Frequently Asked Questions (FAQs)

Severe overweight is associated with a vast array of health problems, including chronic pain, diabetes, etc.  Over the past 75 years or so, two behavioral themes have dominated approaches to losing weight.  The most common but erroneous theme continues to be that finding the “best” commercial diet can provide a path to permanent weight loss for most people.   Another false theme is that the quantity of food one eats, whatever it is,  accounts for weight gain.  The fact is that over 80% of people who attempt to lose weight gradually gain it back, and then some.   I would like to highlight some of the valid themes and facts about weight loss and its relation to eating behavior and activity choices.   My claims here are based on my understanding of the large research literature that exists on weight loss and especially, weight loss failure and success. 

First, it is critical to reject the idea that most people can lose weight through a diet that lasts a few months, and that following weight loss, one can then return to his or her prior eating and activity levels, with little consequence.  This belief is utterly false because your body uses a large number of physiological mechanisms that are specifically designed to retain body fat. Literally, your body is built to fight your efforts to lose weight.  You have probably familiar with the idea of “yo-yo” dieting, in which people regularly spend years losing weight, gaining it back, attempting to lose it again, regaining, etc.  Nearly all people who attempt weight loss find that in the end their body is more persistent in retaining fat than dieters are in losing it. The first general behavioral principle suggests that successful long-term weight loss involves an array of interactive permanent lifestyle changes, usually adopted in “baby steps”. Relatedly, the individual has to find them pleasant and rewarding to do or they will tend to stop doing them at some point.

A second, quite valid behavioral aspect of weight loss is that most people can in fact, lose weight (short term) by adopting any of the generally popular commercial programs that have been around a long time, such as Weight Watchers, Jenny Craig, a “paleo” eating regimen, etc.  Studies that compare the effectiveness of different programs fail to show meaningful differences in long term outcomes.  Also, successful outcomes in these programs are on average, modest (up to about an average of seven pounds lost); and are nearly always short-lived. People nearly always gain the weight back when they leave the program.  I believe that one of the key elements to permanently altering your eating behavior lies in finding one of the effective programs that you really like and that you believe you can “live with” for the rest of your life.

Given the above, note that I am not interested in debates about whether one diet program is superior to another. However, some general food choices are extremely important to permanent weight loss, and they include the following.  Thus, our third behavioral theme suggests that we shop only in the “simple food” areas of the grocery store, avoiding the “prepared foods” (which incidentally, tend to take up over 50% of commercial grocery isle space; soft drinks, candy, chips, snack foods, bakery goods, etc).  The simple food areas include vegetables, meat a fruit and some dairy products.   The goal is to restrict purchases of products that contain added sugar and high levels of refined carbohydrates. Our high intake of processed sugar and carbs and our tendency to allow others to prepare the food we eat (e.g., “fast food”) contributes heavily to the obesity epidemic in the U.S.   Drastically reducing daily intake of carbohydrates and sugar will help your weight loss efforts tremendously.   In summary, significant increases in the proportion of food containing fats, protein, vegetables, with severe reductions in carbohydrates and sugars, is an important weight loss guideline. 

Second, most people I have worked with over the years have found that a permanent lifestyle change in eating behavior requires serious conscious attention to portion control.  I generally coach people who want to lose weight permanently that if they do nothing else, they will benefit from simply reducing  food portions of meals by roughly 30%, to start with.  In conjunction with consuming smaller portions, it is also helpful to allow enough time (maybe, 10-20 seconds) to deliberately assess whether you are minimally, feeling comfortably “full”.  In fact, slowing the pace of your eating and strictly reducing portions, plus, taking a few seconds to assess whether your are comfortably full are a series of fairly easy “first steps” to helping lose weight.

Third, we know that taking small, gradual steps e.g, incorporating new foods into one’s diet, a little at time, works better than making a radical change from a primarily high carb diet (to one that is sparse on carbs and sugar).   An interesting case study involving Type 2 diabetes patients illustrates this point.  A group of diabetic volunteers started a month-long eating and activity regimen change at an Arizona retreat center.  All were immediately placed on a strict, “raw foods” diet, emphasizing vegetables and some whole grains, with no added sugars or carbs.  Several individuals dropped out rather quickly because they could not adjust to such a radical change to their “American Diet” (e.g., OJ for breakfast, bread, hamburgers with French fries, pizza, etc.). The best approach is to make sure that your dietary changes are gradual, and that you like eating what you are transitioning to.  A simple example might be eating a hamburger with only ½ of the bun, later fading this to eating hamburgers with no bun over time.  Another example of easing into portion control can occur when dining out i.e., every time you visit a restaurant, you plan in advance how you will divide the meal in half and take the uneaen half home with you. You then enjoy the other half the next day for lunch or dinner.   After doing this a few times, many will report they start to look forward to having a favorite meal “twice”, because they exercised portion control. Most people greatly overeat when dining out.

Fourth, two other well-known lifestyle changes that aide permanent weight loss are getting enough total sleep at night, and increasing one’s activity level. A number of credible research studies suggest that quality sleep helps a person lose weight.   Most adults probably need 7-8 hours per night of quality sleep but achieve only about 6-7.  The positive impact of sleep on weight loss is due to factors scientists do not yet understand. However, it is well known that if we get enough sleep, we are much more likely to engage in higher levels of physical activity the next day (because we are not chronically tired).   And, with regard to physical activity level—-there is simply no doubt that strength training and aerobic conditioning play a role in helping a person maintain muscle mass that may decline during weight loss. Though it doesn’t appear to be a major contributor to successful weight loss, increasing physical activity seems to be one of the proven lifestyle changes persons who lose weight long term have adopted. It is recommended that you increase your activity level at least enough to achieve improved aerobic conditioning and to maintain your muscle mass.

Fifth, there is a universal behavioral health theme that is supported by thousands of psychological research studies involving many different types of behavior change goals.  Not surprisingly, the theme has huge implications for long-term, permanent weight loss and maintenance.  The theme is that all behavior change occurs more easily and is more easily sustained if one enjoys high social support for the behavior..  In the area of weight loss and fitness, his means that is helpful to have a friend or loved one who positively encourages, supports, or engages with you in the lifestyle changes you are making.  It is very hard to “go it alone”. For instance, an obese child almost certainly will never lose weight on their own.  The entire family needs to change its food-shopping, meal planning, eating habits and activity level.  Similarly, going on walks or visiting the gym is vastly more likely to occur for most people if they have a work-out partner.   One’s meal changes are more likely to become permanent if his or her partner or family also engages in meal planning and cooking. 

Why do over 80% of people who successfully lose weight regain it?  I now want to introduce a simple hypothesis about what I think accounts for most weight regain following successful “dieting”.   This is an educated speculation that is consistent with all of the best long-term studies examining successful versus unsuccessful  weight loss patients.  The primary reason people gradually regain weight is because they ever-so-gradually abandon the eating and activity behaviors that helped them lose weight in the first place.   While vigilant and consistent for many months, they invariably begin to experience very slight, minor “slips” in their weekly sugar or carb intake, or sleep or activity level..  Or, sooner or later, life circumstances may start to interfere with their lifestyle changes e.g, their usual exercise regimen.  They may start to become just a bit less vigilant about portion control and begin to experience “portion creep”.  They may relapse a bit in the habit of slowing the pace of their eating.  They may more often, grab a quick fast food meal during a busy week more and more often.  Or, recently, if under stress, they may begin to fall back on the old habit of de-stressing by eating a favorite “comfort food”.  They may allow themselves to “overindulge” on more frequent occasions than they did during their weight loss period. 

Researchers find that the most successful, long-term weight loss patients are unusually persistent and consistent.  To sustain weight loss over the very long term, the successful group tends to eat a small, healthy breakfast every day.  They weigh themselves regularly, (about once a week).  They have meal plans that they truly “stick with”, enjoy, and which are healthy. They tend to prepare their own meals, consistently. They watch fewer than 10 hours of TV per week (avoid being sedentary).  They have permanently and consistently cut back on how much they eat in a given day and do not stop monitoring what and how much they eat.  Nearly all make sure they maintain an exercise program,. Generally, this is simply walking many times each week.  In general, their frame of thinking has shifted from “trying to be thin”, to being as strong, well-rested and as “healthy” as they can be.  In summary, my speculation about weight regain after dieting emphasizes the idea that over time, patients ever so slowly fall back into patterns of eating, activity, sleep etc., that promoted their weight gain in the first place.   They tend to not realize it is happening. Given the fact that your body is 100% committed to restoring its fat stores, the successful weight loser cannot afford to relapse much in terms of their lifestyle changes.  He or she will catch themselves very quickly when the first few pounds return.  They reassess where they are reverting to old patterns or habits with eating, grocery shopping, activity, sleep, etc.  They then “go back to what got them here” quite consistently.

One starting point for valid information:

www.youtube.com/watch?v=da1vvigy5tQ

www.youtube.com/watch?v=ktQzM2IA-qU

Copyright 2019  David M. Stein, Ph.D.  Readers are welcome to llink to this article.   Coping this article without the written permission of the author is not permitted.  Coping the article and presenting it on one’s website without appropriately crediting the present author is considered plagiarism.  This action will be reported to state or provincial licensing boards as an ethical violation. 

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