Interesting weight loss article...supports the very low calorie losing phase that LapSF recommends I think. But kind of depressing in terms of regain--an extra 10 calories a day causes 20 lbs of weight gain in 30 years??? I guess there goes my daily Hershey's Kiss :-(

 

September 19, 2011

Why Even Resolute Dieters Often Fail

By Jane E. Brody

 If you’ve been trying for years to lose unwanted pounds and keep them off, unrealistic goals may be the reason you’ve failed. It turns out that a long-used rule of weight loss — reduce 3,500 calories (or burn an extra 3,500) to lose one pound of body fat — is incorrect and can ultimately doom determined dieters.

That is the conclusion reached by Dr. Kevin D. Hall and his colleagues at the National Institute of Diabetes and Digestive and Kidney Diseases. Recently they created a more realistic model of how the body responds to changes in caloric intake and expenditure, basing their calculations on how people of different weights responded to caloric changes in a controlled setting like a metabolic unit.

Their work, spelled out in a new study published in The Lancet, explains how body weight can slowly rise even when people have not changed their eating and exercise habits.

Their research also helps to explain why some people can lose weight faster than others, even when all are eating the same foods and doing the same exercise, and why achieving permanent weight loss is so challenging for so many.

 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.

 Debunking a Long-Used Rule

According to the researchers, it is easy to gain weight unwittingly from a very small imbalance in the number of calories consumed over calories used. Just 10 extra calories a day is all it takes to raise the body weight of the average person by 20 pounds in 30 years, the authors wrote.

 Furthermore, the same increase in calories will result in more pounds gained by a heavier person than by a lean one — and a greater proportion of the weight gained by the heavier person will be body fat. This happens because lean tissue (muscles, bones and organs) uses more calories than the same weight of fat.

 In an interview, Dr. Hall said the longstanding assumption that cutting 3,500 calories will produce a one-pound weight loss indefinitely is inaccurate and can produce discouraging results both for dieters and for policy changes like the proposed tax on sugar-sweetened beverages.

 If the 3,500-calorie rule applied consistently in real life, it would result in twice the weight loss that the new model predicts, the authors wrote. This helps to explain why even the most diligent dieters often fail to reach weight loss goals that were based on the old rule.  A more realistic result, he said, is that cutting out 250 calories a day — the amount in a small bar of chocolate or half a cup of premium ice cream — would lead to a weight loss of about 25 pounds over three years, with half that loss occurring the first year.

 Many people get discouraged when weight loss slows even though they are sticking religiously to their diets, but Dr. Hall said a gradual loss is nearly always more effective because it allows the new eating and exercise habits to become a lasting lifestyle.

 Still, obese people would have to cut out more calories to lose weight than it took to gain the extra pounds. Although reaching a weight of 220 pounds may have been caused by consuming, say, 250 calories more than were used each day, losing that weight requires much larger reductions in calorie intake. According to Dr. Hall’s calculations, an extra 220 calories a day are now maintaining the new higher weight.

For the population to return to average body weights of the 1970s, obese individuals, who now represent 14 percent of the population, would have to cut out more than 500 calories a day, the new model shows.

Dr. Hall noted that typical weight-loss programs result in significant losses over a period of six to eight months, followed by gradual weight regain in the years that follow. When weight-loss plateaus at six to eight months — “which happens with all the diets," he said — many dieters unconsciously start to eat a little more.

 Although consuming an extra 100 calories a day would not show up right away as weight gain, it does over time. And it happens more slowly for the obese person than for someone who is lean, Dr. Hall said, because the obese person’s body requires more calories to maintain the extra pounds.

Role of Physical Activity

It is often said that increasing one’s physical activity does not have much, if any, effect on weight loss. But Dr. Hall’s model suggests otherwise. If a man weighing 220 pounds ran an additional 12.5 miles a week at a moderate pace, he would lose more weight, and slightly faster, than if he cut the equivalent amount of calories from his diet, the authors calculated.

However, as activity and calorie reduction are increased, there comes a point at which the weight-loss benefit of diet exceeds that of physical activity, said the researchers, “because the energy expenditure of added physical activity is proportional to body weight itself."

In other words, heavier people burn more calories in an equivalent amount of exercise; but as their weight drops, the number of calories used in exercise does, too.

 The authors warned that when some people increase their level of physical activity, they compensate by eating more. Then, discouraged by a lack of progress, they may cut back on physical activity and gain even more weight.

Nonetheless, Dr. Hall said, physical activity remains important to weight loss and especially to weight maintenance. Studies of the more than 5,000 participants in the National Weight Control Registry have shown that those who lost a significant amount of weight and kept it off for many years relied primarily on two tactics: continuing physical activity and regular checks on body weight.

Some studies have indicated that low-carbohydrate diets that are relatively high in protein and fat are more effective for losing weight than a more balanced low-calorie diet. Dr. Hall said that while low-carbohydrate diets do a little more to reduce weight over the course of six months to a year, it remains to be shown that people are really eating what they say they are eating in these studies and that they can stick to a low-carbohydrate diet indefinitely.

Dr. Hall and his colleagues wrote that “all reduced-energy diets have a similar effect on body-fat loss in the short run" and that “some diets can lead to reduced hunger, improved satiety, and better overall diet adherence during a weight management intervention."

But they added a caveat: Little is known about the long-term effect of diets that vary in their makeup of fat, protein and carbohydrate on either weight maintenance or health.

 

 

 

Interesting article and summarizes alot of the information that I heard at a conference on obesity that I attended in SF last May. Dr. Hall was one of the speakers.  I left the 3 day conference feeling a bit overwhelmed at what an uphill battle that we all have, not only in losing weight, but in maintaining the weight loss. It was a very sobering experience for me, and emphasized the need to continue to practice the behaviors that helped me to lose the weight.

Basically, any diet will work, if one adheres to it. Adherence is the larger issue. The research also showed that a low carbohydrate diet had a larger initial weight loss than a low fat diet, but at the end of a year, the weight loss curve evened out, and was about the same for both groups. The researchers said that the faster weight loss with a lower carb diet tended to be more motivating for people, so they preferred to use this type of diet.

Movement, activity, and exercise are vital for long term maintenance. After listening to various presentations by exercise physiologists, it became even more apparent, that exercise (including strength training) is imperative for long term success at maintenance.

After attending this conference, I decided that I would follow the guidelines from the National Weight Control Registry, including the exercise and strength training recommendations.

Sobering conference and sobering article. This is a battle and we must always be mindful.

Gail

Gail, what are the guidelines and recommendations for exercise and strength training? I'm doing about 5 hours a week of fairly intense formal exercise, 3 aerobic and 2 strength (though the strength absolutely also gets my heart pumping, particularly some of the TRX stuff!)

Lizanne

From the information gleaned from the National Weight Control Studies and the conference, the guidelines or recommendations are for an hour of vigorous exercise at least 5-6 days/week, and for some people, the recommendation may be for 90 minutes/day. The people who were the most successful exercised an hour/day most days of the week. The exercise physiologist recommended changing up the type of exercise on a weekly, daily, or at least every few weeks, so that your body won't become too accustomed to performing the same type of exercise.

Also, ten minute increments count for one's total daily energy expenditure. For example, one could spend ten minutes on the treadmill, then go to the ellipitical machine, rowing machine, or bike, for a total of 30- 60 minutes. The important thing is to mix the exercise up and to change routines frequently.

For example, during the week, one could use the treadmill one day, the elliptical another, spinning/bicycling, dancing, etc., along with strength training 2-3 days/week. The important thing is to keep moving and to do different routines and activities, since each activity works your muscles in different ways. Of course, participation in outside activities are also beneficial and also help your muscles to work in different ways.  Basically, keep moving.

The variety in routines, is part of the reason that I like working with a trainer twice/week. The routines are varied, and the amount of weight lifted also cycles. I have added in TRX, Spinning, and some of the other machines and I try to do different things each week. I do need to try yoga or Tai Chi for more variety. I am so uncoordinated, I have stayed away from Zumba and Step-Aerobics. I did attend one Zumba class several months ago and had difficulty with it. I might give it another try. I had been away from TRX for about a month, because I was spending more time Spinning. When I took a class on Sunday, I felt like I was starting all over again!! Ouch.

Gail

Try Zumba again.  It took me going 3x/week for 3 months before I could do the steps.  Now I am really shaking it up, have increased my times to 5x/week, and finally my pelvic girdle can now disarticulate itself!  LOL!  I go and I wiggle everything on my body at a high rate of speed, even my head and neck. I am determined to shake off the fat.   I come out red-faced, sweating up a storm, but loving every minute of it.  It helps if you are a Latin music addict.  The gals say Zumba resistance classes with weights are really really fun and are NOT as strenuous as the regular Zumba dance classes.  I have not tried the one with weights yet as I as nursing a bum left shoulder (just got it injected for the 2nd time).  I might go to the gym in the future to "shake things up" but right now Zumba for me is as critical as breathing--it grows on you something fierce.  There is also something primal about it--the folks in the class yell and scream and hoot and holler--all cathartic and really fun.  Do a google search on youtube:  Zumba youtube.  Watch the youtubes and I think it might get you excited once again to try it. 

Thanks for sharing.

That was interesting but there is no recognition of the effect of our hormones on weight loss and that our bodies fight to be a certain weight. You definitely have to factor  that in!

I think this is one reason why obese people are doomed without WLS, btw. In the article, they talk about a modest calorie reduction and that this allows you to lose 25 pounds over 3 years. That kind of weight loss is not going to invoke the famine response that causes people to gain back all their weight.

However, that means someone with 100 pounds to lose needs to take 12 years to do so. Have 200 pounds to lose and you are looking at 24 years. That is not realistic as health will deteriate faster than the weight loss can happen. But losing faster than 10-25 pounds at a time will invoke the famine response which will cause the body to fight to regain the weight plus a cushion.

So what researchers need to figure out is what rate of weight loss won't invoke the famine response... is it 10-25 pounds a year? 3 years? 6 months? Then, see if that is a realistic rate for MO and SMO people.

What WLS surgery does, is to reset the "setpoint." I think that this is part of what you were referring to. Our bodies do fight to maintain a certain weight, which might be part of the reason that we stall at certain weights. Even though, I had lost weight prior to WLS, I went through with it, because I was afraid of stalling out, after another 20-30 lbs. My PCP told me that WLS would help to reset the "setpoint." It appears that he was right.

Gail

Thanks for posting this. We have all suspected that the 3500 calorie thing was not an absolute - we are all different and our personal experiences seem to show that weight gain and loss is not just this simple mathmatical formula. While its sort of depressing on how the deck is stacked against some of us, at least we have this great weapon now and with reasonable effort on our part we can manage this with the sleeve. Without the sleeve it was just hopeless. Now I have hope I can stay at a reasonable weight for life if I keep with the program.

Anyway, goes to show that this is all more complex than many doctors think and that there is a lot more to be discovered. Good thing there are researchers like this one.   Diane

I think it depends a lot on definitions.

A Kilo-calorie (what we commonly call a calorie) is a the amount of heat needed to raise the temperature of a liter of water by 1c.  Burn a pound of at and it will generate 3500 calories of heat.  That hasn't changed. the article is a bit misleading in suggesting that 'fact' is not valid.  The real issue is about how efficiently different individuals convert fat to energy and how much energy different bodies require.  The article is absolutely right in that if you weigh 300lbs you burn more calories walking a mile than you do if you weigh 200lbs.  If you want to burn the same amount of calories you have to go harder/faster/longer.

For me, the 3500 calories/lb of fat is pretty much spot on based on my calorie intake, metabolic testing, and body composition testing.  As I've lost, I've maintained my lean, metabolically active mass through strength training, and I've increased my exercise intensity and duration to maintain my daily utilization of calories at 2000-2100 calories/day.  I may have daily fluctuations in water, etc., but over time you can correlate energy deficit (calories in vs. calories out) to my weightloss pretty precisely. 

I calculated this last week :

Average daily loss= .36/day over 4 weeks
Average daily intake: 725 calories (over the same period)

.36 x 3500= 1,260 calorie energy deficit/day

725 calorie intake =1,260 calorie deficit = 1,985

I don't measure my cream in my coffee; so,  I'm sure I'm underestimating my calories by 50-100 day putting me right in that 2000-2100 calorie range.  My RMR testing at my surgeon's has remained constant at about 1800 c/day suggesting I burn another 250-300 through exercise and daily activity.