Few issues have received as much media coverage as the recent public announcement by Toronto mayor Rob Ford (and his brother Toronto councilman Doug Ford) to lose 50 pounds in the next six months. This has prompted a wide range of responses, including from media celebrities like Dr. Oz, who chipped in with rather whimsical tips like recommending Ford eat more green tea ice cream and devour 30 grams of protein within 30 minutes of waking.
By making this announcement and inviting citizens to join them, the Fords have made their personal struggles with obesity a matter of public interest. But is this appeal truly in the public's interest? Are the Fords' efforts a motivation to others battling excess weight? Will they use their considerable reach as a platform to educate Canadians about evidence-based obesity management? Or, will their weight loss antics simply perpetuate obesity myths and stereotypes?
Although I am not privy to the exact treatment plan the Fords are pursuing, from what I can glean, it largely amounts to diet and exercise -- an approach that is notorious for its failure for the seriously obese. As documented in hundreds of studies (and real-life experiences), individuals who do lose 50 or more pounds and keep them off with diet and exercise alone are rare and far between.
Those who do succeed require a lifelong obsession with keeping the weight off -- hours of daily exercise and ongoing severe restriction of caloric intake. The risk for regaining the weight remains as high 10 years after losing it as it does in the first months of the diet. We may have treatments for obesity -- we certainly have yet to find a cure.
Indeed, losing weight is never the problem -- all diets work. The real challenge in obesity treatment is keeping the weight off -- this is where most diets fail. This is not unexpected. The complex biology of energy regulation and the unrelenting tendency of our bodies to defend and regain every gram of fat lost leaves no option but to embrace a lifelong commitment to the given diet if the weight is to stay off. When treatment stops, the weight comes back -- always -- there are few (if any) known exceptions to this rule of nature.
Thus, while restricting caloric intake to 1400 calories (or less) together with 60 minutes of daily exercise will let anyone lose weight -- keeping the weight off requires exactly that -- eating less than 1400 calories and committing to 60 minutes of daily exercise forever!
Increase caloric intake to just 1500 calories or cut back to just 50 mins of exercise, even for a few days, and the weight comes back. The metabolism of a 300-pound individual, who has dieted himself down to 200 pounds will never be that of someone who has always been 200 pounds. While the former will forever struggle to survive on 1400 calories to keep the weight off, the latter can happily continue eating his daily 2400 calories while effortlessly maintaining his 200 pounds forever -- who said life is fair?
But it is not just our biology that virtually guarantees the long-term failure of all diets. Most people fail to keep their weight off simply because cutting back calories and increasing activity addresses the symptoms of obesity -- not its causes. While most of us often mistakenly assume that the seemingly obvious cause of weight gain is simply eating more calories than required, the true cause, namely the underlying drivers of that excess consumption, have to be the actual target of treatment.
Unfortunately, the root drivers of overeating are anything but simple. They can range from genetic predisposition (as in "born with a large appetite") to stress, emotional eating, lack of sleep, lack of time, social pressures ("food pushers"), meal skipping, mindless eating, medications, and countless other factors. Treatment approaches that do not consider this wide range of root causes are bound to fail.
If stress (as admitted to by Doug Ford) is the root cause of overeating -- target the stress -- eating will improve. If skipping breakfast leads to night time hunger binges, learning to have breakfast and eating regularly throughout the day will likely solve the problem.
If you are self-medicating your depression with chocolate cake, treating your mood disorder may be the solution. If the medications you take make you hungry, ask your doctor for medications that don't.
If overeating is a due to mindless eating and lack of impulse control, perhaps it is time to screen for attention deficit disorder. None of these underlying root causes can be addressed by simply cutting back on portion size or spending a few extra minutes on your treadmill. In fact, in many cases, restricting calories or exercising can make the underlying problem worse -- which is part of why many end up heavier after their diets than before.
If you are a stress eater, then it is only natural that adding the stress of having to now restrict calories and find the time to squeeze in those extra minutes of exercise into your already overly packed schedule can only add stress -- the exact opposite of what it would take to better manage your weight.
So while I wish the Ford brothers well and do hope that they eventually find competent health professionals who can help treat their obesity (including discussing with them the option of bariatric surgery), I would be disappointed if we pass up this opportunity to educate Canadians on the real issues that drive the obesity epidemic and why this complex and multi-factorial chronic disease requires the same treatment approach and resources as every other chronic condition.