Diet and Weight Loss

weight lossThe topic of weight loss is one that is charged with emotional significance for many individuals. Perhaps in keeping with that fact, and certainly due to a lack of clear research in this area, there is an incredible amount of misinformation available on this topic.

We have recently completed an exhaustive review of the available clinical research relevant to this topic and we will try to summarize what we discovered here.

First the good news: if you are diligent and, especially, if you seek out help for those aspects of the task that are hard, you should be able to lose about 10% of your body weight using one or more of the techniques that we will discuss below. Moving beyond that is harder and will require a serious effort that you will probably need professional help with.

Taking Stock

First things first, any effort to lose weight needs to begin with taking stock of where you are right now. The best way to figure that out is to calculate your body mass index (BMI). The BMI is the standard way of comparing people with each other and will give you an idea of what strategies you may want to consider in the long run in order to lose weight. To calculate the BMI you need to know your height in inches (convert feet and inches into just inches) and your weight in pounds. The calculation is:

BMI = [(weight in pounds) x 703] / [(height in inches) x (height in inches)]

An easy way to do the calculation is to use the BMI calculator from the National Institute for Health.

Now that you have your BMI let’s see where you stand in terms of weight loss treatment. The most recent expert consensus guidelines suggest dividing people into the following groups:

Level 1: BMI < 27 Self directed diet and exercise
Level 2: BMI 27-29 Self help program, commercial program, behavioral program
Level 3: BMI 30-39 Supervised diet program possibly / probably in conjunction with pharmacotherapy
Level 4: BMI >39 Very intensive intervention and possible consideration of surgical options

This discussion here is probably going to be most useful for those with Level 1 and 2 issues. For Level 3 and 4 you are definitely going to want to have a more formal evaluation and the development of a more comprehensive treatment approach. Read this but also, please, talk to your clinician at Gateway Psychiatric Services about wanting a formal weight loss consultation.

Set a Realistic First Goal

We think it is very, very important that you set an initial weight loss goal at somewhere around that level. We are not arguing that 10% is ideal, nor even that it is the endpoint for your weight loss, but we do know that it is very important that your first efforts with weight loss lead to success. Needless to say, building on an initial success is a much better strategy than trying to convert partial failure into motivation for more hard work.

Our overwhelming experience, and the experiences of many others who have worked to help people lose weight, is that you are more likely to reach your ultimate goal (whatever that is), if you break the task down into smaller pieces and, especially, if you stabilize (using your new habits and supports) your weight between episodes of weight loss.

What we know does not seem to ever work is to set a goal for initial weight loss that is greater than 10% (often we get really optimistic in this phase of the work and will imagine ourselves quickly achieving a weight that is just a little bit less than we have ever been in our entire life). That leads to the following consequences almost inevitably:

  • Generally you have initial success, often losing 10% of your weight in a relatively short period of time, this initial success may even make you feel confident that you can achieve more weight loss.
  • The going gets harder and harder after that and your weight loss slows down (this is a natural phenomenon that is almost universal and the source of it remains somewhat obscure).
  • At some point the incredible pressure you are under gets to be too much and you come off the diet, often with a dramatic episode of eating foods off diet.
  • You have now achieved quite a significant success which you would really have been proud of weeks ago when you first thought of losing weight, but because you can see so clearly that you are far from where you wanted to be it feels like a failure.
  • Because you have failed you really can’t get the energy to do the hard work of building a new, healthy, weight maintenance program… possibly setting the foundation for a further weight loss effort… so you fairly quickly regain the weight you had lost, sometimes overshooting that initial weight.
  • This is called the weight loss “yo-yo”. It is incredibly frustrating and unnecessary.

Weight Loss Diets

This is, of course, where most people begin the process. You are well ahead of the game because you know where you stand, and you have set a realistic goal for your initial weight loss attempt.

Now before we get into the sexy and exciting topic of which diet is best, let’s add in a few additional pieces that distinguish successful from unsuccessful diet efforts:

  • Social support: It is a funny thing, but almost universally the world around us (including family and friends) will do everything wrong when you get started on a diet. So, you are going to need at least one person, and preferably a couple of them, who can be your “diet buddies”. One of the reason that groups like Weight Watchers and Overeaters Anonymous work is that they have built in support. What you need is someone that you can talk honestly with on a daily basis about your diet. Someone who won’t lecture you and who will celebrate your successes. Email or phone check-ins work fine. Other online supports may be useful as well.
  • Choose your moment carefully: Do not start out on a diet when you are feeling depressed and hopeless or overwhelmingly anxious. If that is where you are then you should really focus on getting into a better space psychologically (we know, we know, if you could lose all that weight you would feel better… but it is our experience that for most people getting out of depression and anxiety really needs to proceed significant weight loss).
  • Visualize success: You should take a little bit of time really visualizing what it will be like to lose that initial 10% of weight. In doing so it is absolutely essential that you find a way of seeing that as a success. One of the best predictors of a return to initial weight is how you feel about your new, lower body weight. If you focus entirely on what you haven’t accomplished yet, how far you are away from your ideal, then you will quickly get discouraged. So, right now, think about feeling thinner but still, probably, heavier than you would like, and see if you can imagine being happy about that success. If you can’t, then this may not be the right time to diet. You may need or want to talk to your clinician about ways of changing how it feels to get part-way to a goal.
  • Begin a gradual exercise program: Exercise is not as important in the weight loss phase as it is in the weight maintenance phase, but, in general, overall weight loss over time is better predicted by exercise than it is by diet. So get started. For more information click here.

OK, now how about that all important question of whether the grapefruit and lobster diet works better than the butter cream frosting diet…. (Sorry, but there is an incredible amount of silliness about how to diet).

  • Atkins Diet. A recent pair of studies published in the New England Journal of Medicine confirmed what many of you have already concluded. For initial weight loss a modified Atkins diet (low simple carbohydrates) seems to work more quickly than a low fat diet or than a simple calorie counting diet. However, what the studies also both found was that the dieters who lost weight following the Atkins diet actually seemed to have a harder time making the transition to the weight maintenance phase and that, as a result, the weight lost by the end of the process (weight loss and weight maintenance for one year) was the same with Atkins as it was with the low fat approach.

The Atkins diet puts your body into a state of ketosis, this state, for a number of reasons, makes weight loss easier. On the other hand, you can’t stay in a state of ketosis for the rest of your life and it may be that those who achieve early success with the Atkins diet are going to need more effort in the transition phase (more support, more visits). And before you start an Atkins diet, unless you are young and very healthy, you probably should go talk to your doctor and get some baseline laboratory studies.

  • Low Fat Diet. This is the approach that used to be the one most consistently recommended by nutritionists. More recently, with the success of the Atkins Diet and with the continued weight gain in America despite greater access to low fat foods, questions have been raised about its effectiveness. The studies from the New England Journal of Medicine previously cited show that an appropriate low fat diet is as effective, over the course of a year and a half, as the Atkins Diet. It does seem to be a slower approach, because it doesn’t induce ketosis. On the other hand, the transition from a low fat diet to the maintenance phase is much easier. For many people this is still the best approach. However, there is now no question that the low fat diet approach needs to be combined with caution not to substitute simple carbohydrates and sugar for the missing fat.
  • The Paleo Diet. This is the latest popular diet. The idea has some merit, certainly one of the reasons why weight loss is so hard is because our diet is so very different from the diet that our bodies evolved with. Sugar, white flour (the “whites”) and many other popular foods are a product of the last few centuries. We are just not sure that following a rigid diet that is entirely based on what we think our ancestors ate is going to solve all our problems with weight gain.

For More Information

These books are a good place to begin…

The Paleo Solution: The Original Human Diet by Robb Wolf

The South Beach Diet Supercharged: Faster Weight Loss and Better Health for Life by Arthur Agatston

New Atkins for a New You: The Ultimate Diet for Shedding Weight and Feeling Great by Eric C. Westman,‎ Stephen D. Phinney and Jeff S. Volek