We’re in the midst of a pandemic!
No, not that pandemic. I’m referring to the rapidly increasing worldwide prevalence of obesity, defined by the World Health Organization (WHO) as a condition of abnormal or excessive fat accumulation that presents a risk to health.
Obesity is a serious problem. At the last assessment in 2016, obesity afflicted 650 million adults and 14 million children, worldwide. The condition increases the risk of numerous comorbidities, including cardiovascular disease, type 2 diabetes, and several cancers. In 2014, the global economic impact of obesity was estimated at $2.0 trillion, which is 2.8 percent of the global gross domestic product. What’s more, obesity is increasing at a devastating pace; it is predicted to affect more than half the U.S. population by 2030. More than half!
Profits from the global diet and weight-loss industry are also at a record-high, estimated to be $190 billion in 2019. This statistic seems counterintuitive: How can the prevalence of obesity and profits from the diet industry both be at record levels? The incongruity exists because the diet industry is underpinned by short-term gimmicks and quick fix interventions, neither of which are effective at facilitating long-term weight management.
Why Your Diet Will Never Work
Extreme low-cal, Atkins, dukan, south beach, fasting, the hacker’s diet, paleo, keto … the list goes on and on. My personal favorite, the Inedia Diet, proposes that one can live entirely without food, sustained only on the Holy Breath. Fad diets are a victory for modern consumerism, but the data show they don’t work. After the initial weight loss owing to severe caloric restriction, studies indicate that up to two-thirds of the lost weight is regained within one year, and almost all of it is regained within five years. In many cases, weight increases beyond baseline. This is because diets rarely teach people how to eat healthily in a sustainable way. As a result, people often rebound from one fad diet to the next, perpetually trying and failing to implement long-term change. It’s a vicious cycle characterized by fluctuating weight-loss and regain, a phenomenon so pervasive in the diet world it has its own term: yo-yo dieting. Marketing for fad diets dominates social media, with depictions of emotive before-and-after images and dramatic bodily transformations plastered across Instagram. But those ads never include the “after-after” image showing how the individual’s lost weight has been miraculously found.
Not only do fad diets (like the ketogenic diet and intermittent fasting) fail to promote any aspect of heart health, but the yo-yo dieting that often results may actually increase the risk of heart disease, particularly in woman, and increase the risk of all-cause mortality. The literature also shows a consistent link between fluctuating weight and psychopathology, life dissatisfaction, and binge eating.
Anyone for a Coffee Enema?
Detoxing is another shortcut that’s ubiquitous with the modern health and fitness industry. Juice-fasts, herbal supplements, herbal teas, ear candles, homeopathy, and coffee enemas (yes, really) are just some of the detoxes claiming to facilitate weight loss and purge the body of toxins. But the science shows that detoxes do nothing of the sort, and, as we’ve come to expect from bunk treatments, the research is generally of very low quality and hampered by flawed methodologies. Detox is characterized by a kind of ritualistic purification, drawing inspiration from antiquated notions of evil humors that were once blamed for medical ailments. But these tiny, unmeasurable demons in the body were conceived during a period of medical and scientific naiveté, and their existence is not compatible with modern science. The biological machinery responsible for removing toxic compounds from the body has been well described: The liver and the kidneys, and they usually do a fine job. Accordingly, detoxing has no meaning outside clinical treatments for drug addiction or poisoning.
Some years ago, the claims of fifteen detox protocols (including footpads, detox water, and dietary supplements) were investigated by Sense About Science in their Detox Dossier. Not a single manufacturer was able to provide any evidence for their commercial claims, and no two companies gave the same definition of detox. The dossier concluded that “Detox is a myth. … Many of the claims about how the body works were wrong and some were even dangerous.” But aside from the very real risk of rectal burns from the administration of hot coffee enemas, detox is harmful because it’s premised on the notion that one can atone for lifestyle indulgences by engaging in yet more extreme, short-term behaviors. The reality is that a two-week juice-fast, a liquid diet, or a coffee enema (hot or cold) won’t absolve you of dietary excess. The idea that it can, and hence the popularity of detox, is rooted in our obsession with shortcuts.
What’s the Alternative?
A foremost human trait is to seek simple solutions to complex problems, and obesity is about as complex a problem as you can get. Certainly, it’ll require a unified effort to tackle obesity at its physical, psychological, and socioeconomic causes.
But at a local level, contrary to the claims of the commercial health and wellness industry, the secret to long-term weight management is that there is no secret. There is no quick fix, no “one weird trick to busting belly fat,” no fad diet or detox that’ll yield long-term results. That’s all based on very bad science. The only viable means of achieving any health and fitness goal is to implement long-term behavior change centered on moving more and eating better. This will require many people to acknowledge and break ingrained unhealthy habits and adopt healthy new ones that last a lifetime. It’s a long journey that’ll require time, patience, and sometimes professional interventions from behavioral psychologists and dieticians or nutritionists. But the first step on the voyage is to acknowledge that diets, detoxes, and other delusions are principal barriers to long-term health: This is because they have transience in their architecture.
If the past two years of the other pandemic have taught us anything, it’s that pseudoscience and misinformation are thorns in the side of any initiative aimed at improving public health. Whether it’s obesity, climate change, or airborne viruses, we’re all responsible for improving our critical faculties and confronting bad science in modern culture. This means asking for evidence, being cognizant of our biases, trusting the experts, and holding snake oil salesmen accountable for their claims. Because as long as we’re chasing flashy gimmicks and unproven fads, the truly effective strategies that benefit public health will continue to elude us.