1)    Dieting perpetuates an all-or-none mentality around food

Good/bad, healthy/unhealthy, clean/toxic – diets perpetuate an all-or-none mentality around food. They include over-simplified rules around “accepted” and “forbidden” foods as an attempt to moralize food choices and build the consumer buy-in. When food is labeled this way, it teaches people to create moral virtue around their food choices, which might look like, “I’m a good person for eating ___” or “I am so bad for eating ___”. This drives food fear, judgement, shame, and self-loathing when the rules are broken and you “fall off the wagon”.

What I know now is that the rules are unsustainable long-term, despite the denial from diet culture who will continue to gas-light and blame the consumer. In reality, nutrition science is complex, and a single food is not “healthy” or “unhealthy” on its own. Food does not have its own set of moral values and it serves us in many different ways. Consider these scenarios:

• Vegetables are often considered a “healthy” food. However, if vegetables were the only food someone eats, their physical and mental wellness would be negatively impacted.
• Chocolate bars are often labeled as “unhealthy”. Yet, if a chocolate bar was the only available food to eat in a 6 hour time span, the chocolate bar may contribute to the person’s well-being by supporting their energy levels and making them feel less anxious, moody, light-headed, or nauseous.
• Enjoying a birthday dinner or a slice of birthday cake with a friend contributes to celebration, pleasure, and is associated with positive memories all of which contribute to a person’s well-being.

While the food we eat can be part of who we are, it does not define us. Unless rules and morality around food are challenged, diet culture will keep you in an on-again, off-again relationship.

2) Dieting and intentional weight loss is not sustainable for the majority

Majority of individuals find long term weight loss difficult to achieve, and for good reason. When critically reviewing research around weight loss, it’s important to critique the length of the study, participant dropout rates, amount of weight actually being lost (spoiler alert, it’s often far less than people might expect or hope), and weight regain.

• A review of 31 long term studies on dieting showed that the majority of individuals were unable to maintain weight loss over the long term. About 1/3 to 2/3 of participants regained more weight than they lost.
• Other weight loss studies demonstrate such small reductions in body weight that they are unlikely to be clinically significant. One review looking at weight loss interventions in primary care showed an average weight loss of 1.36 kg (~3 lbs) at 12 months and 1.23 kg at 24 months.
• A systematic review that included more than 278,000 people showed the annual probability of achieving a “normal” body weight was 1 in 210 for men and 1 in 124 for women in the “obese” BMI category. Among participants who lost 5% body weight, over 50% of them regained weight within 2 years and 78% by 5 years.

Ultimately, if we’re suggesting that a patient/client/customer lose weight and keep it off for life, we need to use comparable science. And if we do that, we don’t seem to have enough evidence to recommend this type of “treatment”.

3) Dieting and intentional weight loss may not improve health long term

Although the discourse around health continues to focus on BMI and weight in many circles, research shows we may be barking up the wrong tree. The following studies are just a few demonstrating that the pursuit of health and the pursuit of weight loss are not one and the same. Weight loss can increase health risk long term (see point #4). Yet, engaging in health promoting behaviours such as regular physical activity, reduced smoking and alcohol consumption, or eating more regular, balanced meals can all positively impact health even if weight doesn’t change.

• A review of 21 randomized controlled weight loss trials with at least 2 years of follow-up showed:
  • Minimal improvements in cholesterol, triglycerides, systolic and diastolic blood pressure, and fasting glucose
  • These minimal improvements were not correlated with weight loss
• A multi-centre random controlled trial (called the Look AHEAD trial), focused on whether or not intentional weight loss reduced death from cardiovascular disease (CVD) among “overweight” individuals with type 2 diabetes. It included more than 5000 participants with an average age of 60 years. It also involved a prescribed diet plan, meal replacements, and 175 minutes of moderate activity per week. Participants received weekly group and individual counseling sessions for the first 6 months.
  • After 9 years the study was stopped due to futility. In other words, the intervention with a weight loss focus did NOT reduce the rate of CVD events in “overweight” or “obese” adults. Additionally there was no difference between CVD risk between this group and the control group.
• A review of six randomized controlled trials assessing a ‘Health at Every Size’ (HAES) – based program, found that the HAES approach to health promoted greater physiological and psychological health outcomes when compared to weight loss programs. One study looked at a HAES-based program that emphasized intuitive eating and size acceptance, and evaluated this against a weight-loss program. It included women the age of 30- to 45-years classified as “overweight” or “obese”. Participants within each program received 6 months of weekly group interventions followed by 6 months of monthly group support.
  • Findings yielded more positive results for the HAES-based program over the 1-year and 2-year follow-ups. Specifically, the HAES group decreased total cholesterol, LDL cholesterol, triglycerides, and systolic blood pressure at the 2-year follow-up and sustained improvements from 1-year to 2-year follow-up.
  • The HAES group decreased the drive for thinness, bulimic behaviours, and  depression, and increased self-esteem and body satisfaction at both 1-year and 2-year follow-up.
  • The dieting group lost weight and showed initial improvements on many variables at the 1-year follow up, but had regained weight and did not sustain improvement at the 2-year follow-up.
  •  Furthermore, the drop out rate in the diet-based group was 41% compared to the HAES group which was only 8%.

My interpretation of the science is that we don’t have enough consistent, long term evidence to suggest that pursuing weight loss and reducing BMI is an effective or sustainable intervention for improved health.

4) Weight stigma and fat phobia trigger dieting, which perpetuates weight cycling

Weight cycling is defined as repeated weight loss and regain. I want to be clear that I am by no means blaming the victim here – the folks who try and try again to lose weight – because weight stigma plays a big role in the pressure to continue to pursue weight loss. This is the labeling and stereotyping of individuals based on their body weight or size which stems from negative social attitudes (weight bias) that leads to prejudice and discrimination. Therefore, it is not an individual’s fault for internalizing fat phobia and desiring weight loss, or for spending years in the dieting cycle. Weight stigma and anti-fat bias are pervasive and systemic. Weight cycling is most often connected to the restrict-binge cycle:

• You begin a diet, motivated and excited. The body is deprived of certain foods or nutrients as you follow the food rules and restricted eating patterns.
• In time, food obsession begins, food and eating may consume your thoughts, and you can’t stop thinking about next meal.
• You notice you start binging or feeling out of control around “forbidden” food, when it’s accessible (despite best efforts to avoid it at all costs). This triggers you to “throw in the towel” or engage in the “what-the-hell-effect” where even thinking that you’ve blown your diet is enough to consume of more of the “forbidden foods” (sometimes ignoring fullness cues).
• Guilt, shame, and/or self-loathing set in and you feel desperate to “gain control” again.

The ongoing pursuit of weight loss takes a severe toll on mental health. People start to believe their worth is tied to their size, and disordered eating becomes isolating and exhausting. Weight cycling contributes to:

• Increased likelihood of binge eating
• Loss of muscle, which increases weakness and risk of falls, surgery, and disease and death
• Increased hypertension and heart disease risk

Additionally, weight cycling causes physiological adaptations in the body that make weight loss more difficult, and likelihood of weight gain higher:

• Decreased basal metabolic rate and resting metabolic rate, which decreases energy expenditure (how efficiently the body “burns” energy)
• Reduced muscle mass which further slows metabolism
• Changing hormones that promote energy storage (e.g. Grehlin)
• Changing hormones that increase appetite (e.g. Leptin)

Weight cycling is hard on the body, mentally and physically. Even more, weight stigma needs to be addressed because not only do studies show that it contributes to disordered eating, depression, and body dissatisfaction, it leads to more chronic stress and elevated inflammatory markers. Weight stigma doesn’t just harm people in larger bodies, it harms people in all sized bodies because it reinforces fat phobia and anti-fat bias.

As you explore a New Year and dabble in all the possible resolutions relating to your well-being, I invite you to reconsider another diet.  Instead, you might explore health-promoting behaviours such as:

• Improving sleep quality or quantity
• Consistent movement
• Improving your relationship to food
• Learning about balancing meals and meal spacing that fits your life and your needs
• Therapy
• Being consistent with a medication or supplement that you need
• Seeking support from a new health care provider

Ultimately there is no guarantee as to how your body will adapt to behaviour changes. But don’t let that hold you back from doing things that feel good!

At Food to Fit Nutrition we hold space for clients who want weight loss, no matter their reasons, and while we ethically cannot guarantee weight loss, we help clients to engage in behaviours that might move them towards their wellness goals. Learn more about our dietitians here.

References:
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Himmelstein, M., Incollingo Belsky, A.C., Tomiyama, A. J. (2015). The weight stigma: Cortisol reactivity to manipulated weight stigma. Obesity. 23, 368-374. https://doi:10.1002/oby.20959

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Practice Based Evidence in Nutrition (2017). Background: Weight Stigma. Retrieved from www.pennutrition.com

Quinn, D.M., Puhl, R. M., Reinka, M.A. (2020). Trying again (and again): Weight cycling and depressive symptoms in US adults. Open Access. 15(9). https://doi.org/10.1371/journal. pone.0239004

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