Is weight loss about money, power and trends?

The editorial, of course, dodged the question. Is it possible for most people to permanently lose weight? And, if so, how? If “a healthy lifestyle” were enough, would two-thirds of the nation have a weight problem? Would the nation be gripped by what is often called an obesity epidemic, as evidenced by the grim statistics of a growing national girth? The percentage of people who are overweight or obese was a whopping 47 percent in the period from 1976 to 1980, but now it is an even more whopping 64 percent.

The overweight say it is not that they don’t try to be thin. All they do is try, many say, but nothing seems to help.

They may never have asked whether there is any scientific evidence that one diet is better than another, but most have, in a sense, experimented by themselves, trying diet after diet, hoping to find one that will lead them to their dream weight. They long for the weight that would let them buy clothes in the size they think is really them, or that would give them the sort of confidence in their weight loss that would let them enjoy an ice cream cone without the dread that just a taste of a forbidden treat will set off an out-of-control eating binge, or that would allow them to eat Thanksgiving dinner without the dismal conviction that they will pay for every bite with extra pounds.

They are like Linda Lee, a New York Times writer, who tried the Atkins diet. It worked, but then she backslid. “I just had to have a piece of bread, a slice of pizza, a muffin, and the weight came back.” She went on “the punishing Ornish no-fat diet,” but after losing weight she gained it back again. She bought prepared meals that were made according to the Zone Diet; she went to Weight Watchers. She even tried self-hypnosis, to no avail. The next plan? “I am going back on the Atkins diet.”

The knotty problem was described in a report on obesity treatments by the National Academy of Sciences. Its committee of medical experts concluded that the battle for weight control is never won, even after you lose weight. “An obese individual faces a continuous lifelong struggle with no expectation that the struggle required will diminish with time. For most people, even a brief abatement in effort will be met with a significant setback in control.”

Yet there are those who manage to rid themselves of extra fat, like Richard Wurtman, director of the Clinical Research Center at the Massachusetts Institute of Technology. Wurtman got control of his weight decades ago and has never regained the pounds he lost. He is by no means naturally thin; he says, “I am a fat man in a thin man’s body.” But, somehow, he beat what groups like the National Academy would describe as overwhelming odds. Was it he who beat the odds, or was it his methods?

So the three obesity researchers—Gary D. Foster, James O. Hill of the University of Colorado, and Samuel Klein of Washington University—decided to put the Atkins and low-calorie diets to the ultimate scientific test. They would do a larger study, this time enrolling several hundred obese subjects, enough so that the conclusions would not have to be hedged. They would not just hand people the diets to try on their own but would provide them with intensive counseling and support, an expensive and demanding program that is thought to give the best hope for sustained weight loss. The subjects would follow the Atkins diet or a low-calorie one, and the study would last two years, long enough to get some idea of how well any weight loss held up. Like the initial pilot study, this would be a randomized clinical trial, the most rigorous of clinical studies, in which the subjects would not choose their diets but would be randomly assigned to them.

This is the story of that clinical trial, some of the people who joined it, why they thought they were fat, whether they lost weight, and whether, in the end, one diet was any better than the other. But it is also the story of what came before and what is coming next. It is a story of the weight standards set by fashion and medicine, the lessons learned by science, and what all this means for dieters.

The saga of people’s unending attempts to control their weight is a tale of science and society, of social mores and social sanctions, of politics and power. It raises questions of money and class, and of whether there is such a thing as free will when it comes to eating and body weight. It raises questions of how and why the discoveries of science, which have slowly chipped away at the reasons for obesity and the real health effects of being overweight, have been shunted aside by marketing and hucksterism and politics.

And it is a story of the secret world of the overweight, who fantasize about finally, at long last, getting thin. What is it like to know the calorie count of every morsel of food you see and to worry that a single spoonful of ice cream or a cube of Swiss cheese can send your eating spiraling out of control? What is it like to face, as the National Academy of Sciences so bluntly put it, a “continuous lifelong struggle with no expectation that the struggle required will diminish with time” (emphasis mine)? And how did our society, today, end up with what may be the greatest disconnect ever between the body weight ideals that are held up as obtainable if you really try and the body weight realities for most people?

This is a book about what it is like to be fat in this country today. It is about the nature of the current fixation with obesity, where it came from, and why it persists. It is about personal obsession and social obsession with body weight. And it is, in the end, about obesity—a scientific and social phenomenon that has defined our time, made some rich and others miserable, led to the elation of discovery and the despair of dashed hopes when easy answers did not arise. It is a story that begins with a research study and one newly hopeful dieter.

Excerpted from Rethinking Thin: The New Science of Weight Loss— and the Myths and Realities of Dieting by Gina Kolata. Copyright © 2007 by Gina Kolata. Published in May 2007 by Farrar, Straus and Giroux, LLC. All rights reserved

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