Doctor's Fault
18 April 2016

“A bad workman blames his tools”, the saying goes. So too, it seems, can dieters. Researchers from the National Institutes of Health reported in the Lancet that for many dieters failure to achieve their desired weight loss was the fault “of experts because they gave us the wrong advice”. Seems the wrong advice stems from unrealistic expectations about what weight loss can really be achieved through diet and exercise. Dieters give up their new diet and lifestyle early because they become despondent about their slow rate of weight loss. Look at the advice given by the British Dietetic Association (BDA), and the NHS, and you’ll find they advise that weight loss of around one pound a week is about right. Follow that through for 52 weeks and you should, they say, lose 52 pounds. Obvious? Not so. Because that’s not what’s borne out by reality, or by most people’s experience. Reality is that weight loss occurs at different rates throughout the weight loss cycle, often slows to a halt around 6 months, and then, for many, the slow process of weight regain begins. The rational for the one pound a week figure comes from simple physiology. A pound of fat is made up of around 3500 calories. Decreasing your intake, or increasing energy expenditure to achieve a 500 calorie decrease each day would amount to 3500 calories over one week and result in one pound of weight loss. That’s the basis on which the vast majority of  weight loss programmes are founded. According to a spokesperson for the BDA, “it’s what we are taught….but I don’t know what the scientific evidence is”.

My experience of working with overweight patients for many years is certainly that many don’t see it through, that they make a good effort to begin with, and are buoyed by their initial success, but find the going tough. Those who do achieve long term success are almost always, and with very few exceptions, those who stick to their new dietary regime long-term, who find simple ways to satisfy their hunger, and who maintain their new physically active lifestyle. So, in attempt to set myself apart, and to prevent any misunderstanding, this “expert” wants to make it clear what “realistic expectations” of weight loss a new dieter might have at the outset, and see through to success. All the credible and trusted clinical trials I have read over the years would suggest that a realistic expectation of weight loss over a 12 month period of diet and exercise would be about 20 pounds, or around one and a half stones. Some more, some less, but 20 pounds would be an average. Being an “average” of course means that some people will go on to lose much, often several stones, more, and some will lose less. Dr Cheryl Rock’s independent study, published in the Journal of the American Medical Association in 2010, showed that dieters lost on average around 10% of their body weight, or 9.1kg (20 pounds) over a 12 month period by following a portion controlled, home-based, professionally supported weight loss programme. So for me, and for the vast majority of those who want to lose weight, that’s realistic. Realistic, achievable, and without doubt enough to make anyone feel better in themselves, and improve their health. And enough to bring a smile to your doctor’s face. So go on, prove the experts wrong. Again.