The National Weight Control Registry: the gold standard in bullcrap (Part 3)

In Part 1 of this series on the National Weight Control Registry (NWCR), we looked at the pretty underwhelming response to the launch of the Registry, and in Part 2, we looked at the even more underwhelming results of 2-year follow-up. This was supposed to be a 3-part series. But as it turns out, the NWCR is just too ridiculously crap to tear apart in a mere 3 postings, without them turning into an actual book. Hey – there’s an idea. So welcome to the third instalment.

Just to recap on what we’ve done so far, in a country where over 70 million people are trying to lose weight, in nearly 10 years, a nationwide multimedia campaign managed to attract around 3000 people who have lost at least 30 pounds from their lifetime maximum weight and kept it off for at least a year, and of these, 72% were regaining weight – with most failing to lose it again.

But what’s happened since then you want to know. Well, erm, I dunno. The Registry was founded in 1994, making it nearly 20 years old. But the longest-term follow-up data published to date is the 2-year results I talked about in Part 2. I’m guessing, the researchers saw which way the wind was blowing, and decided not to pursue that avenue of research.

So they admitted the Registry had failed to provide evidence of the achievability of long-term weight-loss in the vast majority of people and moved on to bigger and better things? Did they hell! In the intervening years they have provided a steady stream of published peer-reviewed papers that have contributed pretty much nothing to the scientific debate on weight-loss maintenance. Let’s have a look at one of those papers, shall we?

In 2009, they published a paper comparing 2-year follow-up (there’s that magic number again) in people who had earned their place on the registry by losing weight following weight-loss surgery (WLS) and those who had used non-surgical (NS) methods. Of the less than 5,000 people recruited in the 13 years the registry had been running (not including those who were pregnant or had not been in the registry for at least 2 years), 105 had had WLS. These were matched 2:1 with NS participants, by age, gender, weight at entry (not BMI, so not taking into account height), weight loss within plus or minus 15.9 kg range (that’s a 70 lb range people – not how I would define ‘matched’) and weight loss maintenance duration at entry within plus or minus 2 years (so up to a 4-year difference; see above comment). So we have 315 people in total who were apparently ‘similar’ at baseline, by some interesting definition of the word ‘similar’. But overall, to be fair, those differences evened out and the two groups, if not the individuals in them, did appear pretty similar at baseline.

OK, 1-year follow up: of the 105 WLS entrants, 78 of them made it to 1 year, a dropout rate of 26%; the drop-out rate was lower in the NS group, only 18%. At 2 years, they hadn’t lost too many more WLS entrants – total dropout rate was 31%; disappearances of NS participants had shot up, making up for lost time, and were now at 35%. Now I’ve mentioned before that people drop out of studies for all sorts of reasons, but we can assume that at least some of them gained weight and were too embarrassed to participate further.

The NWCR makes no attempts to chase-up dropouts. It has been suggested to me, by a practitioner with an interest in obesity, that this is reasonable, because the ones who gain weight are not of interest to researchers. I beg to differ. These were the people who were touted, with much fanfare, as successful weight losers, and whose number, as far as I am aware, are still included in the registry total. I want to know what, if anything, went wrong. Did they stop exercising 2 hours a day? Did they go back to eating a moderately normal amount of food? Did they get treatment for their eating disorders? Or did their bodies just give up the charade and fight back? Sadly, we may never know.

But anyway, looking at the results of the ones who chose to continue to return their surveys in the pre-paid envelope each year, the first thing to notice is that method of weight loss didn’t seem to make much difference to results. The trajectory of weight/loss gain was similar between the two groups. After 1 year, this trajectory showed a small number continuing to lose weight (defined as more than 5kg (11 lbs) below baseline) – around 12% in the WLS group and 9% in the NS group, and these numbers didn’t change much over the second year. Where it gets interesting is in the other two groups. At year 1, around 60% of the WLS group and 68% of the NS group were classed as ‘maintainers’. ‘Maintenance’ is defined as being weight ‘stable’ within plus or minus 4.9kg (giving you around 22 lbs of wiggle room – we really should buy these poor scientists a dictionary). By year 2, those numbers had dropped to around 50% in both groups.

So if you’re not losing, and you’re not ‘maintaining’… ah, yes, the regainers. At 1 year, around 28% of the WLS group and 22% of the NS group had gained more than 5 kg (11 lb) since entering the registry a mere 12 months earlier. At 2 years, those numbers had increased to approximately 36% and 42% respectively. So much for the long-term ‘permanent’ weight loss associated with bariatric surgery. So just to be clear, each year, the number of people managing to ‘maintain’ their initial NWCR-entry weight dropped, and those gaining fairly noticeable amounts of weight increased. And when we look at what happened after 2 years, oh, wait, the NWCR doesn’t do more than 2 years in their publications. I wonder why.

But alright, after 2 years, around 60% were at least ‘maintaining’ their initial weight loss (actually, not really their initial weight loss for the most part, but the one that got them into the NWCR). Remember, as I mentioned in Part 1 of this series, 91% of registry members had previous ‘failed’ weight loss attempts, with the average amount of weight lost since they started trying to lose weight being 565 lbs. Some had lost over 1000 lbs before successful managing to keep off their current minimum of 30. Or 40, or 50 or whatever the average NWCR weight-loss at entry is supposed to be. And each year, more and more of them are gaining it back. Impressive, eh. And let’s not forget also that that 60% is 60% of the ones still standing at 2 years, and only 2/3 of the 315 initially entered into this particular study. If you do the analysis the way you’re supposed to (if you practice respectable science) and take into account all the people who started the study, not just the ones who finished it, only 40% are maintaining or better, even after WLS, pretty much in line with what we’ve seen in the registry as a whole.

Just as a point of interest, both groups were averaging about 1400 calories a day, and participants in the WLS group were getting significantly more of their calories from fat, eating fast food more often, and breakfast less often than the NS group. So much for lifestyle change. The WLS group were also exercising about half the amount of the individuals in the NS group (and doing about 1/3 of the amount of high-intensity exercise). To be fair (I seem to be saying this a lot – I’m trying to be fair – they’re not making it easy), the NS group were averaging over 3000 kcals per week of exercise. Or in English, equivalent to walking around 30 miles a week. And the range was huge – some were doing double this. So doing half of this amount isn’t exactly slacking. But the WLS group also reported more depression and stress at entry, and both groups showed significant increases in intensity of depressive symptoms after 1 year. These questions weren’t asked in Year 2. In both groups, the rates were much higher than community norms, with 30% of the NS group and 44% of the WLS group having clinically significant depression 1 year after entry into the registry.

But getting back to the fun stuff: for my finale, may I present to you, drum roll please, the abstract of this study. For the non-scientists among you, the abstract is like a summary of the paper that goes at the front and gives people an idea of what’s inside. It is also the source of press releases and the like. This would all be good and dandy if the abstract bore any resemblance to what was really in the paper. But let’s have a look. Each abstract includes a Conclusion, where the authors summarise their overall findings. If you are a busy doctor, or a busy press officer, this is probably the only bit you look at, after the title so it’s kind of important.  Just in case you’re interested, the title was “Weight loss maintenance in successful weight losers: surgical versus non-surgical methods”. Now I don’t know about you, but to me, that kind of suggests that weight loss was maintained and the ‘losers’ remained ‘successful’. It doesn’t say that as such, but I guess “Weight loss maintenance rates are pretty dire following both surgical and non-surgical weight loss, unhealthy behaviours are apparent at both ends of the spectrum, and the weight losers are pretty damn unhappy to boot” doesn’t have quite the same gravitas. But the title is at least more or less descriptive. And in conjunction with the conclusions, will give most people their take-home message from this study. So what were the conclusions? I’ll let the authors speak for themselves.

“Despite marked behavioral differences between the groups, significant differences in weight regain were not observed. The findings suggest that weight loss maintenance comparable to that after bariatric surgery can be accomplished through non-surgical methods with more intensive behavioral efforts.”

It’s worth noting that, again, cleverly, these conclusions do not say anything actually false. Differences were not really observed between the groups. But the way it is written, if not read carefully, might seem to suggest that significant weight regain did not occur, and that would be somewhat misleading. But not as misleading as the second, also not untrue, sentence. Yes, similar results can be achieved. But they’re still CRAP results people. Man up and admit it already! Tune in next time for more of why the NWCR is a disgrace to science and public health. I’m having too much fun to stop now!

The sad case of Mrs X, and why her husband called her a fat pig

I want to tell you a story. It's not my story to tell, but the woman in question has given permission for it to be told. I first heard about, let's call her Mrs X, about a year ago, when I was doing some training in eating disorders at the National Centre for Eating Disorders in London. We were talking about body image and weight stigma, and our lecturer told us about one of her clients.

Mrs X was overweight. Or fat, if you prefer. Not cut-off-the-side-of-the-house fat, but just your normal everyday fat that you'll see in a good percentage of women as you walk down your high street. She had two grown kids, who had left home, and she was living with her husband. Sadly, it was not a happy marriage. In fact, the relationship was abusive.

Mrs X had come to our lecturer for help with her weight, and during the course of her treatment, details of her abusive home relationship began to emerge. Her husband would call her names. Every day. He'd call her fat, tell her she was a pig, that she was disgusting. If he saw her looking in a mirror, he'd tell her that she was so unattractive, nobody would want to look at her. He'd make her cry. He refused to take her out with him to parties or work events. He said he was embarrassed to be seen with her. And he sure as hell wasn't going to give her money to buy new clothes with. He'd tell her if she wanted new clothes, or to go on holiday, or any other nice things, then she should STFU and just lose some weight. He certainly wasn't going to waste time and money on her looking like she did now. And it went on.

As our class all sat stunned listening to this tirade, our lecturer asked us what advice we would give to Mrs X if she were our client. I piped up first (being the gobby one, no surprise there) that I'd give her the number of a good divorce lawyer. Several similar comments followed. Then one girl at the front said, 'He's probably only saying what she's thinking anyway'.

This is really important. Because when people call us names, it usually only hurts if we believe them. Think of all the insults that could be thrown at a person. Then imagine them being directed at you. Some of them, perhaps based on skin colour, or sexuality, or size, may not even apply to you. If somebody said that to you, you'd probably look at them quizzically and wonder what they were on about. But if they called you something that hit a nerve, something that was already in your head, your own nasty little voice, chances are, it would destroy you. Or at least, bring tears to your eyes and hurt into your heart. As Eleanor Roosevelt said, "No one can make you feel inferior without your consent."

But coming back to Mrs X. That student at the front had hit the nail on the head. The kicker to this story, as some of you may have already guessed, is that there was no husband. At least not the abusive one described above. All of that abuse came from within - that was how Mrs X talked to herself.

Why is it that it is so obvious that this kind of talk is completely unacceptable and nothing short of abuse when we see it in others, but many of us continue to feel we deserve to treat ourselves that way, that we deserve no better, for the sin of daring to be Not-A-Supermodel. Heck, who knows, maybe the supermodels talk to themselves that way too. When did our worth become equated with our looks? When did all that was wrong with our lives become projected onto hatred of our bodies?

Today is Day 4 of the Binge Eating Disorder Association's second National Weight Stigma Awareness Week.* Take this moment to think about how you talk to yourself. And start to treat yourself as you would want somebody to treat your mother, or your daughter, or your best friend. You too are somebody's mother or daughter or best friend. You deserve no less.

*This blog was originally posted at www.neverdietagain.co.uk/blog on 27th September 2012.

Fit vs Fat vs OMG Where Did My Head Go?

This week saw the publication of yet another study showing that fitness is more important that fatness in predicting long-term health outcomes for everything from heart disease and hypertension, to cancer mortality and death in general! It joins the likes of this, and this, and this and dozens more. One of the things that particularly annoys me is that every time a new study emerges showing that fatness is not the same as unhealthy (and lazy and morally bereft), the press treat it like it's a big surprise. Heck, the researches often treat it like it's a big surprise. Do these people not talk to each other? The volume of evidence is getting so large, when do the government and the health service and everyone else start to take notice? Anyhow, the press coverage of this particular story has been mixed. Here are a couple of examples from the online press:

Pic accompanying story by BBC Online

The BBC Online reported the study but included quotes from a BHF spokeswoman, who pretty much contradicted the entire message. It also finished with the comforting advice not to worry too much about the number on the scales. Their suggestion was to track your BMI instead. A true head/desk moment. On the plus side, the photo accompanying the story showed a genuine live fat person, exercising, with a head and everything! So kudos to the BBC for that.

Pic used by Telegraph Online

In contrast, the Telegraph Online reported the study pretty much as is, but failed by posting it with the picture on the right.

After whingeing a bit online, I decided to actually put my money where my mouth is and wrote a letter to the Telegraph expressing my disappointment. 

And here it is:

I would like to register a complaint about a photo used to accompany a story in the Telegraph Online.

The story in question appeared on September 5th and reported on a study published in the European Heart Journal showing that fitness was more important than fatness for determining long-term health outcome. While the story was written by Rebecca Smith, I realise that the writer is not the person likely to be choosing accompanying images.

The vast majority of images of fat people in the media are highly stigmatising and dehumanising - most often, what we call the 'headless fatty'. No head, shown from the back, shown spilling out of their clothes, shown putting a doughnut into their disembodied mouth, that kind of thing. It is these kinds of images that have resulted in a massive increase in weight stigma, increasing body dissatisfaction and an increase in eating disorders and related problems in ever younger people. This dehumanisation also seems to promote the legitimacy of attacks on heavier people, just because of the way they look, that would be illegal if directed against somebody because of, say, their skin colour.

The Yale Rudd Centre for Food Policy and Obesity has done a lot of research on media portrayal of fat people, and the effect of this on perceptions and attitudes. They have also created an image library for use by media outlets. These images show fat people, with heads, doing a range of everyday activities, allowing them to be portrayed as human beings. You can find more information and access the image gallery here: http://www.yaleruddcenter.org/press/image_gallery_intro.aspx

I had a look at the stock library from which you sourced the picture used in this article. Given what you had to choose from, I concede that the image you used was actually one of the better ones! But that's not saying much.

In the interest of more balanced reporting, I do hope you consider the impact of your image choice on the messages received by your readers, and would ask you to choose more responsibly in the future, assuming that it was not your intention to perpetuate the perception of all big people as sub-human blobs of fat undeserving of respect or compassion.

Sincerely,

Angela Meadows
Never Diet Again UK.

More of us need to stand up and call out this sort of thing when we see it if anything is ever going to change. Feel free to use my letter as a template, or if you don't feel like taking on something yourself, but feel it deserves a response, there is a facebook group called 'Rolls not Trolls' who specialise in that kind of thing - just bring it to their attention and let them spring into action.

Dare to bare!

This post started out life as a personal rant in one of the Never Diet Again newsletters but I've been thinking about it a lot since then and so I decided to post it here too.

About a week ago, self-styled 'Etiquette Expert' and all-round stuffed shirt, William Hanson went on ITV's This Morning (a UK morning television show) to argue that women over 50 should not be allowed to wear bikinis. In fact, he added, women under 50 who didn't have great bodies should have the decency to cover up too. In the opposite corner, mature hottie Nancy Dell'Olio was arguing that you could be over 50 and still va-va-voom in a bikini. Click here to watch the old-before-his-time fuzzy cheeked Mr Hanson argue his side whilst squirming with embarrassment and trying not to look at Nancy's legs.

What pretty much everybody seemed to be missing was that if you want to wear a bikini, that is entirely your decision, and nobody else's business but yours. Whether you are tall or short, straight up and down or well-blessed with what my hubby calls Cuddle Padding, whether you are smooth as a baby's bottom or sporting a chest full of ginger curly hair, whoever you are and whatever you look like, if you would rather spend your day at the beach in a two piece, then that is your right.

Mr Hanson rehashed his ridiculous argument the next morning on a local radio station. If you feel like tearing your hair out, you can listen to the segment here - it starts around the 1 hour 17 minute mark. The man clearly has issues with his own body, and apparently thinks it only right that nobody else should be happy with theirs either. Or even if you are so deluded as to think you do look good in a bikini, he claims, if your attire makes anybody else feel uncomfortable, then you shouldn't do it. It's not polite. And he feels uncomfortable. And some people agree with him. So there.

I suppose he would argue that if people are uncomfortable with two men or two women holding hands on the beach (or anywhere else) then that shouldn't be done either. Actually, he seems the sort who would be just as uncomfortable seeing a public display of affection from a 'traditional' couple. What if people are uncomfortable seeing ethnic bodies at the beach, or mixed race couples, or people with scarring. Some people might be uncomfortable seeing a group of severely disabled children on a day trip to the seaside. Clearly these people should stay at home behind closed doors for the good of common decency and not have the temerity to spoil Mr Hanson's Big Day Out.

Of course, there's always the alternative. Look somewhere else. Or if you're that sensitive about seeing other people in less than head to toe cover up, don't go to the beach!

On a personal note, following my first year of HAES, this summer, for the first time ever, I have gone (gasp) sleeveless! Gone are the angst-ridden frustrating attempts to buy summer clothes with sleeves. To never purchase any item that doesn't come with a cover up. This year, clothes are just clothes, and I have dared to bare. And I finally understand why most summer clothes aren't made with sleeves. No, it's not a conspiracy against fat people. It's because in hot weather, it is more comfortable not to be covered up. Mr Hanson, who looked damned uncomfortable on that sofa, should try it sometimes. In fact, in the last couple of months I have been to the supermarket, to concerts, to dinner, and just gone about my daily business in sleeveless tops. And you know what? To date, not a single person has keeled over in horror at the sight of my upper arms. Who knew?

I'd like to leave you with the wise words of Mrs Avoirdupois on the two important steps you need to take to get a beach body.

Number one: have a body.
Number two: take it to the beach.

The National Weight Control Registry: the gold standard in bullcrap (Part 2)

 Last time we looked at the origins of the NWCR and the somewhat underwhelming evidence that weight can be successfully lost and maintained without descending into some seriously disordered ‘health’ behaviours. This time, we’re going to look at what happened to those people after they’d been in the registry for a couple of years.

In a paper published in 2003, six years after the first, the ranks of ‘successful dieters’ had swelled to an astounding 3234. This in a country of 77 million dieters. But we have to work with what we’ve got, so let’s go with that for now. Of the 3200 people who had been in the database for at least two years, only 2400 completed their 2-year assessment. Obviously, we don’t know why the other 800+ registrants did not participate, but at least some of them are likely to have gained weight and been too embarrassed to respond. We do know that they tended to be younger than those who stayed in, weighed more at the time they entered the registry, and had reported greater weight loss. So, not to put too fine a point on it, they were fatter to start with, had lost loads of weight, and then disappeared. Hmmm.

But that still leaves 2400 ‘successful dieters’, you say – so that just proves that it can be done. Well, one year after joining the registry, 1483 of them (66% - or two-thirds) weighed more than they did when they joined. By the end of the second year, that figure had risen to 1630 (72%). In other words, the longer you wait after your starting point, the more people gain weight. This is consistent with what’s been shown in other studies. One of the most comprehensive reviews of long-term dieting success rates reported that in one study, 23% of individuals monitored for less than 2 years had rebounded to more than their baseline weight. The figure for those monitored for over 2 years was 83%. Analysis of studies with longer follow-ups showed that the weight regain doesn't really level off either, even at 5 years.

Getting back to the NWCR, at 2 years from entry into the registry, only 465 people had not regained any weight from their starting point. The researchers point out that this is around 21% - higher than found in typical weight loss trials. But even ignoring the fact that this is 465 of 3234 eligible registrants (or around 14%, not 21%), we’re still talking in the low hundreds – not exactly earth-shattering evidence for dieting success. And we don't yet know what happened over the next few years.

To be fair, the researchers did analyse recovery from weight regain between year one and year two, and this is what they found. Of the 1500-odd people who regained weight between entering the registry and their one-year follow-up, only around 150 of them had lost the weight again by the end of the second year. Unsurprisingly, the more weight they’d regained, the less likely they were to have ‘recovered’. It’s true that the largest proportion of regainers (456 people) was made up of people who had gained less that 3% from their 'successful' weight. Even so, only 80 of them had managed to lose the weight again the following year. Of the 284 people who gained back between 3 and 5% above their entry weight, only 41 of them managed to lose it again by year two. A gain of over 5% of joining weight occurred in about a quarter of the respondents (575 people – this is a rough estimation of the actual numbers – between the graphs and the text, around 120 people magically disappeared). Consider the following an approximation only – don’t try and make the numbers add up – it’s an exercise in futility. So as a rough guide, of the 575 or 627 or whatever people who gained back 5% or more, only 74 of them managed to lose half of it back by year 2, and only 27 people had returned to their starting weight. Twenty-seven. There’s no information what means these rebounders used to get their weight back down to that all-important lower number, especially given that their original maintenance strategies weren’t exactly paragons of healthy behaviour. Probably best not to think about it.

So just to sum up, in a country where over 70 million people are trying to lose weight, a nationwide multimedia campaign has managed to attract around 3000 people who have lost at least 30 pounds from their lifetime maximum weight and kept it off for at least a year, and of these, 72% are regaining weight – with most failing to lose it again.

Having said that, two years is a relatively short time in the grand scheme of things, and the gains weren’t HUGE: the average was only about 8 lbs, although again, there was wide variation. Although other studies have consistently shown weight regain increases with time, these are the SUCCESSFUL weight losers we’re talking about. Maybe they managed to turn it around further down the line? I mean, this paper was published nearly 10 years ago; maybe some longer-term results have been published since then that give greater cause for optimism? Don’t hold your breath, either on the publication of long-term data or the improved maintenance rate. We’re still waiting on that one. But do tune in next time for the final episode of how to make massively disappointing results look like really exciting news.

The National Weight Control Registry: the gold standard in bullcrap (Part 1)

 Whenever anybody talks about the futility of trying to lose weight, somebody like That Awful Woman (TAW), who I won’t give more publicity to by naming, will throw the National Weight Control Registry (NWCR) in their face. See, it IS possible to lose weight and keep it off. This is the proof. You’re obviously just not trying hard enough. But as TAW seems to get all her science from the daily news, she could be forgiven for buying into this myth - it has been carefully crafted to make us believe.

Despite reams and reams of evidence (like this and this and this) showing that NO method of weight loss leads to long-term maintenance, the NWCR continues to be held up like a beacon of virtue, giving hope to all of us failed dieters that lifetime change IS possible. Given the smug condescension with which finger-wagging 'well-wishers', who are apparently just concerned about our health, use the NWCR to belittle and castigate us poor greedy lazy fat people, it is worth looking a bit closer at just what is being touted as evidence of successful dieting. How are these people getting it right when everyone else is failing so miserably?

Well that’s an interesting question. In fact, that’s the very reason the NWCR was set up in the first place. Back in the early 90s, researchers from Brown, Colorado and Pittsburgh universities decided to gather together a database of people who had successfully lost weight and kept it off. The idea was to study these people and find out what their secret was. Not a bad idea, really, particularly since back then we didn’t know as much as we do now about how damaging dieting actually is to your health.

The problems started soon after when they couldn’t actually find any. Well, that’s a bit unfair. They found a few. In a country where over 70 million people are thought to be dieting at any one time, they did managed to attract a few hundred who self-reported that they had lost the required minimum of 30 pounds, and kept it off for at least a year. The first major publication from the NWCR team was based on 784 enrolees who met these criteria. 784. The paper was an analysis of what these people were doing that had helped them to qualify for the registry in the first place. In fact, some had far exceeded the minimum criteria. Average weight loss was 30 kg (66 lbs), and average maintenance was 5 years. It is these particular numbers that are most often bandied about as proof of successful dieting. So let’s look at them a little more closely.

First, that minimum 30 lb weight loss is defined as a weight below their lifetime maximum. So if you lost 100 lbs from your lifetime max, and regained 70 lbs, you’d still qualify. Even if you’d done it numerous times before: 91% had previous ‘failed’ weight loss attempts. The ‘average’ amount of weight lost prior to their current success was 565 lbs. And there was a wide range here, with some losing over 1000 lbs before successfully managing to keep off their current minimum of 30. No information on how long previous weight loss ‘successes’ had been maintained. But enough with the cynicism. What were they doing this time that was different?

 Well, 92% were still monitoring their food intake – counting calories, fat grams and so on. The vast majority maintained a low calorie diet, through whatever means. 95% of men were getting between 1100 and 2300 calories, and for women it was between about 800 and 1800 calories a day. The average was 1700 for men and 1300 for women. About half admitted spending more time and energy thinking about food and weight than they did before. They also  definitely got a lot more exercise, on average, 2830 calories per week, or roughly equivalent to walking 28 miles. Again, the range was big, with some doing up to double this. Most continued to monitor their weight regularly, with 38% continuing to weigh daily, and 7% reporting more than once a day. Now I don’t know about you, but if somebody with a ‘normal’ BMI told me they were thinking about their food and weight a lot of the time, eating just 1500 calories, monitoring every bite of food that went into their mouths, walking over 4 miles and weighing themselves at least once a day, I’d be a bit worried about them.

So that’s how the just under 800 success stories qualified for the NWCR. Even ignoring the well-documented harmful effects of weight cycling (yo-yo dieting), and the somewhat dubious ‘health’ behaviours used to maintain their current weight, let’s just assume that this time really was different. Tune in next time for the not-entirely-surprising results of follow-up studies.

Confessions of an ex-dieter

Some things are almost too shocking to admit. I was talking to a fellow ex-dieter the other day (the incredible Jenny Jameson from F*ck The Diets - why oh why didn't I think of that name???), and we were discussing how our eating habits had changed since we'd given up the dieting mindset. And then I tentatively let slip something so shameful...

'I actually really like cottage cheese...' She laughed, 'Me too'. Phew, it was like a weight being lifted. And then the flood gates opened. 'And diet coke'. Jen countered with 'oat cakes and marmite'. (Urgh) And of course, skimmed milk. I just can't drink the regular stuff anymore - it tastes like double cream to me.

It has been playing on my mind about why we were both almost embarrassed about our continued enjoyment of 'diet' foods. The only thing I can come up with is that it goes against our new-found pride in shrugging off the shackles of the anti-obesity industry. Standing up to The Man. Defiantly refusing to buy into somebody else's rules about what we should and shouldn't eat. If we want pizza, we eat pizza dammit. Chocolate? Ditto.

But it seems that some foods have become so associated with the diet movement that they are no longer recognised as perfectly reasonable food choices for anyone who is not trying to lose weight (without getting in to whether Diet Coke is a reasonable food choice, or even a food. I like the stuff. Get off my back already!) Jenny told me how some friends of hers had praised her for eating cottage cheese one day: 'Ooh, aren't you good!'

So listen up folks: we're done being 'good'. We no longer seek your approbation for trying to alter our bodies into a form that society deems acceptable. We want to stand up and shout: I'm not being 'good'. I'm not trying to change myself. I value myself just the way I am. And I no longer attach any moral value to my food.

Now that I listen to my body, sometimes it just wants cottage cheese. And that's just fine with me. But not today. Today I'm going to head out onto my balcony and enjoy the rest of this sunny afternoon with a nice glass of rose and some fresh scones with clotted cream and strawberry jam. Finally,  I can have my cake and eat it too.

My fave cottage cheese recipe
Take a handful of frozen blueberries and zap 'em in the microwave for about a minute, or until they're just starting to burst. Tip hot contents on top of a generous serving of cottage cheese. Sprinkle with flax seeds. Indulge. (This is a leftover from my high protein/low carb days, but it's still a fab snack.) Feel free to share your best 'diet food' recipes in the comments below.