Changing Lifestyle May Be More Important Than Losing Pounds : Health: Quick weight-loss schemes don’t work over the long haul, many experts believe. It’s better to shed smaller amounts over a longer period of time.
For those striving to shed pounds, the news this spring seemed grim. A panel of experts convened by the National Institutes of Health in March found little evidence to show that diets are effective for the long term.
That doesn’t mean that health experts are saying gain as much weight as you like or don’t try to lose some of that paunch. The experts concluded that “being overweight has serious adverse effects on health and longevity,” but they also noted that, on average, dieters “tend, over time, to regain whatever weight might have been lost initially.”
What the findings suggest is that for many people, weight control needs to be viewed as a long-term commitment to a healthier lifestyle, not a simple one-time effort to lose 20 pounds. The evidence increasingly shows that changing habits--eating less, exercising more--may be more important than simply losing pounds.
Whether you want to trim five pounds or take off 20, the latest research underscores some important lessons for losing weight. Here are some of the highlights of findings that were presented before the 13-member NIH panel.
* Diet is a four-letter word.
Whether an individual effort at curbing calories or an expensive commercial plan with special foods and group motivational activities, diets generally don’t get the job done.
“Don’t diet,” said John Foreyt, director of the Nutrition Research Clinic at Houston’s Baylor College of Medicine. He presented his and other studies on the use of behavioral therapy to lose weight. “Focus on your lifestyle, on what is a healthy eating plan--one that is sensibly lower in fat.” Along with that, add regular physical activity, Foreyt said. “Then let the weight take care of itself.”
The message is to learn to eat “out of gut hunger,” said Foreyt, co-author of “Living Without Dieting,” “not out of emotional feelings” like anger, boredom or frustration.
Frequently, people undertake a diet without being strongly committed to a change in lifestyle, and the weight initially lost can quickly reappear--a pattern often dubbed yo-yo dieting.
Growing evidence suggests that yo-yo dieting may be harmful, although such study results are still quite new and not well understood. Reports from two major scientific studies--the ongoing Framingham Heart Study and the Multiple Risk Factor Intervention Trial (MRFIT)--showed that people who fell into this pattern are at greater risk of health problems.
In the MRFIT study, which only included men, those whose weight cycled were at increased risk of dying from heart attacks and other causes of early death, said Steven A. Blair, director of epidemiology at the Cooper Institute for Aerobics Research in Dallas.
What causes these results from yo-yo dieting is not yet understood, and the panel has asked for more research funding. “It may be that it is the binge-and-gluttony side of the yo-yo thing that is the bad part,” said William Castelli, head of the Framingham Heart Study. “Not the (weight) loss side at all.”
Until researchers know, their advice is to make certain that motivation is high before trying to lose weight.
“Dieting is something that people should undertake with caution,” according to Kelly Brownell, professor of psychology at Yale University. People considering weight loss “should make sure that they have the continued commitment to change their eating and exercise habits. And they should follow a program or plan that offers the best hope for maintenance” of weight loss.
* Figure on a long, slow weight loss.
Weight-loss experts like to point out that it takes time to gain weight, and people shouldn’t be surprised that it takes time to lose pounds, too. Yet the tendency is to look for diet short-cuts, for ways to shed pounds quickly and with as little effort as possible.
“Radical programs don’t seem to make much sense,” said F. Xavier Pi-Sunyer, director of the Obesity Research Center at St. Luke’s-Roosevelt Hospital Center in New York. “It’s the rather conservative, slow approach that seems to work.”
Even fasting--a method that few recommend except for hospitalized, very obese patients--produces an average weight loss of only about four pounds each week.
Most experts recommend setting a goal of losing one to two pounds a week. At this pace, pounds are lost over a long enough time to ingrain new habits. Dieters also tend to feel less deprived, since they are not eating an extremely low-calorie diet. Gradually trimming pounds also seems to result in less protein loss.
Evidence presented to the panel suggests that programs that run four to five months have the least attrition and best long-term results, said Thomas A. Wadden, professor of psychology at Syracuse University.
* Set reasonable weight-loss goals.
Studies reviewed by the NIH panel show that a 10% loss of body weight is the average that most people achieve. For a 200-pound man, this means shedding roughly 20 pounds. For a 140-pound woman, it translates to a 14-pound loss.
While this may not seem like a lot, nonetheless, reports from several large trials suggest that it can benefit health. Research from the Framingham Heart Study and the MRFIT study show that trimming 10% of body weight can reduce the risk of developing high blood pressure or diabetes.
* Switch to low-fat foods but don’t overlook calories.
One gram of fat contains nine calories. One gram of protein or one gram of carbohydrates contain just four calories each. That’s one of the reasons that dieters are advised to eat low-fat foods. This style of eating can also help reduce blood cholesterol levels--a common problem in those who are overweight.
Some researchers had suggested that eating a high-carbohydrate diet might help raise the body’s metabolic rate, and thus burn more calories. But the effect is small, James O. Hill, associate professor of pediatrics at Vanderbilt University School of Medicine in Nashville, told the panel. “Eating more carbohydrates helps . . . but the best way (to lose weight) is to decrease the total number of calories eaten.”
Bingeing on any food--even the low-calorie varieties--won’t help shed pounds. That’s why restricting calories “still remains the cornerstone of weight loss,” said Wadden. Programs that achieve good results over a long term generally recommend eating no more than 1,000 to 1,500 calories a day for women and 1,500 to 1,800 calories for men.
* Combine exercise with dieting.
Numerous studies show that the people most successful at losing weight and keeping it off are those who exercise and reduce calories. Abby C. King of Stanford University presented to the NIH panel a comparison of long-term weight-loss studies that compared the effectiveness of three approaches: dieting only, exercising only and a combination of the two. He found that the average weight loss from diet alone was about nine pounds. From exercise alone, it was nearly 11 pounds. But when participants cut back on calories and exercised, they averaged a weight loss of nearly 16 pounds.
“If you do just a little exercise when you diet, you make the weight come off as fat,” as opposed to protein loss, said Castelli.
It may also help with another persistent problem: keeping the weight off for good. Those who couple exercise with dieting are “much less likely” than those who diet alone to regain weight during follow-up, said Blair.
* Very-low calorie liquid diets should be used only by the very obese.
Liquid diets that restrict calories to 800 per day are effective in shedding pounds. But there is disturbing evidence that the weight may be regained more quickly afterward than with other programs. That’s why researchers advise that these extreme diets be used only for individuals whose weight is so great that they are endangering their lives.
For these individuals, the trend is increasingly toward long-term treatment that can last as long as a year and include diet, exercise and behavior modification.
