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 1: What to eat

Ahh, nutrition – probably one of the most debated areas on the Wheel of Health. There is so much that can be written about eating a “healthy diet” but given that the recommendations seem to change daily, where does one start? Eggs are bad for you. Whoops, now they’re good for you! Eat low fat foods. Nope, now you need healthy fats. No wonder so many people are confused and frustrated – and therefore, reach for the quickest, most convenient thing they can eat regardless of its nutritional value. Who has time to figure it out, right?

Let me start by stating that I do not have a degree in nutrition and I am not a registered or licensed dietician so I will not be dispensing any specific dietary advice. My goal with this post is to help weed through much of the conflicting information out there and present some basic guidelines that most of the experts do agree on when it comes to the food we put in our bodies. I am of the firm belief that everybody – and every BODY – is unique and thus, what works for one person will not work for someone else. The bottom line is choosing foods that nourish and strengthen your body and mind.

What the experts say

It’s probably no surprise that even the experts can’t agree on what specific diet is best for us. However, in a review of the health benefits of many popular diets (think low fat, low carb, vegan, Mediterranean, paleo and so on), there were a few general patterns that rose to the top. In a nutshell, they include:

  • Eat minimally processed foods direct from nature
  • Eat mostly plants
  • If eating animal foods, choose ones that were raised on plant foods

(Of note, the authors point out that these dietary guidelines are beneficial not just to humans, but other species as well as the environment around us. A win-win-win if you are equally concerned about animal welfare as well as the impact of farming on the earth.) The well-known author/journalist Michael Pollan wasn’t too far off when he summed it up in seven words: “Eat food, not too much, mostly plants.” And to clarify, he meant eat real food like vegetables, fruits, whole grains, fish and lean meat. Or as he so simply states it: Don’t eat anything your great-grandmother wouldn’t recognize as food.

Some small steps to get started

I know what you’re probably thinking – easier said than done, especially if you work full-time, have a family to take care of and don’t want to (or can’t) spend hours focused on planning and preparing healthy meals! The good news is that it does not have to be hard. There is a plethora of resources available for anyone who is looking for a little help in this arena. I have listed a few of my personal favorites near the bottom of this post, but here are a few simple guidelines to help you get started:

  • Reduce the amount of processed foods you eat, which is pretty much anything that comes in a box or package with a food label on it. And if that food label has more than 5 ingredients or a bunch of ingredients you can’t pronounce, put it back on the shelf.

 

  • One way to help reduce the amount of processed foods you eat is to avoid the middle aisles at the grocery store as that is where most processed foods are found. You may already be familiar with the advice to shop the perimeter of the store, where most of the fresh foods are located (e.g., produce, fresh meats). Good advice and a great place to start.

 

  • Many of us could benefit from increasing our fruit and vegetable intake. Both the USDA MyPlate and the Harvard Healthy Eating Plate recommend that half your plate at meals consist of healthy fruits and vegetables (unfortunately, potatoes and French fries don’t count). There are so many choices when it comes to produce – experiment and find what works best for you, whether it is munching on raw veggies as a snack, drinking a fruit smoothie for breakfast, or adding a salad of leafy dark greens as a mainstay of your lunch and dinner. Even the pickiest of eaters can find a few fruits and veggies that they like.

Resources to help you take a deeper dive

As someone who is responsible for the bulk of meal planning and grocery shopping for my family, I understand that it may feel daunting to figure out how to put these recommendations into action. Thus, I have compiled a few resources that have really helped me in this arena. As I mentioned earlier, everyone is different so these may or may not work for you, but I pass them along as food for thought (pun intended).

There are many books and websites out there related to the “real food” movement, but one of my favorites is 100 Days of Real Food by Lisa Leake (the website and the related cookbooks). The reason it resonates with me is because it is a real family that made a pledge to reduce – or actually, eliminate – the amount of processed foods they ate and they were successful, even with two young children. My family has not yet taken the plunge to completely eliminate processed foods, but we have been inspired to reduce the processed foods in our diet and cook and eat more real, whole foods. I have one of Lisa’s cookbooks, which has many simple, healthy recipes (a key for me as I am not all that confident in the kitchen). Her website is also chock full of healthy recipes and meal plans for those who need a little extra help in the kitchen.

Given that my family’s quest to eat a truly healthy diet is still a work in progress, and we stumble from time to time with less than optimal choices, I have found comfort in the “good-better-best” approach when it comes to decisions about what to eat. I am not sure who gets credit for this principle, but I found a neat infographic on the Weed ‘Em and Reap website. In essence, this approach is about “doing the best you can with what you have” – which is all we can really ask, right? Maybe you’ll never live in the “best” column, but if you can make some small changes that bump you from bad to good or good to better in a couple of the food areas, that is reason to celebrate. Every little bit helps.

Finally, if you feel overwhelmed by the time and effort you think it might take to implement changes in your diet and seek a supportive community to help you on this journey, you may want to look into The New School Kitchen, or NSK as we members like to call it. The New School Kitchen is an interactive, video-based monthly membership program designed to help you “rock your cooking and eating without hating your family or life” as owner/creator Ryanna Battiste describes it. I have been a member since NSK was launched in August 2016 and it has been a huge help with meal planning and meal preparation centered around eating tasty, healthy real food. Members have access to everything from meal planning tips to healthy recipes to cooking demonstration videos. There is also a private Facebook group where members can ask questions, share resources and support one another along this real food journey. Most recently, the NSK has added the option of working with a health coach either individually or as a group. The beauty of the NSK is that it is self-paced – you determine when and how to engage and work at whatever pace suits your needs. Membership is only $21/month and you can cancel your subscription at any time.

(Note: In the spirit of full disclosure, Ryanna is a fellow Certified Integrative Health Coach – we did our training together at Duke Integrative Medicine. However, I am not getting compensated to promote NSK – in fact, she doesn’t even know that I am mentioning her business in this blog post. I hired Ryanna as my coach a couple of years ago when I decided to work on reducing dairy in my diet after years of suspecting that I had an intolerance. I can personally vouch for her integrity, wisdom and professionalism as a health coach. She is an amazing woman and to me, has created one of the most innovative approaches to healthy eating with The New School Kitchen. She is also just a ton of fun to watch in her videos as she’s not afraid to be real and share the ups and downs of her own real food journey.)

Whew, that was a lot to cover! Next time, we’ll move beyond what to eat and focus on how to eat – mindful eating, one of my favorite subjects!