To hear an interview that Dr Blair-West gave on national ABC radio (Life Matters) click on the play icon below. 

Some Background to Dr Blair-West’s Work

Dr Blair-West believes that the reason why we have an 80% five year failure rate in treating obesity and maintaining weight loss, is because obesity has been traditionally conceptualised as a physical condition resulting from a willpower deficiency. This way of approaching weight loss sets people up to fail as it denies – and therefore fails to manage – the deep emotional attachment that people have to foods that they love. These are the foods that Dr Blair-West refers to as ‘High Sacrifice Fattening Foods’ – the foods that people perceive as a big sacrifice to give up for the rest of their life. These are the foods that people are allowed to have in their ‘new eating lifestyle’. Indeed, these are the foods that Dr Blair-West argues have to be ‘prescribed’ as a necessary part of a weight loss plan.

Do traditional diets promote weight gain?

The research into Restraint Theory is very clear about the ramifications of denying people their High Sacrifice Foods. Traditional restrictive diets that rely on willpower to get people to avoid the fattening foods that they love not only result in rebound, rebellious overeating, but they can promote ‘overshooting’. Overshooting is when people not only regain the weight they have lost, but more. Research would suggest that on average the amount people overshoot is a further 15% of what they originally lost.

One of the concerning ramifications of the research into yo-yo dieting and overshooting is that by advising people to go onto traditional calorie restricted diets, we in the medical profession could actually be promoting weight gain! The solution is to reconceptualise obesity as a complex psychophysiological condition that requires a much more complex psychotherapeutic response.

Selected Papers

What follows are some papers that provide some background to Dr Blair-West's clinical approach along with his personal highlights and some introductory comments on each paper:

Eat Drink & be Merry for Tomorrow We Diet

by Dax Urbszat, C. Peter Herman, & Janet Polivy

Professors Herman & Polivy are the founding fathers (parents?) of Restraint Theory and this paper deals with the fascinating process of the Last Supper Effect.

Click here to read: Eat drink & be merry for tomorrow we diet

If at first you don't succeed ... (The False Hope Syndrome) 

by Janet Polivy & Peter Herman

This is a classic paper by Professor Janet Polivy looking at the mistakes that people make in expecting too much of a weight loss plan. This paper is really all about how people cleverly set themselves up to fail through all-or-nothing thinking. And all to often the clinician colludes with their patient's unrealistic expectations instead of moderating them. Research shows that losing 8% per year of body weight is an achievable goal and much more than this is often a recipe for failure.

Click here to read: Polivy, False Hope Syndrome

Exercise and Weight Loss - This is the controversial one! 

There are many important benefits to exercise: stress management and cardiovascular fitness being the top two - but weight loss is not on the list! This is the research behind this statement. Published on the website of the North American Society for the Study of Obesity - the peak research body in the world - this paper is a review of the relevant, well designed research that clearly demonstrates the limitation of  exercise when it comes to weight loss.  As it says, exercising to a level (that most people cannot sustain) over a year the weight lost is a negligible 2kgs per year - many of my patients vary that amount in a fortnight. This research also suggests that people are more likely to exercise from home than at a gym and to stick to incidental or lifestyle activity rather than designated, or scheduled exercise such as jogging or aerobics.

Click here to read: NAASO - Role of Exercise in Weight Loss

National Weight Control Registry - Overview 

This paper summarises the findings of 5,000 people who have demonstrated their ability to lose weight and keep it off for at least a year. Amongst other things it shows that while exercise is not a big factor in bringing about weight loss, it is a factor in maintaining weight loss. These guys and gals also remind us of the need to start the day feeling full with a good breakfast so we are not chasing our hunger - and finally hunting it to death by the end of the day - and of the need to monitor our weight and our energy intake.

Click here to read: NWCR Overview

Childhood Maltreatment in Extremely Obese Male and Female Bariatric Surgery Candidates

Carlos M. Grilo et al

This paper is a well designed study of  340 consecutive candidates for gastric bypass surgery. Concerningly it found that 69% reported some form of childhood abuse. Allowing for the usual degree of under-reporting this reminds us that this population may have some very powerful motivations driving their obesity - that even gastric banding may not be able to combat unless they are dealt with.

Click here to read: Abuse in Surgical Candidates