Hucksterism, Nihilism, and Reality in Obesity

The time is coming near. As this year draws to a close and the next year opens, people are lining up to sell you inspiring stories of weight loss. These stories are all about people who have changed their lives in dramatic ways. Sometimes they’re selling a product or a program. Sometimes it’s a book. Or it might just be journalists trying to attract clicks and readers for their publications. The inspiration is great. But how well does it line up with reality?

Sustainable Self-Cures Are Rare

Right now, health reporters are offering up the inspiring story of Lexi and Danny Reid. This couple from Indiana has lost 400 pounds over a period of two years. They’ve worked hard at it. And through all this hard work, they’ve supported each other. It’s a beautiful story of incredible discipline and an amazing outcome.

It also illustrates something that’s very rare.

In the recent ACTION study (based on self-reports), only one in ten people with obesity were able to reduce their weight by ten percent and maintain it for a year or more. Remember, this is self-reported. So the weight loss is likely inflated. Call it an optimism bias.

More objective data comes from one of the world’s largest patient record databases in the UK. The study analyzed records from more than 175,000 men and women with obesity. The researchers found that very few people go from obesity to a conventionally healthy weight. For men with severe obesity, the odds were 1 in 1,290. For women, they were 1 in 677. With mild obesity, they were 1 in 210 for men and 1 in 124 for women. For a 5% weight reduction in people with severe obesity, the odds were 1 in 8 for men and 1 in 7 for women.

Hucksterism Promoting Miracles

When Weight Watchers or Nutrisystem shares big success stories, they are required by law to tell people “these results are not typical.” Journalists are not so tethered to that harsh reality. Everybody wants to believe that they’ll beat the odds, so it’s great click bait.

And then of course, you have dietary supplement makers eagar to sell weight loss miracles. The pitch comes alongside a disclaimer that none of this has been reviewed by the FDA. “Not intended to treat, cure, or prevent any disease.”

It’s pure hucksterism.

Nihilism Is Not the Answer

The alternative to hucksterism should not be nihilism. Some people would say that any attention to weight is futile. Whatever a person’s size, health should certainly come first. And in putting health first, ignoring the accumulation of adipose tissue around vital organs is irresponsible. It sets off a cascade of inflammation that leads to liver damage, diabetes, heart disease, and cancer. Weight is not the problem. But it’s a signal of the real problem, which is unhealthy adipose tissue.

Obesity a chronic disease, not a choice. And while it’s not readily cured, it can be managed to help a person achieve better health.

The Reality of Obesity Care

The reality of obesity care is not about miracle cures. It’s about skilled professionals providing evidence-based care. Intensive nutrition and lifestyle programs can reliably deliver a five to ten percent reduction in body weight. Anti-obesity meds can add another five to ten percent on top of that. And for people who need it and choose it, bariatric surgery can yield bigger results – perhaps a 25% reduction in weight.

Even with help, it’s not easy to maintain. But it’s doable. Reality beats hucksterism and nihilism every day.

For more information on dealing with obesity, start with the Obesity Action Coalition. Click here for the ACTION study, here for the UK study of patient records. Last, but not least, we gratefully acknowledge the insights of Andrew Brown, Diana Thomas, and David Allison in sorting through this morass of wishful thinking.

Vendor of Song Books, painting by Vasily Perov / WikiArt

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December 15, 2017