Thursday, August 11, 2011

Will Losing Weight Make You Fat?

I often joke that the easiest way to gain 25 lbs is to lose 20!

Unfortunately, this may not be much of a joke, as there is mounting evidence that intentional weight loss may indeed be an important driver of long-term weigh gain.

New evidence in support of this hypothesis comes from a Finnish twin study by Kirsi Pietiläinen and colleagues from the University of Helsinki, published in the latest issue of the International Journal of Obesity.

Subjects included 4129 individual twins from the population-based FinnTwin16 study (90% of twins born in Finland 1975–1979). Weight and height were obtained from longitudinal surveys at 16, 17, 18 and 25 years and examined in relationship to the number of lifetime intentional weight loss (IWL) episodes of more than 5 kg at 25 years.

A single IWL episode increased the risk of becoming overweight by age 25 almost three-fold in women and two-fold in men. In fact, women who reported two or more IWL episodes had an even higher (5-fold increased) risk of becoming overweight at age 25.

In monozygous twin pairs discordant for IWL, co-twins with at least one IWL were 0.4 BMI units heavier at 25 years than their non-dieting co-twins despite no differences in baseline BMI levels.

Similarly, in dizygous pairs, co-twins with IWLs gained progressively more weight than non-dieting co-twins (BMI difference 1.7 units at 16 years and 2.2 units at 25 years).

These findings not only confirm previous studies that dieters may be more prone to future weight gain but also provide evidence that, this obesogenic effect of dieting is apparently independent of genetic factors.

All the more reason to warn against the widespread obsession with ‘cosmetic’ weight loss – as I have said before, all weight loss attempts should be medically indicated and anyone attempting to lose weight needs to be warned that they may in fact be increasing their long term risk of becoming (even more) overweight or obese.

On the other hand, in cases where weight loss is indeed medically indicated, considerable effort and long-term follow up will be required to prevent relapse – not only is weight loss not a ‘cure’ for obesity but, in many cases, losing weight can actually make the problem worse!

Imagine if all diet and weight loss products and programs had to come with a  clear ‘warning’ that use of these products or programs may increase the risk of obesity!

Clearly something for the weight-loss industry and the many self-appointed weight-loss ‘gurus’ to chew on.

AMS
Edmonton, Alberta

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44 Responses to “Will Losing Weight Make You Fat?”

  1. Yoni Freedhoff says:

    It’s a very interesting study.

    That said, I would imagine that the modality of losing might well play a role.

    Would love to see a study where speed of loss, methods of loss, etc. were explored to see if one style of losing would be more likely to lead to regain.

    My expectation would be that the more extreme/restrictive/rapid the modality of losing, the more likely to see the outcomes described in this paper.

  2. Rebecca L says:

    Ok, So what are we, those of us who are morbidly obese, supposed to do when we have no doctor and losing weight feels literally impossible when you’re too exhausted to even go for a 10 minute walk…what are we supposed to do? I’d LOVE to have a doctor on my ass pushing me along the way, monitoring me, my diet and exercise, my HEALTH…it’s so overwhelming!!

  3. Muata says:

    @Yoni – I was thinking the same thing as I read this article. As someone who has lost, and maintained a 60lb weight loss since 2003, and a 100+ lb. loss for more than 5 years, I believe that there must be some sort of IWL; however, how severe it is plays a tremendous role in maintaining the losses.

    So, Dr. Sharma, I was wondering would your joke apply to an obese person who was “consciously” trying to lose 20lbs in 12 months?

    Good post, as I just came across your blog a couple of weeks ago, and I’m glad I did.

  4. Alexie says:

    I agree with Dr Freedhoff – it would be so interesting to see how people lost weight. Without knowing that, it’s hard to draw conclusions.

    The other I’d be interested in knowing is what happens when people change their style of eating. My partner and I moved to central Europe several years ago and that has forced us to change the way we eat. My partner is not dieting, but we definitely eat far, far better here than we used to and the weight has dropped off him. Under these circumstances, is he likely to get rebound weight?

  5. Jacqueline Jacques says:

    Dr Sharma, Are you also familiar with Traci Mann’s (UCLA) paper from 2007 (Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol. 2007 Apr;62(3):220-33.)? Her group did a detailed analysis of the “benefits” of diet and exercise for weight loss as a treatment for obesity applying medicare criteria. First, the found that at five-years (there were few studies that went this long) the general outcome was weight gain. Secondly, the overall results were so poor that they concluded “In sum, the potential benefits of dieting on long-term weight outcomes are minimal, the potential benefits of dieting on long-term health outcomes are not clearly or consistently demonstrated, and the potential harms of weight cycling, although not definitively demonstrated, are a clear source of concern. The benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity.” So with study after study and even meta-analysis, why are we still pushing this on the obese patient as viable treatment? It makes no sense.

  6. fredt says:

    New Dr R Lustig video at http://ancestryfoundation.org/ on insulin/leptin

  7. DeeLeigh says:

    You have no idea how relieved I am to hear that this phenomenon is beginning to be studied scientifically, and to hear an obesity expert acknowledge that it exists.

    The reason that I have never dieted and the reason why I’m so strongly against a focus on weight loss (as opposed to health) is because, as a teenager and in my twenties, I saw three aunts and an uncle put on 100+ pounds each by yo-yo dieting. My dad experienced the same effect, but didn’t repeat it over and over again and so didn’t gain as much weight.

    I decided that I’d rather stay at around 200 pounds and avoid the physical and psychological discomfort (to put it mildly), and long term weight gain associated with dieting. It worked. I’ve stayed around the same size for 25 years, pretty much effortlessly.

    I wonder how much of the “obesity epidemic” is actually due to the long term weight gain associated with dieting.

  8. DeeLeigh says:

    Oh – and I also wonder how many of the health problems that are attributed to obesity are really effects of yo-yo dieting. I’ve never seen a study that controlled for that.

  9. anonymous says:

    With such a low bmi difference of only .4 or about 2 pounds after a decade comparing the monozgote twins, it would prove to me again that it is mainly genetics that determines your weight, not IWL or dieting.
    I would suspect though, if you were to tease out people who are prone genetically to type 2 diabetes and you look at intentional weight loss in that subgroup you will find final weight/bmi/sugars/health are much improved. By losing weight and avoiding the pitfalls of high carb high glycemic index diets, in those genetically prone people, I have seen a huge benefit and great success at weight loss maintenance. I suspect if you catch them in their “cosmetic” weight ranges and prediabetic fasting blood sugar ranges of 5.5 to 7 you will prevent full blown severe Type 2 diabetes requiring insulin management.
    Does the study also give the range of final bmi’s differences, + or – ,or just the aveage increase difference in bmi for the whole group?

  10. Alana in Canada says:

    Can scientific studies make a distinction between changing behaviours in order to lose weight–and changing behaviours in order to be more healthy and fit (which may include losing weight.)? How can we compare the two approaches? Could a scientific study truly finesse the mental distinction–and if we could–would that change the long-term outcome? Maybe, maybe not. We have a relationship with food. That is what needs to be addressed. The question, for me, is: can I address my relationship with food in such a way as to effect my body becoming a lower weight than it is now–and keep it there (wherever that is) for the rest of my life? No one knows for sure.

  11. Kirsi Pietiläinen says:

    Dear Yoni&others, Thanks for the lively commenting on our study! You make an excellent point with the modality of weight loss. I am sure it matters. Loss of muscle favours weight regain, although we didn’t study this in our twins. I also think that while we should be aware of the potential risk of further weight gain by dieting, we should still encourange people to change lifestyle to a healthier one (as Alana pointed). Interestingly, our study showed that 1) Fattening makes you diet (genetics play a role) and 2) Dieting makes you fat (behaviour matters). Best wishes from Finland!

  12. DeeLeigh says:

    I would suspect though, if you were to tease out people who are prone genetically to type 2 diabetes and you look at intentional weight loss in that subgroup you will find final weight/bmi/sugars/health are much improved.

    Actually, my dad’s side of the family is prone to type two diabetes. I believe that all the yo-yo dieters were diagnosed with it in their forties (although I’m not sure about one of them). I’m now in my forties, am ‘obese,’ and have never dieted. I’m not even “pre-diabetic.” That would suggest to me that dieting tends to bring on the diabetes, not the opposite. You seem to think that the type of diet is the key. Fair enough, although I can tell you that people on the diabetes prone side of the family who were eventually diagnosed with it had certainly done the low carb thing (along with every other diet in existence). I haven’t discussed the details with them. Of course, it’s impossible to draw any general conclusions from that. I may simply not have inherited the diabetes gene(s).

  13. Glamour life says:

    Thank you Doctor for the interesting information.
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  14. Razwell says:

    This is an excellent article , Dr. Sharma. This fits in perfectly with what Dr. Linda Bacon has said.

    I want people to know about the both of you, as you accurately represent things. I have learned so much in the past year from yourself, Dr. Linda Bacon and Dr. Stephan Guyenet.

    Take care,

    Razwell

  15. Razwell says:

    Hi, Dr. Sharma

    I forgot to say :

    It certainly is over for the $100 billion scamming commercial diet industry now that people can see they rely on erroneous assumptions, false promises and outright lies.

    As Dr. Friedman has said in his obesity lecture- studies from all over the world ( Sweden, Isreal, South Africa and elsewhere) show that when people are not actively trying to change their weights, their weights remain remarkably stable year after year, after year, after year differing only by a few pounds literally.

    We need to ditch the dieting mentality forever. I think eating slowly, not distracted and realizing fullness whispers and working WITH our bodies is the way to do it ( at least for a healthy person whose fat cells are not in hoard mode) . Of course overeating is not good and will disregulate our bodies’ natural systems. But I realize there are many, many factors in WHY someone overeats in the first place.

    Take care,

    Raz

  16. AcceptanceWoman says:

    I think it would be fascinating to investigate comparing “never dieters” to “dieters,” if you could find enough of the “never dieters” and they were sufficiently comparable in demographics.
    I wonder about weight loss when it is not intentional as well.
    In my N of 1 studies, I have unintentionally lost weight several times due to a variety of things — an emergency appendectomy performed not laparoscopically, grief/depression, and medications. I didn’t take measures to avoid losing weight, but I didn’t diet during these weight loss episodes, either. The only one that had a lasting impact on my weight was the surgery, in all other cases, I “rebounded” once the medication was stopped or the depression had lifted.
    I think that the takeaway is, in fact, dieting makes you fatter.
    But losing weight, intentionally or unintentionally, might not make you fatter, if it’s a result of permanent shifts to behavior and environment, but I think this might be in a relatively small weight-loss range. Finding those people who have “permanently” lost weight doesn’t invalidate the theory, it’s more a matter of what were those people doing before, and what are they doing now?
    I think it’s possible to simultaneously acknowledge that there are weight-related medical concerns AND say that dieting makes you fatter. In which case, what helps people with those weight-related concerns other than dieting? What other aspects of health can be focused on that might result in small, incremental, “permanent” changes to weight as a side effect rather than a direct goal.

  17. Walter says:

    A thought provoking title.

    As you have noted yourself Dr. Sharma, the challenge in weight management is not losing the weight – it is keeping it off!

  18. Repost: Dr. Arya Sharma — Will Losing Weight Make You Fat? says:

    [...] | The Greatist Team | Friday, August 12th, 2011 03:18 pm GMT -4Tweet EmailThis post was originally published on Dr. Arya M. Sharma’s Obesity Notes Blog. It is republished with permission. I often [...]

  19. Useful Science | Maspik Teruzim says:

    [...] There’s a fascinating Finnish study in the International Journal of Obesity about how intentional weight loss may lead to weight gain. That link is to Dr. A. Sharma‘s post about the study, since the study is behind a paywall. I particularly liked this part of the doctor’s post: “anyone attempting to lose weight needs to be warned that they may in fact be increasing their long term risk of becoming (even more) overweight or obese.“ [...]

  20. Truth says:

    If done right with a proper diet plan and weight resistant exercises…No! It want.

    http://mhlnk.com/3C7DFCF5

  21. Amy says:

    I feel, as I’ve said before, like I’m the poster child for this theory. Lost 40 pounds this past year…have regained 20. Am regaining far, FAR faster than I lost…literally regained 5 pounds in the past week and a half. *weeping commences*

  22. Mango says:

    Keeping the weight off is the challenge. I have lost weight pretty rapidly and have put it back on just as fast. Yo YO dieting is not the answer and not safe long term.
    http://mhlnk.com/2CB782EB

  23. xtrocious says:

    No diet is going to work if it keeps us feeling hungry and depressed…

    That’s why I have gone on a paleo lifestyle…eat real wholesome food and none of the processed carbs, including sugar…

    Been on it for coming to 2 years – lost 25kgs – and am continuing to keep it off…my body continues to lean out week after week :)

    It works because I don’t feel hungry – I feel healthier with improvements in my lipid profile, blood pressure and overall well-being…

    All the previous aches and pains have also vanished since I cut out wheat and other inflammatory stuff like legumes etc…

  24. leomessi says:

    Yup it may increase weight but get me to reduce it up!

  25. loose some pounds says:

    I lost weight by eating better and being active and maintained it with the same behaviors!
    thi si the best way not only to loose but maintain that weight once you have lost it

  26. Louise says:

    Thank you for writing this!

    I feel this speaks to me. In March 2008, I weighed 270 lbs (I was 60 inches tall and 60 inches waist curcumference). I got motivated to lose weight and began eating very little calories (800-1000 cals a day) and joined the local Y, doing cardio and strength training.

    Fast forward one year: March 2009, I has lost 100+ lbs and actually made it down to 140 lbs (by this point, I started taking supplements ie. fat burners, stimulants, etc). I began gaining up to 20 lbs in 2 days, if I stopped the supplements or took a day off at the gym. I was actually working out 2+ hrs a day, just to maintain. Then, any day I took off, I would have a large weight gain, along with pitting edema (I’m assuming from the supplements).

    So…fast forward to today. I weigh in at about 190…work out like a maniac (avg hr is 150, max hr is 180-35 years old), cardio 6-7 days a week, heavy weights and kettle bells for strength, etc. I even stand at my desk, after hearing research about sedentary behaviour problems. I eat pretty well, although I need to have a cheat meal once a week. Here’s the issue…every single time I eat out (1 meal a week at about 1000 calories), I am 5 pounds up within a day or 2. So, I work it off in about a week, which means it’s time for another cheat meal. So…all I’m doing is gaining and losing the same 5 pounds, over and over.

    My body is falling apart (plantar fasciitis in both feet, sciatica, tendons pulled, muscles torn, etc.). I can’t increase the time or intensity of my cardio and can only do strength 3X/wk. What can I do? I feel like a hamster on a wheel, doing the same thing day after day, expecting different results (yes, that IS the definition of insanity!).

    I am hypothyroid (being treated very well for it-completely under control), so that’s not the issue…I just don’t know what else to do.

    Advice?

    Thanks for listening! :-)

  27. The Amazing Berry says:

    One of the hardest things about weight loss is finding the energy to do it… sometimes you just need a little help.

  28. Chad says:

    One the most important thing also is the cholesterol ,I had high cholesterol even I eating right and working out 2 times a day but my cholesterol stayed very high until I did something abt it I start taking this cholesterol thing, and am feeling better now was 239 lbs and very high cholesterol now I am 212 lbs and my cholesterol is normal.

  29. Lizzy says:

    Losing wight can be an emotional stressfull matter, so if you don´t moral seport it makes things even hardero deal with.

  30. lose weight with a pill says:

    You can lose weight through pills, but in my opinion it is better through a healthy lifestyle. But if that is not possible then there are PLENTY of alternative ways.

  31. melmommy3 says:

    Loosing weight can be so physically and emotionally draining. I think having a support system is critical!

    http://mhlnk.com/06C98E27

  32. Health Necessity Products says:

    Just wanted to share the website that LITERALLY improved my life style habits

  33. Living Healthy says:

    Exercise to lose weight or just to look good, it has to be done everyday and became part of your lifestyle. Just like work, we hate it or love it we have to do it.

  34. Keytone miracle says:

    Totally agree, but when nature can help, why not take the help. It is much more confortable to show at the gym if you don’t spill out of your workout clothes

  35. how fat burns says:

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  36. booba says:

    In my opinion the healthy strategy is more safe than pills you eat less food mores fruits,veggie and water

  37. Adil says:

    The perfect addition to any weight loss or fat burning program is to incorporate the vegetarian weight loss plan to cut our fat intake and lose the weight fast. A vegetarian diet can be a very healthy style of eating but you should add variety, balance, and moderation to your new diet. What we want to do is have a lean healthy body without feeling run down and tired from too much exercise.

  38. Jane Savvy says:

    Here I though I was only imagining that weight loss made me fatter. You are right, it starts with the mindset. Friends, family, trainers and spouses can help, but ultimately it is up to you.

  39. Jane Savvy says:

    The article is not exactly uplifting but it touches on something that I suspected. Yo-yo dieting can make a person fatter than ever. Losing weight and keeping it off takes eternal vigilance.

  40. Jesus says:

    Once you lose weight it is best to stay consistent on your work out and on your supplements. It’s worth it to feel great and look great.

  41. Suzan Nashashibi RNutr says:

    All what was said about dieting making u fat or having excess fat necessitates dieting I firmly believe that the word dieting is so wide in range and yes if u starve your body or do high protein carbohydrate deprive your body later your body will get back at u and gain and gain but after years of practice in weight management I believe that the word diet should disappear from our dictionaries it promises u paradise but takes u to hell but if u look at obesity as a multifactorial problem and try to work on physiology and psychology try to change bad habits and adopt a healthy lifestyle this will lessen possibility of weight regain and the most vital key to success on long term is follow up follow up and more follow up that s what I have been doing in my obesity management practice in Amman Jordan

  42. sabry says:

    What are the health risks associated with overweight and obesity?
    http://tinyurl.com/ojpa76p
    - Diabetes
    - Heart disease
    - Diseases of the liver and gall bladder associated
    - Arthritis
    - Cancer
    - Respiratory
    Psychological and social problems of obesity
    Considered poor morale of the most important psychological problems associated with obesity or arising from and this in turn may lead to depression if the increased intensity more and more. Depression itself can lead to low morale and greater depression and exacerbated . Thus a person finds himself going on in the ring treadmill making it more difficult treatment with the passage of time . well as social factors significant impact on
    the course of obesity where exposed people with obesity in our modern life to psychological pressure and rejection by society and will be even worse in the case of women . which is reflected on the behavior of a person with obesity where tends to isolation and loneliness away from people and escape from these positions some of them resorted to eating as a kind of moral compensation which increases the problem worse.
    sabry almasry

  43. Unique says:

    actually losing weight won’t make you fat but the thought of gaining back lost weight or weight that was never loss will make you fat before anything else will! in all honesty it all begins with the approach and or mindset after that there’s the willingness to make the commitment and finally effort you are willing to put forth and the responsibility you are willing to take for yourself which all begins with right knowledge and encouragement!!!!!!!!

    http://tinyurl.com/o7kq4ah

  44. Skinny Body Challenge says:

    Losing weight did NOT make me fat. I recently lost over 50lbs in under 3 months with the skinny body 90 day challenge and I have the belts with 6 extra holes punched in it to prove it.

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Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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