Weight Regain and Weight Loss: Why the Cycle of Yo-Yo’ing Stresses Your HealthJuly 28, 2021
Weight Regain and Weight Loss: Why the Cycle of Yo-Yo'ing Stresses Your Health
Have you been dieting on and off for years? Maybe most of your life?
Have you been asking yourself if there is an end to this?
Are you wondering if yo-yo dieting is somehow hurting your body?
If you said yes to any of these questions, you are not alone!
If you said yes to the last question, you are asking a smart question that has had medical and nutrition scientists stymied for over 5 decades!
This article aims to give you some scientific insight into the world of dieting, if you should do it or not, when enough is enough, and what to do to manage your weight if not a diet!
Weight Regain and Weight Loss
I will break down this topic into a few helpful subjects:
What is the prognosis of dieting in weight management? Are most people successful in losing weight with diets?
- In medicine, we have a saying that when we see too many treatments for a condition, you may suspect none of them is fully effective!
Based on this simple conjecture, when you see thousands of diets out there, you can assume that none of them works perfectly and that none of them works for everyone.
- If you have ever dieted yourself, you know first-hand that just the associated sense of deprivation and the resultant self-pity does not let it last long! No one can be deprived forever!
- We live in an obesogenic culture! You turn on the TV, and there is packaged processed food (or should I say non-food?!) on every channel. You go grocery shopping and try to stay in the periphery of the store to avoid the processed non-food isles (chips, cookies, candy, and soda isles, for instance), and they bring them up front, just before the cashier! Just how much can you resist?!
- With diet (and other non-surgical methods), success is considered losing at least 5% of your weight and maintaining it. This is not typically the success most people are looking for when they take on diets.
All the above put together, you can tell that dieting, in general, has a rather poor prognosis in long-term weight management!
What is yo-yo dieting?
In my opinion, yo-yo dieting, also called weight cycling, is just the natural course of events!
- We diet, we feel deprived and miserable, we go back to the way we were eating!
- Or we diet, we feel deprived and miserable, but we suffer through it and hit our goal weight. Now we feel that we are home-free! Let’s be “normal” again, which may mean eating the same poor dietary choices, eating out frequently, drinking soda and beer, you name it!
Both above scenarios will result in more weight gain than what we suffered from losing!
- Dieting is usually associated with a fear of weight gain and thus fear of failure. This constant emotional stress can chronically increase the cortisol level in our bodies. Chronic increase in cortisol level has been shown to be associated with fat gain, especially truncal fat.
The prevalence of yo-yo dieting seems to keep increasing due to the opposing forces of an 'obesogenic' environment on one hand, and the media pressure for a slim figure that even targets children.
What Opposing Forces Am I Talking About?
We turn on the TV, and we see either processed food commercials or skinny models advertising something, sometimes both in the same commercial, such as the skinny lady enjoying pieces of rich chocolate or a 500 calorie ice cream bar! The media, on one hand, manipulates our brains into purchasing and eating all kinds of junk “food” and, on the other hand, shames us for how we look to sell other advertised merchandise!
This means we will see more of the weight cycling, as these two opposing forces of desire (desire for the advertised processed food and the desire to be desirable) fight each other out in our brains and bodies!
So, as you can imagine, on this battlefield, weight cycling is likely to become an increasingly serious public health issue!
If dieting is not so helpful, why do so many people diet?
This is, in fact, is a very good question!
- One reason is that people don’t know this fact! They are hoping for results, and commercial diets claim huge weight loss and even unrealistic success rates! No diet ad says: “I lost 50 lbs, and I regained 60 back in two months”, do they?
- People may think: What else is out there? If not a diet, how do I lose weight?
In fact, there is something else out there called lifestyle change. But most people confuse it with dieting, so they end up in the web of lies of the commercial diets, expensive diet supplements, and dietary claims that even don’t make common sense! (We will spend more time on lifestyle vs. diet; wait for it!).
So, despite the poor prognosis of dieting in weight management, in the past few decades, more and more people have been dieting! This increase in dieting seems to have been parallel to the steadily increasing number of people dealing with obesity, and one may conclude that more people dealing with obesity naturally translates to more people dieting. But it is not that simple.
Our next question tries to shed some light on who is, in fact, dieting and if dieting is contributing to more obesity!
In reality, who is dieting? Is it the people dealing with obesity? Or people dealing with morbid obesity? Maybe it is the overweight subjects? Maybe all the above?
You may be surprised to hear dieting is not limited to those who are obese or overweight! In fact, a substantial proportion of people with normal body weight are dieting to lose weight! Yes! People with normal body weight!
These include both young and older adults, even normal-weight children and adolescents who perceive themselves as “fat”!
The obesity perception can be due to media propaganda, parental/family, peers, or societal pressures, or a host of another lifestyle, emotional or social factors.
Some examples of normal-weight people going through dieting can be:
- Athletes in weight-sensitive competitive sports (i.e., mandatory weight categories, aesthetic sports, etc.)
- Performers for whom a slim image is professionally an advantage, such as dancers, actresses, fashion models, etc.
- The normal weight adults, with unrealistic expectations from their perfectly healthy bodies, striving to get back to their figure in their early 20’s or before 3 pregnancies.
- Our regular teenage girls, striving for social acceptance and convinced by bony media images portrayed as “the norm.”
I’d like to share my personal experience with you:
When I was 18, I weighed about 40 Kg (88 lb’s). I was 5’2”, which put my BMI slightly over 16. Mind you: Normal BMI is over 18!
I wasn’t trying to lose weight. I wasn’t a cheerleader, starving myself to stay fit! Far from it!
I was a math and physics nerd at school who spent all of my spare time out of the schoolwork reading literature! My mom, my teachers, and even the school principal were worried about me being too skinny! I didn’t have time to eat! There was always something else to read!
I clearly remember that at a BMI of 16 (which translates to malnourished) and with everyone worried about me, I was pretty sure that I was fat! I didn’t care, being a nerd and all, but I KNEW that I was fat! I can only guess now that I probably didn’t see myself bony enough to meet the media’s picture of “the norm”!
Is yo-yo dieting bad for you?
Now we are back to the smart question that has the medical and nutrition scientist stymied!
In 1994, to address the concerns about the health effects of weight cycling or yo-yo dieting, a task force of experts in the fields of nutrition, obesity, and epidemiology, looked over all the English-language medical and psychological studies they could find from 1966 through 1994, with topics on weight cycling, yo-yo dieting, or weight fluctuations.
As you may have guessed, their review was not conclusive one way or the other!
However, since many of the observational studies reviewed showed an association between variation in body weight and increased morbidity and mortality, the task force concluded that:
- Non-obese individuals should attempt to maintain a stable weight.
- Obese individuals who undertake weight loss efforts should be ready to commit to lifelong changes in their behavioral patterns, diet, and physical activity.
I think we should print these two conclusions in gold letters! They just make so much sense!
What The Study Shows About Dieting
In 2017, with the increasing rate of dieting, an updated review of the 1994 study was carried out.
This time, the scientists reviewed and analyzed 31 studies on human subjects on the topic of weight cycling. Although 58% of publications reported that a history of weight cycling increased body fat, especially the fat in the mid-section (central obesity), and another 50% of studies suggested that weight cycling increased the likelihood of future weight gain, the numbers were not statistically strong enough to justify scientific recommendations to stop dieting!
This is why I said this question has got us all stymied!
Despite the whole controversy, there seems to be evidence that:
- Normal-weight people who diet to lose weight fare worse in terms of weight regain! In other words, normal-weight people dieting are more likely to regain more body fat than what they had lost on the diet. This is called fat overshooting or preferential catch-up fat.
Basically, their body makes them eat more (hyperphagia) and burn less first to replace the fat they’ve lost, then some more fat over the amount lost, and then any non-fat mass (such as muscle) lost! It does not stop the hyperphagia and metabolic slow-down until all three goals are achieved, resulting in a total weight regain and a change in their body composition.
This means that after each weight regain, their fat to non-fat ratio may be more than what it was before dieting. This is definitely not what the normal-weight people are looking for when they start dieting!
In summary, it seems that dieting and weight cycling in normal-weight people may be, in fact, predisposing them to more weight gain and even obesity!
- Furthermore, it was noted that repeated fluctuations in the blood pressure, heart rate, blood glucose, lipids, and insulin level during phases of yo-yo dieting could put additional stress on the cardiovascular system. This is not totally surprising. As you can imagine, in every episode of going back to the “normal” diet, or better said, periods of poor eating behaviors, our bodies face repeated overshoots of blood pressure, lipids, blood sugar, and insulin levels above the normal values. The body then has to fight these episodes and go through these physical stressors all over again! Add to this the emotional stress associated with weight regain! And even worse, the fact that each time the weight comes back with a vengeance! You lose 20 lb’s on a diet, only the gain 25 or 30, much faster and with more fatty tissue than before, as soon as you go off the diet!
Isn’t a healthy lifestyle another phrase for diet and exercise?
Not with the current use of the word “diet”!
The origin of the word “diet” in French means “to regulate one’s food for the sake of health.” However, nowadays, the word is used to describe the over-restriction in one’s food to lose weight! So it is no longer about health, and it does not seem to be about regulation, but just restriction.
The word “diet,” therefore, is now commonly equivalent to deprivation and a sense of misery that can end up in the dreaded “failure”!
So, what can you do to manage your weight, if not a diet?
- If you are a normal-weight person: Avoid dieting to lose weight! Instead, focus on what I call a Healthi-Colo-Cious lifestyle, with the goal of a stable weight and maintaining your health.
- If you are an overweight or obese individual who has dieted multiple times with weight regain: Stop! Go Healthi-Colo-Cious instead, to achieve improved health; weight will naturally follow!
- If you are an obese individual with over 75 pounds to lose and obesity-related comorbidities (such as diabetes, high lipids, high blood pressure, sleep apnea, etc.), or a morbidly obese individual with 100 pounds or more to lose and have tried more than once to lose weight: Talk with your doctor about metabolic surgery. You still need to be committed to a Healthi-Colo-Cious lifestyle for a lifetime of success. But it may not be enough to take off over 75 lbs without any tools.
What is “Healthi-Colo-Cious”??
Healthi-Colo-Cious is the slogan of my practice, Better Me Bariatrics & Aesthetics. It is a phrase I created in March 2021 to describe my weight management philosophy.
I have been practicing bariatric surgery for over 13 years and nonsurgical weight loss for over 11 years. In addition, I completed my surgical board, bariatric surgery fellowship, and obesity medicine board with education and board certification in nutrition. As an experienced, multi-faceted expert in the field of obesity, I have noted that what fails diets more than anything is the sense of deprivation and the fear of failure!
Over time, it became a mission of mine to find a way to eliminate the sense of deprivation and the perception of failure associated with the weight loss attempts.
But in an obesogenic society, when everywhere you go, the shiny packages of processed food are in your face, it is not easy not to feel deprived when you avoid those pretty packages of junk! Similarly, it is not easy to feel like a failure when comparing themselves to the norm's bony media symbols!
In my experience, the only way to beat the old seemingly shiny lifestyle is something to replace it, something as shiny, colorful, and delicious but healthy.
Boring cannot replace bright and interesting, can it?
Healthi-Colo-Cious in my mind means a way of life focused on:
- Not only Healthy, colorful, and delicious food
- But also a Healthy, colorful, and delicious lifestyle!
I have been educating my patients for years that weight loss does not always mean eating less, and it does not mean fasting. Instead, it should mean eating better, more colorful, more flavorful “food” instead of the processed “non-food.”
Another factor is outside food, fast food, restaurant dining, carry-outs. I have noted over the years that some of this eating out is related to the need for variety, ambiance, and creating special moments, in addition to the special food one cannot make at home.
Healthi-Colo-Cious, therefore, aims to bring ambiance and color to life, not just the food, to compete with the above situations.
In addition, Healthi-Colo-Cious, emphasizes our health, not the sensitive and emotionally charged matter of weight! By living and eating Healthi-Colo-Cious, we pursue better health, and weight will naturally follow! This aims to minimize the feeling of failure, the associated stress, and thus more risk of weight regain.
Healthi-Colo-Cious, therefore, means to describe all the following:
- Healthy food does not need to be boring; make it exciting, colorful, delicious, even exotic! Let healthy be shiny enough to beat the shiny packages of processed food!
- Seek the real flavor, not the synthetic replica! Why strawberry-flavored gum, candy or drinks, when strawberries have the real flavor and beautiful color? Why not learn about herbs and spices to bring the rainbow of flavor in your kitchen and food?
- Create colorful and delicious recipes that are at the same time healthy.
- Focus on health as the outcome; let weight naturally follow.
- Create the ambiance at home or with the help of nature to minimize exposure to the outside food that is not made with your health in mind.
- Use pre-planning and timely food prep to make it practical to make your own meals, no matter how busy you are.
- Seek and create support from family and friends by making the recipes and lifestyle attractive enough to appeal to them! Set a colorful, tasteful dining on your porch! Hike, bike, or walk to a beautiful spot in your favorite park with your Healthi-Colo-Cious food! Enjoy the ambiance of nature! Nothing beats that!
- Avoid/minimize the company that is unwilling to make at least an effort to support your Healthi-Colo-Cious cause!
- Eliminate the sense of deprivation by:
- Following the above principles,
- Looking at the Healthi-Colo-Cious lifestyle as your choice of lifestyle, not as a crash “diet” that you can’t wait to end!
To learn more about Fariba Dayhim, MD, follow her Healthi-Colo-Cious tips on DrDayhim.com, on her youtube channel, Facebook, and Instagram. Share your Healthi-Colo-Cious food and moments! We can all learn from each other to live more Healthi-Colo-Cious lives!
ABOUT THE AUTHORFariba Dayhim, MD was one of the first bariatric surgeons in the country to get an ABOM certification. Dr. Dayhim completed a minimally invasive/bariatric surgery fellowship at Texas Medical Center/The Methodist Hospital in Houston. As a bariatric surgeon, obesity medicine physician and the Medical Director of a Comprehensive Bariatric Program, she has extensive knowledge of every aspect of Bariatic Medicine. You can connect with her at DrDayhim.com.