Is there one right approach to weight loss?

Kernels of Truth

It is not surprising that many people are looking for a new and different approach to losing weight. People tend to look for a new approach whenever the one that they were using before did not work. Even if the approach got them to lose weight, it did not last. Several surveys have shown that just about every person who has tried to lose weight—and that is a lot of people—has tried a variety of different approaches.

In one survey of adults, a general diet and exercise approach was the most frequently used method for both men and women, followed by vitamins, meal replacements, over-the-counter products, participation in a weight-loss program, and diet supplements. In another survey focusing on younger people, skipping meals was a method used by almost half of all women (interestingly, men did not seem to employ this method).With so many approaches to try, the idea of a new and different one not only makes sense, it is appealing.

The science of weight management as we know it is only about fifty years old, a baby in the world of science. In the early 1960s, therapeutic starvation was the treatment of choice.This particularly diabolical trend was followed by low-calorie diets that restricted particular foods, then moved on to protein-sparing modified fasts that took the idea of food completely out of the weight-loss equation. If you are more than a few decades old, you probably remember these approaches and can attest to the fact that they rarely resulted in sustained weight loss.

Fortunately, the science of weight management has advanced over the years. Dr. Albert Stunkard, the researcher who said back in the 1950s that 95% of diets fail, frequently talks about the advances that have been made in weight management treatments since he put forth his discouraging statistic over fifty years ago. In an article he published in the 1990s on the topic in the prestigious American Journal of Medicine, Dr. Stunkard attributes the advances to the recognition that a variety of factors must be included in a comprehensive weight-loss program. He also credits improved weight-loss success rates to the realization that weight management cannot be viewed as a one-time, weight-loss event that disappears with the achievement of a weight goal. It is not the same as completing a course of antibiotics to get rid of a bacterial infection. Rather, sustained weight loss involves making ongoing lifestyle changes.

The Whole Truth

The central theme of this book is that weight loss that lasts requires a comprehensive method including making wise food choices, getting more active, making positive lifestyle changes, and creating a supportive atmosphere.

This article focuses on making wise food choices. Most weight loss methods address only this component of weight loss, and it is an important one. But you might be wondering how to choose from the hundreds of food plans out there.

Three Steps to Finding the Right Approach for You
Start with the hundreds of diets that are available, then ask yourself:
1. Does it create a calorie deficit?
2. Is it healthy?
3. Does it fit my life?
If you answer yes to all these questions, it’s the one for you!

Weight Loss Means Cutting Calories, and There Are Many Ways to Do It

The fundamental scientific truth of weight loss is that it can occur if a caloric deficit is created.This is the first question when considering any weight-loss method.To lose a pound of fat “costs” about 3,500 calories and those calories have to be “paid” by eating fewer calories than the body needs to stay the way it is, by burning more calories than the body needs to stay the way it is, or a combination of the two. But the number of approaches that a person can take to create the caloric deficit is infinite.

Then, the question is whether the food plan is healthy. Is it nutritionally complete? Does it encourage healthy eating habits? It is possible to eat just enough bacon or chocolate-chip cookies during the whole day to create the calorie deficit you need to lose weight. But your goal is to get your essential nutrition from healthy meals from all the food groups.

Because you are a unique individual with your own personality, lifestyle, preferences, and eating style, the path you follow to achieve sustained weight loss must be your own. The notion of a single approach that works for everyone could hold true only if we were all the same. The laws of thermodynamics for weight loss are universal (1 pound of fat = 3,500 calories), but the laws of human nature (no two human beings are identical) hold true as well.

To lose weight and keep it off, it is critical to find the approach that is right for you. Does the eating plan fit your preferences and your lifestyle? Does is it encourage healthy eating habits you can keep up? Counting and writing down calories is an effective approach to self monitoring food intake for many people, but that does not mean that it is right for everyone. For some people, finding another mechanism that will ensure they eat fewer calories than they burn is preferable. The guideline is to monitor food intake—the approach of how this is done varies.

The focus of credible weight management research today is to define and refine the factors that are critical in a comprehensive weight-loss program, then provide a set of guidelines that reflect the findings. For example, the preponderance of evidence shows that about sixty to ninety minutes of moderate physical activity per day is
associated with sustained weight loss. Science does not say that the exercise has to be walking or swimming or that it has to be done in a single session or spread throughout the day.Your approach is how you create the caloric deficit needed to lose weight.

The remainder of this chapter explores some of the most important things for you to consider in sorting through the myriad available weight-loss approaches.

Wonder Diets Are One-Hit Wonders

It is safe to predict that at least one new wonder diet or product will be promoted this year. It is also safe to predict that next year and the year after that will bring new wonder diets and products. The trend has been well established. A recent online search of books under the title or topic of weight loss revealed 2,214 matches! As the problem of excess weight has increased in the United States and around the developed world, the proliferation of diet books has followed suit.

Every year, new diet books promise a revolutionary approach to weight-loss success. Call these one-diet wonders, much like the one hit wonder bands in popular music that release one hit song and rarely are heard from again. Like the one-hit wonder bands, these diets come onto the weight-loss scene with a splash. Devotees gush over the new diets. But like hit songs and bands, new diets and their creators vanish quickly once the reality of short-term weight loss overtakes the promise of thinness forever.

Most bestsellers do not last, whether they are songs or books. According to a conference report from the National Arts Journalism Program at Columbia University, most diet bestsellers do not stand the test of time. They are on the shelf today and out of print only a few years later.Trendy ideas in weight loss change very quickly and do not make for true longevity.

Testimonials Are One Person’s Story

Almost any approach to weight loss will work for at least one person. Every approach can offer testimonials about how it led to weight loss. While motivating and fun, testimonials need to be read with caution. If the testimonial is one example of the real-world success of many people who have followed the diet, then it can be a valuable resource. But testimonials are just one piece of the evaluation process. They are usually most helpful for learning about the practical aspects of a weight-loss method—which foods are encouraged or discouraged, tips for following the recommended approach to eating, and how making the recommended changes affected the person’s life.They are only useful if they go beyond headlines like “I lost 50 pounds in one month.”

Sort the Truth from the Fiction

Most new diet approaches are simply nonsense, although some are legitimate. Unfortunately, at times it can even be difficult for health professionals to tell the difference because scientific explanations that sound so believable. What are some of the tricks for spotting short term fixes? Typically, they are promoted with grand words like “revolutionary”
or “miracle.” Beneath their title, they often include a tag line with an appealing promise, such as “based on a scientific breakthrough” or “the only program you will ever need.” The front or back cover of the book will include other appealing promises: “lose weight forever,” “never be hungry,” “drop pounds quickly and painlessly.” When it comes to weight-loss promises, if it sounds too good to be true, it often is too good to be true.

Public health organizations have become more active in helping people make informed choices about weight loss. Overweight is a big problem, and the potential for harm or good has greatly increased. Organizations like the American Heart Association (AHA) and the American Dietetic Association, as well as government agencies like the National Institutes of Health and the Federal Trade Commission, provide information and resources to help people sort through the many options available to them.

AHA has declared war on fad diets. As part of its comprehensive education campaign, AHA provides information to help identify ineffective or questionable weight-loss diets and claims. AHA discourages following programs that do not advise people with diabetes, high blood pressure, or other long-term health problems to seek advice from their physician or other health care provider. It also disapproves of programs and diets that do not call for increased physical activity and specifically cautions against certain types of fad diets.

The American Heart Association Does Not Endorse:
Specific combinations of foods or food combining
Diets that eliminate dairy
Liquid-only diets
Programs that require the purchase of packaged meals
High-protein diets
Juice fasting
“Cleansing” diets
Bizarre quantities of only one food (hot dogs, cabbage soup)
Magic or miracle foods that burn fat
Rigid menus with limited foods
Rapid weight loss of more than 2 pounds a week
Source: Adapted from www.americanheart.org.

Find Credible Resources

Armed with strategies for sorting out truth from fiction, it is time to turn to credible resources for information on weight control. According to the government’s National Institutes of Health Weight-Control Information Network (WIN), “Experts agree that the best way to reach a healthy weight is to follow a sensible eating plan and engage in regular physical activity.Weight-loss programs should encourage healthy behaviors that help you lose weight and that you can maintain over time.” Because activity is covered more fully in another article, this article will focus on what to look for in the food plan of a comprehensive weight-loss program.

A credible source for weight-loss information is the Partnership for Healthy Weight Management. Coordinated by the government’s Federal Trade Commission, the mission of this partnership is to promote sound guidance on strategies for achieving and maintaining a healthy weight. A core principle of the partnership is that no single weight-loss approach will work for everyone. The partnership offers general guidance that is in agreement with the principles in this book: nutritional balance, nutrient intake consistent with recommendations for health promotion and disease prevention, and a rate of weight loss that promotes loss of body fat rather than lean muscle. Its brochure available at www.ftc.gov/bcp/conline/pubs/health/wgtloss.pdf  includes a personal checklist for helping select a weight-loss method in line with the partnership’s mission.

Questions to Ask When Choosing a Food Plan
Does it encourage sensible, balanced eating?
Does it include foods from all food groups?
Does it meet all my nutrient needs?
Does it provide information on healthy eating?

Consider Other Factors

In addition to the general factors promoted by the Partnership for Healthy Weight Management, these other factors should be considered when evaluating a weight-loss food plan

Is the plan clear and up front about the role of calories in weight loss? Experts agree that the overwhelming driver of weight loss is the creation of a caloric deficit—fewer calories in than out. No good scientific proof of any kind supports changes in metabolism or other magic approaches to melt away body fat.

Does the plan support an eating pattern that fits your individual lifestyle and preferences? Eating plans are easier to follow when they fit the dieter’s lifestyle and include foods that the dieter enjoys eating. Recently, the AHA revised its dietary guidelines to emphasize the importance of flexibility in food selection.

The number of daily meals and snacks should be based on personal preference. There is no right or wrong approach when it comes to a plan with three meals and a snack versus six or so mini-meals per day. People who have a low level of dietary restraint and respond to food cues by being tempted to eat or overeat may prefer fewer meals and snacks in order to minimize exposure to food. Using an extreme method like skipping meals is not recommended, and eating in an overly strict way to comply with a specific method is not, either.

Does the plan give eating satisfaction? Eating provides pleasure, so you want to enjoy the food that you are eating both while you are losing weight and while you are keeping the weight off. Eating satisfaction is a complex issue, and there is no one meal plan or eating style that is satisfying for everyone.

Factors Affecting Eating Satisfaction

Eating satisfaction is linked to a variety of factors. What works for one person when it comes to eating satisfaction may not work for another. Finding what works is key because being satisfied affects the ability to lose weight and keep it off. While there is no single formula for eating satisfaction, there are threads that can guide you toward finding the
pattern that works best.

Body processes involved in the regulation of appetite are very complex and involve a number of hormones and biological systems. Other factors that affect eating satisfaction include taste, palatability, and energy density. Likewise, the composition of food affects eating satisfaction. In general, high-protein foods are more satisfying than foods with carbohydrates, and carbohydrate foods are more satisfying than high-fat foods. Alcohol stimulates eating.

The term carbohydrate encompasses thousands of foods from sugar to wheat germ. The effect of carbohydrates on eating satisfaction varies. Research suggests that whole grains provide greater eating satisfaction than refined grains. Dietary fiber, a component of carbohydrate foods, has been shown to reduce hunger and increase satiety. Increasing fiber intake as a weight-loss strategy appears to be related to the amount of excess weight—the more weight to lose, the more effective the strategy.

Energy density plays a role too. Some recent research has shown that from a very young age, people are trained to eat a volume of food, not a certain amount of calories. For example, most people will fill the same bowl every time they eat soup; they will not fill the bowl less full if it is a high-calorie bisque or have a second bowl if it is a low-calorie
broth. An effective approach to reduce caloric intake is to choose foods with a low energy density because the amount of food that can be eaten for a set number of calories is greater for a low-energy-density food than it is for a high-energy-density food. In other words, you get more food for the calories, and more food is associated with higher eating satisfaction.

For example, a cup of boiled corn is 130 calories. A cup of airpopped popcorn is 30 calories. Both are kernels of corn, but with popcorn the kernel has been pumped up with air and that makes popcorn a low-energy-density food that is low in calories.

Foods with a low energy density increase eating satisfaction with fewer calories because these foods usually are higher in water or air, lower in fat, and/or higher in fiber. Fruits and vegetables, for example, are rich in water and fiber. As such, they are low-energy-density foods that are useful for weight management. A review of studies looking at weight loss over at least six months concluded that a dietary pattern lower in fat and higher in fiber provided the best results.

For the same calories, a portion of a low-energy-density food is larger than a higher-density food portion. High-energy-density foods, many of which are concentrated sources of refined carbohydrates, sugars, and/or fat and taste good, are more likely to be overeaten.They are harder to stop eating in a single setting and over time.

Several studies have looked at whether altering the amount of food provided or altering the calories in the amount of food makes people eat differently. The findings are consistent. The daily amount of food eaten influences appetite; the number of calories eaten does not affect appetite.

Self-Monitor to Stay on Track

Finding an eating pattern and foods that provide eating satisfaction are critical to lasting weight loss because eating in a way that works for you enables you to stay the course. But there is one more component that is essential: self-monitoring. Without a system in place that helps you monitor what you are doing and eating, it is easy to stray off the path of weight loss and return to old habits without even realizing it. Several studies have found that self-monitoring makes a significant difference when it comes to successful weight loss. One study showed that 25% of weight-loss success is attributable to consistent self-monitoring. The people who are the most consistent in self monitoring have the greatest success.

There is no right or wrong way to self-monitor. Self-monitoring takes different forms and measures different things. It works when you find a method that you are comfortable with and are willing to do over time.

Most people benefit from monitoring two separate but related things when it comes to weight loss: food intake and body weight. Tracking food intake can be as simple as counting and writing down some measurement of food eaten, for example, calories or POINTS values of foods. Tracking may be expanded to include recording the food item and the portion that is eaten in addition to its calorie or POINTS information. To add even more detail, the tracking can include information about what time of day a food is eaten and/or feelings experienced while eating. Information can be written down on a piece of note paper, on an index card, or in a journal, whichever is most convenient.

When used consistently, tracking food intake in writing produces superior weight-loss results. However, not all dieters are consistent in their short-term tracking and over time.

Assessing internal cues for and feelings of hunger and satiety is an alternative method of monitoring eating habits and patterns and eating satisfaction. In practical terms, this means eating the amount of food needed for eating satisfaction, then stopping. Internal cues are closely linked with the person’s level of dietary restraint and disinhibition. One theory says that overweight people do not recognize their body’s cues for hunger or satiety because they never learned how to do this. Learning to recognize and self-monitor these cues may be a helpful technique in weight management.

Monitoring food intake helps keep track of the weight-loss process; monitoring weight loss keeps track of weight-loss progress.Weight loss can be monitored in several different ways: body weight, body measurements, or the clothing test.

Body weight is the easiest measure of progress. An added benefit of using weighing as a self-monitoring strategy is that it allows pacing of weight loss to equal a 1- to 2-pound loss weekly. Body weight measurement is more effective as a weekly weigh-in than as a daily weighin. Because body weight fluctuates a great deal from day to day for many reasons, including menstrual status and recent sodium and carbohydrate intake, it is easy to put too much stock into a change, be it up or down, with a daily weigh-in. A weekly weigh-in is a better indicator of true weight-loss progress and trends.

Body measurements are an alternative to weighing, especially for people who feel stressed from watching the scale numbers go down and up. Keep measurements simple by sticking to key body parts like the bust, waist, and hips. Because measurements change more slowly than weight does, body measurements should be taken only once a month or so.

The clothing test is the simplest method of self-monitoring. One way to do the clothing test is to monitor the fit of a favorite pair of pants or a favorite nonstretch shirt. Try the clothing on immediately after washing before it stretches out with wear. The belt-notch test is particularly useful for men.

Monitoring your weight-loss progress can be a solo event or it can be done with someone’s help. Some people find that being accountable to others is useful. Accountability can include weighing in weekly with a spouse or partner, participating in a structured weight-loss program that includes monitoring activities as part of its program (such as being weighed each week by trained staff), or having a monthly appointment with a physician or health professional to assess your progress. Regardless of the monitoring method chosen, the goal of keeping track is to learn how it’s working.

At the end of the day, paced weight loss is the yardstick for success and goal attainment. And, as shown in the Institute of Medicine (IOM) report and the National Weight Control Registry (NWCR) database, regular monitoring is key to keeping the weight off. The IOM report lists self-monitoring as a positive predictor of weight loss as well as maintenance of weight loss. Participants in the NWCR database say that they frequently monitor their food intake and their body weight.

The Bottom Line

When it comes to weight loss, one diet or approach does not fit all. While there are many ways you can create a calorie deficit, you should also choose a food plan based on whether it is healthy and a good fit with your preferences and lifestyle.We all are different, with different personal habits and preferences. That is why what works for one person may not work or be the right approach for someone else. The science of weight management continues to evolve as researchers learn which program elements help people sustain their weight loss.

Beware of being lured into trying the latest and greatest diets. They usually sound terrific and make big promises. Keep in mind that testimonials, as convincing as they sound, do not apply to everyone and may not tell the full story. Enjoy success stories as a way to get inspired and find out what following the weight-loss program might be like for you. Remember that many diet programs have not been proven with large numbers of people and have not passed the test of time for lasting weight loss.

It is important to look carefully at weight-loss programs for proof that they are healthy and that they work. Compare their features to those discussed by the American Heart Association and use the Partnership for Healthy Weight Management for guidance on selecting an appropriate program. Important features for effective weight loss include adaptability to individual lifestyle and preferences and a diet that is satisfying to eat.

Self-monitoring is essential. Monitoring eating habits and weight loss helps track the process and progress of weight loss. There is no right or wrong way to self-monitor, as long as it is sustainable and useful. Self-monitoring enables you to make adjustments in eating habits for a desirable pace of weight loss.

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