Alfred Dawes | Why do we regain weight?

Not until you have lost weight and regained, will you truly appreciate of what I speak. For persons who have been on crash diets, proper nutritional programmes, or even had weight loss surgery done, they will realise at some point in time that weight regain is a very real and credible threat. In fact, some bariatric surgeons treat obesity as they would cancer. They use terms such as obesity going into remission, and disease progression, whenever the pounds start coming on faster. To lose weight from a body mass index (BMI) at which one would be considered obese is, therefore, not successful weight loss, but success in putting the chronic disease we call obesity into a cancer-like remission.

Considering obesity as a cancer that can recur at any time is a logical approach to a complex problem. Several large studies have looked at the success of obese persons who have lost weight through medication, diet and exercise programmes and surgery. What is shocking but rarely ever spoken of outside of bariatric surgery circles is that the chance of losing weight and keeping it off for at least 10 years is less than five per cent if your BMI is over 40.

If you went to a doctor and they prescribed a pill that would be effective against your medical condition one out of 20 times, you would probably lambast them for wasting your time. Yet every year, billions of dollars are spent by morbidly obese persons in a quest to lose those elusive pounds. Even if they are successful and become disciples for the latest shake, diet or exercise fad, the weight comes piling back on over the next few months or years.

TOO COMPLEX

Obesity is simply too complex a disease for it to be solved with a single magic bullet. The environment, our parents’ habits and genes, our jobs and the available foods are all significant contributors to our weight. Ignorance about obesity is found throughout society, but is most scandalous in the healthcare industry. Unfortunately, money wilfully blinds those who continue to peddle ‘solutions’ they ought to know will not work in the long term. Crash diets and cosmetic surgery are not sustainable weight-loss options. Presenting them as such to unsuspecting clients is borderline fraudulent.

Crash diets based on extreme caloric deficits can lead to weight loss, but loss of what? The human body, when faced with a crisis of scarcity begins to burn its own energy stores to bridge the caloric deficit created from dieting. The body does not differentiate between fat cells and muscle cells based on your goal, if you present it with a massive deficit. Both muscle and fat will be burned for energy. The result is weight loss due to fat and muscle loss. As muscles contribute significantly to our metabolic rate, losing muscles results in your metabolism slowing, and makes a caloric deficit more difficult to achieve as more muscle is lost. The result is frustration and binging. The diet is over. The worst part is that with a slower metabolism, it is far easier to now gain weight, with a rapid return to or beyond the starting weight. Focusing on primarily fat loss while losing weight in a caloric deficit is possible, but requires a commitment to lifestyle changes that will allow you to lose the weight and keep it off. That is the essence of healthy weight loss.

WEIGHT GAIN

Even with bariatric surgery there is still a chance of weight regain, albeit far less than with diet programmes. If an emotional dependence on food for comfort or stress relief is not addressed prior to surgery, the patient will still find ways to pack calorie-dense foods into their four-ounce stomachs. And therein lies a cause of obesity that is either used to fat shame all persons carrying excess weight, or avoided completely lest one be labelled a fat shamer – some people just eat too much.

Unfortunately, this subset of the overweight is used to stereotype persons who genuinely are victims of the multifactorial disease. As one who has had weight issues myself despite knowing exactly what to do, I can relate to it is a mindset problem. Unless a conscious decision is made to avoid certain foods, situations and even people, weight gain is inevitable.

We can identify the habits and other factors that result in us overeating or eating the wrong foods, but until a conscious decision is made to embark on a programme to address them, we will cycle through fad diets. Understanding that a part of why weight loss is difficult for you is due to your habits and lifestyle, is a major step in successful long-term weight loss. You must change aspects of who you are in order to lose weight healthily and keep it off. It should never be a number on the scale that is the focus of your efforts, but the creation of a lifestyle and environment that inevitably leads to permanent weight loss. This is where no laws, national campaigns or scientific breakthroughs will help. It begins in the mind. A decision to change who you are. Once that plane of consciousness is attained, only then will success come as easy as holiday bloats. It is time to redefine wellness.

Dr Alfred Dawes is a fellow of the American College of Surgeons, and CEO of Windsor Wellness Centre. Follow him on Twitter @dr_aldawes. Send feedback to columns@gleanerjm.com and adawes@ilapmedical.com.