Category Archives: Weight Loss

Half of U.S. Adults Trying to Lose Weight

No wonder we’re so fat:

“Exercise, eating less, consuming more fruits and vegetables and drinking more water were the most common strategies. The least common were skipping meals and cutting down on fatty foods.”

Source: Nearly Half of Americans Battling to Lose Weight: CDC Data – Bloomberg Quint

Drinking more water? Come on, America, get serious. And it’s the rare person indeed who can lose with with exercise. You don’t have to cut down on fatty foods.

Paleobetic Diet-FrontCover_300dpi_RGB_5.5x8.5

 

 

Are Pills the Answer to Unhealthy Lifestyles?

paleobetic diet, low-carb diet, diabetic diet

“This is much easier than exercising and losing 30 pounds!”

Fiona Godlee, editor-in-chief of the British Medical Journal, has a heretical short article at BMJ. I recommend you read the whole thing. It starts thusly:

More than half of adults aged over 45 will be labelled as hypertensive if new US guidelines are adopted, concludes a study in The BMJ this week (doi:10.1136/bmj.k2357). This equates to 70 million people in the US and 267 million people in China being eligible for antihypertensive drugs, a marked increase on already high rates of drug treatment for high blood pressure. Furthermore, the study calculates that 7.5 million people in the US and 55 million in China would be advised to start drug treatment, while 14 million in the US and 30 million in China would be advised to receive more intensive treatment. The evidence from trials indicates some benefit from drugs in terms of reduced risk of stroke and heart disease, but is mass medication really what we want?

Hypertension is just one of the many heads of the lifestyle disease hydra. Another is type 2 diabetes. Once thought to be irreversible and progressive, it is now known to be potentially reversible through weight loss. This is the cautious conclusion of the review by Nita Forouhi and colleagues (doi:10.1136/bmj.k2234), part of our series on the science and politics of nutrition (bmj.com/food-for-thought). Whether by calorie or carbohydrate restriction, weight loss has been shown to improve glycaemic control, blood pressure, and lipid profile and is the key to treatment and prevention of type 2 diabetes, they say.

She goes on to talk about fatty liver disease (NASH) and offers an alternative, of sorts, to pills. Good luck with that.

Source: Pills are not the answer to unhealthy lifestyles | The BMJ

Increase Protein Consumption to Help With Weight Loss

Sous vide chicken and sautéed sugar snap peas. Chicken is a good source of high biologic value protein.

P.D. Mangan makes an argument for high-protein diets for those hoping to shed pounds of fat:

In humans, data collected from 38 different trials of food consumption that used widely varying intakes of protein, from 8 to 54% of energy, showed: “Percent dietary protein was negatively associated with total energy intake (F = 6.9, P < 0.0001) irrespective of whether carbohydrate (F = 0, P = 0.7) or fat (F = 0, P = 0.5) were the diluents of protein. The analysis strongly supports a role for protein leverage in lean, overweight and obese humans.”

In obese humans, substitution of carbohydrate with protein leads to far greater weight loss, nearly twice as much.

In a human trial, decreasing the percentage of protein in food from 15% to 10% led to increased calorie intake of 12%. However, increasing the protein percentage from 15 to 25% did not affect calorie intake, which shows that humans may target a certain amount of protein, and eat no more or less when they get it.

There’s more at the link.

Source: Higher Protein for Greater Weight Loss – Rogue Health and Fitness

Julia Belluz Wonders Why Diets Succeed or Fail

You won’t gain weight from this meal

Julia Belluz has an 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 month, 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

Is There a Cure for Type 2 Diabetes?

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). The full text of the scientific report may have been published already. I bet the drop-out rate was high.

 Steve Parker, M.D.

 

If You Resolved to Lose Weight in 2018…

…you need to read my series on preparing for weight loss. It will improve your odds of success.

The answer’s not in this TV infomercial

Lose Weight With Diet; Maintain Weight Loss With Exercise

Exercise was natural when we were kids

It’s a lesson most of us working in the field learned years ago.

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.

Steve Parker, M.D.

Weight-Loss Diets Don’t Work: True or False?

Does A Whole Food Plant-Based Diet Work?

Carb-rich whole-grain bread

Depends on how you define “work.”

New Zealand researchers found significant long-term weight loss and improved cholesterol levels over six and 12 months with a low-fat vegetarian diet. Surprisingly, this was accomplished without restriction on calories and without an exercise component. Weight loss measured at six months was 27 lb (12.1 kg) and they only gained a little back by six months later.

The authors think the successful weight loss was from “… the reduction in the energy density of the food consumed (lower fat, higher water and fibre). Multiple intervention participants stated ‘not being hungry’ was important in enabling adherence.”

I scanned the article pretty quickly and don’t see that they referred to the diet as vegetarian. Here’s their test diet description:

We chose a low-fat iteration of the plant-based diet [7–15% if calories as fat] as this has been shown with previous research to achieve optimal outcomes, especially for heart disease and weight loss. This dietary approach included whole grains, legumes, vegetables and fruits. Participants were advised to eat until satiation. We placed no restriction on total energy intake. Participants were asked to not count calories. We provided a ‘traffic-light’ diet chart to participants outlining which foods to consume, limit or avoid. We encouraged starches such as potatoes, sweet potato, bread, cereals and pasta to satisfy the appetite. Participants were asked to avoid refined oils (e.g. olive or coconut oil) and animal products (meat, fish, eggs and dairy products). We discouraged high-fat plant foods such as nuts and avocados, and highly processed foods. We encouraged participants to minimise sugar, salt and caffeinated beverages.

Perfect diet compliance would make this a vegan diet. I didn’t catch it in the text of the article, but I’m guessing protein calories were 10–15% of the total, and carbohydrates were around 75%.

The researchers called their investigation the BROAD study. All study subjects were overweight or obese adults. A control group ate their regular foods. The intervention group eating the whole food plant-based diet numbered 33, including 7 with type 2 diabetes. All studies like this have people that drop out. I.e., they quit or otherwise get lost to follow-up. Of the intervention group, 75% lasted for six months, 70% stuck with it for the entire 12 months.

There weren’t enough diabetics in the study to make statistically significant conclusions, but the authors write, “Hemoglobin A1c reductions favoured the intervention and all intervention patients with a diabetes diagnosis improved while adherent, and two resolved their condition by HbA1c.”

I’d love to see these researchers repeat this study with 50–100 overweight or obese folks with T2 diabetes. Clearly, it’s a radically different diet than what I recommend for my patients with diabetes.

Steve Parker, M.D.

PS: For science nerds, here’s the study abstract:

Background/Objective: There is little randomised evidence using a whole food plant-based (WFPB) diet as intervention for elevated body mass index (BMI) or dyslipidaemia. We investigated the effectiveness of a community-based dietary programme. Primary end points: BMI and cholesterol at 6 months (subsequently extended).

Subjects: Ages 35–70, from one general practice in Gisborne, New Zealand. Diagnosed with obesity or overweight and at least one of type 2 diabetes, ischaemic heart disease, hypertension or hypercholesterolaemia. Of 65 subjects randomised (control n=32, intervention n=33), 49 (75.4%) completed the study to 6 months. Twenty-three (70%) intervention participants were followed up at 12 months.

Methods: All participants received normal care. Intervention participants attended facilitated meetings twice-weekly for 12 weeks, and followed a non-energy-restricted WFPB diet with vitamin B12 supplementation.

Results: At 6 months, mean BMI reduction was greater with the WFPB diet compared with normal care (4.4 vs 0.4, difference: 3.9 kg m−2 (95% confidence interval (CI)±1), P<0.0001). Mean cholesterol reduction was greater with the WFPB diet, but the difference was not significant compared with normal care (0.71 vs 0.26, difference: 0.45 mmol l−1 (95% CI±0.54), P=0.1), unless dropouts were excluded (difference: 0.56 mmol l−1 (95% CI±0.54), P=0.05). Twelve-month mean reductions for the WFPB diet group were 4.2 (±0.8) kg m−2 BMI points and 0.55 (±0.54, P=0.05) mmol l−1 total cholesterol. No serious harms were reported.

Conclusions: This programme led to significant improvements in BMI, cholesterol and other risk factors. To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise.

Source: Nutrition & Diabetes – The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes

Does Cold Exposure Help With Weight Loss?

Well below room temp here

Probably well below room temp here

David Mendosa found a 2016 research report suggesting that cool temperatures may help with weight management by activating our brown fat, which burns more calories. Heat generated by brown fat is derived from glucose and triglycerides. Keep in mind as you read further that a comfortable environment temperature for a clothed human is about 23°C or 73°F. Those temps don’t stress our bodies by requiring us to either generate or dissipate extra body heat.

David writes:

Researchers have discovered that when we get mildly cold, which they define as being cool without shivering, our bodies burn more calories. As a result, managing our weight can be easier.
This is the conclusion of a recent review that two researchers at Maastricht University Medical Center in the Netherlands published in the November 2016 issue of the professional journal Diabetologia. The title of their article, “Combatting type 2 diabetes by turning up the heat,” puzzled me at first.

The title confused me because the study is about turning down the heat in the room we’re in. But then our bodies compensate by turning up their internal heat production.

When our body does this, its energy expenditure increases, ratcheting up our metabolism. Being mildly cold revs up our bodies’ brown fat, which unlike white fat, burns calories instead of storing them.

It’s not quite clear how much cold exposure it takes to turn on your brown fat. From the link above:

Cold acclimation by intermittent exposure to a cool (14–17°C) [57–63°F], or cold (10°C) [50°F] environment resulted in significant increases in NST [non-shivering thermogenesis or heat production] capacity. A 10 day cold acclimation study with 6 hour exposure to 14–15°C [57–59°F] per day was enough to significantly increase NST by 65% on average. A 6 week mild cold acclimation study (daily 2 hour cold exposure at 17°C [63°F]) also resulted in an increase in NST together with a concomitant decrease in body fat mass. The latter two studies also revealed significant increases in BAT [brown adipose tissue] presence and activation. All in all, cold-induced BAT activity is significant in adults and parallels NST. The actual quantitative contributions of BAT and of other tissues (e.g. skeletal muscle) to whole-body NST are, however, not elucidated and await further studies. Furthermore, more information is needed on the duration, timing and temperatures to find out which treatments are most effective with respect to increasing NST.

Furthermore, cold exposure over the course of 10 days increased insulin sensitivity in T2 diabetics by 43%. Eight study subjects, probably in the Netherlands, were exposed to temps of 14–15°C [57–59°F] but I don’t know for how many hours a day. Increased insulin sensitivity should help keep a lid on blood sugar levels and reduce the need for diabetes drugs.

In case you’re elderly, obese, or have type 2 diabetes, be aware that the activation of brown fat by cold exposure is not as robust as in others.

On the other hand, I found evidence that higher ambient temperatures (above 23°C) [73°F] may also help with weight management, regardless of what brown fat is doing. Science is hard.

Steve Parker, M.D.

PS: Check out my books for more ideas on weight management.