Tuesday, 17 April 2012

The Big Picture of Permanent Weight Loss

Most people who read my articles and e-books know me as a science guy who likes to quote studies and apply research to everyday problems such as weight loss, bodybuilding, and other health/fitness related topics. However, sometimes you have to step back from the science and look at the big picture to help bring people back into focus, so they can see the forest for the trees, so to speak.

For most people reading this article, finding an effective diet that works most of the time must seem as complicated as nuclear physics. It's not, but there are a bewildering number of choices for diets out there. High fat or no fat? High carbohydrate or no carbohydrate? Low protein or high protein? To make matters worse, there are a million variations and combinations to the above diet scenarios to add to the confusion. It seems endless and causes many people to throw up their hands in frustration and give up. In this article I will attempt to change all that.

There are some general guidelines, rules of thumb, and ways of viewing a diet program that will allow you to decide, once and for all, if it's the right diet for you. You may not always like what I have to say, and you should be under no illusions this is another quick fix, "lose 100 lbs. in 20 days," guide of some sort. However, if you are sick and tired of being confused, tired of taking the weight off only to put it back on, and tired of wondering how to take the first steps to deciding the right diet for you that will result in permanent weight loss, then this is the article that could change your life...

Does your diet pass "The Test"?
What is the number one reason diets fail long term; above all else? The number one reason is...drum roll...a lack of long term compliance. The numbers don't lie; the vast majority of people who lose weight will regain it - and often exceed what they lost. You knew that already didn't you?

Yet, what are you doing to avoid it? Here's another reality check: virtually any diet you pick which follows the basic concept of "burning" more calories then you consume - the well accepted "calories in calories out" mantra - will cause you to lose weight. To some degree, they all work: Atkins-style, no carb diets, low fat high carb diets, all manner of fad diets - it simply does not matter in the short term.

If your goal is to lose some weight quickly, then pick one and follow it. I guarantee you will lose some weight. Studies generally find any of the commercial weight loss diets will get approximately the same amount of weight off after 6 months to a year. For example, a recent study found the Atkins' Diet, Slim-Fast plan, Weight Watchers Pure Points program, and Rosemary Conley's Eat Yourself Slim diet, were all equally effective. (1)

Other studies comparing other popular diets have come to essentially the same conclusions. For example, a study that compared the Atkins diet, the Ornish diet, Weight Watchers, and The Zone Diet, found them to be essentially the same in their ability to take weight off after one year. (2)

Recall what I said about the number one reason diets fail, which is a lack of compliance. The lead researcher of this recent study stated:

"Our trial found that adherence level rather than diet type was the primary predictor of weight loss"(3)

Translated, it's not which diet they chose per se, but their ability to actually stick to a diet that predicted their weight loss success. I can just see the hands going up now, "but Will, some diets must be better than others, right?" Are some diets better then others? Absolutely. Some diets are healthier then others, some diets are better at preserving lean body mass, some diets are better at suppressing appetite - there are many differences between diets. However, while most of the popular diets will work for taking weight off, what is abundantly clear is that adhering to the diet is the most important aspect for keeping the weight off long term.

What is a diet?
A diet is a short term strategy to lose weight. Long term weight loss is the result of an alteration in lifestyle. We are concerned with life long weight management, not quick fix weight loss here. I don't like the term diet, as it represents a short term attempt to lose weight vs. a change in lifestyle. Want to lose a bunch of weight quickly? Heck, I will give you the information on how to do that here and now for no charge.

For the next 90 to 120 days eat 12 scrambled egg whites, one whole grapefruit, and a gallon of water twice a a day. You will lose plenty of weight. Will it be healthy? Nope. Will the weight stay off once you are done with this diet and are then forced to go back to your "normal" way of eating? Not a chance. Will the weight you lose come from fat or will it be muscle, water, bone, and (hopefully!) some fat? The point being, there are many diets out there that are perfectly capable of getting weight off you, but when considering any eating plan designed to lose weight, you must ask yourself:

"Is this a way of eating I can follow long term?"
Which brings me to my test: I call it the "Can I eat that way for the rest of my life?" Test. I know, it does not exactly roll off your tongue, but it gets the point across.

The lesson here is: any nutritional plan you pick to lose weight must be part of a lifestyle change you will be able to follow - in one form or another - forever. That is, if it's not a way of eating you can comply with indefinitely, even after you get to your target weight, then it's worthless.

Thus, many fad diets you see out there are immediately eliminated, and you don't have to worry about them. The question is not whether the diet is effective in the short term, but if the diet can be followed indefinitely as a lifelong way of eating. Going from "their" way of eating back to "your" way of eating after you reach your target weight is a recipe for disaster and the cause of the well established yo-yo dieting syndrome. Bottom line: there are no short cuts, there is no free lunch, and only a commitment to a lifestyle change is going to keep the fat off long term. I realize that's not what most people want to hear, but it's the truth, like it or not.

The statistics don't lie: getting the weight off is not the hardest part, keeping the weight off is! If you take a close look at the many well known fad/commercial diets out there, and you are honest with yourself, and apply my test above, you will find most of them no longer appeal to you as they once did. It also brings me to an example that adds additional clarity: If you have diet A that will cause the most weight loss in the shortest amount of time but is unbalanced and essentially impossible to follow long term vs. diet B, which will take the weight off at a slower pace, but is easier to follow, balanced, healthy, and something you can comply with year after year, which is superior? If diet A gets 30 lbs off you in 30 days, but by next year you have gained back all 30 lbs, but diet B gets 20 lbs off you in the next 3 months with another 20 lbs 3 months after that and the weight stays off by the end of that year, which is the better diet?

If you don't know the answer to those questions, you have totally missed the point of this article and the lesson it's trying to teach you, and are set up for failure. Go back and read this section again...By default, diet B is superior.

Teach a man to Fish...
A well known Chinese Proverb is - Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.

This expression fits perfectly with the next essential step in how to decide what eating plan you should follow to lose weight permanently. Will the diet plan you are considering teach you how to eat long term, or does it spoon-feed you information? Will the diet rely on special bars, shakes, supplements or pre-made foods they supply?

Let's do another diet A vs. diet B comparison. Diet A is going to supply you with their foods, as well as their special drink or bars to eat, and tell you exactly when to eat them. You will lose - say - 30 lbs in two months. Diet B is going to attempt to help you learn which foods you should eat, how many calories you need to eat, why you need to eat them, and generally attempt to help teach you how to eat as part of a total lifestyle change that will allow you to make informed decisions about your nutrition. Diet B causes a slow steady weight loss of 8 -10 lbs per month for the next 6 months and the weight stays off because you now know how to eat properly.

Recall the Chinese proverb. Both diets will assist you to lose weight. Only one diet, however, will teach you how to be self-reliant after your experience is over. Diet A is easier, to be sure, and causes faster weight loss than diet B, and diet B takes longer and requires some thinking and learning on your part. However, when diet A is over, you are right back where you started and have been given no skills to fish. Diet companies don't make their profits by teaching you to fish, they make their money by handing you a fish so you must rely on them indefinitely or come back to them after you gain all the weight back.

Thus, diet B is superior for allowing you to succeed where other diets failed, with knowledge gained that you can apply long term. Diet programs that attempt to spoon feed you a diet without any attempt to teach you how to eat without their help and/or rely on their shakes, bars, cookies, or pre-made foods, is another diet you can eliminate from your list of choices.

Diet plans that offer weight loss by drinking their product for several meals followed by a "sensible dinner;" diets that allow you to eat their special cookies for most meals along with their pre-planned menu; or diets that attempt to have you eating their bars, drink, or pre-made meals, are of the diet A variety covered above. They're easy to follow but destined for failure, long term. They all fail the "Can I eat that way for the rest of my life?" test, unless you really think you can eat cookies and shakes for the rest of your life...Bottom line here is, if the nutritional approach you use to lose weight, be it from a book, a class, a clinic, or an e-book, does not teach you how to eat, it's a loser for long term weight loss and it should be avoided.

The missing link for long term weight loss
We now make our way to another test to help you choose a nutrition program for long term weight loss, and it does not actually involve nutrition. The missing link for long term weight loss is exercise. Exercise is the essential component of long term weight loss. Many diet programs do not contain an exercise component, which means they are losers for long term weight loss from the very start. Any program that has its focus on weight loss but does not include a comprehensive exercise plan is like buying a car without tires, or a plane without wings. People who have successfully kept the weight off overwhelmingly have incorporated exercise into their lives, and the studies that look at people who have successfully lost weight and kept it off invariably find these people were consistent with their diet and exercise plans. (4)

I am not going to list all the benefits of regular exercise here, but regular exercise has positive effects on your metabolism, allows you to eat more calories yet still be in a calorie deficit, and can help preserve lean body mass (LBM) which is essential to your health and metabolism. The many health benefits of regular exercise are well known, so I won't bother adding them here. The bottom line here is, (a) if you have any intentions of getting the most from your goal of losing weight and (b) plan to keep it off long term, regular exercise must be an integral part of the weight loss strategy. So, you can eliminate any program, be it book, e-book, clinic, etc. that does not offer you direction and help with this essential part of long term weight loss.

Side Bar: A quick note on exercise:
Any exercise is better than no exercise. However, like diet plans, not all exercise is created equal, and many people often choose the wrong form of exercise to maximize their efforts to lose weight. For example, they will do aerobics exclusively and ignore resistance training. Resistance training is an essential component of fat loss, as it builds muscle essential to your metabolism, increases 24 hour energy expenditure, and has health benefits beyond aerobics.

The reader will also note I said fat loss above not weight loss. Though I use the term 'weight loss' throughout this article, I do so only because it is a familiar term most people understand. However, the true focus and goal of a properly set up nutrition and exercise plan should be on fat loss, not weight loss. A focus on losing weight, which may include a loss essential muscle, water, and even bone, as well as fat, is the wrong approach. Losing the fat and keeping the all important lean body mass (LBM), is the goal, and the method for achieving that can be found in my ebook(s) on the topic, and is beyond the scope of this article. Bottom line: the type of exercise, intensity of that exercise, length of time doing that exercise, etc., are essential variables here when attempting to lose FAT while retaining (LBM).

Psychology 101 of long term weight loss
Many diet programs out there don't address the psychological aspect of why people fail to be successful with long term weight loss. However, quite a few studies exist that have looked at just that. In many respects, the psychological aspect is the most important for long term weight loss, and probably the most underappreciated component.

Studies that compare the psychological characteristics of people who have successfully kept the weight off to people who have regained the weight, see clear differences between these two groups. For example, one study that looked at 28 obese women who had lost weight but regained the weight that they had lost, compared to 28 formerly obese women who had lost weight and maintained their weight for at least one year and 20 women with a stable weight in the healthy range, found the women who regained the weight:

o Had a tendency to evaluate self-worth in terms of weight and shape
o Had a lack of vigilance with regard to weight control
o had a dichotomous (black-and-white) thinking style
o Had the tendency to use eating to regulate mood.

The researchers concluded:

"The results suggest that psychological factors may provide some explanation as to why many people with obesity regain weight following successful weight loss."

This particular study was done on women, so it reflects some of the specific psychological issues women have - but make no mistake here - men also have their own psychological issues that can sabotage their long term weight loss efforts. (6)

Additional studies on men and women find psychological characteristics such as "having unrealistic weight goals, poor coping or problem-solving skills and low self-efficacy" often predict failure with long term weight loss. (7) On the other hand, psychological traits common to people who experienced successful long term weight loss include "...an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability." (8)

The main point of this section is to illustrate that psychology plays a major role in determining if people are successful with long term weight loss. If it's not addressed as part of the overall plan, it can be the factor that makes or breaks your success. This, however, is not an area most nutrition programs can adequately tackle and should not be expected to. However, the better programs do generally attempt to help with motivation, goal setting, and support. If you see yourself in the above lists from the groups that failed to maintain their weight long term, then know you will need to address those issues via counseling, support groups, etc. Don't expect any weight loss program to cover this topic adequately but do look for programs that attempt to offer support, goal setting, and resources that will keep you on track.

"There's a sucker born every minute"
So why don't you see this type of honest information about the realities of long term weight loss more often? Let's be honest here, telling the truth is not the best way to sell bars, shakes, books, supplements, and programs. Hell, if by some miracle everyone who read this article actually followed it, and sent it on to millions of other people who actually followed it, makers of said products could be in financial trouble quickly. However, they also know - as the man said - "there's a sucker born every minute," so I doubt they will be kept up at night worrying about the effects that I, or this article, will have on their business.

So let's recap what has been learned here: the big picture realities of permanent weight loss and how you can look at a weight loss program and decide for yourself if it's for you based on what has been covered above:

o Permanent weight loss is not about finding a quick fix diet, but making a commitment to life style changes that include nutrition and exercise

o Any weight loss program you choose must pass the "Can I eat that way for the rest of my life?" test,

o The weight loss program you choose should ultimately teach you how to eat and be self reliant so you can make informed long term choices about your nutrition.

o The weight loss program you choose should not leave you reliant on commercial bars, shakes, supplements, or pre-made foods, for your long term success.

o The weight loss program you choose must have an effective exercise component.

o The weight loss program you choose should attempt to help with motivation, goal setting, and support, but can't be a replacement for psychological counseling if needed.

Conclusion
I want to take this final section to add some additional points and clarity. For starters, the above advice is not for everyone. It's not intended for those who really have their nutrition dialed in, such as competitive bodybuilders and other athletes who benefit from fairly dramatic changes in their nutrition, such as 'off season' and 'pre-contest' and so on.

The article is also not intended for those with medical issues who may be on a specific diet to treat or manage a specific medical condition. The article is intended for the average person who wants to get off the Yo-Yo diet merry-go-round once and for all. As that's probably 99% of the population, it will cover millions of people.

People should also not be scared off by my "you have to eat this way forever" advice. This does not mean you will be dieting for the rest of your life and have nothing but starvation to look forward to. What it does mean, however, is you will have to learn to eat properly even after you reach your target weight and that way of eating should not be a huge departure from how you ate to lose the weight in the first place. Once you get to your target weight - and or your target bodyfat levels - you will go onto a maintenance phase which generally has more calories and choices of food, even the occasional treat, like a slice of pizza or whatever.

Maintenance diets are a logical extension of the diet you used to lose the weight, but they are not based on the diet you followed that put the weight on in the first place!

Regardless of which program you choose, use the above 'big picture' approach which will keep you on track for long term weight loss. See you in the gym!

References

(1) Truby H, et al. Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC "diet trials" BMJ 2006;332:1309-1314 (3 June),

(2) Michael D., et al, Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction. A Randomized Trial. JAMA. 2005;293:43-53.

(3) Comparison of Diets for Weight Loss and Heart Disease Risk Reduction-Reply. Michael Dansinger. JAMA. 2005;293:1590-1591.

(4) Kruger J. et al. Dietary and physical activity behaviors among adults successful at weight loss maintenance. International Journal of Behavioral Nutrition and Physical Activity 2006, 3:17 doi:10.1186/1479-5868-3-17

(5) Byrne S, et al. Weight maintenance and relapse in obesity: a qualitative study. Int J Obes Relat Metab Disord. 2003 Aug;27(8):955-62.

(6) Borg P, et al. Food selection and eating behaviour during weight maintenance intervention and 2-y follow-up in obese men.Int J Obes Relat Metab Disord. 2004 Dec;28(12):1548-54.

(7) Byrne SM. Psychological aspects of weight maintenance and relapse in obesity. J Psychosom Res. 2002 Nov;53(5):1029-36.

(8) Elfhag K, et al. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005 Feb;6(1):67-85


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