Over the past few weeks, I’ve heard several people advance the National Weight Control Registry as evidence that people can permanently lose weight. To take just two cases, It is currently prominently featured on the Weight of the Nation website and it was thrown at Julianne Wotasik and I during our interview on Dr. Drew’s show earlier this week. Add to that, my new friend Angela sending her amazing slides for a new UK lecture on the NWCR and a blog post seemed kind of inevitable…
The National Weight Control Registry is a list of about 10,000 people who are at or above age eighteen who have lost at least 30 pounds and kept it off for at least one year. There are follow up studies done on subsets of the group over time. But in order to initially qualify for this group you must only meet three criteria: be 18 or older, show an initial weight loss of over 30 pounds, and maintain at least 30 lbs of your initial weight loss for one year. As I mentioned on Dr. Drew’s show, I would have qualified for the NWCR at least two different times in my life. But alas, after the one or two year point, I regained my weight plus a little. (It was only when I stopped weight cycling that I have been able to maintain a steady, albeit higher weight.)
There’s lots of argument back and forth about the level of regain among participants. One follow up study from 2003 indicated that among the subset self selected for the review, over 70 percent had regained some weight over the two years of the study. Granted, most of them had retained a significant percentage of their weight loss at this point, but “recovery from even minor weight gain was uncommon”.
But here’s the main thing folks. The National Weight Control Registry is a study of a very, very small, self-selected sample of people who have lost some weight and kept some of it off. The study was never designed to apply to a general population– “Because this is not a random sample of those who attempt weight loss, the results have limited generalizability to the entire population of overweight and obese individuals.” So this is a study of what a very small percentage of people in the United States did in order to lose weight (lots of different things) and keep some of it off. Sure there have been glowing reports of what these folks have in common in maintaining some weight loss. Most severely restrict calories, exercise daily and weigh weekly. And many media outlets have shouted about the fact that most of these folks eat breakfast every day! (Since I’ve eaten breakfast every day for my entire life, and I’m still waiting for the magic weight loss to appear, I kinda wonder if this breakfast thing has a causal relationship with weight loss. But I digress…)
When I say the NWCR is a small sample, I mean it. At any given time, over 70 million Americans are trying to lose weight for good. The NWCR lists 10,000 who have managed to log some success in that regard. We’re talking about a .00014 percent success rate here. As a point of comparison, over 500,000 people completed a marathon last year. And when it comes to an Ironman race (that’s a 2.4 mile swim followed by a 112 mile bike ride followed by a 26.2 mile run all completed in less than 17 hours with no break) estimates run as high as 25,000 projected participants for this year. So why aren’t we suggesting that all Americans compete in marathons or even Ironman competitions to be healthy? After all, our sample sizes for successful people are 2.5 to 50 TIMES HIGHER than those listed in the NWCR. And since 25,000 people have managed to complete an Ironman, it’s clearly possible, right? Maybe those half million marathoners need to learn from the techniques of the Ironmen and just suck it up and do it. Anybody who doesn’t want to exercise for 17 hours straight is clearly a slacker.
We don’t suggest everyone compete in marathons and triathlons and Ironmans because it’s ridiculous. We know that not everyone has the time, health, money or inclination to train the average 40 miles per week clocked by mere marathoners not to mention the hundreds of miles clocked by Ironmen. While I adored my marathon training and am extremely glad I did it, I just don’t have that kind of time to dedicate to marathon training on top of all of the other fitness classes I’m teaching right now. And with plenty of research indicating that a mere 150 minutes of moderate exercise per week is all that is necessary to achieve extremely significant health goals, I’m happy too treasure my medals and move on. And since there is also plenty of research indicating that I can be happy and healthy by engaging in moderate healthy behaviors without significant weight loss, I’m happy to do that too and just get on with my life.
So my dear little chicklettes, I no longer qualify for the NWCR. Maybe you don’t qualify either, but that’s okay. Why not join my extremely exclusive Fat Chick Clique instead? It’s totally free, you get to get free stuff, and you can live your life however you want. Cuz’ that’s just how I roll.
The Fat Chick
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Ashley — I believe there are many types of obesity and reasons for it. The problem seems to be when we latch onto one (“Just eat a salad!” “Fatties are mentally ill with food obsession!”) and use it as a reason to slam on people that it becomes problematic. I’m somewhere in between — not extremely fat, fat enough that I’m out of BMI range by a good 25 pounds and I’m sure even farther than my “ideal weight,” but my body is definitely built to be a little larger than the charts.
The other problem is that if you reel someone’s bad habits in, sometimes they lose weight, sometimes not. If you lose weight with a few walks and a few salads, great, but it doesn’t work for everyone, and the people in the latter group are not necessarily lying on the sofa eating twinkies every night. It’s one thing to try it initially and focus on habits. It’s another thing to keep entreating people to try harder and tell them they’ve failed and are lying if the numbers on the scale don’t cooperate.
Plus — here is one of my pet peeves — when someone starts gaining weight rapidly, THEY NEED TO BE ASSESSED FOR OTHER HEALTH ISSUES! I’ve read accounts from women who gained 50 pounds in one year, and the assumption was simply that they were eating too much and not exercising, when actually they have an underlying health issue. If they were losing weight at a pound a week, you’d better believe the doctor wouldn’t simply tell them to eat 500 more calories a day.
I would also qualify for the Registry, with my weight loss coming from changes in medication and resolution of some health issues. I’ve often thought of joining and explaining how I did it: “Well, first be hypothyroid for 10 years. Then get thyroid cancer. After a thyroidectomy and radioactive ablation, take high doses of thyroid hormones for the rest of your life to suppress any recurrence. OH — also have a mental health crisis treated with a med that causes weight gain, and later switch to a more weight-neutral drug. I did it! Anyone can do it!”
I weigh 298 lbs. and I qualify for the registry now. I used to weigh 364 like 12 years ago, so I’m a stellar example of successful weight loss. Slap a picture of my size 26 self on your diet products as an “after” photo, please.
Hee Hee! Rock on Susan!
Personally I’m not sure what to believe. I don’t really believe the registry, and I don’t believe everyone who tries to lose only has a 5% shot of success. I’ve known of people who have been fat most of their lives and keep weight off (for 5 years or more) just by starting to jog and cutting down on sweets. I’ve known of people to struggle but still keep it off after they find a certain way their body responds best to. I’ve known of people who’s weight goes up and down, and I’ve known of people who seem to try everything and the scale doesn’t budge, so I’ve personally seen cases all over the map when it comes to weight loss. I am pretty sure some people can do it more easily than other, but that’s all I actually can confidently say I believe at this point.
It can seem pretty hard to make sense of it all in terms of body size. I think there is a lot of body diversity out there and people’s bodies ARE all over the map. Some people can run a mile in 7 minutes (not me). Some people find that once they start running, they have a natural aptitude for it and after only a few months of training they are trotting out 7 minute miles with ease. Some people can train their whole lives and NEVER run a 7 minute mile. The problem comes when the 7 minute milers start saying EVERYONE can run a 7 minute mile if they just follow their patented training regimen. Some people are capable of running a 7 minute mile, but they never train so they never know. Some people simply have no desire to run.
In the same way, I think some bodies are very adept at dropping weight. So when those people make just a few simple changes, they drop the weight for good. Some bodies are not adept and dropping weight at all, and those folks can follow extremely healthy lifestyles for a long time and not lose a lot of weight. Some bodies are so adept at dropping weight that they can stay naturally very thin without trying very much. Again, the problem comes when anybody who has dropped weight (or is naturally thin) thinks they have the magic answer to help EVERYONE do it.
The thing about 5 percent is that it doesn’t seem like much. But you probably know at least 100 people at least casually. Statistically that means you would know at least five people who have lost weight and kept it off for more than 5 years. Now this is statistics here, so you may know 10 people and another might not know any. But when you look at the cases of people in your life who have lost that weight, there is no way of knowing definitively if they are in the 7-minute mile category or not.
However you slice this, it’s pretty complicated. And I want to thank you for venturing out and sharing your thoughts with us!
After watching your interview with Dr. Drew, I wondered why there was no debate about the weight loss registry. It was just Ms. Roth yelling over you so her information was accepted. I’m glad you cleared up some of the questions I had.
Whenever I have heard someone lose and maintain weight loss it always comes with so much restriction. I don’t want to have to think about eating restrictively or exercising excessively! I want to live and have fun!
By the way, I have qualified for the registry a couple of times myself. The last time was when I lost 50 pounds because I had colitis. Yeah, that was a fun weight loss program and I felt soooo good–NOT! 😉