Quality vs. Quantity – A New Approach to Weight Loss?

I wanted to take a moment to highlight a new study that was released last week in The Journal of the American Medical Association (JAMA) that challenges the traditional notion that weight loss is only possible through calorie reduction (i.e., counting or restricting the number of calories you eat). In the DIETFITS study, researchers found that participants who cut back on added sugar, refined grains and highly processed foods while focusing on eating plenty of vegetables and whole foods — without counting calories or limiting portion sizes — lost significant amounts of weight over the course of a year.

The study was a randomized clinical trial that included 609 overweight adults, who were assigned to either a healthy low fat (HLF) or a healthy low carb (HLC) diet group. Members of both groups attended classes with dietitians where they were educated about eating nutrient-dense, minimally processed whole foods, preferably cooked at home. A key difference in this study is that it did not set restrictive limits on the amount of carbohydrates, fats or calories that participants could eat. Rather, the researchers emphasized that participants focus on eating whole or “real” foods and as much as they needed to avoid feeling hungry. The emphasis was on the quality, not quantity, of food that was consumed.

The researchers also wanted to test the hypothesis that some people are predisposed to do better on one diet over the other depending on their genetics and their ability to metabolize carbs and fat. A growing number of services offer people personalized nutrition advice tailored to their genotypes. (See this previous post about my experience with one of these genetic testing services). Somewhat surprisingly, they found that participants’ genotypes did not appear to influence their responses to the diets. This is something to keep in mind if you are thinking about pursuing genetic testing for guidance on nutrition.

The general outcome of the study was that after one year of focusing on food quality, not calories, both groups lost substantial amounts of weight. On average, the members of the low-carb group lost about 13 pounds, while those in the low-fat group lost almost 12 pounds. The good news is both groups also saw other health improvements such as reductions in their waist sizes, body fat percentage, and blood sugar levels.

It is important to note that there was variability among the participants – some people gained weight, and some lost as much as 50 to 60 pounds. One key finding though is that the people who lost the most weight reported that the study had “changed their relationship with food.” For example, they no longer ate in their cars or in front of the television. They also started cooking more at home and sitting down to eat dinner with their families. To me, this demonstrates that how we eat is just as important as what we eat.

As with any research study, there are limitations. This was only one study involving a relatively small number of participants. Repeat studies with larger sample sizes should be conducted to see if results can be replicated. This study also just focused on initial weight loss. Maintaining weight loss can be as hard, if not harder, than losing the weight in the first place. Future studies may want to follow participants over time to see if they can maintain a healthy weight following the same approach of focusing on quality, not quantity.

I hope that this study is just one of many that will show that traditional dieting, where people make themselves miserable by counting or restricting calories, is not the best or most sustainable way to attain and maintain weight loss.  Rather, if we shift our focus to the quality of foods we eat and take time to enjoy and savor our meals, we will change our relationship with food and reap the many health benefits that come along with eating a well-balanced diet.

Nutrition – Part 2 – How to Eat

In the last post about nutrition, I discussed some of the general recommendations around what kinds of foods to eat to promote or maintain good health. Today we are going to look at the topic of nutrition from another angle, one that I believe is equally as important – how to eat to maintain a healthy weight and stay healthy.

Weight loss/weight management is a heavily debated topic, and one that is also very popular based on the number of books, websites, and programs that exist to help individuals on this journey. Again, my goal with this post is to provide general guidelines that are supported by sound research that can help if you are struggling to maintain a healthy weight. As some of the latest science has revealed, there are several surprising factors that play into whether someone can lose weight and keep it off. There is no “one size fits all” approach and what works for one person may not work for someone else. The researchers also concluded that it can take multiple tries to figure out what works for you. My hope is that you’ll find one or two solid strategies that fit your needs and lead to success.

 The Dieting Paradox

 It is probably no longer a shocking fact to hear that 71% of American adults are overweight. A 2017 study found that obesity now drives more early preventable deaths in the U.S. than smoking. This has fueled a weight-loss industry worth $66.3 billion, selling everything from diet pills to meal plans to fancy gym memberships. And yet more and more research is demonstrating that traditional dieting, such as cutting calories or restricting certain kinds of foods, DOES NOT WORK.

There is a body of research dating back to World War II around dieting and the ensuing cycle of losing weight and regaining weight (sometimes more than was lost). The impact of this “yo-yo dieting” is to ratchet up the baseline weight even higher, beyond the individual’s original weight. Researchers at UCLA conducted a meta-analysis of 31 long-term studies on the effectiveness of dieting. They concluded that dieting is a consistent predictor of weight gain – up to 2/3rds of people regained more weight than they lost. So yes, dieting can actually put you at risk of gaining weight. Let that sink in for a minute.

There are neurological, hormonal and metabolic changes that occur when you engage in dieting behaviors and/or lose weight. For example, your metabolism slows down when you lose weight, but researchers have found that if you gain some or all of that weight back, your metabolism does not increase accordingly. So, the bottom line is, unfortunately, that biology is working against you when you diet.

A mindful approach – changing your relationship with food

So, what is the good news, you ask? There is another way! It is a slower, but more sustainable approach to weight management. You’ve probably heard the advice that in order to be successful at losing weight and keeping it off, you can’t succeed with short-term fixes – you have to make lifestyle changes that are sustainable over time. This is solid advice and the basis for what many have now coined “mindful eating.” This approach is not about making external changes such as restricting calories, but rather adopting an inner-oriented process where you tune into your mind and body for cues about hunger and eating.

Changing eating behavior is difficult because it is an automatic behavior that we’ve been doing for decades. How many of you have experienced eating on “autopilot” – when you intend to just have a handful of chips and next thing you know, the bag is empty? And you can’t remember eating them all? Mindful eating is about disengaging this autopilot and bringing awareness and intention to the act of eating. It takes time and practice to be mindful, but by learning to tune into your body, noticing hunger and fullness signals and the way food really tastes, you can radically change your experience of eating.

Some helpful tips, tools and resources

 As you have probably figured out, mindful eating is rooted in the practice of mindfulness. I touched upon mindfulness in my post highlighting the various areas of the Wheel of Health, and we will explore it further in a future post. Mindfulness is about paying attention on purpose, in the present moment and without judgment. Building a mindfulness practice in general will help you eat more mindfully. For now, we will focus on some basic strategies you can explore and adopt to help move you along your path to mindful eating.

  • Be present at meals – stop and focus on eating when you eat. Turn off the TV, put down the newspaper, book or phone, sit down at the table. Slowing down and being present while eating can prevent overeating, eating unhealthy foods, and help you tune into your body’s hunger and fullness signals. This may be a challenge if you are used to eating on the run or multitasking while you eat. If so, start small – try it for one meal and notice how it feels when you give yourself permission to simply be present and eat.

 

  • Stop judging – judgment plays a powerful role for people trying to change their eating habits and/or lose weight. We often turn a simple fact (“I ate the whole pint of ice cream in one sitting!”) into a condemnation of ourselves (“I have no willpower and will never lose weight”).  Being mindful can help break through this “all or nothing” thinking and the failure-shame-avoidance spiral that is common in weight loss (“I pigged out at the buffet. I have no willpower – it’s useless, I’ll never be able to lose weight so I might as well quit trying.”)  Rest assured, this is not about letting yourself off the hook or making excuses for less than optimal choices. As you increase awareness and cease to judge, you will learn to shift course before or while engaging in the unhealthy choice or habit; it actually allows for accountability.

 

  • Be kind to yourself – compassion will get you further than punishment. Think about a baby learning to walk. He is bound to stumble and fall, but do his parents judge or criticize him and tell him he’ll never learn to walk? No, they respond with love and encouragement to keep trying. We need to do the same for ourselves. This can be difficult as our society tends to favor finding the problem and focusing on what needs fixing. This works sometimes but not always. We also find it easier to treat others with compassion but not ourselves. If you had a friend struggling to lose weight and she shared her difficulties and setbacks, you most likely would empathize and encourage her to keep working toward her goal. Why not extend that same kindness to yourself?

If all of this seems a bit overwhelming, it may help to start by trying a simple tool that you can use anytime, anywhere. It is called the Hunger-Fullness Scale and it helps you tune into your body’s natural signals around the need to eat or stop eating. Here is one example that you can use.

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Sample Hunger-Fullness Scale

Before you eat, pause for a moment to assess where you are on the scale in terms of hunger or fullness. The recommendation is to eat when you are moderately hungry (around a 2-2.5 on the scale) and to stop eating at the first sign or signal of moderate fullness (around a 5-5.5). As you may be aware, it takes about 20 minutes for your stomach to signal to your brain that you are full or starting to get full. Thus, slowing your pace of eating can also help you tune into signals of fullness, as will using this scale after you begin eating and when you finish your meal.

If you are interested in learning more about mindful eating, there are a number of excellent resources available on the topic. Two of my favorite books are “The Mindful Diet” by Ruth Q. Wolever and Beth Reardon and “Savor: Mindful Eating, Mindful Life” by Thich Nhat Hanh and Lilian Cheung. In addition, there is an excellent website called The Center for Mindful Eating.

Learning to eat mindfully is a process and a journey, but I believe you will find it is worth the effort. Start small, explore and see what works best for you – one bite at a time.