Body Wise*

*The information contained herein is not intended to diagnose or treat ANY medical condition.

Weight Loss: Take It Slow and Steady

By Marcela Vinocur

Dieting has been around for centuries — the first recorded diet can be traced back to 1087 when England’s King William adopted a diet of alcohol in an attempt to lose weight.
Throughout history, diets were generally prescribed to treat various medical conditions, but over the past century dieting has come to be synonymous with weight loss. Most diets — like the grapefruit diet or the Atkins diet — are used in the short-term for rapid weight loss. These eating programs fail to take into account what may have caused the weight gain in the first place, including emotional factors.

Although most Americans have either been on a diet or known someone who has been on a diet, few are aware of the success rates associated with diets or how one diet compares to another in terms of long-term success and impact on health.

The weight loss industry is a multi-billion-dollar-a-year industry, yet the prevalence of overweight and obesity has reached an all-time high in this country. According to the Center for Disease Control and Prevention (CDC), 35% of American adults are now overweight and 30% are obese. The prevalence of obesity has increased by 75% since 1991.

There may be a variety of factors involved in both weight gain and difficulty losing weight. For example, weight gain can be associated with hypothyroidism, Cushing’s syndrome, and depression, as well as the use of certain medications. Addressing any underlying medical condition is important for anyone undertaking weight loss.

For the majority of Americans, however, weight gain is a result of excess caloric intake in relation to energy expenditure. As a nation, the United States has seen a steady rise in portion size and daily caloric intake. Between 1985 and 2000 the average daily caloric intake of American adults rose by 300 calories.(1)

Given that an excess of 3,500 calories results in a weight gain of one pound, even an excess of 30 calories per day can result in an annual weight gain of three pounds. Over a period of 10 years, that equates to a weight gain of 30 lbs.

The common denominator for weight loss is a negative energy balance — one must consume fewer calories than are expended in order to lose weight. This can be optimally accomplished by reducing caloric intake and increasing physical activity. A net daily deficit of 500 calories (300 from dietary changes and 200 from exercise) will result in a weight loss of four pounds per month.

In general, weight loss results in a reduction in both muscle and fat mass (20% muscle, 80% fat). Weight loss in excess of 6 lbs per month is likely to cause an increased loss of muscle mass, which may result in a reduction in metabolic rate, as muscle burns more fuel than fat. Thus, weight loss may be easier to maintain if it occurs gradually.

Contrary to popular belief, “crash” or “fad” diets that help you quickly shed unwanted pounds do not yield long-term gains. In fact, some of those diets can be harmful to your health. There are medical complications associated with very low calorie diets, such as the formation of gallstones.

Furthermore, rapid weight loss from dieting is almost impossible to maintain. While the exact mechanism of rebound weight gain is not clearly understood, one largely ignored complication is the sense of failure that often accompanies regaining the weight once the diet is over. This can result in lowered self-esteem, loss of self-confidence, and in some cases, shame, guilt, and a sense of hopelessness.

There is now limited scientific evidence indicating that people who diet actually gain more weight than those who don’t. During a seven-year study, researcher Alison Field and her colleagues found that adolescents who engaged in dieting actually showed greater weight gain than those who didn’t. In fact, the longer these adolescents dieted, the more weight they were likely to gain.(2)

On the other hand, clear and compelling research indicates that the ticket to losing and maintaining weight is lifestyle changes. A diet that emphasizes fresh fruits and vegetables, low-fat protein sources, and whole grains, while avoiding processed foods, aids weight loss and improves overall health. Moderate-paced physical activity on a regular basis also plays a significant role in weight management and long-term health.

The good news is that even moderate weight loss (5% to 10% of your total body weight) can yield significantly improved health.

The safest, most effective form of long-term weight loss is maintaining a healthy diet and engaging in regular physical activity.

Marcela Vinocur, MD, completed her residency training in Psychiatry. She has a special interest in chronic disease prevention. She maintains a practice specializing in psychopharmacology and serves as the medical director of the weight reduction program at Portland Health and Wellness. She can be reached at 503-236-4506 or www.portlandhealthandwellness.com.

1. J. Putnam et al, “US Per Capita Food Supply Trends.” Food Review. Winter 2002; 25(3):2-15
www.ers.usda.gov/publications/FoodReview/
2. From a poster presented at the 2005 National Association for the Study of Obesity.