What Works For You May Not Work For Me

Last week, I described Mark, Julie, Gertrude and Janice, who each represented a prototypical cluster in the National Weight Control Registry.

All of them have lost a substantial amount of weight and have managed to keep the pounds off – but there are important objective and subjective differences between the four.

Before, going into the differences, it is perhaps important to point out the limitations of the ‘stereotypes’ that I have described.

They are based on the averages and/or common features of each cluster. So for e.g. While each could be the average age of the people in that cluster, it is impossible to be both male and female – so, as Mark’s cluster was the only one in which men made up a significant proportion of the group (~40%), I chose to make him a man.

With regard to the actual behaviours as well as the amount of calories consumed and expended through exercise, all of the NWCR data has to be taken with a certain amount of scepticism – they are all self-reported. As many of you, who read this and have participated in the registry, have rightly pointed out, the questionnaires and responses that you have provided (on which the registry data are based) may be both an oversimplification and approximation of what you actually do (which of course also changes over time).

Despite these caveats, here is what is evident: everyone, who has lost weight and is keeping it off is doing more than anyone I know, who is ‘naturally’ of a smaller size.

No one that I know of “normal weight” survives on 1400 Cal and the vast majority of “normal weight” Canadians do not even remotely get close to 2800 Cal of exercise per week.

Thus, no one (read that to mean – not one single person) in the NWCR registry is leading a lifestyle that is anywhere close to the lifestyle that a ‘normal weight’ person, not trying to manage their weight or obsessing about a healthy lifestyle, is leading – so here’s the first message to all ‘naturally’ normal weight people, who have advise on weight management – unless you have a professional degree or experience that qualifies you to give such advise – shut up (and I mean it!).

But before we get up in arms about thin people giving weight management advise – let’s also consider the advise that you can get from “naturally fat” people, who have “conquered” their obesity. As is evident from the NWCR (and my experience) – what worked for you, may not work for anyone else.

Imagine Mark, giving advise to Julie or Gertrude. I especially wonder what Mark would have to say to a Janice. Or imagine the advise that a Gertrude could give to a Julie. Or what possible help is a Janice to a Mark, you get the drift…

Not only, is what worked for you not necessarily the solution to everyone else’s problem, but just because you have lost the weight, does not mean you understand the issues relevant to others struggling with their problem – even less (perhaps) the issues of those large people, who are both healthy and content with their size.

Sure, your story is of interest and yes, it is good to know that you are managing, but this makes you no more an expert on obesity than surviving cancer would make you an oncologist.

Having said this – I sincerely love hearing your stories and there is little that I enjoy more than learning from my patients and readers – this continues to be a most humbling experience.

Especially as someone deeply rooted in the bio-medical aspects of obesity, my patients (and readers) have opened my eyes to the tremendous importance of psychosocial issues relevant to managing excess weight.

Incorporating these considerations into my medical practice is exactly what makes this field of health care so rewarding.

Edmonton, AB