I recently had a patient come to me at her wit’s end with weight loss. A woman in her 40s and postpartum, she was frustrated that she couldn’t get back to her pre-pregnancy weight. She had tried all of the diets – intermittent fasting, keto, counting calories – none of it worked. “What am I doing wrong?” She asked me. She reported constantly thinking about food, and what the consequences of the next bite might be. She sounded burnt out, and though I barely knew her, I could tell she was completely exhausted by this journey. I wish I could say this is an isolated case, but unfortunately I hear a similar story from a different woman almost every day I come into work as a Registered Dietitian.
It’s the beginning of a new year, when gyms are packed to the brim, full of folks with resolutions to make this the year they finally accomplish their weight loss goals. This is the best time of year – not for a dietitian, but for the diet industry. Every year, upwards of 45 million Americans start a diet, according to the Washington Post. This translates to $70 billion in profits for the industry that comprises companies like WW (formally Weight Watchers), Jenny Craig, and apps like Noom and MyFitnessPal. Yet every year, millions of men and women inevitably “fail” these diets, give up on their resolutions, and start over again the following year. After years of following this cycle, many of these women (men, too, but mostly women) come to me, feeling inadequate, but hopeful that I’ll be able to correct their weight loss mistakes. Regardless of whether or not I can actually help them, my first point is always this: “The problem is not you, it’s the diet.”
As a society, we have been conditioned to believe that anyone can drop x number of pounds and get to his or her “ideal” weight if they try hard enough. When I first entered the field of nutrition and dietetics, I’ll admit, I genuinely believed this too. Weight loss, I was taught, is about creating a calorie deficit, so if you’re burning more calories than you’re consuming on a consistent basis, then you’ll lose weight. The problem with the calorie deficit “solution” to weight loss is that it tremendously oversimplifies something very complicated. It implies that by using simple calorie math, anyone can make his or herself smaller, irrespective of one major factor: genetics.
The hard truth is, weight – just like height, eye color and shoe size – is largely genetically predetermined. Yes, lifestyle factors do affect weight, but they are only pieces of the puzzle. The more patients I work with on weight management, the more I am convinced by the Set Point Theory, which argues that everyone is predisposed to a certain weight range (which, by the way, can change throughout one’s life). I recognize this when a patient does everything by the book for months and still the number on the scale does not budge. This is by no means a failure on the patient’s part – this is her body fighting to maintain the weight it was meant to be.
Trying to override one’s genetics to achieve weight loss, whether through extreme calorie restriction, fasting or other means, is not only difficult, but also very likely to backfire. One of the best examples of this phenomenon is the story about the contestants from “The Biggest Loser.” The contestants, who were considered morbidly obese when they first came to the “ranch,” were put through rigorous daily workouts and a calorie-restricted diet of 1200-1500 calories per day (for reference, someone who weighs 300 lbs or more needs at least twice the amount of calories to maintain their weight, without even factoring in exercise). To the contestants’ – and America’s – delights, they lost a lot of weight in a very short amount of time. But years after the contestants left the ranch, we learned that many of them had regained a good portion of the weight they had lost. Again, the problem was not the constestants, it was the diet. The ranch lifestyle was simply not reproducible in the real world. Had the contestants instead made gradual changes to their eating and exercise habits, they probably would’ve seen less drastic, but sustainable, weight loss.
Now, it is not my job to patronize any patient who comes to me for guidance on weight loss, nor is it my job to judge their motivations. Some women are interested in achieving a certain aesthetic, which is perfectly fine. But it’s important for them to understand how much time and energy it will take for results that may be unattainable. For those who want to lose weight to improve their health, my opinion is that focusing on weight is unproductive, because, again, it puts the focus on something largely out of one’s control. How are your energy levels throughout the day? How is your digestion? Are you effectively managing conditions like hypertension or diabetes? Are you consistently active? Are you getting quality sleep? The answers to these questions are in your control, and together they are much better indicators of one’s overall health than weight.
When you take weight out of the equation, you can focus your energy on smaller, more tangible, goals like eating more vegetables, drinking more water, making more food at home, eating less processed food, moving more – these changes might contribute to weight loss, they might not. But dwelling on the pounds that are not coming off only invites feelings of guilt, inadequacy, and failure. When you stop trying to lose weight, you’ll celebrate small successes everyday.
With many patients who ditch the scale and focus more on overall health, I see a reduction in binge eating, more awareness of hunger and satiety cues, and less preoccupation with, and anxiety surrounding, food. When you stop trying to lose weight, you’ll free up so much brain space, so much time usually spent tracking every calorie. There are no more Monday resets or post-holiday juice cleanses. When you stop trying to lose weight, you’ll finally disrupt the years-long cycle of dieting and instead you can work on developing healthy habits that you’ll keep for the rest of your life, not just the rest of the year.
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