In a previous post, I described the size of the weight cycling epidemic as 70 million U.S. adults losing weight at any given time who will regain their weight. That’s 30% of all adults in the U.S. The sheer numbers of those who weight cycle each year, and throughout their lives, make this an epidemic with huge economic and societal costs. It is one of the greatest human-made public health problems we face today.
But just as great is the effect weight cycling has on an individual over a lifetime, an impact well beyond the effects of being overweight or obese. Here are some things that happen to people who try to lose weight and why it’s critical to understand them.
“I Feel Trapped on an Emotional Rollercoaster”
Weight cycling exacts an enormous emotional toll. Depressive symptoms are associated with weight cycling, but this doesn’t paint a full psychological picture. The experience is best shared in a story.
I interviewed numerous weight cyclers who shared their experiences. They often began by describing previous weight loss attempts and lessons they learned. Eventually, however, they all described the emotional rollercoaster that accompanied their weight cycling.
One interviewee in her early 30’s - let’s call her Jane - discussed the rollercoaster-weight cycle experience in extraordinary detail. Each cycle began with a trigger, such as looking in the mirror or having difficulty sitting in an airplane seat. The pain of the trigger drove her through a progression of very sophisticated, stage-based diet and exercise regimens she developed over years of weight cycling. She spoke of the rush or high she would feel during the weight loss phase of her cycle. Then inevitably, she would slide down the “punishing loop” phase, caused by the need for increasingly rigorous diet and exercise to reach and then simply maintain her weight goals. During this phase, she would also experience the pressure, fear, and sense of vulnerability of not being able to “keep it up.” This “punishing loop” is a horrible place to be. After exerting tremendous willpower and effort, she would eventually become overwhelmed. All it would take to relapse were common disruptions in her life, such as increased stress at work. This would always be accompanied by a sense of guilt, shame, and failure. Having relapsed, she would begin to regain her weight, until the cycle repeated with another painful trigger. She had already completed several weight cycles in her life.
Jane is a highly educated and successful business woman who has always been extremely motivated to lose weight. Over the years, she put in the time and effort. She tried medically supervised weight loss. She used personal trainers, nutritionists, and naturopaths. She tracked everything and tried many weight loss apps. She studied weight loss extensively on her own, learned things that seemed to work for her during each cycle and applied them to the next. Yet she couldn’t break the weight cycling.
Nearly all weight cyclers I interviewed said they felt trapped in repeating weight cycles and on the emotional rollercoaster. They tried to get off but couldn’t.
During my interviews, the interviewees’ emotions would always break through. This only proved their tremendous courage to share their painful stories in the hopes they would help others. It was plain to see weight is one of the most difficult emotional issues they face in their lives. There was no way to not be deeply touched by their struggles.
No doubt some of you have similar experiences and yet have found the will to try again.
“I Feel Punished for Even Trying”
You might be conflicted about trying to lose weight again, especially if you end up regaining it like you did last time. I agree - another attempt should give you pause if you’re just going to tackle it the same way as before.
Weight cycling is a perverse punishment because it is reserved exclusively for the very people who try to improve their health, appearance, self-esteem, and lives in general. As described above, each cycle initiates an emotional rollercoaster. But the costs don’t stop there. Let’s take a step back and see what the process nets you. You have to muster the courage to hope and to risk failure, over and over. You can lose tremendous time and effort, added up over years, even decades. Then at the end of each cycle, you are punished with weight regain. Perhaps worst of all, many people (1/3 to 2/3) regain more than they lost.
Imagine committing to get healthier, only to be punished by getting worse.
It’s been suggested that if you’ve weight cycled multiple times, you’ll be less willing to attempt weight loss in the future. I think it’s worse than that. Perhaps the most horrible effect of our society’s failure to address obesity is, if you’ve weight cycled in the past, you may have learned it’s not worth trying again.
Weight cycling is an epidemic of learned helplessness among those who try to improve their lives.
At any given time, with about 70 million people likely to regain the weight they lost, perverse punishment is nothing less than a public health tragedy on a massive scale. As a member of the health care community, my biggest frustration is: we haven’t been able to help people who are actually trying. This damage needs to be undone.
Is Weight Cycling Harmful?
For over 30 years, researchers have explored whether weight cycling itself was harmful to your health (1, 2) beyond the effects of obesity. Results ranged from finding no difference in health compared to those who are stable in their obesity, to increased risk for various conditions such as heart disease and mortality. In the past, health care professionals have even recommended that diet-based weight loss programs should not be funded because the “benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity.” More recently, the pendulum has swung the other way, with a recent review of the scientific literature arguing that increased disease risk related to weight cycling is sparse, and “weight loss intervention should not be discouraged because of a person's propensity to be a weight cycler”.
This area of research is a quagmire of mixed and inconclusive results. It may be that certain populations are at greater risk for certain health issues after weight cycling, and other populations for developing different ones. As this field of research standardizes its study designs, the question remains open.
My takeaway message is this:
Don’t be afraid to try to lose weight for fear of the health effects of regain.
And if you’re going to do it, make it count
by focusing on achieving SUSTAINED weight loss
Here’s Why Focusing on Weight Cycling Matters
So why did I detail the personal toll of weight cycling?
Understanding the pain of weight cycling is the start to breaking the cycle
We’re all driven to lose weight in part from the psychological pain of being overweight. That was certainly true for me. But focusing exclusively on removing JUST that pain is part of what leads to weight cycling itself, which I will illustrate in future posts. A better pain to target is the entire toll of weight cycling. Feeling the cost from a broken process makes you want to fix that process.
Let’s step back and look at the big picture. Consider the Emotional Rollercoaster, which starts with the pain of being overweight and goes on from there. Then add the psychological harm of Perverse Punishment of regaining weight. This is the collective pain generated throughout each cycle AND afterwards. This is what you want to fix. Don’t just lose weight. Lose weight in a way that doesn’t lead you to weight cycle.
Successful (and Happy!) Sustainers have Solved the Weight Cycling Problem
Now that you recognize the toll weight cycling has taken, let’s make something good come from it. For a long time now, there has been hope, if you know where to look. Long term sustainers (people who have maintained long term weight loss) do exist. They have been studied and reported on extensively. Researchers have isolated many things they do differently from weight regainers. Let’s see how sustainers begin to break the weight cycle.
Through my interviews, I’ve learned that sustainers don’t just go on an all-out quest to lose as much weight as possible. Instead, driven by a strong desire to avoid weight cycling again, they go on an all-out quest to lose weight in a way they can live with. How? Here’s the insight you’re ready for.
Many sustainers have discovered a way to enjoy the process of losing weight and the resulting lifestyle that sustains their weight loss.
Incredibly, many sustainers enjoy their new lifestyles as much as or more than their previous lifestyles. What does this mean? It isn’t just that losing weight and keeping it off can be enjoyable. Maybe enjoying the process is essential to sustaining your weight management efforts.
This is how sustainers end weight cycling and avoid its toll. You can lose weight in a way that makes you more and more miserable, but you’ll almost definitely gain it back. In contrast, those who become sustainers adapted their approach so that it’s more and more enjoyable. I’ll show you how sustainers do this in future posts.
What You Can Do Now
Cement your own experience weight cycling. The goal is not to relive the pain, but to acknowledge it as a concrete and important problem to solve. Have you been on your own version of the Emotional Rollercoaster of Weight Cycling? Have you felt punished for trying to lose weight when you regain it? Some things in this article will apply to you while others won’t – everyone’s experience is different. But the pain each of us feels as we weight cycle results in part from an unsustainable approach to weight loss.
Let’s recognize what you just accomplished. Your big leap forward from this article is that you now understand the toll weight cycling takes on you, and hopefully you’ll take that toll seriously in your weight loss plans. From now on, don’t think only of the pain of being overweight, but also the pain of weight cycling. You may have just shaved years off your weight loss journey.
You have taken a big step towards becoming a sustainer by realizing the need to deal with weight cycling.
So how do you avoid weight cycling the next time you lose weight? That is the right question, the right focus. If the weight cycling epidemic is a terrible experience that everyone wants to fix, and we already know what successful sustainers do, why does just about everyone weight cycle at least once? In future posts, you’ll see why the dieting mindset is so hard to break.
Until then, I’d love to hear your comments.
Chris Tsai, MD
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