The Fat Trap: My Response

Once a month, in a small room off the lobby of Lake West Hospital in Willoughby, a special group convenes. For someone observing the group and unaware of its purpose, it might appear to be a simple mix of everyday people….young, old, racially diverse. The members would seem to be old friends but with a particular seriousness of purpose, perhaps a community group attending a lecture or learning some new skill together. What a casual observer would not guess is that each of these people was once obese, some having weighed over 100 pounds more than they do today. 

Our Refuse to Regain group is an experiment, a safe haven for maintainers who have lost weight in many different ways and now face the reality of reconstructing their lives. We’ve had people from Weight Watchers, people who’ve undergone bariatric surgery, people I’ve treated in my practice and others who simply did it on their own. A weight loss diet is no different than emptying the trash. It doesn’t matter which technique you use to toss out the garbage. But learning how to avoid the reaccumulation of unwanted junk is a completely different skill. There are many basics in this process that will be the same for everyone. There are also many specifics that will vary from person to person and which must be individually discovered.

Here’s some of what we’ve learned so far:

1. Weight maintenance is possible. There is nothing in our group experience (or in my personal clinical experience) to suggest that the body “forces” one to regain.
2. Weight maintenance requires a separation from the world of “normal” American eating…which is not normal at all.
3. Some people are heavy simply because they are susceptible to the modern diet, no more no less. Others are heavy because they use food for soothing or sedation. Most people are a mix of both.  If psychological issues are a major part of weight gain—significantly beyond the common enjoyment of food for pleasure, they need to be addressed during the maintenance phase.
4. Weight maintainers are special people who live on a kind of food island. It’s really nice to know that the island is inhabited, often with fascinating, determined people just like you. Rarely do maintainers get to meet and talk with one another.

This week, I gave my group a reading assignment. That was a first. I asked everyone to read Tara Parker Pope’s article on weight maintenance called The Fat Trap. This article is currently online and will appear in Sunday’s New York Times Magazine. Our group will be discussing it at our January meeting, but I’ll give you a preview of my reaction here. Many of you may be reading our blog because you read The Fat Trap and discovered Lynn Haraldson, my blogging partner on this site. The fact that you got here likely means that you are interested in knowing whether we are bound to regain the weight we lose, so please, read on…leave comments and join the discussion.

For those of you who are new to this blog, you should know that I am a physician who has specialized in weight management since the late 1980s. This is the only thing I do and that’s unusual. Why? Because most doctors are not particularly interested in obesity, and certainly weren’t back in the 80s. Over the past twenty years, a continuing source of frustration for me has been the willingness of doctors and the general public to accept “truths” about weight loss that are the beliefs of everyone except those who actually work with overweight people.  

Scientific research needs to square with what we see in clinical practice. If it doesn’t, we should question its validity. “The Fat Trap” is an article that starts with a single, small research study and builds around it. Its point? That there are inevitable biological imperatives that cause people to regain all the weight they lose.

I don’t buy it.

Here is the opening paragraph of Ms. Parker Pope’s article:

For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again.

At one time, this was my experience too. But things have changed. After years of focusing my practice much more on weight maintenance, writing a book about it, and trying to figure out how to teach and encourage it, I no longer see patients with an “entire effort come undone”.  Instead, I see more and more people learning how to become successfully anchored at their new weight. And these POWs (previous overweight people) are not from my practice alone. They are people like Lynn Haraldson and her friends “The Maintaining Divas”. They are the long-term POWs who write to me via this blog, on Facebook and on Twitter. They are the people I hear about with increasing frequency every day. 

I admire Ms. Parker Pope for acknowledging her own struggles with weight, but as someone who has not yet solved the maintenance problem I would submit that she is not the best person to rationally evaluate evidence that says that regain is inevitable. After talking to a number of scientists who believe that the body fights weight loss, her concluding paragraph says:

For me, understanding the science of weight loss has helped make sense of my own struggles to lose weight, as well as my mother’s endless cycle of dieting, weight gain and despair. I wish she were still here so I could persuade her to finally forgive herself for her dieting failures. While I do, ultimately, blame myself for allowing my weight to get out of control, it has been somewhat liberating to learn that there are factors other than my character at work when it comes to gaining and losing weight.

Those of us who come from families that struggle with obesity can believe one of two things. We can believe that biological and metabolic factors doom us to fatness or we can believe that we come from families who are very sensitive to the current food environment and perhaps need to live in a new and more creative way. It has been my experience that all successful maintainers have learned how to live a life that exists outside the current food norms. For some, this is a daily and difficult challenge and for others it becomes a simple and treasured way of life, but either way, it is not about some inevitable biological destiny. Rather, these maintainers have come to terms with the fact that they are ancient bodies and souls living in a modern environment and that our food culture is capable of killing them. Controlling that environment is their choice and their challenge. 

Where I do agree with “The Fat Trap” is in its assertion that obesity is much more difficult to deal with once it is established. We would do well to focus intense and constant attention on healthful nutrition during pregnancy and in childhood. I believe that we can do this much more easily than we believe, if we would only adopt the idea that we should eat more like we did originally as hunter-gatherers. It has been my clinical experience that elimination (or major curtailment) of starches and sugars (including whole grains and the things that come from them, by the way) simply works. And this clinical observation makes sense, since the ancestors whose genes we carry were not exposed to the large amounts of starch and sugar we now eat. Along with consumption of real food…not things in boxes, cans, or packages.... this easy concept can change lives. We could make things so much easier by teaching this lesson to kids rather than endlessly focusing them on percents of fat, protein and carbs and on counting calories.

But such approaches to weight maintenance are not easily sold. It’s far simpler to believe that weight must be regained. I’m fond of using this example for patients: If you were to tell your friends that you are becoming vegetarian and that you will no longer touch a drop of red meat, fish, or poultry, no one would blink an eye. You’d probably be encouraged and congratulated. If, on the other hand, you announced that you were giving up sugar and grain, the same friends would be horrified. “You mean you’re never going to have another piece of bread???”

I believe that the resistance to finding the maintenance solution comes from the addictive nature of starch and sugar foods. I also believe that most of America and other SAD (standard American diet) countries are operating “under the influence” of addictive carbs. Life without them, or even with LESS of them, is too awful to contemplate. 

But I digress. To return to my original point, I want to forcefully say that we must stop finding reasons we can’t maintain and start getting much, much better at teaching people how to do it. Support networks, communication between maintainers, and many more books, advocates, and techniques that focus on maintenance are key.

I believe I may scream if I see yet another book with a catchy title that touts yet another weight loss approach without ever talking about what happens in the after-diet world.  January is the month for those glossy little productions. 

Time to get serious. Maintenance can be done, and if you want to meet the people who are doing it, hang around this blog. 

Dr. Barbara Berkeley blogs at www.refusetoregain.com. You can also see her videos on weight loss on YouTube.