SLBMI Psychology and Religion Program>> Psychology and Religion Resource Center>> Articles of Interest

Understanding the "5% Statistic"
By David Rowan, PhD May 2007

In the November 2006 edition of UpDATE, Doctors Randy Flanery and Rachel Wells considered the role of mindfulness in treating the problem of obesity.

Since its publication I have received a number of comments on the article. One consistent theme reflected the common belief that losing weight may be hard enough, but maintaining weight loss for the long term is nearly impossible.

Many of these comments were accompanied by a story. In one form or another, most of those stories included something to the effect that “we have seen Father [or Sister] lose weight before, only to regain it.” The cycle of weight loss and weight gain often had recurred more than once.

The implication was clear, if not always clearly articulated. “Why should we invest time and money for an organized weight loss program? No matter how good it is and no matter the initial weight loss, the positive effect is not likely to last.”

A few commentators even had read on the subject. These several persons quoted a statistic that only 5% of all persons who diet to loss weight have been found to be successful for the long-term.

I was curious about the source of this statistic.

I knew, for one thing, that a number of scientist-practitioners have reported impressive treatment success. Dr. Daniel Kirchenbaum, for example, reports of an astounding 90% success rate in individuals involved with the National Weight Control Register project.

I knew also that our experience with integrated, multi-modal treatment of obesity has produced some wonderful, life-altering outcomes that have allowed clients to return to lives of active service.

I decided, like any good investigator, to seek out the source of the statistic and to consider what might be the facts of the matter.

I started my search by simply asking colleagues about the 5% statistic. Did they know of it and of its source?

Among the five psychologists, one physician, one physical therapist, and one dietician/nutritionist included in the initial inquiry, all had heard of the statistic, but none could quote the source.

I moved on to the next step, the Internet search. Using my favorite search engine, I entered “the 5% statistic and weight loss;” it returned 6,440,000 results.

I waded into the first few hundred and found over 20 references to the “5% statistic;” all told the same story that had been repeated to me by our commentators. That is; these entries asserted, while many can take off pounds, only 5% keep the weight off in the long run.

These findings, while reinforcing what had been repeated to me, did not advance my search. Not one of the websites gave a citation or reference indicating the source of the number.

I began to wonder what I was dealing with. Was the 5% statistic something in the nature of an urban legend? Had it risen to the status of common wisdom?

Undeterred, I turned to the professional literature. I searched PubMed Central (a listing of peer-reviewed medical journals supported by the National Institutes of Health) and the American Dietetic Association's on-line journal data base. I perused the bibliographies of books and articles in the SLBMI library. Finally, I was rewarded with a promising lead; an article written almost 50 years ago by Dr. Albert Stunkard.

Almost unbelievably, I had the good fortune to locate Dr. Stunkard, alive and well, among the faculty of the University of Pennsylvania .

I wrote to him and he kindly responded. Sure enough, he felt reasonably confident that the elusive 5% statistic originated with an article he published in 1959 in The Archives of Internal Medicine.

Dr. Stunkard has lost none of his scientific acumen. Building on his reading of the literature since that time, he offered an elaboration of the 5% statistic.

Based on more recent data, it appears that very few people, using diet alone, are successful at maintaining weight loss. Thus, the 5% statistic maintains its relevance for persons who approach weight loss in this one-dimensional manner.

On the other hand, many people, with a multi-modal approach to weight loss that emphasizes change in lifestyle, are quite successful for the long term.

Dr. Stunkard then directed me to the scientific literature for a more comprehensive explanation and associated empirical findings.

Again, most providentially, he noted that just this April, the American Psychologist had published two articles on weight loss that seemed exactly what I was looking for. Here are the findings that were reported.

Mann and colleagues looked at the effect of diet alone. They considered twenty-four studies evaluating this approach that had been published in peer reviewed scientific journals from 1983 to 2003. Of the 49,370 persons in these twenty-four studies, after four or five years between 29 and 64 percent had regained all the weight they had lost or even gained additional weight.

Most importantly for my quest, when the standard was almost all the weight they had lost, the percentage rose to between 80 and 95. That is pretty close to the 5% statistic.

Powell and colleagues looked at the effect of multi-modal interventions that included various changes in lifestyle. They considered nine studies evaluating this approach that had been published in peer reviewed journals from 1987 to 2002.

Of the 19,662 persons in these nine studies, after 2 to 10 years, 78 percent maintained clinically significant weight loss.

This was much closer to my experience of the effect of integrated, multi-modal treatment to reduce weight.

Dr. Stunkard had been my reliable source. The 1959 data, now nearly fifty years old, had attained a place in the annals of common wisdom. As is often the case with common wisdom, it was partly right, and partly wrong.

It is right in that efforts to manage weight through dieting alone are not effective in the long term for almost all people.

It is wrong in that multi-modal treatments that change various aspects of life style in addition to dieting can produce lasting positive effects.

So, we have come some ways. The 5% statistic is now known for its source, for how it applies and in what ways it leads us into an unnecessary sense of futility and concomitant inaction in the face of life-altering obesity.

On the other side, we see what really can be accomplished according to the most recent statistics. Yet, statistics, as convincing as they are to a scientist, often do not resolve the lingering doubts of the non-scientists that have to make decisions about how to proceed when a member struggles with obesity.

The following story about a program participant tells in very human terms the reality behind the numbers.

Fr. Z [named changed] had struggled with his weight for years. His history was not atypical. Already heavy as a young man, he gained more and more weight after ordination in response to the stress of ministry. At times, certainly in an effort to cope with his taxing schedule and the loneliness and boredom that characterized his personal life, he turned to food for comfort.

The weight gain did not go unnoticed or unchallenged. Fr. Z would become frustrated with his size and with great determination would diet for a time. Each time he undertook this effort he did lose weight. He felt positive about his smaller self. Unhappily, like so many who respond to obesity with self-loathing and rely on a burst of will power to undertake an unsustainable diet, he invariably gained back more weight than he lost.

In the spring of 2006 he found himself deeply discouraged and full of despair. Now well over 400 pounds, his secret life was marked by binge eating, deep shame and isolation. He could not walk more than twenty steps without stopping to rest. Not only was ministry seriously impaired, he was at severe risk of life-threatening illness.

Seeing his pain and praying that he would return to health, his community encouraged Fr. Z to come to the Saint Louis Behavioral Medicine Institute's Program for Psychology and Religion to participate in the multi-modal weight management protocol. He agreed, and within the first week, hope was renewed.

Fr. Z met with each one of our specialists and saw immediately that the weight management protocol was not “just another diet.” He saw that he would (and indeed he did) gain new information about stress management, self-care, nutrition, exercise, self-monitoring techniques, mindfulness, and other practical skills that constituted a whole new way of living, a life marked by healthy behaviors.

I do not exaggerate when I say that his life has been transformed.

In the program Fr. Z was challenged to look closely at each moment, thought, feeling, interaction and choice. As he experienced each individual and group therapy session he gained insight, self-acceptance, and new habits of balanced thinking.

As he experienced his internal world differently, outward behavior change followed. New habits of thinking supported new habits of eating and exercise, which in turn supported new ways of interacting with others. A cycle of health replaced the cycle of illness.

Fr. Z began to live his values and beliefs. With the spirituality group and spiritual director, his faith life, prayer and meditation became rich and fruitful.

The weight scale reflected his progress and accomplishments. He lost over 100 lbs during his stay in St. Louis, and continued to lose weight during aftercare.

Most importantly, Fr. Z returned to active ministry, re-connected with his community, and took on a busy schedule.

Today, more than one year after he started treatment, Fr. Z has lost nearly 140 lbs, and has maintained this loss. He exercises six times a week, monitors his nutrition and food choices, recognizes and eschews critical patterns of thinking, works to accept emotions and imperfections, practices mindfulness, and spends time each day in meditation and reflection on God's word.

In a recent communication he noted that the urges and temptations to overeat and to binge are less frequent and less enticing, yet, he is aware that there will be difficult moments and days for the rest of his life.

Rightly, with this awareness that he will never be completely free of risk, Fr. Z spoke of his sense of a deep and abiding confidence that, so long as he follows this path, he will be well.

While there is work to be done, the method is clear and the commitment is evident. I am reasonably confident that this person will persevere and continue to live a much more active life of service than would have been possible only a little more than one year ago.

This is not an isolated event. I could share many more. But I hope that this story, combined with the statistical evidence I have shared, will be enough to encourage you to look more deeply.

I hope in particular that if you or one of your own suffers with life-altering obesity, you will not respond with resignation and accept the concomitant disability as inevitable.

If you would like to discuss any of the issues in this article, please write or give me a call at (314) 534-0200.

Bibliography

Kirchenbaum, D. (2005). The Healthy Obsession Program . BenBella Books; Dallas , Texas .

Powell, L., Calvin, J.E. III, and Calvin, J.E. Jr. (2007). Effective Obesity Treatments. American Psychologist , 62, 3, 234-246.

Mann, T., Tomiyama, J., Westling, E., Lew, A., Samuels, B., and Chatman, J. (2007). American Psychologist , 62, 3, 220-233.

Stunkard, A., (2007). Personal communication.