Moving on from last week’s piece that didn’t say much, I want to delve into a topic that will be a bit of a mish-mash from a book I started last year from which the woman’s book spun off from. I will get back to it and this may be a bit disorganized since I’m pulling stuff out of some different chapters but so be it. But I want to look today at the causes of diet failure. Now, I’ve written a bit about this before although that was more about how dieters fail their diets but this is all inter-related.
To be honest, and I’ve been saying this for a lot of years, I don’t think that the issue with dieting failure has much to do with diet (or exercise) per se. That is, we know and have known for a long-time HOW to get people to lose weight/fat (I’m going to use these interchangeably for writing style reasons just understand that body composition is more important than changes in body weight per se and let’s move on). Bottom line, almost everyone manages to lose some amount of weight or fat when they diet. That isn’t the issue.
The bigger issue to me is why people don’t keep the weight off. That is, why are making long-term behavior changes so difficult for most people. Make no mistake, this isn’t isolated to dieting and people tend to fail at most behavior changes. Exercise program, most quit. Stopping smoking, drinking, any bad habit you care to name and most people do poorly at making changes and maintaining them.
And this is the issue to me: how do we fix this? How do we improve adherence. Because another study about how fiber is good for fullness isn’t telling us jack crap. We need to know how to get people to eat high fiber foods in the long-term.
Biological Reasons for Diet Failure
One topic I’m actually not going to go into in detail in this piece is all the various biological drivers that tend to make fat loss difficult. While I have been hilariously accused of ignoring metabolic adaptation from time to time (which is absurd given that I was writing about it over a decade ago), I’ve written enough about this to fill multiple books and will write about it again to be sure. The body fights back. Leptin, ghrelin, PYY, changes in neurochemistry, etc.
Metabolic rate slows, we burn less calories during exercise, NEAT goes down. Hunger goes up, appetite goes up, food is tastier and we’re more attentive to it. It’s one big set of adaptations that acts to limit fat loss and promote weight and fat regain.
That’s on top of that weird piece I wrote about dog training and how the relative time points for reward and punishment are reversed from what would be ideal. No debate, no argument; there’s a biology to all of this. I want to talk about some other stuff here. We can’t do much about the biology to be honest outside of refeeds, diet breaks, etc. so let’s focus on other negative behaviors that people take into dieting.
Statistics on Diet Failure
I want to start here since there is a common statistic that is cited endlessly that happens to be wrong. You’ve probably heard or read or even stated that only 5-10% of people succeed on a diet but here’s the thing: this number is bullshit. It comes from two early reviews (one of which was in 1959) that looked at the rather poor results in clinical studies.
But here’s the thing (and this was a point made in a paper I’m not going to cite or mention because I gotta keep some guru secrets): those types of studies are invariably enrolling the absolute hardest cases. The people who have failed on every other approach who have been in multiple studies without success. Of course they show the worst results but that’s simply because they aren’t a representative sample of the majority. These types of things were self-selecting for the people most likely to fail.
It’s like on weight and fat loss forums where it seems that EVERYONE is having issues with their diet or can’t gain msucle because that’s the posts that are being made. But here’s the thing: people who aren’t having problems usually aren’t the ones asking questions. (i.e. it’s far more rare for people to post about their amazingly successful progress so you don’t hear about it).
And the fact is that a majority of people who lose weight and keep it off don’t enter clinical studies or even commercial program like Weight Watchers. Quite in fact, the National Weight Control Registry, a group of people who have lost at least 30 lbs and kept it off for at least 3 years, reports that over 50% of the member’s lose weight on a non-commercial, non-clinical type of program. My point being that the 5-10% number is artificially low and people need to stop repeating it as if it were true.
Which isn’t to say that a large number of even a majority do succeed. Numbers vary but about 30% or more do have at least some success. Some of this depends on how you define success but clinically this is defined as a weight loss of 10% below current weight that is maintained for several years. Now we might argue is someone who is 250 losing 25 lbs is ‘succeeding’ or will be happy with that result but that’s the clinical definition so that’s what I’ll use. So what else may be contributing here?
False Expectations and Diet Failure
To talk about false expectations, I actually want to talk about two distinctly opposite things. The first ties into this falsely repeated belief that only 5-10% of people succeed at weight loss or the more recent “Nobody ever maintains weight loss.” Because I think this is creating a desperately negative false expectation for failure.
It’s programming people for failure from the get go. Like that trite saying about “If you think you can or think you can’t, you’re right”; well, it’s true here. When everyone has heard “You can lost weight but won’t keep it off” people either don’t try or expect to fail.
If you told someone “Nobody ever succeeds at quitting ____” (insert whatever: smoking, drinking, etc.”) either nobody would try or everybody would fail because they expect to fail. What I actually find funny is that, despite similarly poor success rates, nobody has ever argued not to suggest people stop smoking or drinking to excess. Yet….fat acceptance…go figure. But I’m not going down that rabbit hole.
Which isn’t to say that the opposite is any better or that dieting success is easy and quick and everyone can do it. False expectations of success can be just as detrimental as false expectations of failure and there are several aspects of this. One is something called the False-Hope syndrome. Remember that weird dog trainer piece, how immediately rewarding behaviors tend to be the strongest in terms of it’s impact on our behavior?
Well the first part of any diet is usually easy: weight and fat come off, there’s no struggle with hunger and it’s all both hunky and Dory. Then it gets progressively harder, results slow as the effort requires intensifies and people give up. But they all remember the first easy bit, the initially super-rewarding aspect of it. So when it’s time to try again, they go into the diet expecting that to happen again. Which it does for 3-6 weeks before it gets hard. Rinse and repeat.
But this invariably leads people to think that weight loss will be quick and easy and painless, driven at least partially by the remembrance of that initial easy period from the last diet. Of course, diet books pander to this. Everyone has the new magic bullet, a promise that weight can be lost quickly, easily, rapidly, without counting calories, without food restriction while enjoying “all the foods you love.” I don’t do this of course, I’ll tell you up front that long-term fat loss is difficult and that my own UD2 and RFL are not easy diets. But they work.
So when it gets difficult, when weight loss stalls or slow (due to a variety of factors including metabolic adaptation, increasing hunger, a lack of adherence, etc.) while it’s getting harder, the expectation is broken and people give up. Who wants to work harder for less results when they think it should be super easy?
Another false expectation is what people think will happen when they reach their goals. People think or are told that losing weight and fat (or for younger men, getting abs or big pecs and arms) will change their lives. They will become more popular, get a promotion, one study found that women thought losing weight would help them get a boyfriend (of course young males think abs will get them laid without effort which is what muscle magazines tell them).
Some think it will change people’s opinions of them from “lazy and gluttonous” to “self-disciplined”. And when they get to their goal, if they do, and it doesn’t happen. Well it’s easy to go “Screw this.” All that work and your life didn’t turn into unicorns and sunshine overnight? Bring me donuts. Maybe with a unicorn on it.
Goal Setting and Diet Failure
But that ties in with realistic goal setting and people setting goals that are often absurd. They may be absurd in magnitude, someone at 300 lbs expecting to end up at 150. They may be absurd in time frame: weight loss is always about twice as slow as predicted based on the numbers because of all of the adaptations that occur from the get-go. People do simple math, 500 cal/day = 3,500 cal/week = 1 lb/week and it never happens except maybe in the very earliest stages (sometimes it’s a bit quicker due to changes in water weight and stuff but then it slows down) . So they get frustrated and give up.
I have “joked” that people always want fat loss to be twice what it is. Losing 1 lb/week and you want 2 lb/week. Losing 2 lb/week and you want 4 lb/week. Losing 4 lb/week and you want 8 lb/week. Shows like the Biggest Loser aren’t helping. People lose 18 lbs in a week and that becomes an expected result. I watched a depressing documentary about an ex-contestant who had gained all the weight back. He said he was unable to get back on track: a normal diet got him 2-3 lbs loss per week and he was programmed to think anything less than 15 lbs/week was a failure.
One study actually found, tying very indirectly into this that something like 50% of dieters were unhappy that they only reached half of their weight loss goal. Their goal was 32% of their starting weight, that’s 75 lbs for a 250 lb person. They only got to 16% of that. A mere 37+ lbs. And they were unhappy.
And I’m actually going to cut it here for no other reason than I’m bored of writing and this will make next week’s update easier so I don’t have to come up with a new title. This is going to be one of my famously unplanned series so it might be 3 parts, it might be 6. I’m hoping for two but that may be a false expectation knowing me.
Fantasy, Reality and Diet Failure
Here’s an interesting one, a weird paper that looked at issues of positive and negative expectations/fantasies and this ties in with what I was talking about last week. Basically you can draw up a 2X2 grid with four options for positive and negative fantasies about each. And without doing so, the worst results were seen the group that had negative expectations about success (i.e. they were expecting to fail or have poor results) but positive fantasies about how easy the process would be.
In contrast, the best results were seen in the people who had positive expectations about their results but, perhaps confusing, negative expectations about what would be involved. So they expected to succeed but were at least realistic about the potential negatives that they would encounter (and as I’ll discuss thoroughly in the book this piece is being taken from, there are strategies that help to not only identify problems but find solutions before they occur).
So think about how many people, either due to past failures or having heard “Nobody keeps weight off” decide to lose weight but basically expect themselves to fail. But who still think that the false expectation of quick, easy and painless weight loss will occur. It’s kind of a confusing combination: thinking you’re going to fail but it will be easy until you do.
Rigid Restraint and Diet Failure
The concept of dietary restraint is a bit oblique and comes along with some other concepts such as disinhibition. You can think of dietary restraint as an overall concern about food intake and bodyweight but it’s not synonymous with dieting per se because it’s not synonymous with actual caloric restriction. It’s just a mental concern with it.
I reviewed a paper showing that these people have elevated cortisol (and this is due to the mental stress) and folks with certain types of restraint often show disinhibition. This means that under certain conditions, they lose control over their eating and overeat. Frequently restraint is associated with higher rather than lower body weight levels for this reason.
Recently, there has been a distinction made between rigid and flexible restraint. You can think of rigid restraint as the absolutist type of black/white, good/bad food mentality that so many have. Clean eating is a perfect example and orthorexia is the eating disorder extreme of this. It’s a pathological obsession with the relative healthiness/goodness of foods that, confusingly leads many people to make less healthy choices. In contrast, flexible restraint is where there is attention to overall food intake but with the acknowledgement that food is not an absolutist issue.
Not much research has been done on rigid and dietary restraint per se at this point but study after study after study links a shift from rigid to flexible dieting attitudes as being a HUGE predictor of success. This isn’t even up to debate at this point even as the online orthorexics continue to argue against it and defend their subclinical eating disorder (note that I am NOT considering flexible dieting attitudes with IIFYM or any specific flexible dietary STRATEGY per se).
Food Attitudes and Diet Failure
I wasn’t sure what to call this section but had to get my SEO right since this kind of overlaps with the last section. But here I’m focusing less on restraint per se and more about people’s attitudes towards eating. Because keeping with the idea of rigid restraint, some people actually think of what they eat on a diet as being fundamentally different than what they eat normally. There are their diet foods and there are their regular foods and the number of problems this causes is enormous.
First, and this is really a Kindergarten concept, many people don’t think of dieting/weight loss as a long-term process. The thought seems to be that they can diet, lose weight, return to their old habits and it will magically stays off. This is like thinking you can exercise for 6 weeks and then stop and stay fit. Weight loss is, rather depressingly, a lifetime process. Food and activity patterns have to be changed and, most importantly, stay changed to at least one degree in the long-term. That’s the reality and one of the expectations that has to be in place.
Second, and I vaguely recall that this has been studied but can’t be bothered to look right now, many people automatically think of “diet foods” as tasting worse. It’s a purely psychological thing but you can’t ignore that. People expect a diet to be a bland, tasteless, cardboard set of foods. And this was arguably true in the older days when so-called diet foods were crap. But at this point in the game, when you can get high-protein foods and food bars that taste like candy, and where even pre-packaged microwave meals are often not only healthy but delicious, this is idiotic.
I’m not saying that diets should be based entirely around those foods but if someone can’t figure out how to make “diet” foods (and this is where people online get utterly pedantic and that you should think of it as a lifestyle rather than a diet, which is fine) taste good in 2016, you’re not trying hard enough. But parsing the foods “on a diet” as different than what you intend to eat in the long-term is going to cause diet failure.
F’ing Stupid Diets and Diet Failure
Make no mistake, I’m not ever going to claim that weight and fat loss is an easy process (despite having been accused of such since I sell books on the topic). I’m never going to claim that a majority of people succeed because it’s not true.
However, on top of everything else, on top of every pathological and asinine attitude people bring into the weight loss process that contributes to diet failure, on top of all the bullshit media programming telling people either not to bother or that they will fail, I think that a huge part of diet failure is due to the fact that most approaches to weight and fat loss completely and utterly suck.
If you get bored, get online and look at generic weight loss sites. Or for even more amusement, check out the junk magazines for weight loss advice. In the US, we have Women’s World and I can’t ever not look at it while I’m waiting in line to see the magic “How You Can Lose 12 lbs in 7 Days” weight loss articles. I can’t help myself because it both amuses and aggravates the absolute piss out of me (and we all know I like being angry).
The kind of moronic stuff that is in there is just incredible. How eating some vegetable can change your life, ramp up your thyroid, burn off 17 lbs in 10 days. Broth, cabbage soup, the idiocy is stunning. God, just watch Dr. Oz. Look at any of it and easily 99% of what’s written about how to lose weight and keep it off is just such absolute bollocks (this isn’t a cuss word in the US). When they think this is how you lose weight, how can people not realistically fail? Hell, even outside of all of the above, who can do the cabbage soup diet or whatever nonsense long-term in the first place?
Now, we can quibble about an optimal diet, high-carb, high-fat, whatever although the big reviews show that, in the long-term, any difference in total weight loss is negligible (like 1 kg/2 lbs) and mostly irrelevant. The best diet, as I’ve said for years is the one you can stick to but most diets can’t be stuck to because they are just so stupid.
But there are a lot of good indications on better approaches to diet set up and, in my opinion, the biggest single one is a higher protein intake. Protein blunts hunger (the Protein Leverage theory shows that simply increasing protein intake often decreases food intake), keeps blood sugar stable, spares lean body mass (meaning more fat loss).
If weight is regained a higher protein intake ensures that more is gained from lean body mass instead of fat mass. The major benefit from “low-carbohydrate” diets is probably through increased protein (and why they are incapable of distinguishing low-carb from high-protein per se is still beyond me but zealots gonna zealot. If this is unclear consider that you can just as readily eat enough protein on a carb-based as l0w-carb diet and they have nothing to do with one another) as well. It’s protein, protein, protein all the way down.
In 2016, there is simply NO reason not to follow a diet that is higher in protein and current research is finally realizing that even the general public needs more protein than the old DRI. How much higher? That depends on factors such as initial body fat percentage (higher BF% needs less protein), activity levels (which increase protein intake) and there are charts with my recommendations in every one of my books. But, genuinely, if nobody gets anything else about their diet right, this should be it: eat sufficient/more lean protein.
And although I’m not getting into exercise, sufficed to say that, even if exercise doesn’t drastically improve overall weight loss, it’s critical for long-term weight maintenance. And I’d add to that that IF a single type of exercise has to be done on a diet, it should be proper weight training. It’s not usually the case that only one type is done but that should be the one if a choice has to be made.
The Causes of Diet Failure
And I think that’s a sufficient amount on this topic. yeah, I could add endless other stuff, mainly having to do with various strategies such as regular tracking/self-weighing and many others but that’s just basic stuff. The above is some stuff that I think often is unconsidered in terms of what causes diet failure. Once again, I’m not saying that the success rate will or will not be improved by changing those or getting people to take a different approach to the process.
But it sure as hell can’t hurt.