The nature of choice in diets
There’s a lot of statistical evidence that dieting doesn’t work. I’ll postpone the documentation of the highlights of that evidence for a later post, but you can google it for yourself (avoid, if you can, the links that are trying to get you to buy something).
And when I say “diets don’t work,” here’s what I mean. I mean that, statistically speaking, people who go on diets don’t successfully lose and keep off weight for more than about six months. So, after two years or so, the average weight is about the same or higher in a group of dieters.
Can we take that as a given for now? Thanks. We can argue about it later if you want.
Here’s the thing. That statement confounds lots of people, I think because it’s statistical in nature. They will always imagine that, because they are themselves examples of someone who has lost weight and kept it off for more than two years through dieting, dieting does in fact work, and we should all try what they’ve tried.
It’s annoying to be told this over and over again, especially when you’re someone who’s tried a million things. And believe me, almost every fat person I know has tried a million things. For that reason I’d appreciate no more such advice, although in a later post I will be asking for zany pseudo-scientific theories about why fat people stay fat (there are so many!).
So yeah, people don’t understand statistical facts. But I think there’s something more going on here. Namely, the illusory nature of choice when it comes to dieting.
Because diets do seem to work short term, people think they’ve gotten control over their eating, at least temporarily. And then, at some point, people drop off their diets. They sometimes do it with a “what the fuck” attitude, but my guess is most of them don’t even remember doing it. It’s a kind of momentary amnesia, and before they know what’s happened they’re eating something they shouldn’t have. That is certainly my experience.
From the outsider’s perspective, that’s a person who has chosen to go off their diets, and in a certain sense it’s obviously true, since for example anyone who was locked in a cell with no food would not have the ability to go off a diet, nor would someone who cannot feed themselves. Indeed, it requires the access to food and the action of eating to go off a diet. So in that sense it takes a certain amount of freedom.
But, there’s another sense in which, I’d argue, there’s no choice in the matter at all. After all, dieting requires a positive declaration of a desire to lose weight. Sometimes it even requires forking over cash, maybe a lot of cash. People are trying hard to lose weight, in other words, and yet they can’t, and even statistically speaking they cannot.
Said another way: if 1000 people went to a lot of trouble to do something, and they all tried but 990 of them failed to do it, would we decide they had made the choice not to do it?
I’m ready to say there’s something else at work here, something more basic than free will. It’s like our choice to breathe. We can’t decide not to do it. Or we can, but only for a bit.
Commenters, please stick to the question of the nature of choice in dieting. I will delete other stuff, thanks!
mathbabe 
I’m drawn to Bruce K Anderson’s premise that many harmful behaviours (addiction, eating unhealthily, overweight/obesity) are a coping mechanism to counter psychosocial dislocation (feeling separate/isolated from family, community, society). There is a huge amount of pressure to “live healthy” however, the information on how to do so is so convoluted by industry propaganda, that at some point, a clear choice becomes impossible.
The type of lifestyle that one would have to live in order to eat right as a normal part of living, instead of as a temporary measure, would require that we change our current system away from industry dictated nutrition labeling, and pretending massive amounts of sugar aren’t horribly bad for you.
The problem goes well beyond the notion of will power, self discipline, and resistance. There’s only so much an individual can do in the face of widespread, pervasive industrial pressure.
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sorry, Bruce K Alexander…
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Choice is a fuzzy concept. It’s not just a person locked in a cellar who would be able to “maintain” their diet. If you had a gun to someone’s head and promised to shoot them if they went off their diet, you can be sure they would stick to it. So I don’t think you can really say they have no choice. It’s just that the stakes have to be really high, higher than they are in the average person’s life. I haven’t seen data on this, but celebrities whose careers depend on it seem to lose and keep weight off at higher rates than most people, and I imagine it is because they have a lot of money on the line. Similarly, I think if someone’s life was at stake in an immediate and obvious way (not long term health, which most people don’t take seriously), they would be able to stick to their diets. I had always thought the problem was that diets are not effective, meaning most diets don’t work even if you stick to them.
On another note, isn’t dieting data littered with people who are just a little overweight and want to lose weight, but not that badly? For most people, I would imagine the stakes are not high. Being chubby or overweight – but not obese – is probably upsetting when you dwell on it, but not mostly otherwise, therefore not really worth all the physical and emotional demands of dieting.
Have you seen studies where they take into account how much of an issue it is in the person’s life? I think you would need a measure of how much is at stake for a person, before you can evaluate how much they are probably trying and how effective their attempts are.
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“people who go on diets don’t successfully lose and keep off weight for more than about six months.”
As you say, this is because people don’t actually stick to the diet. So it’s not that dieting doesn’t work, but that people aren’t good at dieting. It’s a bit like saying “Exercise doesn’t work (because people who quit exercising after a few months aren’t any better off 2 years later).” Well, right, pretty much anything stops working if a person quits doing it.
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I don’t agree that these are two different things.
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I think this may be the difference between “diets” work, but “dieting” doesn’t.
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I wonder if the data is somewhat polluted. If I go on a diet and am successful and maintain my loss, I am not going to go on another diet. If I fail, I’ll probably try another diet sometime in the future. If we run several regressions of this, you will end-up with a population of dieters who have failed many prior diets but this does not account for the population of people who followed a diet, had success, maintained their weight loss, and saw no reason to begin yet another diet.
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Nor do we choose to disrupt our endocrine system (a la Kristof today. And the more we learn about the microbiome, the more we realize that foods we ingest (along with coatings of pesticides etc.) affect us in ways that are often harmful.
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I think part of it is that people don’t take sugar seriously as an addictive drug. Let’s say you have an addiction to nicotine. You successfully quit smoking for a few months. I don’t have the recidivism rates off hand, but I’d assume people who make it that long are actually pretty good at staying off smoking. Psychologically, I’d guess it’s due to people understanding deep down how dangerous “just having one” would be. We understand nicotine is addictive. People who have quit the addiction don’t “use in moderation” or “binge because it’s Christmas.”
With something like sugar, even if you kick it for a few months, it’s hard to take seriously the idea that eating a single piece of cake because it’s your birthday will trigger a hormonal reaction and flare that addiction back up. For some reason, as a culture, we get the cigarette thing, and the people around you will help you by saying things like, “Do you really think it’s worth it to backslide this once?” Yet with sugar, probably equally addicting and maybe even as harmful, people do the opposite. They’ll encourage backsliding, “Come on. It’s just this once. Are you really such a health fanatic as to not eat a single bon bon at Christmas?”
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This is true for me. I quit smoking and lived in fear that one cigarette would make me a smoker again. I have also dieted and but not worried about the occasional backslide. Right now I am probably 190 when i should be 170. but i still haven’t smoked.
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When someone “goes on a diet*”, generally there is a presumption that they’ll stay on it until they reach some goal, then be able to maintain that target weight with a more relaxed set of behaviors. I agree that many diets are hard to stick with, due to cost/labor involved (preparing food, counting calories, finding some place that sells meat without bread and/or picking apart your burger at the table, etc.), but I view the long term failures more as attributable to the yet-still-harder task of permanently changing behavior and/or physical/metabolic factors. (I don’t believe there are actionable behaviors most people can successfully undertake long-term, just to clarify.)
How can the two factors, defection from the diet before a short term goal is reached, versus behavior after the diet is completed and/or the difficulty of permanent behavior change be?
I assume that “the craze for dieting” penetrates countries at different times. Is there anything which can be learned from defection from diets cross-culturally, or longitudinally measured from T=0 being the “start” of the fad?
How does this compare to non-compliance with medication? Is this different from (mostly men, afaik) not wanting to take their blood pressure meds due to psychological issues around autonomy and mortality?
* I’m aware that the old fashioned/ancient notion of a diet included both food and behavior, and was not short-term in nature. I’m using the term in the modern sense.
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Do you see a difference between a weight loss diet and a lifestyle diet?
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Tremendously so. Weight loss diets are short term and is the kind of thing you do to drop 10 emergency pounds to fit into those jeans. Lifestyle diets are long term and are much more of an investment in one’s self for overall health.
JamesNT
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I enjoy your brilliance, am eager to follow this.
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This may be a helpful study:
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2015.302773
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Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records:
http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2015.302773
(I was on mobile when I initially googled the study)
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My view of this basically comes from Duhigg and Kahnemann. As Duhigg says I think convincingly, the trick isn’t to find a diet, there are a million of them and nearly all of them “work”, if only insofar as when you’re on the diet, you’re eating less food. In 99% of diets, there are foods you *can’t eat*, and when you’re not eating those foods, you’re eating less food, and there’s a good chance you’re losing weight as a result. The problem is that the *active choice* to avoid certain foods is System 2 thinking, while eating (like, yes, breathing) is a System 1 thing.
The result is that if you want a diet to work, it needs to move from System 2 to System 1: to use Duhigg’s term, it needs to become a *habit*. And while there are lots of books which will tell you what to eat and what not to eat, there are very few which will tell you how to effectively make a habit of it, so that you end up dieting even when you’re not thinking about it. Duhigg made a decent first stab, but it’s a really tough question with no easy answers.
So I agree: It’s almost impossible to *choose* to stay on a diet for years on end. It’s just too cognitively exhausting to be making those choices on a daily basis for years and years. And any diet which doesn’t recognize that fact is likely to fail.
Bill Clinton’s solution to this problem was to become a vegan. A simple rule, which he believed in and followed, and which became part of his core personal identity. (It helps that he believed in it beyond its utility as a diet.) That’s really hard! But yeah, these things are hard.
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One important thing to keep in mind is that for many people that want to lose weight, they have to change literally decades of habits that they have had since childhood. A prime example is to stop eating fast food. If you’ve been doing that since you were 8 years old and today you’re 35, good luck with that. It’s going to be tough.
JamesNT
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Few people are grasping Cathy’s point – the people dieting are motivated and they know more about diet and exercise than most skinny people. It just doesn’t seem to work over the long term. Everyone has their pet theory as to why – and you are all wrong.
I’d argue that fat is an outcome and not a disease. Most people seem to ascribe being fat to one cause: willpower or genetics or the obesinogenic environment and then stick with that as the solution. And you are likely all right and all wrong.
What causes cancer? Genetics and lifestyle and exposure and a million other things.
What causes obesity? Same as cancer. There is no one cause and there is no one solution. And like cancer, sometimes a cure is necessary and sometimes it’s best not to cure because the situation is benign.
If you lock someone in a room and don’t feed them, they will lose weight, so why don’t fat people lose weight?
The answer is control theory and non-linear equations. The more weight you lose, the harder it is to lose weight and maintain that weight loss. And it goes literally to the body’s efficiency when it comes to processing food. We think about the calorie content of food as being stable, but the reality seems to be that some people process a dinner as if it had 600 calories and a fat person might process the same dinner as having 1100 calories. This is different from metabolism, which can also vary between people.
In other words, this is an immensely difficult issue and the decision as to what to do, or if something should be done, should never be made by people with simple and obvious solutions.
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I’ve read this comment several times, and it seems to be a bizarre case study in overconfidence. (“Few people are grasping Cathy’s point…Everyone has their pet theory as to why—and you are all wrong.”)
The post is extremely clear. Diets work when people stick to them. The problem is that few people can stick with them in the long term. The question to us is: why? Many of us who have grasped Cathy’s point have posed potential reasons, but I wouldn’t call them “pet theories.”
This comment and several others made by the same person seems to assume that people can’t lose weight, even on a diet, due to some weird complicated reasons we don’t fully understand. Ironically, it seems this commenter doesn’t understand the point Cathy is making.
Despite what the media might tell you, the biochemistry of weight loss/gain is pretty well understood. There’s still a ton of work to be done in the realm of gut microbiota, but the basics are there.
And for the record, everyone I know who has tried dieting does not “know more about diet and exercise…” These people tend fall prey to marketing trends. A Kind Bar and orange juice is not a healthy breakfast despite what many dieters will tell you. They have so much sugar, you may as well eat a Snickers for your breakfast.
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Oh, I’m being comically overconfident. I know that.
But the point is serious. Why do so many people fail at losing weight? And the answer is actually unknown. Diets actually don’t work. There was the Penn study on the subject. We do know that fat people who lose weight actually do process calories differently. And it’s pretty obvious that there are different reasons why people are fat, if you pay attention.
No one questions why their skinny friend can eat 10 meals a day and stay skinny. All I’m asking is the reverse question.
And while Cathy certainly doesn’t need me to make her point, she is obviously questioning if diets work:
“I’m ready to say there’s something else at work here, something more basic than free will. It’s like our choice to breathe. We can’t decide not to do it. Or we can, but only for a bit.”
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Actually I don’t think you’ve understood me, Matt. And I know you’ve tried, so I guess I’ll need to write more about it.
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I look forward to it. I’ve just reread the entire post, and I remain baffled by how my summary differs from your intent. You point out that people can often temporarily lose weight on a diet, but it almost never is a viable long-term solution. The “choice” to go off a diet is mostly not a choice but something subconscious or at least outside of willpower. So you’ve asked us what we think that thing might be. I’m certainly curious how I’ve misinterpreted the post.
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Losing my persona for a second. I think the question is that diets, over a 2-5 year time span, seem to fail 95% (or some similar amount) of the time. No medical treatment would be approved with a success rate like that. The Penn study, later repeated in Canada I think, looked at 4 mainstream diets, gave people the most support possible and had a very motivated population and in all cases, the weight came back on the timescale of years.
So the question is whether diets make any sense at all. People seem to have the ability to control their weight over a very narrow range of maybe 20-30lbs and outside of that range, it’s incredibly hard to maintain weight loss or even lose more weight. There is some biological process that keeps people fat. The flip side is the Vermont prison over feeding study. Inmates normal weight inmates were fed until they gained weight. Some stopped gaining at 8 or even 10,000 calories per day and they felt awful doing it.
But what about fat people going off of diets? Most fat people who lose weight actually become miserable, they are chronically hungry. There have been leptin and ghrelin studies that show that those hormone levels in fat people who have lost weight are almost indistinguishable from people starving from actual famine.
There was also a really amazing study done during WWII that would be considered unethical today in which contentious objectors were starved and studied (they agreed to it in place of military service.) They were miserable all the time, obsessing constantly about food, but also they stopped losing weight at even low calorie levels.
And in the last couple of weeks early stage research suggests that a hormone secreted by bones affects hunger levels. Bones! Who would have thought that?
My point is that many people have struggled with losing weight and many very intellignent and successful people have read much of what I have (Rethinking Thin by Gina Kolata, a science writer for the NYTimes among others.) What we see as problematic is that there are several seminal studies that get routinely ignored when talking about this stuff, not just in Internet forums, but by doctors and health researchers. It’s very rare to meet a fat person who hasn’t spend some large amount of their life dieting (or lifestyle modifying or whatever.) Somehow the advice we receive isn’t just inconsistent with our experience, but it’s inconsistent with some gold standard studies – they are just ignored.
Here’s the thing, there are ways to spin anecdotes and stats to invalidate everything I wrote above. It happens every day in newspapers, TV shows, and even in most places of science. But there is another approach to this science that is real and it can also use stats and it would tell a very different story than what many would believe.
As a proof of concept, I’d encourage you to to go to a bicycle event this summer – one that isn’t a race. Look at the people biking 50 miles or farther. That’s a distance that’s typically difficult without some amount of practice, especially if hills are involved. You will see people of all shapes and sizes – many had to practice for months to do the event. I get all the arguments to what I just said, that they eat too much or whatever. But the point is that fat people defy stereotyping all the time and even if these people are outliers, the question remains – why are they outliers? What makes them different? They are the exceptions that might prove a different set of rules.
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Dieting is a choice that people make. However, it isn’t the choice to eat that doughnut or not. It is the choices that one makes in setting up their environment. If one doesn’t have doughnuts in the house, one doesn’t even have the temptation to eat it. If we choose to only have healthy items in the work break room, the thought of having something “off diet” is less likely to occur.
Dieting fails because the very definition of dieting has failure built in. If a person diets and gets the results they want, and then goes back to their previous diet, they will slowly go back to the way they were before. Losing weight and keeping it off requires lifestyle change. For life.
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Or maybe some people are genetically fat and the quinoa and tofu they eat looks to their body as if it’s 2000 calories. Many fat people eat like skinny people are perceived to. And many skinny people eat like fat people are perceived to. Your argument doesn’t account for this.
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I think this is Cathy’s point… that everyone gives simplistic answers and assumes that fat people just haven’t tried them. Fat people have. They don’t work.
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Sorry, I wasn’t about to write a novel here. I have struggled with yo-yo dieting before. I have weighted twice what I am now. I have been there. I have felt the futility. There isn’t “one simple trick” that will change everything. It took me years to learn and understand everything I have figured out to this point. It wasn’t easy. But I enjoyed it. And I worked at it. And I didn’t do it alone. I needed help. I still need help.
Studies have shown that impoverished people don’t get metabolic syndrome and obesity and all that comes with it because they eat poorly. Some of it yes, but an overriding cause has been from social isolation. There are many causes for your body to seem like it “looks at food differently” than those lucky skinny people. The reason could be sleep, stress, social isolation, or eating more calories than perceived. Reporting & understanding the inputs we put into the body is extremely difficult. Calorie counting is almost always underreported.
I have heard many remedies for weight loss stalls that have nothing to do with diet or exercise. Sleep quality increasing, getting off of prescription drugs, being more active in the community, having sex after a long dry spell, the list goes on. Or when someone stops eating processed foods but keeps their calories the same. There is always a reason, even if it doesn’t seem clear at first.
Please don’t put words in my mouth again. I said the act of dieting itself is a choice, but it’s the choice of the environment we put ourselves in, not when it comes down to looking at an item of food. I wasn’t talking about “fat people not doing it right” or some nonsense. I was talking about when people yo-yo diet and why it fails. Because dieting is short term.
Thanks.
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I don’t want to stray too far here, but how does the genetics argument account for the skyrocketing rates of obeisity over the last 50 years? Unless you’re positing some sort of extremely rapid evolution or an environmentally caused, population-wide mutation wouldn’t a genetic cause lead you to expect a relatively constant obesity rate over time? Or at least to expect that in affluent societies where most people can afford to consume a functionally arbitrary number of calories in some form or another, say in the US post 1950? (Or: How do you account for international comparisons to other affluent societies?)
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I just posted a similar thoughtL https://sterbalssundrystudies.miraheze.org/wiki/Obesity#Obesity_rate_over_time
Obesity rate over time
“Approximately 10 percent of U.S. adults were classified as obese during the 1950s. In 2011 to 2012, however, the CDC reported approximately 35 percent of U.S. adults were obese; the prevalence of obesity among American adults has more than tripled within the last six decades.Feb 1, 2016”
https://www.google.com/search?q=obesity+rate+in+1960 (Featured snippets in search)
The key question is what is different from the 1950s. Some combination of those differences is what has changed the obesity rate.
Note that the 10% rate in the 1950s was not 0%. Some obesity is a normal state of a population.
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I don’t think we get to blame most obesity on genetics yet. Maybe at some point in the future there will be a genetic diagnosis that accounts for more people, but there isn’t one right now.
Faq’s – How many people have Prader-Willi syndrome?
It is estimated that one in 12,000 to 15,000 people has PWS. Although considered a “rare” disorder, PWS is one of the most common conditions seen in genetic clinics and is the most common genetic cause of obesity that has been identified to date.
http://www.pwsausa.org/basic-facts/
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I think your argument is missing a very important point – for some people obesity may not be a disease state at all, but rather is genetic. We accept a range in heights, same thing with weight.
Notice that I am hedging with “some cases.” Like I said above, there are likely multiple causes of obesity and multiple things that can be done for it. For some people, no intervention is the best intervention. For others, it may be intermittent fasting, or treating an underlying disease state. It’s actually quite hard for someone to get fat if they aren’t predisposed to it, so we are almost certainly talking about some combination of genetics, environment, actions, and any number of other variables.
The point is that this is a very complex condition that should be solved (or not) by a patient and their physician. And any individual’s experience, even if it’s successfully losing weight, is inconsequential when compared to the data. And most people who have opinions don’t have any real data at all, or have at best poorly understood statistical data that they shouldn’t be applying.
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Please take care of yourself as best you’re able, but please consult statistics before giving anyone else advice. (Granted, that’s a more stringent criterion than we apply to doctors or public health advocates, but you don’t want to know what I think of those.)
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Ok, no opinions. Your facts are wrong.
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I’m fat, in fact I am morbidly obese. It fucking sucks. I hate sweating. I hate being uncomfortable in most chairs. I hate asking for a seatbelt extension in the plane. I hate that I am ugly to most people, I hate that I hate (that part of) myself.
So there is only one question : why in god’s name am I doing this to myself ? I have no idea. I can tell you this though :
It isn’t because I haven’t found the right diet.
It isn’t because I don’t live in the right environment.
It isn’t because I have no willpower.
I think that there is one anecdote which most obese people have lived (many many many times over) that is crucial to begin understanding obesity : it’s late at night, i’m not hungry, I’m coming home. I stop at the store down the street because I need to buy something. The moment I enter the store my brain kinds of separate from my body and I start buying things like sweets and maybe a pizza or bacon or whatever shitty food they have in large amounts. Then I go home and I fucking binge eat for 10 minutes still only able to see myself doing these things. It brings me no pleasure. When it stops I don’t feel anything. I just go to bed hating myself a little bit more. These moments when you lose control are scary and horrible.
I don’t know how to fight this. Like Cathy said every fat people has managed to lose weight. Every fat people knows what they should eat, what they should not have in their fridge. But for one reason or the other we keep inflicting serious damage to our health and serious pain to our soul.
I don’t know if it is addiction or if it is psychologically tied to some emotional problem or whatever but I believe that the only way to approach obesity is through the lens of this self-destructing behavior.
Anyway I assure you that unless you have been there (and i don’t mean 3 pounds to loose after christmas) you should be careful before having an opinion on this (complicated) subject.
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Stephan Guyenet, author of The Hungry Brain: Outsmarting the Instincts That Make Us Overeat, makes the point that a lot of eating behavior is controlled by evolution so we don’t have as much control over how many calories we consume as we think we do. Great interview here
https://chriskresser.com/why-your-brain-makes-you-fat-with-stephan-guyenet/
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on the point/definition of willpower, are we talking about cases of eating when one is conflicted about the act and yet does it anyway?
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