Diets Don’t Work. So What Should You Do?

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A NY Times story from May popped up on my Facebook feed and it got me thinking. (I’m not sure why a story from May would come up now but I’m glad it did.) Why You Can’t Lose Weight on a Diet is a worthwhile discussion of the biological and neurological mechanisms of weight-loss, weight-gain and what happens when we diet.

(Though it’s not defined in the article, the term “diet” seems to refer to a strict, restrictive type of eating plan which causes prolonged hunger and feelings of deprivation. “Diet” implies the use of white-knuckle willpower. “Diets” are almost never sustainable over the long-haul.)

I won’t go into all the information but here are some important details:

Diets and weight-gain seem closely related.

“Long-term studies show dieters are more likely than non-dieters to become obese over the next one to 15 years. That’s true in men and women, across ethnic groups, from childhood through middle age. The effect is strongest in those who started in the normal weight range, a group that includes almost half of the female dieters in the United States.

“Why would dieting lead to weight gain? First, dieting is stressful. Calorie restriction produces stress hormones, which act on fat cells to increase the amount of abdominal fat. Such fat is associated with medical problems like diabetes and heart disease, regardless of overall weight.

“Second, weight anxiety and dieting predict later binge eating, as well as weight gain. Girls who labeled themselves as dieters in early adolescence were three times more likely to become overweight over the next four years. Another study found that adolescent girls who dieted frequently were 12 times more likely than non-dieters to binge two years later.”

Weird huh? The question is do diets cause weight gain, or do weight-gain-prone people tend to diet? The chick-or-egg question is discussed in the article.

Diets change the brain. Not for the better.

“In the laboratory, rodents learn to binge when deprivation alternates with tasty food — a situation familiar to many dieters. Rats develop binge eating after several weeks consisting of five days of food restriction followed by two days of free access to Oreos. Four days later, a brief stressor leads them to eat almost twice as many Oreos as animals that received the stressor but did not have their diets restricted. A small taste of Oreos can induce deprived animals to binge on regular chow, if nothing else is available. Repeated food deprivation changes dopamine and other neurotransmitters in the brain that govern how animals respond to rewards, which increases their motivation to seek out and eat food. This may explain why the animals binge, especially as these brain changes can last long after the diet is over.

“In people, dieting also reduces the influence of the brain’s weight-regulation system by teaching us to rely on rules rather than hunger to control eating. People who eat this way become more vulnerable to external cues telling them what to eat. In the modern environment, many of those cues were invented by marketers to make us eat more, like advertising, supersizing and the all-you-can-eat buffet. Studies show that long-term dieters are more likely to eat for emotional reasons or simply because food is available. When dieters who have long ignored their hunger finally exhaust their willpower, they tend to overeat for all these reasons, leading to weight gain.”

I LOVE the part about diets teaching us to eat by rules rather than paying attention to hunger. More on that in a bit.

Diets don’t improve health:

“In addition, the evidence that dieting improves people’s health is surprisingly poor. Part of the problem is that no one knows how to get more than a small fraction of people to sustain weight loss for years. The few studies that overcame that hurdle are not encouraging. In a 2013 study of obese and overweight people with diabetes, on average the dieters maintained a 6 percent weight loss for over nine years, but the dieters had a similar number of heart attacks, strokes and deaths from heart disease during that time as the control group. Earlier this year, researchers found that intentional weight loss had no effect on mortality in overweight diabetics followed for 19 years.”

That’s surprising to me. Read more of the article to learn why this might be the case.

What should you do?

The research discussed in the article tells us that diets aren’t only ineffective, they’re actually harmful. Is it time to give up hope? I don’t think so. There are other, better strategies to weight-loss and health than the Spartan drudgery of the typical diet. Here are some suggestions:

Eat when you’re hungry. Stop when you’re no longer hungry.

My client Dorothy had a great insight. She made the distinction between being truly hungry vs. saying “I could eat.”

Question: “Are you hungry?”

Answer: “I could eat.”

If you’re eating ask yourself why. Is it hunger or something else? Are you eating out of boredom, sadness, happiness or some similar emotion? Are you eating because food is in front of you? We eat for all kinds of reasons that have nothing to do with actual hunger.

Further, as you’re eating, continue to pay attention to your hunger. Is it still there? If not, then it’s time to stop eating. We often keep eating until we’re stuffed. You may have been taught to clean your plate. Food often tastes great — so we keep eating!

I suggest that you wait to eat until you are truly, definitely hungry. I’m not saying you should walk around famished but rather know for certain that your stomach is definitely signaling you that it’s time to put something in there.

The idea of eating when hungry and stopping when no longer hungry seems like an obvious and easy concept but make no mistake, it’s a skill. (I say “no longer hungry” rather than “full” because to me, “full” is too much like stuffed.) It requires mindfulness, awareness and deliberate action. Many of us are probably out of practice on this front.

Eat protein

Eating protein at each meal is a very good idea for anyone looking to lose weight. Three reasons, as mentioned in this article from the American Journal of Clinical Nutrition

“1) increased satiety—protein generally increases satiety to a greater extent than carbohydrate or fat and may facilitate a reduction in energy consumption under ad libitum dietary conditions;

“2) increased thermogenesis—higher-protein diets are associated with increased thermogenesis, which also influences satiety and augments energy expenditure (in the longer term, increased thermogenesis contributes to the relatively low-energy efficiency of protein); and

“3) maintenance or accretion of fat-free mass—in some individuals, a moderately higher protein diet may provide a stimulatory effect on muscle protein anabolism, favoring the retention of lean muscle mass while improving metabolic profile.”

Precision Nutrition recommends men eat two palm-sized servings of protein at each meal while women should get one palm of protein.

Lift weights.

Lifting weights (or any kind of resistance training) helps build and preserve muscle mass. Why is that good? Glad you asked:

Further advocacy for weight training is found in a recent interview with Dr. Wayne Westcott, professor of exercise science at Quincy College. The interview stemmed in part from research and news that contestants from the Biggest Loser seem to gain back all their weight and then some in the years following their weight loss. The article discusses several issues, but as it pertains this blog post, this is pertinent:

“But the key isn’t fat, it’s muscle: His [ Dr. Westcott’s] central point is that loss of muscle mass — whether through inactivity or aging or dieting — helps lead to many of our ills, from regaining weight to developing diabetes.

“But it doesn’t have to be that way, if only we’ll do a modicum of strength training — defined as any exercise that uses resistance to build muscle, from weightlifting to push-ups —  and keep doing it.”

Sleep.

I’ve written about the link between lack of sleep and obesity. Dr. Westcott also emphasizes the role of sleep in staying trim. He says, “Sleep is probably more important than all the other put together.”

The journal Current Opinion in Clinical Nutrition & Metabolic Care conducted a review of research on the sleep/obesity link. The key points:

  • The worldwide increase in the prevalence of obesity in the last several decades has been paralleled by a trend of reduced sleep duration in adults, as well as in children.
  • Evidence from both longitudinal and prospective epidemiological studies suggests that chronic partial sleep loss is associated with an increase in the risk of obesity.
  • Laboratory studies show that sleep restriction leads to hormonal alterations, which may favor an increase in calories intake and a decreased energy expenditure and ultimately lead to weight gain.
  • In addition to short sleep duration, evidence suggests that also sleep disturbance, such as obstructive sleep apnea and poor sleep quality, may increase obesity risk.
  • Prospective interventional studies are needed to clarify whether increasing sleep duration or improving sleep quality protects from weight gain or even favors weight loss.
  • Until results from such studies are available, the current evidence supports recommending sufficient amounts of habitual sleep and good sleep hygiene in patients at risk of obesity.

Want to lose weight? Sleep well.

Finally

Diets aren’t just a depressing drag, they may in fact facilitate the exact type of weight-gain you’re trying to avoid. In other words, they don’t work!  Rather than diet, tune into your hunger. Eat when you’re hungry and stop when you’re no longer hungry. Eat protein at each meal, lift weights and get solid, regular sleep.

 

 

 

 

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