On the Futility of Dieting

Edward Abramson, PhD

Disclosures
In This Article

A More Inclusive Approach To Weight Regulation

A more inclusive approach to weight regulation would include an increased emphasis on the energy-expenditure side of the weight equation. According to the Surgeon General's Report on Physical Activity and Health,[9] more than 60% of American adults don't get the recommended amount of physical activity, while 25% aren't active at all despite evidence that it is almost impossible to maintain any weight loss without regular activity.[10] Instead of simply admonishing overweight patients to "get more exercise," it will be necessary to recognize the environmental and psychological barriers that contribute to their reluctance to becoming more active.[11] Likewise, successful weight loss efforts should address the body image issues that plague frustrated dieters. For example, a better understanding of the role of genetics in determining fat distribution[12] could avoid some of the demoralization that occurs when weight loss doesn't result in an ideal physique.

In addition to individual changes, a more comprehensive strategy would include social and environmental changes that would help prevent obesity. For example, removing sodas and junk foods from schools and controlling food advertisements directed towards children would help minimize unnecessary weight gain. Interventions in schools, workplaces, and the larger community can also be useful. For example, one study[13] found that an illustrated sign ("Your heart needs exercise...here's your chance") doubled stair usage when placed near stairs and an escalator. On a larger scale, urban planning that encourages bike riding or walking to work and shopping areas rather than driving would be helpful.

Despite the disappointing outcomes of dieting, there is reason to believe that a more comprehensive approach to weight regulation can be effective. For example, a Consumer Reports survey[14] found that 4000 of the 32,000 respondents were able to lose an average of 37 pounds and maintain the loss for 5 or more years by "self-directed lifestyle changes." A study of the 3000 participants in the National Weight Control Registry found an average weight loss of 66 pounds that was maintained for 6 years.[15] Since 90% of these participants reported at least 1 previous unsuccessful attempt to lose weight, healthcare providers should encourage their patients to make modest lifestyle changes regardless of earlier dieting failures. At the very least, improving eating and exercise habits should slow the rate of weight gain that typically comes with aging.

Rather than concentrating on the relative merits of different diets, physicians can correct the black-or-white thinking implicit in dieting and help patients to understand the different reasons why they are overeating and underexercising. It would then be possible to suggest practical changes that would reduce unnecessary eating, increase routine physical activity, and help patients regulate their weight.

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