Just in time for the peak of the holiday eating frenzy and New Years, the New York Times published an article in its Health section last week exploring the difficulty of losing weight. The article starts out seeming to address the idea that the reason weight management is so challenging is that we have failed to grasp its many types and instead have tried to deal with it as if it were one condition. The author compares being overweight to cancer, which was once thought to be caused by a single genetic alteration but that we now know can result from an infinite number of such alterations, each of which results in uncontrolled cell division but seems to require different treatment. To support its point, the Times article tells us the stories of 6 people, who we’re supposed to believe, I guess, finally had the genetic/biochemical/metabolic cause of their weight gain miraculously discovered, enabling them to…equally miraculously…get their weight under control. But instead, the examples really demonstrate the opposite, at least to me and I would think to most weight loss counselors, namely that there is no magic genetic or metabolic answer, but that we can still learn to manage our weight. We know that appetite (the stimulus that impels us to want to eat something) and food metabolism (what our bodies do with food after it goes into our mouths) are influenced by many complex biochemical (that is, neurochemical, hormonal, and enzymatic) processes, none of which we’ve really figured out how to control to our benefit. The best we’ve been able to do is to observe that some medications have the side effect of appetite loss and as a result, weight loss, while others seem to do the opposite. Thus, in spite of decades of research, we basically have only a few types of diet drugs, drugs that actually help people lose weight, most of which were adopted, as I said, because weight loss was discovered to be a side-effect of the intended effect of the drug. One type, amphetamines (speed), works on the brain to get us to focus on things…other than food. Another type inhibits cravings, mainly for opioid drugs. A third drug that works on the brain and has been associated with weight loss is a drug primarily used to treat seizure disorders and migraine. Finally, a fourth type of drug works on our digestive system to keep it from absorbing as much of certain nutrients. None of these drugs has proven to cause loss of substantial amounts of weight in large, well-designed clinical trials. In fact, some of these drugs are addictive and/or have annoying side effects; and of course none of them work permanently, meaning that even if you lost as much weight as you wanted, you would start to regain it as soon as you stopped taking the drug. None of the knowledge we’ve gained about eating regulation has translated into a pill we can take that permanently keeps us from turning the cheesecake calories into unwanted fat or having us choose it in the first place. The most effective treatment for extreme overweight (obesity) is weight loss surgery (i.e., making the stomach smaller or bypassing part of the intestine) and even weight loss surgery has less than stellar long-term success overall. So getting back to the Times piece, this article tells the stories of 6 people from many different walks of life, all of whom have their own stories of weight management failure but each of whom finally finds success. The point the article seems to completely miss—or tries to avoid confronting—is that ultimately, each of these people finds success, not because a doctor discovers some novel biochemical defect and is able to address it medically (by giving them a pill, or some other magical medical miracle), but because each of them works with a counselor to figure out the habits that have been keeping them overweight, AND they find the motivation to do the incredibly arduous, challenging, lifelong work of changing those habits. For years, I—and a few other weight loss specialists I know—have been arguing that every person who wants to lose weight is completely different. Everyone has his own eating habits, life habits, really, and no one diet or piece of eating management advice can work for everyone. The best diet is the one that works for you. Unfortunately, some members of the medical and nutrition community have latched onto the notion that overweight is simply caused by a genetic defect or one of a bag of genetic defects and that we just have to identify which defect a person suffers from and match the diet to the defect. There’s another new idea called “functional” medicine that says each of us is as dissimilar metabolically from our neighbor as a buffalo is from a fish. This idea has spawned the idea that every overweight person is overweight because of some completely different genetic imbalance, which of course, they insist, can be diagnosed by a bizarre and costly set of lab tests and addressed by an expensive combination of dietary supplements. These costly supplements never work (unless combined with a program of strict calorie restriction and lifestyle modification, which would work very well on their own, thank you), increasing people’s frustration and hastening the day they just give up and buy into the idea that they’re destined to be overweight forever. The truth is that it takes a huge amount of determination and never-ending effort to scrutinize one’s life habits and go through the arduous process of identifying and changing the ones that are keeping us fat, whether it’s finding a new route to work that doesn’t lead past six donut shops, keeping your boss’s bottomless candy dish out of your line of sight, chewing gum to resist those repeated tastes while you’re cooking, keeping ice cream out of the house, or writing down everything you eat. It’s always more enticing to imagine taking that magic pill that is offered. What I’ve learned—through my own journey and those of patients, friends, and family members—is that real weight management begins when we are so sick of being overweight that we commit to the hard, never-ending task of identifying and breaking the old habits that are keeping us stuck, one by one, and replacing them permanently with new habits, ones that promote healthy weight management. Whatever habits you decide to adopt to lose weight, they had better be ones you are willing to live with for the rest of your life. Because if you get to your goal weight by sticking to some unpleasant diet or taking some magical pill or attending an exercise boot camp, you will begin to regain the lost weight as soon as you return to your old habits, as sure as the sun rose this morning! When we gain a lot of weight, lots of biochemical processes are off track. Whether the derailment was the cause or the result of the weight loss has yet to be figured out. But rather than waiting in frustration for the cause of your personal weight issues and the right pill to be discovered, I encourage you to read the Times article. Let the examples of determination and perseverance inspire you to start scrutinizing your own routines to identify the habits that are keeping you stuck. You have the rest of your life to try out new routines, figure out what works, form new habits, and just make a detour around that train wreck you used to call your diet! Happy New Year!