What You Can Change _. And What You Can't - Martin E. Seligman [96]
Michael Weintraub, an obesity researcher, coordinated a well-done study of these two drugs.28 One hundred twenty-one participants, mostly women, started the study at over two hundred pounds. The study lasted four years: Those women receiving the drugs (coupled with behavior therapy and exercise) lost an average of thirty pounds and kept the weight off for as long as they took the drugs. As soon as they ceased taking the drugs, however, the weight returned.
These two drugs have some side effects—dry mouth, nervousness, sedation, vivid dreams, and depression—which are milder than the early appetite-suppressing drugs. The side effects are not trivial, though, and because of them, more than one-third of the patients dropped out without much benefit. Overall, however, one-third of the patients lost a good bit of weight and kept it off—a much better result than any diet has achieved. Future research on these drugs should determine the long-term effects of taking them, and how to reduce the side effects and therefore the dropout rate. The development of these drugs is promising, but until more research is completed I regard them as experimental.
Overweight vs. Dieting: The Health Damage
Being heavy carries some health risk. There is no definitive answer to how much, because there is a swamp of inconsistent findings. Distilling these findings is hazardous, but here is my best guess:29
Enormous obesity (double “ideal” weight or more) may well cause premature death.
Substantial obesity (30 to 100 percent above “ideal” weight) possibly causes health damage and may be associated with somewhat increased mortality.
Mild to moderate overweight (10 to 30 percent above “ideal” weight) may possibly be associated with a marginal increase in mortality, particularly for those at risk for diabetes.
Underweight is clearly associated with substantially greater mortality.
If you are overweight, you should ignore scare tactics like Optifast’s desperate “Obesity is a death sentence” ad. Even if you could just wish pounds away, never to return, it is not certain you should. Being somewhat above your “ideal” weight may actually be your healthiest natural condition, best for your particular constitution and your particular metabolism. Of course, you can’t wish pounds away, but you can diet them away with any popular diet, chosen at random. But the odds are overwhelming that most of the weight will return, and that you will have to diet it away again and again. From a health and mortality perspective, should you diet? There is, probably, a serious health risk from losing weight and regaining it.
There have been three large-scale studies of weight cycling and death. The first, a study of one million Americans, is often overlooked since it shows increased mortality with increased weight. But it also shows that men and women who lose more than ten pounds in five years have substantially more heart attacks and strokes than expected. This is true of the people who lose weight voluntarily (dieters) as well as the people who lose weight involuntarily because they are ill. In the second study, men who had at least one cycle of loss and regain are at double the risk for death from heart disease than men who progressively gain weight over twenty-five years. In the third study, more than five thousand men and women from Framingham, Massachusetts, were observed for thirty-two years. People whose weight fluctuated over the years had 30 to 100 percent greater risk for death from heart disease than people whose weight was stable. When corrected for smoking, exercise, cholesterol level, and blood pressure, the findings became more convincing, suggesting that weight fluctuation (the primary cause of which is presumably dieting) may itself increase the risk of heart disease.30
Being overweight is risky. But dieting is risky as well. Which risk is bigger? From a health perspective alone, should you diet or not?
I suspect, but I am not yet certain, that the weight-fluctuation