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Health Risks of Weight Loss 1HIRD Edffion Copyright 1992, 1993, 1994, 1995 by Frances M e1' oss Frances M. Berg Healthy Weight Journal • Statistics • Fasting Diets • Weight Cycling • Diet Pill Abuse • Graphs & Charts • NIH Conferences • AMA DATT A panel • Congressional Hearings • New York City Investigation • Healthy Weight Journal Research Reports ... ealthRisks of Weight Loss Frances M. Berg Healthy WeightJournal Health Risks of Weight Loss 1HIRD EDffiON Copyright 1992, 1993, 1994, 1995 by Frances M. Berg. The special report was initially published in part in Health Risks of Obesityin1992. All rights reserved. Reproduction in whole or in part prohibited without publisher's written permission. ISBN: 0-918532-44-2 Printed in USA Published by Healthy Weight Journal (formerly Obesity & Health), Established in 1986 Healthy Living Institute Editor: Frances M. Berg, M.S. Associate Editor: Kendra Rosencrans, M.S. Production Manager: Ronda Irwin. Subscription rate: $59 per year (bimonthly) Add $1 Canada; $9 other countries. U.S. funds only Visa, MasterCard. Student and group rates available. Healthy Weight Journal, Healthy Living Institute, 402 South 14th Street, Hettinger, ND, 58639 IB: 701-567-2646; FAX: 701-567-2602. Contents Introduction Part I - Risks of weight loss 1. General treatment risks ....................................................................... 14 Dexfenfluramine use risks brain damage ...................................... 16 2. Starvation and fad diets .................................................................... 27 VLCD destroys self-initiative ........................................................ 28 500 clients sue Nutri/System ......................................................... 31 Chinese puzzle ............................................................ ... .................. 32 3. Diet pills and drugs............................................................................ 34 Ephedrine strikes again ................................................................. 34 Dieters light up more often .......................................................... 36 4. Purging, exercise ..................................... .............. ........ ..... .... .... ... ...... 39 S. Surgery ... ...................................... .. ....................... ......... .... ........ .... ... .... 44 Liposuction ads ......................................................... .... ....... ........... 48 6. Sports and athletes............................................................................. 50 7. Eating disorders - physical and mental effects ............................ 56 Thin people are the 'saints' among us ........................................ 57 Anorexia nervosa .......... ... ... .............. ............. .... ... ... .... ..... ... .... 58 Bulimia nervosa ................................................................. ....... ... .... 59 Eating disorder not otherwise specified...................................... 60 Binge eating disorder ..................................................................... 61 8. Psychological risks .............................................................................. 63 9. Weight cycling ...................................................................................... 70 Heart disease in men ..................................................................... 70 Weight cycling women ................................................................... 71 Weight cycling drops metabolism for wrestlers ......................... 72 Weight variability in Sweden ........................................................ 75 10. Mortality increase with weight loss ............................................... 80 11. Thinness: a cultural obsession ....................................................... 89 Fashions in the female figure ....................................................... 90 Hearty, nuturing fat ........................................................................ 92 Thin mania turns up the pressure ............................................... 95 Fighting for acceptance in the fitness world .............................. 96 Fat kills.............................................................................................97 Slimness: the new religion.............................................................98 12. Effectiveness of treatment ............................................................. 100 Grope in the dark ........................................................................100 Obesity keeps scientists humble .................................................103 A doctor's weight loss education ...............................................105 Part II - Challengesfor healthychange 13. To treat or not to treat............................................................... 108 Diet vs. nondiet thinking .......................................................111 Obesity treatment without harm ..........................................112 14. Diet industey regulation .............................................................. 114 New York Oty regulates weight loss centers .................... 116 Weight loss consumer bill of rights .....................................117 New York State proposal .....................................................118 15. Challenges for wellness and wholeness .................................... 122 Beauty ideas are fluid ...........................................................123 Boost self-esteem with fat affirmations .............................. 125 Wal-Mart, CNN and Snapple honored for size diversity.........................................................................127 Preventing eating disorders in Norway .............................. 129 10 things men can do and be to help prevent eating disorders ....................................................130 Appendix Obesity definitions ......................................................................134 1992 NIH conference statement .................................................135 New York Oty investigation.......................................................136 Potential side effects of very low calorie diets .........................139 The biology of human starvation ................................................140 Adverse effects of weight loss: Framingham Heart and Cardia Studies ..............................144 References ......................................................................................148 Associations and resources ..........................................................153 lndex ................................................................................................154 Introduction The effects of the current obsession with dieting can be devestating. Pressures to be thin are more severe in the western world today than they have ever been in the past. These pressures - from television, Madison Avenue, magazines, Hollywood and the medical community - are so great that nearly half of American women and girls, and about one fourth of men, are actively trying to lose weight. These statistics include as many as 80 percent of girls as young as ten or 11 with disordered eating because of their fear of fat. These facts prompt some disturbing questions. Are these people - an estimated 60 to 80 million adults - improving their health by their weight loss efforts, or not? How safe are the methods they use? How does the drive to be thin and "always dieting" impact individuals of all sizes, their families and their communities? Our obsession with weight and dieting is a national crisis not being adequately addressed by the health community. Significant rapid weight loss affects every part of the body, and can be fatal. Since weight loss is a health-related endeavor, many might assume treatments are subject to clinical testing, accountability and regulation. Unfortunately, this is not the case. Even many medi­ cally supervised programs seem to proceed with the rationale that weight loss justifies any detrimental effects. High-risk patients are commonly subjected to high-risk treatments. Healthful solutions often do not get the attention or encouragement they deserve. The powerful weight loss industry and its entrenchment with policy makers is undeniably partially responsible. Consumers spend $30 to $50 billion annually on weight loss services and products. This does not include smoking for weight control, which is a highly lucrative marketing area for the tobacco industry. A dazzling array of weight loss methods is available - diet pills, surgery, exercise, starvation, purging, and a multitude of di­ ets. They are heavily advertised, and promoted by friends, family and health professionals. Some interventions appear benign; oth­ ers clearly entail risks much greater than the risks of overweight. Some are supervised by trained medical teams; others are self­ administered by mere children. Even repeated cycles of weight gain and loss, or simply weight loss itself in some degree, may be harmful. It is generally assumed that weight loss will improve the health of large people. But there is little research to support this. HEALTHY WEIGHT JOURNAL 7 HEALraRlsKS OF WBIGHTLoss Purpose of report This report brings together the scientific evidence on the health risks of dieting and other weight loss interventions. It is intended to help both professionals and consumers cope in healthful ways with the complex dilemmas of weight. It is also intended to gener­ ate discussion which can lead to preventive action and a more comprehensive way of dealing
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