Category Archives: Weight Loss

From Vox: Why Do Diets Fail…or Succeed?

Julia Belluz has interesting article at Vox regarding low-fat and low-carb diet success over the course of 12 months. Her focus is on a few individuals who participated and were outliers.

As I read this, I was reminded that successful long-term weight management starts and ends in the kitchen. It also took me back to 2009, when I determined that low-carb diets were just as legitimate as low-fat.

I don’t recall the author mentioning the typical pattern with 12-month weight loss studies: most folks lose significant weight in the first few months, then at six months they start gaining it back. Cuz they go back to their old eating habits. Sure, diets don’t work………..if you don’t follow them.

From Ms. Belluz:

As a longtime health reporter, I see new diet studies just about every week, and I’ve noticed a few patterns emerge from the data. In even the most rigorous scientific experiments, people tend to lose little weight on average. All diets, whether they’re low in fat or carbs, perform about equally miserably on average in the long term.

But there’s always quite a bit of variability among participants in these studies. Just check out this chart from a fascinating February study called DIETFITS, which was published in JAMA by researchers at Stanford.

The randomized controlled trial involved 609 participants who were assigned to follow either a low-carb or a low-fat diet, centered on fresh and high-quality foods, for one year. The study was rigorous; enrollees were educated about food and nutrition at 22 group sessions. They were also closely monitored by researchers, counselors, and dietitians, who checked their weight, waist circumference, blood pressure, cholesterol, and other metabolic measures throughout the year.

Overall, dieters in both groups lost a similar amount of weight on average — 11 pounds in the low-fat group, 13 pounds in the low-carb group — suggesting different diets perform comparably. But as you can see in the chart, hidden within the averages were strong variations in individual responses. Some people lost more than 60 pounds, and others gained more than 20 during the year.

Read the whole thing. It’s not long.

Source: Why do dieters succeed or fail? The answers have little to do with food. – Vox

The DIETFITS Trial

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com in the U.S.

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Have You Heard of the Milk Diet?

hiking, Arizona, Steve Parker MD,

Tom’s Thumb trail in Scottsdale, AZ

 

I vaguely recall a milk diet to treat stomach ulcers in the mid-20th century. Tagamet changed that!

I’ve been reading scientific articles on low-energy liquid diets for weight loss and diabetes remission, and ran across a reference to a milk diet. I found impressive results in a 16-week study.

This was a small randomized trial that enrolled 45 very fat folks — BMI 41-47, average weight 122 kg (268 lb), mostly women — and assigned them to one of three diets:

  1. Control: conventional balanced diet of normal foods providing about 800 calories/day and at least 36 grams of protein.
  2. Milk: “variable combination of full cream or semi-skimmed milk and unsweetened yoghurt,” about 800 calories/day. BTW, a cup (240 ml) of whole milk has 150 calories.
  3. Milk Plus: same as the milk diet plus “unlimited amount of a single food selected by the patient on each day of the week. Of these seven extra foods, three were a fruit or vegetable, two were a high protein food, and two were a “favourite” food. The seven foods were repeated on the same day of successive weeks.” (If you understand this, you’re smarter than me, which wouldn’t be unusual.) Average calories were 1,350/day.

The researchers figured these adults were eating about 2,500 calories/day at baseline. Diabetics were excluded.

Results

The Milk group lost the most weight. Eleven of the 14 participants completed the 16-week study, with an average weight loss of 11.2 kg (24.6 lb). Constipation was the only “serious” side effect reported. The authors admitted that deficiencies in some vitamins and iron might be a problem, but cited a similar but longer trial (24 weeks) that found no such deficiencies.

Eleven of the 17 in the Milk Plus group persevered for the whole 16 weeks. Average weight loss was 8.2 kg (18 lb).

Nine of the 14 in the Control Group were able to put up with it for the duration. Average weight loss was only 2.6 kg (5.7 lb). I suspect they had a bit of a compliance problem. When you weigh 268 lb, a 5.7 lb loss isn’t much.

“Analysis of compliance (not reported) showed that it was similar for the two milk diets but much lower for the conventional diet.”

Comments

The researchers opine that…

  • “Patients are more likely to respond to a simple diet which they have not tried before than to advice on conventional diets.”
  • Probably the best strategy is to rotate diets,…[to prevent compliance from falling].”

I wonder how well the Milk diet would work for someone who weighs 205 lb (93 kg) and just wants to lose 25 lb (11.4 kg).

I wonder how important are the exact proportions of “full cream or semi-skimmed milk and unsweetened yoghurt.”

I wonder if the Milk diet has ever been tested in overweight people with diabetes. The carbohydrate in milk shouldn’t be a problem since overall calories are so low. A cup of milk has 12 grams of carbohydrate.

As with all diets, weight regain will be a problem after the 16 weeks.

I’m skeptical about the nutritional adequacy of the Milk diet.

The Milk diet might be a good temporary option for someone who wants to lose more excess weight but has hit a weight-loss plateau in their current regimen.

The simplicity of the milk diet is very appealing to me.

Steve Parker, M.D.

Reference: Summerbell, C.D., et al. Randomised controlled trial of novel, simple, and well supervised weight reducing diets in outpatients. British Medical Journal, 317: 1487-1489. November 28, 1998.

Low-Carb Mediterranean Diet, front cover

 

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This May Be Why You’re Not Losing That Weight

Old-school preparation for exercise; stretching actually doesn’t do any good for the average person

You’ll see the term “diet resistant” in the scientific abstract below. It refers to folks who are on a reduced-calorie diet who aren’t losing the weight they should, base on total calorie consumption. Long story short, they’re eating much more than the think and exercising less than they think.

BACKGROUND AND METHODS

Some obese subjects repeatedly fail to lose weight even though they report restricting their caloric intake to less than 1200 kcal per day. We studied two explanations for this apparent resistance to diet — low total energy expenditure and underreporting of caloric intake — in 224 consecutive obese subjects presenting for treatment. Group 1 consisted of nine women and one man with a history of diet resistance in whom we evaluated total energy expenditure and its main thermogenic components and actual energy intake for 14 days by indirect calorimetry and analysis of body composition. Group 2, subgroups of which served as controls in the various evaluations, consisted of 67 women and 13 men with no history of diet resistance.

RESULTS

Total energy expenditure and resting metabolic rate in the subjects with diet resistance (group 1) were within 5 percent of the predicted values for body composition, and there was no significant difference between groups 1 and 2 in the thermic effects of food and exercise. Low energy expenditure was thus excluded as a mechanism of self-reported diet resistance. In contrast, the subjects in group 1 underreported their actual food intake by an average (±SD) of 47±16 percent and overreported their physical activity by 51±75 percent. Although the subjects in group 1 had no distinct psychopathologic characteristics, they perceived a genetic cause for their obesity, used thyroid medication at a high frequency, and described their eating behavior as relatively normal (all P<0.05 as compared with group 2).

CONCLUSIONS

The failure of some obese subjects to lose weight while eating a diet they report as low in calories is due to an energy intake substantially higher than reported and an overestimation of physical activity, not to an abnormality in thermogenesis. (N Engl J Med 1992; 327:1893–8.)

Source: Discrepancy between Self-Reported and Actual Caloric Intake and Exercise in Obese Subjects | NEJM

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Diet to Lose Weight, Exercise to Keep It Off

Exercise is more helpful for preventing weight gain than for inducing weight loss

From The New York Times:

It is a question that plagues all who struggle with weight: Why do some of us manage to keep off lost pounds, while others regain them?

Now, a study of 14 participants from the “Biggest Loser” television show provides an answer: physical activity — and much more of it than public health guidelines suggest.

On average, those who managed to maintain a significant weight loss had 80 minutes a day of moderate activity, like walking, or 35 minutes a day of vigorous exercise, like running.

My patients taught me this years ago.

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Is It True That “Diets Don’t Work”?

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Can I Do the Newcastle Diet On My Own?

Some of these are Newcastle-compliant

Probably. Also probably not a good idea to fly solo, without personal medical attention.

Here’s a link to details of the diet, which has reversed some cases of type 2 diabetes, prepared by Professor Roy Taylor. Overall, his advice looks pretty reasonable to me. However, with such severe calorie restriction (600-800 cals/day), I think a multivitamin supplement might be a good idea.

Note that Taylor says any reasonable diet that leads to loss of enough excess weight may be just as good as the Newcastle diet.

Steve Parker, M.D.

low-carb mediterranean diet

Front cover of book

 

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Brown Fat: What’s That?

The Joslin diabetes blog has an interesting article on brown fat and its effect on metabolic rate and insulin sensitivity. Brown fat is just a type of body type different from the more plentiful white fat (which is actually more pale yellow). If there are other colors of body fat, I don’t know.

If you can “activate” your brown fat, it helps you burn more calories, which could be helpful if you’re trying to lose weight. It also improves insulin sensitivity: beneficial if you have type 2 diabetes or are prone to it.

From Joslin:

“When brown fat is fully activated, it can burn between 200 and 300 extra calories per day. It is most successfully activated through cold exposure. A recent study of people with type 2 diabetes had volunteers sit in a 50 degree room for a couple of hours a day for 10 days in shorts and short-sleeved shirts.

“When I say cold, it’s not icy cold, it’s not like the winter in Boston,” she says. “It’s more or less like the temperature we have here in autumn. After this mild cold exposure, all ten volunteers with type 2 diabetes, as shown in that study, displayed increased brown fat activity and improved insulin sensitivity. This is very exciting.”

Dr. Tseng is working on understanding exactly what is happening on a cellular level to activate brown fat in the cold to see if she can create a drug that will mimic the effects. “Although cold works, it’s just not pleasant,” she says. “If you had to sit in a cold room for a few hours every day, perhaps not everybody could accept that.”

Source: How Your Body Temperature Can Affect Your Metabolism | Speaking of Diabetes | The Joslin Blog

Another way to activate brown fat is exercise (at least if you’re a man or a mouse).

Steve Parker, M.D.

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Over Three Years, Gastric Bypass Beats Intensive Medical Therapy in Obese Type 2 Diabetes

…in terms of weight loss, lowering of HgbA1c, and weight-related quality of life. The specific gastric bypass surgery used in the study is the Roux-en-Y version.

bariatric surgery, Steve Parker MD

Band Gastric Bypass Surgery (not the only type of gastric bypass): very successful at “curing” T2 diabetes if you survive the operation

Average initial weight of participants was 104 kg (229 lb). Bypass patients dropped their weight by 25 kg (55 lb)and HgbA1c decreased by 1.8% (absolute decrease), compared to intensive medical management participants who lost 10.3 kg (32 lb) and dropped HgbA1c only by 0.4%.

I doubt that intensive medical therapy included a low-carb Mediterranean or paleo diet.

Source: Clinical and Patient-Centered Outcomes in Obese Patients With Type 2 Diabetes 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study | Diabetes Care

 

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Cut the Crap: Are You Serious About Weight Loss in 2018?

To improve your odds of success, read my series on preparing for weight loss.

Failing to plan is planning to fail.

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Is Type 2 Diabetes Reversible?

Seems to be, at least for some folks who are overweight. Nine of 10 T2 diabetes are overweight or obese

Science Alert has the story.

The “cure” at hand involves reduction of daily calories to 800 for four weeks. Average weight loss of those in the experimental group was 10 kg (22 lb). I look forward to the published scientific journal report. I bet the drop-out rate was high.

 

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