We started to ask questions because we noticed our patients shared the following similarities:
Patients Awareness of the problem reality
- Timing surrounding onset of symptoms (ie: divorce, job loss, trauma, etc.)
- Failed attempts at changing behaviours despite understanding them and wanting to change
- Evidence of co-morbid disorders requiring treatment (sleep problems, mood disorders, etc. )
What we began to Notice
We never found that weight loss failure occurred as a result of “weak willpower” or ignorance. In fact individuals referred here for comprehensive analysis are always found to know more than enough about diets and lifestyle changes to have succeeded in weight loss, and in keeping that weight off, if only they had been able to sustain those changes.
Our deepest insight into why so many people failed at weight loss came from an early research study Dr. Levy was part of in 1985.
In this study, 50 patients were recruited through a newspaper advertisement. People who read it were asked to call regarding a study on weight loss failure. They had to be very overweight, have failed at weight loss for 10 yr.+ , age 25-60yr. , and be currently weight stable. They were advised that they would need to spend 2 days with us in clinic undergoing various tests to determine why they had failed at weight loss. They would also have to pay $350, as the tests needed ( dietary analysis, psychological test, Potassium 40 study etc.) were not covered under OHIP.
Honestly, we worried that no one reading that advertisement would call in; too expensive perhaps. I was shocked when many more people called than I could ever use in the study. The very first caller said “ if I can find out why I have failed, then $350 is cheap, I’ve spend thousands by now anyway”. She went on to say that having an honest reason for being fat meant everything to her, as that would allow her guilty feelings about being too weak-willed to fade away.
After analyzing the data from psychological tests and interviews, my colleagues and I found a very surprising and unexpected fact. All 50 volunteers had a very low score on what is termed “Drive for Thinness”, basically a measure of the likelihood that an individual has the ability to make losing weight a serious priority, devote time and energy to it to the exclusion of some other tasks, and to persevere on course long enough to succeed. So in essence, these people were , subconsciously, very deeply skeptical as to the usefulness of spending their time and money coming in. Clearly their many failures at weight loss informed their opinion that nothing they would hear from us after the research was done would be helpful in the long term. They really had given up trying to lose weight.
- Some came to prove to a worried spouse that they had not given up the battle.
- Others had elements of magical thinking; somehow a totally new way for them to succeed at weight loss would be found.
- All were intrigued by the idea of research studying “failure to lose weight”. They had never heard of such a thing before.
- Because of their extreme skepticism, most if not all were subconsciously betting the results would not be useful, and that they would be proven right; all of weight plans are just “schemes” for money, and once and for all they would prove it.
- They would also get the satisfaction of a full refund. It is not unusual for people to have a “wild hope” for a positive outcome overtaken and dashed by a much more deeply held negative view predicting a defeat.
Happily, at the end of the study we had scientifically valid reasons by which to explain to each participant the causes of their weight loss failure, each of which could be addressed in turn and would significantly enhance their chances of weight loss. We also took many of these participants on as patients to manage the various difficulties that had blocked efforts at weight loss.
Only 2 individuals did not accept the facts of what we told them, and both got a full refund.