Sustainable Weight Loss: Minding What Matters - Forbes

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As if we needed yet another reminder that life isn't fair, a new mathematical model for weight gain/loss shows that the deck really is stacked against us.

Anyone who has tried to diet knows that losing weight and keeping it off is hard. Really, really hard. No matter how many pounds you are trying to lose, getting good results from whatever diet you're on takes vigilant effort and attention: you snooze, you don't loose. And for almost everybody such vigilance is impossible to maintain. "The Real Diet Story" pictured here is all too familiar to too many people.

In contrast, putting on weight just seems to happen. Poof. Without anything really changing you wake up one morning and think, "wow, my clothes feel a little tight, how did that happen." Or you start to get discouraged because you are eating less and moving more—the magic formula—but the weight no longer seems to be coming off as quickly as it had been.

At least now we know why such an unfair imbalance exists: it's built into the dynamic changes human energy-use goes through while people lose weight, at least according to new research published this summer in The Lancet and nicely discussed by Jane Brody in the NY Times. Using a "mathematical modelling approach to adult human metabolism that simulates energy expenditure adaptations during weight loss " (Quantification of the effect of energy imbalance on bodyweight ), the researchers provide a nugget of wisdom that should become the new common sense: the more you lose and the longer you do it, the harder it gets.

Our dietary common sense needs to shift. No longer should people make decisions based on the idea that exercising a specific amount or reducing calories by a specific amount always results in predictable weight loss. Dr. Kevin Hall and his colleagues write:

Health and nutrition organisations have perpetuated the myth that a reduction of food intake of 2 MJ (478 calories) per day will lead to a steady rate of weight loss of 0·5 kg (1.1 lbs) per week. Because this static weight-loss rule does not account for dynamic physiological adaptations that occur with decreased bodyweight, its widespread use at both the individual and population levels has led to drastically overestimated expectations for weight loss.

via Quantification of the effect of energy imbalance on bodyweight : The Lancet

It's well known that when you lose weight you spend less energy doing the things you do. For example, running the same distance now uses less energy because your legs are carrying less of you: an over-sized SUV use lots more gas than a sedan (and please excuse the metaphor). In researcher-ese, "the energy expenditure of added physical activity is proportional to body weight itself." What Dr. Hall and his colleagues did was integrate this observation into a model that predicts the familiar experience that dieting gets harder and harder the longer you do it.

Their model is directly applicable to people trying to diet. If you don't expect difficulties to emerge as you have success losing weight, you will get discouraged and go back to familiar, routine food choices that put on weight. As they predict, without realizing it you'll start to eat just a little bit more, not that much but enough to shift the balance. These additional calories, even just a few, combined with the reduced energy expenditure from the weight loss to-date puts people back on a weight gain trajectory.

So, instead of just busting into a diet with some dramatic gesture—like a fast or some dramatic, trendy food choice—people might want to think upfront about developing a a new lifestyle, one that includes a new, psychologically sustainable relationship with food.

The model shows that lasting weight loss takes a long time to achieve and suggests that more effective weight loss programs might be undertaken in two phases: a temporary, more aggressive change in behavior at first, followed by a second phase of a more relaxed but permanent behavioral change that can prevent the weight regain that afflicts so many dieters despite their best intentions.

via Why Even Resolute Dieters Often Fail –

This model does not lead to wild optimism; it leads to patience and hard work. It won't generate new products enthusiastically pitched by some "success story." No urban gym will witness a wildfire rumor about some new diet being "the answer!". But there's comfort, real comfort, in the model. It's good to know that if you've been caught on the "diet treadmill," it's not your fault, you do not need to be a better dieter and you do not need a better "diet." Rather, the dynamics of eating, activity, energy expenditure, time, and weight actually combine to make it impossible for there to be any solution—no matter how popular the diet or charismatic the spokespeson—other than sustainable, enduring lifestyle changes.

While this new understanding takes away the illusory comfort of dramatic quick-fix diet-solutions because we now know it is an effort doomed to fail, we gain the comfort reality brings when reality offers viable alternatives. What works takes time. If you want to lose weight, you need to develop a new, psychologically sustainable relationship with food that can carry you for years and years. How to do that, what I've elsewhere said comes from developing "culinary mindfulness," is of course another question and something I hope to write about again soon.

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26 Sep, 2011

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