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Is Losing Weight Getting Harder?

January 5, 2021 by Dr. Steve Chaney

Why Is Weight Loss More Difficult Than It Used to Be?

Author: Dr. Stephen Chaney

If you are one of the millions of Americans who set a New Year’s goal of losing weight and eating healthier, you are to be congratulated.

However, if you are like many Americans, you are probably asking yourself “Is losing weight getting harder, or is it just my imagination?”

If you are asking yourself “Is losing weight getting harder than the first time I went on a weight loss diet?”, the answer to that question is a clear yes. It has to do with the perils of yo-yo dieting.

But here is the question that most of you never thought to ask: “Is losing weight getting harder than it was for my parents and grandparents?”

If this study (RE Brown et al, Obesity Research & Clinical Practice, 10: 243-255, 2016) is correct, the answer to that question is also yes.

How Was The Study Done?

The authors used data from The National Health and Nutrition Examination Study (NHANES), which is conducted by the CDC on an ongoing basis. For those not familiar with this program, here is a description of the NHANES program from the CDC website.

“The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States.

The survey examines a nationally representative sample of about 5,000 people per round, with 2-year data sets available for analysis. These people are located in counties across the country.

The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel.

All participants visit the physician. Dietary interviews and body measurements are included for everyone. All but the very young have a blood sample taken and have a dental screening. Depending on the age of the participant, the rest of the examination includes tests to assess various aspects of health. In general, the older the individual, the more extensive the examination.

Health interviews are conducted in respondents’ homes. Health measurements are performed in specially-designed and equipped mobile centers, which travel to locations throughout the country. The study team consists of a physician, medical and health technicians, and dietary and health interviewers.”

In short, the NHANES dataset represents a valuable source of data for this kind of study in that it provides a 2-year snapshots of the health and nutritional status of the American population over many decades.

The authors of this study looked at the association between total caloric intake and diet composition with BMI (body mass index a measure of obesity) at 2-year intervals between 1971 and 2008. There were 36,377 US adults in this part of the study.

Because physical activity was only part of the NHANES dataset between 1988 and 2006, the correlation of physical activity with BMI was measured at 2-year intervals between 1988 and 2006. There were 14,419 adults in this part of the study.

Is Losing Weight Getting Harder?

The study showed:

Between 1971 and 2008 total caloric intake, carbohydrate intake, and BMI increased between 10% and 14%.

Nobody was surprised by this result. Americans are eating more calories and more carbs (primarily refined carbs and sugar) than we did 30 years ago. It’s no wonder we weigh more.

Between 1988 and 2006 physical activity increased a whopping 47-120%.

This result was a little surprising. It raises the question: “Why isn’t all this extra physical activity paying off in keeping our weight under control.

However, when the authors compared people who had the same diet (same caloric intake and same amount carbohydrate) and same physical activity with their BMI over the years they found a very surprising result.

When they compared people eating the same diets in 1971 and 2008, the group in 2008 weighed 10% more! And this wasn’t a single data point. There was a relatively linear increase in weight between 1971 and 2008 for people consuming exactly the same diet.

When they compared people with the same amount of physical activity in 1988 and 2006, the group in 2006 weighed 5% more! Once again, there was a relatively linear increase in weight between 1988 and 2006 for people performing exactly the same amount of exercise.

In other words, people weigh significantly more today than they did 20 or 30 years ago, even if they follow the exact same diet and exercise plans. Nobody saw this one coming.

That means it is harder to maintain a healthy weight today than it was just a few decades ago. You may have suspected this, but now you know for sure. Life isn’t fair!

The authors concluded: “Factors other than diet and physical activity may be contributing to the increase in BMI [in this country] over time. Further research is necessary to identify these factors and to determine the mechanisms through which they affect body weight.”

In other words, the real question is: “Why is weight loss more difficult than it used to be?”

Why Is Weight Loss More Difficult Than It Used To Be?

The short answer is, “Nobody knows for sure”. However, the authors raised several possibilities.

We are increasingly exposed to persistent organic pollutants (such as pesticides, flame retardants, and chemicals in food packaging) that accumulate in our bodies and may affect how our bodies process food and store fat.

The use of prescription drugs has risen dramatically since the 70’s and 80’s. Antidepressants, for example, are now one of the most commonly prescribed drugs in the US, and many antidepressants have been linked to weight gain. However, it’s not just antidepressants. Allergy medications, steroids, and pain medications can also cause weight gain.

Just looking at caloric intake and diet composition (% carbohydrate, fat, and protein) obscures other major changes in our diet over the last few decades. We are eating more meat, more highly processed foods, and more artificially sweetened foods. Highly processed foods and artificial sweeteners have both been linked to weight gain.

Our microbiome (gut bacteria) appears to be changing as well. Meat, highly processed foods, and artificial sweeteners have all been shown to influence which gut bacteria inhabit our intestines. We also know gut bacteria can influence our tendency to gain weight.

In short, a lot of things have changed over the past few decades. And these changes may be making it more difficult for us to lose weight. Some of these things, like diet and the influence of diet on our microbiome, we can control. Other things may be beyond our control.

The Bottom Line

A recent study has looked at the effect of diet and physical activity on BMI (a measure of obesity) over the past few decades.

When the authors compared people who had the same diet (same caloric intake and same amount carbohydrate) and same physical activity with their BMI over the years they found a very surprising result.

When they compared people eating the same diets in 1971 and 2008, the group in 2008 weighed 10% more!

When they compared people with the same amount of physical activity in 1988 and 2006, the group in 2006 weighed 5% more!

In other words, people weigh significantly more today than they did 20 or 30 years ago, even if they follow the exact same diet and exercise plans. Nobody saw this one coming.

That means it is harder to maintain a healthy weight today than it was just a few decades ago. You may have suspected this, but now you know for sure. Life isn’t fair!

For more details and to learn why it is harder to lose weight now than it was a few decades ago read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Which Weight Loss Diet Is Best For You?

December 29, 2020 by Dr. Steve Chaney

Tips For Choosing A Diet That Works

Author: Dr. Stephen Chaney

Diet season starts in just a few days! Like millions of Americans you will probably be setting a goal to lose weight. But which diet should you choose? Vegan, Paleo, Keto, 360, Intermittent Fasting, low-carb, low fat – the list is endless.

And then there are the commercial diets: Meal replacements, low calorie processed foods, prepared meals delivered to your door – just to name a few of the categories.

You can choose to count calories, focus on portion sizes, or keep a food journal.

And, if you really want to live dangerously, you can try the latest diet pills that claim to curb your appetite and rev up your metabolism.

The advertisements for all these diets sound so convincing. They give you scientific-sounding mumbo-jumbo to explain why they work. Then they talk about clinical studies they say prove their diet works.

If you are like most Americans, you have already tried several of these diets. They worked for a while, but the pounds came back – and brought their friends with them.

But, as the saying goes, “Hope springs eternal in the human breast. Surely some diet you haven’t tried yet will work for you.

There is such a diet. But it will require a change of mindset. It will also require effort. There is no magic wand that will chase the extra pounds away forever.

If you are searching for the perfect diet to start the new year, let me be your guide. Here are:

4 tips on what to avoid and…

6 tips on what to look for…

…when you are choosing the perfect diet.

Tips For Choosing A Diet That Works

Things To Avoid:

1) Endorsements

Endorsements by your favorite athlete or public person are paid for. They don’t necessarily represent their opinion. Nor do they assure you that they follow that diet or use that diet supplement.

Endorsements by Dr. Strangelove and his buddies can be equally misleading. They usually tell you that the medical establishment has been lying to you, and they have discovered the “secret” to permanent weight loss and the “Fountain of Youth”.

Recommendations of the medical and scientific communities usually represent a consensus statement by the top experts in their field. I would choose their advice over Dr. Strangelove’s opinion any day.

2) Testimonials

Most of the testimonials you see on TV or in print are either paid for or are fake

Testimonials by your friends can be equally misleading. We are all different. What works for your friend or your trainer may not work for you.

For example, some of us do better on low-carb diets, and others do better on low fat diets.

[Note: Some DNA testing companies claim they can sequence your DNA and tell you which diet is best. However, as I reported in a recent article in “Health Tips From The Professor”, independent studies show that DNA testing is of no use in predicting whether low-carb or low-fat diets are better for you.]

3) Diets Based on “Magic” Or “Forbidden” Foods or Food Groups.

I have often said we have 5 food groups for a reason. Each food group provides a unique blend of nutrients and phytonutrients. And each plant food group provides a unique blend of fibers that support the growth of different types of friendly gut bacteria.

The bottom line is that each of us does better with some foods than others, but there are no “magic” or “forbidden” foods that apply to everyone.

4) “Magic” Diets.

I have written perhaps the first diet book, “Slaying The Food Myths”, that doesn’t feature a “magic” diet that is going to make the pounds melt away and allow you to live to 100. Instead I recommend a variety of healthy diets and suggest you choose the one that fits you best.

However, I understand the allure of “magic” diets. Dr. Strangelove claims the diet will be effortless. He gives you some scientific-sounding mumbo-jumbo to convince you the diet is scientifically sound. Then he cites some clinical studies showing the diet will cause you to lose weight and will improve your health parameters (things like cholesterol, triglycerides, blood sugar, and blood pressure). It sounds so convincing.

Before you fall for Dr. Strangelove’s latest “magic” diet, let me share two things that may blow your mind:

- The studies are all short-term (usually 3 months or less).

- When you rely on short-term studies, the very low-fat Vegan diet and very low-carb Keto diet give you virtually identical weight loss and improvement in health parameters!

Those two diets are as different as any two diets could be. That means we can forget all the scientific-sounding mumbo-jumbo as to why each of those diets work. Instead, we should ask what these two diets have in common.

The answer is simple:

#1: The clinical studies are comparing “magic” diets to the typical American diet. Anything is better than the typical American diet! It is high in sugar, refined carbohydrates, saturated fat, and highly processed foods. No wonder the “magic” diets look so good.

#2: The diets are whole food diets. Anytime you eliminate sodas, fast foods, and highly processed foods, you will lose weight.

#3: The diets eliminate one or more food groups. Whenever you eliminate some of your favorite foods from your diet, you tend to lose weight without thinking about it. I call this the cream cheese and bagels phenomenon.

If you are following a low-fat diet, it sounds great to say you can eat all the bagels you want. But without cream cheese to go with the bagels, you tend to eat fewer bagels.

If you are following a low-carb diet, it sounds great to say you can eat as much cream cheese as you want, but without bagels to go with your cream cheese, you tend to eat less cream cheese.

#4: Because they eliminate many of your favorite foods, “magic” diets make you focus on what you eat. Whenever you focus on what you eat, you tend to lose weight. That is why food journals and calorie counters are effective.

#5: Finally, whenever you lose weight, your health parameters (cholesterol, triglycerides, blood sugar, and blood pressure) improve.

Things To Look For In Choosing A Healthy Diet For The New Year

1) Choose whole food diets. Avoid sodas, fast foods, and highly processed foods.

2) Choose primarily plant-based diets. These can range from Vegan through semi-vegetarian, Mediterranean, DASH, and Nordic. All are healthy diets. I have discussed the evidence for this recommendation in my book “Slaying The Food Myths”. Here is a brief summary.

When we look at long term (10-20 year) studies:

- Vegetarians weigh less and are healthier than people consuming the typical American diet.

- People consuming semi-vegetarian, Mediterranean, and DASH diets are healthier than people consuming the typical American diet.

If you look at low-carb diets:

- People consuming plant-based low-carb diets weigh less and are healthier than people consuming the typical American diet.

- People consuming meat-based low-carb diets are just as fat and unhealthy as people consuming the typical American diet.

- The Atkins diet low-carb diet has been around for more than 50 years, and there is no evidence it is healthy long-term

3) Choose diets that include a variety of foods from all 5 food groups. I have discussed the rationale for that recommendation above.

4) Choose diets that consider meat as a garnish, not a main course.

5) Choose diets that feature healthy carbs and healthy fats rather than low-carb or low-fat diets.

6) Think lifestyle, not diet. If you choose a restrictive diet so you can achieve quick weight loss, you will probably be just as fat and unhealthy next December 31^st as you are this year. Instead, choose diets that teach healthy eating and lifestyle changes that you can make a permanent part of your life.

Tips For Keeping The Weight Off

You know the brutal truth. Around 95% of dieters regain everything they lost and then some within a few years. You have probably gone through one or more cycles of weight loss and regain yourself – something called “yo-yo dieting”. You may even be asking yourself if it is worth bothering to try to lose weight this year.

Rather focusing on the negative statistics of weight loss, let’s look at the good news. There are people who lose the weight and keep it off. What do they do?

There is an organization called the National Weight Control Registry that has enrolled more than 10,000 people who have lost weight and kept it off. The people in this group lost weight on almost every diet imaginable. However, here is the important statistic: On average people in this group have lost 66 pounds and kept it off for 5 years.

The National Weight Control Registry has kept track of what they have done to keep the weight off. Here is what they do that you may not be doing:

They consume a reduced calorie, low fat diet.

They get lots of exercise (around 1 hour/day).

They have internalized their eating patterns. In short, this is no longer a diet. It has become a permanent part of their lifestyle. This is the way they eat without even thinking about it.

They monitor their weight regularly. When they gain a few pounds, they modify their diet until they are back at their target weight.

They eat breakfast on a regular basis.

They watch less than 10 hours of TV/week.

They are consistent (no planned cheat days).

Which Weight Loss Diet Is Best For You?

I have covered a lot of ground in this article. Let me summarize it for you.

If you are thinking about popular diets:

Primarily plant-based diets ranging from Vegan to Mediterranean and Dash are associated with a healthier weight and better health long term.

If want to lose weight quickly, you may want to start with the more restrictive plant-based diets, like Vegan, Ornish, Pritikin or semi-vegetarian.

If you do better with a low-carb diet, my recommendation is the low-carb version of the Mediterranean diet.

If your primary goal is rapid weight loss, you could also start with one of the healthier of the restrictive low-carb diets, like the Paleo or the 360 diet. I do not recommend the Keto diet.

No matter what diet you start with, plan to transition to the primarily plant-based diet that best fits your lifestyle and food preferences. This is the diet you will want to stick with to maintain your weight loss and achieve better health long term.

Plan on permanent lifestyle change rather than a short-term diet. Otherwise, you are just wasting your time.

Eat whole foods. Big Food keeps up with America’s favorite diets and is only too happy to sell you highly processed foods that match your favorite diet. Avoid those like the plague.

If you are thinking about commercial diets featuring meal replacement products:

Look for meal replacement products that:

- Do not contain artificial sweeteners, flavors, or preservatives.

- Use non-GMO protein. A non-GMO certification for the other ingredients is not necessary. For a more detailed explanation of when non-GMO certification is important and when it is unnecessary, see my article in “Health Tips From the Professor”.

- Have stringent quality controls in place to assure purity. “Organic” and/or “non-GMO” on the label do not assure purity.

Look for programs that can provide clinical studies showing their diet plan is effective for weight loss and for keeping the weight off. Many programs have short-term clinical studies showing they are effective for weight loss, but very few have longer-term studies showing the weight stays off.

Finally, look for programs that teach permanent lifestyle change. This should include guidance on exercise and healthy eating.

I do not recommend most commercial diets that feature prepared low-calorie foods “shipped right to your door” as a major part of their program. The foods are highly processed. Plus, they include all your favorite unhealthy foods as part of the program. Even if they include lifestyle change as part of their program, they are undermining their message with the foods they are providing you.

I would be remiss if I didn’t mention that Weight Watchers is highly recommended by most experts in the field. Weight Watchers emphasizes journaling and counting calories, which is a plus because it makes you focus on what you are eating. They also have a good lifestyle program and support that can help you transition to permanent lifestyle change if you are willing to put in the effort. However, I don’t recommend their prepared low-calorie foods. They are no better than foods provided by the other commercial diet programs.

The Bottom Line

Weight loss season is upon us. If you plan to lose weight and/or adopt a healthier diet in the coming year, you are probably trying to decide which diet to try this year. In this issue of “Health Tips From The Professor” I give you:

4 tips on what to avoid when selecting your diet.

6 tips on how to choose your perfect diet.

7 tips on how to keep the weight off.

Then I put all this information together to help you choose the best diet, the best meal replacement product, and/or the best commercial diet program.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Can DNA Testing Help You Lose Weight?

June 30, 2020 by Dr. Steve Chaney

How Does DNA Testing Work Best?

Genomics (DNA testing) is hot. You are being told that if you just knew your genes, you could lose weight successfully, be healthier, be happier, leap tall buildings in a single bound (Actually, I haven’t heard the last claim, but it’s about the only claim that genomics marketers haven’t made). Which of these claims are true, and which are just hot air?

The experts agree that the benefits of DNA testing have been greatly oversold. As I said in a recent article on DNA testing, the idea that genes control our destiny is no longer considered valid. There are 3 reasons for this. I will start with the scientific term for each and then give you the non-scientific explanation.

Penetrance simply means that the severity of most gene mutations is influenced by our genetic background. Simply put, the same mutation can have a significant effect in one individual and a trivial effect in another individual.

Epigenetics refers to modifications of the DNA that influence gene expression. These DNA modifications are, in turn, influenced by diet and lifestyle.

Microbiome refers our gut bacteria. In many cases, our microbiome has just as much influence on our health as our genes. And our microbiome is influenced by diet and lifestyle.

Now you know the complexity of DNA testing, it is easy to see why experts feel that it is premature to use DNA testing to predict the best diet for either weight loss or health.

As an example, one recent study used DNA testing to predict whether study participants were more likely to lose weight on a low-carb or low-fat diet. The participants were then randomly assigned to low-carb and low-fat diets. At the end of 12 months:

There was no significant difference in weight loss for those on low-fat and low-carb diets. This has been reported in multiple previous studies but is an inconvenient truth that most low-carb enthusiasts tend to ignore.

DNA testing offered no predictive value as to whether a low-carb or low-fat diet was more effective for weight loss.

However, DNA testing may have one benefit that is overlooked by many experts. What if the DNA test results motivated people to do better? After all, most diet advice is generic. People feel it may or may not apply to them. Does personalized diet advice based on their genetic makeup motivate people to stick with the diet better?

Some studies have suggested that people may follow personalized diet plans based on their DNA more faithfully. However, most of those studies have been short-term.

That is why I have chosen today’s study (J Horne et al, BMJ Nutrition, Prevention & Health, 2020) to discuss. It is a very well-designed study and it lasted for a full year.

How Was The Study Done?

This was an extremely well-designed study. In fact, it was so well designed that it probably needs the “Results are not typical” designation the FDA requires when some diet companies make claims about weight loss success. Here are the details:

The study participants were highly motivated, college educated, middle-aged (average age = 55), obese (average weight = 216 pounds) Caucasian women who had a positive attitude about their ability to change what they ate. In case you weren’t counting, there were four characteristics of this group that might be considered atypical for the average American.

The participants volunteered for a highly structured weight loss program called the “Group Lifestyle Balance”, or GLB, program.

- Participants were given a detailed calorie-controlled nutrition plan at the beginning of the program.

- They were asked to track their daily food and beverage intake for the first 2-3 months of the program.

- In the second week of the program participants were educated on how to count and track calories and nutrients such as total fat or saturated fat.

- There were weekly meetings with dietitians the first 3 months and monthly meetings for the remainder of the 12-week program to provide the guidance and support needed to stick with their nutrition plan.

The plan also incorporated a behavior change program called Theory of Planned Behavior (TPB) that evaluates and influences attitudes, subjective norms, and behavioral control that are key to behavior change. During the regular meetings:

- The participants were informed about of the health benefits associated with a healthy lifestyle.

- They were educated on positive mindsets and mindfulness.

- They were taken through a stepwise, goal setting approach designed to positively impact behavioral change.

In short, this is a gold standard diet program that provided the nutritional support needed to stick with the diet program and the psychological support needed to change eating behavior. Unfortunately, this is also atypical. Very few diet programs provide this level of support.

Everyone in the study participated in this program. However, the participants were divided into two groups.

Both groups were advised to follow a standard calorie-controlled, moderately low-fat (25% of total calories) nutrition plan.

In addition, the second group was put on a plan that was either high protein or low saturated fat (<10% of total calories) based on their DNA test results.

The nutritional support was identical except that the second group was told that their nutrition plan was specific for them, based on their DNA analysis.

The dietary intake of both groups was assessed with a 3-day dietary recall (2 week days and 1 weekend day) at baseline (before the program began) and at 3, 6, and 12 months to assess the participants adherence to their diet plan.

Can DNA Testing Help You Lose Weight?

I hate to disappoint you, but the short answer to this question, is no. Both groups lost the same amount of weight, which is not surprising considering the comprehensive nature of the diet program that both groups were enrolled in.

However, the group given advice based on their DNA test were more motivated to stick with their personalized nutrition goals. Specifically:

Long-term adherence to reductions in saturated fat intake was significantly greater in the group that was told their diet plan was personalized based on their DNA analysis.

- The control group reduced their saturated fat intake by 12% at 3 months, but only by 4% at 6 months, and 2.5% at 12 months.

- The group with the personalized diet plan reduced their saturated fat intake by 14% at 3 months, 18% at 6 months, and 22% at 12 months.

Long-term adherence to reductions in total fat intake was also significantly greater in the group that was told their diet plan was personalized based on their DNA analysis.

- The control group reduced their total fat intake by 18% at 3 months, but only by 4% at 6 and 12 months.

- The group with the personalized diet plan reduced their total fat intake by 11% at 3 months, 13% at 6 months, and 16% at 12 months.

- It is important to remember that both groups had been advised to reduce their total fat intake to 25% of calories and had received nutritional and psychological support to achieve that goal. The only difference was that the second group had been told that advice was based on their DNA test.

The authors of the study concluded: “Weight management interventions guided by nutrigenomics can motivate long-term improvements in dietary fat intake above and beyond gold-standard population-based interventions.”

How Does DNA Testing Work Best?

There remain significant concerns about the validity of personalized weight loss advice based on DNA testing. However, this and other studies suggest that DNA testing may provide one valuable asset for weight loss programs. It appears that people are more likely to stick with a program they believe has been personalized for them.

There are, however, several caveats to this conclusion.

Participants in this study received nutritional and psychological support throughout the 12-month program. We don’t know how well participants would have stuck with the program if they had not been continually reminded that the program had been personalized for them.

Participants in this study were well-educated, highly motivated, Caucasian women. We don’t know whether these results apply to men and to other ethnic and socioeconomic groups.

This study only looked at personalized diet advice based on DNA testing. Some studies suggest that other methods of diet personalization may also improve adherence.

Personalization can be misused to recommend unhealthy dietary changes. It is not enough to follow personalized diet advice. You also need to ask whether it is healthy dietary advice.

For example, DNA test results consistent with reduced carbohydrate intake are sometimes used to recommend unhealthy diets that eliminate one or more food groups rather than low-carb versions of healthy diets like the Mediterranean diet.

The Bottom Line

There remain significant concerns about the validity of personalized weight loss advice based on DNA testing. However, DNA testing may provide one valuable asset for weight loss programs. Some studies have suggested that people are more likely to stick with a program they believe has been personalized for them.

However, most of these studies have been short term. A recent study asked whether the improvement in motivation lasted for 12 months.

Two matched groups of well-educated, highly motivated women were enrolled in a “gold-standard” weight loss program that provided both nutritional and psychological support for 12 months.

Both groups were given a diet plan that restricted total calorie intake and advised reducing fat intake to 25% of total calories. However, based on their DNA test results one group was given a personalized diet plan that also advised them to reduce their saturated fat intake to less than 10% of total calories.

The group receiving personalized diet advice did a better job of reducing both saturated and total fat intake and maintaining that change for 12 months compared to the group that just received a set diet plan.

These results suggest that personalization of diet advice may improve long-term adherence to healthy dietary changes.

There are, however, several caveats to this conclusion.

Participants in this study received both nutritional and psychological support throughout the 12-month program. We don’t know how well participants would have stuck with the program if they had not been continually reminded that the program had been personalized for them.

Participants in this study were well-educated, highly motivated, Caucasian women. We don’t know whether these results apply to men and to other ethnic and socioeconomic groups.

This study only looked at personalized diet advice based on DNA testing. Some studies suggest that other methods of diet personalization may also improve adherence.

Personalization can be misused to recommend unhealthy dietary changes. It is not enough to follow personalized diet advice. You also need to ask whether it is healthy dietary advice.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure, or prevent any disease.

Does Intermittent Fasting Work?

January 7, 2020 by Dr. Steve Chaney

Will Intermittent Fasting Help You Lose Weight?

Author: Dr. Stephen Chaney

If you are like millions of Americans, one of your New Year’s resolutions is to lose weight. Now your dilemma is how to accomplish that. You have tried various diets before – Atkins, paleo, keto, Whole 30, etc. You lost some weight, but it came right back. You are looking for something new, something different from anything you have tried before.

What about intermittent fasting? It’s hot right now. It’s probably different from what you have tried in the past. It doesn’t require radical changes to what you eat. Some of your friends are singing its praises. Could this be the one that solves your weight problem forever?

A Primer On Intermittent Fasting

Let’s start by defining intermittent fasting and reviewing what we already know about it. There are several variations of what the mass media refers to as intermittent fasting, but the two most popular versions are:

Time-restricted fasting which limits daily intake of food to a 4 to 12-hour period. The most popular version of this restricts food intake to 8 hours followed by 16 hours of fasting.

Intermittent fasting in which there is a day or more of fasting or decreased food intake between periods of unrestricted eating. The most popular version of this allows 5 days of unrestricted eating followed by 2 days of fasting.

A major review (Di Francesco et al, Science, 362: 770-775, 2018) of time-restricted and intermittent fasting was published a little over a year ago. At the time that review was published, there were lots of studies comparing time-restricted fasting with continuous caloric restriction. I summarized those findings in a previous issue of “Health Tips From the Professor” last January.

Here is a brief summary of the key findings from that review:

If you read the blogs about time-restricted fasting, you will come across all sorts of metabolic mumbo-jumbo about ketone bodies, adiponectin, leptin, IGF-1, and blood glucose levels. It sounds so convincing. Don’t get sucked in by these pseudo-scientific explanations. At this point they are mostly speculation.

Although there is no conscious effort to control calories, time-restricted fasting result in an inadvertent reduction in food intake by restricting the time allowed for eating and by eliminating late night snacking. This reduction in caloric intake is likely responsible for most of the weight loss associated with intermittent fasting. When you control for calories, there is no difference in weight loss between time-restricted fasting and continuous caloric restriction (your typical reduced calorie diet).

However, at the time the review was published, far less was known about the relative benefits of intermittent fasting and simple caloric restriction. Since that time, two studies have rigorously compared the effectiveness of intermittent fasting and continuous caloric restriction on weight loss. I review those studies below

Will Intermittent Fasting Help You Lose Weight?

The first study (YM Roman et al, International Journal of Obesity, 43: 2017-2027, 2019) was a systematic review and meta-analysis of 9 clinical studies comparing intermittent fasting with continuous caloric restriction. Total caloric reduction was controlled and was the same for both intermittent fasting and continuous caloric reduction.

The studies ranged from 12 weeks to 52 weeks with most of them in the 20 to 30-week range. This meta-analysis found:

· There was no difference between intermittent fasting and continuous caloric restriction in terms of weight loss, waist circumference, or body fat loss.

· Loss of lean body mass, on the other hand, was greater for intermittent fasting than for continuous caloric restriction.

The authors concluded: “Since it is ultimately fat mass loss that improves health indices, and not the loss of muscle, the significantly greater loss of lean mass in the intermittent dieting group versus the continuous dieting group is concerning and needs to be further assessed.”

I would add, it is also concerning because lean mass muscle burns calories faster than fat mass. Loss of lean muscle mass could lead to a lower metabolic rate. That would make maintenance of the weight loss more difficult.

The second study (ML Headland et al, International Journal of Obesity, 43: 2028-2036) compared intermittent fasting versus continuous calorie restriction for 12 months in a group of 332 healthy overweight or obese adults. Again, total caloric reduction was the same for the two groups. In this study:

· There was no significant difference between intermittent fasting and continuous caloric restriction for weight loss, body fat loss, and lean body mass loss. [Note: The retention of lean body mass in this study differs from the loss of lean body mass reported in the previous study. Additional studies will be required before we become overly concerned about potential loss of lean body mass with intermittent fasting.]

· There were also no significant differences between the groups for blood levels of glucose, total cholesterol, triglycerides, HDL, and LDL.

Does Intermittent Fasting Work?

These studies make it clear there is no “magic” associated with either time-restricted or intermittent fasting.

· If either time-restricted or intermittent fasting allows you to reduce your daily caloric intake by restricting the time that you are eating, you will lose weight and keep it off. However, if you compensate for the fasting periods by consuming additional calories when you are eating, all bets are off.

· In clinical studies that restrict calories to the same extent in the various diets, neither time-restricted nor intermittent fasting results in greater weight loss than continuous caloric restriction (your typical reduced calorie diet).

o In addition, neither time-restricted nor intermittent fasting results in better improvement in blood parameters (glucose, total cholesterol, triglycerides, HDL, and LDL) than continuous caloric restriction.

· Intermittent fasting may result in greater loss of lean muscle mass than continuous caloric reduction. If confirmed by subsequent studies, this would be concerning.

This also means:

· If you happen to read the blogs about time-restricted or intermittent fasting, you can forget all the metabolic mumbo-jumbo about ketone bodies, adiponectin, leptin, IGF-1, and blood glucose levels.

o At this point this metabolic information comes mostly from animal studies. Its application to humans is purely speculation.

o Since time-restricted and intermittent fasting offer no advantage over continuous caloric restriction, there is no evidence that changes in any of those metabolic markers has any effect on weight loss in humans.

Finally, you need to ask whether time-restricted and intermittent fasting are something you can maintain in the real world.

· Your friends are unlikely to be on the same schedule. It won’t be easy to fit your diet around socializing, travel, and holidays.

The Bottom Line

There are several variations of what the mass media refers to as intermittent fasting, but the two most popular versions are:

Time-restricted fasting which limits daily intake of food to a 4 to 12-hour period. The most popular version of this restricts food intake to 8 hours followed by 16 hours of fasting.

Intermittent fasting in which there is a day or more of fasting or decreased food intake between periods of unrestricted eating. The most popular version of this allows 5 days of unrestricted eating followed by 2 days of fasting.

The latest studies make it clear there is no “magic” associated with either time-restricted or intermittent fasting.

· Intermittent fasting may result in greater loss of lean muscle mass than continuous caloric reduction. If confirmed by subsequent studies, this would be concerning.

Finally, you need to ask whether time-restricted and intermittent fasting are something you can maintain in the real world.

· Your friends are unlikely to be on the same schedule. It won’t easy to fit your diet around socializing, travel, and holidays.

For more details, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Why Do Most Diets Fail?

January 6, 2020December 31, 2019 by Dr. Steve Chaney

How To Lose Weight And Keep It Off

Tomorrow is the official start of another dieting season. Millions of Americans will be making a New Year’s Resolution to lose weight. The top three reasons for these weight loss resolutions are:

1) Reduce disease risk (73%). After all, we are being told those excess pounds increase our risk of diabetes, heart disease, cancer, and just about every other disease known to man.

2) Improve self-esteem (61%). Some of this may be due to the social stigma associated with obesity, but many people simply want to improve the image they see in the mirror every morning when they get out of the shower.

3) Boost energy (49%).

Those are all good reasons for losing weight. But before you make your New Year’s resolution to embark on another weight loss journey, you should ask yourself “Do weight loss diets work?” If you look at the statistics, they aren’t very encouraging:

1) 45 million Americans go on a weight loss diet every year.

· 50% go on fad diets.

· They spend $33 billion on weight loss products.

· 90% regain almost all the weight. That’s called the yo-yo effect.

· On average, Americans gain 11 pounds on every diet yo-yo.

o They might as well have thrown that $33 billion to the wind.

2) 228,000 Americans get gastric bypass surgery.

· 80% regain almost all the weight.

o Their digestion and their health will never be the same.

As if those statistics weren’t bad enough, the obesity epidemic gets worse year after year (see the graphic on the right). Americans keep getting fatter. What we are doing clearly isn’t working.

You are probably saying to yourself: “I know that, but this year I’m going to try a new diet.” As the saying goes “Hope springs eternal in the human breast”, but is it realistic to think this time will be different?

Let me share a quote from a book and TV series called “The Weight Of the Nation” by John Hoffman & Dr. Judith Salerno”:

“First we blamed fat – low fat diets didn’t work! Then we blamed carbs, eggs, red meat, dairy, white flour, sugar, juices, sodas, high-fructose corn syrup, & partially hydrogenated fats. One by one, we replaced the evil food du jour…and watched our collective waistlines grow.”

In other words, they are saying it’s not just low-fat diets that don’t work. None of the popular diets work long term. I come across lots of people who tell me the Atkins weight-loss diet works best for them. That would be convincing if they were slender, but they aren’t! They gained it all back and then some. Now that the keto diet has been around for a few years, I am starting to see the same pattern there as well.

Clearly, the problem isn’t losing the weight. Any diet can help you lose weight. The problem is keeping the weight off. Let’s look at why this is.

Why Do Most Diets Fail?

To understand the answer to this question, let’s start with another quote from “The Weight Of the Nation”: “Our bodies were designed to store fat in times of plenty and retain fat in times of famine”

Essentially, the authors were saying when our ancestors were hunters and gatherers, there were times when food was abundant, and times when food was scarce. In order to survive, our bodies had to store energy in its most efficient form when food was abundant and hold on to those energy stores as long as possible when food was scarce.

Fat provides more than twice as many calories per gram as either carbohydrate or protein. Additionally, our ability to store carbohydrate is limited. And we don’t really have protein stores. All the proteins in our body have essential functions. However, our ability to store fat is unlimited. Now you understand why fat is the preferred energy store in times of plenty and our bodies try to hold on to it as long as possible in times of famine.

With that perspective in mind, there are three reasons why most diets fail:

1) Most dieters are looking for rapid weight loss (at least 2-5 pounds/week). That is a problem because “Our bodies were designed to…retain fat in times of famine”. When we lose weight quickly, our bodies interpret that as famine. Our bodies respond by decreasing our metabolic rate so we can hold on to those fat stores.

The solution to this problem is to set more reasonable weight loss goals. If we keep the rate of weight loss in the 1-2 pound/week range (0.5-1 pounds/week is even better), we can largely avoid this famine response. You should ask yourself, “What’s the rush?” After all, the average American only gains 1-2 pounds/year. Why do we need to get rid of that excess weight in just a few weeks?

2) Most dieters are looking for significant weight loss (more than 20 pounds). That is a problem because our bodies are designed to retain fat stores, not protein stores. When our bodies sense a famine they burn our protein stores (lean muscle mass) to spare as much of our fat stores as possible. The longer the diet (famine) lasts, the more muscle mass we lose.

That’s a problem because muscle burns calories much faster than fat. The more muscle we lose, the more our metabolic rate decreases. It gets harder and harder to lose weight, and eventually we reach a plateau. Most people get discouraged at that point and go off their diet.

That’s where the other part of the quote from “The Weight Of The Nation” kicks in: “Our bodies are designed to store fat in times of plenty”. Once again, it is fat we store, not protein. Most people never regain the protein stores they lost, so their metabolic rate remains low. They regain most of the weight they lost, and then some. This is the origin of the yo-yo effect.

There are two solutions to this problem:

· Increase your resistance exercise and your intake of protein with high levels of the essential amino acid leucine. I have covered this in a previous issue of “Health Tips From The Professor”.

· Set more reasonable weight loss goals. It is possible to lose more than 20 pounds without losing muscle mass. We just need to think in terms of reaching those weight loss goals in years rather than in months. Once again, remember it took us years to gain the weight. Why not think in terms of years to lose the weight?

3) Most dieters think in terms of diets rather than lifestyle change. Diets have an expiration date. Then most people just drift back to “the way they really live”. Lifestyle change, on the other hand, is permanent. Once we change to a healthier lifestyle, we no longer need to focus on weight loss. The weight comes off automatically.

To better understand the power of lifestyle change let’s look at something called “The National Weight Control Registry”.

How To Lose Weight And Keep It Off

Rather than focus on the abysmal statistics for long-term weight loss, doctors Rena Hill and James O Wing decided to focus on the characteristic of people who manage to keep their weight off. They founded something called “The National Weight Control Registry” and invited people who were successful at keeping the weight off to participate in their program.

Currently, the National Weight Control Registry is tracking over 10,000 individuals who have lost 30 pounds or more and have kept it off for long periods of time. They use detailed questionnaires and annual follow-up surveys to study the behavioral and psychological characteristics and the strategies of weight loss maintainers.

When you look at how they lost weight, they are a very diverse group:

· They lost weight on every possible diet – from vegan to keto to just plain crazy.

· 50% lost weight on commercial diet programs. 50% lost weight on their own.

· Some lost weight quickly. Some lost weight slowly.

When you look at weight maintenance, you realize that the dismal weight maintenance statistics don’t have to apply to you. The good news is:

· On average, people in The National Weight Control Registry have lost 66 pounds and have kept it off for 5 years or more.

· 12-14% of them have maintained a weight loss of 100 pounds or more for 5 or more years.

· Even better, once they maintained their weight loss for 2-5 years, it became easy.

They no longer had to battle hunger and a sluggish metabolism. They no longer had to think about the lifestyle changes they were trying to maintain. Their new lifestyle became what they did automatically, without even thinking about it. Their weight loss had become permanent.

By now, you are probably wondering how they do it. Here are the top 7 characteristics of those who are successful at keeping the weight off:

1) They consumed reduced calorie, low-fat, healthy diets.

2) They had internalized their eating patterns. It had become how they ate every day without even thinking about it.

3) They monitored their weight regularly. This allowed them to make adjustments whenever they saw their weight start to creep up.

4) They ate breakfast on a regular basis.

5) They got lots of exercise (on average, about 1 hour/day).

6) They watched less than 10 hours of TV/week. If you were wondering where you would find the time to exercise an hour/day, this is probably your answer.

7) They were consistent. They had no planned “cheat days”. This doesn’t mean they were purists. They still allowed themselves to eat some of their favorite unhealthy foods on an occasional basis. They just didn’t set aside regular times when they planned to “pig out”.

There was one other interesting observation from this study:

· Those who used meal replacement shakes as part of their weight loss, focused more on diet and included meal replacement shakes as part of their maintenance program.

· Those who lost weight on their own, also followed healthy eating habits, but put a bit more emphasis on exercise to keep themselves on track.

· Both approaches were effective.

The take-home message of the National Weight Control Registry is clear. There is no magic diet that guarantees you will keep the weight off. The “secret” to keeping the weight off is a healthy eating pattern and a healthy lifestyle.

In short, if your resolution is to lose weight next year, don’t focus on the diet you will follow to lose the weight. Instead, focus on the healthy lifestyle you will follow to keep the weight off.

Of course, you will be most successful if the diet you are following to lose weight incorporates the healthy lifestyle you plan to follow to maintain your weight loss.

What Role Do Habits Play In Weight Loss?

Finally, I would like to share a recent study (G Cleo et al, International Journal of Obesity, 43: 374-383, 2019) that puts the whole issue of weight loss and weight maintenance in a different perspective. This study looked at the role that habits play in weight loss.

In short, the study enrolled 130 participants who wanted to lose weight. All the participants were told this was a weight loss study, but none of the participants were given detailed diet and exercise recommendations to follow. The study had a 12-week intervention phase followed by a 12-month follow-up phase. The participants were divided into three groups.

1) Group 1 received no advice during the intervention phase. This was the control group.

2) Group 2 focused on breaking old habits. During the intervention phase they were sent daily tests suggesting new habit patterns. These were suggestions like “Drive a different route to work today”. None of the texts had anything to do with diet or lifestyle.

3) Group 3 focused on creating new healthy habits. They were given a list of 10 healthy habits. During the intervention phase they were asked to log how many of these habits they implemented each day. The 10 healthy habits were:

#1: Keep to a daily meal routine.

#2: Choose reduced fat versions of foods.

#3: Walk off the weight (aim for 10,000 steps/day).

#4: Pack a healthy snack (Choose healthy options such as fruits, nuts, or low-fat yogurt).

#5: Read labels.

#6: Be cautious with your portions.

#7: Break up your sitting time (Stand for 10 minutes every hour).

#8: Think about your drinks (Choose water instead of sodas and fruit juices).

#9: Focus on your food (Slow down. Don’t eat while watching TV).

#10: Don’t forget your 5 servings of fruits and vegetables a day.

The results were:

· People in both habit change groups lost significantly more weight than people in the control group.

· People in the habit change groups continued to lose weight for 12 months after the intervention ended.

· Weight loss was essentially identical in the two habit change groups.

The last observation is particularly interesting. Remember that one of the habit change groups was simply focused on breaking old habits, yet people in this group did just as well as people who were taught healthy lifestyle habits. This implies that people already know about healthy lifestyle habits. They just don’t know how to break their old habits. Once they become comfortable breaking old habits, they find it easy to adopt healthier lifestyle habits.

In short, change your habits, change your lifestyle. Change your lifestyle, control your weight.

What Does This Mean For You?

I covered a lot of information in this article. Let me sum it up by giving you my top 10 tips for losing weight and keeping it off.

1) You don’t need to achieve your “ideal weight”. Losing 5-10% of your body weight may be enough.

2) Ditch diets. Focus on lifestyle change.

3) Slow and steady wins the day.

4) Change your habits, change your weight.

5) Long-term weight loss is possible.

6) Low-fat, healthy eating patterns are best.

7) Once you have internalized healthy habits, they become automatic.

8) If you stick with a healthy lifestyle long enough, keeping the weight off becomes easy.

9) Focus on all the healthy food choices you have, not what you have to give up. There is a cornucopia of great tasting, healthy foods to choose from.

10) Never say never. Allow yourself to enjoy your old favorite foods on occasion. Just don’t make it a habit.

The Bottom Line

I cover a lot of information in this article. Let me sum it up by giving you my top 10 tips for losing weight and keeping it off.

1) You don’t need to achieve your “ideal weight”. Losing 5-10% of your body weight may be enough.

2) Ditch diets. Focus on lifestyle change.

3) Slow and steady wins the day.

4) Change your habits, change your weight.

5) Long-term weight loss is possible.

6) Low-fat, healthy eating patterns are best.

7) Once you have internalized healthy habits, they become automatic.

8) If you stick with a healthy lifestyle long enough, keeping the weight off becomes easy.

9) Focus on all the healthy food choices you have, not what you have to give up. There is a cornucopia of great tasting, healthy foods to choose from.

10) Never say never. Allow yourself to enjoy your old favorite foods on occasion. Just don’t make it a habit.

For more details on how to lose weight and keep it off, read the article above. In fact, if you plan to lose weight in the coming year, you should really read this article first.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.