The NWCR and Weight Loss Maintenance “Success”

After the big news about The Biggest Loser broke recently, some weight loss specialists urged the disappointed masses to take heart, not lose faith, and keep on keepin’ on with their weight loss efforts. Why? Because long-term weight loss is possible! The proof? Aside from the completely anecdotal cases they’ve come across in their offices, they point to the 10,000 people who are part of the National Weight Control Registry (NWCR).

The NWCR has been around since 1994. To be eligible to join a person has to have lost 30 pounds and kept it off for one year. Yep – just one year. Because apparently that is the standard for “long-term” now. But I digress.

As we all know, weight loss is possible. Of course it is! Most of us have done it at least once – many of us several times. And in fact, even long-term weight loss maintenance is possible – I know because I was one of those maintainers for 16 years, and I’ve met a few more too. But saying something is possible is different from saying something is likely. It is possible I’ll win the lottery if I buy a lottery ticket…though it’s not very likely that will actually happen, given the usual odds. Should I go ahead and quit my job anyway since there is always that possibility?

And that’s what we’re talking about when we say long-term weight loss maintenance isn’t sustainable for most people. The best data we have says that most people (95% or so) regain some, all or even more weight within 3-5 years of losing the weight. Some people – around  5% of the population, again, based on all the available data – will maintain their weight loss, usually through an enormous amount of effort and vigilance. These are the people being tracked by the National Weight Control Registry.

This group of people is frequently held up as proof that long-term weight loss maintenance is possible (which we’ve already established), but somehow that gets translated to “also likely.” Here’s where we need to put on our analytical and critical thinking caps and do the math. According to the 1999 Behavioral Risk Factor Surveillance System survey, 78% of women and 64% of men were dieting or trying to maintain weight loss; I expect these numbers are even higher now that we seem to be reaching new heights of fat-phobia and healthism. But let’s say that there was nothing special about 1999 and that this number of dieting people is more or less the norm. In 1998 there were 61 million women (I’m just too lazy to count the men right now) between the ages of 15 and 44 – let’s assume this is our potential-dieters category (we’re missing a lot of older women but counting a few younger ones makes up for it a bit). Seventy-eight percent of this number is roughly 47 million (rounded down) females who are dieting each year. But since 1994, the NCWR could only round up 10,000 one-year-weight-maintainers? This represents 0.02% of the population of women – and not even all of them. In reality, it’s hard to derive any sort of real rate of success from this “study group” since this is not a random, representative sample of the population and there is no control group. It’s sort of like asking all the elite athletes in the country to be in this study, and we see what they do to become elite athletes, and then someone says, see, we can ALL become elite athletes just like this tiny group! Uh, no.

Another way to look at this is to estimate the number of Americans who are “overweight or obese” – approximately 60% of adults, or 147 million – and then figure that an average of 71% (78% and 64% averaged) of them are dieting or trying to maintain weight loss – that’s 104 million – so 10,000 weight-loss-maintainers comes out to about 0.01%.  Either way is of course a very rough but generous estimate. Ragen Chastain of the Dances with Fat blog came up with this even bleaker estimate.

The NWCR has been in the news for ages – it’s not some secret society. It’s so NOT secret that even I found it, bumbling around on the internet one day, in one of my chronic internet searches on “How the fuck do you stay thin when you’re this hungry?” I found it and I joined it; after all, I’d maintained my weight loss for years. Wouldn’t other maintainers find it just as easily as I did?

I answered all sorts of questionnaires on how much I ate, and of what, and what kind of exercise I did, and how did I like being skinny? They used food frequency questionnaires which are notoriously sketchy –it’s hard for even the most vigilant eater/dieter to know accurately how much broccoli she ate in the past 6 months. I had disordered eating habits that kept me thin but that didn’t likely translate well on paper – or perhaps they were just expected. Rest assured, probably like many of the other 10,000 “successes,” I was eating very little. If you want to know how many of this elite group maintains their weight loss, I wrote about that here.

Here’s what I don’t know: when I decided to quit dieting because the mental, emotional, and social qualities of my life were seriously suffering despite continuing to maintain a low weight, I don’t know how the NWCR accounted for me as my weight naturally increased. Did they drop me out of their data, and just add in a new maintainer to keep the 10,000 steady? I can’t find any information on drop-out rates or weight re-gain rates. Out of 10,000 people, there must be some other people who didn’t maintain their weight loss. As I filled out the questionnaires with my increasing weight, I started to get the feeling that my data was no longer needed. Eventually, not wanting to do anymore food counting or weight reporting, even for the sake of science, I just quit sending in my information.

(As a side note, I’ll admit, dieting actually “worked” pretty well for me, at least as far as weight maintenance goes. But it also worked to turn me into someone who had learned body dissatisfaction and distrust, who couldn’t have a good meal without guilt or fear, who grasped for societal approval at the expense of her happiness, and who had a burning, singular interest in food and not much else (in other words, a boring person). I was a “successful” weight loss maintainer, I wasn’t really happy with the life of a weight maintainer, and that’s why I finally quit. That might be a moot point to the people who research this stuff but it’s not to me.)

Studying a small group of very special people, for which there is no control group, and then saying, “Hey, everyone can do this!” is bad science. This is simply not enough proof for me to risk a weight loss attempt that is more than likely to end up in complete weight regain, or an even higher body weight that I started with, with some lasting psychological effects as a bonus. I know I can be healthy without taking that kind of risk. What do you think – is it enough proof for you?

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