study: obese people lose more than 50 lbs for more than 5 years
A descriptive study of individuals successful at long-term maintenance of substantial weight loss Mary L Kiem, et al. - Am J Clin Nutr 66 (2): 239. (1997) [PubMed ID 9250100]
Abstract: The National Weight Control Registry (NWCR) is, to the best of our knowledge, the largest study of individuals successful at long-term maintenance of weight loss. Despite extensive histories of overweight, the 629 women and 155 men in the registry lost an average of 30 kg and maintained a required minimum weight loss of 13.6 kg for 5 y. A little over one-half of the sample lost weight through formal programs; the remainder lost weight on their own. Both groups reported having used both diet and exercise to lose weight and nearly 77% of the sample reported that a triggering event had preceded their successful weight loss. Mean (+/-SD) current consumption reported by registry members was 5778 +/- 2200 kJ/d, with 24 +/- 9% of energy from fat, Members also appear to be highly active: they reported expending approximately 11830 kJ/wk through physical activity. Surprisingly, 42% of the sample reported that maintaining their weight loss was less difficult than losing weight. Nearly all registry members indicated that weight loss led to improvements in their level of energy, physical mobility, general mood, self-confidence, and physical health. In summary, the NWCR identified a large sample of individuals who were highly successful at maintaining weight loss. Future prospective studies will determine variables that predict continued maintenance of weight loss.
This paper describes men and women with an average max lifetime weight prior to the study of 121 kg (266 lbs) and 95 kg (209 lbs), respectively. These correspond to BMIs of 37.2 +/- 8.5 and 34.6 +/- 6.8, which means that significant numbers of participants in the study were genuinely morbidly obese according to World Health Organization (WHO) guidelines published in 2000:
- A BMI of 40.0 or higher is severely (or morbidly) obese
- A BMI of 35.0 or higher in the presence of at least one other significant comorbidity is also classified by some bodies as morbid obesity. [Source: WHO TRS 894 (PDF)]
After weight loss, the average weight for men and women was 86 kg (190 lbs) and 66 kg (146 lbs), respectively. Weight loss strategies including eating selectively (92%), eating less (49%), eating less fatty foods specifically (38%), counting calories (35.5%), and counting grams of fat (30%). The average duration of weight loss was 5.6 +/- 6.8 years.
The paper also takes great pains to describe input and output in terms of energy, expressed as kJ/day. The thermodynamic analysis demonstrates that the common framework of energy analysis suffices to describe reduced energy in (eating behavior) as well as increased energy out (excercise and activity). It is clear from the data that thermodynamics is indeed teh single most important factor at work in the weight loss.
The massive sample size (> 700 people!) also shows that genetic effects, metabolic variation, etc are not dominant factors, since the variability of these factors across such a huge sample size would presumably be maximized, yet traditional weight loss strategies still resulted in success.
Finally, the paper sounds several cautionary notes in the discussion section, which I will not spoil here. Due diligence for future discussions on the topic of obesity includes reading this paper in full. I have uploaded this paper and it may be downloaded for your review by clicking the icon below.
NOTE: the previous assertion, was that
“No study has ever shown that human beings can drop more than 5-40 pounds or so of excess weight through diet and exercise alone. Not long-term anyway.”
I think that the study linked above provides a compelling counterargument. If you disagree, you will need to not just quibble with minor differences and qualifiers to the assertion above, nor try to argue about what the study in question does not say. You must address what the study above does say.
Subscribe to Dean's World by Email
32 comments
I’ve had this study thrown at me on more than one occasion. As I’ve noted on all such occasions, doing a study on the rare (less than 1%) of the obese population who become nonobese through diet and exercise is approximately as useful as studying the rare cases of lethal cancers which go into remission on their own. It may be interesting, and it may point to useful strategies for addressing the disease, but that’s all.
Indeed, I find it telling that whenever I issue a challenge to identify a program that boasts better than a 1% success rate, this is *always* the study that gets thrown at me, even though it pretty clearly is only marginal. With all the weight loss programs out there, and all the studies that have been done, you’d think we could do better than this if there was any program out there that could boast a better than 1% success rate over 5 years.
Still, let’s continue to analyze this non-representative sample of the obese population. Even here, we see support for what other studies of the obese population show. For example, most subjects experienced some weight rebound, some of it quite significant (losing about 30 kilograms but maintaining only about 15 of it long term). Also, many subjects didn’t do much formal at all, which is consistent with multiple studies which have shown that some individuals only become obese due to some major change in life activity patterns, often brought on by stress, and that when their lives allow them to return to their normal patterns they tend to lose the excess weight they put on without needing a lot of help. Indeed, numerous studies have shown that people who pound up due to stress will tend to do better if they *don’t* do anything special but try to resume their pre-overweight activity patterns with maybe a little extra diligence.
So far, I’m not seeing where this study is in conflict with anything I’ve written on this matter recently, or in the last 10+ years for that matter. Indeed, it seems to align perfectly with everything I’ve stated.
Dean, i love you, but you are wrong. this study refuted your assertion as stated above. do you want to restate your assertion?
It seems to me that you are defining the issue so narrowly that it is you, not this study (with impeccable methodology, gargantuan sample size, and plenty of supporting followup research) who is arguing the marginal case.
I quoted your core assertion on obesity verbatim at the end of this post and the study clearly refutes it. again, do you want to restate that assertion?
perhaps you think i am idiot who simply does not understand what you are saying. ok, fair enough. i certainly am not immune to idiocy. Explain it to me again, then, but do not handwave about why this study doesnt count. it does. if i am not getting your point, then you are partially at fault for not making your case. heres your chance, this is where i am coming from, so the ball is in your court.
Aziz Poonawalla’s last blog post..the Qur’an shooter
As I’ve noted on all such occasions, doing a study on the rare (less than 1%) of the obese population who become nonobese through diet and exercise is approximately as useful as …
the study sample size definitively demonstrates that the results and findings of this study are not "rare" or "marginal". I hate to invoke my own authority, but i do have a degree or two in science which tells me im on solid ground here with respect to interpretation of statistics. I am sure others of similar scientific qualification will agree.
Aziz Poonawalla’s last blog post..the Qur’an shooter
Even here, we see support for what other studies of the o
obese population show. For example, most subjects experienced some weight rebound
yes, correct, and the issue of some rebound is not at dispute. however yourcore assertion is that >5 ys maintenance of >50lbs loss is not possible, and the study shows conclusively and convincingly that such loss maintenance is indeed achievable, and not in rare/marginal cases only (sample size!).
Aziz Poonawalla’s last blog post..the Qur’an shooter
some individuals only become obese due to some major change in life activity patterns, often brought on by stress, and that when their lives allow them to return to their normal patterns they tend to lose the excess weight they put on without needing a lot of help. Indeed, numerous studies have shown that people who pound up due to stress will tend to do better if they *don’t* do anything special but try to resume their pre-overweight activity patterns with maybe a little extra diligence.
fine. but the issue is not temp weight gainers who became obese as adults due to stress, we are talking morbidly obese people whove had issues since childhood.
Aziz Poonawalla’s last blog post..the Qur’an shooter
Ok, I didn’t read it, but can you just briefly tell me three things (so that I can tell whether reading it is worthwhile):
(1) How were the participants in the study chosen?
(2) At what confidence level are the results presented?
(3) Did anyone else do a study to help show that these results weren’t by pure chance?
(Remember that if every paper is at the 95% confidence level, then 5% of papers should have gotten their results by pure chance. (that’s not a super-precise statement of the situation, I’m merely alluding to the real situation.)
ctl, i am not your mom. read the paper or dont, you decide. if you dont, then you have nothing of value to add to this discussion.
Remember that if every paper is at the 95% confidence level, then 5% of papers should have gotten their results by pure chance.
what total bollocks and nonsensical pseudojabber. Read this, and understand it, before trying to discuss statistics in public again, please.
Aziz Poonawalla’s last blog post..the Qur’an shooter
OK, let’s look at the statement you quoted:
“No study has ever shown that human beings can drop more than 5-40 pounds or so of excess weight through diet and exercise alone. Not long-term anyway.”
You’re right. The phrasing in that paragraph is too loose. I think it’s not being taken in fair context, however. I have repeatedly written that we know this approach works for a tiny minority, and that these folks are not representative. For example, in my latest post, I wrote:
No study has ever shown that human beings can drop more than 5-40 pounds or so of excess weight through diet and exercise alone. Not long-term anyway. Those who can do so are so rare they barely qualify as statistical anomalies.
I said that right here, and that’s consistent with everything I’ve said so far that I can recall.
You’ve given us a study on the non-representative marginal cases. And even still, in those cases, the study pretty unambiguously shows that substantial weight rebound is still typical, and, that many of these non-representative individuals report not doing much formal to lose the weight.
It would be very easy to do what I and others have asked for. Simply take a representative weight loss program–there are tons of them, starting with the likes of Jenny Craig and Weight Watchers, but also countless programs being offered by doctors, clinics, and local gyms. Show us the tracking studies on the folks on these programs. Include the dropouts as best you can (at least show the dropout rate), and, those who stuck with the program.
I can already tell you what you’ll find in those cases if the studies have been done at all: most obese subjects don’t become nonobese, even if they stick with the program. They just don’t. This is why, amongst other things, if you look very closely at the ads for gym programs and/or diet programs, they always flash a "results not typical" message while showing you pictures of very fat people who’ve become non-fat on their program.
My hypothesis (and it’s not really mine, there are plenty of others who share it) is that the average human body is simply not equipped to deal with morbid obesity, and cannot handle dropping more than a certain amount of weight without a pathological response. We pound up much easier than we pound down, because our systems are better equipped for one than the other, and our bodies will actively fight against efforts to drop more than a certain amount of weight.
What the overwhelming majority of obese people can hope for from diet and exercise is improved weight and improved health, but if their goal is more than that they are likely to be disappointed and may even damage their health or make themselves worse. I think it’s very important, therefore, that they have a realistic, fact-based look at what’s possible and what’s not.
You’ve given us a study on the non-representative marginal cases.
No, I have certainly NOT. I have given you a study that gives a VERY representative, mainstream result. The reason is because of the sample size, and the methodology.
You have no basis to assert that this study is marginal, except for the results. If you can justify that assertion then do so.
Aziz Poonawalla’s last blog post..the Qur’an shooter
"The National Weight Control Registry (NWCR) is, to the best of our knowledge, the largest study of individuals successful at long-term maintenance of weight loss. Despite extensive histories of overweight, the 629 women and 155 men in the registry lost an average of 30 kg and maintained a required minimum weight loss of 13.6 kg for 5 y."
Those who do not succeed are not tracked or even examined. And even among those who were tracked, if they regained more than half the weight they were still included.
What am I getting wrong?
Dean,
This study proves our point exactly. IF and WHEN people stick to a reasonable diet based on thermodynamic reality (calories in, calories out) they will keep the weight off.
There’s never been any question that the diet industry is, on the whole, full of bullshit that leads people nowhere. Only a very small percentage of people diet the way they are supposed to (moderately, long-term, getting proper nutrients and with carefully monitored caloric restriction).
Obviously, there is some sort of psychological barrier to obese people sticking with diets. Partially it is not their fault, because there are so many snake-oil salesmen out there masquerading as "dieticians" or "personal trainers" that tell them what they want to hear, not the truth.
But partially it is their fault. If you have eaten like a hog for the better part of your life, it can be hard to change. But we should be looking for ways to help the obese stick to their diets, not give them excuses to stay fat.
If I give you a study with a massive sample of, say, 1,000 people who go into remission from cancer despite refusing chemotherapy or radiation–and such people certainly do exist–what do you think it would prove about cancer treatment?
Edgar: Most of what you’re saying is not in contention, and is irrelevant to anything I’ve said.
Dean:... remission from cancer… chemotherapy… radiation… cancer treatment
Most of what you’re saying is not in contention, and is irrelevant to anything I’ve said.
It is relevant. If I select a sample of people who go into spontaneous remission despite refusing traditional therapy, I would be irresponsible to assert that this means most people can cure their cancer by avoiding chemo and radiation.
I have made it clear multiple times what a responsible study would be. Simply take a proposed weight loss program, and show us the results, including both those who drop out and those who stick with it. The result, so far as I’ve seen, is ever the same: even just looking at those who don’t drop out and who do stick with the program, most will remain overweight.
Even this study Aziz has given us includes people who regained more than 25 pounds, and are thus still overweight at the end of five years.
It is quite true that there are a lot of bullshit programs out there that overpromise and underdeliver. But even the responsible programs which include everything the experts say you need–permanent lifestyle change including regular exercise and permanent dietary change–still don’t result in more than moderate weight loss and maintenance.
Look, I don’t know how many times I have to repeat it: show me the study of the program (any program) which consistently delivers a result of going from obese to non-obese and staying there long-term, even for those who stick with the program.
You haven’t produced this, and I assert that you haven’t because any study done on the matter has shown the same thing: most fat people will still be fat even if they stick with the program long-term.
I think it’s important that we not lie to fat people and promise them things we can’t deliver. It’s more likely they’ll give up in despair and self-loathing if we do, and probably make themselves sicker. They need to have a realistic assessment of what’s really possible–and we need further research to stretch the bounds of what’s possible.
Dean: You haven’t produced this
Dean, you are simply going to argue that any study we present represents the "outliers."
I don’t mean to be a stickler, but the very least you could have done Aziz is give credit to who actually found and presented this article first. I’m sure you found this article in my post from yesterday in the ‘obeseity’ thread. I provided both the citation, a summary of the work, and a link to the free access .pdf.
That’s somewhat besides the point though, and I’m happy we have a few more people seeing the light that obeseity is not a disease in the same context that cancer is a disease.
Dean, this study provides ~700 independent trials demonstrating that obese people can lose weight and keep it off for over 5 years through diet and exercise. Again, if you’re going to keep lying to yourself that these people only represent the 0.1%, then I think the onus is on YOU now to prove that they are that part of the population. We have done our work, time for you to do some of yours.
And no.. Fruit Flies are not good approximations to how human physiology is or functions. At the very least find an article using mammals.
I’ve had about enough of this tail-chasing exercise. As I’ve noted before, I’m familiar with this study and have addressed it many times, just as I have here. It’s nice to have a copy of a study I’ve already addressed, and I’m grateful, but so what?
The study in question clearly excludes any and all failures. Furthermore, it defines "success" in such a way that even individuals who regain more than 25 pounds (13.6 kilograms is 29.9 pounds) are included.
So you’ve selected out anyone who regains 30 pounds or more, and, you’ve defined "success" to include people who are still fat.
All in a study which clearly shows that some people who do lose the weight have done so without much of any formal program.
None of this is what I asked for. But it supports pretty much every damned thing I’ve said anyway.
I am inclined to agree with Dean on this study.
In the ”Subjects and Methods” section (p. 239), the study states:
Subjects were 629 women and 155 men currently enrolled in the NWCR. To be eligible for enrollment, an individual must be aged ≥ 18 y, have lost ≥ 13.6 kg (30 lb), and maintained the weight loss for ≥ 1 y.
In the ”Methods used to lose weight” section (p. 242), the study states:
Nearly 77% of the registry reported that there was a triggering event or incident that preceded their successful weight loss (Table 3) and women and men were equally likely to report occurrence of such an event…
In the “Discussion” section (p. 246), the study states:
Although the actual prevalence rate of successful weight loss and maintenance remains unclear, our data clear showed that some individuals are highly successful at losing weight and keeping it off. Future studies will seek to determine the actual prevalence of successful weight loss in the general population and to examine environmental and individual variables that influence continued maintenance of weight.
So only individuals who had already shown successful weight loss and maintenance for a period of at least one year were studied. Additionally, most of the people involved (77%) were “triggered” into losing the weight. Finally, this study acknowledges that it may not even be relevant to the general population.
I wouldn’t call this the best example of successful weight loss and long-term maintenance.
If I select a sample of people who go into spontaneous remission despite refusing traditional therapy, I would be irresponsible to assert that this means most people can cure their cancer by avoiding chemo and radiation.
You are absolutely right. However, the selection criteria for this study only required maintenance of weight loss of 30lb for one year. Thats hardly a rarefied sampling criterion, and in no way analogous to the extreme cancer case you invoke.
Aziz Poonawalla’s last blog post..the Qur’an shooter
[…] But there are not just problems with how a study is conducted. There are also problems with how a study is interpreted. One of the common errors in interpreting studies is to mistake who the population being studied is. This has the same effect (for the person trying to interpret the study) as sampling bias in the study itself, and we just saw a pretty spectacular example of it. […]
Aziz
Why did you decide to start a new thread? What was wrong with the other one?
Edgar, Aziz, John D
Please address what Texas, Dean, Elizabeth & others have stated several times in this and the other thread: the registry specifically excludes people who lost little or gained weight. It is a very skewed population, and the intent of the Klem paper is to learn how they did it - not to generalize the way you are doing.
There is a lot of talking past one another that is really annoying.
Aziz, do you really not get that these eight hundred people are a sample of people who have lost weight, not people who *need* to lose weight?
800 people would be a huge number if we started with a sample of randomly selected obese individuals from the population and showed that our intervention was able to get them all to become non-obese. That’s not what this paper is about. It’s about studying 800 of those rare individuals who have managed to lose weight, identified AFTER they have lost the weight.
As I said in an earlier thread, there are a substantial number of people who can run a mile in under five minutes. There is a huge difference between taking 200 ordinary people and showing you can modify them so they can run a mile in under five minutes, and taking 200 people who *can* run a mile in five minutes and deciding that means that such individuals are not rare and therefore everyone should be able to do it.
JohnDakota,
So I take it your search for a study in which obese people are subjected to any behavioral intervention and achieve and maintain substantial weight loss is coming up empty?
It’s almost as though behavioral interventions don’t work. Weird.
I’m not doing any more work on this until the naysayers PROVE that the vast majority of obese people fall into a group who can’t lose weight. The crux of their argument, which has been from the start, is that anyone who loses weight is this 0.1% of the population. At this point I’m giving up on trying to provide a landslide of evidence because even the biggest landslide (i’d say 700 people is pretty big) isn’t going to do anything.
I have yet to see a SINGLE CITED REFERENCE FROM THE NAYSAYERS SUPPORTING THAT THE VAST MAJORITY OF OBESE PEOPLE CANT LOSE WEIGHT. THIS IS THE CRUX OF YOUR ARGUMENT. THE LEAST YOU CAN DO IS BACK IT UP.
It’s very easy to sit back and keep telling you opposition that what they’re providing is not enough. Now we’re saying what you’ve provided is not enough. All I’ve read is a single news article conveying some work done on Fruit Fly fat cells. Last I checked the physiology of a fruit fly is drastically different from a human. Maybe the physiology of a fruit fly is more comparable to an obese human then? Is that what you guys are trying to say?
BTW.. Aziz, in your degree or two in science did they ever teach you about academic integrity?
I know I didn’t author the article, but I did find it and provide the first analysis of it yesterday. You ripping it off and calling it your own doesn’t make it yours.
The least you could have done is give credit to who actually found the manuscript.
John
Quit whining. Aziz isn’t calling the article his. He’s given credit to the authors. Just because you cited it first in the other thread doesn’t make it yours either.
Since you asked, check out the article you’re whining about. From the introduction:
Most patients return to their baseline within 3-5y. Hmm… I wonder why… Well so do the authors of the article. In fact they conclude thus:
The authors of the study are careful not to leap to the conclusion that you seem to be. The article isn’t supporting what you believe.
3-5 years after the program ended. Ever consider the possibility that the people just simply didnt have the willpower to maintain their changed lifestyles without the push of the program on them? That’s not a failure of the program, that’s a failure of the person. That’s totally different from claiming the majority of obese people are incapable of losing weight and keeping it off. It means the vast majority lack the willpower and the dedication needed to maintain the changed lifestyle. They are still physically capable of losing the weight and keeping it off. The ones that fail are not mentally strong enough to keep to the dedicated healthy lifestyle.
yes, John Dakota first mentioned the article. I suppose "they" didn’t teach me academic integrity, no. Guilty as charged.
I didnt start a new thread, that was ctl, and I have no intention of wading into that one because I’d rather be paid for my TA work than do it pro bono.
Elizabeth, I well understand that the people in this study met selection criteria, but these criteria are not even close to the extreme. Dean is the one who set teh standard of 50 lbs and 5 years, the criteria for this study fall well below that.
I havent seen anyone actually quote a study that supports Dean’s or Elizabeth’s assertions.
Scott, I’m with you. Part of the reason I find this study so compelling is precisely because they are very restrained in their assertions. They do, however, have results that ARE applicable to the argument, particularly the assertion by Dean that I quoted, and I do not see why the substantial data in this study should be breezily dismissed. The authors are not invalidating their study nor agreeing it is an extreme unrepresentative case, by their comments in the discussion above. A theory about Obesity needs to fit ALL the facts, and the facts clearly show that it is well within the human capability to lose more than 50 lbs and keep it off for 5 years plus, using only diet and excercize techniques. That was the original argument of impossibility made by Dean, and Elizabeth, and I think we have moved on from that ground since then.
Aziz Poonawalla’s last blog post..the Qur’an shooter
I think we need to be more clear about this.
Please show us a peer-reviewed study that proves YOUR contentions, namely:
1) the vast majority of obese people who started it couldn’t maintain the weight loss even though they stuck to the program (something with figures- caloric intake, LBM, BF %, etc.)
2) It was not a matter of willpower (i.e. it was some physiological change, like a massive metabolic slowdown, that caused them to regain the weight). Please provide figures (e.g. BMR before and after and the change).
(crickets)
Not to bring pop culture into this, but has anyone watched The Biggest Loser? It used to be on during Ramadan in Egypt (har har har), and I was constantly amazed by how much weight the VERY morbidly obese contestants were able to lose through diet and exercise alone. What interests me about this is that these contestants are selected for the emotional sellability of their stories (I was always the fat kid in school…I used to be a prize fighter but now I’m 300lbs…my father died of a heart attack at 45…) not according to some scientific guideline. So one can assume the show has a more or less random sampling of obese people. (Different ages, ethnic backgrounds, some from fat families, some from thin families, etc.) And the results were jaw-dropping. One woman went from a size 18 to a size 6. Another dude lost a full 38% of his total body weight.
Now, I will grant you that this is not a 5+ year study, but what interested me was that the majority of contestants kept losing weight after they were off the show. Which would suggest that a good exercise/eating regime that one can stick to (as opposed to a crash diet that is impossible/unhealthy to sustain longterm) does make a significant difference for a lot of people, not just in terms of health, but in terms of raw body weight.
You must log in to post a comment.