There are choices for almost everything these days. Call the customer service department of your cell provider or cable company and you will be offered (in a maddeningly slow computerized voice) at least a half a dozen options from which to choose. We are now also given choices of what type of therapeutic intervention we want when faced with a medical problem. The choices include immediate intervention, wait-and-watch drugs, dietary changes, physical therapy or surgery. Even chemotherapy is personalized whenever possible in order to target specific cancer cells with chemicals designed to eradicate them.
Not so with diets. Sure, one can choose among different weight-loss options such as packaged portion-controlled meals, low-calorie liquid diets, calorie counting, point counting, reducing stomach size through surgical techniques or following a celebrity-generated fad. But once the dieter is enrolled in a program, little attention is given to how he or she may differ in metabolic, psychological or hormonal characteristics from the other dieters.
Some diet programs with gender-specific plans don't take into account that some women may be as large as men and vice versa. For example, should a 5'6" man whose starting weight is 190 pounds be given more calories to eat than a 5'11" woman whose starting weight may be 250 pounds just because he is following the men's diet and she, the women's? Should someone who is used to consuming 4,000 plus calories a day be started on the same diet as someone who eats 2,500 calories a day? Predictably the former is going to be really hungry for the first week or two and perhaps leave the diet because of that. Recent surgical interventions take into consideration the individual physical differences of the patient, but how much attention is given to the differences in their psychological profiles and reasons for gaining so much weight? A patient, morbidly obese because of years working as a chef, and a patient with the same excess weight who gained it because of childhood sexual abuse may have totally different long-term outcomes from the surgery.
A friend who is on Weight Watchers was staying with us recently and expressed her frustration with the program because it is simply not set up to deal with individualized diet counseling.
"The program is wonderful for people who have been eating unhealthily and really didn't know that a bacon double cheeseburger with fries has more calories than a grilled turkey sandwich on whole wheat bread. They not only lose weight; they learn to improve their food choices. But I know all this. My problem is that when I have to go to court [she is a litigator] I eat my way through hours of preparation. And of course I pay no attention to the diet. I want someone to tell me how to lose weight when I am stressed -- and I am always stressed."
It is time for personalized weight-loss therapy? There is no (at least to my knowledge) facility that does in-depth analysis of a dieter's life style, emotional health, susceptibility to hormonal and seasonal changes in eating, exercise commitment and previous diet history. So the dieter or potential dieter has to figure out whether a diet fits their life profile and/or push for more personal intervention if a diet is not working.
A home hospice worker and I talked on the phone for an hour so we could figure out how she could eat most of her meals in the car, as she spent sometimes up to 10 hours driving from home to home. And more importantly, we talked about what she should eat to take away her own emotional pain after a day of helping the families of someone on hospice care. A neighbor who lost the first 100 of the 200 pounds he has to lose after lap band surgery sat in my living room and confessed that he was gaining rather than losing weight. "I am lonely," he said. "I eat all evening. I am careful not to put too much food in my stomach at once but I can consume several hundred calories after supper." He thought if the band was made tighter, reducing even more the size of his stomach, that his problem would go away. But I pointed out to him that what he really needed was therapeutic support so he could turn away from eating to solve his loneliness.
Personalized weight-loss programs must become part of our efforts to decrease the national rise in obesity. It will initially be more expensive than simply recommending a program without determining if it offers the best support for the personal needs of the dieter. But, like identifying specific types of cancer cells before settling on a chemotherapeutic protocol, it may have a better long-term outcome.
One thing is certain: Failure to reach a weight-loss goal and/or to maintain the loss does not mean the dieter can never lose weight. Like finding the perfect pair of jeans, it is simply of matter of seeing what fits best.