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Weight Loss /Healthy Options

Weight loss interventions: Do they work?
Why weight loss doesn’t work: The setpoint
Weight cycling risks
What does work: Healthy options
Preventing excess weight gain and eating disorders
Top 10 Reasons Not to Diet PDF
5 Health Care Myths PDF
News Briefs on Weight Loss/ Gain







Revised in March 2009

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
  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.

Many patients regain all the weight lost.(21)

Liposuction is another popular body-shaping surgery that is not risk-free. It can result in death, severe injury or disfigurement.(22)

Surgery carries higher risk of death than often claimed – nearly half of Medicare patients age 75 and over died within the year.

D. Gadgets and gimmicks
An assortment of gadgets and gimmicks are promoted for weight loss by the quack weight-loss industry. Dozens have won notoriety through the annual Slim Chance Awards that each January spotlight the four “worsts.”

Creams, gels, toning lotions, thigh cream and liquids claiming to dissolve fat and “flush out cellulite,” or “smooth the appearance of cellulite,” are so profitable that cosmetics companies now develop and sell them, too.

Popular in the quackery medicine show are appetite patches, acupressure earrings, ear staples, appetite sprays, fiber cookies, body wraps, defatting soap, chewing gum, spot reducing gadgets, muscle stimulators, stomach balloon, battery-operated toner belts, vacuum devices, heating gadgets claimed to disperse fat under the skin, passive exercise tables, slimming insoles, vacuum pants, massage, body shaping clothing, hypnosis seminars, aromatherapy, mystical ways to “realign energy” or invigorate “soul patterns” and detoxifying.

Detoxing the body is an elaborate hoax that usually begins with fasting and proceeds through expensive long-term regimens of herbal pills, body wraps and other gimmicks that keep the victim enmeshed in related quack schemes of many kinds.

Over 200 methods – none successful
Numerous other harmful weight loss techniques are practiced by teenage girls and others, such as vomiting, fasting, smoking, abuse of diuretrics and laxatives, and use of illegal drugs.(23, 24)
In its 20 years of publication Healthy Weight Journal reported on well over 200 highly-advertised ways to lose weight. Most were promoted as quick fixes – for complex problems that developed over many years.

None are successful; most are worthless; many are sold illegally and all too many are dangerous.

An old story
“The inability of the volunteers to maintain their diets must give us pause,” wrote Dr. Martijn Katan in a recent Feb. 2009 editorial in the New England Journal of Medicine. He was reviewing a careful two-year diet program reported in the same issue.(25)

It’s an old story: Participants had lost weight for 6 months, then regained and were still gaining more weight at the end of the two-year trial. Nevertheless, a positive spin by the authors claimed “clinically meaningful weight loss.”

It was a scenario often repeated in medical journals throughout the years: negative results obscured by positive spin. But Katan didn’t seem to buy it. He writes:

“Even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed.

“We do not need another diet trial;
we need a change
of paradigm.”
– Katan
  “It is obvious by now that weight losses among participants in diet trials will at best average 3 to 4 kg after two to four years and that they will be less among people who are poor or uneducated, groups that are hit hardest by obesity.

“We do not need another diet trial; we need a change of paradigm.”

The problems were stated clearly as early as 1991 by Dr. Susan Wooley and Dr. David Garner:

"It is now widely agreed that obesity treatment is, in general, ineffective. It may be argued moreover, that it is more than ineffective: in many instances it is destructive.

“It may provide patients with failure experiences, expose them to professionals who hold them in low regard, cause them to see themselves as deviant and flawed, confuse their perceptions of hunger and satiety, and divert their attention away from other problems.(26)

Unfortunately, despite years of experience in failing with such programs, some health professionals continue to pursue the same care for large persons while expecting different results – and promising better results.

In effect, they tell the patient who comes with a health problem, “First, we’ll get you thin – I know how. Then we’ll treat your medical problem.”

It doesn’t happen. With best of intentions, they try – and so does the patient, who has been through this many times before. When the treatment fails, the solution is to try harder or buy into a more radical weight loss treatment.

The body cannot be shaped at will. Let the buyer beware.

Such people fail to appreciate the fact that many large patients are basically healthy and already have appropriately healthy lifestyles.

They may fail to notice that, not infrequently, after prolonged radical interventions, patients are not as healthy as they were

before and appear to be living with compromised immune systems.

It has been documented – and never successfully challenged – that 95 percent to 97 percent of all weight loss attempts fail.(27)

Oh yes, there are successes. A weight control registry has been set up by obesity specialists to showcase their best cases through the years.

Ironically, the number they have compiled is such a pitifully small percent of totals, and the single-minded obsession revealed in some of the personal stories so extreme, that the weight control registry seems to prove just what it seeks to disprove – that true weight-loss success is rare indeed.(28)

The situation has not changed since 1998 when, in their New Year’s Day editorial, “An illfated New Year’s resolution,” Marcia Angell, MD, and Jerome P. Kassirer, MD, editors of the New England Journal of Medicine, warned of the dismal record and questionable value of weight loss interventions:

 “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.”(29)

The body cannot be shaped at will. Caveat emptor – let the buyer beware.


    1. Allison DB, Zannolli R, Faith MS, et al. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. I J Obesity 1999;23:603-611.
    2. Wadden TA, Stunkard A, et al. Three year follow-up of the treatment of obesity by very low calorie diet, behavior therapy, and their combination. J Consult Clin Psych 1988;5:6:925-928.
    3. Berg FM. Health risks associated with weight loss and obesity treatment programs. J Social Issues 1999;55:2:2770297.
    4. Lissner L, Odell P, et al. Variability of body weight and health outcomes in the Framingham population. New Engl J Med. 1991;324:1839–1844.
    5. Williamson DF, Pamuk E, Thun M, et al. Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40-64 years. Am J Epidemiol 1995;141:1128-1141.
    6. Rothblum ED. I’ll die for the revolution but don’t ask me not to diet: Feminism and the continuing stigmatization of obesity, in Feminist perspectives on eating disorders. Fallon P, et al., eds. 1994, p64. Guilford Press.
    7. NIH Technology assessment conference: Methods for voluntary weight loss and control. March 30-April 1, 1992.
    8. Berg FM. Women Afraid to Eat: Breaking Free in today’s Weight-Obsessed World, 2001, p p156-194. Healthy Weight Network: Hettinger, ND.
    9. Sacks FM, Bray GA, et al. Comparison of weight-loss diets with different compositions of fat, protein and carbohydrates. N Engl J Med 2009;360:859-873.
    10. NIH Technology assessment conference
    11. Wadden. Three year follow‑up
    12. Garner DM, Wooley SC. Confronting the failure of behavioral and dietary treatments for obesity. Clin Psych Rev 1991;11:729-780.
    13. Lee IM, Paffenbarger RS Jr. Is weight loss hazardous? Nutr Rev 1996;54(suppl):S116-124.
    14. Berg. Health risks weight loss. 1999.
    15. Lissner. Variability of body weight and health outcomes
    16. Berg  Women Afraid to Eat, p152-153, 202-206.
    17. Kaplan A, and Garfinkel P. Medical issues and eating disorder, 1993.. New York: Brunner/Mazel.
    18. Ernsberger P. Surgery risks outweigh its benefits. Healthy Weight J/Obesity & Health. 1997;5:18:21-
    19. Flum DR, Salem L, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA 2005;294:1903-1908.)
    20. Bennet I. Omalu, MD, MPH; Diane G. Ives, et al. Death Rates and Causes of Death After Bariatric Surgery for Pennsylvania Residents, 1995 to 2004. Arch Surg. 2007;142(10):923-928.
    21. Dunham W. Neurological condition linked to obesity surgery. Reuters: Washington 3/12/07; Singh S. Neurology 3/13/2007.
    22. Berg  Women Afraid to Eat, p165.
    23. Berg F. Harmful weight loss practices are widespread among adolescents. HWJ/Obesity & Health 1992;6: 4:69‑72.
    24. Dieting and purging behavior in black and white high school students. J Am Dietetic Assoc. 1992;92:3:306‑312.
    25. Katan, Martijn B. Weight-Loss Diets for the Prevention and Treatment of Obesity. NEJM 2009;360;9: 923-925. (Feb 26, 2009).
    26. Garner, D. M., & Wooley, S. C. Confronting the failure of behavioral and dietary treatments for obesity. Clinical Psychology Review, 1991;11, 729-780.
    27. https://www.msu.edu/user/burkejoy/unit3a_2.htm
    28. McGuire MT, Wing RR, Klem ML, Seagle HM, Hill JO. Long-term maintenance of weight loss. Int J Obes Relat Metab Disord. 1998 Jun;22(6):572-7.
    29. Kassirer JP, Angell M. Losing weight: An illfated New Year’s resolution. N Engl J Med 1998;338:5254.


Why weight loss doesn’t work: The setpoint
Weight loss doesn’t succeed long term because, whether we want to admit it or not (and most weight loss specialists don’t) – it seems that we each do have a set point or settling point.

The setpoint is our usual weight at this time in our lives when well nourished and reasonably active, and which the body defends. It's the weight that we have attained through a complex interplay of both genetic and environmental factors.(1)  

Our bodies vigorously defend this weight and seem to make adjustments to restore it to the setpoint after either weight loss or gain.(2)

The human body is well designed to resist starvation – it’s a survival trait that was critically important until recent times. We store up fat and protect those fat stores. We defend them all the more vigorously when they seem threatened.(3)

When not dieting, most people maintain a stable weight, despite what can be wide day-to-day variations in

The setpoint is our usual weight at this time in our lives when well nourished and reasonably active, and which our body defends.
calorie intake. The body makes its own adjustments to match food intake.(4)

When we begin losing weight or fat – it’s not clear what triggers this – the alarm bells go off. All sorts of regulatory mechanisms kick in to protect calories and stored fat by shutting down the usual body processes: slowing metabolism, reducing temperature and decreasing heart rate. These are the processes – running our inner clock – that use most of the calories we consume (not physical activity, as some believe). So there are many subtle ways for calorie readjustment.

Since there is much flexibility in the system, that inner clock can slow down at many points. It reduces the calories used for generating heat, heartbeat, circulating blood, breathing, digestion, thermogenesis, cell repair, fighting infection, sexual function, growth of children and youth, and dozens of other processes related to physical, mental, emotional and social function – even reducing the capacity for intelligent thought, planning, social relationships and spiritual restoration. The fires are banked to conserve fuel.

This is why counting calories doesn’t work. Trying to predict weight loss from the old adage “calories in equal calories out” is meaningless in the face of such a vigorous, unpredictable and unmeasurable slow down of calorie burn. "Calories out" becomes unfathomable.(5)

At the same time the body closes down to defend against starvation, the drive to eat increases. It’s not a matter of willpower. It’s biology.(6)

The setpoint apparently is not normally lowered, even for people who keep themselves thin and undernourished for years. Instead, the alarm bells are continually going off. They feel constantly chilled, exhausted, hungry, self-absorbed, socially isolated and lonely.(7)

“Setpoint creep,” on the other hand, apparently occurs with relative ease, sometimes advancing a half-pound or more each year. There is evidence that chronic dieting may stimulate this with its cycle of weight loss, regain and ratcheting weight up higher.(8) Another path to setpoint creep may be sustained overeating with sedentary living and lack of activity over time.

The Starvation Syndrome     
The “starvation syndrome” is the body’s defense against food shortage and weight loss.

The starvation syndrome is the way the body closes down and defends against food shortage and weight loss.

It’s a time of crisis, in which our bodies begin to close down to conserve energy. The more severe the food restriction, the more severe and lasting are the starvation effects.(9) 

The teenage girl with anorexia nervosa is the extreme example of living in this depressed state.

Yet, the same adjustments operate mildly even with relatively minor food deficits. Skipping breakfast induces effects such as reduced

concentration and problem-solving ability to some extent, as documented in school breakfast programs. For the person with severe food restriction – even short term – the effects can be fatal.

The Minnesota Starvation Study, conducted over 50 years ago by Ancel Keys and his colleagues at the University of Minnesota, is the classic study of the mental and physical effects of the starvation syndrome. These devastating effects are confirmed by research on eating disorders and starvation in Africa.(10,11)

Physical effects of the starvation syndrome shut down may include weakness, fatigue, dizziness, headache, nausea, hair loss, anemia, chills, cold hands and feet, diarrhea, constipation, muscle and abdominal pain, impaired immune system, reduced sexual function, amenorrhea, bone density loss, irregular heartbeat, heart arrhythmias and risk of sudden death.(12,13,14)

Mental, emotional and social effects can be seen in increased anxiety, depression, irritability, intolerance, distrust, moodiness, lowered self-esteem, inability to concentrate or comprehend, loss of ambition, narrowed interests, lack of sexual interest, decrease in mental alertness, memory, comprehension, sense of spirituality, intense food and weight preoccupation, withdrawal from usual interests and activities, withdrawal from friends and family, loneliness, self-centeredness, self-absorption, reduced feelings of compassion, generosity and love.(15,16)

Weight cycling – the yo-yoing cycle of weight loss and regain that comes with repeated dieting – is shown to be a mortality risk in long-term studies.(17)

Loss of lean body mass
Public health concerns about the safety of weight loss methods have not been fully explored.

While many people assume that losing weight is only about losing fat, this is not what really happens. A certain percent will be loss of critical lean body mass from organs, bones and muscles.

The big chunk of plastic fake fat popular in many clinics that represents, say, a 10-pound weight loss, is a deceptive prop. In any diet, muscle is also lost. Instead of all fat, a large portion of that chuck should show the lean mass lost from muscles and vital organs, including heart, lungs and kidneys.

Rapid weight loss seems to cause an especially high percent of muscle loss. Ironically, one type of very-low-calorie diet was once called a protein sparing diet, suggesting that it spared muscle.

“Sudden death syndrome” is a known risk of the very-low-calorie diet and other extreme diets,  believed to be the result of a reduced-size heart being thrown into cardiac arrhythmia or irregular heartbeat.

Losing muscle mass weakens the patient all the more after radical food restriction. For patients with severe obesity and medical problems, this can be extremely detrimental and significantly increases mortality risk.(18)

After weight loss of both fat and lean mass, the full regain of weight was primarily fat, at least initially, as documented in the Minnesota Starvation Study.(19)

That fat can be more rapidly restored than muscle makes sense. After all, storing fat requires minimal processing compared with

Sudden death syndrome is a known risk of severe diets, believed to result from a reduced heart thrown into irregular heartbeat.
  other nutrients. Building muscle and lean organ mass is far more complex, so restoration may be expected to take longer.

Asking the wrong question
For decades health providers have asked the question: “How can I make this patient thin?”

With all that we know today – and don’t know – about weight loss and its clinical interventions, it’s clear this may be the wrong question.

Instead, the right question seems to be, “How can I help make this patient healthier?”


  1. Keesey RE. Physiological regulation of body energy: implications for obesity. In Obesity: Theory and Therapy, eds. AJ Stunkard and T Wadden. 1993, p77-96. New York: Raven Press.
  2. Flodmark CE, Lissau I, Moreno LA, Pietrobelli A,Widhalm K. New insights into the field of children and adolescents' obesity: the European perspective, International J Obesity 2004;28, 1189–1196. doi:10.1038/sj.ijo.0802787.
  3. Berg FM. Women Afraid to Eat: Breaking Free in today’s Weight-Obsessed World, 2001;130-135. Healthy Weight Network: Hettinger, ND.
  4. Keesey RE. A set point analysis of the regulation of body weight. In Obesity, ed. AJ Stunkard. 1980, p55. Philadelphia: W.B. Saunders Co
  5. Weigle DS. Energy efficiency of reduced‑obese men. In Obesity in Europe 88, eds. P Bjorntorp, and S Rossner. 1988, p359‑364. London: John Libbey.
  6. Garner D. The effects of starvation on behavior: Implications for dieting, disordered eating, and eating disorders, Healthy Weight J 1998;12:5:68‑72.
  7. Clinical Trials: Pilot Study of Dietary Modification of Appetite Set Point in Obesity. June-Sept 2008. State University of New York - Upstate Medical University
  8. Berg FM. Underage and Overweight: Our Childhood Obesity Crisis – What Every Family Needs to Know, 2005, p186-188. Hatherleigh Press: NY.
  9. Andersen RE, Barlett SJ, Morgan GD, et al. Weight loss, psychological, and nutritional patterns in competitive male body builders. Int J Eat Disord 1995;18:49‑57.
  10. Keys, Ancel et al. The biology of human starvation, 1950. School of Public Health. Minneapolis, MN.: U of Minnesota Press.
  11. Berg FM. Women Afraid to Eat, 2001, p133-143.
  12. Berg FM. Underage and Overweight, 2005, p193.
  13. Berg FM. Children and Teens Afraid to Eat: Helping Youth in Today’s Weight-Obsessed World, 2001, p88. Healthy Weight Network: Hettinger, ND.
  14.  Kaplan A, and Garfinkel P. Medical issues and eating disorders, 1993. New York: Brunner/Mazel.
  15. Guetzkow HS, and Bowman PH. 1946. Men and Hunger. p9. Elgin, Ill.: Brethren Publishing House.
  16. Berg FM. Women Afraid to Eat, 2001, p145, chart.
  17. Lissner L, Odell P, et al. Variability of body weight and health outcomes in the Framingham population. New Engl J Med. 1991;324:1839–1844.
  18. Allison DB, Zannolli R, Faith MS, et al. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. I J Obesity 1999;23:603-611.
  19. Keys, Ancel et al. The biology of human starvation, 1950. 


Weight cycling risks
Weight cycling risks come with the repeated loss and regain of body weight. Also called weight fluctuation, weight variability or yo-yo dieting, this is a critical issue for public health. And for good reason: If weight cycling is harmful and yet is the almost inevitable result of dieting and weight loss, then perhaps weight loss intervention as it stands today is inappropriate at any size. (1)

There is little doubt that weight cycling is extremely prevalent in the U.S. Sixty to 80 million adults are trying to lose weight at any one time, and among high school students 45 percent of them were trying to lose weight in 2007, an increase from 41.8 percent in 1991.(2) Research shows that most of those who lose weight regain it within a short time, and many continue to repeat this pattern.

In a review of weight cycling research, Kelly Brownell and Judith Rodin cite a six-year study which tracked the weight of 153 middle-aged adults. The women lost an average of 27 pounds and gained 31 pounds during that time, while the men lost and gained an average of 22 pounds. For the women, this was a loss of 19 percent and gain of 21 percent of initial body weight. The men lost and gained about 12 percent.(3)

John Foreyt and colleagues at the Baylor College of Medicine, Houston, cite research that shows more than half of obese individuals fluctuate up or down 12 pounds over intervals of 1 to 5 years.

Major concerns have been raised that cycles of weight variability can increase risk factors and the risk of mortality, especially cardiovascular deaths. Further, some experts suspect that weight cycling may lower the metabolic rate, increase fat-to-lean ratio and waist-hip ratio, increase the appetite for dietary fat, and decrease a person’s ability to lose weight.

Thus, the research focuses on two major issues:
        1. Is weight cycling associated with increased risk for physical or mental harm?
        2. Does weight cycling make weight management more difficult by invoking survival mechanisms?

Mortalilty increase
Research indicates weight cycling is associated with an increase in mortality from all causes and from coronary heart disease.

In 1991 Lissner and colleagues analyzed 32 years of weight fluctuations among 3,130 men and women in the Framingham Heart Study. They found those with high weight variability had higher death rates overall, and increased mortality and illness due to coronary heart disease (CHD) –regardless of their initial weight. This study originally reported higher risks with overweight and obesity, but those differences were negated when weight cycling was studied independently.(4)
Individuals with a high weight variability  many weight changes or large changes  were 25 to 100 percent more likely to be victims of heart disease and premature death than those whose weight remained stable.

The relative risk for a high degree of weight variability compared with 1.0 for a low degree of variability was as follows:

                            Total mortality............................ 1.30
                            Mortality due to CHD................. 1.48
                            Morbidity due to CHD............... 1.48
                            Total mortality............................ 1.27
                            Mortality due to CHD................. 1.47
                            Morbidity due to CHD............... 1.42
These results seemed to hold true regardless of the individual’s initial weight, long-term weight trend and cardiovascular risk factors such as blood pressure, cholesterol level, glucose tolerance, smoking and physical activity.

In a German study, 505 men, who were 40-59 years at recruitment and followed for 15 years, were grouped by stable obese, stable non-obese, weight gain, weight loss and weight fluctuation. During the 15 years there were 183 deaths, and only weight fluctuations had a clear significant impact on all-cause mortality. The researchers concluded that weight fluctuations are a major risk factor for all-cause mortality in middle aged men. Moreover, obesity that was stable did not increase further mortality in men aged 55-74 years in long-term follow-up.(5)

Similarly, a Swedish study showed that weight cycling measured over 17 years was independently related to mortality for 1,462 women, ages 50 to 72 at last exam. For 855 men age 75, measured five times in 25 years, results were the same.(6)


What does work: Healthy options

The good news is: What works best in dealing with weight issues is also the healthiest option.

It’s a healthy living approach that allows excess weight to come off gradually and naturally, as a by-product of good habits. Least disruptive of normal life, it’s a diet-free approach that avoids setting off alarm bells and activating the body’s defense system.(1,2,3)

When lost this way, weight stays off. It comes off because habits are changed, and stays off as long as the new habits continue. Thus, the process may lower the setpoint, as well, in a way that remains lower.

At this point, it seems we have learned three things:


Overweight and obesity are not as dangerous or prevalent as they have been portrayed. Associated health risks at grade 3 obesity affect about 5 percent of U.S. adults, or perhaps up to 15 percent, to include grade 2, and these risks may not even be caused by excess weight or fat, but likely involve third factors.

2. Current weight loss interventions are usually ineffective long term and often prove harmful to health and well being. As such, they need to be considered experimental.
3. Weight is probably not the key to good health, but at most, a marker for it, a proxy. Rather, regular physical activity appears to be that key, independently, along with other healthy living habits

The answer seems to be: Leave weight alone, and focus on helping people improve their health at the size they are, if warranted.

For severely obese individuals who have medical issues, it is even more important that interventions be conservative, health-centered and lasting. This means gradual change, one step at a time. Anything less than lasting habit change is irrelevant, a wasted effort and may be harmful.(4)

Treat medical problems of large patients the same as for others, say advocates of the healthy living, diet-free approach. Help all people gradually develop regular physical activity habits. Everyone can engage in regular physical activity at an appropriate level, and fit it comfortably into his or her life.

It’s no quick fix, but rather a long-term commitment to better living that, even without weight loss, pays major benefits in improved health and well being.

Researchers at the Cooper Institute say that losing weight is not necessary to get the benefits of an active lifestyle: “The key, it appears, is to be sufficiently active to develop good basic fitness.”(5)  

What is Health at Any Size?  
Somewhat wistfully, Dr. Katan called for a new paradigm in his editorial, indicating his disillusionment with the thought of yet “another diet trial.” (6)

Today many health providers feel the same way. There is overwhelming agreement about the failure of weight loss programs and widespread concern for the harm they cause.

Many professionals have moved on to a health-centered approach of sound and compassionate care in dealing with weight issues.

Health at Any Size  
Health at Any Size is a health-centered paradigm that focuses on total health and well-being, not weight. It promotes active living, eating well without dieting, and a nurturing environment that includes respect and acceptance for people of all sizes. Everyone qualifies. Right now, just as you are.

The health at any size paradigm, also called health at every size or simply healthy living without diets comes as a refreshing change.(7,8,9)

With roots in Health Canada’s Vitality program of the early 1990s, this approach echoes Vitality's simple eloquence, “Live actively, eat well, and feel good about yourself.”(10)

We normalize and improve our lives by:

  1. Living actively, engaging in regular moderate physical activity
  2. Eating well of all five food groups, in normal diet-free ways
  3. Accepting and respecting ourselves and others, and managing stress in a nurturing environment

This healthy living approach enables people to put weight and food in perspective, on the back burner, as only a small part of daily living. No gimmicks, no fuss.

It frees people to be their best selves. After decades of dieting, they are able to get back on track and move ahead with what is really meaningful and fulfilling in their lives.

Preventive of weight and eating problems, it’s a health-centered, compassionate approach that leaves restrictive thinking and weight loss goals behind, and instead promotes health in body, mind and spirit for people of all sizes.

Do no harm is an important precept of the health at any size philosophy. It recognizes that every person deserves health-centered treatment.

The health at any size approach recognizes that problems of overweight, eating disorders, malnutrition, size prejudice and dangerous weight loss attempts are not separate issues. All are interrelated.

All are intensified by the diet industry’s current “war on obesity” being fought in the front pages of newspaper and in medical clinics. The problems need to be addressed together in comprehensive ways to avoid doing harm.(11,12)

This health at any size approach helps to prevent problems and heal the damage done. It embraces these concepts:

  • Accept and respect your own and others’ unique traits and talents; celebrate diversity.
  • A healthy lifestyle is achievable by everyone, unlike so-called “ideal weight.”
  • Enjoy physical activity every day, your own way, as natural and beneficial (rather than to burn calories).
  • Enjoy eating well without dieting; rediscover normal eating — tune in to hunger, fullness and appetite.
  • Enjoy full nutrition; honor balance and variety; all foods can fit.
  • Focus on wellness in body, mind and spirit; focus on overall health and well-being.
  • Enhance supportive relationships and good communication with family, friends and within communities.

This philosophy embraces the big picture, keeps weight and eating issues in perspective, and is basic to the guidelines provided here at healthyweightnetwork.com and in books by Healthy Weight Network.(13,14,15)

Healthy Living guidelines
Healthy Living/ Health at Any Size: Healthy living at Your Size
Children: Guidelines for Parents
Eating disorders: Dysfunctional Eating disrupts Normal Life
Self esteem: It's about You
Schools: Crisis grows in Schools

Healthy Living guidelines: Handouts
Healthy Living at Any Size
Healthy Living Guidelines  
Celebrate Health at Every Size (large poster)
Normal Eating: Are you a Normal eater?  
Top 10 Reasons Not to Diet  


  1. Berg FM. Women Afraid to Eat: Breaking Free in today’s Weight-Obsessed World, 2001, p213-244. Healthy Weight Network: Hettinger, ND.
  2. Berg FM. Children and Teens Afraid to Eat: Helping Youth in Today’s Weight-Obsessed World, 2001, p201-215. Healthy Weight Network: Hettinger, ND.
  3. Berg FM. Underage and Overweight: Our Childhood Obesity Crisis – What Every Family Needs to Know, 2005, p209-233. Hatherleigh Press: NY.
  4. Burgard D, Lyons P. Alternatives in obesity treatment: focusing on health for fat women. In Feminist perspectives on eating disorders. Fallon P, et al., eds. 1994, p64. Guilford Press.
  5. Brodney S, Blair SN, Chong Do Lee. Is it possible to be overweight or obese and fit and healthy? In Bouchard C (ed). Physical activity and obesity, Human Kinetics, Champaign 111., 2000. J of Eating Disorders 2000; 28: 215-220.
  6. Katan, Martijn B. Weight-Loss Diets for the Prevention and Treatment of Obesity. New Engl J Med 2009;360;9: 923-925. (Feb 26, 2009).
  7. Berg FM. Women Afraid to Eat, 2001, p213-225.
  8. Berg FM. Children and Teens Afraid to Eat, 2001, p200-215.
  9. Berg FM. Underage and Overweight, 2005, p219-233.
  10. The Vitality Approach: A guide for leaders. Leader’s Kit, 1994. Canada Health and Welfare, Ottawa, ON.
  11. Guidelines for Childhood Obesity Prevention Programs: Promoting Healthy Weight in Children, from the Society for Nutrition Education, 2002. In English and Spanish. http://www.healthyweight.net/schools%20SNE.pdf
  12. Danielsdottir, Sigrun, Burgard Deb, Oliver-Pyatt Wendy. Academy for Eating Disorders. Guidelines for Childhood Obesity Prevention Programs. Feb. 26, 2009. http://aedweb.org/media/Guidelines.cfm
  13. Berg FM. Women Afraid to Eat, 2001.
  14. Berg FM. Children and Teens Afraid to Eat,2001.
  15. Berg FM. Underage and Overweight, 2005.

Preventing excess weight gain and eating disorders

Obesity prevention efforts are going forward in schools, health care agencies and state legislatures. However, there are growing concerns that, despite the best of intentions, these efforts may contribute to unintended negative consequences. It is critical that they do no harm.

Above all, it is important that efforts to prevent obesity take into account the high prevalence of eating disorders, body dissatisfaction, disordered eating, nutrient deficiencies, unhealthy weight loss efforts, binge eating and size prejudice.(1,2)

In any such programs it is advisable that from the beginning eating disorders and related problems be incorporated along with obesity prevention, preferably right upfront in the title or a subtitle.

A starting framework in fostering a broader way of thinking about these issues and seeking to prevent a wide range of weight-related problems is offered by Dianne Neumark-Sztainer, Ph.D., M.P.H., R.D., of the School of Public Health, University of Minnesota. She sets out five research-based recommendations:(3)

1. Discourage unhealthy dieting; instead encourage and support the use of eating and physical activity behaviors that can be maintained on an ongoing basis.
2. Promote a positive body image.
3. Encourage more frequent and more enjoyable family meals.
4. Encourage families to talk less about weight and do more at home to facilitate healthy eating and physical activity.
5. Assume that overweight teens have experienced weight mistreatment and address this issue with teens and their families.

The goal is to help teens and their families focus less on weight and more on healthful, sustained behavioral change.

In schools, some obesity prevention programs may inadvertently contribute to negative self-esteem, body dissatisfaction, eating disordered behaviors among young people and reinforcing anti-fat stigma. Having an eating disorder specialist in on the planning, and a clear awareness of eating disorder risks helps to prevent such harmful effects.

Excellent planning guidelines are available from three resources to help schools with these issues. They are:

More information is available at the Schools section of this website. http://www.healthyweight.net/schools.htm

This includes the diagram that many schools are finding helpful in promoting “Healthy Students of All Shapes and Sizes” as illustrated in the model.


  1. Fisher M, Golden NH, Katzman DK, et al. Eating disorders in adolescents: A background paper. J Adolesc Health 1995;16:420–37.
  2. Golden NH, Katzman DK, Kreipe RE, et al. Eating disorders in adolescents: Position paper of the Society for Adolescent Medicine. J Adolesc Health 2003;33:496–503.
  3. Neumark-Sztainer, Dianne. Preventing Obesity and Eating Disorders in Adolescents: What Can Health Care Providers Do? J Adolesc Health 44, 2009;206–213.
  4. Guidelines for Childhood Obesity Prevention Programs: Promoting Healthy Weight in Children, from the Society for Nutrition Education, 2002. In English and Spanish. http://www.healthyweight.net/schools%20SNE.pdf
  5. Weighing and Measuring Students in School Settings: A Position Paper. Developed by the North Dakota Healthy Weight Council, 2007. Dept. of Health, Bismarck
  6. Danielsdottir, Sigrun, Burgard Deb, Oliver-Pyatt Wendy. Academy for Eating Disorders. Guidelines for Childhood Obesity Prevention Programs. Feb. 26, 2009. http://aedweb.org/media/Guidelines.cfm

Copyright 2009-1994 by Frances M. Berg, Healthy Weight Network, Hettinger, North Dakota. All rights reserved. www.healthyweight.net





352 pages


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352 pages



Also accepts Visa, MasterCard, Discover and American Express.

If ordering more than 4 books, call for shipping costs.




496 pages



Also accepts Visa, MasterCard, Discover and American Express.

If ordering more than 4 books, call for shipping costs.