UPDATE: My thoughts on this have changed significantly since writing this piece. To find out my current thinking about weight loss, read my more recent pieces: The Fat-Positive Diet, The Fat-Positive Skeptic, and An Open Letter to the Fat-Positive Movement.
I'll say this up front: Some of this theory is based on anecdotal evidence. So I could have it wrong. If any of you know of any actual research either supporting or contradicting it, please let me know.
Let’s start with some actual facts: Weight loss very rarely works. Studies vary somewhat in their numbers, but somewhere in the range of 80 to 95 percent of all people who lose significant amounts of weight eventually gain it back. Most of the numbers I've seen are around 90 percent. Pretty much regardless of which weight loss program people are on.
Those aren't very good numbers. To put them in perspective: If you were testing a new drug or treatment for an illness, and it only worked 10% of the time, you'd give up on it unless you were desperate and had no other alternatives. To put the numbers in a different perspective: You stand about as good a chance of permanently kicking a heroin habit as you do of losing weight and keeping it off. There is clearly something going on here other than just lack of discipline or will power. There seems to be some physical process at work that makes permanent weight loss in adults very difficult and very uncommon.
So let's just get that out of the way now: It doesn't work. Or rather, it rarely works. It would be nice if it worked -- there are health problems associated with being fat, I'm not going to pretend that there aren't -- but it almost never does.
Now, here's another fact: While there are significant health differences between fat and not-fat people, those differences come close to disappearing when people eat well and get regular vigorous exercise. Sedentary thin people have much better health than sedentary fat people, to be sure... but active thin people aren't that much healthier than active fat people, and active fat people are a whole lot healthier than sedentary thin ones.
In other words: Exercising regularly and improving your diet are excellent things to do that will greatly improve your health... regardless of whether you lose weight doing them.
Which brings me to the anecdotal part:
It seems to me that our fixation on weight loss is tremendously counter-productive -- because it's so damn discouraging.
See above, re: weight loss almost never working.
My experience and observation has been that when people change their exercise and eating habits with the sole purpose of losing weight, they're a lot more likely to just give up on those changes when they either don't lose the weight or gain it back again. And when they've lost and gained the weight back several times, they get even more discouraged, and are more likely to give up.
Even if they're getting other benefits from their diet and exercise programs.
I'm not even talking about the stupid unhealthy diets people go on to lose weight. (We're back in fact-land now, btw.) I'm not talking about the people who won't quit smoking because they know it means they'll gain weight. And I'm not talking about yo-yo dieting (repeated weight loss and gain) actually being a likely cause of long-term weight gain. There are a zillion ways that our obsession with weight loss injures our health, but I'm not talking about them now. I'm just talking about this one thing: the discouraging effect that repeated failed weight-loss efforts have on people who are trying to make serious lifestyle changes.
Because there are much, much better reasons to eat right and exercise than losing weight. It improves your overall mood and stamina. It helps you sleep better. It's a natural anti-depressant. It improves your digestion. It improves your libido. It reduces your risk of heart disease and other causes of early morbidity... I could go on and on. There is pretty much no system in your body that won't be improved by a healthy diet and regular vigorous exercise.
Regardless of whether you lose weight.
Which doesn't work anyway. And which doesn't do that much to keep you healthy if you're eating right and exercising.
I'm not saying we should ignore weight entirely as a public heath concern. As Ingrid points out, the fact that permanently quitting drug addictions is difficult and rare doesn't mean we shouldn't encourage people to try. And Ingrid also reminds me of recent research showing that even a small amount of weight loss, like ten pounds, can contribute significantly to your health. So losing a small amount of weight may still be a useful goal, even if you don't lose as much as you might like to or think you ought to. (Although if memory serves, that research was done on an average population of sedentary Americans; other studies, like the ones I mentioned above, show that if you're already eating well and getting regular vigorous exercise, health differences between thin and fat people are pretty small.)
And we should definitely be paying serious attention to obesity in kids. Because the one exception to the "weight loss almost never works" rule is with kids. And fat kids who actually stand a good chance of losing weight will very likely -- if the obesity isn't addressed early -- grow up to be fat adults who are very likely going to be fat for life.
I'm just saying this:
We need a serious public health campaign -- doctors, nurses, billboards, public service announcements, dancing polar bears, the whole thing -- encouraging people to exercise regularly and eat better... regardless of whether they lose weight. We need a serious public health campaign emphazising and spelling out the specific non-weight-loss advantages -- better mood, better stamina, better sex life, better longevity, etc. -- of eating well and getting regular vigorous exercise.
Because the weight loss thing just isn't cutting it.
Appendix 1: We also need a society that makes it easier to walk instead of driving; a society where food production isn't run almost entirely by agribusiness and processed-food conglomerates; a society where people aren’t so exhausted from working two jobs that they don't have time or energy for physical activity or even cooking; a society that doesn't cut physical education in the public schools to balance the budget; etc., etc., etc. But that's a rant for another day.
Appendix 2: The anecdotal part of this piece wouldn't actually be hard to test. You take two groups. You put one group on a healthy eating and exercise plan with the stated goal of losing weight, including regular weigh-ins and counseling/ cheerleading about weight loss. You put the other group or groups on a healthy eating and exercise plan, with some different stated goal or goals -- improving stamina, sleep, mood and mental health, etc. -- and give counseling/ cheerleading/ regular check-ins about that. (You stick a control group or two in there as well.)
And after a year or two, you see which group has better maintained their improved eating and exercise habits.
If somebody does this, or knows someone who has, please let me know.