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The Validation and Frustration of Stunkard et al.
Studying the Studies: The One Weight Loss Study from the 1950's
Stunkard et al.’s 1959 study “The Results of Treatment for Ob*sity: A Review of the Literature and Report of a Series” is one of the earliest studies that really sought to determine the success of weight loss interventions. As someone who works full-time pointing out that weight loss interventions almost never succeed at creating significant, long-term weight loss and often do harm, every time I read this study it is a combination of validating and incredibly frustrating.
Content note: this post will include discussion of calories and weight loss so please make sure to take care of yourself.
Let’s dig in:
They begin by saying: “The current widespread concern with weight reduction rests on at least two assumptions: first, that weight-reduction programs are effective, second, that they are harmless.”
They continue “Recent studies indicate that such programs may be far from harmless. This report documents their ineffectiveness.”
Again, it’s validating to see that they were explaining this in 1952, but incredibly frustrating that the only thing that has changed since then is that the weight loss industry profits have grown exponentially, and the interventions have become more dangerous and more expensive.
The study looks at weight loss success/failure in two ways. First, a review of the weight loss literature for the previous 30 years, and second, an examination of the outcomes of the treatment of 100 consecutive higher-weight patients at New York Hospital’s Nutrition Clinic.
Here they use a phrase that I say or write some version of pretty much daily. “Hundreds of papers on treatment for ob*sity* have been published in the past 30 years. Most, however, do not give figures on the outcome of treatment, and of those that do, most report them in such a way as to obscure the outcome of treatment in individual patients.” They point out the following issues:
Reporting the number of patients and total pounds lost without specifying how much/the average that each patient lost
Reporting as a percentage rather than a number of pounds
The exclusion of those who dropped out or were “uncooperative” who the authors explain likely represent intervention failure and comprise an “impressive part” of the study samples
They point out that “if papers with these shortcomings are omitted, the vast literature on treatment for ob*sity shrinks to just eight reports.”
I’ll point out that these are still incredibly common occurrences in weight loss research. That, to me, indicates that those doing the research aren’t interested in creating good research, but are interested in creating research to prop up the failed weight-loss paradigm. Anyway, back to Stunkard et al.
The eight studies had subject groups ranging from 48-314.
Of the eight studies, interventions ranged from “self-selected diet,” to starvation diets (from 600 to 1,000 calories per day), to amphetamines.
Four of the studies had more people lose less than 10 pounds than those who lost 10 or more pounds. Only one had a majority lose more than 20 pounds.
Overall, only 25% of people were able to lose 20lbs and only 5% where able to lose 40lb short-term (and remember that research since 1959 has repeatedly shown that about 95% of this small group will regain all of the weight within five years.)
Study of 100 patients
Moving on to their study of 100 patients. Here they point out that the health of “most subjects” was good, suggesting that they were referred for “treatment” solely to manipulate their body size. They were prescribed diets of 800 to 1,500 calories (all below, and some far below, the caloric intake for the Minnesota Starvation Experiment.)
They characterize the results of these 100 people as “even poorer than those reported in the literature.” Of the 100 patients, 39 dropped out after the first visit, 28 never returned to any clinic in the hospital (suggesting that the intervention lowered their overall healthcare engagement, which the authors refer to as “a rupture of at least two therapeutic relationships” since patients only come to the Nutrition Clinic by referral from another clinic in the hospital.) Only 12 managed to lose more than 20lbs and only one of those was able to lose more than 40lbs.
In terms of maintenance of weight loss, they found that, of the 12 who lost at least 20 pounds only 6 had maintained at least a 20 pound loss a year later, a number that dwindled to 2 people after two years. Moreover, 4 had already regained all of the weight they lost at two years, the others had already regained significant amounts of weight. Of the two “successes,” at two years the man who had the greatest weight change (-51lbs) reported that the diet had been “associated with mounting tension which culminated in what was diagnosed as an acute schizophrenic reaction” requiring a four-month hospitalization and treatment with tranquilizers. He regained 35 pounds before follow-up stopped.
While they were still coming from a “body-size-as-disease” model, a lot of the discussion section of this study is, to speak colloquially, fire! They point out that the idea of higher weight as unhealthy and weight loss as health supporting had grown “in recent years” resulting in doctors and patients considering weight loss as a therapeutic intervention. They also explain that “lay institutions, notably the magazines for women, has seized upon this growing interest in weight reduction and has helped to magnify it to the proportions of a national neurosis.” They further insist that “The medical profession…must accept some responsibility.” They characterize the pervasive blaming of patients by their physicians for not losing weight by saying “Rarely have physicians so readily surrendered a part of their domain to moralizing, indifference, and despair.”
They go on to say that “the naïve optimism of the medical profession about treatment for ob*sity has been widely accepted by the lay public.”
And even though they cling to the body-size-as-disease and weight loss as “treatment” model, they admit that “perhaps” some higher-weight people should not undertake weight loss interventions.
One thing that I’ve had happen to me (and seen happen to others) is that when we talk about the failure rate of weight loss interventions, someone will claim that it’s “just that one study from the 1950’s” so this is first a reminder that this study actually looked at 30 years of research, and that these findings have been consistently replicated through today.
So, as I said, it is validating to see that others reached the same conclusions that those of us doing work around weight science still are, but it’s also incredibly frustrating that it is 64 years later (94 considering that they looked at data since 1929) and researchers are still pulling the same fail-your-freshman-research-methods-class nonsense, and the medical profession is still operating from the same combination of naïve optimism and patient blaming about interventions that have been utter failures since the 1920’s.
Fat people deserve better. We deserve a weight-neutral paradigm that focuses on supporting us in the bodies we have rather than risking our lives and quality of life in failed attempts to shrink us. And we deserve more than that - we deserve medical science and healthcare systems that do the work to then move from a weight-neutral to a truly weight-inclusive paradigm.
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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 Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.