Are You a Serial Dieter or Weight Manager?Posted: June 28, 2013 in Obesity Medicine by Rob Ziltzer MD. FACP
By Robert Ziltzer, MD
It is not unusual for our patients to have tried 12 or more serious diets. The problem likely lies in your understanding of the disease of obesity. In some cases, our patients have been chronically dieting for years. Dieting while not seeing weight loss success can certainly be depressing. The longer you diet without seeing the scale drop, the more likely you are to experience feelings of failure and futility. Even more frustrating is spending your whole life losing and regaining weight.
So many people treat obesity as if it were an acute illness. As such, once one reaches her goal weight, she is presumably “cured.” Like a sinus infection, once you’ve finished your antibiotics, you are DONE. This is the model of an acute, curable medical illness.
Unfortunately, obesity is more akin to type 1 diabetes. This is a chronic condition. Like obesity, type 1 (insulin dependent) diabetes usually starts early in life. From that point, daily injections of insulin are required to survive. If a patient stops treatment (insulin) they will get very sick, develop diabetic ketoacidosis, and end up in the emergency room. Teens will often rebel, skip taking their insulin, in vain hopes that their disease will miraculously vanish. This has catastrophic results. In short, there is no cure for type 1 diabetes.
A diabetic learns they are diabetic every day, and have to have a plan every day. They take their insulin when they go on vacation, when they are busy at work, when they have usual (and unusual) life stresses, when they are well and when they are sick.
Obesity is similar to diabetes, in which there is no cure. Those who are successful in controlling their weight have a plan every day. They don’t take vacation from obesity. There are no “days off,” any more than diabetics ever take a day off from taking insulin. They continue to see their physician to help them maintain the weight they have lost, and return any time they have gained five pounds (and are therefore not controlled). The understanding of obesity as a chronic, controllable but not curable disease explains why stopping treatment leads to weight regain. Serial dieters repeatedly regain their weight. Weight managers attain long term control of obesity.