Thursday, February 01, 2007

Epilogue: the desperate hourglass.

Americans are "desperate to lose weight," declares the executive summary of a 1997 Washington, D.C. conference on dieting that took place under the joint auspices of the FTC and CDC. * "We're a nation searching desperately for answers to the riddle of weight loss," reports a recent issue of Men's Health. * Today's dubious weight-loss products "are just feeding into [the] desperation" of people who for years have fought an unsuccessful battle against the bulge, says WebMD. * "The plethora of diet books and remedies have created a complex and contradictory array of choices for those who are desperate" to get in shape, writes Dr. Mehmet C. Oz, director of the cardiovascular institute at Columbia-Presbyterian Medical Center and co-author of the No. 1 best-seller, You: The Owner's Manual.

Let's put it this way: If there's a single overarching theme that applies to the diet-and-fitness movement, that theme is desperation.

(None of this contradicts what we've observed about body image. As noted, we've reached a curious juncture in American society where the people who really need to lose weight can't, while the people who don't need to lose weight—notably millions of teenage girls and young women—feel they must. The underlying factor in this peculiarly American dilemma is that weight loss is sold based on vanity, not health. We'll return to this theme in due course.)

An experienced journalist knows enough to be skeptical of the more extreme claims trumpeted by advocates for any given cause, whether that cause is global warming, domestic violence, world hunger or obesity. Yet it's hard to dismiss the grim warnings here as hype. Hoping to wake up an American public that generally takes its health issues the way it takes its food—with a grain of salt—Health Affairs in 2002 commissioned a meticulous analysis of the problem; the resulting article made a striking case for the fact that obesity adds decades to a person's "medical age." The magazine's research showed that the typical obese person at chronological age 50 presents with much the same symptomology as a 70-year-old of normal weight. Chillingly, this would mean that the 15 million obese Americans age 51 and over have in effect skipped midlife, eating and lazing their way to an instant, sedentary, disability-plagued old age. It's no great surprise, then, that according to the American Obesity Association, we spend $100 billion a year to ameliorate the effects of the nation's progressive bloat and confront its laundry list of disabling, life-threatening repercussions.... Plus what we spend to take care of America's millions of overweight kids.

It's also important to realize that this isn't just "their problem." Money spent treating obesity-related symptoms and physical breakdowns represents a national trickle-down nightmare, because about half the load is shouldered by Medicare, which is funded with (shrinking) public tax dollars. Add to that the lost productivity, the unemployability, and the host of wider economic consequences.

There are softer costs, too. Obese American adults are far more likely to report symptoms of depression, says Georgetown University’s Center on an Aging Society.

Unfortunately, for all the reasons described in this series of posts, America's current approach to weight loss actually works against a lasting solution. In its November 2004 announcement of its latest initiative against diet fraud, the FDA notes that today's weight-loss options, beyond being a waste of money, "steer [consumers] away from products that are proven to achieve the results they are seeking." Harvard's Dr. George Blackburn says much the same thing in the executive summary of a report he authored under the auspices of the FTC. "By promoting unrealistic expectations and false hopes," he writes, "[misleading and fraudulent programs] doom current weight loss efforts to failure, and make future attempts less likely to succeed." (If you've been reading this blog all along, you'll recognize that as one of my major gripes against the self-help movement as a whole.)

Short-term weight loss is in no way synonymous with long-term weight management. (In fact, growing evidence suggests that the two concepts are mutually exclusive.) Take Atkins, for example: Despite all the anecdotal success stories and the nationwide hubbub, Atkins dieters are poorly represented in the National Weight Control Registry overseen by Dr. James Hill, director of the Center for Human Nutrition; at last reporting, they accounted for less than 1 percent (click and scroll down) of the 2681 monitored individuals who had lost at least 30 pounds and kept it off for a full year. Hill emphasizes that a "less effective" diet that you can live with—slow and steady, like the turtle in the children's story—is more valuable to America than a "more effective" diet that users abandon after a few weeks or months. Of course, that's not how diet plans are promoted in this country.

In SHAM, I spent a good deal of time refuting Alcoholics Anonymous' exaggerated claims for its success rate, explaining how that deception does a disservice to drinkers in need of effective therapy. I point out that it's unfair to claim a "success rate of 75 percent," as AA often has, if the only people you're measuring are those who stick with the program for more than a few meetings. Data variously peg AA's dropout rate at between 70 percent and 90 percent (!) of those who give the organization a try. In moments of candor, AA has come close to admitting this.

Those dropouts are still alcoholics. They're desperate people whom AA fails. And in a right-minded world, they'd count against AA's stats. In fact, let's do the math. Say there are 1000 alcoholics seeking help, and out of that pool, 70 percent (we'll be charitable) bolt after a few meetings. If AA is effective for 75 percent of the 300 who stay (and I have my doubts about even that ratio), we're left with 225 people who are helped. And 775 who aren't. Ergo, a final, honest success rate of...not 75 percent, but 22.5 percent. That's a failure rate of more than 75 percent!

In the same way, a diet program that helps obese people lose weight for just a few weeks or months cannot be considered a success. It's the program's job to be good enough, and user-friendly enough, for people to stick with it. Nonetheless, the weight-loss industry's ability to deliver short-term results by selling you a program you've already bought several times before—spun a slightly different way, or with alfalfa sprouts substituted for mangos in its menu planner—keeps diet-minded Americans locked into the same despairing pattern.

For my money—and, I would think, yours—integrity counts. We don't buy diet books or join diet groups thinking, "Oh well, it doesn't matter if this plan has no basis in fact and was dreamed up in somebody's Porsche as he drove through Malibu. It doesn't matter if I'm being lied to or laughed at, if the guru forgets about me as soon as my check clears and the plan itself ends up hurting me. As long as I lose a pound or two—even if I gain it all back, plus more—who cares!" No, that isn't what we think. We believe the authors. We believe the programs. We trust the "science."

After all, you'd never willingly accept a short-term "cure" for heart disease. Would you? Especially if it was sold to you as the "ultimate solution…."

* If I was widely attacked for anything in the wake of SHAM's publication, this was it. People simply don't want to hear it.

Femme fat-ale?
Those lumps, those bumps...those chumps.
DietLand: A brief history of federal oversight(s).
Only the data are slim. Part 2.
Only the data are slim. Part 1.
Hoodia wanna believe?
Waste size.


RevRon's Rants said...

Desperation is most commonly a product of inaction. Whether due to fear, inertia, or conscious choice, the best way to overcome that desperation is to get off one's butt and attempt to do something about the situation. This might mean getting started on an exercise program, consulting a physician to determine a proper course of action, or - if all else proves fruitless - re-evaluating one's self-image. In the final analysis, living one's life wrapped in desperation - quiet or otherwise - is probably at least as detrimental to one's health as carrying an extra 20 pounds or so.

acd said...

It seems to me that true desperation--with regard to anything, not just weight loss--is a product of failed action, not necessarily inaction. That is, you get up and do everything you can to solve the problem, but are still faced with failure no matter what you try. I agree that it is unhealthy to live in a prolonged state of desperation, but I would argue that the solution is not just a matter of effort.

Steve Salerno said...

ACD, I'm assuming that your comment is intended in direct response to RevRon's comment, inasmuch as what you're saying pretty much echoes the philosophical thrust of my original post: i.e. that dieters have tried everything (or think they've tried everything) and continue to fail anyway, which only produces a heightened sense of desperation. And yet I can also see merit in RevRon's observation, which seems to argue that at least for some of us, maybe it's best (i.e. healthier) to just "make peace with" those extra 20 pounds, or any other chronic "failing."

In any case, ACD, I second the motion with regard to your broader focus here: that true desperation in any area of life is a terrible state in which to exist.

RevRon's Rants said...

As Steve surmised, my point was that the desperation arises primarily from a failure to make the *right* effort, which may well involve the effort to accept a physical condition over which one lacks control. Desperation is not a secondary product of a physical anomaly, but rather of the individual's *reaction* to that anomaly. Change the reaction (change your mind), and the physical condition loses the power to make you desperate.

Anonymous said...


That's a very interesting concept you mention. The larger point here seems to be one of convincing millions that changing their minds about dieting will, essentualliy, change the way they view dieting, their body and its image.

Changing your mind is a tall order to fill for many of us. I'm faced with some areas in my own life where changing my mind about and pursuing a diffierent direction other than the one I have been is, for the record, extremely difficult. But I've been told the rewards far outweigh the current state I'm in.

For dieters I think it's the same. But many of us don't know how to think for ourselves, and many of use are living our lives on auto-pilot.

RevRon's Rants said...

Nobody can change the minds of the millions... It's an inside job, relegated solely to the individual. And sure, it's difficult at first, as emotional inertia dictates that we continue following patterns with which we are accustomed (and frequently digging ourselves into a deeper hole).

Once the individual manages to truthfully affirm his or her preferred direction, letting go of elements destructive to the desired outcome can become second nature (sorry for the use of the new age affirmation/denial model, but it seemed appropriate here). That's not to say there won't be repeated setbacks & challenges.

An old teacher once told me, when I was beating myself up for failing at some self-test, that as long as we're walking the Earth, we aren't finished learning... and learning requires failures.

Anonymous said...

Ron, I hate to say this but in that last comment you souns just like the "gurus" as Steve calls them that he's always attacking! I'm surprised Steve himself didn't jump all over you for that self growth garbage. I say that with affection of course,

RevRon's Rants said...

Carl -
The "self-growth garbage" to which you refer is the only reason I'm not dead or in prison today. The master who instructed me was as far removed from the current crop of pseudo-gurus as you can get, and was firm in keeping me grounded in common sense, even as he guided me to seek out some things that didn't fall within the framework of my previous reality.

I'm all for debunking the charlatans who peddle nonsense for profit, but think it foolish to throw out all the tools by which we can improve our lives, just to get rid of the garbage. And I think Steve probably has a pretty good handle on my perspective - though it is occasionally at odds with his own - and can effectively sort the gems from the BS. :)