We've Known About the Harms of Dieting for 80 Years

In 1944, a group of healthy young men volunteered to be starved in the name of science. What happened to them — physically, psychologically, and socially — is one of the most important pieces of evidence we have about what dieting actually does to the human body. Evidence that has been ignored for 80 years. This week, I break down the Minnesota Starvation Experiment, asks why medicine continues to prescribe a treatment it knows causes harm, and make the case that forcing fat people to diet isn't medical care — it's cruel and unusual punishment.

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Transcript

Hello, and welcome to episode 11 of the Fat Doctor podcast. I am your host, Dr. Asher Larmie, weight-inclusive GP and budding author, getting ready to release a book in a few weeks' time — all about how we've been lied to when it comes to weight loss. Just every single thing we've ever been told about weight loss is actually a lie.

I'm going to cover today something that many of you will be familiar with, but perhaps I'll be introducing some little-known facts that you've never come across before. I was studying the Minnesota Starvation Experiment as part of my research for my book, and I want to tell you about what we found — and challenge the lie.

Someone at some point in time has told you there's no harm in trying to lose weight, right? A lot of people have said that to you. And they're lying. There's a lot of harm. And we've known about this harm for decades. We're going to talk about what actually happens when you restrict food, what the science actually says. We're going to talk about the Minnesota Starvation Experiment — the most important study that some of you will be familiar with, and a lot of people have never even heard of.

Let's talk about the actual study itself — the who, the what, the why of it all. I'm going to set the scene. It's 1944. World War II is coming to a close, but we didn't know that at the time. There are people starving across German-occupied Europe. The US has entered the chat — somewhat later than they should have, according to some. We'll leave that one there.

There's a young physiology professor named Ancel Keys. You might have heard of him — he actually introduced the world to the Body Mass Index, the BMI, but that came later. Right now it's 1944, he's young, fresh-faced, full of enthusiasm, a professor at the University of Minnesota. And he has realised that we know almost nothing about what happens to the human body when it's starved — and most importantly, what happens after a person is starved. How do we safely refeed someone who's been starving?

And so he decides to call on a group of conscientious objectors — people who had refused to go and fight in the war. Already feeling a little bit guilty, right? They've chosen not to serve. And he sends out pamphlets that basically read: "Will you starve that they be better fed?" 400 men responded. That's a lot of guilty conscientious objectors. 36 were selected, and the project ran from November 1944 all the way through — actually beyond the end of the war.

It lasted about a year, and there were three phases. The first was three months long, during which they observed these men eating normal amounts of food — roughly 3,200 calories. The next six months was a period of restriction, where they were given around 1,800 calories. Then the final three months was gradual refeeding, with different participants assigned to different calorie levels to begin with — which was quite cruel. Meals were served twice a day and were intentionally monotonous, to mimic wartime food shortages. They were required to walk 22 miles a week, attend classes, work, and keep personal journals. They all lived together in the South Tower of the university football stadium and went through extensive testing throughout all three phases.

Now, before we get into what happened to them, I want to make a point. What counted as starvation in 1944 was 1,800 calories. How many of you are actually eating 1,800 calories a day? Those of you who are on a diet, or who have ever been on a diet, are probably consuming significantly less. We currently recommend that the average person consume between 2,000 and 2,500 calories. So what was starvation to them is almost standard for us now. And there are doctors out there prescribing very low energy diets of 800 calories — that's less than half of what the Minnesota volunteers received. 21st century dieting is more extreme than wartime starvation. Get that into your head. And keep it in mind for everything that follows.

Because now I'm going to tell you what actually happened to these men — who had never been on a diet before in their lives.

First and foremost, on average they lost 25% of their body weight. Which is interesting, because nowadays if you can lose between 2.5% and 5% on a diet, you've done well. They lost 25% because it was their first time. It's really easy to lose a lot of weight over six months if your body has never been primed for famine. But remember — we've talked in the past about epigenetics, about environmental factors, and about the fact that weight cycling is the biggest risk factor for weight gain. The more you diet, the more your body learns to hold onto its fat stores. Which is why, if you were to restrict to 1,800 calories now, you almost certainly wouldn't lose 25% of your body weight. Because you've done this before. Many, many times.

They were visibly emaciated. There was muscle wasting, oedema, swelling — regardless of starting weight. There was a significant metabolic slowdown. When you stop eating as much as you used to, the first thing your body does is reduce your metabolic rate — we've talked about this time and time again. There was anaemia, dizziness, extreme weakness, cold intolerance, chronic fatigue, intestinal disturbances, hair loss, and reduced stamina. That's what happened to people eating 1,800 calories a day.

Only 32 of the 36 completed the study. Two broke the diet — one stole raw root vegetables and ate them, another went through garbage bins and ate scraps they found there. One developed urological complications and couldn't continue. One was excluded due to inconsistent weight loss, as researchers suspected he was sneaking food. And they chewed up to 40 packs of gum a day as a coping mechanism, until gum was banned.

Those were the physical effects. Now onto the psychological effects, because we're just getting started.

Psychological effects included mood fluctuations, irritability, decreased motivation, low libido, and impaired concentration. Many dropped out of their university classes — most of them were students, but they simply couldn't manage it. There's a journal article written years later in which participants — around 60 years on — recalled the events. One said that food became "the only central and only thing, really, in one's life." Everything revolved around those two meals a day. They developed very unusual food rituals — diluting meals with water to make portions look bigger. They dreamt about food, read about food, talked about food constantly. One participant accumulated nearly 100 cookbooks. These were men in the 1940s. They didn't buy cookbooks. They couldn't stop thinking about food.

We call it food noise now, like it's a bad thing — oh, we need to get rid of the food noise. But the food noise exists because your brain is telling you to eat. If you're constantly being bombarded with thoughts about food, dreaming about food, looking at recipes, unable to think about anything else — you're not eating enough. That is a guaranteed sign. I don't care how much you're eating, it's not enough.

Then there's the exercise piece. Remember, they had to cover 22 miles a week — about 3 miles a day. Not a strenuous gym workout, just walking. In Phase 1, they were fine. In Phase 2, it got so bad that one man described standing outside library doors waiting for someone else to open them, because he was too weak to do it himself. Another talked about crossing the road — he would wait until he found a dropped kerb so he didn't have to step up onto the pavement. That's how exhausted he was.

Are you getting this? Right now, you are consuming far fewer calories than these men were. They dropped from 3,200 to 1,800, became emaciated, so weak they couldn't open a door, all they could think about was food — and it was only six months. You're doing more exercise on fewer calories, and you're expected to go to work, keep up with all your responsibilities, come home, walk the dog, go to the gym. Some of you are on 800 calories a day.

And I know some of you might be thinking — but those were thin men. It's different for me because I'm fat. How is it different? Do you think having fat stores somehow makes you immune to all of this? It doesn't. Fat is a long-term energy store, not a short-term one. Yes, it means you can probably go for longer — but it doesn't mean you won't experience these symptoms. You will experience them, to a greater or lesser degree.

Most of these men lost all interest in dating and sex. They described being profoundly miserable — and 60 years later, they could still recall exactly how miserable they were. They were desperate for Phase 2 to end.

But here's the part that nobody talks about. For many of them, Phase 3 — the refeeding — was actually the worst part. They'd been telling themselves, just get through this, just get through this, and they expected to feel instantly better. They didn't. The symptoms persisted long after the restriction ended. None of them reported feeling back to normal at the end of the three-month rehabilitation period. None of them.

To begin with, they were given a modest calorie increase — somewhere between 400 and 1,600 calories. But all of them said it wasn't enough. Even those getting 1,600 said they needed more, because their bodies were trying to rebuild. The body doesn't just go, "oh good, there's food now, we can relax." The body goes: eat as much as you possibly can, because you don't know if it's going to be there next week. The body has learned not to trust the food supply. And so bingeing becomes commonplace.

In the journal article I mentioned, many reported it took up to two years to feel like themselves again. One participant was hospitalised and had to have his stomach pumped after overdoing it. Another vomited on a bus — just couldn't satisfy his cravings, ate and ate and ate and then got on the bus and threw up. Disordered eating became really commonplace. Even a year later, there was still food noise, bingeing, and self-harm — one person cut off their own fingers.

We know now that dieting leads to disordered eating, and disordered eating can lead to eating disorders. But we knew that then. We've always known that. So why do doctors recommend weight loss when they've been watching this happen for almost a century?

Healthy men who volunteered to starve themselves for science — they were praised. When we see predominantly thin women starving themselves because of an eating disorder, we pity them — I'm not sure that's the appropriate emotion, but we do. But when we see fat people starving on doctors' orders, we call it medical care. We applaud it. We don't see anything wrong with it.

That is not medical care. That is medical malpractice. If I'm prescribing a treatment that has never been demonstrated to benefit patients in any meaningful way, but causes all of these side effects, I'd argue that is intentionally causing harm. That violates the most fundamental principle of medicine: do no harm.

When you develop side effects from going on a diet, you are told to endure them without complaint. Get on with your life. Stop moaning, stop being weak. And you do — you're great at it. You do it over and over again. You don't complain. You're not allowed to complain. And when you give up — because of course you will eventually, nobody can live like this forever — you're labelled non-compliant. You're a failure, you're weak-willed, you lack mental fortitude. Your doctors write it in your notes.

When the weight loss slows down, and then plateaus, and then reverses — which is just adaptive thermogenesis, a well-documented process that happens to everybody — the doctors say you gave up. They don't say: this is a predictable biological response. Even though there was a conference in 1992 where they all agreed that weight regain is a normal and expected part of the process. Your doctor will still say it's your fault.

When your health deteriorates as a result of weight cycling, instead of saying it's the weight cycling, they say it's because you were fat in the first place.

Being fat was never the problem. Attempting to cure fatness is the problem. Denying people their basic human rights because they're fat — that's the problem.

If I found evidence that having friends was associated with certain cancers — let's say I did some observational study and found that link — should I be prescribing isolation? Should I be telling my patients to eat alone, avoid social gatherings, cut off the people they love, indefinitely, on the off chance it might reduce their cancer risk? No. Of course not. That would be absurd. Isolation in itself is harmful. It causes health complications. It's also just cruel.

And yet — human touch is one of the most effective ways to spread infection. Genuinely. Coming into close physical contact with other people is one of the most efficient transmission routes for infectious disease. But we don't tell patients to live without physical contact. We don't say: don't hug your loved ones, don't have sex, don't comfort your children. Of course we don't. Because yes, there's a risk — but human touch is important. People who go without it can become profoundly touch-starved. The benefits are undeniable.

Sunlight genuinely causes cancer. There is no question about this. But we don't tell patients to live in darkness, to spend their lives pale and vitamin D deficient, never feeling the sun on their skin again. What do we say? Be sensible. Wear a hat. Use sunscreen. Don't take unnecessary risks. We don't just say: suffer, so that you can reduce your risk of melanoma.

So why, when it comes to food — something just as fundamental as human touch, as sunlight, as connection — why do we think it's acceptable to tell people they're not allowed to eat it anymore? Eating is not just fuel. It is joy. It is connection. It is comfort. How can we tell people to surrender that? To spend their lives hungry, obsessed, exhausted, and joyless? These men couldn't manage it for six months. And we're saying you have to do it for the rest of your life.

And more importantly — we're not even giving people a genuine choice. It has become the price of medical care. It's the price of admission. Lose weight, or be excluded. Lose weight, or go without treatment. Lose weight, or suffer the consequences of your untreated condition. You're not choosing between dieting and not dieting. You're being forced to choose between one kind of suffering and another.

That is completely and utterly unethical. It is wrong on a fundamental human level. And there were 36 men who proved it to us 80 years ago.

And the same man who designed that experiment is the same man responsible for the BMI. If it weren't for Ancel Keys, there would be no BMI — and if there were no BMI, you and I would be able to access the surgery and the care we need without being forced to diet first.

I want you to walk away from this episode angry. Really angry. You are being forced to do something that nobody has any business forcing you to do. Food is a fundamental right — like safety, like oxygen. Don't let anyone tell you that you should have to suffer just because of the size of your body.

This is not medicine. This is punishment. This is punishment dressed up as medicine, and it has to stop.

If you're a healthcare professional listening to this, I want you to ask yourself: what gives you the right to tell people to do this? To force them to endure this, and to do so without complaint? Do you think that because your fat patient hasn't cried in your office, they're not suffering? Do you think that because they're still going to work and raising their children and getting on with life, it's no big deal? It is a big deal. The evidence from the Minnesota Starvation Experiment shows that the physical and psychological effects of starvation — whether in a wartime study, an eating disorder, or a medically prescribed diet — are remarkably similar. There is very little difference between the three.

So next time you tell someone to eat less and move more, to reduce their calories, or if you have the audacity to recommend 800 calories a day to a patient, I want you to remember: you are actively harming them. You are punishing them in a cruel and inhumane way. And you should be held to account. If no one else is holding you to account, hold yourself. You know better. Do better.

This is Chapter 5 of my book — "The Treatment Causes the Disease." If you want to know more, the book is available to pre-order on the 22nd of April. Watch this space in case that changes. And if you don't want to wait, or if you want to be part of the process, hang out with me, and ask me questions — you can join The Weighting Room for just £15 a month. Every Monday we have Book Club, where I read a chapter of my book to you. I have the audacity to call it a book club even though it's only my own book. I'm not even going to apologise for that. See you next week, folks.