When it Doesn’t Work, It’s Time to Change the Approach

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14 Aug 2018

If you are a frequent reader of my columns, then you already know how I feel about diets.  But it’s not about how I feel, it’s much more about what we know works and what we know doesn’t work.  We have created a mentality that is faulty.  This includes governments, doctors, and big business.  For decades, efforts to fight chronic disease have focused primarily on obesity—encouraging dieting as the best way to lose weight. But even as the U.S. weight loss industry has grown to over $60 billion annually, we haven’t seen significant improvement in rates of chronic disease (Bacon & Aphramor 2011).  So a few questions should be asked.  First, why do we keep trying the same failed methods again and again?  Second, if diets aren’t a sound approach, what is?  Third, how important is the number on the scale as opposed to other factors that are important indicators of good health and wellbeing?


Dieting (eating less and moving more) has two goals: losing weight and improving health. Unfortunately, dieting fails on both counts.  Studies have demonstrated that sustained weight loss is an extremely rare outcome of dieting. More than 90% of diets result in weight regain (Bombak 2014; Ikeda et al. 2005; Bacon & Aphramor 2011). Even worse, dieters tend to regain more weight than they initially lost (Bombak 2014; Tribole & Resch 2012). This happens because the human body has a mechanism that protects against famine and starvation.  In other words—alone in the desert or the jungle and waiting to be rescued, your basal metabolic rate-the speed of your metabolism-will slow down in order to preserve the calories and energy you have. 

Dieters will usually achieve some short-term weight loss.  It can even be easy. But that creates a misconception of weight loss success that will almost always result in weight regain. Then, you regain what you have lost launching a round of weight cycling that wreaks havoc on the body and causes many problems routinely blamed on obesity. For example, weight cycling increases inflammation and raises the risk of hypertension, insulin resistance and dyslipidemia (Bacon & Aphramor 2011). That will bring type 2 diabetes, hypertension and cardiovascular disease.

The relationship between dieting and health outcomes is a bit more complex. In the short term, dieters strictly adhere to healthy behavior changes that may stabilize blood sugar, improve energy levels and reduce joint pain. All too often, weight loss gets all the credit for these health improvements, when other factors may be more important. It may well be that behavior change—independent of weight—is driving many of these improvements.  Furthermore, the long-term effect of intentional weight loss is more harmful than beneficial to health. As studies have shown, dieting can produce immediate health gains that overshadow long-term damage.

It comes back

When one diets, and restricts calories there are both physiological and psychological factors that result in weight regain.  Looking from the physiological side, research suggests that this stems from the body’s hormonal response to dietary restriction. In short, eating less than the body needs triggers endocrine system changes that actively promote weight regain, reducing satiety after eating and increasing hunger (Bombak 2014).  These effects can last for a full year after one begins dieting. In addition, dieters develop a lower resting energy expenditure (metabolic rate), so they require less food to maintain their weight compared with people who don’t diet.

From the psychological side, deprivation is always a sure sign of dietary failure.  In addition, a habit is habit is habit.  You can decide to eat less or eliminate certain foods from your daily intake.  However, at some point the willpower runs out and there you are again, doing what you have always done, possibly for the last 20, 30 or 40 years. You are eating too much, eating late at night, using food for the wrong reasons, and eating socially.  After all, these are things you have been doing for years and years.  With all this said, dieting is still the number one recommendation of the medical establishment in spite of its record of terrible failure.

Changing the approach

Most physicians tell their overweight and obese patients that they need to lose weight.  The influence of that statement usually ends up negative.  They simply stay the same or as an adverse reaction to what they have been told, will actually gain more weight.  When something isn’t working, we can’t pretend it is, and keep offering the same advise over and over that results in failure.  So what should we be doing instead?

I still remember reading a summary from a speaker presenting at the annual American Dietetic Association (now called “Eatright”) convention.  This was at least 15-16 years ago.  She said, then, that doctors should start encouraging their patients to start adding good behaviors.  Add a fruit and a few vegetables a day, do daily walking, cut out a few desserts, etc.  Don’t talk about or emphasize weight loss and dieting, she said.  Much research over the last decade has borne out this idea. 

A formal initiative called HAES, an acronym for Health at Every Size, was started.  This is a weight-neutral approach to chronic-disease management that encourages healthy behavior change.  “Health at Every Size rejects a focus on an individual’s weight, or change in weight, as a measurement of health,” says Jennifer McGurk, RDN. McGurk says HAES “stands for the right that all bodies deserve respectful healthcare, regardless of size.”   HAES promotes healthful eating, body acceptance, and attention to internal hunger and satiety cues. It also promotes active engagement and using enjoyable physical activity (Bacon & Aphramor 2011; Bombak 2014). Instead of emphasizing the number on the scale and being a healthy weight,  it contends that behavior changes can lead to weight loss and getting to a healthy weight eventually.  This stabilized weight may or may not fall into the arbitrary “ideal body weight” range.

The HAES model does not ignore health risks and medical issues, but it does try to shift the focus away from prescribing weight loss as the solution.  Focusing on weight loss has proven not only to be unsuccessful, but it can lead to eating disorders and can reset basal metabolic rates to lower levels.  In other words, your metabolism now runs slower. That makes losing the next time around very difficult.  When it comes to eating and food, remember the following two things:

  1. Make peace with food. Rather than labeling high-calorie, low-nutrient foods as “bad,” eat intuitively and keep a neutral perspective on the moral value of foods. Letting go of self- and diet-imposed judgments of foods can help heal relationships with food.
  2. Address emotional eating. People often get temporary emotional relief from eating, followed by a realization that their problem remains. Intuitive eating encourages followers to show themselves compassion by entertaining a solution that is unrelated to food and that directly addresses their emotional challenges. 

Remember that 80% compliance in any area works.  So if you are doing 80% on your food and exercise, you are doing great.  So taking a very occasional treat or missing a day of exercise once in a while will not stop you from success.  The mindset to work on is that when mistakes happen or even when you plan to be off your program, just get back on track right away.

The failed world of dieting needs to come to an end.  It is a world of gimmicks and promotions that can harm you.  So let’s focus on changing one or two habits at a time to improve our health.  I have worked with many people who never got to their “desired” weight, but they most certainly achieved their desired health, such as lowering blood pressure, triglycerides and sugar substantially, even though they never lost all of the weight they wanted to. Many got off medications and their mood and overall demeanor were also much better.

Changing behaviors and habits when it comes to eating and exercise will add hours to your days, days to your years, and years to your life.” 

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.