Learning Curve: Do 95% of People Who Lose Weight Really Gain It Back?
It’s a statistic you’ve probably heard a lot over the years: 95% of people who lose weight on a diet will gain it back.
Nobody is saying that losing weight is easy, but is that really true that most people don’t keep it off? Why, or why not?
Where did that 95% number come from, and why do we still use it?
Should we just not even try to lose weight?
A history of the 95%
The 95% statistic is from a 1959 study by Dr. Albert Stunkard and Mavis McLaren-Hume. The study looked at 100 people at an obesity clinic who, in the words of Stunkard, ‘were just given a diet and sent on their way.’
Funny enough, even Albert Stunkard doesn’t support the 95% statistic being used today. He told the New York Times in 1999, “That was state of the art in 1959. I’ve been sort of surprised that people keep citing it; I know we do better these days.”
We should probably listen to him.
There are some who believe that intentional weight loss is not only more dangerous than being overweight; it’s also unsustainable and pointless and shouldn’t even be attempted, because you’re going to fail at it, like 95% of people.
There’s that statistic again!
Let’s put this into perspective:
5% of 10,000 is 500. So if the statistic was true, 500 people is still a significant number. As Kevin Bass puts it in this Twitter thread, some medical therapies – blood pressure medication, mammograms, statins etc. – has similar or lower efficacy. But we don’t stop using them, because they do help some people. So why discourage people from trying to lose weight?
Some people will rebut that point by saying that those therapies don’t cause eating disorders, but diets do.
This theory has never been proven. Correlation doesn’t equal causation, and I think that for the vast majority of people, diet behavior may be a symptom, not a cause, of disordered eating. Sure, weight loss might appear to be a trigger for an ED, but underlying issues were probably the cause. Also, I assume that people who are predisposed to ED or who have ED are more likely to go on restrictive diets.
Weight loss is not for everyone
That being said, effective nutrition therapy doesn’t mean an RD accepts everyone for weight loss counselling. It means they take the time to work with a person to understand their history, asking the right questions to determine if they’re at risk for an eating disorder or have had one that was undiagnosed. The fact is that weight loss is not appropriate for everyone, especially people who have no weight to lose.
In counselling, we manage client expectations while meeting them where they are, and changing their habits. And as far as the ‘weight loss,’ part, it’s probably not what you think.
We demystify and de-weaponize food. We teach clients how to accept their body the way it is. Even if they don’t want to love it right then. Weight loss may result from the changes they make, in particular if they’ve been consuming a lot of ultra-processed foods.
Whether clients lose or not, the changes we make can have a tremendous positive impact on their life in terms of physical and emotional health.
Most importantly, we aren’t trying to make ‘fat’ people ‘thin.’ That’s pretty much the last thing I’ve ever tried to do, wanted to do, or promised to anyone.
Weight loss, at least in my practice, is never an indicator of success. I don’t even have a scale in my office.
Is intentional weight loss unsustainable?
Putting the 95% stat to the side for a second, there’s still the insistence that most intentional weight loss is unsustainable.
And while most of us know people who have lost weight and kept it off, modern studies on weight loss can be discouraging in terms of results.
This is because of a few things.
First, the diets that people are put on when they participate in a nutrition study are usually restrictive: Super low carb, very low calorie, etc. They’re not individualized to the actual person, and they’re hard to maintain for the long-term. So, it’s not surprising that the rate of attrition is high in many diet studies, likely along with the rate of regain.
It’s not rocket science: if you lose weight on a restrictive diet and then start eating your normal diet, you’re going to regain the weight you lost.
Is there a weight-health link?
People don’t always want to lose weight to look better. Although some groups say that weight loss doesn’t improve health, the fact is that in not all, but many cases, it actually does.
If someone with obesity has high glucose, chances are that losing weight will improve that. If an overweight person has high blood pressure, losing weight may reduce it. Pregnancy can be more risky for somebody who is obese. An obese person with sore knees who loses weight obviously takes the pressure off of their knees. There are a lot of examples that I can give.
And again – because weight loss isn’t appropriate for some people, should we not be using it for others?
Taking the weight-health link a bit further, this 2013 review of studies that has been quoted numerous times (mostly in articles about weight stigma) purports to show that diets don’t improve health outcomes like cardiovascular risk and blood glucose. This argument is often used by certain groups, but the evidence doesn’t support it.
Take this review as an example.
Most of the studies used in it (and yes, I went through every single one) all put participants on weight loss diets that were either low in fat or low in calories. Many of them weren’t even measuring health outcomes. Many of them were over 20 years old, and used outdated diet recommendations such as replacing fats in the diet with 6+ servings of grains.
Even more bizarre, more than a few of the studies actually contradicted the authors’ hypothesis, finding that weight loss positively affected health outcomes and/or that longer-term weight loss could be sustained. One study on blood pressure even concluded that “Clinically significant long-term reductions in blood pressure and reduced risk for hypertension can be achieved with even modest weight loss.”
Another concluded that “Reduced sodium intake and weight loss constitute a feasible, effective, and safe non pharmacologic therapy of hypertension in older persons.”
These conclusions echo much of what I saw when I delved into the studies.
The review authors admit that the positive outcomes might have confounders such as ‘increased exercise, healthier eating, and engagement with the health care system.’
‘Healthier eating’ resulting in positive outcomes isn’t what I’d call a ‘confounder’ in a review that tries to show that diet and health aren’t linked.
Don’t get it twisted – Diet culture SUCKS.
Regardless, there must be a distinction made between RDs and the diet industry.
We don’t put people on ‘diets.’
We all hate the diet industry, diets, and diet culture. We know that restrictive diets seem to increase likelihood of weight regain, metabolic damage, and a breakdown of a person’s relationship with food, eating, and their body. We deplore weight stigma, and believe that a person’s weight should never affect the quality of or access to care that they receive.
If not 95%, then what?
Do I know the exact percentage of people who lose weight with behavior change and a non-restrictive way of eating? I don’t. Some estimates place it at around 20%, but even that is up for debate.
But I do know that telling people not to bother trying to lose weight because they’re just going to fail, is as defeating as it is incorrect.
The Bottom Line – Meeting folks where they’re at
If a person wants to lose weight for whatever reason, giving them some guidelines about what they should be eating, teaching them to eat intuitively, and digging deeper to help them work on their emotions and behaviours around food and eating is not pointless.
Teaching them to focus not on weight, but on finding joy in their life and in food and in what their body can do, is a good thing. Treating the desire for weight loss as something shameful and harmful, is not.
People will always want to lose weight. That’s never going to change. The best thing we can do is not to ignore that, but to accept it and work with them in the kindest, most gentle way possible.
We’re making progress in understanding that not everyone is the same, and that individualized care is key to getting people away from restrictive diets and into a way of eating that they enjoy. When people find joy in food and eating, they’re more likely to keep going with those behaviors.
Yoni Freedhoff, an Ottawa obesity medicine physician, is in the process of developing a toolfor assessing satisfaction with eating patterns, meant to tailor eating recommendations to each client. This will further distance our practice from ‘diets.’
Kevin Hall, who I highly respect for his work in nutrition science, published this 2018 studyabout long-term weight maintenance strategies. In it, he describes what we already know: managing weight is a lifelong commitment, just like managing other aspects of one’s health.
But it can be done, with strategy, support and compassion.