Weight loss interventions: Do they work?

It sounds simple enough to lose weight: consume fewer calories than you burn. Eat less and exercise more.

This does work short term, but not for long. The body powerfully defends its fat, even at the expense of lean muscle and vital organs.(1)

Body regulation is a complex and finely-tuned process, and the many mechanisms standing ready to restore the body’s usual weight and replenish depleted fat cells soon take over their task.(2)

Weight loss interventions are not without risk of lasting injury and even death.(3) 
Furthermore, the evidence is lacking that health is improved through weight loss; studies tend to show higher mortality.(4,5)
Research also finds weight loss can backfire. Individuals who lose weight tend to weigh more than others, even when they initially weighed the same.(6)

Despite at least four decades of intensive research on weight loss interventions, replete with promises and proofs, obesity specialists are still unable to show lasting success for any weight loss method, whether diet, drugs or surgery.

Therefore, it seems, all these methods must be considered experimental. None are proven safe and effective.(7)

A. Dieting  

Dieting and restricting food causes short-term weight loss rarely lasting more than six months before it plateaus, followed by inexorable regain. Whether the diet is high or low protein, high or low fat, high or low carbohydrate, very-low-calorie liquid diets (800 or less), moderately low calorie, behavior modification, or one of dozens of fad diets – rice, fruit, steak and grapefruit – makes no difference at all.(8,9,10)

All weight loss methods must be considered experimental – none are proven safe and effective.	Diets don't work, except rarely – the dismal figure of only three to five percent success has been advanced and never seriously contested. Success is rare enough that it would be considered coincidental in treatment for any other condition.(11,12) What dieting does do, all too often, is cause nutrient deficiencies, impaired immune system, food preoccupation, bingeing, chronic dieting, dysfunctional eating and eating disorder risk. Because of the body’s defensive shut-down with abrupt calorie restriction, all
aspects of one’s personhood (intellectual, emotional, social, spiritual and physical) are slowed down in direct relation to calorie restriction.(13,14)

Almost by definition, dieting also causes weight cycling (yo-yoing), a well-known mortality risk.(15)

B. Prescription drugs

Drugs offer minimal weight loss, 5 to 11 pounds at best, inevitably regained when the medication is stopped, so they must be taken long term, which entails higher risk.

During the fen-phen/Redux fiasco which ended abruptly Sept 15, 1997, when the drugs were pulled off the market, the FDA warned that of 6 million U.S. adults treated, one-third likely developed leaky heart valves. Some died of it. Others died of primary pulmonary hypertension. Dexfenfluramine, the most popular of the combination drugs, had only been approved in April 1996, against the “no” vote of FDA’s advisory board. Two of its terrible effects already were well-known by then: brain damage and primary pulmonary hypertension, a highly fatal lung disease.(16) The two drugs currently approved are sibutramine and the fat blocker orlistat (sold over the counter as Alli). The first tends to increase blood pressure and speed up heart rate, and the second frequently causes “fecal urgency” and diarrhea. Neither can show more than minimal weight loss (7 to 11 pounds or less), and the weight comes right back on as soon as the drugs are stopped. Since weight loss is so unimpressive with sibutramine and orlistat, a diet will		An Ill-fated New Year’s Resolution “Given the enormous social pressure to lose weight, one might suppose there is clear and overwhelming evidence of the risks of obesity and the benefits of weight loss. "Unfortunately, the data linking overweight and death, as well as the data showing the beneficial effects of weight loss, are limited, fragmentary, and often ambiguous. Most of the evidence is either indirect or derived from observational epidemiologic studies, many of which have serious methodologic flaws. … “Until we have better data about the risks of being overweight and the benefits and risks of trying to lose weight, we should remember that the cure for obesity may be worse than the condition.” “Since many people cannot lose much weight no matter how hard they try, and promptly regain whatever they do lose, the vast amounts of money spent on diet clubs, special foods, and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted.” – Marcia Angell, MD, and Jerome P. Kassirer, MD, Editors of the New England Journal of Medicine, Editorial, Jan 1, 1998 (29)
	usually be prescribed along with the pills. Typical dieting results then occur as above – impressive weight loss followed by regain and perhaps ratcheting up the weight. Patients often blame themselves because, after all, the combination treatment “did work,” at least for a few months, though destined to failure.

Drugs offer minimal weight loss, regained when stopped, so drug must be taken long term, at higher risk.

Over-the-counter, non-prescription drugs can be dangerous, too, more so when taken in large quantity and long-term, as is often the case for teen girls.(17) Quackery and fraud flourish in the diet pill market, as well. Sold as food supplements, thus evading need for FDA approval, are many herbal and “natural” products touted to take off the pounds quickly and lastingly. Healthy Weight Network spotlights the worst of these each year with the Slim Chance Awards.

C. Gastric surgery
Weight loss surgery can work, but cannot be considered safe. This is an elective surgery that can turn deadly or leave previously-healthy patients incapacitated for life.(18)

Bariatric surgery carries a higher mortality risk than often claimed, especially for older patients, according to a study that analyzed risks for 16,155 Medicare patients who underwent this surgery between 1997 and 2002.

While many surgeons count only deaths on the operating table, or within a few days, and report a death rate of under 1 percent, this study found mortality risk of nearly 5 percent within the first year. Older patients had higher risk – nearly half of patients age 75 and over died within the year.(19)

A recent study in Pennsylvania found a high suicide rate as well as similarly higher death rates for older patients.(20)

In addition, morbidity risk includes severe infection, leaks, blood clots, malnutrition, brain disorder, memory loss and confusion, inability to coordinate movement, vision impairment and a long list of other complications, along with repeated hospitalizations.