The New England Journal of Medicine recently considered the problem of “which diet is best” in an editorial. The author observed several problems with weight loss trials, including the lack of control groups, the problems with monitoring people, and the difficulty of getting folks to do something that they may not really want to do.
Astutely, the author notes:
The inability of the volunteers to maintain their diets must give us pause. The study was led by seasoned investigators who were experienced in the performance of diet and drug trials. The participants were highly educated, enthusiastic, and carefully selected. They were offered 59 group and 13 individual training sessions over the course of 2 years. Nonetheless, their body-mass index (the weight in kilograms divided by the square of the height in meters) after 2 years averaged 31 to 32 and was moving up again. Thus, even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed to reverse the obesity epidemic. The results would probably have been worse among poor, uneducated subjects. Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices.
It is obvious by now that weight losses among participants in diet trials will at best average 3 to 4 kg after 2 to 4 years and that they will be less among people who are poor or uneducated, groups that are hit hardest by obesity. We do not need another diet trial; we need a change of paradigm… Like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action.
Now, I’m sure we can all agree that having some level of self-motivation is important. Otherwise you’d just end up “lying in bed just like Brian Wilson did”. But as motivated as we all are, it’s really hard to fight against the tide of shit food and inhumanely constructed physical environments that practically demand that we sit in cars. On my last days in LA, I was on my own in a hotel. I almost literally had to forage for food: the nearest grocery store was nearly 2 miles away, and I was the only person walking. The streets were laid out to privilege the car, not the walking human. I had to dodge traffic and trudge across vast parking lots. When in the store I had to filter out plenty of loud, colourful, visually attractive things begging me to buy sugary procssed garbage.
Imagine trying to shop for a family of 4 without a car in this kind of community. Imagine trying to deal with a toddler while trying to pick up dinner, excavating the aisles to find something — anything — not full of crap: colourings, sodium, sugar, hydrogenated fats, paradichlorobenzeneestermethyl-blue. I’m a food magazine editor and so called expert, and it still took me way longer than it should have to figure out what kinds of things I could safely and sanely consume. (New sugar discovery: in fish. Why? WHYYYYY?!) The hilarious irony of that situation is that I walked past two gyms and a Pilates studio to get to that grocery store… and of course nobody else would have walked to their gym.
In other words, trying to lose weight and keep it off, and stay in shape in an obesegenic environment requires a massive act of will and motivation. It can be done, of course — and many of y’all are a testament to that. But it’s really fucking hard. Why don’t we start trying to make it easier on ourselves?! Demand better from our grocers and our food providers. Demand better from our community planners and municipal governments. Demand sidewalks, parks, bike lanes, good public transit, and high-density, human-scale urban planning. Reconsider our priorities in real estate — do we want a big cavernous house in the middle of a razed field or a smaller, manageable home in a community that allows us to know our neighbours and walk to the damn grocery store?
Meanwhile a study in the International Journal of Obesity reports a comparison between people who lost weight via surgery and via non-surgical methods such as diet and exercise. While both groups regained a bit of weight, they weren’t substantially different. What surgery patients shared, though, was less physical activity, more fast food and fat consumption, less dietary restraint, and higher depression and stress. People who were susceptible to external cues (such as availability of food, or stressful situations) gained weight back regardless of how they lost it. As always, “what diet should I follow” is an important question, but perhaps not as important as “what’s around me and how am I dealing with it?”