Overall, energy restriction is the primary factor producing weight loss, and it is increasingly understood that distinct macronutrients may vary in energy yield and effects on satiety, also based on individuals’ phenotype and genotype. Although an overall healthy diet, either Mediterranean or a low-fat, high-complex CHO [carbohydrate] diet may be effective in diabetes and cardiovascular prevention, insight is increasing that dietary prevention or treatment may require more personalized approaches to become most effective.
—E.E. Blaak, in a review of effects of dietary carbohydrate in body weight control, glucose homeostasis and cardiovascular risk
In plain English, Blaak is saying:
- weight loss depends on calorie restriction
- proteins, fats, and carbs provide different amounts of energy and have different effects on hunger
- your response to proteins, fats, and carbs depends on your genes and how you look
- the healthiest diet for you probably isn’t the best for everyone else
Steve Parker, M.D.
…according to an article at MedPageToday.
Band Gastric Bypass Surgery
Self-harm emergencies rose by 50% after gastric bypass surgery in the Canadians in this study.
Folks on my diets lose weight without an increase in suicide risk, as far as I know. Click on my name for the diets.
Steve Parker, M.D.
PS: If you’re thinking about killing yourself, please please please call the National Suicide Prevention Lifeline or some other reliable source for help!
It may not matter whether you eat this particular low-carb meal at lunch or dinner
They say that to lose excess weight, you should eat breakfast like a king, lunch like a prince, and dinner like a pauper.
A recent study tested whether weight loss in dieting women was more effective by making lunch rather than dinner (evening meal) the main meal of the day. Over the course of 12 weeks, dieters making lunch their main meal lost 4 lb (2 kg) more than the other group. Furthermore, the lunch eaters had better improvement in their insulin resistance (as measured by HOMA-IR)
From the abstract:
“Background: The association between the time of nutrient intake and health has been described in a few studies. To our knowledge, no study has evaluated the relation between high energy intakes at lunch compared with at dinner on weight loss in overweight and obese subjects.
Objective: We compared the effect of high energy intake at lunch with that at dinner on weight loss and cardiometabolic risk factors in women during a weight-loss program.Design: Overweight and obese women [n = 80; body mass index (BMI; in kg/m2): 27–35; age: 18–45 y] were asked to eat either a main meal at lunch (LM) or a main meal at dinner (DM) for 12 wk while in a weight-loss program.
Conclusions: The consumption of higher energy intake at lunch compared with at dinner may result in favorable changes in weight loss in overweight and obese women after a weight-loss program of 12 wk. The consumption may also offer clinical benefits to improve insulin resistance.”
Source: Beneficial effect of high energy intake at lunch rather than dinner on weight loss in healthy obese women in a weight-loss program: a randomized clinical trial
I don’t have the full text of the research report, so I don’t know what kind of diet the women were on. The researchers seem to be based in both Iran and Great Britain. I don’t know the nationality of the women participating. The metabolism of Iranians may be different from Brits.
Steve Parker, M.D.
MNT has the details:
“Around the world, weight gained from holiday feasting takes months to lose, a study found.
Christmas Day in particular is a holiday that appears to pack on the pounds: in a study of some 3,000 individuals in three countries, Americans showed an average 0.4% weight gain from 10 days before Christmas to 10 days after; Germans gained 0.6% more weight; and the Japanese 0.5%.
U.S. participants packed on 0.7% more weight in total during the full Christmas-New Year holiday season, but the Germans had us beat with a 1.0% weight gain, according to Brian Wansink, PhD, of Cornell University in Ithaca, N.Y. and colleagues.”
Source: Holiday Feasts Take Months-Long Weight Toll | Medpage Today
Those percentages aren’t very helpful, are they? In real life, if you weigh 180 lb (81.8 kg) and gain an extra 0.7%, you’re all the way up to a whopping 181.26 lb (82.4 kg). But if you do that—1.26 lb—every year for 20 years and fail to lose the weight, you’re up to 205 lb (93.2 kg) and now you’ve got diabetes and high blood pressure.
Here are a few tips to avoid the weight gain:
- On the day of the major feast, just eat two meals, and make one of them small
- Don’t snack or graze; just eat at mealtimes
- Work in some extra exercise
- Minimize the alcohol that weakens your discipline
Steve Parker, M.D.
Pro Tip: Read one of my books before you make your annual New Year’s weight-loss resolutions.
PPS: Click for the research report in NEJM.
Dr. Sarah Hallberg makes a hell of a lot of sense in her New York Times article:
“Recently, 45 international medical and scientific societies, including the American Diabetes Association, called for bariatric surgery to become a standard option for diabetes treatment. The procedure, until now seen as a last resort, involves stapling, binding or removing part of the stomach to help people shed weight. It costs $11,500 to $26,000, which many insurance plans won’t pay and which doesn’t include the costs of office visits for maintenance or postoperative complications. And up to 17 percent of patients will have complications, which can include nutrient deficiencies, infections and intestinal blockages.
It is nonsensical that we’re expected to prescribe these techniques to our patients while the medical guidelines don’t include another better, safer and far cheaper method: a diet low in carbohydrates.”
Source: Before You Spend $26,000 on Weight-Loss Surgery, Do This – The New York Times
“Those numbers are so small!”
I’ve been reading about Banting’s diet for at least six years. Thanks to Tim Noakes in South Africa, it’s seeing a mini-surge in popularity. William Banting published his Letter on Corpulence in 1863. Eating like him to lose weight is sometimes referred to as “Banting.” It’s one form of a low-carb diet and considered a precursor to the Atkins diet.
Form your own opinion of what William Banting may have eaten by reading these:
In terms of macronutrient calories, here’s my rough back-of-the-envelope synthesis of Banting’s diet:
- 20–25% carbohydrate
- 25% protein
- 20–25% fat
- 25% alcohol
- 1800–2000 total calories
For the 200 lb (91 kg) man that Banting was, 2000 calories would almost certainly have been a calorie-restricted diet. Leigh estimated he was eating at least 2800 cals/day at baseline before losing weight. I don’t doubt that.
In summary, Banting drank a lot of alcohol (even more than on the Ketogenic Mediterranean Diet), and ate fairly low-fat, moderately carb-restricted, and relatively high protein. In other words: low cal, low carb, low fat, high protein, high alcohol.
His weight loss, assuming it wasn’t a hoax, came from calorie restriction. Something about that combination of macronutrients apparently allowed him to stick with the program and maintain a 50-lb (23 kg) weight loss. Protein is particularly satiating. Your mileage may vary.
I’m concerned that 25% of calories from alcohol would displace more healthful micronutrients.
Steve Parker, M.D.
PS: Fun Fact: William Banting was a distant relative of Frederick Banting, the co-discoverer of insulin in 1921.
PPS: My diets are healthier than Banting’s, thanks to 150 years of nutrition science since then.
Strength training helps get excess blood sugar out of circulation, but exercise is often disappointing as a weight-loss method
It’s common on any weight-loss program to be cruising along losing weight as promised, then suddenly the weight loss stops although you’re still far from goal weight. This is the mysterious and infamous stall.
Once you know the cause for the stall, the way to break it becomes obvious. The most common reasons are:
- you’re not really following the full program any more; you’ve drifted off the path, often unconsciously
- instead of eating just until you’re full or satisfied, you’re stuffing yourself
- you need to start or intensify an exercise program
- you’ve developed an interfering medical problem such as adrenal insufficiency (rare) or an underactive thyroid; see your doctor
- you’re taking interfering medication such as a steroid; see your doctor
- your strength training program is building new muscle that masks ongoing loss of fat (not a problem!).
If you still can’t figure out what’s causing your stall, do a nutritional analysis of one weeks’ worth of eating, with a focus on daily digestible carb (net carbs) and calorie totals. You can do this analysis online at places like FitDay or Calorie Count.
What you do with your data depends on whether you’re losing weight through portion control (usually reflecting calorie restriction) or carb counting. Most people lose weight with one of these two methods.
Are you eating too many of these?
If you’re a carb counter, you may find you’ve been sabotaged by “carb creep”: excessive dietary carbs have insidiously invaded you. You need to cut back. Even if you’re eating very-low-carb, it’s still possible to have excess body fat, even gain new fat, if you eat too many calories from protein and fat. It’s not easy, but it’s possible.
Those who have followed a calorie-restriction weight loss model for awhile may have become lax in their record-keeping. The stall is a result of simply eating too much. Call it “portion creep.” You need to re-commit to observing portion sizes.
A final possible cause for a weight loss stall is that you just don’t need as many calories as you once did. Think about this. Someone who weighs 300 lb (136 kg) is eating perhaps 3300 calories a day just to maintain a steady weight. He goes on a calorie-restricted diet (2800/day) and loses a pound (0.4 kg) a week. Eventually he’s down to 210 lb (95.5 kg) but stalled, aiming for 180 lb (82 kg). The 210-lb body (95.5 kg) doesn’t need 3300 calories a day to keep it alive and steady-state; it only needs 2800 and that’s what it’s getting. To restart the weight loss process, he has to reduce calories further, say down to 2300/day. This is not the “slowed down metabolism” we see with starvation or very-low-calorie diets. It’s simply the result of getting rid of 90 pounds of fat (41 kg) that he no longer needs to feed
Steve Parker, M.D.