Why do dieters regain weight?

Nutrition Q&A [Moderated]
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Hi Jordan,

I recently read an APA article entitled “Why do dieters regain weight?”: https://www.apa.org/science/about/ps…ie-deprivation. The author noted that there are substantial amounts of data showing that the majority of dieters (i.e. people trying to lose weight through calorie monitoring/logging) lose the weight in the short term but tend to regain the weight back in the long term. From my understanding, this is the central tenet of setpoint theory. In the author’s own words:

Calorie deprivation leads to physiological, neural, and attentional changes, and those changes make it difficult to engage in the behaviors necessary to keep weight off. But since those changes do not directly cause weight to return, it is still possible to keep weight off, which a minority of dieters do. This possibility allows people to discount the powerful role of these changes, and instead to argue that if people regain the weight, it must be due to their poor self-control. And because the changes ultimately do operate through eating behavior, the weight regain does seem to be the fault of the apparently weak-willed dieter. As many people have said to me about failed dieters, “they’re still the ones holding the fork.” The key misunderstanding here is the different physical and cognitive context in which dieters hold the fork compared to non-dieters: they feel hungrier, their attention is biased toward food, they find food tastier, and they get more reinforcement from it. Plus they need to consume an even smaller quantity of food than earlier in the diet (as well as less than a non-dieter of the same size), because their more efficient metabolism is burning fewer calories. So dieters don’t necessarily have worse willpower than non-dieters, but calorie deprivation has put them in a situation that requires much more willpower in order to successfully limit consumption.

She concluded that attempting to lose weight through calorie monitoring is ineffective for most people due to the reasons noted above. Instead, she recommends that people engage in healthy behaviors (eating 5+ fruits/vegetables a day, exercising regularly, managing sleep and stress, etc) and let the weight loss be a side-effect of these healthy behaviors. Essentially, she is making the argument that engaging in those healthy behaviors will, over time, lead people to a better weight. She notes that a recent study published in JAMA (The DIETFITS Randomized Clinical Trial) does support this position (increasing healthy food intake and decreasing unhealthy food intake while not monitoring calories), though she does admit that, besides this study, there is little long-term evidence supporting the efficacy of this position.

What are your thoughts? Should people forego trying to lose weight through traditional means of logging their calories? Instead, should people aim to settle on a healthy weight indirectly through behavioral change?

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Based on what you’ve read from our material, what do you think?

Also to be clear, ALL successful dieters lose weight via calorie restriction. 100%. The method used to drive that calorie restriction varies and there are a number of evidence based behavioral change strategies that can be useful here, which we have covered in great detail.

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Also to be clear, ALL successful dieters lose weight via calorie restriction. 100%. The method used to drive that calorie restriction varies and there are a number of evidence based behavioral change strategies that can be useful here, which we have covered in great detail.

My apologies, I meant to use the term “calorie monitoring” to refer to tracking ones calories–not calorie restriction. I’m aware that all weight must be loss through calorie restriction. I edited my post to fix this mixup.

Based on what you’ve read from our material, what do you think?

I’m conflicted. You guys have published much material on behavioral change, so I know you guys think behavioral change is incredibly important. However, you’ve also mentioned in the nutrition podcast with Vanessa Burman, and she mentioned in an article on BBM’s website called “Handling Hunger”, the idea of a “dietary RPE”–essentially, how hard it is to adhere to a diet. The definition of diet I’m assuming you’re referring to is “weight loss through calorie monitoring”, which is the definition used in the article I linked and is one of the commonly used definitions of a “diet”. Thus, if you are tracking such a measure of “dietary RPE” and using this definition of a diet, this means that you are prescribing diets (weight loss directly through calorie monitoring) as well, which would conflict with the idea presented in the article of weight loss indirectly through behavioral change being more effective than weight loss directly through calorie monitoring.

Additionally, in “How To Measure Your Waist Correctly”, you note that “If [waist circumference] is greater than 40 or 37″ for a male or female, respectively, then I would recommend immediate weight loss via calorie restriction and training modifications (if needed).” “immediate weight loss via calorie restriction” seems to imply that one should start monitoring their calories and reduce them quickly, as weight loss induced through behavioral change is slow compared to calorie monitoring (the DIETFITS participants, for instance, only lost around 1lb per month).

Again, I want to make it clear that I’m aware all weight loss must be loss through calorie restriction; the distinction is whether it should be lost directly through calorie monitoring or indirectly through behavioral change. Personally, I have been conflicted on what conclusions to draw based on the BBM material I’ve ingested.

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This is a weird bit of logic and I don’t think I agree with your definition of a diet, which is just the standard pattern and amount of foods consumed.

That said, yes, we commonly employ techniques to get people to consume fewer calories. Direct calorie monitoring is not a technique we use often, but it would be incorrect to say that it doesn’t work and should be avoided.

Additionally, ALL WEIGHT LOSS occurs via behavioral change. You can’t reduce calories without behavioral change.

  1. No, the DIETFITS participants lost more weight than that initially, but it’s a 12 month study so the average is 1lb a month. Of note, this achieved clinically significant weight loss in most of the participants so I would not suggest this is meaningless.

  2. Weight loss via behavioral change is not necessarily slow compared to calorie monitoring. Calorie monitoring is a type of behavioral change. To suggest that calorie monitoring is an ineffective behavioral change strategy is not based in evidence, though it may not be appropriate for all individuals.

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Additionally, ALL WEIGHT LOSS occurs via behavioral change. You can’t reduce calories without behavioral change.

The article I linked came across somewhat confusing as it seemed to describe weight loss through calorie monitoring distinct from weight loss through behavioral change, but now that I think about it you are right in that it makes sense to classify calorie monitoring as a form of behavioral change.

To suggest that calorie monitoring is an ineffective behavioral change strategy is not based in evidence, though it may not be appropriate for all individuals.

This is what the author seemed to suggest. The authors final recommendation was that “increasing vegetable consumption and decreasing certain unhealthy foods without monitoring calories” is more effective for most people than going on diets and monitoring calories.

The evidence she provided to arrive as this recommendation was a meta analysis that concluded that most diets don’t keep weight off in the long term. (Mann, T., Tomiyama, A. J., Westling, E., Lew, A.-M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: diets are not the answer. The American Psychologist, 62(3), 220–233. APA PsycNet).

Note that she defines diets in the paper as “severely restricting ones calories” in order to lose weight and keep it off in the long term. However, it wasn’t really defined what “severally restricting ones calories” meant quantitative speaking and if the studies they looked at adhered to their criteria. Additionally, it seems like the studies they looked at in the meta-analysis weren’t controlled for what behavioral change method each study was doing. But, I’m not sure if they really cared to control for this, since they were strictly looking to see long term outcomes of diets in the literature.

With that said, I’m not sure how she made the jump to her recommendation of “increase vegetable consumption and decrease certain unhealthy foods without monitoring calories” from that meta analysis that concluded that diets (defined as severely restricting ones calories for the goal of long term weight loss) are ineffective in the long term.

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Yea, that doesn’t really make sense to me.

That’s not really well supported by direct evidence and is, very clearly, a diet.

Seems odd to suggest that most dietary interventions, which are behavioral changes, don’t work long term…then turn around and suggest behavioral changes.

Yea, I don’t really take articles like this seriously to be honest. There are much better review articles available through The Obesity Society, The AACE, etc.