The Harm of Weight Cycling
Failing at weight loss attempts is not benign
When I talk to healthcare practitioners who are still entrenched in the weight loss paradigm about the fact that intentional weight loss fails about 95% of the time, there are some who honestly believe that intentional weight loss works, but that 95% of people are just not doing it right. Then there are those who say “Well sure it fails 95% of the time, but you just have to keep trying until you’re one of the 5%.” Setting aside the mathematical reality that this is absolutely not how statistics work, this method would only be valid if a failed attempt was, at the very least, benign.
So, for example, quitting smoking fails the majority of the time. But the person is healthier for every cigarette they didn’t smoke during that time, so even if the person resumes smoking the change in smoking habits doesn’t cause harm. Can we say the same thing for intentional weight loss? Not according to the research.
There are many ways that failing at dieting can do harm, but perhaps the most clear and direct is through weight cycling, which is what we’ll discuss today. Weight regain is the result of the vast majority of intentional weight loss attempts. By far the most common outcome of more than one attempt is weight cycling (known colloquially as as yo-yo dieting.) Weight cycling is independently associated with many harms.
In their 2011 paper Weight Science, Evaluating the Evidence for a Paradigm Shift, Bacon and Aphramor point out:
Consider weight cycling as an example. Attempts to lose weight typically result in weight cycling, and such attempts are more common among ob*se individuals. Weight cycling results in increased inflammation, which in turn is known to increase risk for many ob*sity-associated diseases. Other potential mechanisms by which weight cycling contributes to morbidity include hypertension, insulin resistance and dyslipidemia. Research also indicates that weight fluctuation is associated with poorer cardiovascular outcomes and increased mortality risk. Weight cycling can account for all of the excess mortality associated with ob*sity in both the Framingham Heart Study and the National Health and Nutrition Examination Survey (NHANES). It may be, therefore, that the association between weight and health risk can be better attributed to weight cycling than adiposity itself. [emphasis added]
Gaesser and Angadi, 2021 found:
weight cycling is associated with numerous adverse health outcomes including increased mortality
This table from O’Hara and Taylor’s 2018 paper What’s Wrong With the ‘War on Ob*sity?’ draws the problem into sharp relief:
Then there are the psychological impacts. In their 2014 paper Tylka et. al explain:
Greater emotional distress was found to be connected to weight cycling among men and women, especially those who expected to have more personal and social success when thin (e.g., “I will be more successful, loved, desired, and healthy once I am thin/lean”), a mindset that the weight-normative approach cultivates…Overall, research conducted around the world for the past 25 years has repeatedly shown that weight cycling is inextricably linked to adverse physical health and psychological well-being.
That’s an awful lot of harm for an intervention that is recommended to up to (what the CDC claims is) 73.6% of the population. Adding insult to all this injury, many of these issues end up in articles (both academic and mainstream media) that blame fat bodies with wording like “[negative health outcome] is associated with ob*sity” without any acknowledgement that it is associated with the weight cycling to which most fat people are subjected.
The fact that intentional weight loss continues to be prescribed despite clear knowledge of the low likelihood of success and the high likelihood of harm (not to mention the fact that studies show that health-supporting behaviors have much greater success with much less harm) is a testament to weight bias and the power of the weight loss industry, including within healthcare.
I don’t believe that a large body meets the definition of a health condition, and so I don’t think that intentional weight loss qualifies as a health intervention. But if an HCP believes that it is and it does, then they, at the very least, have to treat intentional weight loss like any other intervention. Which is to say that if what they are prescribing has almost no chance of success for increasing health, and a massive chance of harm, and if other interventions are available that have greater chance of success with less risk of harm, then they should be recommending those other interventions.
So even for those HCPs who believe that 100% of people can be part of the 5% if they just keep trying, or those who believe that intentional weight loss works, and it’s just that 95% of fat people don’t do it right… the failure rate is still reality and the harm of failure still applies, and so it’s not just that intentional weight loss isn’t an ethical evidence-based intervention for anything (though that’s true,) it’s that its most common outcome is harm. To reiterate, it’s worth noting that typically that harm gets blamed on fat bodies and not the weight cycling they’ve endured, often under doctor’s orders. We can and we must do better than this.
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.