Long-term weight loss is achievable and reduces the risk of death

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A common refrain of Health At Any Size people is that, “But only 5% of people achieve sustained weight loss!”

Then follows the suggestion that, therefore, nobody should try to achieve sustained weight loss.

This 5% figure is a fiction, as one can see from scientific reviews of the research literature. Read carefully:

In fact, in the right circumstances, an impressively large % of overweight people can maintain an impressively large amount of weight loss. Read the above. It is simply wrong that long-term weight loss is “impossible”. A large number of people do it, and they do a lot of it.

But for a moment, let’s pretend that the 5% figure was correct: only 5% of people maintain sustained, long-term weight loss, right? Here’s the kicker: for most people we give medical treatments, an even smaller percentage will benefit.

Yep, not only is weight loss possible among a rather large % of people, but even if were only 5%, this would still be better than many of our mainstays of medical treatment.

How can this be? Let us take a look. Statins.

Only about 7% of individuals will benefit from a statin. Now this benefit will be equal to about 99 months of life, but only 7% of people will benefit from a statin.

In many weight loss studies, many more than 7% could sustain long-term weight loss! Does this mean we should throw statins out as a medical treatment, because we’re throwing out weight loss?

Blood pressure medications. Only about 1 in 125 people will avoid death from taking a blood pressure medication. Throw out blood pressure medications?

Mammograms. Only about 1 in 2500 women will avoid death because of mammograms. Throw out mammograms?

Prostate cancer screening. Only about 1 in 50 men will avoid death because of prostate cancer screening. Throw out prostate cancer screening?

Colorectal cancer screening. Only about 1 in 1250 people will avoid death from colorectal cancer screening. Throw out colorectal cancer screening?

Metformin for diabetes. Only about 1 in 14 people will avoid death by being treated by metformin for 10 years. That’s *still* worse than the number who will lose weight in many studies.

Am I cherrypicking? Nope. The case for drugs not causing a benefit in most people was also made on http://sciencebasedmedicine.org in an article called “Most Patients Get No Benefit from Most Drugs“.

These are easily demonstrable, widely accepted facts. Modern medicine saves lives. It improves the quality of life. But on the whole, it is pretty weak. However, applied many times over and to many people, and we get millions of lives saved. It adds up.

But what about weight loss? How much death would be avoided per person assigned to receive weight loss in a clinical trial setting?

According to this paper, which analyzed a total of 15 weight loss randomized controlled trials involving 17,186 obese participants, about 12 pounds of weight loss in obese subjects over a mean follow-up period of just 27 months resulted in a 15% reduction in death from all-causes. Including only trials with a follow-up period of 4 or more years yielded the same result.

Just 12 pounds? With a mean follow-up of just 27 months? 15% reduction in total deaths.

Still, for comparison’s sake, I calculate the number of people needed to attempt weight loss to avoid one death in the 27-month follow-up period using the findings of the above paper:


Not as good as metformin, roughly comparable to blood pressure medication, vastly superior to mammograms and colorectal cancer screening. So again, throw out blood pressure medications, mammograms, and colorectal cancer screening?

Even though modern medicine saves millions of lives, much of it is still weak compared to long-term weight loss. Yet the HAES people say that because not everyone can lose weight, nobody should try to lose it.

If that’s the argument, then to be logically consistent, the HAES people should reject the screening and treatment of many chronic diseases and much of modern medicine.

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  1. Since LDL is directly implicated with plaque building, I find it stunning that statins doesn’t improve outcome in 93% of patients. Were they simply put on the drug too late in the development of atherosclerosis? Do statins increase oxidation of the remaining LDL particles; or even HDL particles?

    This is certainly a confusing statistic.

  2. Prostate cancer screening is probably a bad analogy. Prostate cancer screening in the general population (excluding patients known to be at high risk, such as patients with a strong family history and BRCA mutation carriers, has been shown to cause harm because most cases of prostate cancer, especially in older patients, will not cause significant harm during the expected life span of the patients. In fact, it is now acceptable to not treat many cases of prostate cancer because the disease is so indolent.

    1. Overdiagnosis and overtreatment (leading to harm) is a problem for many areas of modern medicine. I think that is also the issue that people in the HAES community have with the treatment of obesity: what are the downsides of treatment? do they ever outweigh the benefits? My post was focused on the benefits of treatment and I used prostate cancer in that context. Deaths are certainly prevented by prostate cancer screening. But duly noted about the downsides and agreed.

  3. The average smoker makes between 8 and 30 attempts to quit smoking before success. Should we stop telling people to quit smoking because most cessation attempts fail? A lot of diet “failures” are minimal attempts by people who are not yet ready to stop overeating. They’re waffling, like smokers, between the contemplation and the early cessation stages.

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