Volume 11, Issue 6 p. 557-570

The emperor’s tailors: the failure of the medical weight loss paradigm and its causal role in the obesity of America

I can easier teach twenty what were good to be done than to be one of the twenty to follow mine own teaching. The brain may devise laws for the blood, but a hot temper leaps o’er a colddecree. Portia, Merchant of Venice .

J. S. Puterbaugh

Corresponding Author

J. S. Puterbaugh

Providence St. Vincent Medical Center, Portland, OR, USA

J.S Puterbaugh, Providence St. Vincent Medical Center, 9155 SW Barnes Rd. Suite 422, Portland, OR 97225, USA
jsputerbaugh@gmail.comSearch for more papers by this author
First published: 06 May 2009
Citations: 19

Conflict of interest:

[This article, loaded on 08 May 2009, after first online publication, replaces the version originally published online, and several corrections have been made to the references.]


During the past century, the medical profession has developed a paradigm for the treatment of obesity, which prescribes specific exercise and dietary goals under the umbrella of ‘lifestyle change’. It has three components, all of which evolved from origins that had nothing to do with weight control. First, it is individually prescriptive, that is weight loss is considered the responsibility of the individual as contrasted to a societal or group responsibility. Second, it recommends exercise aimed towards structured, or non-functional, activities with a variety of physiological end-points. Last, dietary goals are defined by calories, exchanges, food groups and various nutritional components. Diets are usually grouped by these goals. This model is unique to America, it is not working and it has also played a causal role in the obesity it is attempting to eliminate. A new model must be developed, which contains an observationally based societal prescription and links activity with functional outcomes and diets, which are food rather than nutritionally based.