Rethinking Weight Loss
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People commonly attempt or desire weight loss because they want to “be healthy.” Athletes might pursue weight loss to “get faster,” “jump higher,” or “perform better.” However, many efforts to lose weight consist of practices and behaviors that are harmful to health and can work against optimal performance.
Why do we think weight loss is the answer in the first place?
It’s easy to blame the thin and/or muscular “ideal” body presented in magazines, on social media, or among news headlines. Just as often, however, people are told to “lose weight” by well-intentioned doctors, nutritionists, dietitians, coaches, trainers, and other health professionals.
In this article, we’ll explore the following questions:
Is weight loss necessary for improved health and/or performance?
Is weight loss sustainable?
What would happen if we stopped focusing on weight as the goal, and focused more on the process of improved health behaviors?
What if we aim to enjoy food and exercise, rather than try to manipulate them?
The Cost of the “Dieting Cycle”
Despite the high failure rate of dieting for sustained weight loss, weight loss is still encouraged and pursued, giving rise to an endless “dieting cycle.” The dieting cycle is characterized by starting and stopping diet after diet (yo-yo dieting) and the “binge-restrict cycle.”
The binge-restrict cycle is characterized by restricting specific foods or food groups, leading to a biological drive for those foods and inevitably leading to binging on them (shown in the image below.) These patterns are often accompanied by feelings of shame, guilt, hopelessness, anxiety, and worthlessness.
The dieting cycle perpetuates negative self-talk, poor body image, stress, anxiety, guilt and even fear around food. It also causes weight cycling, which is not conducive to increasing metabolism, gaining muscle mass, or improving health. In fact, yo-yo dieting is one of the largest predictors of weight gain and may lead to a higher fat-to-muscle ratio over time. Studies show that many people who lose weight must maintain their caloric intake and level of activity or risk weight regain. And, if further weight loss is desired, they must work even harder and reduce calories further to continue losing weight – does this really seem sustainable?
Another characteristic and consequence of the dieting cycle is under-nourishing. Under-nourishing is the act of restricting calories and/or nutrients the body requires daily to function optimally. Chronic under-nourishing is when under-nourishing is prolonged, leading to more severe consequences over time.
In general, the common consequences of under-nourishing are binging behavior, inability to sense hunger and fullness cues, altered/inconsistent hunger and fullness cues, obsessive thoughts about food, poor healing, poor immune function, poor focus and concentration, sleep disturbances, and poor hormonal function. When athletes are under-nourished, they also increase their risk of injury and fractures and experience poor performance (especially at higher intensities,) poor recovery, weakness, and decrements in strength, power, flexibility, and endurance.
Why is Everyone Chasing Weight Loss?
The public and the scientific communities have traditionally adopted the conclusion that dieting works, based on the many weight loss studies concluding that dieting for weight loss is effective due to the immediate loss of weight.
At face value, this conclusion is intuitive. However, it is always imperative to consider research and data within the context of the experimental design. When reviewing the literature, there are two primary reasons why I see this conclusion as problematic:
Many of these studies did not measure long-term weight loss.
As I say this, I understand that “long term” is arbitrary and is defined differently depending on who you ask. However, in thinking about what “long term” really is, I believe 10, 20, 30+ years are adequate timeframes to consider, depending on the age of the person in question. Think of it this way: if you are going to do something with the goal of extending your life and improving your overall health, wouldn’t you want it to last longer than 1-5 years?
Behaviors such as exercise and sleep may also contribute to improved health outcomes.
It is necessary to also consider the other factors, in addition (or even as precursory factors) to weight loss, which may have led to health outcomes in those studies. The important question that is repeatedly overlooked in these studies is this, “Were the health improvements observed attributable to the weight lost? Or, rather, the behavioral factors that also resulted in weight loss?”.
While we currently have evidence that in certain circumstances weight loss may be beneficial in improving lab values (a marker of health), another important question is: “is this weight loss sustainable?” Most of the time, it is not - and attempting to maintain it often comes with baggage of its own (discussed a bit later). Additionally, there is sound evidence that has measured post-study outcomes of weight loss programs and diets, showing 80-95% of dieters gain most or all the weight back, in addition to 33-66% of dieters regaining more weight than what they lost, resulting in a higher baseline bodyweight.
With that said, let’s explore some of the reasons why weight loss is pursued:
Reason #1: “Science tells us weight loss will improve health”
As I alluded to already, there is a common (albeit unpopular and controversial) outlook when it comes to weight loss studies: was it the weight loss, or was it the health behaviors such as a balanced diet, exercise, etc. that led to improved health? I am not saying the evidence we have for weight loss does not hold any truth. Instead, I am challenging the idea that weight loss is the cause of the health improvements identified in many weight loss studies.
We have a large body of evidence that shows adopting the aforementioned health behaviors result in improved lab markers in addition to improvements in overall mental and physical health. This evidence typically draws a relatively clear line from cause to effect, while the studies that measure weight in relation to health do not.
Reason #2: “My BMI is too high”
In addition to the number on the scale, the Body Mass Index (BMI) is a number that people often hang their hats on when it comes to measuring or defining health. Without diving too deep into the topic of BMI (it’s a doozy), know that it is not an accurate measure of body fat percentage or health, and is particularly problematic when applied to the athletic population. BMI is simply a measure of height and weight and lacks the ability to distinguish between fat and lean mass (bones, blood, skeletal muscle, organs, etc.), measure fat distribution, and adjust for differences in gender and race.
If you are interested in learning more about the history of BMI, it’s intended purpose, and the evidence around the BMI, check out the resources listed at the end of the article.
Reason #3: “My doctor told me my weight is the cause of my health issues”
You may have heard your or a family member’s doctor recommend weight loss and attribute an injury or medical condition to weight. This is often hardly the case, as many injuries and conditions can be prevented and improved through health behaviors previously discussed. The side effects of some medications can also cause severe negative health symptoms and are often overlooked in individuals with larger body sizes.
Reason #4: “Societal beauty standards”
Despite the ever-changing beauty standards, the harsh reality is people consistently attempt to conform to whatever the “ideal body” is. Many have gone through great lengths (and still do) to achieve a body our society deems beautiful and worthy of love, kindness, compassion, and happiness.
The Relationship Between Weight Loss and Health
Health can be defined as “the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”, according to the World Health Organization (WHO).
Notice, health is not solely dependent upon whether a person is with or without disease – it is multifaceted. People often make the mistake of thinking that being “overweight” or “obese” results in being unhealthy, and that health can simply be attained by decreasing body weight. The simplistic statement, “losing weight will make you healthy,” fails to account for other important factors that influence health, such as medications, genetics, and social determinants of health.
*Social determinants of health are factors such as access to nutrient-dense food or access to food in general, health insurance and adequate coverage, quality healthcare, access to fitness centers and programs, safety and accessibility of the neighborhood, history of trauma, education, racism and discrimination, and more.
By exploring which factors influence health, we can learn how to achieve health.
Regular exercise and movement directly and positively affect mental and physical health. While there are studies in support of specific forms of exercise such as high intensity interval training (HIIT), one does not need to do HIIT to be healthy and reap the benefits of exercise. What is more important is finding a form of exercise or movement you enjoy and can sustain long-term. Notice the words ‘regular’ and ‘sustain’; it’s not about doing the hardest workout possible - it’s about finding an option that you look forward to engaging in on a consistent basis.
Getting enough quality sleep is frequently overlooked as a major contributor to health and well-being. Did you know that a lack of adequate sleep opens the door to altered hunger and fullness cues, insulin dysregulation, fatigue, brain fog, increased stress, hormonal abnormalities, and more? The amount of sleep varies based on age, and ultimately, individual needs, though generally, 7-9 hours of sleep is ideal. The quality of sleep is of concern as well, but its discussion is outside the bounds of this article. In recent years, sleep has become a more commonly acknowledged factor for improving cognitive performance and mood. Yet, when it comes to improving health, most people still tend to focus on diet and exercise as the sole factors to control. Adopting more consistent sleep and wake times, adopting a bedtime routine, and improving sleep hygiene all have the power to improve both the amount and quality of sleep.
Stress management: While stress is not something to be avoided altogether, many suffer from chronic stress, increasing their risk for conditions such as heart disease and diabetes. Fortunately, various stress management techniques, both small and large, can be used when stress comes knocking. Small techniques, such as journaling, meditation, crafting, reading, and video games, can be used easily without much effort. Large techniques take a bit more time and effort, and might include going on a hike, biking, running, strength training, yoga, walking, going to eat with friends, dancing, cleaning, and organizing, etc.
A balanced diet (including play foods) with variety is ideal for optimal physical and mental health. A balanced diet consists of carbohydrates, fat, protein, fiber, and color (fruits and veggies). Having variety in the diet ensures you are meeting your nutrient needs, reducing the risk of developing food allergies and intolerances, and taking care of your gut microbiota (the friendly gut bugs in your intestines that do many health-promoting things for you).
Better Ways for Measuring Health
We can measure our health by tracking lab values and markers (such as cholesterol, triglycerides, HDL, LDL, and hemoglobin A1c, to name a few), and monitoring energy levels, stress levels, happiness, and how we feel from day to day. Other helpful measures include heart rate variability, ability to sustain exercise and movement, ability to participate in activities with the ones you love, ability to heal and recover in a timely manner, and quality of digestion. Did you notice I did not mention weighing yourself daily, weekly, or monthly? That is because your weight does not tell you if you are healthy or not – the measurements previously mentioned can give you a significantly better idea of your health status.
A notable caveat to this is if you notice sudden, unintentional weight gain or loss - this is something worth bringing up with your provider to explore reasons why this could be happening. There are times in which significant weight changes are a sign something could be wrong. Though, weight changes, in general, do not necessarily mean something is wrong. Why? Because bodies change over time for various reasons unrelated to acute and chronic conditions – that is life.
If weight loss is not the answer, what is?
Sustainable practices that promote mental, physical, and social health and well-being, including:
A balanced diet with variety (including play foods – see previous blog post here
Consistent and adequate nourishment
Consistent movement and exercise you enjoy
Adequate, quality sleep
Effective stress management
Keeping up with your yearly physicals and bloodwork
That means, if you are following a meal pattern and lifestyle that causes stress, anxiety, constant hunger, obsessive thoughts about food and exercise, or binging behavior, it is not for you.
If you truly want to improve your health and overall well-being – eat, move, sleep, manage your stress, socialize, and enjoy the life your body works hard to help you live!
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