“NOT MY CIRCUS, NOT MY MONKEYS”

On August 13, 2019, WW (“Weight Watchers”) launched its WW/Kurbo app, an alleged free nutrition and weight-loss app for children as young as eight (8) years old. Issues and questions were immediately raised concerning the release of this app. And with regard to the eating disorder industry, the initial inquiry must first be, why should the heart and soul of the eating disorder industry care about this particular app? Shouldn’t the criticism and complaints be left to the fringe elements in the industry? Yes, we understand that this app could possibly lead to disordered eating. But, isn’t this the bailiwick of the HAES movement, the neo-NEDA and the militant anti-diet and weight loss movement? Isn’t this really their monkeys?

The Background of the App

WW acquired the nutrition app Kurbo in 2018. It then spent a year purportedly developing it, allegedly consulting with experts and adding features like breathing-exercise instructions, a Snapchat-inspired interface and multi-day streaks to encourage “regular” activity. The app was designed to allow children (or parents on their behalf) to enter their height, weight, age and health goals, then begin logging what they eat.

The WW/Kurbo app ranks food choices using a purported, Stanford University developed “traffic-light” system: Green items are “go foods” that can be eaten freely; yellow foods should be consumed in moderate portions; and red foods should make kids “stop and think.” For a fee—starting at $69 for a month—weekly video coaching is also available. Coaches employed by WW/Kurbo are allegedly trained to pick up on signs of disordered eating or unhealthy weight loss.

WW/Kurbo explained that the app was designed to be a new tool for the millions of “obese” children in the United States struggling with their weight. They also anticipated outrage for potentially furthering unhealthy body standards and eating behaviors. With regard to the latter issue, the eating disorder community did not disappoint.

Eating disorder counselors, dietitians, nutritionists, advocates and activists grabbed their pitch forks and burning torches and aggressively spoke out against it. An eating disorder treatment center based in New York reinstated its campaign against WW. It generated a petition demanding the WW/Kurbo app be taken down. (The petition currently has in excess of 110,000 signatures). It is planning a demonstration at 8:00 o’clock a.m. on Friday the 13th of September at WW’s corporate headquarters in Manhattan just south of the Design District.

Demands are being made that all eating disorder organizations issue statements condemning the WW/Kurbo app. And in all circles, the statistic that 95% of people who go on diets will regain all of the weight they lost on that diet within one (1) to five (5) years is being bandied about as the “gospel truth.”

And yet, there is so much more to these issues than that which meets the eye. So, let’s address some of the myths and parochial thinking which are so prevalent and which continue to haunt the eating disorder community and industry today.

The Myth of the 95% Failure Rate

The Anti-Diet and Weight Loss crowd spearheaded by the HAES movement trumpet the statistic that 95% of people who go on diets will regain the weight they lost, if not more, within one (1) to five (5) years. That statistic has been quoted widely over the last four decades in Congressional hearings, diet books, research papers and seminars. 

And yet, according to Dr. Thomas Wadden, a professor of psychiatry at the University of Pennsylvania,  “That 95 percent figure has become clinical lore … There is no basis for it, but it’s part of the mythology of obesity.” [emphasis added]

So, one must ask, what is the origin of this number? According to Dr. Kelly D. Brownell, the former director of the Yale Center for Eating and Weight Disorders, and now the Dean of the Sanford School of Public Policy at Duke University, “The number was first suggested in a 1959 clinical study of only 100 people. The finding was repeated so often that it came to be regarded as fact.

Research indicates the oft-quoted, 95% figure does not come from random sampling, but instead from a very limited study of 100 patients treated for obesity at a nutrition clinic at New York Hospital in the 1950’s. In this study, there was no oversight, no laboratory conditions, no control group, no objective reporting and obviously, no credibility. In 1959, its authors, Drs. Albert Stunkard and Mavis McLaren-Hume, published a paper in which they concluded, ”Most obese persons will not stay in treatment, most will not lose weight, and of those who do lose weight, most will regain it.”

However, years after the study was released, Dr. Stunkard revisited the study and remarked, “… the study has little relevance to the current understanding of how to control weightThe 100 patients in the study were ”just given a diet and sent on their way.” [emphasis added]

He also stated “That was state of the art in 1959 … I’ve been sort of surprised that people keep citing it; I know we do better these days.” These statements come from the architect of and primary author of the study!

Before he passed away in 2014, as part of his on-going research, Dr. Stunkard stated, “The intervening years have brought significant changes to the treatment of obesity, the most important of which, has been the introduction of behavior modification techniques.”

Nonetheless, the Anti-Diet and Weight Loss crowd led by the HAES movement use this statistic to suggest that sustainable weight loss is wholly impossible and trying to lose weight is simply an exercise in futility. Other groups attempt to use the statistic to suggest that the only way someone with obesity can ever succeed is by means of drugs or surgery.

The HAES movement claims the Diet and Weight Loss Industries are conducting a “War of Obesity.” HAES further states that “We’ve lost the war on obesity.” That, “The war on obesity has taken its toll.”  And then it characterizes itself as, “Health at Every Size is the new Peace Movement.” But, if HAES and the Anti-Diet crowds are using outdated, inaccurate statistics to support its arguments, then it is attempting to fight a 21st Century war utilizing 17th Century weapons.

If an individual’s goal is to lose every last ounce of fat they want and then keep it off, undoubtedly, that goal is unrealistic and mostly unattainable. But, losing weight and keeping it off is not. By way of example, one can study the Look AHEAD trial. The Look AHEAD trial is considered one of the more personalized, involved and lengthy weight management studies ever conducted. Purportedly, after eight years, nearly 50 percent of participants were reported as maintaining losses of greater than 5 percent of their presenting weights, and more than a quarter of them were maintaining losses of greater than 10 percent. Of greater significance is the fact that all BMI groups in that trial had comparable improvements in fitness, physical activity, LDL cholesterol, triglycerides, blood pressure, fasting glucose, and HbA1c at 1 year and continuing thereafter.

Further, if the “War on Obesity” is over and a failure, people would not be investing vast amounts of money, and gambling with their very health in the Diet and Weight Loss Industries. And yet, we know that that is not the case.

So, how prevalent and financially viable are the Diet and Weight Loss Industries?

The Diet and Weight Loss Industries

The diet and weight loss industries sustain financial growth on an annual basis.  On a global scale, the Global Weight Loss and Obesity Management Market is forecast to exceed more than $253.1 Billion [US] annually by 2024. ONE QUARTER OF ONE TRILLION DOLLARS ANNUALLY.

The total U.S. weight loss market grew at an estimated 4.1% in 2018, from $69.8 billion to $72.7 billion. The total U.S. market is forecast to grow 2.6% annually through 2023.

Commercial chains as a group posted an 18% increase in revenues in 2018, to $3.74 Billion. However, this segment of the market is forecast to grow not quite as strongly—8.6% in 2019, and 6.0% per year through 2023.

With regard to weight loss surgeries, an estimated 239,000 bariatric surgeries were performed in the U.S. in 2018, constituting a $5.98 billion market. The number of surgeries continues to grow about 5% per year.

Companies like Weight Watchers, Jenny Craig, Nutrisystem, Medifast, Noom, continue their financial growth and advertising blitzes.

Millions of people in the United States and throughout the world, the publicly traded corporations, the medical profession and the United States government recognize that obesity is a serious health issue and must be addressed. This is also proven by the vast amount in research dollars spent on studying Obesity.

Research funding regarding Obesity

In 2015 alone, the NIH spent an estimated $900 million on obesity research.

In 2016 alone, the NIH spent an estimated $965 million on obesity research.

In 2017 alone, the NIH spent an estimated $999 million on obesity research.

In 2018 alone, the NIH spent an estimated $1.055 billion on obesity research.

In 2019 alone, the NIH is estimated that it is going to spend $1.097 billion on obesity research.

By way of comparison, from 2015 through 2019, the NIH will be spending an estimated total of $169 million on eating disorder research.

To summarize, Obesity research garners $5.016 BILLION during this time period.

Eating disorders garners $169 million during this same time period.

This amount of financial expenditure by the NIH alone bolsters the reality that the Diet and Weight Loss Industries are flourishing. They are addressing a very real health problem according to the United States government. And the eating disorder industry is left sitting at the kiddie’s table while the grown-ups talk about life and death issues.

The eating disorder industry has a very large, very real problem. And that problem is only growing and will not be going away any time soon.

“Houston, We Have a Problem”

Lucy-monkey

The reality is the eating disorder industry is a multi-billion dollar industry. And the only entities which appear to be treating it that way are the private equity firms and the insurance companies. Even the National Institutes of Health are treating it as of relative unimportance. To this end, the NIH spent a comparable amount of money on eczema research, Caregiving research, breast feeding, lactation and breast milk research, back pain research, and headache research. Again, breast feeding and lactation research receives approximately the  same amount of NIH funding as eating disorder funding!

To exacerbate this calamity, up to this point, it appears as if the eating disorder industry has not embraced collaboration with or partnering with “Big Pharma,” the “Diet and Weight Loss Industries” or the insurance entities. The impact of this short-sightedness, unwillingness or inability for collaboration is being felt to the greatest extent by the patients and victims of this insidious disease. And we must question why this collaboration is not being aggressively pursued.

If the WW/Kurbo app is as ill-advised and misinformed as the eating disorder counselors, dietitians, nutritionists, advocates and activists would have us believe, at what point does at least part of the blame fall upon the eating disorder industry as a whole? Why haven’t the eating disorder organizations actively reached out to the Diet and Weight Loss Industries and convinced them that they have a large and ever-growing public relations problem? That they can salvage their integrity (and increase their profits) by openly embracing collaborating with eating disorder professionals. That through such collaboration, health and wellness apps which include substantive, authoritative information regarding food, the impact food has upon the brain and general health and wellness can be generated. Instead of being confronted with burning torches and pitchforks, they would have substantive and well-researched information originated by medical and mental health professionals.

At the same time as a result of this collaboration, eating disorder organizations and professionals would have access to greater and different avenues of funding, marketing, advertising and information. The very manner in which society thinks about and looks upon eating disorders could evolve. Additional avenues of funding for research being conducted by the National Center of Excellence for Eating Disorders and other reputable professionals would be possible.

But, in order to be treated as serious professionals conducting serious research into this serious, life threatening disease, the eating disorder industry must first start to comport itself as if it was a professional, knowledgeable, diverse multi-billion dollar industry.

This is our circus. These are our monkeys. We need to embrace that reality. The reality that we must collaborate … or our loved ones will continue to die.

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