Thursday, January 24, 2013

Why (Most) Diet and Exercise Regimens Fail (Hum Magazine, January 2013)

Every January, Americans nationwide start the year off with a new diet and exercise regimen. I am confident that almost all of these will fail. I am loath to bet against the underdog, as I have found myself in that very position multiple times in my life,  but with this one I can’t help myself. This approach to change is simply fundamentally flawed because it does not acknowledge that being overweight is an addiction. Like so many other addictions, being overweight is merely the tip of the iceberg below which myriad other addictions reside. Not only are we addicted to the transient hyperglycemia/caffeine high from our high-sugar cereals and coffees, we are addicted to the speed with which our cars take us to our parking spots as this allows us to sleep in just a bit longer. We are addicted to the convenience of the elevator that whisks us to our comfortable desk where we will work our sedentary jobs that keep us at a comfortable heart rate. We are addicted to the productivity we feel as we motionlessly work while eating our lunches at these desks and eventually reverse the entire trip home all the while jonesing for the largest meal of the day, the calories from which will transform directly into fat as we slip into sleep. Then the cycle begins again.

With all of these micro-addictions, it makes sense that wholesale change is Herculean at best and Sisyphean at worst. I don’t blame people for failing; the entire enterprise is destined for failure. I don’t mean to say that change is impossible but I think the only way to approach the kind of change most people seem to want (lower BMI, definition of skeletal musculature, higher exercise tolerance, lower daytime fatigue, improved mood, etc.) is to assess every change you are considering instituting as something you will do for the rest of your life. For example, ask yourself, “Will I wake up every day for the rest of my life and run thirty minutes before work?” or “Is it realistic for me to never eat sugar again?” The answer is most likely no.

Nothing frustrates me more than to see new diet programs advertised on television. These programs propose a precisely opposite approach to what has been proven to help people overcome addiction. We don’t need more options. We need better ways to utilize the ones we already have. I think we should approach our addiction to food and our sedentary lifestyles via the Alcoholics Anonymous model for change. Alcoholics Anonymous has been demonstrated to work in the long term. In the market of ways to curb alcoholism this program has the largest body of evidence for success.

In AA, successful members of the program acknowledge first that they are powerless to alcohol. I love the seriousness of that word: powerless. I have never heard a dieter say that they are powerless to food. But its true. The truly amazing part of AA is despite the rigor with which they have achieved their long-lasting effects, even the most stalwart participants have relapsed twenty and thirty years after sobriety. This is how devastating addiction really is. I also love that alcoholics consider themselves alcoholics for life as a way to internalize the disease and remain constantly vigilant. To approach such a difficult change with any less intensity is like trying to fight a lion with an overcooked noodle. You might as well put an apple in your maw and lie down on a plate.

So what the hell are we supposed to do? I have an idea. If being overweight is a multifaceted addiction, why not approach each part individually as opposed to some kind of all encompassing diet/exercise regimen. I would employ a multistep method akin to AA. The first step could simply be taking the stairs to your office every single day for a few months. That’s it. Eat anything you want day-in and day-out but you no longer use elevators. You don’t even remember what that box with sliding doors and buttons does. I know that sounds incredibly slow on the scale of weight loss progress but I guarantee you many would fail. I don’t say that to be harsh; the odds are stacked against people as its not easy to even find the stairs in many buildings. Also, you’re busy. You are expected to be somewhere quickly all the time. I think if you can do that for a couple months you’re ready for the park-your-car-far-away-from-the-office-and-walking routine. That’s not easy either. You’re going to need a good parka because you will be the only one who parks in the last space and walks through a torrential storm while coworkers silently consider the state of your mental health. Now, here comes the real challenge. Now you have to take the stairs every day AND walk from the furthest parking lot spot. And remember: this is for the rest of your life. Let’s do just that for another few months. Notice that we have not even touched the issue of diet. No gym memberships purchased. No spandex worn. Indeed no money has changed hands and yet you have done an incredible amount of change: you now leap up stairs to meetings, powerwalk in the parking lot daily, and have replaced that once savory morning sleep time by going to sleep earlier. Forever.

Of course, it stands to reason that at some point in the future when a large number of obesity promoting habits have been stably changed that you could start using the elevator or the closer parking spot. However, at that point you’ll likely be making up for those easy yet inconvenient tasks with replacements that are far more rigorous and in a much more compressed time frame such that you might miss the days of a simple walk up the stairs.

Eventually, if one is successful at stacking these tasks I imagine one could tack on a diet change here or there. But just like the stairs and parking lot scenario, this would have to be relatively small and repeated for a rather long time before larger changes are instituted. If all of this seems exhausting, then you’re accurately appreciating how incredibly difficult it is to treat an addiction. You need to physically change your brain on a neuron-to-neuron basis. Considering there are billions of neurons in the cerebral cortex alone, this is no simple task.

I think the problem with most people’s wish to diet is our underlying desire is not to actually change the way we look but rather to be someone else entirely. We see a picture on a magazine cover or in a film and secretly covet not only the way that person looks but the glamour of their very existence. Being ourselves with an improved physique is nice but far from glamorous. Consider that rarest-of-rare person who is hard-headed enough to start January 1st running thirty minutes daily, consistently eating low-fat, low-carbohydrate, high-protein foods, sleeping eight hours nightly, and drinking copious amounts of water and actually keep it up for, say, six months. The pounds will no doubt come off but that person is the same person with the same hang-ups that made him overweight in the first place. Relapse is almost inevitable. The problem is that no real neuronal change has been effected as this blitzkrieg of reform was enacted out of the excitement of turning over a new leaf rather than a reasoned decision to completely change one’s life forever. The discipline that comes out of slow and steady piecemeal segmental modification represents actual character change for which I can’t think of any substitution. That level of discipline likely feels superior to any level of glamour and probably leads to a greater likelihood of overcoming the addiction in the long-term. If this seems overwhelming and impossible, consider what they say in AA: you have to take it one day at a time.