Fight Against Obesity Fails, Panel Says

Most Americans who lose weight through commercial programs gain it all back within five years, a blue-ribbon advisory panel to the National Institutes of Health announced Wednesday, saying that 20 years of nationwide struggle against obesity have failed.

“Most people who need to lose weight are not succeeding,” said Dr. Suzanne W. Fletcher, chairwoman of the panel. As many as one in three adult Americans is overweight, a percentage that has not changed in more than 20 years, the panel said.

Up to 95% of patients regain lost weight within five years--even after going through the best commercial weight-reduction programs, according to James G. Nuckolls, a Galax, Va., physician who is a member of the panel.

And two-thirds of such patients regain lost weight within the first year, the panel said.

“For most people, achieving body weights and shapes presented to us in the media is not a reasonable, appropriate or achievable goal. . . . “ the report declared.

The 12-member panel urged overweight Americans to change their approach toward slimming down.

Instead of setting a specific, short-term weight-loss target, the group urged people to adopt a longer view that emphasizes healthier lifestyles and exercise as well as dietary changes.

Staying trim “requires a lifelong commitment to permanent change. . . . “ the report said. “Modest goals and a slow course of weight loss will maximize the probability of both losing the weight and keeping it off.”

After the report’s release, several panelists hastened to put a brighter face on it. For many obese Americans, they said, losing weight can prove life-saving--especially if they have such conditions as high blood pressure, gallbladder disease, some forms of diabetes--even if they regained the weight years later.

“I don’t think we should look at this as a lost cause,” said Helen A. Guthrie, a retired Pennsylvania State University nutritionist.

The advisory panel stopped short of outright criticism of what is now a $30-billion industry. Instead, they advised consumers to demand from commercial weight-loss programs specific data on their effectiveness before enrolling.

Among such information are the percentage of all participants who complete the program, the percentage of their weight loss and the proportion of weight loss that is maintained after one, three and five years.

“If this kind of data is not available, it (enrolling) may not be the sensible thing to do,” said Barbara Kafka, a New York health writer and the panel’s one lay member.

“One should not be distracted by anecdotal ‘success’ stories or by advertising claims,” the panel’s report warned.

Commercial weight-reduction programs typically last from several weeks to a few months, with sharply varying dropout rates, ranging as high as 80%. Many patients register losses of as much as 10% of their weight at the time they begin their programs, said panelist O. Dale Williams, dean of the University of Alabama’s school of public health. Thus, prolonging the duration of such programs might make their effects more enduring, he said.

The committee of physicians, nutritionists, exercise physiologists, epidemiologists, behavior specialists and biostatisticians spent 2 1/2 days taking expert testimony and reviewing the vast amount of scientific literature on weight loss before issuing its report.

The report also said that obesity is disproportionately high among women, the poor and members of some ethnic groups.

At any given time, the panel said, 33% to 40% of adult women and 20% to 24% of men are trying to lose weight, with an additional 28% of the population seeking to maintain weight. “Some attempts may be successful in the short term, but most often the weight lost is regained,” the panelists concluded.

The panel warned that extremely low calorie diets (800 or fewer calories per day) should not be adopted, even by severely obese persons, without close medical supervision. Such diets can cause serious side effects.