Tuesday, January 15, 2013
Over the past few posts, I have been discussing the findings of the National Weight Control Registry, which found that the people, who successfully manage to keep weight off, fall into roughly four clusters.
As readers will recall, the prototypical representatives of these clusters (Golden Boy Mark, Fitness Enthusiast Julie, Poor Eater Gertrude, and Struggler Janice), all have lost considerable amounts of weight, but each is using a different approach and coping differently.
But why are they successful?
Frankly, I have no idea!
Of course, we now know “what” Mark, Julie, Gertrude and Janice are doing – we know “how” they are keeping the weight off – but nothing in the NWCR data tells us “why” they can do what they do.
Not only, do we not find any answers to why these folks are “successful” at something that the overwhelmingly vast majority of people with excess weight tend to fail at, nor does the data tell us how to take someone, who is not “successful” and lead them to “success”.
In fact, we do not even understand what makes Mark, Julie, Gertrude and Janice different from each other. Are the reasons for their different strategies genetic, physiological, psychological, social, or environmental?
Does Mark find it effortless to manage his weight because of the make up of his mitochondrial DNA, his mental resilience, his extra-ordinarily large frontal lobe, or simply the fact that he has a job that allows him ample of time to pursue his healthy eating and physically active lifestyle. Perhaps, he has a social support system that supports rather than sabotages his efforts. Perhaps he has a healthy dose of narcissism (some might call it “selfishness”) that allows him to put himself before others.
We don’t know.
What led Julie to take up her active lifestyle and why has she decided to devote such considerable energy to her sporting activities – has she perhaps simply transferred here addictions from food to workouts?
We don’t know.
Why can Gertrude get by by eating so little.
We don’t know.
So, while it is of considerable “academic” interest to know “what” successful weight-loss maintainers do, it is not at all clear how to turn an average Joe into Mark or an average Jane into Julie.
Which brings me back to clinical practice.
If I were simply to tell my patients that successful weight loss maintainers tend to eat 1400 Cal (reportedly!) and exercise 2800 Cal (so they say) and so all they have to do is to also only eat 1400 Cal and simply start exercising enough to burn off 2800 Cal, I do not think I would be of any use to them.
Unfortunately, we live in a culture that assumes that anyone can do anything if they really want it – in other words, if you can’t do it, you simply don’t want it enough – this is not a recipe for success, it is a recipe for self-blame, disappointment, and further damage to your self-esteem. It is a recipe for unrealistic expectations.
The folks in the NWCR are remarkable, exactly because they are so few and far between – if their “success” was more common, there would not be anything worth remarking on.
So, while I appreciate the effort that goes into maintaining the NWCR and the time that the registrants spend providing their data, I am not sure that I learn anything from this exercise apart from the fact that we need better treatments that go beyond “eat less – move more”.
But perhaps my readers see this differently?