing. If you don’t like the life you’re living while you’re losing, even if you lose a great deal, you’re not going to keep on living that way.
Given that there are only three main simplified categories of foods for diet gurus to demonize (carbohydrates, fats and proteins), removing or vilifying one will certainly limit your dietary choices dramatically. What that means is that even if you lose a huge amount of weight by avoiding a particular food grouping, it will likely take an enormous effort to keep it out of your life forever (and even more so if you happen to enjoy that grouping’s foods). Old foods return, then old calories return, and with them, old weights.
Cutting out entire food groups or categories is a dietary strategy that’s like an icy cold lake. While you might be able to muster up the courage to dive in, and while you might even get numb enough while you’re in to enjoy a brief frolic, once you pull yourself out, the likelihood of heading back soon thereafter for another dip is low. If you’ve got to numb yourself against the carbs or fats or whatever it is you’re avoiding, chances are once you inevitably climb out of that icy dietary lake, you won’t be rushing back in. And really, who can blame you?
Myth: It Works to Skimp All Day for a High-Calorie Night
This myth is incredibly pervasive and incredibly destructive.
We’ve already discussed the impact of hunger on choice. So what happens if you’re having a big meal out for which you show up hungry because you’ve been “saving” up your calories? You’ll probably say hello to the breadbasket, order an appetizer, finish your main course and ask to see the dessert menu. The appetizer alone will likely contain more calories than you’ve “saved” all day long. That’s not helpful math for your weight management effort. Skipping 500 daytime calories can easily lead you to consume 1,500 calories you’d otherwise have been able to proudly, happily and easily avoid.
Instead of starving yourself all day in order to indulge all night, the real trick is to be thoughtful and organized with your eating throughout the day. Show up to your festive or social meal not hungry, and you’ll give yourself the ability to thoughtfully navigate the table.
Myth: There's Weight Loss in That There Bottle
If only there were a natural weight loss product that made a remarkable difference. While there is no shortage of products claiming they will help you lose weight, there is a complete lack of scientific studies to back up such claims.
Two professors of complementary medicine, Max Pittler and Edzard Erst (2004) published a systematic review of the most commonly touted natural weight loss aids and products. They looked at chitosan, chromium picolinate, Ephedra sinica, Garcinia cambogia, glucomannan, guar gum, hydroxymethylbutyrate, plantago psyllium, pyruvate, yerba maté and yohimbe. Their conclusion was very straightforward: "The evidence for most dietary supplements as aids in reducing body weight is not convincing. None of the viewed dietary supplements can be recommended for over-the-counter use".
For both drug and nutraceutical companies, a safe and effective weight management product is their holy grail, and like the grail, it has yet to be found.
Myth: The Last 10 Pounds Are the Hardest
What does that mean—last? For most people, it means the cool and safe. But fluids are last 10 pounds to go before getting to a preset weight goal.
But if you have to try that much harder to lose, they’re probably not staying off; if those 10 pounds require losses and help keep you going. effort above and beyond what you’re comfortable living with happily ever after, their loss will last only as long as you sustain your now superhuman efforts.
Try swapping adjectives. Instead of those pounds being the "hardest, perhaps it's fair to say that they'll be the “slowest,” because as a person gets smaller, for a variety of reasons he or she burns fewer calories. Therefore, the closer you get to your eventual final weight resting place, the more slowly those pounds will come off.
"Harder" suggests unsustainable, and whatever interventions, diets, exercises, etc., are employed to lose the weight, if they are not sustained the weight will undoubtedly return, and so will those "last 10 pounds." They also might not be the only 10, since for many folks, regain is so demoralizing that they often abandon all of their weight-related interventions, and not only do those "last" 10 come back, but eventually the "first" 10 do, too.