Change is worth it for its own sake. Can you believe that? Can you want it?

Interesting discussion on weight and diet over at Megan McArdle's.  I participated as "bearing." 

I chose to press a different point, but I really do agree with many of the principles of the HAES (Health at Every Size) movement mentioned by commenter "silentbeep."  Health is more important than weight and appearance, and focusing too much on weight instead of healthful behaviors (particularly exercise for its own sake) can discourage people from making changes that really matter.   Weight is an imprecise and maybe even harmfully misleading proxy for overall health and especially cardiovascular health.  Permanent, significant weight loss is difficult, is shown to be achieved in only a tiny minority of attempts, and is maybe not as important for health as people think it is.  Overweight people are treated poorly, and lots of folks think they deserve it, and that's wrong and unhelpful.

Where I part company is this idea that (a) people shouldn't want to lose any weight, nor try to; and (b) if they do try to, "science has proven" that they will likely gain it back anyway.  So you should definitely tell everyone who's lost a lot of weight that they will just gain it back.

(I tell you, chronic dieters just can't win.  Thinness moralists assume they don't have the moral character to stick to their plans, and HAES moralists assume they don't have the moral character or intelligence to break the cycle of self-hatred and accept themselves as they are.)

There is one persistent fact that flies in the face of the "you can't lose weight and keep it off" crowd:  Some attempts succeed.  There are real people walking around who really lost a lot of weight and really kept it off for years.  I have a long way to go before I can count myself among them, but they exist.  The National Weight Control Registry is trying to keep track of them and learn what makes their experiences different from so many others. 

(I often think of my uncle, a retired pipefitter and plumber who was diagnosed with Type II diabetes at least ten or twelve years ago.  He quit smoking, gave up sugar, took up gardening and canning his own vegetables, lost an enormous amount of weight... and today at 65 he looks great.  I haven't written about him here before, and hadn't even thought much about it, but the truth is that his achievement has been a quiet inspiration to me.  I'll have to tell him that the next time I see him!)

One thing I notice in these discussions is a failure to discriminate among several distinct issues.  These four questions, for example, are very, very different:

1. "How can we make the population less overweight?"
2. "How can we make the population eat more healthfully and get more exercise?"
3. "How can a person who wants to lose weight permanently be helped to succeed?"
4. "How can a person who wants to make a permanent change for healthier eating and more exercise be helped to succeed?"

I have little patience for making people, or populations, do anything.  Especially since, as has been convincingly argued, few people in long-term studies achieve permanent change; public policies designed to put the population on a diet are probably hugely wasted effort (there is still room to experiment with nudging the external incentives around -- I'd like to see a change in the structure of agricultural subsidies, for one thing).  So much for #1 and #2.

As for the difference between #3 and #4...

But having been through it myself over the past year, I can attest to the power of desiring to change behavior for its own sake.

Imagine the difference between someone who "wants to lose weight" and someone who...

• finds himself staring at the grocery cart, thinking "I'm sick of eating all this processed stuff...  I want to learn how to eat, prepare, and enjoy real food for a change."

• decides "I spend too much time staring at a screen... I need to get outside more."

• wants to set a good example of healthful living for her children, sharing fun physical activity and learning to cook good food together.

• realizes she wants to become an athlete, and can if she is willing to try.

• realizes that she eats far more food than she needs, and that she feels out of control of her food, and that she's tired of it and wants to stop.

I think people with these real desires have a real chance of permanent change, and so support for those who fall into category #4 is probably worth a great deal of effort.   I can't prove it, but it's my suspicion that the desire to change behavior from within, for its own sake, is the key to success; and that the desire to change appearance and "to do what's necessary to achieve that" (that is, wanting to change the behavior only because it might help change one's appearance) is a marker for likely failure. 

I think few people can keep doing what they don't want to do in the absence of immediate and ongoing reward; and that numbers going down on the scale might be enough reward, but that numbers staying the same on the scale probably aren't, at least not for long.  But lots of people can do what they really want to do, even if it's hard.

So maybe people should stop looking for inspiration that tells them "You can do it!  You can stick to a diet and exercise plan to lose weight and keep it off!"  And they should start looking for inspiration that will convince them "You want to do it!  You want to permanently change your eating and activity to something that's heathier...  whether you lose weight and keep it off, or not."