It’s not news that losing weight and keeping it off is a struggle for most dieters. It’s a tall order to find any study in which the majority of participants lose a lot of weight and keep it off for a long time. Even if the oft-repeated claim that “95% of dieters fail” is an exaggeration, the data still isn’t that promising either. For some studies, the bar for ‘success’ is as low as losing a few percent of starting weight and keeping it off for a couple years, which is almost indistinguishable from water fluctuations. Or ‘long term’ weight loss in some studies is defined as only a minimum 24 or 52 weeks, which still is only attainable by 10-20% of individuals.
Yet there are outliers, but more research needs to be done as to why they are successful. The ‘National Weight Control Registry‘ (NWCR) is one such attempt at tracking long-term successful dieters. It’s a database that tracks 10,000 individuals “who have lost significant amounts of weight and kept it off for long periods of time”. The criteria stipulates that participants must have lost at least 30 pounds and maintained that weight loss for one year or more to be eligible to join the study.
However, the NWCR is not as useful as its authoritativeness and garnered media attention would seem to suggest. For one, it’s affected by survivorship bias. While habits like “eating healthy,” “being active,” or “eating breakfast” work for some, they fail for many. The mere existence of successful cases offers little practical insight without understanding how many others did not succeed. Also, presumably at least some people on the registry eventually regain weight later and drop off the registry or are still included despite no longer meeting the criteria.
There is also the confusion of correlation with causality. Consider the oft-claimed stat that the majority of successful dieters on the NWCR eat breakfast. This can be explained not by breakfast being effective at staving off weight gain or having other special properties, but that skipping dinner or having only a small meal and going to bed hungry leads to insatiable hunger in the morning due to hypoglycemia, hence breakfast.
Others on the registry only lose a little relative to starting weight. A 300-pound man who loses 30 pounds, although still a decent amount of weight, is still obese. A 190-pound male who loses 30 pounds represents a more dramatic weight loss. There is a huge difference in terms weight loss plateaus and perceived hunger between a starting weight of 300 lbs vs. 200 lbs. Thus, the registry will likely be biased to overrepresent dieters who lose large amounts of absolute weight compared to relative weight.
So there isn’t much information to go on, in large part because so many people fail, like trying to track glioblastoma multiforme survivors or stage-four small cell lung cancer survivors. However, one such example of a very-long-term success is blogger and AI researcher Zvi Mowshowitz, who has been dieting for over 20 years and describes his experience in detail in the post Sleep, Diet, Exercise and GLP-1 Drugs.
His secret? Indomitable willpower and eating absurdly small quantifies of food, although he doesn’t specify how much he eats on a daily basis. He also claims to have to have a “stupidly-slow metabolism,” but again, without knowing his ‘stats'(e.g. height and weight) and how much he is eating, it’s impossible to make a determination as to how slow he means.
I’ve run a natural version of this experiment, because my metabolism is so slow that I don’t ever eat three meals in a day. For many years I almost never ate after 2pm. For the most recent 15 years or so, I’ll eat dinner on Fridays with the family, and maybe twice a month on other days, and that’s it.
From the comments:
But the results are clearly evident. In any group picture he’s the smallest, and it’s not even close. If the average American is overweight or obese, then to not be either presumably entails eating less, so this should not be much of a surprise.
This passage stood out:
If I had to choose between ‘food is permanently joyless and actively sad, although not torture or anything, but you’re fit and healthy’ and ‘food is a source of joy, comfort and love, but you don’t feel so good about yourself physically and it’s not your imagination’ then I’d want to choose the first one… but I don’t think the answer is as obvious as some people think, and I’m fortunate I didn’t have to fully make that choice.
For Zvi, food is for function, not enjoyment. If given a choice between self-image or pleasure, he chooses the former. This mindset explains his long-term success. To join the elite ranks of the 25% of non-overweight or non-obese Americans requires a level of attentiveness to diet that most people would find extremely unpleasant or impractical.
Eliezer Yudkowsky offers caveats on GLP-1 drugs regarding muscle mass. Even if these concerns turn out to be fully correct, the drugs still seems obviously worthwhile to me for those who need it and where it solves their problems.
Sure, it’s his blog, and he can cite whoever he wants—but why not reference an actual medical expert or, at the very least, someone with long-term experience using these drugs? I can’t think of a worse source than Eliezer Yudkowsky, whose opinions on this matter are nothing more than speculation. He openly admits that he never used the drugs because they didn’t work for him, so what insight could he possibly have on their long-term effects?
The fact that bodybuilders now commonly use these drugs, whose profession requires being acutely attuned to the creation and preservation of muscle mass, suggests such concerns may be overblown. If they were losing muscle they would be the first to notice and discontinue the drugs. From what I have read, a high-protein diet is essential to offset possible nutritional deficiencies and muscle loss. When people try to eat their ‘old diets’ on a GLP-1-induced calorie-reduced state, they become deficient, leading to the muscle loss.
Given how long he has been dieting, likely he has heard of every trick in the book, and has tried everything, and eventually settled on a routine that works. Everyone has a fixed allotment of daily calories and going above that leads to weight gain. So he has to force himself to not exceed this limit, hence willpower. As I describe in the post The sad truth about metabolism: why nothing works, the evidence is extremely lacking that there are any diet hacks or tricks to raise this limit. Advice such as “do cardio,” “just build muscle, bro,” or shifting the macros (e.g. high fat vs high carb) at best are of mixed to no efficacy. Even drugs can only do so much; in the end, the only option is to eat less.
Except for children or adolescents, who are still growing, I believe people need far fewer calories to be functional than commonly assumed. Humans survived for millions of years on the brink of starvation and only recently has civilization allowed people to enjoy surpluses and not having to live in a state of precarity. The putative guidelines of 2,500 kcal/day for an adult male is likely an overestimate. Zvi is able to be fully-productive, writing huge blog posts on a consistent basis about matters as complicated and diverse as economics and AI, while consuming relatively few calories. Being on such a strict diet for so long evidently hasn’t hindered his productivity.
But having to constantly restrict food to such a dramatic extent and for so long, seems like a hell of his own creation to conform with societal pressures. This is why despite being on the ‘right’ I support body acceptance, not out of any personal preference, but because the alternative to acceptance is a Sisyphean struggle with one’s own body and society–that if the abysmal data on dieting is any indication–is likely an unwinnable one. Or in Zvi’s case, not without great psychological cost or effort. Effort is good, but we’re talking something as fundamental as food, not trying to learn a new skill. And dieting does not get easier with time either, whereas practice leads to progress at said skill.
For many reasons, lot of people become fat and making them un-fat is close to impossible long-term despite the best efforts. Doctors seem indifferent because treatments options are limited to begin with, short of various drugs, and a ‘failure to put the fork down’ is not really a disease with a clear etiology. Thus, acceptance is the best option, like baldness-acceptance or short-people-acceptance. It is a grey area in which obesity is not immutable in the same way losing leg is and thus needing wheelchair ramps, or immutable like blindness and needing dog access; but still, obesity is damn hard to fix.