Losing It: A Weight-Loss Mecca’s Secrets

depict asparagus, bananas, peace, and a pineapple. The outline of a runner cuts through the background, painted in shades of orange and purple. And then there's a DNA DNA on the right. There are blue and pink fish at the bottom, canteloupe on the side. The longer I stare, the more bowls of healthy living reveal themselves. But it's all about

what we do. I mean, you know health, genetics and biology, and you have you have all the elements of nutrition, you have the exercise, you have the d n A. The whole thing makes the place feel like a temple to nutrition, because it kind of is. Pennington is a sprawling research center working to study obesity. Our tour guide today is Eric Ravasan, a prominent scientist in the space who is Associate executive director for Clinical Science at Pennington.

He's the one talking me through all of the stuff in this very large stained glass window. Stained glass is obviously more a feature of churches, but the religious symbolism is sort of fitting. Really, this is a place that treats weight loss as a sort of gospel. Pennington has two acres of campus, including labs and research facilities, around two hundred scientists and state of the art equipment, much of it dedicated to unlocking the secrets to shedding pounds.

It's in Baton Rouge, Louisiana, and it feels like a college campus minus the students. I've been on a journey to get to the bottom of the science of weight loss, and as our stained glass windows shows, weight loss is something we all have lots of ideas about. Some of those ideas are actually true, but they're all too often not the whole truth. If anyone could help us sort one from the other, I figured it would be the people here. First, though, We're going to take a look around.

That's part of the way you test. Participants are like, we're walking up to the fourth floor. Yeah, we got. Our first stop is to check out some fairly innoxious looking medical machinery. It's big and gray and looks almost like a bed. And is this the machine beginning now? It started already. Radiation is on right now because you can see the lagser on saying in a radiation is that this equipment can actually tell you how much of your body is fat, and how much of it is muscle,

and how much is bone. I want to call it a nightmare machine. It's the scan no one wants to see of themselves. But what this equipment really measures is body composition. And the total of this person here is thirty points six of the body is fat. We often talk about the number on the scale like it's the only thing that matters, but this is a good reminder that wheat isn't every thing. That's why weight loss researchers use tools like these body composition machines. And a big

finding they've had is that people vary a lot. People's bodies are different, really really different, and that's actually at the root of a lot of the findings they've made here at Pennington. But first, back to the tour, We check out a big area known as a metabolic kitchen, where calorically precise foods are prepared for studies, and we walk by spaces that look like hospital rooms. They're also used for research. Eventually we get to the craziest stop

on the tour. We step into a hall that looks into small furnished rooms to seek a curtain and the bed and you have everything could be happy, and there's Stevie. They look like really sad studio apartments. Even though there's furniture, the rooms are sterile looking. There aren't exactly many homey touches. That's because they're actually rooms where scientific research happens. They're

called metabolic chambers, and they measure metabolism. Like the name suggests, these sad little rooms are designed to measure how many calories the person inside is burning. People stay in them for a good chunk of time, thus all the furniture. Eric also points out that they have windows. We fast the food and uh and you know through here outside of the metabolic chambers, in the hallway where we're standing, a bunch of pipes and scientific instruments line the walls.

It kind of looks like a boiler room or something. This equipment track everything going on in the little rooms. Cool right, Maybe a little creepy too. Eric tells me that there are only about thirty metabolic chambers in the world thirty, and Pennington is home to four of them. When we arrive, there's actually a woman in one of the rooms already. She's sitting on the bed. It looks like she's scrolling on her phone. Maybe in a little

while she'll go use the adjoining toilet. Watching the stranger live her life in a little box while equipment measures what's going on inside her body is pretty weird, Even if it is for science. The whole thing feels a bit dystopian. It makes me think of like a lab rate in a maze or something. Now she probably can't see this, but a computer screen right behind Eric and I actually shows how many calories she's burning on a minute by minute basis. A chart shows us how that

rate is changing over time. Eric tells me that while the woman slept, she burned just under a calorie a minute. Then I would say she got up here. He's saying that because we can see on the screen that at this point her metabolism jumps. People tend to burn more calories as they become more active. She went to brush your teeth, you know, metabolious me here goes to three calories a minute. Then you can see and at the end of the day we summarize how many calories she

has doing. The real work of the metabolic chamber is happening silently in the air, because the chamber is actually tracking how much oxygen the woman in the room is taking in and how much carbon dioxide she's breathing out. I Well, both oxygen and carbon dioxide are involved in the process of converting food into usable energy. A little

math and toda, you have calories burned. This is all part of metabolism, something we usually think about only in terms of how fast we gain or lose weight, and that's definitely part of it, but metabolism is also what keeps us alive and kicking, something that we should celebrate not blame. You know how people are always talking about calories in calories out. A metabolic chamber is a very

precise way of calculating the calories out. Part. Technology like this is really important at places like Pennington where researchers are digging into the secrets of weight loss. And by the way, some of what they've learned, is that calories in, calories out is not the whole story, not by a long shot. I asked Eric what to make of the numbers the metabolic chamber is spitting out? Would another person burn three calories a minute doing the same things as

the woman in the room just now? Like? Did I burn that much getting ready this morning? That seems like really interesting and even important data to have about yourself. If any given way, sex page, and body composition, you have large variability in between people. Metabolism differs a lot by person. In other words, Eric couldn't really say if I or another person would burn as many calories a minute as the woman in the room. But he tells me about some research he did way back in the eighties.

We measured people like in the chambers, re measured them five years later and looked at the relationship between the metabolism and the weight gain. They gain a lot of weight, and we found that a low metabolity create is a risk factor for weight game, otherwise known as I have a slow metabolism. People love to say I'm gaining weight just because I have a slow metabolism. But when we say that, do we really know it for sure. No, no, that you have to measure it. You have to get

into one of the sad little rooms. Metabolism isn't a straight line. It can change over your lifetime, including as you age and when you lose weight. Researchers have learned more about that in recent years, and it may help explain why dieters overwhelmingly regain weight over time. We'll get more into this later. We walk by another suite of rooms with a tread mill and stationary bike. Researchers use

these to push people to their exercise limits. It's kind of like a stress test done by a cardiologist, except even more intense. Nearby, a person is actually getting biopsies taken of her fat and muscle. I watched the lab tech sitting at her microscope work on a sample. There are actual fat and muscle cells in front of her. Is there anything you can't measure here? When it comes to UM two, obesti, diabetes and cardiovascular disease. I think we have it all. One of my co league used

to say, it's like toys are us for a kid? Uh, you know, it's toys are us for a scientist? So yeah, you're probably realizing by now that this is a place with incredible resources fort etting weight loss. And the thing about weight loss is that we all kind of think we know the basics. Losing weight is about eating fewer calories than you burn calories in calories out right. In this episode, I'm going to get to the bottom of

what we actually know the science of weight loss. How it's actually a lot more complicated than that simple formula. And we're going to try to figure out why, why it's so complicated, and why despite that the simple formula of calories in calories out keeps getting repeated anyway, not just by your neighbor or uncle, but by doctors and scientists. To do that, we'll start this mecca of weight loss, but we'll go beyond its walls too. I'm Bloomberg News

health reporter Emma Court and from the Prognosis podcast. This is Losing It. Imagine that you're at the doctor's office and they tell you to step onto the scale, which they invariably do visit after visit. That number is measuring not just your bone, muscle, and fat, but also possibly your lunch from earlier, your shirt and pants, maybe some p You can't talk about weight loss without first, making

sense of weight itself. And what doctors and scientists are concerned about is not your clothing or undigested chopped salad, or even your bone and muscle. They're worried about fat, and specifically a person having too much. So how does a person get more body fat? That comes back to calories, which we went deep on in our first episode. Remember, calories aren't just align on a nutrition label. They are source of energy for your body. Calories are the gas

in your cars fuel tank. Every day we're taking from that tank because we gotta um, we gotta move. This is Leanne Redman. She's an expert in physiology or how human bodies function, and she works for Pennington. We've got a digest food we think we just function to every day, we've got energy going out of the tank. So every day we have to replenish the energy going into the tank to keep your weight the same. Ideally, you'd be eating around the same number of calories that you burn.

Lean says, there's a little wiggle room here of about a few hundred calories a day. But eat too many calories for too long and that energy has to go somewhere. It gets stored in the adipose tissue in the body fat, and then we gain weight gain atiposity of a time, and that eventually leads to obesity. In other words, fat is another store of energy. We've demonized it the same way we've demonized metabolism, but it actually serves this and

other really important functions. Still, extra fat can put a lot of stress on your body. That's why doctors and scientists worry about people having too much fat. A quick note about language here. We will be talking a lot about weight in this episode, in particular because of the stigma and bias about this subject. There are different schools of thought about how to talk about it. The fat Acceptance movement embraces the term fat. Some doctors and scientists

favor saying person with obesity. I will talk about it as much as possible the way people do themselves. I have tried to avoid the terms overweight and obese, though I have had to use them at times for clarity's sake, times like now. Obesity is usually defined as when a person's body mass index is over thirty. As a refresher b M I equals weight divided by height squared. The number is supposed to be a proxy for body fat.

But as the formula I just rattled off makes clear, b M I doesn't actually rely on your body's measured fat composition, just weight and height, and b M I is what's overwhelmingly used to talk about weight, like when rates of obesity in the US began increasing in the eighties. Around this time, government stats show that nearly six of American adults were considered too heavy increase from an earlier period. That judgment was made using b M I, and it keeps being made using b M I, and it tells

us that Americans keep getting heavier. Today, nearly three quarters of adults are considered by the government to have higher than normal weights. So again, calories matter because extra calories can turn into fat. It's that saying that you've heard so many times before, calories in calories out. This is also something we've known for a long time. When you eat just enough food to supply the energy you need,

your white stays the same. But when you eat more than you burn up an energy, the rest is starred as fact. So is it really just that simple calories in calories out. The answer is yes, sort of ish, not exactly. Calories in calories out is true, but it's also not true. If you're lost right now, that's okay. I promise it will all make sense by the end of the episode. Remember, we came here to Pennington for

a reason. We wanted to sort out when it comes to wait, what's fact, what's fiction, and what's still a mystery? So how do we know that calories in calories out works? When you walked through this thing that looked like a medical ward to get to the metabolic chambers. This is Owen Carmichael. He runs the Biomedical Imaging Center at Pennington. So basically some of the fancy machines we've been looking at, we've actually had studies where people live there and they

sleep in the hospital like beds. They're living in a what looks like a hospital where they're interacting with a lot of nurses and um that they do not have a refrigerator that they have free access to. They cannot order up snacks. They're in a controlled environment. They're being given calorically precise meals. The sprawling Pennington Gym is nearby. For some people, this might sound like the ideal conditions to diet, the v I P diet life, and that's

exactly what the scientists intended for other people. Of course, this might sound more like torture, but anyway, Pennington researchers have found that they really, honest to goodness, lose weight, and they lose fat, not muscle, So it's good weight loss. People lose weight, at least they do when they spend that whole time at Pennington. But you can't do that

for a really long time. Study participants have lives to get back to, and it's exactly when they do that step outside the boundaries of Pennington out into the real world, that the trouble begins. I think it's very difficult to really wrap your head around how seven this thing we call the obesogenic environment is that scientists speak for the

kinds of unhealthy environments that surround us every day. The Danish cart on the corner by your office, not having a grocery store in your neighborhood, living somewhere with lots of cars but no sidewalks. If you're lucky enough to have enough to eat, the world can sometimes seem like it's shoving a plate of fries down your throat. Seven. And while you have some limited ability to decline, that metaphorical plate of fries. Not everything is under your control.

We've all experienced this. I even saw it when I was visiting Pennington for this episode. Here I was speaking with scientists all day long, talking about the importance of healthy eating and portion control and cooking food at home. And meanwhile, I'm staying in a hotel and eating literally all of my meals out. And did I mention that Pennington is based in Louisiana A fantastic lace into like a little peopood. This is a place essentially a full boy.

I like my overflowing with brad shrimp. That thing is as big as you. Everywhere I went, I kept ordering food without realizing that it was all deep fried. I was at lunch one day with a bariatric surgeon who works at Pennington, and the waiter rattled off a long list of very fried recommendations. Again, my dining companion here does weight loss surgery for a living. It was kind of surreal. When we finished up, they actually brought us a plate of cotton candy, which we had not ordered

for free. And it's not just the environment around us that's making things difficult. It can be us too. Here's leanne again, So it is definitely ultimately about this imbalancing calories. But it's very, very complicated, right because there are so many factors that determine what we eat when we you know, where we're craving something, whether we're full, whether we're hungry or not. And then on the other side, when you reduce people's calories, they're like, oh, I'm eating less, so

I'm gonna like, I can, you know, move less? Right, So they start conserving calories and maybe not as physically active. The same is true when people are exercising more, they need more calories, and when people start eating less, our bodies respond to that. Remember that calories aren't some inconvenient aspect of oreos their energy. When you have less energy coming in, your metabolism slows down. That actually makes sense

if you think about it. Your body is now smaller, so running it moving it around that takes less energy, kind of like how smaller cars can be more fuel efficient. But studies of contestants on the TV show The Biggest Loser have found that metabolism can drop even more than you would expect. Pennington researchers were actually involved in those studies, including Eric Ravesson, who took us on the tour earlier, but we we measured all the people from this season eleven.

He was quite a riot to go to the ranch outside in California. There's a name for this phenomenon of metabolism slowing more than expected after weight loss. It's called metabolic adaptation. Scientists have also found that after weight loss, hormones that regulate hunger and weight can get disrupted for long periods of time. These hormonal disruptions and metabolic adaptation could help explain why so many people regain weight after dieting. In other words, a person goes on a diet, they

regain the weight later, and people assume it's the dieter's fault. Right, It seems pretty logical. After all, they say, oh, she stopped eating as many salads, or that he stopped going to the gym as much, and maybe they say even more unkind things than that. But here's the thing. Scientific research tells us that there may actually be a biological

reason for those things happening. That a dieter could be getting really hungry because of hormonal disruptions, that their body might actually be burning way fewer calories after weight loss. When I first learned about this, It kind of blew my mind because there seems to be a scientific explanation for why so many dieters regain weight over time. Your body is actively fighting back, and that actually makes sense if you think about evolution, because bodies need energy to live.

An energy used to be a lot harder to come by, so at the end of the day, it does come down to the energy imbalance, the intake, and the expenditure. You have to be out of balance in order to change weight. But it's all of these other physiological signals that are driving the intake and the expenditure that we need to understand better in order to be able to

achieve weight loss for everyone. We're simplifying the science here, but needless to say, these are complicated things to study, and it helps to have a dedicated research facility like Pennington with all its bells and whistles focused on it. Remember how earlier I said that Pennington feels like a college campus. It's actually officially part of Louisiana State University, which is also in Baton Rouge a few miles away.

Back in the nineteen eighties, the head of l s U got the billionaire oilman Claude Bernard Pennington to commit hundred and twenty five million dollars to start a nutrition research center. Over the decades since, the center has been involved in some of the most cordant research done about weight and weight related conditions at the Pennington Biomedical Research

Center Biomedical Research Center. Researchers from the Pennington Biomedical Research Center in Louisiana found Pennington Biomedical Pennington Biomedical Research Center Pennington Biomedical Research Center in Baton Rouge, So to summarize, studies, including ones done at Pennington, have shown that when people eat less, they lose weight. Calories matter pretty self explanatory, but as we just talked about, calories also aren't the

full story. There's this big gulf between what happens in research studies at places like Pennington with its gadgets and gizmos, and the real world. And scientists are also still learning more about how your body seems to fend off long term weight loss. So what is all this add up to. It means that weight loss is more complicated than advertised, a lot more complicated. It also means that losing weight isn't fully in a person's control, even though that's how

we tend to talk about it. Reasons like this are why scientists and doctors have started to call obesity a disease the same way that diabetes and cancer are diseases. And if obesity is a disease, dieting takes on even more importance. It's not just a way to lose weight, but also a form of medical treatment. And if diets are medicine, surely we know what the best diet is for a person. Right the Great diet debate, low carb or low fat, high fat diets actually may be superior

to low fat diet. In the low carbohydrate groups, they lost about two and a half to five pounds more than those in the low fat diet crew. Carbohydrates are the single most important thing you can eat for health and weight loss. And you're thinking, right now, Dr Hyman, have you gotten nuts? Practically each decade has had a new dietary villain. First fat was bad, and then carbs were bad. Now I think maybe they're both still bad, but so is sugar too. Right where did we land

on all that? I'll answer that in a minute. First though, back to Pennington. As I spoke with scientists at the Center, I kept feeling like I was going in circles. They would tell me how complicated weight loss turns out to be. Now there's so much variability between people, and not just with burning calories, but in terms of how easily people lose or gain weight. Now there's still so much scientists are learning. And then I would ask them, well, what

should people do if they want lose weight? And they would say, diet, eat fewer calories. And so I'm going to get the person to write down everything that they eat and drink for the next five days, and we're going to look at where the excess calories are coming from, and we're going to start there. I told Leanne how confused I was by this. How can it be more complicated than calories in calories out? But also that calories in calories out is the answer. And then leon tells

me something that just might haunt me forever. Remember our metabolic chamber from earlier, the sad little rooms. She and her colleagues at Pennington did a study where they put people in there, and the scientists actually over fed these people on purpose. They gave them more calories than needed. They were trying to make them gain weight, and this is what they learned. Some people will burn majority of the excess calories that they've eaten, and they're the people

that will retaine their weight. Some people will burn, will burn those extras, some people will burn none. And Leanne says they've also found that the opposite is true. When you give people less to eat, some people lose weight immediately and others just don't. In other words, it's calories in, calories out, but only for some people. So what I'm taking away from all this is, if you are a person who wants to lose weight, we don't have great

information for you dieting calories in, calories out best. We have another way of putting all this is other people get to eat as many honey buns from the vending machine as they want and just burn it all off. But you don't. By the way, there are other options for weight loss besides diet, like medication and surgery, but they're used a lot less. I was struck by what Leanne said. Though, for all the new fingled machinery and fancy gadgets we toured earlier, the answer is that we

still don't have an answer. Even though dieting doesn't work in a long term way for many people, dieting is still the best we've got, and yet the dogma is still why don't you just diet? No uncertainty, no caveats, none of the nuance we uncovered here at Pennington. I asked Leanne about the uncertainty about the lack of sufficient answers a couple of times, until finally she said this.

You know, we've spent billions of dollars trying to understand obesity and white management and how it a fixed people and how we can help people, and it just seems like it's all going to a black hole because you know,

even with that huge investment, we have no answers. You just heard Leanne Redman, an expert in physiology at Pennington, saying that despite all the money that's been invested in weight loss, not to mention all the fancy equipment and scientists who have spent their careers working on the subject, we have no answers. We have no answers. In fact, that's exactly why we keep coming back to diets. They're not the answer, but they are the closest we've gotten

to an answer. Then again, there are a lot of diets out there. The South Beach diet low fat whole thirty, So so many diets, which ones actually work the best? I put the question to Christopher Gardner, a nutrition scientist at Stanford. This is a super depressing answer that nothing works because we haven't resolved the obesity epidemic. I know, this is getting really frustrating, right. One of the things that we do know is that there isn't one diet

for everyone. So people who claim that it's my diet or it's the Paleo or the Kido or the something else, I just it's not true. Let's say I invented a diet, it's named after me, obviously, and I go around telling everyone, look, this is the diet that's going to finally make you lose weight. Basically, what I'm saying is I tried Emma's diet and it was awesome, and everybody should try Emma's diet. And what I do as a scientist is I get a hundred people and I signed fifty two Emma's diet

and fifty to the other diet. And I have to see that, yeah, way more people on diet A work than DIETETE and you really doesn't happen. And so what we found is that there isn't one diet for everyone. The big problem is keeping it up. I don't eat carbs until I'm craving them so much that I give in. I don't eat out until it starts crushing my social life. All diets have at least this in common. What's the best diet to be on? It's the one you can maintain.

In other words, if you can keep up a low carb diet, power to you, same for a low fat diet. But how do you know at the outset which one is going to work for you. That's where lots of scientists across this field are now channeling their efforts. The consensus now is that diets should be individually matched a person based on different factors about them, kind of like dating. My diet biography might say I'm a court journalist, sits at a desk all day, works out a few days

a week, loves her kale salads, sweet tooth. But there's still a lot missing from that description, things that I couldn't tell you, and even Pennington scientists can't use right now to match me to a diet, Like what's going on in my gut microbiome that's the collection of bacteria involved in digestion and metabolism. What about my genetics? Those are factors that could help you match a person better

to specific diet or what's known as precision health. But it's very hard to find the genetics or the metabolism so far that would point you to one diet or another. We're not there yet, not by a long shot. Scientists are trying to figure it out though. In fact, the National Institutes of Health is just starting to fund a study about this. So again, low fat diets aren't the best diet it for everyone. Neither is low carb diets

may have to be tailored to the individual. All the research on dieting and weight loss over the years has brought scientists to this conclusion. I know, I know. But the thing is, for all we don't know about weight loss, there are some things we do know. We actually know a fair amount about the people who lose weight and keep it off, what they do, and what it takes. There was a sense of it's pretty hopeless, uh and nobody,

nobody really succeeds in weight management. If you're a based you're just out of luck because you know there's not much you can do about it. People try to diet but it doesn't work. That was James Hill, who is Chair of Nutrition Sciences at the University of Alabama at Birmingham. He's talking about how in the late nineteen eighties rates of obesity began rising very suddenly. Remember we talked about this earlier, how those rates had been stable beforehand, but

they've risen and risen until today. And again, as all this is happening, people are feeling pretty hopeless about losing weight. So James and his colleague Rena Wayne, who is a professor at Brown University's Medical School, decided to start tracking successful dieters. They created the National Weight Control Registry, which people can join if they have lost at least thirty pounds and kept it off for at least a year.

There are more than ten thousand members today. James says that the Registry was supposed to answer a key question, what does it take to lose weight long term? And the Registry has actually provided some answers, as evidenced by thirty scientific papers James and his colleague have written about it. That's right, we know what it takes to lose weight long term. You just have to diet and exercise and prioritize it every single day and worked really hard forever.

So one of the things I always tell people that we've learned from the National Wake Control registreet it takes a lot of conscious effort for these people to stay successful. So it's not the case that they lost weight and then they went back to living your lives and didn't think about it. You might remember from our last episode that this is a diet myth the South Beach Diet helped spread in the two thousands. They prioritize their weight

very very highly. Of all the people who diet, and there are many, very few of them actually end up joining the Red Distry. We'll talk about that more in a bit. First, though, here's what we know about people in the National Weight Control Registry. Most of them eat a relatively low fat diet, but some people do the low carb thing too. Again, the specific diet doesn't seem to matter that these folks. Diet seems to matter more

than what kind of diet. Most of them spend probably more time than the average person thinking about their diet during the dash, thinking about what they eat, keeping track. A lot of them keep diet diaries, so they pay attention to the food they eat. National Weight Control Registry members weigh themselves every day. They track what they eat and how much physical activity they get. They're also all

exercising about an hour a day. Jane Fonda and eighties exercise icon wanted everyone to feel the burdens, not just National Weight Control Registry participants. If you're thinking that an hour a day is a lot of exercise, you're right. The US government recommends a few hours of exercise a week, and most adults aren't even doing that. I spoke with five members of the National Weight Control Registry for this

episode and heard similar things for starters. Nearly all of them exercise intensely most days, and a lot have adopted some pretty extreme habits to keep their weight off over time. One guy I spoke with, his name is Marcos Goodman, told me that he had lost sixty five pounds eight

years ago. To keep it off, he eats the same five or six meals every day so he doesn't have attract different foods, like for breakfast, oatmeal with flax seed and sesame seeds, a banana and some non fat milk, a stew for lunch made of either sardines or chicken, and then an evening meal of soybeans. Another woman I spoke to, Susan Pierced Thompson, lost sixty pounds eighteen years ago and then since then maintained her weight by cutting out flour and sugar completely. Susan ended up starting her

own weight loss program based on those ideas. But the thing that struck me the most was the mental and emotional energy all these people spent on simply maintaining the weight that they had lost. It just became this big part of their lives. For some of them, their lives even sort of seemed to revolve around this one thing. No one ever says, this is going to be really painful. You better get ready because you are going to suffer. No one ever says that, and I did suffer tremendously.

This is Desha Gill, a fifty six year old stay at home mom who lives in Dallas, Texas. She's talking about the process of losing weight what it was like for her. I don't know if you've ever tried to sleep when you're really really hungry, not just wanting to eat, but truly feeling like you're starved. That's how I had to feel every night. Disia says she has struggled her weight since she was eleven years old. She told me that she started off binging on candy bars at summer camp.

I was always very interested in health and longevity, and I wanted to be active and athletic, and but who I felt like and what I looked like could not have been anymore opposite. And I found it humiliating and embarrassing to look at myself and for people to see how I would. I was repulsed and so ashamed all the time, all the time. Desha says she has probably read hundreds of weight lost books. She has tried weight watchers, Jenny Craig over eaters anonymous, she got a lap band,

a surgical procedure that constricts the stomach. She even tried hypnosis, none of it worked. She also says she experienced health issues that seemed related to her weight, like fatty liver disease, and asthma. Desha knew she needed to make a major change. She begins shifting how she eats and ends up losing a hundred and ten pounds, But she's also raising suns,

which means lots of tempting foods in the house. I did research and found these food safe that have timers on them, and so I bought some food safe so that I could put the food that I had trouble controlling myself with those food staves, so that my son and this could get them, or if I wanted to treat at some point, I could time it so that I couldn't get into the food safe until I said that I could. Disha still uses those food saves. They're made of plastic and have a dial at the top.

She sets them to unlock over periods of hours or days, so she can't eat, say, candy or chocolate whenever she wants. She also keeps a fridge near her bedroom in case she gets the urge to eat late at night. There are protein bars in there, as well as apples and bottles of water. It keeps me from going downstairs and eating four thousand calories because I can't sleep and I'm upset about something that happened that day. Disha also spends

about five days a week exercising for ninety minutes. She has a special playlist of upbeat music that she listens to when she exercises, and only when she exercises, like Let's say she gets a craving to listen to those songs at another time. It happens a lot, in fact, but Disha doesn't do it. She won't let herself. So anything I can do to spice it up and make

it different. And because it is easy to stop feeling motivated, especially when you're basically at your goal, but I do find new ways to constantly motivate myself and make it fun. It has to be fun. The measures that successful dieters take, other words, can take over their lives. This is the part that's usually missed about the National Weight Control Registry. Sure, these people have all lost large amounts of weight and kept it off for many years, but what it has

taken to get them there is totally unreasonable. It just doesn't seem possible for most people or even worth it. And you always find a few people who are able to lose a lot of weight. This is Glenn Geeser, a professor at Arizona State University who's criticized the National Weight Control Registry. Most people are unwilling to do what it takes to get the weight loss that they would like, things like lock your favorite snacks in a safe so there's a huge gap between what people would like to

weigh and what is feasible. Glenn has actually done some math to figure out how many dieters make it to the National Weight Control Registry. In other words, lots of people diet, how many lose at least thirty pounds and keep it off for a year or more. About a hundred and twenty five million Americans try to lose weight each year, So the ten thousand people that are in the National Weight Control Registry represent about one out of every twelve thousand five US adults trying to lose weight.

As in, for every person in it, there are probably twelve thousand, four hundred and people who didn't lose that kind of weight or didn't keep the weight loss off. That means registry participants aren't even the one percent, they are the point zero zero eight. But the point is is that the people who are in the National Weight Control Registry are just a very very small drop in in a big, big bucket of people. James Hill, the registry is co founder who we talked to earlier, actually

sort of agrees with some of the criticism. This is not for the faint of heart. If you're going to succeed, You're going to have to put time and effort into it for the foreseeable future. This idea, you know, it's short of the American ideas go out and go on a diet and then everything will be fine. Right, It doesn't happen. Most people who lose weight regain it. The hardest part, James says, is keeping it off. He has responded to some of these critiques by starting a whole

new project. It's called the International Weight Control Registry, and it launched last year. This new registry is tracking a much wider group of people, including those who have not been able to lose weight. The team is also trying to reach a more diverse group of members. The National Week Control Registry's typical member is four. You're fifty years old and generally a white woman. I kept thinking about how much people in the registry who have kept weight

loss off have had to diet and exercise. For some of them, it became so all encompassing that they turned it into a profession. They became dietitians or personal trainers, and it seemed like it was worth it for them. Many of the things they did probably did help make them healthier, and they probably started thinking of themselves differently too, as someone really fit with a lot of willpower and determination.

Like Dasha, I basically did something that I have been able to do according to science, according to everything that I've ever read, And in a way, Desha and the others have new lives now, but that number on the scale still rules their time, their energy, their interests, and their identities. They're afraid of what will happen if they stop dieting and exercising, because they might gain the weight back. Even though they've gotten what they wanted, they still live

with a lot of fear. So maybe you're wondering why diet anyway, The backlash against dieting is very much at our doorstep. So I really don't like the word diet. That word, to me is just so negative and it's just, you know, the thoughts that come with that word are like deprivations, starving and just not getting to have anything good.

And in our next episode will look at how diet has become sort of a four letter word but hasn't really gone away a some of the people in the biggest rush away from dieting, they actually run weight loss companies. It's different it's something that I can actually live with. It's I wouldn't even call it a diet losing. It is written and reported by me Ema Court and edited by Kristin B. Brown. Magnus Hendrickson is our senior producer, Stacy Wong our associate producer, and Blake Maples is our

audio engineer. Our theme was composed and performed by Hannis Brown. Thanks to Francesco Leavie and Tim Annette. Be sure to subscribe to Prognosis if you haven't already, and if you like our show, please leave us a review that helps others find out about it. Thanks for listening, See you next time. Two