Some studies suggest that there is no cure for obesity except surgery and that long term weight loss is almost impossible.
For example, for a long period of time, I was particularly discouraged by this article here:
I suspect there is a lot of truth to these findings. I also suspect there might also be other things at play which might explain discouraging results, such as the fact that studies usually focus on patients in clinical settings who are officially diagnosed with obesity. This means it probably includes people who are seriously obese, and who failed to manage their weight on their own – so they seeked help. The study probably excludes lots of people who successfully lost weight on their own, because many of them never seeked help in the first place. So they are invisible to the study.
But also, the study looks at a very long term, like 5 or 10 year follow up… At such long term, it might indeed be likely that most of the people will re-gain their weight.
The study says only 5% of people maintain their new weight in long term.
As much as I would like to be able to invalidate the results I admit that results are there and they hold some weight to them – long term weight loss is indeed very rare, especially if we look at a very long term.
Yeah some people will lose weight, maintain it for couple of years, they will think they have finally won the battle against obesity, but then, for many of them, something will happen in their life, some change will happen, it can be anything, any stressful event, or simply a shift in priorities that will cause them to lose focus on food, or simply to focus on other things in life… this can be a trigger for regaining weight.
This actually happened to me around 2012… I lost weight, successfully maintained it for more than 2 years, without regaining anything… But then I started college, started meeting new people, my priorities shifted from food and nutrition to other stuff, and, I was also influenced by some articles about dangers of eating disorders, including too much focus on food being healthy (orthorexia nervosa)… I realized I probably lost too much weight, more then I intended, and more than was healthy for me… and one morning when I stepped on my scale and it read 66 kg… I got kind of scared and a mental shift occured in my mind, which basically said… screw it… and I started eating more, and eventually I regained all the weight… it of course didn’t happen overnight, but over a couple of years of focusing on my studies and other stuff, and pretty much unrestrained eating. So at that time I failed. Right now I am in overweight range, but not obese, and I think for me my current weight is in acceptable range, so I don’t intend to lose weight now. My current weight is 86.5 kg, and my current BMI is 27.27, which is officially “overweight” but lies in a region that is not associated with many health risks. So I think that trying to mess with my weight right now could do more harm than good. As long as my weight is stable in that range I am happy with it.
Anyway, back to the main topic. Therefore, long term weight loss is indeed very rare, and the longer the term the rarer it is. Even if this study that puts the probability at 5% for long term weight loss is too pessimistic, or biased towards more serious cases… I personally don’t believe the real percentage to be much higher… Maybe it’s 10% maximum, which is still a very low percentage.
But, let’s see WHY is this so? Why is long term weight loss SO INCREDIBLY RARE?
And I offer a hypothesis: Long term weight loss is incredibly rare because we are treating the symptom and not the disease. Obesity is just a symptom. The real disease, the real cause of it, is excessive food intake. But let’s not trivialize that… like saying… you eat too much, that’s why you’re fat! – even if in reality, this is precisely true. But let’s focus more closely on it… excessive food intake… what this actually means?
What if this is actually another eating disorder? We can call it hyperrexia. We can define it as: “Hyperrexia is an eating disorder characterized by excessive food intake – wherein one consumes more calories from food than one would need if they had a healthy body mass. The main symptom of hyperrexia is obesity or being overweight.”
What if we should treat this eating disorder, and not obesity or excessive weight?
What if obesity is simply a symptom of hyperrexia? And yeah, diets can fight the symptom but underlying disease remains – and this underlying disease – hyperrexia, will cause its symptom – obesity (or at least excessive weight), as soon as we lose focus, as soon as we stop fighting symptoms with various dietetic regimens.
And finally, what if obesity is so hard to treat in long term, precisely because we’re treating the wrong thing – we’re treating the symptom and not the disease. Maybe if we directly treated hyperrexia, the results would be much, much better?
But let’s see first what types of hyperrexia exist?
I propose the existence of 4 main types: hyperrexia nervosa, hyperrexia endocrinologica, hyperrexia culturae and hyperrexia simplex.
Hyperrexia nervosa – it is excessive eating mainly caused by stress, anxiety, depression or other psychological issues. People might seek comfort or escape in food, due to emotional problems. It should best be treated by psychiatrists or psychologists, while of course closely monitoring physical health of the patients as well. It is a rare form of hyperrexia.
Hyperrexia endocrinologica – excessive eating due to problems in hormonal regulation, including diabetes. Best managed by medical doctors, specializing in endocrinology and diabetology. This too, is a rare form of hyperrexia.
Hyperrexia culturae – excessive eating due to deeply entrenched cultural habits, values and beliefs – by far the most common form of hyperrexia, and luckily, easiest to treat – as there are no underlying psychological nor hormonal issues.
Hyperrexia simplex – a simple personal tendency to eat excessivelly, a simple deviation from norm – quite rare, and difficult to treat – those are the people who have always been overweight. It might have genetic background.
I could argue that over 80% of the cases of obesity and overweight are caused by hyperrexia culturae. I could back it with the following arguments:
- differnet cultures/countries have very different rates of obesity. Japan, for instance, in spite of being an affluent, rich country, has extremely small rates of obesity in comparison to US or Western Europe
- in the pre-industrial societies obesity was very rare
So if most cases of obesity are caused by hyperrexia culturae, how to treat it?
There are 2 elements of treatment, closely related to each other:
a) applying asymptotic nutrition approach: that is discovering an energy intake level that your body needs at your target body weight, and sticking permanenently to this level of energy consumption.
b) changing cultural beliefs, habits, and values, so to put them in line with normocaloric and not hypercaloric energy intake levels.
These two things are pretty much the same… both of them result in permanent, but slight lowering of caloric intake, so it’s not excessive anymore, but normal for a healthy body weight. They just approach the issue from different angles. Asymptotic Nutrition approach still sees the obesity as a disease, and tackles it directly through caloric intake intervention, but in most reasonable and long term sustainable way possible. Changing cultural beliefs goes a step further by saying that obesity is not a disease but just a symptom of hyperrexia culturae, and that cultural habits, values, etc… are the root cause of obesity. Changing such cultural beliefs, will also cause you to eat less, and therefore, your caloric intake will decrease, which will rid you of excessive weight. So changing cultural beliefs will also accomplish what asymptotic nutrition requires, a permanent, but slight lowering of caloric intake. It is pretty much the same thing, two sides of the same coin.
In fact, even with pure Asymptotic Nutrition approach, in the long term, it might be necessary to also adopt different cultural beliefs so that you eliminate the root cause of hyperrexia culturae, which further causes obesity. Perhaps only by eliminating such beliefs, long term success is possible.
Or to put it in other words, for the most part, obesity is a societal and cultural and not individual problem. It’s our culture and society with its habits, norms and customs that causes obesity epidemic. But luckily we as indivuduals can emancipate ourselves from these beliefs, and such emancipation can lead us to permanently change our eating habits, and therefore get rid of obesity, and become healthier overall.