Category: History of Weight Loss

A History of Bariatric Surgery: From 1954 to the Sleeve

In short: Weight-loss surgery began in 1954 with the jejunoileal bypass, an operation that skipped most of the small intestine and was later abandoned because of severe diarrhea, kidney stones and liver damage. In 1966 Edward Mason at the University of Iowa performed the first gastric bypass, and the Roux-en-Y version became the standard by the late 1970s. The 1980s and 1990s added stomach-stapling, adjustable bands and the duodenal switch; in 1994 surgeons first did a gastric bypass through small keyhole cuts. The sleeve gastrectomy began in the early 2000s as the first step of a two-stage operation and became the most common procedure in the U.S. by 2013. Today about 270,000 procedures are done a year, and in 2022 the specialty replaced the 1991 rules on who should be offered surgery.

This page tells that story from the original surgical papers, FDA approval records, Medicare’s coverage history and the American Society for Metabolic and Bariatric Surgery (ASMBS). It is history, not advice: for today’s options side by side, see every weight-loss procedure compared, and for how surgery works now, our bariatric surgery guide. The wider story of diets, drugs and programs is in our history of weight loss.

Seven decades of weight-loss surgery in four numbers

1954the first published intestinal bypass work, the start of metabolic surgeryKremen AJ et al., Annals of Surgery 1954
1966Edward Mason performs the first gastric bypass at the University of IowaFaria GR, Porto Biomedical Journal 2017
1994first laparoscopic (keyhole) Roux-en-Y gastric bypass reported, in five patientsWittgrove AC et al., Obesity Surgery 1994
58.2%share of 2023 U.S. procedures that were gastric sleeves, up from 17.8% in 2011ASMBS estimates

Checked on October 6, 2026

1954 to the 1970s: intestinal bypass (ABANDONED)

Modern weight-loss surgery started with the intestine, not the stomach. In 1954, surgeons A. J. Kremen, J. H. Linner and C. H. Nelson published an experimental study in the Annals of Surgery on how much of the small intestine the body needs to absorb food. A 2017 history in the Porto Biomedical Journal credits Kremen with the first metabolic operation, the jejunoileal bypass, which joined the start of the small intestine to its end and bypassed most of it in between. In 1963, J. H. Payne and colleagues reported on patients who had a “jejunocolic shunt”, connecting the small intestine directly to the colon, in the American Journal of Surgery.

Many versions followed in the 1960s and 1970s, but the Porto review notes that none gained wide acceptance, because patients developed severe diarrhea and dehydration. A 1977 randomized trial in the Annals of Surgery, led by W. O. Griffen Jr., compared the jejunoileal bypass with a gastric bypass in 59 patients: after the intestinal bypass, 56% had significant diarrhea, kidney stones and gallstones appeared that were not seen after gastric bypass, and fatty liver worsened at one year in 75% of the intestinal-bypass group, while it improved or stayed stable in everyone after gastric bypass. Results like these ended the jejunoileal bypass. Medicare’s national policy today lists intestinal bypass as not covered.

1977 trial: problems in the intestinal bypass groupValues in %

Significant diarrhea56%

Needed medication (late effects)74%

Fatty liver worse at 1 year75%

1977 trial: problems in the intestinal bypass group
Item	Value
Significant diarrhea	56%
Needed medication (late effects)	74%
Fatty liver worse at 1 year	75%

Share of the jejunoileal bypass group. In the gastric bypass group, kidney stones and gallstones were not seen and liver findings improved or stayed stable.

Source: Griffen WO Jr et al., Annals of Surgery 1977 (randomized trial, 27 intestinal bypass vs 32 gastric bypass patients) (checked on October 6, 2026)

1966 to 1977: the gastric bypass

Edward E. Mason was a surgeon at the University of Iowa. According to the Porto review, he proposed the first gastric bypass in 1966, building on observations of weight loss in patients who had had part of the stomach removed; he and C. Ito described it in “Gastric bypass in obesity” in 1967. The first version used a horizontal division of the stomach with a loop of intestine. Surgeons later rebuilt it with a Roux-en-Y limb, a Y-shaped connection that keeps bile away from the stomach and esophagus. ASMBS’s profile of Mason says that W. O. Griffen Jr.’s Roux-en-Y gastric bypass became the bypass of choice for most surgeons in 1977, when Griffen published his experience.

The basic idea has lasted: a small stomach pouch connected further down the small intestine. Today’s gastric bypass uses an egg-sized pouch joined 3 to 4 feet down the intestine, according to ASMBS, and it is still the second most common operation in the U.S.

1979 to 1998: diversion and the duodenal switch

In Italy, Scopinaro and colleagues reported the biliopancreatic diversion in the British Journal of Surgery in 1979, after studies in dogs. In their first 18 patients, average weight loss was 33.7% of body weight at 12 months, and the authors suggested it as an alternative to the jejunoileal bypass. In 1993, Marceau’s team at Laval Hospital in Québec reported a version that replaced the partial stomach removal with a long, narrow “parietal” gastrectomy and kept the valve at the stomach’s outlet, which reduced loose stools and protein malabsorption. In 1998, D. S. Hess and D. W. Hess at Wood County Hospital in Bowling Green, Ohio, reported their first 440 patients with “biliopancreatic diversion with a duodenal switch”, the operation now called the duodenal switch. Its stomach portion is essentially a sleeve, which became important later.

The duodenal switch is still done, along with a simpler variant with one connection, SADI-S. ASMBS says it produces the most weight loss of the approved operations but carries the greatest risk of vitamin and mineral deficiencies.

1982 to 2001: stapling and bands

Some surgeons tried restricting the stomach without bypassing anything. In 1982, Mason described the vertical banded gastroplasty (VBG) in the Archives of Surgery: a row of staples created a pouch of less than 50 mL, with a mesh collar around its outlet. He reported fewer complications and more weight loss in 42 patients than with any other operation he knew of. VBG and gastric bypass were the dominant procedures by the time of the 1991 NIH consensus conference, according to the 2022 ASMBS/IFSO guideline. Medicare’s national policy now lists open and laparoscopic VBG as not covered, and it has largely disappeared.

The adjustable gastric band came next. The Porto review credits Kuzmak with introducing it in 1986, adjustable without another operation, and says Cadière placed the first band by laparoscopy in 1992; Belachew’s team reported their laparoscopic series in 1994. The FDA approved the Lap-Band on June 5, 2001, for adults with a BMI of 40 or more, or 35 or more with a severe related condition, and expanded it in 2011 to a BMI of 30 to 34 with an obesity-related condition. The band was briefly very popular: it made up about 35% of U.S. procedures in 2011. Use then fell sharply, to 773 operations in 2023, as ASMBS lists slower weight loss and a high reoperation rate among its disadvantages. Our Lap-Band guide covers where it stands today.

1991: the NIH sets the rules

In March 1991, a National Institutes of Health consensus panel met on gastrointestinal surgery for severe obesity. Its statement recommended that people first be offered a non-surgical program combining diet, exercise, behavior change and psychological support; that surgery could be considered for well-informed, motivated patients with acceptable risk; that candidates be evaluated by a multidisciplinary team with medical, surgical, psychiatric and nutritional expertise; that surgeons be experienced and well supported; and that patients have lifelong medical follow-up after surgery. The thresholds that grew out of it, a BMI over 40, or over 35 with related conditions, were used by surgeons, hospitals and insurers for three decades, according to the 2022 guideline that replaced them.

1994 to 1995: keyhole surgery and a diabetes surprise

In 1994, Alan Wittgrove, G. W. Clark and L. J. Tremblay in San Diego reported the first laparoscopic Roux-en-Y gastric bypass, in five patients, with comparable weight loss and less morbidity and disability than the open operation. Laparoscopy changed the field: today most bariatric operations are done this way, according to the National Institutes of Health.

A year later, W. J. Pories and colleagues at East Carolina University published a 14-year follow-up of 608 gastric bypass patients in the Annals of Surgery with a title that captured the field’s surprise: “Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus.” Among patients with adequate follow-up, 121 of 146 (82.9%) with type 2 diabetes kept normal blood sugar, HbA1c and insulin levels. The society’s current name, the American Society for Metabolic and Bariatric Surgery, reflects that focus on metabolism, and later randomized trials such as STAMPEDE tested the diabetes effect formally.

2003 to 2013: the sleeve takes over

The gastric sleeve began as a safety step. For patients with very high BMIs, a full bypass or duodenal switch in one sitting carried more risk, so surgeons began removing most of the stomach first and doing the second operation later. In 2003, Regan, Gagner and colleagues at Mount Sinai in New York reported seven patients with a BMI of 58 to 71 who had a laparoscopic sleeve gastrectomy followed by a gastric bypass about 11 months later; patients had lost about a third of their excess weight after the sleeve alone. The Porto review notes that the sleeve was then increasingly used as a stand-alone operation. Medicare allowed its regional contractors to cover stand-alone laparoscopic sleeve gastrectomy from June 27, 2012.

The change in practice was fast. ASMBS estimates show the sleeve at 28,124 operations (17.8%) in 2011, ahead of the band and bypass by 2013, and at 157,254 (58.2%) in 2023.

Share of U.S. bariatric procedures by typeValues in %

201195.9%

201499.5%

201794.1%

202094.5%

202393.8%

Share of U.S. bariatric procedures by type
Item	Sleeve	Bypass	Band	Revision
2011	17.8%	36.7%	35.4%	6%
2014	51.7%	26.8%	9.5%	11.5%
2017	59.4%	17.8%	2.8%	14.1%
2020	61.4%	20.8%	1.2%	11.1%
2023	58.2%	23.4%	0.3%	11.9%

Shares computed from ASMBS best estimates (totals 158,000 in 2011 to 270,089 in 2023). 'Other' includes duodenal switch, SADI-S, one-anastomosis bypass, ESG, balloons and other procedures.

Source: ASMBS, Estimate of Bariatric Surgery Numbers, 2011-2023 (checked on October 6, 2026)

2004 to 2013: coverage and quality rules

As operations multiplied, the profession built quality programs. The society Mason helped found in 1983 as the American Society for Bariatric Surgery (now ASMBS) released accreditation standards for Bariatric Surgery Centers of Excellence in 2004, and the American College of Surgeons released its own in 2005. In 2012 the two merged into one program, MBSAQIP, which today covers nearly 1,000 sites in the U.S. and Canada.

Medicare’s coverage followed a similar arc. On February 21, 2006, it began national coverage of open and laparoscopic gastric bypass, laparoscopic adjustable banding and the duodenal switch for qualifying people at certified facilities. In 2009 it confirmed type 2 diabetes as a qualifying condition, in 2012 it allowed contractors to cover the sleeve, and from September 24, 2013, facilities no longer had to be certified. The same policy still lists gastric balloons, intestinal bypass and VBG as not covered.

Year	Milestone	Status today
1954	Kremen, Linner and Nelson’s intestinal studies; jejunoileal bypass begins	ABANDONED
1963	Payne’s jejunocolic shunt report	ABANDONED
1966-1967	Mason’s first gastric bypass; published with Ito	Evolved into Roux-en-Y bypass
1977	Griffen’s trial; Roux-en-Y bypass becomes the bypass of choice	Second most common operation
1979	Scopinaro’s biliopancreatic diversion	Evolved into the duodenal switch
1982	Mason’s vertical banded gastroplasty	Largely abandoned; not covered by Medicare
1983	American Society for Bariatric Surgery founded (now ASMBS)	Active
1986	Kuzmak’s adjustable gastric band	Rare (773 in 2023)
1991	NIH consensus statement on surgery for severe obesity	Replaced in 2022
1992-1994	First laparoscopic band (1992) and laparoscopic bypass (1994)	Laparoscopy is standard
1993-1998	Marceau’s and the Hesses’ duodenal switch	In use, with SADI-S
1995	Pories: “Who would have thought it?” diabetes paper	“Metabolic surgery”
2001	FDA approves the Lap-Band	Approved; rarely used
2003	Sleeve gastrectomy as the first stage of a two-stage operation	Most common operation
2006	Medicare national coverage	Updated 2009, 2012, 2013
2012	MBSAQIP accreditation program formed	Nearly 1,000 sites
2015, 2021	FDA approves ORBERA and Spatz3 balloons	Approved; not covered by Medicare
2022	FDA authorizes endoscopic sleeve gastroplasty; ASMBS/IFSO update who should be offered surgery	Current
2026	FDA approves the Allurion balloon, the first swallowable balloon placed without endoscopy	Approved; first U.S. patients April 2026

Dates from the original papers (PubMed), FDA PMA and De Novo records, CMS National Coverage Determination 100.1, ASMBS and the 2022 ASMBS/IFSO guideline. Checked October 7, 2026.

2007 to today: long-term evidence, devices and new rules

Long-term studies answered the question critics had asked for decades. The Swedish Obese Subjects study, published in the New England Journal of Medicine in 2007, found lower long-term death rates after surgery than with usual care, and people who had a bypass were about 25% lighter after 10 years. The STAMPEDE trial reported in 2017 that, five years on, 29% of people with type 2 diabetes who had a bypass and 23% who had a sleeve had an HbA1c of 6.0% or less, compared with 5% on medical therapy alone.

Less invasive options arrived through the FDA’s device pathway: the ORBERA gastric balloon was approved on August 5, 2015, the Spatz3 adjustable balloon on October 15, 2021, and endoscopic sleeve gastroplasty, which folds the stomach with stitches from the inside, was authorized on July 12, 2022. The newest device is the Allurion balloon, approved on February 20, 2026, for “short-term limited weight loss” in adults aged 22 to 65 with a BMI of 30 to 40: it is swallowed as a capsule, filled through a thin tube without endoscopy or anesthesia, and empties and passes on its own after about four months. Not every approved device lasted: our overview of FDA-authorized weight-loss devices shows which are still sold. Also in 2022, ASMBS and IFSO published new indications, describing them as major updates to the 1991 NIH guidelines: surgery is recommended from a BMI of 35 regardless of other conditions and can be considered from 30 with metabolic disease, there is no upper age limit, and insurer-required diets before surgery were called “scientifically unfounded”. The guideline puts the risk of dying around the operation at 0.03% to 0.2%.

The newest chapter is medicines. U.S. procedures fell from an estimated 279,967 in 2022 to 270,089 in 2023, while GLP-1 medicines came into wide use, and revisions of earlier operations now make up about 12% of all procedures. Surgery and medicines are increasingly discussed together; our GLP-1 vs bariatric surgery comparison and history of weight-loss drugs pick up that story.

Five lessons from 70 years of surgery

Side effects decide what lastsThe intestinal bypass worked for weight but harmed too many people, so it was dropped.
Simpler often winsThe sleeve spread fastest because it was simpler and safer for many people.
Long-term follow-up mattersProblems such as deficiencies and reflux show up years later, so lifelong care is part of every operation.
Weight is not the only outcomeDiabetes and other conditions changed how surgery is judged.
Rules change with evidenceThe 1991 thresholds were replaced in 2022 after decades of new data.

If you are considering a procedure today, start with our procedures hub, read about life after bariatric surgery, and use our guide to finding a bariatric surgeon to check accreditation. Your own decision belongs with you and a qualified bariatric team.

October 7, 2026

Who Invented BMI? The History of Measuring Body Weight

In short: BMI was invented by a Belgian astronomer and statistician, Adolphe Quetelet, who noticed in the 1830s that adult weight rises roughly with the square of height. It was a tool for describing the “average man,” not for judging anyone’s health. The name “body mass index” came much later, in 1972, from American physiologist Ancel Keys, and the familiar cutoffs of 25 and 30 were adopted by the NIH and the World Health Organization in the late 1990s. Since 2023, major medical groups have said BMI works best as a first screening number, used alongside waist size and other measures.

This page tells the story of how a 19th-century statistics project became the number on your chart, and why doctors are now adding measures beside it. If you just want your number, our BMI calculator works it out in seconds; for the wider story of weight and health, see our history of weight loss.

How BMI came to be, at a glance

1830sQuetelet finds that adult weight rises about with the square of height (described 1832, in his 1835 book).
Before BMIDoctors use height-weight tables built from life-insurance data (revised as late as 1983).
1972Ancel Keys tests several weight indexes in 7,424 men and names the winner the "body mass index".
1985An NIH consensus conference reviews the health effects of obesity.
1997-1998A WHO consultation and new NIH guidelines set 25 for overweight and 30 for obesity.
2004WHO experts note higher risk at lower BMI in many Asian populations.
2022-2025Waist-to-height ratio joins BMI in UK guidance; the AMA and a Lancet Commission say BMI alone is not enough.

1830s: an astronomer counts people

Adolphe Quetelet (1796 to 1874) was a Belgian mathematician, astronomer and statistician who wanted to apply the tools of astronomy to human beings. He measured births, deaths, heights and weights to describe what he called the “average man.” According to a 2008 history in the journal Nephrology Dialysis Transplantation, he described the weight-height relationship in 1832, and it appeared in his principal work, Sur l’homme et le développement de ses facultés, published in 1835 and translated into English in 1842 as A Treatise on Man and the Development of His Faculties.

In the English edition, Quetelet explains that if people grew equally in every direction, weight would rise with the cube of height, but that is not what he saw. Between infancy and puberty, he wrote, weight increases nearly as the square of height, and when he compared fully grown adults of different heights, he found their weight was “nearly as the square of the stature.” That observation, weight divided by height squared, is the whole of the BMI formula.

Two things are worth knowing. First, Quetelet was describing averages in a population, not diagnosing anybody; his treatise is about statistics, growth and social patterns, not about obesity. Second, his ratio was known for over a century as the “Quetelet index.” He went on to organize the first International Statistical Congress in 1853, which pushed for a common list of causes of death, an early ancestor of today’s International Classification of Diseases.

Before BMI: insurance height-weight tables

For much of the 20th century, doctors did not use Quetelet’s ratio. They used height-weight tables. A 2000 review in Annals of Pharmacotherapy explains that these tables were built to compare groups by relative weight, and that because the weights in them were linked to lower death rates among insured people, they came to be called “desirable” or “ideal” weights. The search for a simpler index, the 2008 history adds, began after life-insurance actuaries reported higher death rates among their heavier policyholders.

The tables had quirks. The Metropolitan Life tables of 1983 split people into small, medium and large frames by elbow width, which was supposed to put about 25%, 50% and 25% of people in each group. When Canadian researchers tested this in 19,305 people in 1989, the split did not hold, and very few people came out as large-framed. The “ideal body weight” formulas used to dose some medicines, such as Devine’s equations, grew out of these same tables; the 2000 review found that the various formulas agree because the tables behind them agree. Our ideal weight calculator shows these formulas side by side and explains their limits.

1972: Ancel Keys gives it a name

After World War II, researchers studying heart disease needed a way to compare body weight across very different countries. Ancel Keys of the University of Minnesota, working with colleagues in Italy, Finland and Japan, tested several “indices of relative weight” in 7,424 healthy men in 12 groups across five countries, plus body-density measurements in two smaller groups. They judged each index by two tests: it should not depend much on height, and it should track body fat as closely as possible.

The ponderal index, which uses the cube root of weight, did worst. Percentage of average weight for height worked, but only within a given population. Weight divided by height squared came out slightly better than weight divided by height, and in their 1972 paper in the Journal of Chronic Diseases the authors wrote that “the ratio of weight to height squared, here termed the body mass index,” seemed preferable because it was simple to calculate and could be applied to all populations at all times. Note what they did and did not claim: BMI was the best of several simple options for comparing groups, not a precise measure of an individual’s fat.

The studies behind the number

7,424men in 12 groups across five countries in the 1972 study that named the body mass indexKeys A et al., J Chronic Dis 1972
97 millionU.S. adults estimated to be in the overweight or obesity range when the NIH set its 1998 cutoffsNHLBI Clinical Guidelines, 1998
40.3%of U.S. adults had obesity by BMI in August 2021 to August 2023CDC NCHS Data Brief 508, 2024

Checked on October 7, 2026

1985 to 1998: the cutoffs we use today

BMI moved from research into the clinic over the next quarter century. In February 1985, the National Institutes of Health held a consensus development conference on the health implications of obesity, published that December in Annals of Internal Medicine. In June 1997, a World Health Organization consultation in Geneva met on preventing and managing obesity; its report, Obesity: Preventing and Managing the Global Epidemic, followed in 1998 and was later issued in WHO’s Technical Report Series. WHO’s definitions today are simple: for adults, overweight is a BMI of 25 or more and obesity a BMI of 30 or more.

In September 1998, the NIH’s National Heart, Lung, and Blood Institute published its Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. It defined overweight as a BMI of 25 to 29.9 and obesity as 30 or above, estimated that 97 million American adults were in those ranges, and noted that a BMI of 30 equals about 221 pounds for someone 6 feet tall and 186 pounds at 5 feet 6. The guidelines also paired BMI with a second number: waist circumference above 40 inches for men or 35 inches for women signaled higher risk. The same report admitted that the cutoffs are “somewhat arbitrary,” because disease risk rises gradually as weight rises rather than jumping at one number.

Those data also show how quickly things changed. Using the new definitions, national surveys found that obesity rose from 10.4% to 19.9% of men and from 15.1% to 24.9% of women between 1960 and 1994. By August 2021 to August 2023, the CDC found that 40.3% of American adults had a BMI of 30 or more, and 9.4% had severe obesity (a BMI of 40 or more).

U.S. adults with obesity by BMI, 1960 and 1994Values in %

196010.4%15.1%

199419.9%24.9%

U.S. adults with obesity by BMI, 1960 and 1994
Item	Men	Women
1960	10.4%	15.1%
1994	19.9%	24.9%

Obesity = BMI of 30 or more. By 2021-2023 the CDC put the figure at 40.3% of all adults (men and women together).

Source: NHLBI Clinical Guidelines on Overweight and Obesity in Adults (1998), citing NCHS/CDC surveys (checked on October 7, 2026)

The categories, as used today

The CDC’s adult categories, for ages 20 and up, are below. The CDC calls BMI a screening measure and says it should be considered with other factors when assessing a person’s health; it is not a diagnosis.

BMI	CDC category (adults 20+)	Lower thresholds NICE uses for some groups*
Below 18.5	Underweight	Same
18.5 to under 25	Healthy weight	18.5 to under 23
25 to under 30	Overweight	23 to 27.4
30 to under 35	Obesity, class 1	Obesity from 27.5
35 to under 40	Obesity, class 2	Classes 2 and 3 about 2.5 points lower
40 or more	Obesity, class 3 (severe)

*NICE (England) advises lower thresholds for people of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean background. Sources: CDC adult BMI categories; NICE NG246. Checked on 2026-10-07.

2004: one number does not fit every body

Keys had hoped BMI would apply to all populations, but doubts appeared quickly. In 2004, a WHO expert consultation published in The Lancet reviewed evidence that many Asian populations have more body fat and higher health risks at the same BMI than European populations. It found that the BMI at which risk rises varies from 22 to 25 in different Asian populations, kept the international cutoffs, and suggested extra “public health action points” at 23, 27.5, 32.5 and 37.5. England’s NICE now uses lower thresholds for several groups, as shown in the table above.

There are other blind spots. The 2025 Lancet Commission described below notes that BMI can both underestimate and overestimate body fat: because it only sees weight, a very muscular person can score high, while someone who has lost muscle can score in the “healthy” range and still carry a lot of fat around the organs. That kind of deep belly fat, called visceral fat, matters for heart and metabolic health; our visceral fat guide explains why, and the belly fat guide covers what helps.

2012 to 2022: the waist joins the conversation

Because BMI can’t see where fat sits, researchers looked for a simple measure that can. A 2012 meta-analysis in Obesity Reviews pooled 31 studies covering more than 300,000 adults in several ethnic groups and found that waist-to-height ratio was better than both waist size and BMI at picking out people with high blood pressure, diabetes and other heart and metabolic risk factors. Waist size alone improved on BMI by about 3%, and waist-to-height ratio by about 4% to 5%.

In 2022, England’s National Institute for Health and Care Excellence (NICE) added waist-to-height ratio to its guidance for adults with a BMI under 35, with a memorable message: keep your waist to less than half your height. Its current guideline sorts a ratio of 0.4 to 0.49 as healthy, 0.5 to 0.59 as increased risk and 0.6 or more as high risk. You need only a tape measure: measure around your waist and divide by your height in the same units.

	BMI	Waist-to-height ratio
What it is	Weight (kg) divided by height (m) squared	Waist divided by height, same units
Where it came from	Quetelet (1830s); named by Keys (1972)	Backed by a 2012 meta-analysis; added to NICE guidance in 2022
What it sees	Total weight for height	Fat around the middle (central adiposity)
Common cutoffs	25 overweight, 30 obesity (lower for some groups)	Under 0.5 healthy; 0.5 to 0.59 increased; 0.6+ high
Main blind spot	Can’t tell muscle from fat or see where fat sits	Needs a careful tape measurement; NICE uses it for adults with a BMI under 35
Best use	Population tracking and first screening	Adding a risk signal alongside BMI

Sources: Keys et al. 1972; Ashwell et al. 2012; NICE NG246; CDC. Checked on 2026-10-07.

2023 to 2025: “useful, but not on its own”

In June 2023, the American Medical Association adopted a policy calling BMI an imperfect way to measure body fat. The policy notes that BMI was based mainly on data from earlier generations of non-Hispanic white people, that it has been used in ways that caused historical harm, and that it loses predictive power at the individual level. The AMA now suggests using BMI together with other measures such as waist circumference, body composition, visceral fat and metabolic factors, and says BMI alone should not be the reason to deny insurance coverage.

In January 2025, a Lancet Diabetes and Endocrinology Commission of 58 experts, including people with lived experience of obesity, went further. It recommended using BMI only as a population-level or screening measure, confirming excess body fat with a direct measurement or at least one other body measure such as waist circumference, waist-to-hip or waist-to-height ratio. It also proposed separating “preclinical obesity” (excess fat with normal organ function) from “clinical obesity” (excess fat that is already affecting how organs or daily activities work). For people with a BMI above 40, it said, excess fat can be assumed.

What this history means for your number

Almost two centuries on, Quetelet’s ratio is still the quickest way to sort large groups and to start a conversation, and many guidelines still use it. FDA labels for weight-management medicines, for example, describe their approved use in terms of BMI, as our FDA-approved medications comparison shows, and bariatric surgery criteria also start from BMI. But the history is clear that it was never meant to be the whole story about one person’s health. A gentler, more complete picture adds your waist, how you feel and function, and your blood pressure, blood sugar and cholesterol.

If you want more than one number, our body fat calculator estimates body fat from tape measurements, and our comparison of smart scales, DEXA and tape measures explains how accurate each method is. If you track at home, our best smart scales list explains what their body-fat readings can and can’t tell you, and if you are building muscle while losing fat, the body recomposition guide explains why the scale can stall while your shape changes. For how weight got counted in calories, read the companion story, the history of calorie counting.

October 7, 2026

The History of Calorie Counting: From Atwater to AI Apps

In short: Calorie counting began as a 19th-century physics unit that an American chemist, Wilbur O. Atwater, turned into a way to measure food. His U.S. Department of Agriculture bulletins of the 1890s and 1900s gave the 4-9-4 rule (calories per gram of protein, fat and carbohydrate) that is still written into food-label law. Physician Lulu Hunt Peters made counting a diet tool in 1918, Congress put calories on almost every package in 1990, and phones and AI apps now estimate them from a photo. The method has always worked best as a rough guide: labels, menus, memory and apps can all be off by a meaningful amount.

This page follows the calorie from the lecture hall to your phone. If you want to work out your own numbers, our calorie calculator uses a modern equation, and our calorie deficit guide explains how a deficit works in practice. For the bigger story, see our history of weight loss.

Calorie counting at a glance

1819-1824Nicolas Clément uses "Calories" in lectures on heat engines in Paris.
1887-1902Atwater brings the Calorie to American food, with the 4-9-4 factors.
1918Lulu Hunt Peters' Diet and Health makes counting a weight-loss method.
1918-1990Equations estimate how many calories a body burns (Harris-Benedict, then Mifflin-St Jeor).
1990-1994The Nutrition Labeling and Education Act puts calories on packaged food.
2016-2021A new label makes "Calories" bigger; chain menus list calories from 2018.
2010s-2020sTracking moves to apps, then to photo-based AI estimates.

Before food: the calorie as a unit of heat

The calorie started in physics, not nutrition. A 2006 history in the Journal of Nutrition by James Hargrove traces it to Nicolas Clément, who used “Calories” in lectures on heat engines in Paris between 1819 and 1824. The word was defined in a French dictionary by 1845 and entered English in 1863 through a translated physics textbook, which defined a Calorie as the heat needed to raise 1 kilogram of water by 1 degree Celsius. That big “Calorie” is the same as the kilocalorie (kcal) we use for food today.

1887 to 1902: Wilbur Atwater measures food

The capital-C Calorie on American labels, Hargrove writes, comes from Wilbur O. Atwater’s 1887 article on food energy in Century magazine and his 1894 USDA Farmers’ Bulletin No. 23, Foods: Nutritive Value and Cost. Atwater, a chemistry professor at Wesleyan University, wanted working families to get the most nourishment for their money. In that 1894 bulletin he also proposed a daily standard: 3,500 calories of energy for a man at moderate muscular work, higher than the German standard of about 3,050 because, he wrote, Americans led a more active life.

Atwater then built the evidence. With Charles D. Woods he published The Chemical Composition of American Food Materials (USDA Bulletin No. 28, 1896), a large set of food tables. With physicist E. B. Rosa he built a respiration calorimeter, a sealed room in which a person could live while every bit of heat and breath was measured, described in USDA Bulletin No. 63 in 1899. Those experiments let him check how much of the energy in food the body actually uses.

The result is the rule every nutrition student still learns. In Farmers’ Bulletin No. 142, Principles of Nutrition and Nutritive Value of Food (1902), Atwater gave the fuel value of protein as 4 calories per gram, fats 8.9 calories per gram and carbohydrates 4 calories per gram, counting only what is digested and burned. He noted that older figures of 4.1 and 9.3, which did not allow for losses, had come into common use. More than a century later, the federal rule for Nutrition Facts labels still lets food makers calculate calories with “the general factors of 4, 4, and 9” or with Atwater’s more specific factors.

Calories per gram: Atwater 1902 vs today's food label

Protein44

Fat8.99

Carbohydrate44

Calories per gram: Atwater 1902 vs today's food label
Item	Atwater, USDA Bulletin 142 (1902)	General factors in U.S. label rules (21 CFR 101.9)
Protein	4	4
Fat	8.9	9
Carbohydrate	4	4

Food makers may also use Atwater's food-specific factors or lab measurements. Alcohol and fiber have their own values.

Source: Atwater WO, USDA Farmers' Bulletin No. 142 (1902); 21 CFR 101.9(c)(1)(i) (checked on October 7, 2026)

1918: Lulu Hunt Peters makes it a diet

Atwater measured food for economy and nutrition. Physician Lulu Hunt Peters turned his unit into a weight-loss method in Diet and Health, With Key to the Calories (1918), now in the public domain. She told readers to use the word calorie as often as “foot, yard, quart, gallon,” and to stop thinking in slices and pieces: you would now eat “100 Calories of bread, 350 Calories of pie.” She wrote that she had once carried 70 pounds more than her usual weight, walked readers through cutting an example maintenance diet of 2,200 calories down to 1,200, and supplied tables of 100-calorie portions. The book’s warm, funny tone and simple arithmetic made counting a household habit.

Some of Peters’ ideas have aged well, such as noting that a small daily excess adds up over a year. Others have not; her very low fixed targets would not be advised for everyone today. Modern guidance from the NIH points to an initial goal of losing 5% to 10% of starting weight over about six months, with a calorie target set for the person, and our history of diet fads shows how her book set the stage for a century of plans that either embraced counting or promised you could skip it.

1918 to 1990: estimating the other side of the equation

Counting what you eat is only half of the math; you also need an idea of what you burn. In 1918, the same year as Peters’ book, J. Arthur Harris and Francis G. Benedict of the Carnegie Institution’s Nutrition Laboratory published “A Biometric Study of Human Basal Metabolism” in the Proceedings of the National Academy of Sciences, the basis of the Harris-Benedict equations. In 1990, Mark Mifflin, Sachiko St Jeor and colleagues published a newer equation in the American Journal of Clinical Nutrition, built from measurements in 498 healthy adults, both normal weight and with obesity, aged 19 to 78. The Mifflin-St Jeor equation is the main one our TDEE calculator uses today.

The old shortcut that “a pound equals 3,500 calories” has been revised too. NIH researcher Kevin Hall and colleagues showed in The Lancet in 2011 that the body adapts as weight changes, so the 3,500-calorie rule overestimates long-term loss. Their rule of thumb for an average adult with overweight: every lasting change of about 10 calories a day changes weight by about a pound in the end, with half of that change coming in about a year and nearly all of it in about three years. Our metabolism guide explains the adaptation.

1990 to 2021: calories on every label and menu

For most of the 20th century, a calorie count on a package was optional. The Nutrition Labeling and Education Act, Public Law 101-535, was signed on November 8, 1990. According to the FDA, it required all packaged foods to carry nutrition labeling, and according to the USDA’s Economic Research Service, the Nutrition Facts label it mandated dates from 1994. The FDA notes that the serving sizes behind that label were published in 1993.

In 2016, the FDA finalized an updated label, its first big change in more than 20 years. “Calories” and the serving size became larger and bolder, serving sizes were updated to reflect how much people actually eat and drink, and the “Calories from Fat” line was dropped because the type of fat matters more than the amount. Large manufacturers had to switch by January 1, 2020, and smaller ones by January 1, 2021. Meanwhile, chain restaurants and similar food sellers with 20 or more locations have had to show calories on menus and menu boards since May 7, 2018, along with the reminder that “2,000 calories a day is used for general nutrition advice, but calorie needs vary.”

How accurate are the numbers?

Labels are close, not exact. Federal rules treat a packaged food as misbranded if its calories are more than 20% above the label. When Tufts University researchers measured food in the lab, the average stated calories of 269 restaurant items from 42 restaurants matched well overall, but 19% of items had at least 100 calories more than stated. In an earlier study of reduced-calorie meals, restaurant dishes averaged 18% more calories than stated and supermarket frozen meals 8% more.

The bigger gap is usually our own memory. In a 1992 New England Journal of Medicine study of people who said they could not lose weight on fewer than 1,200 calories a day, careful measurement showed their metabolism was normal; they underreported what they ate by an average of 47% and overreported their activity by 51%. That isn’t a character flaw. It is simply very hard to estimate portions by eye, which is why a kitchen scale helps so many people who count.

How far calorie numbers can driftValues in %

Reduced-calorie restaurant meals, above stated18%

Supermarket frozen meals, above stated8%

Self-reported food, below actual (diet-resistant group)47%

AI photo estimates, average error (two chatbots)35.8%

How far calorie numbers can drift
Item	Value
Reduced-calorie restaurant meals, above stated	18%
Supermarket frozen meals, above stated	8%
Self-reported food, below actual (diet-resistant group)	47%
AI photo estimates, average error (two chatbots)	35.8%

Different studies, methods and directions of error; shown together only to give a sense of scale.

Source: Urban LE et al., J Am Diet Assoc 2010; Lichtman SW et al., NEJM 1992; Fridolfsson J et al., Curr Dev Nutr 2025 (checked on October 7, 2026)

From paper diaries to phones and AI

Writing down what you eat is, in researchers’ words, the centerpiece of behavioral weight-loss programs. A 2011 systematic review in the Journal of the American Dietetic Association looked at 22 studies published from 1993 to 2009: the paper diary was the most common tool, with the internet, handheld computers and digital scales appearing in five studies. Across the studies, self-monitoring was consistently linked with weight loss, though the authors rated the evidence as weak because of study limitations.

The 2010s moved the diary into phone apps with barcode scanners and big food databases, and the 2020s added photo-based estimates. Accuracy is still a work in progress. A 2023 review of 52 studies of image-based dietary assessment found calorie errors ranging from 0.1% to 38.3%, lowest for simple single foods. In a 2025 test of 52 standardized food photos, two AI chatbots misjudged calories by about 36% on average and underestimated more as portions grew. Our article on how accurate AI calorie counting is covers these studies in detail, and our best weight-loss apps list compares today’s trackers.

Calorie counting by the numbers

4-9-4calories per gram of protein, fat and carbohydrate, from Atwater's work, still allowed on U.S. labels21 CFR 101.9
20%how far above the label a packaged food's calories can be before it counts as misbranded21 CFR 101.9(g)
47%average underreporting of food in a 1992 study of "diet-resistant" adultsLichtman SW et al., NEJM 1992

Checked on October 7, 2026

What a century of counting teaches

Atwater’s numbers have lasted because energy balance is real: trials of named diets keep finding that the calories, more than the label on the diet, drive weight loss. What history adds is humility about precision. Treat every number, from the label to the app to your own estimate, as an approximation, and watch the trend in your weight and waist over weeks rather than the total for one day. Counting is also not the only route: our comparison of intermittent fasting vs calorie counting shows that structured eating windows can work about as well for many people, and the macro calculator helps if you would rather track protein than every calorie.

If you are keeping weight off, the habit of self-monitoring matters even more; see our habits of people who keep weight off and the maintenance guide. And for the story of the other number in most weight conversations, read who invented BMI.

October 7, 2026

From Corsets to CoolSculpting: A History of Body Shaping

In short: For about 250 years, people have reshaped the body from the outside before anyone could change it from the inside. Stiffened stays and corsets of the 1700s and 1800s gave way to rubber girdles in the 1920s to 1940s, then to stretchy nylon shapewear. Surgeons began removing fat in the 1920s, liposuction took its modern form in the 1970s, and in 2010 the FDA authorized the first fat-freezing device, the start of CoolSculpting. Every step changed the outline of the body, and none of them is a way to lose weight: shapewear moves soft tissue, and contouring removes or shrinks a limited amount of fat in one area.

This page traces body shaping from museum corsets to today’s clinic treatments, with dates from The Metropolitan Museum of Art’s Costume Institute, medical journals and FDA records. If you are shopping now, our shapewear guide explains fabrics and fit; if you are curious about treatments, start with our body contouring hub. If your goal is to lose weight, our lose weight guide is the place to begin.

Body shaping at a glance

1760s-1890sCorsets and stays of linen, silk and baleen; crinolines and bustles shape skirts.
1900s-1940sWaist cinchers, then girdles of silk, rubber and rayon.
1920s-1980sSurgeons try fat removal; the Fischers (1975) and Illouz (1977) create modern liposuction.
1987-1992Tumescent anesthesia, then ultrasonic liposuction.
1990s-2010sNylon and elastic shapewear; the FTC acts on "slimming" garments in 2014.
2008-2015Fat freezing is studied in pigs, authorized by the FDA in 2010; Kybella approved in 2015.
2020sNon-surgical fat reduction peaks, then falls; lifts grow as GLP-1 users seek help with loose skin.

1700s to 1800s: stays, corsets and whalebone

The Met’s Costume Institute holds a French corset from the late 1760s made of silk, linen, leather, wood and baleen, the flexible plates from whales’ mouths that were long called “whalebone.” Its collection also includes Italian stays from the mid-18th century, British stays from the late 1700s and American cotton stays from 1825 to 1835. These garments did not make anyone thinner. They held the torso in the fashionable shape of the day.

By the mid-1800s, the shaping moved to the skirt as well. The Met’s collection has an American crinoline, a framed underskirt of metal and cotton, from about 1860, and American bustles of linen and metal from the 1880s. A silk corset by the Paris maker Maison Léoty, dated 1891, shows how refined corset-making had become by the end of the century. Nineteenth-century physicians campaigned against tight lacing and what they called unhygienic dress, as a 1993 history of Swedish doctors’ efforts describes, and its effects can still turn up: a 1985 report in the Journal of Clinical Gastroenterology described four patients with “corset liver,” a rare benign change in the shape of the liver that was at first mistaken for a tumor.

1900s to 1940s: cinchers and girdles

The 20th century softened the frame but kept the squeeze. The Met holds an American waist cincher of silk and whalebone from 1900 to 1910, and girdles from the 1920s: one of silk from 1924, and a French girdle of silk, rubber and metal from about 1925. A waist cincher by the Royal Worcester Corset Company dates from about 1939, and an American girdle of rayon, cotton and rubber from about 1940. Brassieres appear in the collection from the 1920s.

Date (Met record)	Garment	Made of
Late 1760s	Corset, French	Silk, linen, leather, wood, baleen
1825-1835	Stays, American	Cotton
About 1860	Crinoline, American	Metal, cotton
About 1885	Bustle, American	Linen, metal
1891	Corset, Maison Léoty (Paris)	Silk
1900-1910	Waist cincher, American	Silk, whalebone
About 1925	Girdle, French	Silk, rubber, metal
About 1940	Girdle, American	Rayon, cotton, rubber
1990-1997	Girdle, Playtex (American)	Cotton, nylon, elastic

Source: The Metropolitan Museum of Art, Costume Institute collection records (several have public-domain images). Checked on 2026-10-07.

1990s to today: stretch shapewear and “slimming” claims

By the 1990s, girdles in the Met’s collection were made of nylon and elastic, by brands such as Playtex and Papillon, and the late-20th-century waist cinchers there are elastic and synthetic fiber. Modern shapewear works the same way, with firm stretch fabric that smooths and compresses. What it can’t do is remove fat. In 2014, two makers of caffeine-infused shapewear paid about $1.5 million to settle FTC charges that their garments’ claims to slim thighs, reduce cellulite and destroy fat cells were false and unsupported.

The waist trainer, a modern corset worn for hours a day, brought back old worries. The American Board of Cosmetic Surgery has said waist trainers don’t reduce belly fat or cause weight loss, can make breathing harder and may weaken core muscles with long-term wear. In a 2017 study in Gastroenterology, a tight belt around the waist increased acid reflux after a meal about eightfold in people prone to reflux. Our waist trainer guide covers the evidence, and our tummy-control shapewear picks and compression leggings picks focus on comfort and fit rather than slimming promises.

1921 to 1992: surgeons learn to remove fat

The first attempts to reshape the body with surgery went badly. A 2017 review in Annals of Medicine and Surgery recounts that in 1921, French surgeon Charles Dujarrier removed skin and tissue to reshape a dancer’s knees and ankles; too much tissue was removed and the closure was too tight, and the result was tissue death and amputation. Later attempts removed fat and skin together, with frequent complications. In 1972, German surgeon Schrudde described a less invasive method that scraped out fat with a small surgical instrument through a short incision.

Modern liposuction, the same review says, was developed in 1975 by father-and-son surgeons Arpad and Giorgio Fischer, at first only for the outer thighs. In 1977, Paris surgeon Yves-Gérard Illouz modified the equipment and extended the method to the whole body, and in 1983 he reported his five-year experience with more than 3,000 cases in Plastic and Reconstructive Surgery. In 1987, California dermatologist Jeffrey Klein described tumescent anesthesia, large volumes of very dilute numbing fluid that allowed liposuction under local anesthesia with much less bleeding. Ultrasonic liposuction followed in Italy in 1992. Today, liposuction is the most common cosmetic operation in the United States: ASPS member surgeons reported 317,196 procedures in 2025, about the same as the year before, according to the American Society of Plastic Surgeons (ASPS). Our liposuction guide explains what it involves.

2008 to 2010: freezing fat, from popsicles to the FDA

Doctors had long known that cold can inflame fat; pediatric journals have described “popsicle panniculitis” in young children. In 2008, Harvard researchers led by Dieter Manstein reported in Lasers in Surgery and Medicine that cooling the skin of pigs to just below freezing for 10 minutes caused a gradual loss of several millimeters of fat over the 3.5-month study. They called it selective cryolysis.

On August 24, 2010, the FDA granted ZELTIQ’s De Novo request for its dermal cooling device, as an aesthetic treatment to affect the appearance of the flanks (love handles). That decision created a new device type, and the CoolSculpting name and newer models followed through many later clearances; the CoolSculpting Elite clearance of 2024 lists areas from the upper arms and abdomen to the thighs and under the chin. The ASPS says cryolipolysis reduces fat in a treated area by about 20% on average, with results over several months. In 2015 the FDA approved Kybella (deoxycholic acid), an injection for fat under the chin. See our guides to cryolipolysis (fat freezing) and Kybella, and our comparison of liposuction vs cryolipolysis.

Fat freezing in three numbers

2010FDA De Novo decision for the first fat-freezing device (flanks), August 24FDA De Novo DEN090002
About 20%average fat-layer reduction in a treated area, per the ASPSASPS, Cryolipolysis
0.22%pooled rate of paradoxical adipose hyperplasia (fat that grows instead of shrinking) in a 2025 meta-analysisMah AE et al., Aesthet Surg J Open Forum 2025

Checked on October 7, 2026

Interest has moved in waves. ASPS member surgeons reported 682,932 non-surgical fat reduction procedures in 2022 and 745,967 in 2023, then 447,581 in 2024, a 40% drop. The ASPS reports don’t give a reason, and we don’t guess one here. Our non-surgical fat reduction comparison puts fat freezing, muscle stimulation, radiofrequency, laser and ultrasound side by side.

Non-surgical fat reduction procedures reported by U.S. plastic surgeons

682,9322022

745,9672023

447,5812024

Non-surgical fat reduction procedures reported by U.S. plastic surgeons
Item	Value
2022	682,932
2023	745,967
2024	447,581

Counts are ASPS estimates from member surveys; the 2025 report lists top procedures without this count.

Source: American Society of Plastic Surgeons, 2023 and 2024 Procedural Statistics Releases (archived copies) (checked on October 7, 2026)

The 2020s: shaping after major weight loss

The newest chapter is about the body after weight loss rather than instead of it. As GLP-1 medicines helped many people lose large amounts of weight, more of them began asking surgeons about loose skin. In its 2025 report, the ASPS said lift procedures across the body grew significantly and that 82% of its member surgeons had received consultation requests related to GLP-1 use. Tummy tucks ranked as the third most common cosmetic surgery, with 173,251 procedures. The ASPS describes patients as seeking “restoration, not transformation.”

This marks a real change in the story. For most of history, shaping was a way to look slimmer without losing weight. Today it is often the last step after weight loss, used to remove skin that diet, exercise or medicine can’t tighten. The ASPS has called lifts contouring tools, not weight-loss procedures, and the ASPS says a tummy tuck, which removes excess fat and skin and in most cases restores weakened or separated muscles, is not a substitute for weight loss. If you are on that path, our guides to loose skin after weight loss and the tummy tuck explain the options and timing, and the GLP-1 medications guide covers the medicines driving the trend.

The thread through 250 years: shape is not weight

From whalebone to cold plates, body shaping has always worked on the outline, not the scale. The FDA says plainly that non-invasive body contouring will not result in weight loss, and does not treat obesity or improve health. Liposuction removes a limited amount of fat from chosen areas; the ASPS says it is not a treatment for obesity or a substitute for proper diet and exercise. Shapewear changes how clothes sit for the hours you wear it. Each can help some people feel more comfortable, and that is a fair reason to choose them, as long as the expectations are honest.

If you are thinking about a procedure, our questions to ask before body contouring will help in a consultation. For a broader look at how we see our bodies, see body image. The history of body shaping also overlaps with outright hoaxes, from “reducing” soaps to sweat suits, which we cover in weight-loss hoaxes in history.

October 7, 2026

Tapeworm Pills, Sauna Suits and Slimming Soap: Weight-Loss Hoaxes in History

In short: For as long as people have wanted to lose weight, someone has sold a shortcut. Mail-order “fat reducers” of the early 1900s could contain thyroid gland; “slimming soaps” promised to wash fat away; tapeworm diet pills were mostly a myth, but the idea still hurts people today; and rubber sweat suits only ever removed water, sometimes with deadly results. Regulators slowly caught up, and the same promises now come back as patches, teas, creams and “body-slimming” clothing. The pattern is the useful part: if a product says you can lose weight without changing what you eat or how you move, history says it is a hoax.

This page looks at the best-known weight-loss hoaxes and dangerous fads, what was actually in them, what regulators did, and the modern version of each. It sits alongside our history of weight loss and the histories of diet fads and weight-loss drugs. Nothing here is a recommendation; several of these products were dangerous.

Weight-loss hoaxes at a glance

1906-1912The Food and Drugs Act passes; the AMA exposes mail-order "fat reducers".
1912-2013Tapeworm diet pills: a scare story, a fake poster and later real copycats.
c1926-1937La-Mar Reducing Soap promises to "wash away fat."
1931-1938The Supreme Court limits the FTC; Congress gives it power over ads, and the new drug law calls DNP extremely dangerous.
1997Three college wrestlers die using sweat suits to drop weight; the same year the FTC launches "Operation Waistline."
2006-2020The FTC acts on slimming soap, a sprinkle-on powder, caffeine shapewear and detox tea.

Early 1900s: mail-order “fat reducers”

Before 1906, there was no federal law against selling a mislabeled medicine. The original Food and Drugs Act was passed by Congress on June 30, 1906, and in 1912 Congress added the Sherley Amendment to cover false therapeutic claims, according to the FDA’s history office. That same year, the American Medical Association collected its investigations into patent medicines in a book called Nostrums and Quackery, with a full chapter on products sold to make people thinner.

One example was Kellogg’s Safe Fat Reducer, sold by a mail-order businessman from Battle Creek, Michigan. The AMA reported that it had been sold as “Kellogg’s Obesity Food” with the claim that it “turns fat into muscle,” and that federal chemists found it contained poke root, toasted bread and thyroid gland. Thyroid in a slimming product would reach the Supreme Court two decades later (see below). The same seller ran a company that sold a pill to put weight on, from the same building. The AMA also described the business model: a “free” sample, then a bill and a series of letters lowering the price each time. Another chapter covered Marjorie Hamilton’s “drugless” mail-order fat treatment.

Verdict: hoax, and sometimes dangerous. Modern version: the FDA’s list of tainted weight-loss products, which keeps growing with diet pills, “fat-burning” pills, supplements and teas found to contain hidden drug ingredients. The FDA says its list covers “only a small fraction” of the contaminated products on the market. Our guides to fat burners and “Nature’s Ozempic” supplements check the modern claims.

Tapeworm diet pills: mostly myth, still dangerous

The tapeworm diet is the most famous weight-loss hoax of all, and it is mostly a hoax about a hoax. A 2023 review in the medical humanities journal Hektoen International traces the story to a 1912 newspaper report from Peoria, Illinois, in which a husband supposedly had his wife’s diet pills analyzed and found tapeworm in them. The U.S. Surgeon General at the time, Rupert Blue, said in the Washington Post that the story was false. A widely shared poster advertising “sanitized” tapeworms turned out to be a fake, stitched together from other advertisements. Other reports of real tapeworm pills from that era, the review notes, were unverified.

The danger is modern. In 2013, a woman in Iowa bought a “tapeworm pill” online and swallowed it, then saw her doctor, who contacted the state health department. In a 2021 case report in the American Journal of Tropical Medicine and Hygiene, a 20-year-old woman in Beijing bought capsules sold online as beef tapeworm eggs to lose weight. She appears to have swallowed pork tapeworm eggs instead and developed cysticercosis, with cysts in her brain, tongue, muscles, liver and other organs; she needed four courses of antiparasitic medicine before recovering. The authors’ conclusion: deliberate parasitic infection for weight loss is dangerous.

Verdict: historical hoax; never try it. Tapeworm infection can cause pain, nausea, diarrhea, anemia and, with some species, serious disease far from the gut.

Slimming soap: “wash away fat”

Soap that dissolves fat sounds like a joke, but it sold. The Royal Pharmaceutical Society’s museum in London holds a box of La-Mar Reducing Soap, dated about 1926 to 1937: three wrapped bars in a box whose lid promised to “Wash away fat and years of age,” with drawings of a woman growing slimmer in three stages. Soap cleans skin; it can’t reach or remove the fat beneath it.

The idea came back. In October 2006, the Federal Trade Commission sued the sellers of the “Centro Natural de Salud Obesity Treatment,” three pills plus a bar of “special soap” sold with promises like “Lose 35 pounds in 2 months” and weight loss with no dieting, no skipped dinners and no calorie counting. The FTC said the claims were false and unsubstantiated. Verdict: hoax. Modern version: slimming creams and lotions. In 2014 the FTC settled with L’Occitane over skin creams said to “trim 1.3 inches in just 4 weeks.”

1931 to 1938: thyroid, DNP and new laws

The FTC’s early fight against weight-loss ads hit a wall. In FTC v. Raladam Co., decided May 25, 1931, the Supreme Court looked at a preparation sold to treat obesity that contained desiccated thyroid. The FTC had ordered the seller to stop advertising it as a scientific remedy unless it warned that it could not be taken safely without medical direction. The Court agreed there was evidence the product could endanger health, but ruled that the FTC had overstepped, because it had not shown harm to competing businesses. In 1938, the Wheeler-Lea Act gave the FTC clear authority over advertising for products the FDA regulates.

The same decade brought a far deadlier product. In 1933, Maurice Tainter at Stanford found that the industrial chemical 2,4-dinitrophenol (DNP) caused rapid weight loss in people, and it was soon sold as a slimming drug. It works by making the body waste energy as heat, which can push body temperature out of control. A 2011 review in the Journal of Medical Toxicology notes that the 1938 Federal Food, Drug, and Cosmetic Act labeled DNP “extremely dangerous and not fit for human consumption,” that it can cause cataracts, and that 62 deaths had been reported in the medical literature, with internet sales bringing it back. Verdict: dangerous; never take it.

Sauna suits and sweat belts: losing water, not fat

Rubber and plastic “sauna” suits make you sweat, and the scale drops right away, which is why they keep coming back. What you lose is water, and it returns when you drink. Used hard, they can be fatal. In November and December 1997, three college wrestlers in North Carolina, Wisconsin and Michigan, aged 19 to 22, died while trying to lose weight quickly before competitions. The CDC reported that they had restricted food and fluids and tried to maximize sweating by wearing vapor-impermeable suits under cotton warm-ups while exercising hard in hot environments. On average, each had aimed to drop about 30 pounds between preseason and competition, roughly 15% of body weight.

After the deaths, the NCAA banned vapor-impermeable suits, rooms hotter than 79°F, laxatives, diuretics, vomiting and excessive food and fluid restriction for making weight, according to the CDC’s report. Verdict: water loss only; dangerous in heat or with exercise. Modern version: sweat belts, waist trainers and “fat-burning” clothing. In 2014, two shapewear makers paid about $1.5 million to settle FTC charges over caffeine-infused garments said to slim thighs and reduce cellulite; the head of the FTC’s consumer bureau warned to steer clear if someone says you can lose weight by wearing their clothes. Our waist trainer guide explains what tight garments can and can’t do, and our history of exercise fads covers vibrating belts and electric ab belts.

The cost of shortcuts

62published deaths linked to DNP, a 1930s slimming chemical still sold onlineGrundlingh J et al., J Med Toxicol 2011
3college wrestlers who died in 1997 using sweat suits and dehydration to make weightCDC, MMWR 1998
$6 billionestimated yearly U.S. spending on fraudulent diet products in 1997FTC, Operation Waistline (1997)

Checked on October 7, 2026

1997 to 2020: patches, powders and detox tea

In March 1997, the FTC launched “Operation Waistline” against misleading weight-loss claims, including fat-burner supplements, a skin patch, shoe insoles said to work through reflexology, and “fat-blocking” products. It estimated that Americans were spending about $6 billion a year on fraudulent diet products. In January 2014, the FTC announced settlements of about $34 million with four marketers: Sensa ($26.5 million), a powder sold with the line “sprinkle, eat, and lose weight”; L’Occitane’s slimming creams; HCG Diet Direct, which promised up to a pound a day; and LeanSpa, which used fake news websites to sell acai and colon-cleanse products. In March 2020, the FTC settled with Teami, a seller of detox teas whose “30 Day Detox Pack” was promoted for weight loss through paid celebrity Instagram posts with hidden disclosures; a $15.2 million judgment was suspended after a $1 million payment. Our guide to detox teas and cleanses explains what these products actually do.

Money paid or surrendered in FTC weight-loss cases, 2014-2020Values in USD millions

Sensa (sprinkle-on powder, 2014)$26.50 USD millions

LeanSpa (acai and cleanses, 2014)$7.30 USD millions

Wacoal (caffeine shapewear, 2014)$1.30 USD millions

Teami (detox tea, 2020)$1 USD millions

L'Occitane (slimming cream, 2014)$0.45 USD millions

Norm Thompson (caffeine shapewear, 2014)$0.23 USD millions

Money paid or surrendered in FTC weight-loss cases, 2014-2020
Item	Value
Sensa (sprinkle-on powder, 2014)	$26.50 USD millions
LeanSpa (acai and cleanses, 2014)	$7.30 USD millions
Wacoal (caffeine shapewear, 2014)	$1.30 USD millions
Teami (detox tea, 2020)	$1 USD millions
L'Occitane (slimming cream, 2014)	$0.45 USD millions
Norm Thompson (caffeine shapewear, 2014)	$0.23 USD millions

LeanSpa surrendered assets; Teami's $15.2 million judgment was suspended after $1 million. HCG Diet Direct's $3.2 million judgment was suspended and is not shown.

Source: FTC press releases, January 7, 2014; September 29, 2014; March 6, 2020 (checked on October 7, 2026)

Hoax then, modern equivalent now

Then	What it really was	Modern equivalent	Closest FTC “gut check” claim
Mail-order “fat reducers” (1900s-1910s)	One contained thyroid gland, poke root and toast	Supplements with hidden drug ingredients	Causes substantial weight loss no matter what you eat
Tapeworm pills (1912 story)	Mostly a myth; real copycats sold online now	“Parasite” and worm-egg capsules	Weight loss without dieting or exercise
La-Mar Reducing Soap (c1926-1937)	Ordinary soap	Slimming creams and lotions	Weight loss by rubbing a product into the skin
Thyroid “obesity” remedy (1931 case)	A hormone with real risks	Unapproved or counterfeit prescription drugs	Causes permanent weight loss
DNP (1933)	An industrial chemical; deadly	DNP still sold online	Safely lose more than 3 pounds a week
Sauna suits and sweat belts	Water loss only	Waist trainers, caffeine shapewear	Weight loss by wearing a product
Cleanses and laxative teas	Laxative effects; no good evidence for weight (NIH)	Detox teas promoted by influencers	Substantial weight loss for all users

Sources: AMA Nostrums and Quackery (1912); Hektoen International (2023); Royal Pharmaceutical Society museum; FTC v. Raladam (1931); J Med Toxicol (2011); CDC MMWR (1998); FTC Gut Check (2014) and press releases; NCCIH. Checked on 2026-10-07.

How to spot the next weight-loss hoax

In 2014, the FTC published a “gut check” for the media listing seven weight-loss claims that can’t be true. They are: weight loss of 2 pounds or more a week for a month or more without dieting or exercise; substantial weight loss no matter what or how much you eat; permanent weight loss even after you stop the product; blocking fat or calorie absorption enough to lose substantial weight; safely losing more than 3 pounds a week for more than four weeks; substantial weight loss for everyone; and substantial weight loss from something you wear or rub on your skin. Every hoax on this page made at least one of them.

Real options look different. They come with realistic numbers, tell you about side effects, and ask for changes in eating or activity, or come from a licensed prescriber. Our weight-loss myths page checks common claims, the guide to losing weight fast, safely explains what a realistic pace looks like, and every FDA-approved weight-loss medication compared shows what proven treatments actually do. If you are shopping for supplements, start with our supplements hub, and if you are choosing a program, use our 12 questions to ask. For the story of corsets, girdles and modern contouring, see our history of body shaping.

October 7, 2026

From TOPS to Telehealth: A History of Weight-Loss Programs

In short: Organized weight-loss programs began in 1948, when TOPS (Take Off Pounds Sensibly) opened as a low-cost support group. Weight Watchers grew out of Jean Nidetch’s living-room meetings in Queens and became a company in 1963; Nutrisystem (1972) and Jenny Craig (1983 in Australia, 1985 in the U.S.) added packaged meals and centers. In 1993 the Federal Trade Commission charged five of the biggest programs with unsupported weight-loss claims, which is why ads now say results are not typical. Research then caught up: the Diabetes Prevention Program (2002) showed what a structured lifestyle program can do, and Medicare began covering behavioral therapy in 2011. Apps arrived in the 2010s, and since 2023 many programs have added telehealth prescribing of GLP-1 medicines.

Friends, group, people, day out, park, strolling, walking, long hair, blonde, women, hair, female, young, friends, friends, friends, friends, friends, group, walking, walking — Photo: 27707 / Pixabay

This page tells that story from company records and SEC filings, FTC case documents and the major trials. It is history, not a recommendation: for today’s options, see our weight-loss programs hub, the non-prescription programs ranked by evidence and, for prescribing services, telehealth programs compared. The bigger picture of diets, drugs and surgery is in our history of weight loss.

Weight-loss programs in four dates

1948TOPS opens, "the first weight loss organization of this kind," in its own wordsTOPS Club
1963Jean Nidetch officially founds Weight Watchers after starting meetings in her Queens living roomWeightWatchers
1993the FTC charges five of the largest commercial diet programs over unsupported claims and testimonialsBaltimore Sun, October 1, 1993 (reported)
2023WeightWatchers completes its purchase of the telehealth company Sequence (April 10)WW International 10-Q, SEC

Checked on October 6, 2026

Before programs: books and calorie counting

For the first half of the 20th century, people trying to lose weight mostly did it alone, with a book. William Banting’s “Letter on Corpulence” (1863) and Lulu Hunt Peters’ calorie guide “Diet and Health” (1918) were best sellers, but there was no group, coach or follow-up. Our history of diet fads covers that era. The idea that changed weight loss after World War II was simple: people do better together, with regular check-ins.

1948: TOPS and the support group

TOPS, short for Take Off Pounds Sensibly, describes itself as “the first weight loss organization of this kind” and says it opened its doors in 1948. It is a nonprofit based in Milwaukee, Wisconsin, with weekly peer-led meetings in person and online across the U.S. and Canada, and members who reach their goal join “KOPS” (Keep Off Pounds Sensibly). TOPS is still one of the lowest-cost programs. A 2015 study in the American Journal of Preventive Medicine looked at 207,469 people who joined between 2005 and 2011: the 35.9% who renewed their membership had lost an average of 6.0% of their weight at one year, and those who renewed for seven years in a row kept off 8.3%. Because it only counted people who stayed, it shows what is possible for committed members, not what is typical for everyone who joins.

1961 to 1968: Weight Watchers and the weekly meeting

Jean Nidetch, of Queens, New York, began her own weight-loss effort with a New York City Board of Health program and started inviting friends to talk about it in her living room. According to the company’s own history, about two months later 40 women were meeting there weekly. She officially founded Weight Watchers in 1963 and took the company public five years later. Weekly group meetings with a weigh-in became the familiar model for commercial programs. In 2013, New York’s mayor declared March 25 Weight Watchers Founder Celebration Day for its 50th anniversary. Today’s program is covered on our WW (WeightWatchers) page.

1972 to 1985: packaged meals and diet centers

The next wave sold food as well as support. Nutrisystem’s SEC filings say its businesses began in 1972 and operated for years through company-owned and franchised weight-loss centers; in late 1999 it began selling directly to consumers by internet and phone, and in 2001 through the QVC shopping channel. Jenny Craig’s filings say the company began in Australia in 1983, had 69 centres there by the end of fiscal 1985, and expanded to the U.S. in February 1985 with 13 centres in the Los Angeles area, followed by six in Chicago that September. Both combined portion-controlled meals with counseling, an approach that later trials tested directly. Our pages on Nutrisystem and Jenny Craig describe them now.

1993 to 1997: the FTC and “results not typical”

By the early 1990s, commercial programs were a big business, and regulators questioned their advertising. In September 1993, as the Baltimore Sun reported on October 1, the Federal Trade Commission charged five of the largest programs, Weight Watchers, Jenny Craig, Diet Center, Physicians Weight Loss Centers and Nutri/System, with making unsubstantiated weight-loss claims and using testimonials without evidence that they reflected typical results. Three settled right away; Weight Watchers and Jenny Craig said they would fight. The FTC estimated that about six million people spent more than $2 billion a year on these programs.

Jenny Craig settled in May 1997. Under the order, testimonials had to show typical results or carry the line “This result is not typical. You may be less successful,” claims about keeping weight off had to say “For many dieters, weight loss is temporary,” long-term maintenance claims needed evidence from customers followed for at least two years, and ads had to disclose mandatory fees. Disclosures like these are now a familiar part of weight-loss advertising. The FTC kept up the pressure: its 2014 “Gut Check” guide for media lists seven claims it calls false, such as losing a lot of weight without diet or exercise. Our guide to choosing a program turns those warnings into questions.

2002 to 2015: science tests the programs

Rigorous trials changed how programs are judged. The Diabetes Prevention Program, published in the New England Journal of Medicine in 2002, randomly assigned 3,234 adults with prediabetes to placebo, metformin or a lifestyle program aimed at losing at least 7% of body weight and doing 150 minutes of activity a week. Over an average of 2.8 years, the lifestyle program cut new cases of diabetes by 58% and metformin by 31%. That program became the model for the CDC’s National Diabetes Prevention Program and, after CMS certified it for expansion in 2016, for a Medicare benefit.

Diabetes Prevention Program: new cases of diabetes per 100 person-years

11Placebo

7.8Metformin

4.8Lifestyle program

Diabetes Prevention Program: new cases of diabetes per 100 person-years
Item	Value
Placebo	11
Metformin	7.8
Lifestyle program	4.8

3,234 adults with raised blood sugar, average follow-up 2.8 years. The lifestyle goal was at least 7% weight loss and 150 minutes of activity a week.

Source: Knowler WC et al., New England Journal of Medicine 2002 (Diabetes Prevention Program) (checked on October 6, 2026)

Turning a trial into a national program took time. In the first four years of the CDC’s National Diabetes Prevention Program, 14,747 adults took part; they attended a median of 14 sessions, lost 4.2% of their weight on average, and 35.5% reached the 5% goal, with each extra session linked to a little more loss. Medicare’s version runs as 16 weekly core sessions followed by monthly sessions, and Medicare.gov says people who qualify pay nothing. The lesson that carried over to every later program was that attendance matters: people who keep showing up tend to lose more.

In 2011, Medicare began covering intensive behavioral therapy for obesity in primary care for people with a BMI of 30 or more: weekly visits in the first month, every other week for months 2 to 6, and monthly for months 7 to 12 for those who had lost at least 3 kg (about 6.6 lb). The Look AHEAD trial, published in 2013, tested an intensive lifestyle program in 5,145 adults with type 2 diabetes, with planned follow-up of up to 13.5 years. Weight loss was 8.6% vs 0.7% at one year and 6.0% vs 3.5% at the end; the program improved blood sugar and fitness but did not reduce heart attacks and strokes, showing both the reach and the limits of lifestyle programs on their own.

Look AHEAD: average weight loss with an intensive lifestyle programValues in %

At 1 year8.6%0.7%

At study end (median 9.6 years)6%3.5%

Look AHEAD: average weight loss with an intensive lifestyle program
Item	Lifestyle program	Diabetes support and education
At 1 year	8.6%	0.7%
At study end (median 9.6 years)	6%	3.5%

5,145 adults with overweight or obesity and type 2 diabetes at 16 U.S. centers. The trial stopped early for futility on its heart outcome.

Source: Look AHEAD Research Group, New England Journal of Medicine 2013 (checked on October 6, 2026)

Commercial programs were finally compared too. A 2015 systematic review in the Annals of Internal Medicine of 45 studies found that, compared with education or no program, Weight Watchers led to at least 2.6% more weight loss at 12 months and Jenny Craig at least 4.9%; Nutrisystem led to at least 3.8% more at 3 months, and very-low-calorie programs such as Medifast showed short-term gains that faded after 6 months. The authors noted that many trials were short and lost many participants. Our medical vs commercial programs guide puts these results next to medical care.

Extra weight loss with commercial programs vs education or no program (2015 review)Values in %

Jenny Craig, 12 months4.9%

Very-low-calorie programs, short term4%

Nutrisystem, 3 months3.8%

Weight Watchers, 12 months2.6%

Extra weight loss with commercial programs vs education or no program (2015 review)
Item	Value
Jenny Craig, 12 months	4.9%
Very-low-calorie programs, short term	4%
Nutrisystem, 3 months	3.8%
Weight Watchers, 12 months	2.6%

Minimum differences ('at least') vs control or education, at different time points; the very-low-calorie figure is vs counseling. Not a ranking: the programs were studied in different trials, and the programs have changed since.

Source: Gudzune KA et al., Annals of Internal Medicine 2015 (45 studies) (checked on October 6, 2026)

2008 to 2020: apps and digital coaching

Smartphones moved programs from the church hall to the pocket. Noom was founded in 2008, according to a profile of its co-founder by the Korea Society, and built a program of short daily lessons based on behavior-change psychology with food and weight logging; a 2016 study of 35,921 users found 77.9% reported losing weight while using it, though it was observational and relied on self-reported data. Established programs added apps and online meetings, and Nutrisystem had already shifted to online sales. In 2018 the U.S. Preventive Services Task Force recommended that clinicians offer or refer adults with a BMI of 30 or more to intensive behavioral programs, noting that the effective ones usually had 12 or more sessions in the first year. Our Noom page and WW vs Noom comparison show where those two stand now.

2023 to today: programs that prescribe

GLP-1 medicines changed the business model. On April 10, 2023, WeightWatchers completed its acquisition of Sequence, a telehealth company, and now offers clinician visits and prescriptions alongside its points program. Noom, Ro and Hims & Hers built similar services. The older center-based model weakened: in May 2023 news reports covered the closure of the original Jenny Craig company, and on July 5, 2023 Wellful, which also owns Nutrisystem, bought the Jenny Craig brand and relaunched it online. WeightWatchers itself went through Chapter 11 bankruptcy in 2025, filing on May 6 and emerging on June 24 after eliminating $1.15 billion of debt.

Prescribing brought new questions. During and after shortages, many telehealth services sold compounded semaglutide and tirzepatide, which the FDA stresses are not FDA-approved or reviewed for safety, effectiveness or quality; on February 6, 2026, the agency announced it intends to act against non-FDA-approved GLP-1 drugs that are mass-marketed by companies. Our pages on telehealth weight loss and compounded GLP-1s explain what to check before signing up.

Year	Milestone	What it added
1948	TOPS (Take Off Pounds Sensibly) opens	Low-cost peer support groups
1963	Weight Watchers founded by Jean Nidetch; public in 1968	Weekly meetings and weigh-ins as a business
1972	Nutrisystem businesses begin	Centers and packaged foods
1983 / 1985	Jenny Craig starts in Australia, then the U.S.	Centers, meals and one-to-one counseling
1993 / 1997	FTC charges five programs; Jenny Craig settles	“Results not typical” disclosures
1999	Nutrisystem moves to internet and phone sales	Direct-to-consumer delivery
2002	Diabetes Prevention Program results	Proof that a structured lifestyle program prevents diabetes
2008	Noom founded	App-based coaching
2011	Medicare covers intensive behavioral therapy for obesity	Programs in primary care
2013	Look AHEAD results	Long-term limits of lifestyle programs alone
2014	FTC “Gut Check” guide	A public list of false weight-loss claims
2015	Systematic review of commercial programs	Side-by-side evidence
2016 / 2018	Medicare Diabetes Prevention Program certified; USPSTF recommendation	Coverage and a national standard
2023	WeightWatchers buys Sequence; Jenny Craig brand sold to Wellful	Programs that prescribe
2025	WeightWatchers completes Chapter 11	A restructured industry

Sources: TOPS; WeightWatchers; Nutrisystem and Jenny Craig SEC filings; FTC; NEJM; CMS; USPSTF; Annals of Internal Medicine; SEC and company releases. Checked October 6, 2026.

What 75 years of programs teach

Five lessons from TOPS to telehealth

Support worksFrom TOPS meetings to the DPP, regular contact and accountability are the common thread of programs that help.
More sessions, more resultsThe USPSTF found that effective programs usually had 12 or more sessions in the first year.
Typical is smaller than the adsThe FTC made "results not typical" a rule because testimonials overstated what most people lose.
Keeping it off is the hard partLook AHEAD and the TOPS study show weight loss can last, but usually less than at the peak.
Ask what is prescribedTelehealth programs can be helpful, but check whether a medicine is FDA-approved or compounded.

If you are choosing a program today, start with our 12 questions to ask, and for keeping weight off afterward, see our guide to maintaining weight loss and the habits of people who keep it off. Programs that prescribe medicines are medical care, so the decision belongs with you and a clinician.

October 7, 2026

A History of Diet Fads: 1900 to 2026

In short: Diet fads have come in waves for more than a century: chewing every bite slowly in the 1900s, counting calories from 1918, books in the 1960s that said calories didn’t count, high-protein and low-carb plans from 1967 and 1972, dangerous liquid-protein fasts in the late 1970s, low-fat eating, then detoxes, paleo, intermittent fasting and keto. When researchers finally tested the famous ones head to head, the answer was surprisingly consistent: most produced similar, modest weight loss at a year, and the people who stuck with their plan lost the most. A few fads were harmful, and a few left lasting lessons.

A book, old, antique, pages, empty pages, book pages, wooden table — Photo: Pezibear / Pixabay

This page covers diet fads from 1900 to today and what the evidence said about each one later. Dates come from the original books (several are now in the public domain) and National Library of Medicine catalog records; results come from randomized trials. For the wider story, including drugs, surgery and programs, see our history of weight loss; for today’s eating patterns ranked by evidence, see the 10 best diets for weight loss.

Diet fads at a glance, 1900 to 2026

1900sFletcherism: chew every mouthful slowly and thoroughly.
1918Calorie counting goes mainstream with Lulu Hunt Peters.
1960s"Calories don't count" and the quick-weight-loss diet.
1970sAtkins' low-carb revolution, then deadly liquid-protein fasts.
1980s-2000sLow fat vs low carb: the "diet wars".
Recent decadesDetoxes, paleo, intermittent fasting and keto, each later tested in trials.
2020sBig analyses find most diets work about equally; GLP-1 medicines change how people eat.

Before 1900: the first diet bestseller

The modern diet book starts in 1863 with William Banting’s Letter on Corpulence, in which a Londoner described losing 46 pounds by cutting bread, sugar, beer and potatoes. “Banting” became a word for dieting, and his low-starch idea came back again and again over the next 160 years, as this page shows. Our history pillar tells his story in full.

1900s: Fletcherism, or “chew, chew, chew”

Horace Fletcher, an American businessman, became famous in the early 1900s for one rule: chew food very slowly and thoroughly before swallowing. His books include The A.B.-Z. of Our Own Nutrition (1903) and Fletcherism: What It Is (1913). In the 1913 book he wrote that at 40 he weighed 217 pounds, about 50 more than he thought right for his height, and that after he started chewing carefully he lost more than 60 pounds of fat. He noted that a dozen years earlier the idea had been laughed at as the “chew-chew” cult. The habit spread widely enough that the book quotes a newspaper report of John D. Rockefeller telling people to “Fletcherize, or chew very slowly”.

What the evidence said later: partly supported. Fletcher’s claims about digestion and health went far beyond the evidence, but one piece holds up. A 2014 meta-analysis of 22 experiments found that eating more slowly led people to eat less at that meal, though it did not change how hungry they felt afterward. Slow, mindful eating is still a reasonable tool, not a weight-loss plan on its own.

1918: the calorie arrives

Physician Lulu Hunt Peters’ Diet and Health, With Key to the Calories (1918) taught readers to think of food in calories, with tables to make counting practical. It was less a fad than a framework that every later diet would either embrace or try to escape. What the evidence said later: supported. Calorie balance still sits at the core of weight loss: a 2014 JAMA analysis of 48 trials of named diets found that any low-carbohydrate or low-fat diet produced significant weight loss, and the differences between named diets were small. Our calorie deficit guide and calorie calculator use modern equations.

1960s: “calories don’t count” and the quick-weight-loss diet

By the 1960s, a new kind of diet book argued against counting. Herman Taller’s Calories Don’t Count (1961) made the case in its title. Irwin Maxwell Stillman’s The Doctor’s Quick Weight Loss Diet (1967) put speed in its title. Fast, effortless results became the standard promise of the diet book.

What the evidence said later: “calories don’t count” not supported; quick loss rarely lasts. When trials compared diets with very different mixes of fat, protein and carbohydrate, weight loss was similar, which is why the idea that calories don’t matter has not held up. As for speed, the NIH today recommends an initial goal of 5% to 10% of starting weight over six months. One macronutrient idea of the era does have modest support: higher-protein diets led to 0.79 kg more weight loss and better retention of lean mass than standard-protein diets with the same calories in a meta-analysis of 24 trials. Our high-protein diet guide covers the modern version.

1972: Atkins and the low-carb revolution

Robert C. Atkins’ Dr. Atkins’ Diet Revolution (copyright 1972) became one of the best-known diet books ever. Its core idea, sharply cutting carbohydrates while eating protein and fat freely, was Banting’s idea updated, and it returned in waves for decades.

What the evidence said later: works, but not magic. The first randomized trial of the Atkins diet did not appear until 2003. In that New England Journal of Medicine trial of 63 adults, the low-carb group lost more weight at 3 and 6 months, about 4 percentage points more, but by 12 months the difference was no longer significant. Larger trials followed. In Stanford’s A TO Z study of 311 women, Atkins led to the most weight loss at 12 months (4.7 kg), but only its difference from the Zone diet was significant.

The first randomized trial of the Atkins diet: weight lost over a yearValues in %

3 months6.8%2.7%

6 months7%3.2%

12 months4.4%2.5%

The first randomized trial of the Atkins diet: weight lost over a year
Item	Low-carbohydrate (Atkins)	Conventional low-fat
3 months	6.8%	2.7%
6 months	7%	3.2%
12 months	4.4%	2.5%

Percent of body weight lost. The 12-month difference was not significant. Adherence was poor and dropout high in both groups.

Source: Foster GD et al., New England Journal of Medicine 2003 (63 adults) (checked on October 6, 2026)

A group of friends enjoy a colorful meal outdoors with a sunflower centerpiece. — Photo: RDNE Stock project / Pexels

Late 1970s: liquid protein, the fad that killed

The darkest chapter came in the late 1970s with very-low-calorie “liquid protein” diets, in which people lived for months on protein drinks of about 300 to 400 calories a day. A 1981 investigation in the American Journal of Clinical Nutrition, by researchers including FDA and CDC staff, studied 17 people who died suddenly of heart rhythm problems after using these regimens for a median of five months. The deaths happened regardless of medical supervision or the protein product used, and the heart damage resembled that seen in starvation. The authors called for these regimens to be curtailed.

What the evidence said later: harmful as practiced. Today’s medically supervised very-low-calorie programs and meal-replacement shakes use complete nutrition, higher protein quality and limited time frames, and they are a different thing. Anyone considering an extreme low-calorie plan should do it only with medical supervision.

1980s to 2000s: low fat vs low carb

Low-fat eating was widely promoted in this period, and low-carb proponents pushed back, some suggesting that low-fat, high-carbohydrate diets were partly to blame for rising obesity. That argument was tested directly in the Women’s Health Initiative, which randomly assigned 48,835 postmenopausal women to a low-fat eating pattern or to usual eating, with no weight-loss goal. Women in the low-fat group lost 2.2 kg on average in the first year and stayed slightly lighter over 7.5 years, with no tendency to gain. What the evidence said later: low fat did not cause weight gain, and did not cause much loss either.

The “diet wars” were finally settled, as far as weight goes, by head-to-head trials of the popular diets of the era. In a Tufts trial published in 2005, 160 adults were assigned to Atkins, Zone, Weight Watchers or Ornish. At one year, weight loss was similar across all four, about 2 to 3 kg, and the amount people lost was tied to how well they stuck to their diet, not to which diet they had.

Four famous diets, one year later (Dansinger 2005)Values in kg

2.1 kgAtkins

3.2 kgZone

3 kgWeight Watchers

3.3 kgOrnish

Four famous diets, one year later (Dansinger 2005)
Item	Value
Atkins	2.1 kg
Zone	3.2 kg
Weight Watchers	3 kg
Ornish	3.3 kg

Average weight lost at 1 year, counting dropouts as no change. Only 50% to 65% completed. Weight loss tracked adherence, not diet type.

Source: Dansinger ML et al., JAMA 2005 (160 adults, randomized) (checked on October 6, 2026)

More recent fads: detoxes, paleo, fasting and keto

Detoxes and cleanses: not supported. Juice cleanses, teas and colon cleanses promised to flush out “toxins” and weight. The NIH’s National Center for Complementary and Integrative Health says there is no compelling research supporting detox diets for weight management or removing toxins, warns about unpasteurized juices, laxatives and dangerous electrolyte imbalances from days without food, and notes that the FDA and FTC have acted against companies over hidden ingredients and false claims.

Paleo: partly supported. The idea is to eat like our hunter-gatherer ancestors. In a two-year Swedish trial of 70 postmenopausal women, a paleo-type diet led to more fat loss than a standard healthy diet at six months (6.5 vs 2.6 kg of fat), but by two years the difference was no longer significant, and triglycerides stayed lower in the paleo group.

Intermittent fasting: supported, but not better than counting. Plans such as 5:2 and time-restricted eating set when you eat rather than what. A 2025 BMJ analysis of 99 trials found every fasting style beat eating freely, but only alternate-day fasting edged out daily calorie restriction, and in trials of 24 weeks or more, none did better. Our intermittent fasting vs calorie counting comparison and intermittent fasting guide go further.

Keto: supported, with trade-offs. The very-low-carb ketogenic diet is the strictest modern heir of Banting and Atkins. A meta-analysis of 13 trials lasting a year or more found 0.91 kg more weight loss than low-fat diets, with better triglycerides and HDL but higher LDL cholesterol. See our keto guide before trying it, especially if you take medicines for diabetes or blood pressure.

Grapefruit, a fad that keeps returning: weak evidence. Grapefruit diets have come and gone many times. One small 12-week trial of 91 adults found that half a fresh grapefruit before meals led to 1.6 kg of weight loss, compared with 0.3 kg with a placebo, but no single food has been shown to “burn” fat, and grapefruit can interact with some prescription medicines, so ask your pharmacist.

What the evidence said later, fad by fad

When	Fad	The promise	What the evidence said later
1900s	Fletcherism	Chew slowly for health and weight	Partly: slower eating lowers intake at a meal
1918	Calorie counting	Weight follows calories	Supported: still the core of weight loss
1961	Calories Don’t Count	Food type matters, not amount	Not supported
1967	The Doctor’s Quick Weight Loss Diet	Fast results	Fast loss rarely lasts; 5% to 10% in 6 months is the realistic goal
1972	Atkins low-carb	Eat fat and protein, cut carbs	Supported short term; similar to others at 1 year
Late 1970s	Liquid protein fasts	Rapid loss on protein drinks	Harmful: sudden deaths reported
Tested 2006	Low-fat eating	Fat makes you fat	No weight gain, but little loss without calorie goals
Recurring	Detoxes and cleanses	Flush toxins and pounds	Not supported; some risks
Tested 2014	Paleo	Eat like our ancestors	Partly: early edge faded by 2 years
Reviewed 2025	Intermittent fasting	When you eat matters most	Supported, about equal to calorie counting
Reviewed 2013	Keto	Burn fat in ketosis	Supported, small edge; LDL rises
Recurring	Grapefruit	A food that burns fat	Weak: one small trial

Sources in the references; checked on 2026-10-06.

The 2020s: from fads to patterns

The biggest change in recent years is not a new diet but new evidence about old ones. A 2020 BMJ network meta-analysis of 121 trials and 14 named diets found that most produced similar weight loss at six months and that the effects shrank by twelve months for every diet, with only the Mediterranean diet keeping its heart-risk benefits. At the same time, GLP-1 medicines changed what many people eat, with more attention to protein, fiber and smaller portions; our eating on a GLP-1 guide covers that. The Mediterranean diet, never a fad, remains the best-supported long-term pattern on our list.

What the big diet analyses found

48randomized trials of named diets in a 2014 JAMA analysis: differences between diets were smallJohnston BC et al., JAMA 2014
121trials of 14 named diets in a 2020 BMJ analysis: weight loss shrank for every diet by 12 monthsGe L et al., BMJ 2020
r = 0.60link between sticking to the diet and weight lost in the 2005 four-diet trial; diet type showed almost none (r = 0.07)Dansinger ML et al., JAMA 2005

Checked on October 6, 2026

How to spot the next diet fad

A century of fads offers a simple test. Be skeptical when a diet promises that one food, one nutrient or one rule overrides calories; when results are fast and effortless; when it bans whole food groups for everyone; or when it sells its own supplements. The FTC lists claims that can’t be true, such as weight loss “no matter what” you eat. Look instead for an eating pattern you could follow for years. Our weight-loss myths page checks popular claims against research, the diets hub compares today’s options, and the nutrition hub has everyday meal ideas. The rest of our history series covers weight-loss drugs and exercise fads.

October 7, 2026

From Vibrating Belts to Walking Pads: A History of Exercise Fads

In short: For more than a century, exercise fads have swung between two promises: results without effort (vibrating belts, electric ab belts, toning shoes) and results from real work made fun or simple (strongman routines, aerobics, workout videos, interval training, step counting). The effortless gadgets failed: the Federal Trade Commission took action against electric ab belts in 2002 and toning-shoe makers paid $25 million and $40 million in 2011 and 2012. The “real work” fads mostly held up, and today’s federal guidelines boil them down to 150 to 300 minutes of moderate activity a week plus strength training twice a week. The newest version of the oldest advice is simply to walk more.

Women, crosswalk, street fashion, happy, casual wear, walking together, crossing the street, urban, city, friends — Photo: Surprising_Media / Pixabay

This page follows exercise fads from the 1890s to the 2020s and what the evidence said about each one later. Dates come from the Smithsonian’s collections, the National Library of Medicine catalog, the U.S. Department of Health and Human Services, the Kansas Historical Society and the FTC; results come from research. For the full story of weight loss, see our history of weight loss; for today’s options, our exercise hub.

Exercise fads at a glance

1890s-1900sStrongmen and machines: Sandow's dumbbells and Zander's exercise apparatus.
1900s-1960sVibrating belt machines promise to shake fat away.
1950s-1960sTV fitness, a President's Council and air-force exercise plans.
1968Aerobics gives cardio a name.
1980sWorkout records and videos bring exercise home.
2000sElectric ab belts and toning shoes meet the FTC.
2010s-2020sInterval training, step counts and walking pads.

1890s to 1900s: strongmen, dumbbells and machines

The first fitness celebrity was a strongman. Eugen Sandow, born Friedrich Wilhelm Müller in Prussia in 1867, became an international star after appearing at the 1893 World’s Columbian Exposition and in early Thomas Edison films, according to the Smithsonian’s National Museum of American History. By the late 1890s he was promoting physical fitness through Institutes of Physical Culture, health books and licensed exercise equipment, and in 1901 he organized the first international bodybuilding competition, at London’s Royal Albert Hall. His book Strength and How to Obtain It appeared in 1897, and the museum holds one of his spring-grip dumbbells from around 1900.

At about the same time, Swedish physician Gustav Zander designed a series of exercise machines, and the Smithsonian holds several Zander apparatus pieces, including one for circular movement of the arm. They look strange now, but they were early ancestors of today’s gym machines. What the evidence said later: supported. Strength training is now part of the federal Physical Activity Guidelines, which advise muscle-strengthening activities for all major muscle groups on two or more days a week. Our strength training guide shows how to start.

1900s to 1960s: the vibrating belt

The vibrating belt machine, a motorized strap that shook the hips or belly, is the classic effortless fad. The Kansas Historical Society, which holds a 1960s Walton Belt Vibrator once rented out for $10 a month, says such devices existed from the 1850s, peaked between 1900 and 1930 and came back in the 1950s and 1960s. A 1958 advertisement it quotes promised “3200 times a minute” of vibration for “fast, effective, spot reduction” in 15 minutes a day, even while watching television.

What the evidence said later: not supported. Shaking does not remove fat, and neither does working one area. In a 2011 randomized trial, six weeks of daily abdominal exercises improved muscular endurance but did not reduce belly fat, waist size or body fat compared with no exercise. Fat loss happens across the whole body when you use more energy than you take in. Our belly fat guide explains what actually helps.

1950s and 1960s: TV fitness and a President’s Council

After reports in the early 1950s that American children were less fit than European children, President Eisenhower created the President’s Council on Youth Fitness in 1956, following a national conference at the U.S. Naval Academy, according to the Department of Health and Human Services. Today it is the President’s Council on Sports, Fitness and Nutrition. Television made fitness personal: the Smithsonian notes that Jack LaLanne developed exercise routines and equipment from the 1930s and brought them to the public through his television shows; the museum holds one of his exercise videotapes and the swimsuit he wore at 60 when he swam from Alcatraz Island to Fisherman’s Wharf, handcuffed and shackled, towing a 1,000-pound boat.

Short, structured home routines followed. The Royal Canadian Air Force’s exercise plans, the 11-minute-a-day 5BX plan for men and the 12-minute XBX plan for women, were published in an American edition in 1962, according to the National Library of Medicine catalog. What the evidence said later: partly supported. Short daily routines are a good start, and the current guidelines say any amount of moderate-to-vigorous activity brings some health benefit. For weight, though, total activity over the week matters more than any single routine.

1968: aerobics gives cardio a name

In 1968, physician Kenneth H. Cooper published Aerobics, followed by The New Aerobics (1970) and Aerobics for Women (1972, with Mildred Cooper), according to the NLM catalog. The word moved from physiology into everyday language, and jogging, aerobic dance and cardio classes followed. What the evidence said later: supported. Aerobic activity is the backbone of today’s guidelines: 150 to 300 minutes a week of moderate activity, or 75 to 150 minutes of vigorous activity, with more benefits beyond 300 minutes. Our best exercises for weight loss list shows how many calories common activities burn.

1980s: the workout comes home

Records and videotapes turned living rooms into studios. The Smithsonian’s collections include Jane Fonda’s Workout Record and several Richard Simmons videotapes, among them Dance Your Pants Off! and Tonin’ Uptown, along with workout videos in its Video Press Kits collection. These programs made exercise social, upbeat and possible without a gym. What the evidence said later: supported, if you keep doing it. The 2018 Physical Activity Guidelines dropped the old rule that activity only counts in bouts of at least 10 minutes and say adults should “move more and sit less”, so a home routine, a dance video or a walk all count.

2000s: electric ab belts and toning shoes meet the FTC

The effortless promise returned with new technology. In May 2002, the FTC charged the marketers of three top-selling electronic ab belts, AB Energizer, AbTronic and Fast Abs, with falsely claiming the devices would give users “six pack” abs without exercise and cause fat and inch loss, including promises of losing 4 inches in 30 days. The FTC chairman said there are “no magic pills, potions, or pulsators” for losing weight. The Fast Abs marketers agreed to pay more than $5 million in 2003. Our muscle stimulation guide explains what today’s clinic devices can and cannot do.

Then came toning shoes, with curved or unstable soles that promised to firm the legs and buttocks while you walked. In September 2011, Reebok agreed to pay $25 million in customer refunds to settle FTC charges that it falsely claimed its EasyTone shoes were proven to give 28% more strength and tone in the buttock muscles. In May 2012, Skechers agreed to pay $40 million over claims that Shape-ups and other shoes would help people lose weight and tone their muscles.

What effortless fitness claims cost their makersValues in USD millions

Skechers toning shoes (2012)$40 USD millions

Reebok EasyTone and RunTone (2011)$25 USD millions

Fast Abs electric ab belt (2003)$5 USD millions

What effortless fitness claims cost their makers
Item	Value
Skechers toning shoes (2012)	$40 USD millions
Reebok EasyTone and RunTone (2011)	$25 USD millions
Fast Abs electric ab belt (2003)	$5 USD millions

Settlements with the FTC over unsupported fitness and weight-loss claims. Fast Abs: more than $5 million.

Source: Federal Trade Commission press releases (2003, 2011, 2012) (checked on October 6, 2026)

What the evidence said later: not supported. No belt, shoe or gadget does the work for you. Shapewear and waist trainers make a similar promise for the waistline; our guides to shapewear and waist trainers explain what they can do (change how clothes fit) and what they can’t (remove fat).

1996 to today: interval training

High-intensity interval training (HIIT) grew from sports science. In a 1996 study, Japanese researcher Izumi Tabata and colleagues had athletes cycle in seven to eight 20-second bursts at very high intensity with 10 seconds of rest, five days a week for six weeks; it improved both aerobic fitness and anaerobic capacity. The “Tabata” format became a fitness brand of its own. What the evidence said later: supported as a time saver, not a fat-burning shortcut. A 2017 meta-analysis of 13 trials in adults with overweight or obesity found that HIIT and steady moderate exercise reduced body fat and waist size equally, but HIIT took about 40% less training time. Interval training is hard on the body, so build up slowly and check with your clinician if you have heart or joint problems.

Interval training in three numbers

20 s on, 10 s offthe original Tabata protocol, 7 to 8 setsTabata I et al., Med Sci Sports Exerc 1996
13trials comparing HIIT with moderate continuous training in adults with overweight or obesityWewege M et al., Obesity Reviews 2017
~40%less training time with HIIT for similar body-fat changesWewege M et al., Obesity Reviews 2017

Checked on October 6, 2026

The 10,000-step goal, checked

Ten thousand steps a day became one of the most popular fitness goals, especially once pedometers and fitness trackers made counting easy. Researchers point out that the number had little scientific basis. When they tested it, the picture was encouraging for everyone who walks less. In a 2019 study of 16,741 older women, about 4,400 steps a day was linked with significantly lower death rates than about 2,700, and the benefit leveled off at about 7,500. A 2022 analysis of 15 studies with 47,471 adults found risk kept falling up to about 6,000 to 8,000 steps a day in people 60 and older, and 8,000 to 10,000 in younger adults.

Daily steps and risk of death, compared with the least active group

1About 3,550 steps (reference)

0.60About 5,800 steps

0.55About 7,840 steps

0.47About 10,900 steps

Daily steps and risk of death, compared with the least active group
Item	Value
About 3,550 steps (reference)	1
About 5,800 steps	0.60
About 7,840 steps	0.55
About 10,900 steps	0.47

Adjusted hazard ratios by quartile of daily steps (lower = lower risk). Observational studies; they show a link, not proof that steps alone cause the difference.

Source: Paluch AE et al., Lancet Public Health 2022 (15 cohorts, 47,471 adults) (checked on October 6, 2026)

What the evidence said later: the goal is useful, the number is flexible. More steps are better up to a point that depends on age, and any increase from a low starting point helps. A fitness tracker can keep count, and our walking guide has a plan for adding steps gradually.

2008 and 2018: the government writes it down

The first Physical Activity Guidelines for Americans were released in 2008, and the second edition in 2018. Together they turned a century of fads into a few plain rules: move more and sit less; aim for 150 to 300 minutes of moderate aerobic activity a week (or 75 to 150 minutes of vigorous activity); add muscle-strengthening on two or more days; and count activity of any length. For keeping weight off, the NIH suggests 150 to 300 minutes or more a week, and people in the National Weight Control Registry average about an hour a day, mostly walking. Our habits of people who keep weight off covers that research.

The 2020s: walking at your desk

The latest trend is the quietest: walking more through the day, including on compact under-desk treadmills called walking pads, often with a weighted vest for extra effort. It is a modern answer to the old wish to exercise while doing something else, and unlike the vibrating belt, it involves real movement. Our walking pad guide explains how to choose one safely, and the best walking pads lists researched picks. A walking pad won’t replace brisk walks outdoors, but it can add steps on busy days.

Exercise fads and what the evidence said later

When	Fad	The promise	What the evidence said later
1890s-1900s	Strongman training, dumbbells, Zander machines	Strength and health	Supported: strength training twice a week
1900s-1960s	Vibrating belt machines	Shake fat away, spot reduction	Not supported
1956	President’s Council on Youth Fitness	A fitter nation	Still running as the President’s Council on Sports, Fitness and Nutrition
1962	Air-force exercise plans (5BX, XBX)	Fitness in minutes a day	Partly: a good start; weekly total matters
1968	Aerobics	Heart and lung fitness	Supported: core of the guidelines
1980s	Workout records and videos	Exercise at home	Supported if kept up; any activity counts
2002	Electric ab belts	Six-pack abs without exercise	Not supported; FTC action
2011-2012	Toning shoes	Tone and lose weight by walking in special shoes	Not supported; $25 million and $40 million settlements
1996 onward	HIIT and Tabata	Faster fat loss	Similar fat loss in less time
Checked 2019-2022	10,000 steps	A magic number	More steps help, leveling off at 6,000 to 10,000 depending on age
2020s	Walking pads	Walk while you work	Real activity; adds steps

Sources in the references; checked on 2026-10-06.

The lesson of a century of fads is reassuring: there is no secret machine, and you don’t need one. The activities that held up, walking, strength work, aerobic exercise and intervals if you enjoy them, are cheap and flexible. Pick one you like, and use the calories burned calculator to see what it adds. For more fads checked against research, see weight-loss myths and our history of diet fads.

October 7, 2026

A History of Weight-Loss Drugs: From Thyroid Pills and Fen-Phen to GLP-1s

In short: For most of the last century, weight-loss drugs followed the same cycle: a promising pill, wide use, then harm and withdrawal. Dinitrophenol in the 1930s, amphetamines and “rainbow pills” in the 1950s and 1960s, fen-phen in the 1990s, sibutramine in 2010 and lorcaserin in 2020 were all pulled or restricted for safety reasons. A few older medicines survived with limits, such as phentermine (short-term only) and orlistat. The pattern changed with GLP-1 medicines: Saxenda in 2014, Wegovy in 2021 and Zepbound in 2023 produced larger losses, and Wegovy became the first weight medicine shown to lower heart attack and stroke risk. Today’s pills, Wegovy tablets and Foundayo, were approved in December 2025 and April 2026.

This page tells that story from FDA notices, approval records, the Federal Register, DEA scheduling and peer-reviewed research. It is history, not advice: whether any medicine fits you is a decision for you and your clinician. For today’s options side by side, see every FDA-approved weight-loss medication compared, and for the wider story of diets, surgery and programs, our history of weight loss.

A century of weight-loss drugs in four numbers

1938the year a new federal law finally let regulators stop sales of dinitrophenolColman E, Regulatory Toxicology and Pharmacology 2007
18 million+U.S. prescriptions for fenfluramine and phentermine in 1996, a combination the FDA never approvedConnolly HM et al., NEJM 1997
5drugs or drug groups for weight loss withdrawn or banned in the U.S. since 1997: fenfluramine, dexfenfluramine, phenylpropanolamine, sibutramine, lorcaserinFDA and Federal Register records
2021Wegovy approved, beginning the GLP-1 era of larger average weight lossDrugs@FDA

Checked on October 6, 2026

Before 1938: thyroid extracts and a dangerous “metabolism booster”

The first drug treatments for obesity tried to speed up the body’s energy use. A 2022 review of anti-obesity drug discovery in Nature Reviews Drug Discovery lists thyroid hormones, amphetamines and dinitrophenol among the treatments of the last century that were abandoned because of serious side effects. Giving thyroid hormone to someone whose thyroid works normally can push the heart and metabolism into overdrive, which is why it is not a weight-loss treatment today.

2,4-Dinitrophenol (DNP) (BANNED). In the early 1930s, DNP, an industrial chemical, became a popular weight-loss drug, largely through the work of Stanford pharmacologist Maurice Tainter. It works by making cells waste energy as heat. An FDA reviewer’s 2007 history describes its therapeutic margin as “razor thin”: thousands of people suffered irreversible harm before physicians abandoned it. Federal regulators had no power to stop patent-medicine sellers until the Food, Drug, and Cosmetic Act passed in 1938. DNP never went away: a 2011 review counted 62 published deaths, and it is still sold illegally online as a “fat burner”. Our fat burners guide explains why such products are dangerous.

1940s to 1960s: amphetamines and “rainbow pills”

After the 1938 law, the FDA approved several amphetamine and amphetamine-like drugs for obesity in the 1940s and 1950s, according to a 2005 history by an FDA medical officer in the Annals of Internal Medicine. Methamphetamine was approved for weight loss in the U.S. in 1947, and phentermine and phendimetrazine followed in 1959, according to a 2022 review in Nature Reviews Drug Discovery. These drugs curb appetite by stimulating the nervous system. Their popularity helped drive what historian Nicolas Rasmussen calls “America’s first amphetamine epidemic”, which peaked around 1969. From 1961 to 1968, “rainbow pills”, colorful combinations of several drugs taken together, were sold in the U.S. for weight loss and were linked with palpitations, raised blood pressure and deaths, according to the same review.

Regulators responded with limits rather than outright bans. The FDA restricted labeling to short-term use and added warnings about abuse and addiction, and these drugs are now controlled substances. The Drug Enforcement Administration lists amphetamine and methamphetamine in Schedule II (the strictest category for drugs with medical uses), benzphetamine and phendimetrazine in Schedule III, and phentermine and diethylpropion in Schedule IV. Phentermine, with an initial U.S. approval in 1959, is still prescribed, and its label limits it to short-term use as part of a broader plan. Our appetite suppressants guide covers it today.

1973 to 1997: fenfluramine, fen-phen and the heart-valve crisis

Fenfluramine (Pondimin) and dexfenfluramine (Redux) (WITHDRAWN 1997). Fenfluramine, an amphetamine relative that acts on serotonin, was approved in the U.S. in 1973 as an appetite suppressant. In the 1990s, doctors began prescribing it together with phentermine, a pairing known as “fen-phen” that the FDA never approved as a combination. Its close relative dexfenfluramine (Redux) was approved in the mid-1990s, and long-term use of these drugs spread quickly. In 1996, U.S. prescriptions for fenfluramine and phentermine passed 18 million.

In August 1997, doctors at the Mayo Clinic reported unusual heart-valve disease in 24 women who had taken fen-phen and had no history of heart problems; eight also had new pulmonary hypertension, and five had needed heart surgery. Fenfluramine and dexfenfluramine were withdrawn from the U.S. market in 1997 because of valve disease, and in 1999 the FDA listed both in the Federal Register as withdrawn for reasons of safety or effectiveness. Phentermine itself was not withdrawn. In a twist, fenfluramine returned in 2020 under a new name, Fintepla, approved for seizures in a rare childhood epilepsy, Dravet syndrome, with heart monitoring. It has no weight-loss approval.

1997 to 2010: sibutramine, orlistat and over-the-counter scares

Sibutramine (Meridia) (WITHDRAWN 2010). Approved on November 22, 1997, sibutramine was meant to be a safer appetite drug. It became the subject of SCOUT, a large trial of its long-term cardiovascular effects, which enrolled 10,744 older adults with heart disease, type 2 diabetes or both. Over an average of 3.4 years, heart attacks, strokes, cardiac arrest or cardiovascular deaths occurred in 11.4% of the sibutramine group and 10.0% of the placebo group, a 16% higher risk, while extra weight loss with the drug was small. On October 8, 2010, the FDA recommended against continued use and asked the maker to withdraw it, and the company stopped U.S. marketing. The FDA still finds sibutramine hidden in products sold as supplements.

SCOUT trial: heart attack, stroke, cardiac arrest or cardiovascular death over 3.4 yearsValues in %

11.4%Sibutramine

10%Placebo

SCOUT trial: heart attack, stroke, cardiac arrest or cardiovascular death over 3.4 years
Item	Value
Sibutramine	11.4%
Placebo	10%

Hazard ratio 1.16. Nonfatal heart attack 4.1% vs 3.2%; nonfatal stroke 2.6% vs 1.9%. The FDA recommended against continued use in October 2010.

Source: James WP et al., New England Journal of Medicine 2010 (SCOUT, 9,804 randomized adults) (checked on October 6, 2026)

Orlistat (Xenical, Alli) (still approved). Orlistat took a different route: it blocks part of the fat in food from being absorbed rather than acting on the brain. Xenical was approved on April 23, 1999, and a half-strength version, Alli, became the first over-the-counter weight-loss medicine on February 7, 2007. Its digestive side effects are well known, but it has stayed on the market. See our orlistat and Alli pages.

Phenylpropanolamine (PPA) (REMOVED 2000). PPA was sold for decades in over-the-counter diet aids and cold remedies. A Yale case-control study of 702 stroke patients, published in 2000, found that women who used PPA appetite suppressants had about 16 times the odds of a bleeding stroke. In November 2000, the FDA issued a public health advisory and asked all drug companies to voluntarily stop marketing products containing PPA, and stores and manufacturers removed them; a 2005 Federal Register notice proposed making the removal permanent.

Ephedra (BANNED IN SUPPLEMENTS 2004). Ephedra, a plant source of ephedrine alkaloids, was a common ingredient in weight-loss supplements. On February 11, 2004, the FDA published a final rule declaring supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk of illness or injury, including heart attack, stroke and death; it took effect on April 12, 2004. Our supplements guide explains why supplements are not FDA approved for weight loss.

Rimonabant (never approved in the U.S.). This drug blocked the brain’s cannabinoid receptors to reduce appetite. It was sold in Europe from 2006 to 2009 before being withdrawn over depression and suicidal thoughts, according to the 2022 review, and it never reached the U.S. market.

2012 to 2020: new combinations, and one more withdrawal

A new generation of medicines arrived in the 2010s. Qsymia (phentermine plus topiramate) was approved on July 17, 2012, and Contrave (naltrexone plus bupropion) on September 10, 2014. Both are still approved. Saxenda (liraglutide), approved on December 23, 2014, was the first GLP-1 medicine for weight management and a sign of what was coming; its approval extended to teens aged 12 and older in December 2020. Imcivree (setmelanotide), approved on November 25, 2020, treats rare genetic forms of obesity confirmed by testing.

Lorcaserin (Belviq) (WITHDRAWN 2020). Approved in 2012, lorcaserin acted on a serotonin receptor more selectively than fenfluramine had. A large safety trial, CAMELLIA-TIMI 61, followed 12,000 patients for five years. Cancer was diagnosed in 462 patients (7.7%) on lorcaserin and 423 (7.1%) on placebo, with several cancer types more frequent with the drug. On February 13, 2020, the FDA asked the maker to withdraw Belviq and Belviq XR from the market, and the company did so.

CAMELLIA-TIMI 61: patients diagnosed with cancer over 5 yearsValues in %

7.7%Lorcaserin (Belviq)

7.1%Placebo

CAMELLIA-TIMI 61: patients diagnosed with cancer over 5 years
Item	Value
Lorcaserin (Belviq)	7.7%
Placebo	7.1%

462 vs 423 patients among about 12,000 in the trial. The FDA said the risk of cancer outweighed the benefits.

Source: FDA, request for withdrawal of Belviq and Belviq XR (February 13, 2020) (checked on October 6, 2026)

2021 to 2026: the GLP-1 era

On June 4, 2021, the FDA approved Wegovy (semaglutide 2.4 mg), a weekly injection; in its main trial, average weight change was -14.9% with Wegovy and -2.4% with placebo. Its approval was extended to adolescents 12 and older in December 2022. Zepbound (tirzepatide), which acts on two gut hormone receptors, followed on November 8, 2023, with average losses up to -20.9% vs -3.1% on placebo. Then the uses widened. In March 2024, Wegovy became the first weight-loss medicine approved to reduce the risk of heart attack, stroke or cardiovascular death in adults with heart disease and obesity or overweight, based on the SELECT trial. Zepbound was approved for moderate to severe obstructive sleep apnea in adults with obesity in December 2024, and Wegovy for a form of fatty liver disease with liver scarring (MASH) in August 2025.

The newest chapter is pills and higher doses. Wegovy tablets were approved on December 22, 2025, a higher-dose Wegovy and an Imcivree approval for acquired hypothalamic obesity followed on March 19, 2026, and Foundayo, a daily small-molecule pill, on April 1, 2026. Our GLP-1 guide explains how these medicines work, and oral GLP-1s covers the pills.

The GLP-1 era brought its own problems. Shortages led to compounded copies, which the FDA says are not reviewed for safety, effectiveness or quality, and to counterfeits. Read our guide to compounded GLP-1s before considering one.

Approval and withdrawal timeline

Year	Drug	What happened	Status in 2026
1930s-1938	Dinitrophenol (DNP)	Popular from the early 1930s; federal power to stop sales arrived with the 1938 Food, Drug, and Cosmetic Act	Banned; sold illegally online
1947	Methamphetamine	Approved for weight loss in the U.S.	Schedule II
1959	Phentermine	Initial U.S. approval	Approved, short-term use; Schedule IV
1961-1968	“Rainbow pills”	Multi-drug combinations sold for weight loss	Gone
1973	Fenfluramine (Pondimin)	Approved as an appetite suppressant	WITHDRAWN 1997 for weight
Mid-1990s	Dexfenfluramine (Redux)	Approved	WITHDRAWN 1997
1997	Fen-phen	Heart-valve report in 24 women (never approved as a combination)	Fenfluramines withdrawn
1997	Sibutramine (Meridia)	Approved November 22	WITHDRAWN 2010
1999	Orlistat (Xenical)	Approved April 23	Approved
2000	Phenylpropanolamine	FDA advisory; companies asked to stop marketing	REMOVED
2004	Ephedra	Banned in supplements (rule effective April 12)	BANNED
2007	Alli (orlistat 60 mg)	First over-the-counter weight-loss medicine, February 7	Approved, OTC
2010	Sibutramine	FDA recommends against use after SCOUT (October 8)	WITHDRAWN
2012	Qsymia; Belviq	Qsymia approved July 17; Belviq approved	Qsymia approved; Belviq WITHDRAWN 2020
2014	Contrave; Saxenda	Approved September 10 and December 23	Approved
2020	Belviq; Imcivree	Belviq withdrawn February 13; Imcivree approved November 25	Belviq WITHDRAWN; Imcivree approved
2021	Wegovy	Approved June 4	Approved
2023	Zepbound	Approved November 8	Approved
2024	Wegovy; Zepbound	Heart-risk reduction (March 8); sleep apnea (December 20)	Approved uses
2025	Wegovy; Wegovy tablets	MASH (August 15); tablets approved December 22	Approved
2026	Wegovy HD; Foundayo	Higher dose March 19; Foundayo April 1	Approved

Sources in the references: Drugs@FDA, FDA safety communications and reviews, the Federal Register, DEA, and peer-reviewed histories; checked on 2026-10-06.

How long withdrawn weight-loss drugs were on the U.S. marketValues in years

Phenylpropanolamine (1960-2000)40 years

Fenfluramine (1973-1997)24 years

Sibutramine (1997-2010)13 years

Lorcaserin (2012-2020)8 years

Dinitrophenol (1933-1938)5 years

How long withdrawn weight-loss drugs were on the U.S. market
Item	Value
Phenylpropanolamine (1960-2000)	40 years
Fenfluramine (1973-1997)	24 years
Sibutramine (1997-2010)	13 years
Lorcaserin (2012-2020)	8 years
Dinitrophenol (1933-1938)	5 years

Approximate years between first U.S. marketing for weight loss and withdrawal or removal. Some harms took decades to recognize.

Source: Muller TD et al., Nature Reviews Drug Discovery 2022 (Table 1); FDA withdrawal records (checked on October 6, 2026)

What a century of drugs teaches

Five lessons from weight-loss drug history

Rare harms show up lateValve disease, strokes and cancer signals appeared only after wide use or large outcome trials.
Weight loss is not the only outcomeSibutramine lowered weight but raised heart risk; Wegovy lowered both weight and heart risk.
Combinations need their own proofFen-phen was never approved as a combination.
"Natural" is not safe by defaultEphedra was banned, and DNP and sibutramine still turn up in illegal products.
Approval is ongoingThe FDA keeps reviewing safety after approval, and labels change.

These lessons help explain why today’s medicines carry long labels and why supplements that promise drug-like results deserve suspicion. They also explain why InstaTuck’s medication pages never rank medicines and always link to the FDA label.

Thinking about a medicine yourself? Our questions to ask before starting a GLP-1 help you prepare for the conversation, the weight-loss pills hub covers every oral option, and what’s new in weight loss in 2026 picks up the story from here.

October 7, 2026

The History of Weight Loss: Every Method From 1860s Diets to 2026 Pills

In short: Modern weight loss started with a pamphlet: in 1863 a Londoner named William Banting described losing 46 pounds by cutting bread, sugar, beer and potatoes. Calorie counting went mainstream in 1918, group programs arrived in 1948 and 1963, surgery began in 1954, and weight-loss drugs went through cycles of hope and withdrawal, from a dangerous 1930s “fat burner” to fen-phen in 1997 and sibutramine in 2010, before GLP-1 medicines changed the field from 2021. Each era left a lesson that still applies, and this page links every one of them to where things stand today.

This is the overview of our history series. Dates and numbers come from original documents (such as Banting’s and Peters’ books, now in the public domain), FDA records and peer-reviewed papers. For today’s options side by side, see 40 ways to lose weight compared.

Milestones in numbers

1863William Banting publishes his Letter on Corpulence (first edition: 1,000 copies)Banting W., Project Gutenberg
1918Lulu Hunt Peters' Diet and Health, With Key to the Calories, popularizes calorie countingProject Gutenberg
1954first metabolic operation (jejuno-ileal bypass)Faria GR, Porto Biomed J 2017
2021FDA approves Wegovy, the first weekly GLP-1 injection for weight managementDrugs@FDA

Checked on October 6, 2026

1863: Banting and the first diet bestseller

William Banting was in his sixties when he wrote his Letter on Corpulence, Addressed to the Public, dated May 1863. On his doctor’s advice he gave up bread, butter, milk, sugar, beer and potatoes, which he called the main foods of his old diet, and ate meat, fish, some vegetables, a little dry toast and fruit. He printed a careful weight log: from about 202 pounds in August 1862 to 156 pounds by September 1863, a total loss of 46 pounds, mostly at 2 to 3 pounds every three weeks. The first edition of 1,000 copies sold out, and “banting” became a word for dieting.

William Banting's own weight log, 1862 to 1863Values in lb

202 lbAug 1862

187 lbDec 1862

176 lbMar 1863

164 lbJun 1863

156 lbSep 1863

William Banting's own weight log, 1862 to 1863
Item	Value
Aug 1862	202 lb
Dec 1862	187 lb
Mar 1863	176 lb
Jun 1863	164 lb
Sep 1863	156 lb

Selected dates from his printed table (Aug 1862 = his reported 200 lb on Sept 7 plus the 2 lb he says he had lost). One person's report, not a study.

Source: Banting W., Letter on Corpulence, Addressed to the Public (1863), Project Gutenberg edition (checked on October 6, 2026)

The lesson that lasted: cutting refined starch and sugar can reduce how much people eat. What we know now: modern trials find that low-carbohydrate and low-fat diets give similar results when calories are similar. In DIETFITS, the 12-month difference was under 1 kg. Banting’s idea lives on in keto and other low-carb plans; our diets hub compares them.

1918: counting calories

Lulu Hunt Peters, a physician, published Diet and Health, With Key to the Calories in 1918. She urged readers to think of food in calories, writing that instead of “one slice of bread” they would say “100 Calories of bread”, and she included tables to make it practical. It became one of the best-known diet books of its time. What we know now: a calorie deficit is still the core of weight loss in the 2013 AHA/ACC/TOS guideline, which suggests 500 to 750 fewer calories a day, but the body adapts as weight falls, so the old “3,500 calories equals a pound” rule overpredicts losses. Our calorie deficit guide and calorie calculator use modern equations.

1930s to 1950s: dangerous drugs and the first rules

In the 1930s, 2,4-dinitrophenol (DNP), an industrial chemical that speeds up metabolism by making cells waste energy as heat, was briefly sold as a weight-loss drug before the FDA banned it after reports of severe toxicity. It has since reappeared as an illegal “fat burner” sold online, with deaths reported. The lesson is a recurring one: a drug that forces weight loss by overriding the body’s safety limits can kill.

Appetite-suppressing stimulants came next. Phentermine, related to amphetamine, received its initial U.S. approval in 1959 and is still labeled today only for short-term use (a few weeks) as part of a broader plan, and it is a controlled substance. Our appetite suppressants guide covers it.

1948 and 1963: weight loss becomes a group activity

TOPS (Take Off Pounds Sensibly), a nonprofit, says it opened in 1948 as the first weight-loss support organization of its kind. In 1961, Jean Nidetch, a homemaker in Queens, New York, joined a program run by the New York City health department and began inviting friends to her living room for weekly support; within about two months, 40 women were meeting. She founded Weight Watchers in 1963. What we know now: regular support works. The U.S. Preventive Services Task Force recommends intensive, multicomponent behavioral programs for adults with a BMI of 30 or more, and such programs often bring 5% to 10% loss. Today’s options are on our programs hub.

1954 to 1994: the surgical era begins

The first metabolic operation is credited to Kremen in 1954: a jejuno-ileal bypass that skipped much of the small intestine. It caused serious nutritional complications and was abandoned. In 1966, Edward Mason, a surgeon at the University of Iowa, noticed that patients who had part of the stomach removed for cancer lost weight, and proposed the first gastric bypass. Vertical banded gastroplasty followed in 1982, the first laparoscopic (keyhole) gastric band was placed in 1992, and the first laparoscopic gastric bypass was performed in 1994, which made surgery safer and far more common. The sleeve gastrectomy began as the first stage of a bigger operation and became a stand-alone procedure after surgeons saw how much weight patients lost from it alone.

U.S. metabolic and bariatric procedures in 2023, by type

U.S. metabolic and bariatric procedures in 2023, by type
Item	Value
Sleeve gastrectomy	58.2%
Gastric bypass	23.4%
Revisions	11.9%
Other (duodenal switch, ESG, balloons, band)	3.9%

Other = duodenal switch 1.4%, endoscopic sleeve gastroplasty 1.7%, balloons 0.5%, band 0.3%.

Source: ASMBS, Estimate of Bariatric Surgery Numbers (2023: 270,089 procedures) (checked on October 6, 2026)

What we know now: surgery produces the largest and longest-lasting average losses. In the Swedish Obese Subjects study, people who had gastric bypass were 25% lighter ten years later. The once-popular band is now rarely used: it made up 0.3% of U.S. procedures in 2023. Our bariatric surgery guide covers today’s operations.

1972: naming the body mass index

The ratio of weight to height squared got its modern name in 1972, when Ancel Keys and colleagues compared several “indices of relative weight” in 7,424 men in five countries and wrote that “the ratio of weight to height squared, here termed the body mass index” worked slightly better than the others. BMI became the standard screening number for obesity. What we know now: BMI is a quick screen, not a diagnosis. Labels and guidelines use it to describe who medicines and surgery are generally considered for, and clinicians add waist size and health history. Try our BMI calculator.

A doctor in scrubs consulting a female patient in a modern clinic waiting room, using a tablet. — Photo: Cedric Fauntleroy / Pexels

1990s to 2010: fen-phen, withdrawals and supplement scares

In the 1990s, doctors combined fenfluramine with phentermine, a pairing never approved by the FDA as a combination. In 1996, U.S. prescriptions for the two drugs exceeded 18 million. In August 1997, Mayo Clinic doctors reported unusual heart-valve disease in 24 women who had taken fen-phen, and fenfluramine and dexfenfluramine were withdrawn from the U.S. market that year. Sibutramine (Meridia), approved in November 1997, was withdrawn in December 2010 because of heart attack and stroke risk, yet the FDA still finds it hidden in products sold as supplements. The FDA banned ephedra in supplements in 2004.

One approval from this era is still used: orlistat (Xenical), approved in April 1999, blocks some fat absorption. Pooled one-year trials showed 13.4 pounds lost vs 5.8 with placebo, and a half-strength version, Alli, became the first over-the-counter weight-loss medicine in 2007. See orlistat and our supplements guide for why supplements are not FDA approved.

2012 to 2020: new pills, and another withdrawal

In 2012, the FDA approved Qsymia (phentermine and topiramate) in July, and lorcaserin (Belviq) the same year. In 2014 came Contrave (September) and Saxenda (December), the first GLP-1 medicine approved for weight. Belviq was withdrawn in 2020 after a safety trial found more cancers. In their label trials, Qsymia, Contrave and Saxenda added roughly 4 to 9 percentage points of weight loss over placebo. Research on keeping weight off also grew: studies of the National Weight Control Registry described habits such as about an hour of daily activity, consistent eating and regular self-weighing among people who maintained large losses.

2021 to 2026: the GLP-1 era

On June 4, 2021, the FDA approved Wegovy (semaglutide 2.4 mg), a weekly injection that averaged -14.9% vs -2.4% with placebo in its main trial. Zepbound (tirzepatide) followed on November 8, 2023, at up to -20.9% vs -3.1%. Then came pills: Wegovy tablets on December 22, 2025, and Foundayo, a small-molecule daily pill, on April 1, 2026, plus a higher Wegovy dose in March 2026. Weight medicines also began to show benefits beyond the scale: in the SELECT trial of 17,604 adults with heart disease and overweight or obesity, semaglutide lowered the rate of heart attack, stroke or cardiovascular death (6.5% vs 8.0%), and in March 2024 Wegovy became the first weight-loss medicine approved to reduce that risk. Our GLP-1 guide explains how these medicines work.

Average weight change in the main trial of medicines approved over timeValues in %

3%Xenical (1999)

10.9%Qsymia (2012)

7.4%Saxenda (2014)

5.4%Contrave (2014)

14.9%Wegovy (2021)

20.9%Zepbound (2023)

11.1%Foundayo (2026)

Average weight change in the main trial of medicines approved over time
Item	Value
Xenical (1999)	3%
Qsymia (2012)	10.9%
Saxenda (2014)	7.4%
Contrave (2014)	5.4%
Wegovy (2021)	14.9%
Zepbound (2023)	20.9%
Foundayo (2026)	11.1%

Chronological, not a ranking. Medicine arm only (placebo groups also lost weight). Xenical = about 3 percentage points more than placebo in pooled 1-year trials. Different trials and lengths.

Source: FDA labels on DailyMed; STEP 1 (NEJM 2021); SURMOUNT-1 (NEJM 2022) (checked on October 6, 2026)

What we know now: these medicines work best as long-term treatment. When people stop, much of the weight tends to return, and losing muscle along with fat is a concern that strength training and enough protein help address. The bigger losses also brought new problems: shortages, then compounded and counterfeit versions that the FDA warns about.

Shaping the body: corsets to contouring

Alongside weight loss, people have always tried to change shape. Today’s versions are shapewear, waist trainers and cosmetic procedures such as liposuction and fat freezing. None of them is weight loss: the American Society of Plastic Surgeons says liposuction is not a treatment for obesity or a substitute for diet and exercise. Our guides to shapewear, waist trainers and body contouring explain what each can and cannot do.

Era timeline

Year	Milestone	Type
1863	Banting’s Letter on Corpulence	Diet
1918	Peters’ Diet and Health, With Key to the Calories	Diet
1930s	DNP sold for weight loss, then banned by the FDA	Drug
1948	TOPS opens	Program
1954	First metabolic operation (jejuno-ileal bypass)	Surgery
1959	Phentermine’s initial U.S. approval	Drug
1963	Weight Watchers founded	Program
1966	Mason proposes the gastric bypass	Surgery
1972	Keys names the body mass index	Measurement
1992-1994	First laparoscopic band and gastric bypass	Surgery
1997	Fen-phen heart-valve report; fenfluramines withdrawn; sibutramine approved	Drug
1999	Orlistat (Xenical) approved	Drug
2004	FDA bans ephedra in supplements	Supplement
2007	Alli, first over-the-counter weight-loss medicine	Drug
2010	Sibutramine (Meridia) withdrawn	Drug
2012-2014	Qsymia, Belviq, Contrave and Saxenda approved	Drug
2018	USPSTF recommends intensive behavioral programs for BMI 30+	Program
2020	Belviq withdrawn	Drug
2021	Wegovy approved	Drug
2023	Zepbound approved	Drug
2025-2026	GLP-1 pills (Wegovy tablets, Foundayo) and Wegovy HD approved	Drug

Sources listed in the references; checked on 2026-10-06.

Five lessons from 160 years

What history teaches

No single diet winsFrom Banting to keto, similar calories give similar results.
Support mattersGroup programs since 1948 show that regular help works.
Be wary of quick fixesDNP, fen-phen and sibutramine all looked promising before harm was found.
Surgery works, with follow-upThe largest, longest results, plus lifelong vitamins and care.
Keeping it off is the hard partHabits and, for some, long-term medicine.

The thread through all of it is that lasting change comes from something you can keep doing, with the right medical help when you need it. Our keeping weight off guide and the exercise hub are good places to put these lessons to work, and what’s new in 2026 picks up the story from here.

October 7, 2026