Why I’m Not a Weight Loss Doctor

Written By Dr. Jen Johnson

Give yourself permission to enjoy food as much as a child with an ice cream cone.

Diets don’t work.

Many of us know this intuitively. If any diet led to sustained weight loss, popular culture wouldn’t swing from low calorie to Atkin’s to low fat to keto. For many of us, it is also lived experience. Perhaps we or a loved one have had disappointing experiences with diets (maintaining or gaining weight despite strict changes) or lost weight and then attributed later re-gain to a lack of “willpower.”

The fact is that since the late 1950s, research has repeatedly shown that no intervention leads to sustained weight loss. After 5 years, at least 95% of people will have regained the weight they lost (or more). This may seem shocking, given what you hear in the news or from your doctor. There seem to be endless reports of new research showing some intervention caused weight loss. Typically, these studies are short, the weight loss is extremely modest, and the research was funded by a company with financial interests in good outcomes. Scratching beneath the surface of press reports, you’ll find studies as short as a couple weeks, and weight loss as low as 1 lb. The results are neither impressive nor likely to be maintained.

Diets lead to food obsession and binging.

I’ve had many people describe feeling “addicted” to sugar. They crave it, and if they consume their preferred sweet, they eat to the point of discomfort. Rather than reflecting an addiction, this signals to me the person needs more nourishment.

Intense food cravings and binging are a physical response to deprivation. It makes sense from a biology standpoint - if the body undergoes a period of famine, it will make finding food a high priority via obsessive food thoughts and intense cravings. When food becomes accessible, the body will try to stock up in case of another famine. Dieting or even the threat of it (“diet starts Monday!” sort of talk) can make people feel more out of control around food because of these biological mechanisms.

Many people have internalized messages around how much they ought to eat. Every nutrition fact label refers to 2,000 calories per day, an unscientific number that is an underestimate for most everyone. If you want some light reading on how the body responds to even mild calorie deprivation, google the “Minnesota Starvation Experiment.”

My goal is to support an easy relationship with food, and a strong intuition about and trust of hunger and fullness signals. It is a more peaceful and joyful way to live (imagine never having to pretend cauliflower rice is as good as white rice, or that you only want 1/4 of a donut instead of the whole thing).

Weight should be viewed as a characteristic, not a health condition.

Since the World Health Organization (WHO) lowered thresholds for the body mass index (BMI) to be considered “overweight” and “obese” in 1998, weight has been a public health crisis. You probably have heard messaging about weight causing diabetes, heart disease, cancer, and many more common conditions. It is understandable people would come to their doctors wanting weight loss advice given this information.

However, research connecting weight and negative health outcomes don’t take into account important caveats. People in larger bodies often avoid preventative exams and delay seeking medical help due to negative experiences in healthcare settings, such as inaccessible spaces and weight-based shaming. Doctors often miss serious health conditions because of attributing symptoms to weight. There is also the chronic stress of weight-based discrimination in everyday life. Finally, weight cycling (also called yo-yo dieting) is harmful to health, and people in larger bodies are relentlessly pressured to diet. Without these factors being taken into consideration, we can’t make clear conclusions from the data.

Instead, it is helpful to think of weight as a characteristic. Most bodies will naturally exist in an individualized weight range, and we can optimize our health regardless of where that range falls.

Resources

Dr. Jen Johnson
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