Low Carb, Low Fat, Whatever — Let’s Study Stick-With-It Diet Behavior

Lose weight now

This post is not about low-fat diets versus low-carb diets. Or Jenny Craig versus Weight Watchers. It’s about just the opposite: a provocative paper just out in a leading medical journal that argues that we should “end the diet debates” and move away from doing research comparing various diets altogether.

Instead, the authors say, researchers should focus on how to help people change their eating behavior long-term, the real key to controlling weight and reducing disease. It begins:

As the obesity epidemic persists, the time has come to end the pursuit of the “ideal” diet for weight loss and disease prevention. The dietary debate in the scientific community and reported in the media about the optimal macronutrient-focused weight loss diet sheds little light on the treatment of obesity and may mislead the public regarding proper weight management.

It’s hard to imagine abandoning our second-favorite national pastime — pitting the Atkins diet against the Paleo diet against the South Beach diet. And what would the American diet and weight-loss industry, estimated at $60 billion, do without “the latest study” to tout?

But the paper just out in the Journal of the American Medical Association argues that there’s already been plenty of research on the question of which sort of diet helps people lose weight best — many dozens of studies, even studies compiling and analyzing other studies.

And all these millions of dollars of research basically come down to a big fat draw. The different diets help people lose weight pretty much equally well — with maybe a difference of a couple of pounds in one direction or another.

We have to understand what’s affecting our ability to make healthier decisions and really drill down into that conundrum.

So if which diet you follow doesn’t much matter, what does?

The key word is adherence — sticking to healthier eating for a long time. (I’m reminded of pet adoption appeals seeking a “forever home;” we need “forever eating habits.”) The paper’s lead author, Sherry Pagoto, an obesity researcher at the University of Massachusetts Medical School, says that what we most need to study now is behavioral change, what makes people stick to healthier eating and exercise habits.

“We have to understand what’s affecting our ability to make healthier decisions,” she said, “and really drill down into that conundrum.”

What makes one diet easier to stick with for one person than for another? It varies for different people, she says. “Some people say, ‘Oh, it’s very easy for me to follow a low carb diet.’ Other people say, ‘Oh I could never do that. I need to go low fat or Mediterranean.’ It may have to do with what they’re used to eating, their food preferences, their family traditions. So there are a lot of factors that go into whether you can stick to a diet.”

“And so that’s what we’re saying: We really need to understand those factors. We need to understand the key to adherence and it does not appear to be the content of the diet. It’s more the context of the dieter.”

In essence, Sherry Pagoto and her co-author, Bradley Appelhans of Rush University Medical Center in Chicago, are talking about a shift of focus: the idea that the most important aspect of dieting is not nutrition — not the balance of carbs or fats or proteins — it’s behavioral change, and how to make it last.

A couple of other points she made when we spoke:

“Obesity is a chronic health care issue and it needs chronic care. And one thing we point out in the paper is that we don’t have reimbursement policies right now for chronic care for obesity, and that’s the big challenge. We do have effective interventions that involve behavioral modification, but we don’t pay for them, clinicians don’t have access to them.”

The most common thing a patient will say is, ‘I want to lose weight, but life is getting in the way.’

“I am a clinician in a [clinical weight loss] program, but patients actually have to pay out of their pocket for it. So it’s not something that’s easy to bill for and get third-party reimbursement for right now. There is a piece of legislation called the “Treat and Reduce Obesity Act 2013” that was put forward by a bipartisan group of Congresspeople in June that I’m really excited about, because it does expand reimbursement policy for counseling for obesity.”

On the research that’s needed now:

“I think it’s a behavioral science question. So we need to understand all of the factors that go into behavioral adherence, and there are biological factors. We do know, for example, there are neurobiological differences across people in terms of your affinity for certain types of foods. There are environmental factors — food availability, neighborhood characteristics. We live in a toxic food environment right now, so helping people figure out how to navigate that, because it’s working against them, is important.”

“Then there are also psychological factors like stress. Stress is a huge factor in undermining adherence in any diet, undermining adherence to an exercise program. So there are the factors we really need to be focusing on.”

“The most common thing a patient will say is, ‘I want to lose weight, but life is getting in the way.’ And what they mean is, “I am struggling with figuring out how to make these changes last and stick given everything else I’ve got to do.’ And that’s what they need help with. That’s a behavioral science question. It’s not a nutrition question per se.”

Readers, if you controlled a weight-loss research budget, which questions would you most want your researchers to ask and answer? Personally, mine would be: Why is eating healthfully so easy for me in the morning and so close to impossible as the day wanes?

Please follow our community rules when engaging in comment discussion on this site.
  • http://Cooledeko.de/ Coole Dekoration

    Here is a link to a good calorie calculator that will tell you how much you should be eating based on your goals.
    You can select, gaining muscle, gain muscle/lose fat/ and the a percentage of calorie reduction.
    They say that you can still get good muscle gains and lose fat at a 10% calorie reduction if you are a new lifter

    http://caloriescalculator.org and http://venusfactorreviewed.org/

    It sounds like your workout goals are great and if you are worried about upping the calories trying upping by 200 every week and let your body adjust until you are eating the number of cals you should be…but I don’t think it’ll hurt just to up them either you body will adjust in a week or two.

  • MITBeta

    This paper ignores the simple fact that WHAT you eat is directly connected to the sustainability of a diet. Eat lots of carbs and little fat, even on a calorie restricted diet, and you’ll end up in what researchers over 50 years ago called “internal starvation” where all the carbs, because of their effect on insulin, end up being shunted into your fat cells for storage while the rest of your body starves and makes you hungry as a result.

    It all comes down to the hormonal response to the foods we eat, and the science behind this has been known for quite some time, but ignored by the like of the AMA, the AHA, the ADA, the USDA, etc. Read “Good Calories, Bad Calories” (or anything else by Taubes) for a truly eye opening experience.

  • Jaime Smith

    People are starving even while overeating. The nutrition in the uber-processed convenience-based American diet is nil. Once I started eating whole foods, I stopped having such a hard time losing. It’s only during the holidays I have trouble now, letting down my guard with cookies and alcohol. If people would simply eat food that satisfies their nutritional needs, the craving would stop and they would be satisfied with less food. I’ve done all the diets. Whole, real, unprocessed and un-Frankenfood is the way to make peace with food and your body.

  • Learn Nutrition

    Until people learn about Carbs and how much exercise is required to burn off those carbs, they will not understand food. It’s a source of energy and all foods are digested by either acid OR alkaline. Eaten together, they neutralize within the stomach, causing acid reflex, burping and passing gas. Great examples of having eaten badly.
    People are fat because they eat too many carbs for the amount of exercise they do or don’t do. It is really simple. Learn the chemistry.

  • Michelle

    And the best way you can stick with a “diet” is to not diet. Move your body, eat a reasonable amount of nutritious food, get enough rest, eliminate stress, and strength train. Almost all diets advocate some kind of drastic calorie restriction, whether it’s straight calories or whole food groups. Too great a calorie deficit will show great short-term results but will kill your metabolism, making it even harder to maintain the new weight or cause weight gain….which is EXACTLY WHAT THE DIET INDUSTRY WANTS TO HAPPEN. They are not your friends, they want you to fail so they’ll get repeat business. 1,200 calories a day is far too little for almost all women. Put your numbers through this calculator and find out your daily energy expenditure; you may be surprised: http://scoobysworkshop.com/calorie-calculator/

    Shave 10-15% from your TDEE. It may not be a quick fix, but it is sustainable for the long term.

  • Reasonable?

    While many diets can induce weight loss, I think their characteristics vary when it comes to long term maintence. Most of the nutrition studies reported in the literature run 3 to 6 months. Very few are a year or longer.

    There is also the issue of the target. Is the target weight loss, prevention of cardiovascular disease, diabetes, mortality? Different diets have different impacts here too and not a lot of it has been studied well mostly because it’s hard and expensive to design long term dietary experiments.

    Finally there is a risk that personal and cultural preferences may not be in alignment with the best evidence. In that circumstance people have to be willing to change their behavior or acknowledging consequences.