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‘A User’s Guide to Cheating Death: Slimming Down’ — the truth of America’s weight-loss obsession

Don’t make that New Year’s resolution yet.

“By the time a woman is 45 years old, she will have tried 61 diets!”

The fourth episode of Timothy Caulfield’s 2017 Canadian television series, A User’s Guide to Cheating Death, now streaming on Netflix, tackles the challenge of “Slimming Down.” Similarly to his earlier installments, Caulfield digs into a popular health trend, in this case weight loss, identifying frauds and fads before aiming at more serious aspects of its impact on health or disease treatment.

This may be the most depressing episode so far.

Caulfield examines the ways people are encouraged to focus on weight loss, and to see that as a goal to be achieved in and of itself. This arises from slimness as a cultural beauty ideal — the message is everywhere, and the beauty and weight-loss industries cooperate to reinforce it.

He forces himself to read every word of every issue of People magazine going back a full year. “77% of those articles were about appearance, not about health,” Caulfield says. “Even when they were framed as a kind of health story, the core of the article was about how you are going to look.”

A woman’s “health” magazine — with the same cover article three times — devoted to improving appearance, not health, by weight loss.

The first problem with the fear- and conformity-driven ideal of thinness is that substantial weight loss is simply not a realistic goal for the vast majority of people. Caulfield interviews Dr. Arya M. Sharma, M.D./Ph.D., Chair of Obesity Research and Management at the University of Alberta, who notes that statistics show weight loss from dieting is minimal, and that very few dieters who do lose weight keep it off more than a few years.

“None of them work long term,” Sharma says.

Caulfield also cites the history of the popular NBC TV show “The Biggest Loser,” in which people competed to lose the most weight, through exercise and dieting. Many of the contestants made dramatic changes in their weight and appearance, but what the show doesn’t acknowledge is that follow-up studies of 14 competitors showed almost all had gained weight back within six years of being on the show. Several ended up weighing more than they had at the beginning.

The second problem is the inevitable advice to add exercise to nutritional changes for increased weight loss. This also doesn’t work.

“[A] lot of the way weight loss is presented in popular culture focuses on the idea that you can exercise your way thin,” Caulfield says. “That’s problematic because of the focus on appearance, but also because exercise doesn’t work that way. Exercise is not a great strategy for weight loss.”

Caulfield introduces experts who discuss the way the body reacts to changes in fat composition or nutrition. Turns out, your metabolism changes in response to factors that cause you to lose weight, almost as if your body were “trying” to stay heavy (it’s often speculated this is an evolutionary response to times of famine).

The bottom line is, the common assumption that you can change body weight by simply reducing caloric intake and increasing physical exertion is too simplistic, and just plain wrong. Worse, achieving the significant health benefits available to the sedentary or overweight requires giving up the goal of weight loss, a suggestion that is almost inconceivable to the American public.

“The fashion industry pretty much lives off talking us into being dissatisfied with the way we look . . .  and then offers solutions because that’s what they’re selling,” Sharma says of the misleading diet-and-exercise double whammy. “And if there’s one thing we know about diet and exercise, it is that if you’re doing this for looks, you’re going to be disappointed.”

A woman undergoes treatment with lasers to disrupt subcutaneous fat. Though FDA-approved as safe, it’s minimally effective for weight loss.

That’s not to say there’s no good news for people who have weight-related health problems. It’s just not news the beauty and weight-loss industries are selling, or want people to hear.

Caulfield emphasizes, with expert testimony, that exercise can produce significant improvements in health for people who are overweight, without reducing their body mass. Exercise decreases the risk of heart disease, lowers cholesterol and resting heart rate, and offers many other benefits. Overweight people can become much healthier through exercise, and feel better doing so. They just don’t lose weight.

This information is the heart of the show’s message, and bears repeating — significant weight loss is almost impossible for most people, and both diet and exercise are almost useless in attaining it, but exercise is very beneficial to health for almost all people, especially those who are overweight.

Unfortunately, the beauty and weight-loss industries, with their exclusive emphasis on weight loss as a primary goal, are charging people thousands of dollars, over years or decades, to pursue an ideal that is not healthy for them and they can never achieve.

Caulfield profiles the one health treatment that does produce significant and permanent weight loss: bariatric surgery. By removing large parts of the stomach (and making other changes), the surgery physically restricts the amount of food a person can eat, thus permanently reducing caloric intake, and also diminishes the stomach’s hormonal control of digestion, addressing the metabolic changes that can stymie weight loss.

The results can be amazing – loss of 90% or more of medically-defined “excess” weight, and dramatic reversal of weight-related pathologies like Type II diabetes, sleep apnea, and high blood pressure. The improvements are permanent for the large majority of patients, but the fact that such drastic interventions are necessary to produce real weight loss only underscores how misguided typical consumer-oriented weight-loss advice is.

Even this medically successful approach comes with dangers. The surgery is expensive, and many people don’t have health coverage that offers it. In response, a medical tourism industry has sprung up offering gastric bypasses, for cash payments, to foreign patients in distant countries, often by doctors they’ve never met and who have little accountability. As seen in his earlier profile of the massive South Korean cosmetic surgery industry, there’s a downside to profit-driven medicine preying upon people’s fears and insecurities.

In this episode of User’s Guide, Caulfield takes a straighter approach to his topic than in earlier episodes. There are fewer humorous interludes showcasing goofy gimcracks like DNA music or magnetic detox headbands. The healthcare scams he surveys are so mainstream they’re believed to be a necessary part of healthy living, and the patients he talks to are severely ill.

One man resorts to living with a nasogastric tube down his throat for medical feedings, because he’s found no way to control his weight and is terrified of dying from complications of obesity. In the face of such desperation, merely useless interventions like diet and exercise seem actually benign. Caulfield, here, seems less accusatory than appalled.

This man had a nasogastric tube placed down his throat, which he wore 24 hours a day to provide medically-supervised feedings of just 800 calories per day, in a desperate bid to reduce life-threatening morbid obesity.

The fraud the weight-loss industry is selling is not some gimmicky device or pseudoscientific theory, it’s the very goal and ideal of weight loss itself. Every one of the thousands of weight-loss diets and exercise regimens is fundamentally a scam – even those peddled by cheerful, alarmingly fit and thin instructors, some with credentials, many of whom honestly believe they’re giving people what’s best for them.

Most of that industry is enabled not by a realistic understanding of body weight, with health-related goals, but by a manipulated desire to achieve an artificial standard of beauty, relentlessly sold and reinforced through pop culture.

At the same time, almost anyone can attain real health benefits through simple exercises undertaken with realistic expectations, generally requiring no fancy equipment, gym memberships, or paid classes. That is the message the fear-mongers of weight and diet are not telling people.

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