Losing Weight Is Easy Staving It Off Aint A Lesson in High vs Very High Energy Restrictions Whats More Effective

If you tried to follow all the "good advice" you can find on the Internet and in the myriad of diet books and ebooks, I can guarantee that you are going to get fatter, not leaner. When it comes to dieting, there is after all nothing worse than doings things by halves... but is this also true for cutting your energy intake by half?

Ok, I freely admit that I have tricked you. Despite the fact that the study at hand is a randomized human study, it is possible that it is not 100% relevant for all of you. After all, the subjects in Lisa M. Nackers, Kathryn R. Middleton, Pamela J. Dubyak, Michael J. Daniels, Stephen D. Anton and Michael G. Perris latest experiment were not exactly as lean as I would expect most of you are (this reminds me that I wanted to put up a questionnaire).

In other words, the subjects were obese. Whether the fact that they were also female is as grave a difference is something I cannot tell, but in view of the fact that this makes weight loss even harder, I would say its probably not much of a problem if you are a man (and lets be honest, dont we all have a female friend who is constantly complaining about her weight, guys?)

Inspite of a mean BMI of 37.84kg/m², the relative results of this study will probably apply to a lean person, as well. In other words, if the women in the study at hand were randomized to consume either 1,000 or 1,500 kcal/day per day, I would suggest that a lean man / woman with much lower fat reserves to draw on should never go below 1,500 / 1,200 kcal/day.

So, this is not you, but the results are still intriguing

The important question was and still is now: Whats more effective? A high, or a low caloric deficit? As a seasoned SuppVersity student, you will be aware that the "grazing approach to lose weight" in the course of which you reduce your calorie intake by only 5%, to make sure that (a) its not getting to hard for you, or (b) you are not losing any muscle, will fail miserably and can result in serious deteriorations of your body composition (learn more). But what about the alternatives? Which of them, i.e. the -50% or the -25% diet, is appropriate for the obese ladies and which could be a model for yourself?

No exercise = not necessarily negligence: I know, for physical culturists like you and me, it sounds hilarious that the subjects were not encouraged to actually work out. If we are honest, we all know that this would have been the first thing the participants dropped in the unsupervised phase II of the study. I was thus not negligent to tell the subjects to simply follow the 10,000 steps per day approach as it is recommended by Donelly et al. in their often-cited 2009 ACSM Position Stand.

We know from previous research that lifestyle interventions are capable of inducing weight reduction of 7-10% and corresponding decreases in risk factors for heart disease and diabetes within weeks (DPPRG. 2002; Look AHEAD Research Group. 2010; Butryn. 2011).

"Get Your Protein, Veggies & Fruits and Get Them Regularly: High(er) Meal Frequency (6 à Day) + High(er) Protein Diet Support Weight & Fat Loss on a Diet " | learn more

"Nonetheless, behavioral changes initiated during lifestyle treatment often are poorly maintained and regaining of lost weight is common, thereby diminishing health benefits of weight loss. As a variety of biological and environmental influences make it difficult to maintain large dietary changes, a number of researchers and professional organizations have proposed a ‘‘small change’’ approach to weight management, arguing that small sustainable changes will produce better long-term weight control than larger changes that are unlikely to be sustained.

Alternatively, other researchers have observed that larger initial dietary changes, and the greater, more rapid weight losses they produce, are more likely to reinforce the weight-change process and lead to better long-term weight-loss outcomes." (Nackers. 2013)

In other words, as of now, its mostly a question of faith, not one of scientific evidence, whether you answer my previous question in favor of the "small change" or the "massive reduction" approach.

Fast and hard, or slow and steady? How would you like it?

Ah, well... this is of course before youve taken a look at the results of this 12 months dietary intervention, of which the researchers speculated that it would demonstrate greater short- and long-term weight losses, and higher rates of weight loss in the metabolically relevant >5% body weight region in the 1,000kcal/day vs. 1,500kcal/day group.

If you do now finally take a peak at the actual results after 6 months with group-care (supervision) and the subsequent unsupervised 6 months "weight maintenance" (mind the inverted commas ;-) phase, what would you tell your chubby female friend shed do? Cut back drastically or moderately?

Figure 1: Weight loss in the supervised (0-6m) and unsupervised (7-12m) of the study; the %-values indicate the relative difference between the 1,000kcal and the 1,500kcal diets (Nackers. 2013)

If we go by the results of the study at hand, the answer probably is: "Cut back drastically." Someone who is, unlike the ladies in the study at hand, not putting his health at risk if he maintains his current body weight, would yet probably be better off running a "moderate" caloric deficit of 25-30%. This could help him or her minimize the dreaded "fat rebound".

I mean, despite the fact that the post-diet weight gain in the study at hand was less pronounced than the average Internet craze about "yoyo"-dieting would suggest, any form of uncontrolled weight gain after weeks or months of serious dieting could potentially raise your body fat levels to previously unexpected new heights.

You can learn more about dieting at the SuppVersity

Chronic Dieting
➫ Fat Athletes

Diet Down to Below 5% BF

Overtraining & Undereating

Calculate your Energy Intake!

Half As Heavy, Twice As Fat!

5% Energy Deficit Makes You Fat!

For someone who was lean, when he or she started out dieting, the endless circuits of "cut back drastically" <> "gain fat rapidly" certainly entail the risk of making the highly undesirable transition from having a small gut, but enough muscle to make up for that (metabolically), to having the same or even a bigger gut, but no muscular metabolic currency to balance it. That this is very bad news for both your health and sex-appeal is something I shouldnt have to tell you, right (learn more about skinny fats).

 You cannot program weight loss for all!

Even in the study at hand, we can find evidence for one of the fundamental messages researchers who are dabbling with diet and nutrition appear to be too afraid to tell their financiers: There is no magic formula. It is thus not surprising that Nackers et al. observed that a "subset of participants may not benefit from this level [1,000kcal only] of, baseline caloric" (Nackers. 2013) intake.

When we look more closely at the underlying reasons, it becomes clear that the baseline energy intake, which is - even in the morbidly obese - a(n allegedly unreliable) gauge of the basal energy requirements of an individual determined, whether the high caloric deficit worked, or sucked: 

"Breakfast Keeps You Lean" Myth or Mystically True?" | find out

"Participants with high baseline caloric intake ( 2,000 kcal/day) regained more weight during months 7-12 if assigned 1,000 kcal/day than those with low baseline caloric intake (<2,000 kcal/day).

For individuals who consumed high levels of baseline calories, the prescribed intake of 1,000 kcal/day required a reduction in energy consumption of 50% or more — a level that may be unsustainable long term." (Nackers. 2013)

In their discussion of the results, the authors rightly point out that "this findind holds important treatment-matching implications" - implications, every Suppversity reader has been aware of for years:

"At the start of lifestyle interventions, participants reporting high baseline calorie levels may benefit from energy prescriptions based on either a percentage of their baseline intake (e.g., 25-50% reduction) or a projected amount of weight change per week (e.g., 0.50-0.75 kg) rather than a fixed energy intake, such as 1,000 kcal/day." (Nackers. 2013)

With their last suggestion, i.e. the formulation of a "less restrictive calorie goal" for a phase of "extended care treatment" that would be "gradually moving participants from 1,000 to 1,250 to
1,500 kcal/day" that would also allow for one or another "cheat" by providing "acceptable intake goals" instead of inflexible calorie values, Nackers, Middleton, Dubyak, Daniels, Anton, and Perry eventually formulate a bottom line to their study that should look vaguely familiar to all of you for whom this is not the first visit to the SuppVersity.

I am not sure, if you all remember that, but the energy deficit Adelfo Cerame Jr. ran during the contest preps he logged, here at the SuppVersity (read them), was always in the 15-30% range. His success would confirm my previous statement that the "radical approach" (-50%) is only appropriate for those of you who still have a very long way to go.

Bottom line: If you asked me if we can learn something new from the study at hand, I am reluctant to say "Yes, we can!". The notion that obesity requires rapid weight loss even if that implies a larger post-intervention weight (re)gain should after all not be news to any of you.

The experimental confirmation that the weight rebound does not (necessarily) ruin an obese individuals weight loss success, on the other hand, is news. It would argue in favor of an aggressive dietary intervention and - as the scientists point out in their discussion of the results - a staggered return to a lower caloric deficit in the months to come. I mean, despite the upheaval about  Abercrombie & Fitch not offering "plus size" clothes, one thing should be 100% clear: 90kg, which is the average weight of the ladies in the 1,000kcal group after 6 months, is not a normal body weight for a 145cm tall 52 year old woman, right?

References:

• Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity.Psychiatr Clin North Am. 2011;34:841-859.
• Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459-471.
• Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.N Engl J Med. 2002;346:393-403.
• Nackers LM, Middleton KR, Dubyak PJ, Daniels MJ, Anton SD, Perri MG. Effects of prescribing 1,000 versus 1,500 kilocalories per day in the behavioral treatment of obesity: A randomized trial. Obesity (Silver Spring). 2013 Dec;21(12):2481-7. 
• The Look AHEAD Research Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus. Arch Intern Med. 2010;170:1566-1575.

Something to thinking when you try losing weight

Whats the worst thing anyone ever said to you when you were trying to lose weight? Thats the question our friends at Health put to their Facebook audience, and boy, did they get an earful!

Research backs those responses up. A whopping 66 percent of women aged 25–55 who have dieted or are trying to lose weight say those closest to them — including spouses and friends — actually undermine their attempts to get slim and healthy, confirms a recent survey by Medi-Weightloss Clinics in Tampa, Fla.

Here, we present the worst things someone can say to you on your weight loss journey — and what your best response should be to stay on course.

#1. "Here, try these brownies… I baked them just for you."

Guilt-inducing? Sure. But typical. Half of all dieters report that other people pressured them to eat food that was not on their diet, and a whopping 56 percent succumbed to that pressure, usually because they didnt want to hurt the brownie-bakers feelings.



Best response: Pass the buck, says Frances Largeman-Roth, RD, a nationally recognized health expert and the co-author of "The CarbLovers Diet," and do it with a smile. "Wow, thats so sweet! Im not eating that right now, but Im sure Sally in accounting would love them!"

#2. "Im buying, lets go out for dinner."

This can be a typical response from someone who is jealous of your weight loss efforts but is not aware of it, says Sejal Shah, MD, medical director of the Medi-Weightloss Clinics.

Best response: "Be honest and say, I appreciate the gesture and I would like to take you up on it another time," she suggests. Better yet, go … but choose a healthy salad, not a fattening entrée.

#3. "What difference will a few pounds really matter on you?"

Dieters need to expect this kind of undermining, and steel themselves against it, says Greg Hottinger, MPH, RD, co-author of "Coach Yourself Thin."

Best response: Let your actions do the talking. Say, "If youre not on board with my weight loss plans, lets change the subject." Keep your responses short and let go of the need to explain your behavior, says Hottinger.

#4. "Have you tried the Blood Type/Dukan/Forking diet?"

This suggestion often comes from friends who dont really know how unhealthy yo-yo dieting can be for you long term, says Largeman-Roth.

Best response: "No, those fad diets dont work. Im on a healthy plan that allows me to stay healthy and still lose weight," suggests Largeman-Roth.

#5. "You look better when youre heavier," or "I like a woman with lots of meat on her bones."

This kind of undermining usually comes from the man in your life, who feels threatened that your weight loss efforts leave him out — or that you will look so great afterward that you will make him jealous, says Dr. Shah.



Best response: Try to make it a win-win for him, says Largeman-Roth: "I feel better at my goal weight; then we can do more fun things together!"

#6. "When are you expecting?"

Amazingly, women dieters say they still hear this dig!

Best response: Ignore em, or reply, "When are you going to stop being a jerk?"

#7. "Dont become anorexic!"

This undermining comment is often a way for concerned loved ones to make sure you are dieting in a healthy way, says Dr. Shah.

Best response: "There may in fact be those who develop eating disorders, but I will not be one of them," says Dr. Shah. "I am following a healthy weight loss plan and I check in often with my physician."

#8. "Just practice willpower/cut down on dessert/stop eating."

Largeman-Roth says these comments usually come from naturally thin people who have no idea what you are going through — and never will.

Best response: "That might work for you, but it doesnt work for me." Then change the subject.

#9. "My two-year-old held up a peanut butter cookie right in my face and said, Mommy, thats for you."

Best response: Kids always push your buttons, but dont let them. Largeman-Roth suggests turning their sharing instincts in a healthier direction with, "Thanks sweetie, but thats not healthy for mommy. Why dont you get me a carrot instead? I LOVE those!"

#10. "Are you SURE you can eat that?"

Best response: "I want to be my own diet police," says Dr. Shah. "Let them know you dont need any extra monitoring, even if they think they are being helpful."

#11. "Ive seen you try this before … youll never lose the weight."

Sometimes, its best to realize that some people will never be supportive, and to surround yourself with those who are, says Hottinger.

Best response: Back away. Take steps to identify those people you can count on for unconditional support, and only go to them for advice.

#12. "Come on, another helping of mashed potatoes wont hurt."

Family members can be trouble when youre trying to lose weight, especially because you usually share meals with them. Hottinger suggest negotiating with them to keep trigger foods out of the house and temptation off the dinner table. An informal contract can be your backup when the undermining — "Look what I bought … Ring Dings!" — gets too intense.

Best response: "Thanks, but no thanks … We discussed this and I need to not have these foods around me."

#13. "You dont want to get TOO SKINNY, do you!?"

Best response: Says Largeman-Roth: "How thin I get is my business. You dont want to get TOO RUDE, do you?"

#14. "Youre no fun when youre on a diet."

Best response: Says Dr. Shah: "You know what? In all honesty, it saddens me to be the weight I am now. Bear with me while I work on being the fun person I want to be."

#15. "Youre dieting during the holidays/on Friday night/on our anniversary weekend?"

Best response: "Yeah, it may seem inconvenient, but its worth it," says Largeman-Roth. "The holidays only come around once a year, but I need to be healthy every day."

How losing weight could be the key to controlling asthma

Sally Edwards was in for a shock when the nurse at her asthma clinic asked her to step on to the scales.

My doctor had retired and I changed to a new surgery where they had an asthma clinic, says Sally, 45, a hairdresser from Aldington in Kent.

They saw on my notes that I suffered from asthma, but this was the first time anyone in the medical profession had weighed me.

She took a sharp breath and made a face, so I knew it wasnt good news, says Sally.

Like many women, she usually avoided the scales, and was appalled to discover her weight had shot up to more than 11st. At only 5ft 2in tall this made her officially obese.

The problem was that I didnt feel fat because the weight had crept on so gradually during and after my pregnancies, says Sally. Then when the children left things on their plates, Id pick at the leftovers.

Sally was also struggling increasingly to manage her asthma, making simple tasks such as walking up the stairs and looking after her children, Maizie, now 12, and Merrin, nine, more difficult.

The asthma clinic nurse advised her to lose weight and said it would reduce her asthma symptoms. It was a real wake-up call, says Sally. I knew that I had to do something about it or my asthma would just get worse because I would become more immobile and reluctant to exercise.

There is a clear link between obesity and asthma attacks, as Deborah Waddell, clinical lead nurse at the charity Asthma UK, explains: Obese people find their asthma much harder to control.

It seems they dont respond as well to treatment as people who are a healthy weight. Indeed, a recent study by Royal Brompton Hospital in London, involving more than 600 patients at severe asthma clinics across the UK, found that patients with a BMI of more than 30 were more likely to need the steroid prednisolone - used to reduce inflammation in the airways - and to resort to their inhalers more often.

But as Dr Andrew Menzies-Gow, a consultant in respiratory medicine at Royal Brompton, says: Unfortunately, one of the side-effects of prednisolone is increased appetite and weight gain, so patients are more inclined to find activity difficult.

Its a vicious circle, but if an asthma sufferer can break that cycle and lose weight, the benefits will be obvious.

Sallys asthma started when she was 19, triggered by a severe bout of flu. Upper respiratory infections are often caused by cold and flu viruses and are a common trigger of asthma.

Sally lost a stone-and-a-half and it made a huge difference, bringing the asthma under control

I had the flu jab when I was 19, but I was one of the unlucky people who contracted the flu badly, she says.

Her asthma started to affect her daily life. Getting up the stairs was very scary because the wheezing was so loud. And it stayed at the same level in my 30s and into my 40s. I couldnt run after the children at the park.

Since being diagnosed with asthma, Sally has used a brown preventer inhaler each morning to build up a constant level of protection and a stronger, fast-acting Ventolin version when symptoms worsen. This would tend to happen in winter, and also if she was stressed or had been in contact with pet hair, particularly rabbits.

As well as losing weight, Sally embarked on an exercise regimen - which can be a brave step for an asthma sufferer, as many worry that increased activity will spark an attack.

But, in fact, exercise is good for asthmatics because it improves their lung capacity. Done carefully, it shouldnt be risky. And, for Sally, the regimen has been a life-changer.

After seeking advice from the Asthma UK website, she took up jogging.

As well as running four miles three times a week, she started going to a weekly spinning class, while cycling short distances instead of using the car soon became part of her routine.

I lost a stone-and-a-half in eight months and it made a huge difference, says Sally.

It really brought the asthma under control and made the attacks less frequent and less severe - I have just one a month instead of three a week.

She can now also run up the stairs. When I was 11st, my body was struggling to cope with the weight, especially climbing stairs, but the fitter you are, the stronger your lungs become.
Sallys experience is backed up by Asthma UK.

If you can exercise, this will expand the airways, and improve your lung function, says Deborah Waddell. Following a low-fat, low-sugar diet and getting rid of weight, especially around the middle, will make a big difference. Its all about changing your behaviour and lifestyle.

Andrew Menzies-Gow suggests that people with asthma should look closely at their whole lifestyle, stop smoking, avoid pets which aggravate the condition, and take up exercise gradually, especially walking, swimming and cycling.

When it comes to exercise, he recommends taking a friend with you when you first start, stopping your work-out to rest if wheezing starts and choosing gentle, age-appropriate exercises to begin.
Weight loss and exercise are not a magic bullet for asthma, but they can help enormously, adds Dr Menzies-Gow.

As for Sally Edwards, shes delighted that her asthma is now under control.

But that day at the asthma clinic is so vivid and humiliating that she still steers clear of the scales.
I still dont weigh myself very often, but now I have a pair of size 12 jeans and I try them on once a week.

I know that if they dont fit then I have to try just that bit harder to keep the weight off, she says.