A Study in Paradigm Entrenchment

I have seen some crazy things when it comes to study interpretation but this one may take the cake.  The full article is here, but here are the high points:

The study looked at weight loss in post-menopausal women during and after a five month diet. They found that:

  • the women lost about 12% of their body weight
  • within a year more 3/4 of the women had regained their weight (some having gained more than they lost)
  • the weight that they lost was twice as much fat as muscle
  • the weight that they gained was four times as much fat

To be clear, this study did not include a control group and so they aren’t sure if the proportion of weight regained is because of the dieting, or due to the natural change in body composition over time.

They are sure that, yet again, dieting left most people as fat or fatter than when they started -after one year 75% of the women (and we would expect it to be 95% after two years) were as heavy or heavier, and had more fat and less lean muscle than when they started.

So what does researcher Barbara Nicklas, PhD, professor of geriatrics and gerontology at the Wake Forest School of Medicine say?

I think there are huge benefits to losing weight. When older obese people deliberately slim down, their osteoarthritis improves. They can get up out of chairs and climb stairs more easily. Even if they eventually regain all of the weight, she says, it usually takes a few years to do it.

Ok, there is confirmation bias, which is a bad enough trap for a scientist to fall into, but then there’s sticking your fingers in your ears and yelling LALALALALALALA.  I feel pretty strongly that this is the latter – this is a special kind of stupid. First of all, nothing in her data proves that weight loss will help osteoarthritis, stair climbing or getting up out of chairs.  But even if it did, this woman really thinks that a “huge benefit” is to have these improvement for a year before you gain the weight back (and then some) while losing muscle mass, thus leaving you in worse condition than when you started for the rest for the rest of your life?

You know what helps people get up out of chairs and climb stairs more easily?  Movement and increased strength  (of which weight loss is a possible, but likely temporary, side effect).  You know what doesn’t help getting out of chairs, climbing stairs, or osteoarthritis?  Being heavier than you were a year ago with less muscle mass.  Would we give someone medication that prevents heart attacks for a year and then INCREASES their heart attack risk for the rest of their lives?  Would you take birth control that had a near 100% success rate for the first year but then made you MORE likely to get pregnant for the rest of your life?

Nicklas also notes that “There are a few very vocal geriatricians who are totally against an older person losing weight,”   Which is to say that, apparently, there are only a few geriatricians who posses both a basic understanding of human anatomy and the ability to do very simple math.

The title of this article is “If Postmenopausal Women Lose Weight, They’re Better Off if They Keep It Off”   Which is the equivalent of saying “If Postmenopausal Women are in a Plane Crash, They’re Better Off if They Can Fly.”  Nothing in the study suggests that the researchers have the slightest clue how to keep these women from regaining their weight, only that when they regain it, they may be gaining fat and losing lean muscle. Were we not so entrenched in a weight loss paradigm, a more reasonable title would be “Study Shows that Weight Loss Attempts May Not be Beneficial in Post Menopausal Women”. Somewhat unbelievably that would likely be controversial, but the ridiculous conclusion that “there are huge benefits to weight loss” is what we expect to hear despite no actual benefits being proven by this research.

I’m not just talking about this because I love a good rant (although I do).  I say it because this is the kind of thing that gets picked up by the media with the headline “Huge benefits to losing weight in later life, says researcher”.  We have to remember to keep a very critical eye and ask questions because people are very seriously entrenched in the weight loss paradigm and clear evidence, even evidence that they created, cannot always shake their belief in the mystical, magical power and likelihood of weight loss.

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19 thoughts on “A Study in Paradigm Entrenchment

  1. I’d like to read the actual study. The tone of the WebMD article is actually quite skeptical, I think, and leans in the direction of saying that weight cycling is harmful, especially in older adults who may lose lean muscle. So, although I agree with your frustration about the researcher’s statement, remember that what you’re reading is a quote by a journalist, not the actual analysis of the data.

    1. Hi Chris,

      I did read the full study. I chose to comment on the article because that is what is part of the public discourse. To be clear the quote is not by the journalist – the quote is by the researcher as recorded by a journalist. The conclusions section of the abstract says “Although not all postmenopausal women who intentionally lose weight will regain it within 1 y, the data suggest that fat mass is regained to a greater degree than is lean mass in those who do experience some weight regain. The health ramifications of our findings remain to be seen.” I find it a bit odd that their first sentence highlights the fact that a small percentage of women didn’t regain weight, rather than that the majority had.


  2. Nicklas also notes that “There are a few very vocal geriatricians who are totally against an older person losing weight,”

    Gee, I wonder why this is?

    Could it have anything to do with living in a culture where all research is interpreted as claiming weight loss is good, so that even if you have actual evidence suggesting the obvious, everything thinks you’re denying a basic fact of medicine? Could it possibly be a factor that a very small percentage of the population experiences healthy, sustained weight loss and they get such a disproportionate emphasis that not only is no doctor likely to ignore them, most doctors are likely to assume those people are the norm? Could it be anything to do with the pervasiveness of conventional wisdom being stronger than scientific evidence? Could doctors who oppose weight loss be reluctant to speak up? Could they be given less of a platform than doctors vocally pushing weight loss?

    No, that’s just being silly. The most commonly-expressed belief among doctors who are given a public platform must be scientifically accurate. That’s how science works, after all! /sarcasm

  3. Big Fat Blog also discusses this article. Anyway, as a menopausal woman I’ve lost weight and regained it due mostly to change in exercise routine that I couldn’t maintain long term. I still have as much muscle as before since I walk everywhere. I regained the weight while exercising over an hour a day. The exercise routine didn’t keep the weight off forever. I kept trying to exercise more to keep it off, but eventually, I gave up.

    I now exercise at least an hour a day three or four days a week, not perfect, but I think it maintains my muscle mass. I never check my bodyfat levels, but I feel a solid as ever and I can fix into my old jeans. I think if one loses weight intentional or not and regains that they need to keep exercising. I think being sedentary is the bigger problem.

  4. I wonder if the people who join these clinical trials are told that doing so is likely to result in weight gain over the long term? I bet that most people sign up to be part of it because they think they”re getting medically supervised weight loss.

  5. Count me as one postmenopausal woman who is NOT going to diet, ever, for any reason. I am staying as active as I can & trying to manage joint pain, but weight loss does not help health issues & in fact often exacerbates them & considerable research has shown that for those of us who are older, weight loss increases mortality risk by several hundred percent. Perhaps that is part of what the ‘few’ geriatricians are aware of.

  6. These kinds of research trials study weight loss outcomes (short term) but they could choose to focus on, instead, are results of changes in diet and exercise, independent of weight, with hypothesized outcomes of improved well being (increased mobility and decreased pain related to decreased inflammation–such as reduced pain from arthritis and/or fibromyalgia), improved sleep patterns, and decreased symptoms of metabolic syndrome (thus, less fatigue and muscle weakness, lower insulin resistance, and lower blood pressure.) All of these improvements in symptoms and risk factors may result from gentle changes in diet and exercise–without cutting calorie amounts or requiring odious activities.

    Incorporating new kinds of movement, as you demonstrate so beautifully with your dancing, can be highly pleasurable and relaxing (or stimulating!) Weight loss should not be the goal because behaviors that correlate solely with weight loss (calorie restriction) seldom improve risk factors or reduce symptoms in the short or long term.

    However, at least 3 major problems arise when encouraging people to change their diet and exercise patterns: 1) People tend to think in terms of losing weight as the desired “health improvement” goal/outcome because that’s what our culture throws at them 24/7; 2) A classist and/ablist bias assumes that people have equal access (or ANY access, period) to factors such as adequate income/time, which may be critical variables in behavior change; and 3) Stress plays a major role in disease processes and cannot be controlled for (in populations) under current conditions of social injustice, inequality, and other social determinants of health (such as unsafe environments, health care rationing, and/or lack of transportation).

    So, basically, the weight cycling industry (including much of the medical research establishment) keeps endorsing calorie deficit/increased hunger diets for people with the insane expectation that humans can magically endure, SOMEHOW—and long term—the “madness of hunger.” It’s barbaric.

    Speaking of paradigms, I recommend “The Paradigm Dialog” by Egon Guba (Ed.) to explore better options to conventional positivism (classic quantitative studies.)

  7. Who does an experimental study and doesn’t include a control group? And more importanly, who gives funding to an experimental study that doesn’t include a control group? To me, as a statistician with an MsPH, this study was a complete waste of money, time, effort and mental energy! You absolutely cannot conclude a single thing about their study without a control group. What IRB does this investigator report to? They are obviously not doing a good job!

  8. “Would you take birth control that had a near 100% success rate for the first year but then made you MORE likely to get pregnant for the rest of your life?”
    I can think of a lot of people who would like that. It’s perfect for women who want to start a family in a year.

  9. I have Graves disease, a type of hyperthyroidism. Mostly, it’s in remission, but I’m currently in my 3rd relapse. One of the symptoms is weight loss.

    When the Graves first occurred, my first baby was about six months old and I was breastfeeding him. Contrary to Hollywood stars with personal trainers and chefs, it took me about four months to fit into my pre-pregnancy clothes again, but suddenly the weight started falling off without my doing anything. I was thrilled and chalked it up to breastfeeding. This went on for about two months until one day I was signing something at the bank and realized that my hand was shaking so much I didn’t recognize my own signature.

    A blood test revealed that I was hyperthyroid. The endocrinologist explained that all the weight I had lost was muscle, not fat, and proceeded to show me how weak I was with a simple resistance test on my arms.

    Now, whenever I lose even a pound, I wonder whether it’s the Graves–and practically inevitably, it is. The only time I lost weight was when I discovered intuitive eating. I lost about 10% of my body weight, gained back about 5% and have stayed pretty stable ever since.

    I’m now on medication again and guess what? The weight’s climbing merrily back to my pre-Graves level. I fear that it’s mostly fat and that the muscle is not coming back for the most part since arthritis prevents me from doing anything but moderate walking and gentle yoga. I just do my best to stay as healthy as possible.

    Let’s hear it for HAES. Honestly, is there any other real option? I think not!

  10. Regan, another fabulous post.

    I actually wonder if this widespread phenomenon of focusing on what the dieter must be doing as opposed to the process of dieting is also a roaring case of the fundamental attribution error – (http://en.wikipedia.org/wiki/Fundamental_attribution_error).

    The support for dieting is a perfect storm of economic self-interest, heuristic bias, paradigm strain, limitations of the medical model, the resistance of healthcare providers to feeling helpless to deal with patient unhappiness (often stemming from weight stigma, not being at a higher weight per se), social conformity, stereotyping, scapegoating, ignoring class/SES, and the dieter’s own Fantasy of Being Thin as a way to solve all problems (http://kateharding.net/2007/11/27/the-fantasy-of-being-thin/).

    I love the plane analogy – I was thinking too, I wonder what geriatrician would advise the patient to use up their retirement funds for one really great year, even if it meant struggling financially for the rest of the person’s life. Especially if there was a way to have a really great year without blowing your savings, and even more especially if there was a way to have all the remaining years be great.

  11. “If Postmenopausal Women Lose Weight, They’re Better Off if They Keep It Off”… Why is it so completely impossible for anyone to suggest that you don’t have to lose weight in the first place? I get really weary of these studies that offer good information to help us break up the idea of weight equals health but then the researchers or the journalists have to toss in, “But you should still not be fat!” Ugh. Fail.

  12. My Grandmother (may she rest in peace) had a doctor that discouraged her from losing weight and simply prescribed a physio regimen that would help her gain strength. He said the excess ‘fat’ on her frame would help protect her from a broken bone in case of a fall (which since she suffered from mini-strokes quite frequently, were a common occurrence). My Grandmother would have been considered obese for her 5’4″ frame, however she never had a broken bone or problems with osteoporosis. Her movement issues occurred because of a lack of will to go on after my Grandfather passed. I think people at any age but especially at 70+ should be encouraged to enjoy their time and not restrict it.

  13. Nicklas also notes that “There are a few very vocal geriatricians who are totally against an older person losing weight.” Who to the what now? I live in Florida, land of the geriatric, and the vast majority of the elder-care specialists down here take weight loss as a sign that something’s wrong, not right.

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