Don't dig your grave with your own knife and fork. – English Proverb
Weight loss vs. Diet.
Losing weight is less complicated than your diet. Despite mountains of information on the subject, weight loss still comes down to the calories you consume versus those you ‘burn’. The calories you consume are either converted to energy or stored within your body as fat.
What is a Calorie?
A calorie is the energy needed to raise the temperature of 1 kilogram of water by 1 °C [1]. A Calorie is equal to one thousand small calories and is often used to measure the energy value of foods. Simply put, calories = energy.
The first law of thermodynamics, also known as the Law of Conservation of Energy, states that energy can neither be created nor destroyed; it can only be transferred or changed from one form to another [2]. Depending on whether you have a calorie surplus or deficit, the form that would be changing is you! To reduce your body weight, simply reduce the number of calories you consume.
Weight loss option 1: Count Calories.
Online Basal Metabolic Rate (BMR) calculators are free and available just by typing in “BMR calculator” in any search engine. Another option is using TDEE calculators, which stands for Total Daily Energy Expenditure. These calculators will help you determine the number of calories you need to consume to stay at your present weight. This is termed your ‘maintenance calories’.
Once your maintenance calories are determined, simply reduce the calories you consume by 500 - 1000 per day.
The only way this doesn’t work is if your initial calculations are incorrect. The calculators aren’t perfect after all, and can’t account for all of the variables associated with each individual’s metabolism. It’s an easy fix though. If you have calculated your maintenance calories, and you reduce them by 500, and you don’t lose weight after a couple of weeks, just drop another 250-500 calories. It wouldn’t be that the process didn’t work; just the initial calculations were incorrect.
Counting calories can be tedious, but ultimately, it’s the most effective way to lose weight. There are several free apps available online to help with this (MyFitnessPal is one example). Or you can do it the old-fashioned way and keep a written food log. After a while, estimating the caloric content of food becomes easier, and you can dispense with calorie counting. If your progress stalls, just pick back up where you left off.
Don’t’ believe calorie counting works? Frank Beard, at an already lean 165 pounds, lost 6 more pounds after only eating gas station foods for a whole month [3]. Frank is a health-conscious individual that had previous experience with losing weight, so he did make an effort to consume the healthiest foods available to him. With that being said, Frank tracked his calories using MyFitnessPal and attributes this in part to his success.
John Cisna, a high school science teacher, ate only McDonald’s for 6 months and lost 56 pounds. He did so by keeping his calorie count to no more than 2000 and burned a little extra by walking forty-five minutes per day [4].
Now, I’m not advocating using either of these methods for weight loss, just pointing out the fact that lowering your calories means lowering your weight, regardless of what you eat.
Weight loss option 2: Eat Real Food.
If counting calories isn’t your thing, (and that’s ok, it’s not mine either), then just fill up your plate with foods that are nutritionally dense but lower in calories. You can find a non-exhaustive list of nutritionally dense foods here: https://oldwayspt.org/system/files/atoms/files/MedGroceryList_2017.pdf
Fruits, vegetables, and lean proteins are the simplest solution. They are low in calories and high in nutrients. Over-consuming calories and gaining too much weight through eating these foods is difficult, if not impossible.
Fruits and vegetables contain fiber. Fiber adds bulk to your diet without adding significant calories, and takes up space in your belly and makes you feel full [5]. This is only one aspect of satiation, so don’t go thinking increasing your fiber is a magic bullet.
Protein is both satiating and has a higher caloric burn than fat or carbohydrates. The technical term is ‘thermic effect of food.’ As a rule, it takes more calories to digest protein than it does carbohydrates or fats. Thus, the net caloric gain is less with protein than with the other macronutrients [6].
Taking this approach to weight loss is akin to utilizing the Volumetrics Diet, which is recommended by The American Association of Clinical Endocrinologists in their algorithm for the medical care of patients with obesity. They also recommend the Mediterranean, Vegetarian, DASH diets, and using meal replacements to help reduce caloric intake [7].
How much Weight loss?
There is no hard rule to determine how much weight you should lose per week. There are far too many variables to estimate this, such as: height, starting weight, gender, age, and activity level. Losing anywhere between 1 up to 3 pounds per week is a reasonable goal.
As a guideline, reducing calories by 500 per day will equate to 1 to 2 lbs. of weight loss per week. 1000 calories reduced per day will equate to 2 to 3 lbs. lost per week. For example; 6’1”, 220lb male requires 2594 calories to maintain his weight. He would consume 2094 calories to lose 1 lb. per week, and 1594 to lose 2 lbs. per week.
The alleged “starvation mode” that occurs when you drop your calories too low and quit losing weight simply doesn’t exist. It’s debatable that your metabolism slows down as you lose weight. If it indeed does, it would make sense given the fact that there is now less of you, and thus less metabolism is needed. Regardless, as you lose weight keep in mind your maintenance calories will change and need to be adjusted if you wish to lose even more weight.
Weight loss is important but pounds on the scale are not the only measure of success. Body fat percentage, waist circumference, and waist-to-hip ratio are important markers for health as well. In certain circumstances, these measurements may be more important than how much you weigh.
Risks associated with lowering your calories.
Keeping your calories too low and for too long can have negative consequences. A calorie-reduced diet can lead to decreases in muscle mass, strength, and measures of aerobic fitness which could negatively impact your health and affect athletic performance [8].
Individuals on long-term calorie-restricted diets often report feeling cold. The dropping of core body temperature has been reportedly observed in calorie-restricted diets.
Reproductive capacity may be inhibited, as well as a loss of libido. From a survival standpoint, as a mother grows a child she would need on average an additional 300 calories per day [9].
And finally, unsurprisingly, people report feeling hungry [10]. Striking a balance between feeling satiated and managing caloric intake would appear to be of utmost importance when trying to lose weight.
The above-mentioned concerns associated with a calorie-restricted diet are assuming that nutrient intake is sufficient. A deficiency in nutrients is a whole different ballgame and can lead to conditions such as Beriberi, Osteomalacia, Rickets, Scurvy, and more.
Health Benefits of lowering your calories.
There is a significant amount of research that indicates that lowering your calories has numerous health benefits.
“To date, prolonged caloric restriction (i.e., a reduction in caloric intake without malnutrition) is the only non-genetic intervention that has consistently been found to extend both mean and maximal life span across a variety of species [11].”
“Calorie restriction (CR) without malnutrition is the most studied and robust non-genetic non-pharmacological experimental intervention for extending health span and lifespan in multiple animal models [12].”
“CR is the most studied and reproducible non-genetic intervention known to extend healthspan and/or lifespan in organisms, ranging from unicellular yeast to monkeys [13].”
Caloric restriction studies vary in the number of calories that are reduced in a participant’s diet, with anywhere from 10-40% being used in human studies. Science doesn’t know if it’s desirable for human beings that are of a healthy weight to participate in such caloric restriction, especially to the level used in the studies.
The science does strongly indicate, on the other hand, that individuals that are overweight or obese would greatly benefit from caloric restriction. In doing so they reduce their risks of developing diabetes, heart disease, certain sleep disorders, and some cancers. Also, anti-inflammatory effects have been observed in calorie-reduced diets.
Risks associated with being overweight or obese
Using scare tactics with individuals that are overweight or obese simply doesn’t work. By now most of us know the harmful effects of carrying around extra pounds.
“Obesity is becoming a global epidemic in both children and adults. It is associated with numerous comorbidities such as cardiovascular diseases (CVD), type 2 diabetes, hypertension, certain cancers, and sleep apnea/sleep-disordered breathing. Obesity is associated with an increased risk of morbidity and mortality as well as reduced life expectancy [14].”
It is well documented and accepted that being overweight or obese increases the likelihood of disease and death. Yet most of us still engage in behaviors that push us toward weight gain, such as eating a poor diet and being sedentary.
For some people, the reported health benefits of lowering their body weight are enough to encourage sustainable lifestyle change. For a lot of people, it just doesn’t register. As physicians, we need to be aware of techniques such as motivational interviewing and be prepared to meet people where they are on the spectrum of readiness to change. As individuals, unearthing the root motivations of why we would want to lose weight is important. Using the 'Five whys' technique can be an extremely helpful exercise. https://en.wikipedia.org/wiki/Five_whys
Tidbits on weight loss.
Drink enough water. Take your body weight in ounces, and drink ½ that per day. For example; an individual weighs 200 lbs. 200 lbs. / 2 = 100 ounces of water to be consumed per day.
Being properly hydrated increases metabolism and will help you feel full. As we age, our thirst mechanisms begin to fail. Often we think we are hungry when we are just thirsty [15].
Meal prepping is a fantastic way to make calorie counting expedient.
Cooking one or two meals and dividing the leftovers into meal-prep containers will keep you cooking and counting less often, as you’ve already calculated the meals' caloric content.
Meal replacement shakes and/or protein shakes are already portion-controlled, again making compliance with caloric requirements a breeze [16]. Mix your shake with organic cow’s milk or almond milk if you desire. This will increase your total caloric intake, but will also slow down the digestion of whey, which will help you feel fuller, longer. You can add your favorite fruit or vegetable as well.
There are good reasons to take a multivitamin/mineral supplement, even if you’re not trying to lose weight. However, if you are reducing calories then you are reducing vitamin and mineral intake as well and it may be advantageous to supplement to make up for that loss [17].
Exercise 30 minutes, 5x per week, minimum. Exercise has to be something you will enjoy or you won’t stick with it. Walk, swim, lift weights, ride a bike, play a sport, anything to get you moving. The body was designed to move and operates optimally only when you incorporate an adequate amount of physical activity into your lifestyle.
Mythbusting
Macronutrients
Where you get your calories from (whether it’s fats, proteins, or carbohydrates), is to some extent important for health parameters. This is less important for weight loss [18-19].
Grazing/Gorging/Fasting
This is covered in our Diet: The Basics article. Again, what you eat and how much of it you eat, is more important than when you eat it [20].
I’ll burn it off later at the gym
They say you can’t outrun your fork, and to some degree that’s true. One snickers bar contains 215 calories. You would have to jog about 25 minutes to burn that many calories. A much better option, time-wise, is to simply not eat the snickers bar.
Notwithstanding, exercise can and should be utilized if you wish to create a larger caloric deficit to lose more weight. Lowering your caloric intake by 500 and increasing your exercise to burn another 250 calories is better overall for your health than just lowering your consumption of calories by 750 [21-22].
Using exercise alone without dieting appears sub-optimal for weight loss. “Excess exercise tends to be counterbalanced by excess hunger, exemplified by the phrase 'working up an appetite.' A few people with extraordinary willpower can resist such hunger day after day, but for the vast majority, weight loss through exercise (only) is a flawed option.” - Andrew Weil.
For long term weight loss success
All weight-loss diets that reduce your calories can work, as long as you stay on them.
There has been an effort to study the differences in individuals who succeed in long-term weight loss (2-5 years on follow-up) vs. those who regain their weight. There appear to be some commonalities among the successful which include:
Have a measure of accountability. Whether be in a weight loss support group or have regular follow-ups with a health care practitioner [23].
Consume a diet lower in fat, regularly self-monitor weight and food intake, and increase physical activity [24].
Many people that intentionally lose weight will indeed regain some of that weight back over the next few years. What is a measure of weight loss ‘success’ often changes from study to study which makes observance of these trends difficult. It’s not all doom and gloom though:
“…most individuals who participate in structured weight-loss programs in the United States of the type reported in the literature do not regain all of the weight lost at 5 y of follow-up [25].”
“Weight-loss interventions utilizing a reduced energy diet and exercise are associated with moderate weight loss at 6 months. Although there is some regain of weight, weight loss can be maintained [26].”
Maintaining weight loss requires not just a mechanical understanding of how to lose weight, but the acknowledgment that behavioral changes will need to be implemented to maintain that weight loss. To make these changes, you need to be aware of what drives your current behavior. For further understanding, I recommend you purchase and read “Secrets to Weight Loss and Weight Management” authored by David R. Seaman, DC, MS, DABCN, DACBN.
Additional Resources
Want to know where that fat goes when you ‘burn’ it? (17 mins.) https://www.youtube.com/watch?v=nM-ySWyID9o
NIH Bodyweight Planner: https://www.niddk.nih.gov/bwp
Glossary
Diet: the food that a person or animal usually eats.
Basal metabolic rate (BMR): the rate at which the body uses energy while at rest to keep vital functions going, such as breathing and keeping warm.
Total Daily Energy Expenditure (TDEE): an estimation of how many calories you burn per day when exercise is taken into account.
Metabolism: the chemical processes by which a plant or an animal uses food, water, etc., to grow and heal and to make energy.
Satiate: the quality or state of being fed or gratified to or beyond capacity.
Fiber: plant material that cannot be digested but that helps you to digest other food.
Works Cited
1. “Definition of CALORIE.” Merriam-Webster.com, 2019, www.merriam-webster.com/dictionary/calorie.
2. “Thermodynamics - Definition, Equations, Laws, Meaning, Formulas | Basics of Thermodynamics.” BYJUS, byjus.com/physics/thermodynamics/.
3. Wildenradt, Reegan von. “This Guy Lost Weight and Got Faster after Only Eating at Gas Stations for a Month.” Men’s Health, 12 May 2017, www.menshealth.com/nutrition/a19546881/man-only-eats-at-gas-stations-for-a-month/. Accessed 4 Oct. 2021.
4. “Man Loses 56 Pounds after Eating Only McDonald’s for Six Months.” TODAY.com, www.today.com/health/man-loses-56-pounds-after-eating-only-mcdonalds-six-months-2D79329158.
5. Gerstein, Dana E., et al. “Clarifying Concepts about Macronutrients’ Effects on Satiation and Satiety.” Journal of the American Dietetic Association, vol. 104, no. 7, July 2004, pp. 1151–1153, 10.1016/j.jada.2004.04.027. Accessed 18 Oct. 2021.
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15. Begg, Denovan P. “Disturbances of Thirst and Fluid Balance Associated with Aging.” Physiology & Behavior, vol. 178, Sept. 2017, pp. 28–34, 10.1016/j.physbeh.2017.03.003.
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17 Major, Geneviève C., et al. “Multivitamin and Dietary Supplements, Body Weight and Appetite: Results from a Cross-Sectional and a Randomised Double-Blind Placebo-Controlled Study.” British Journal of Nutrition, vol. 99, no. 5, May 2008, pp. 1157–1167, 10.1017/s0007114507853335. Accessed 18 Oct. 2021.
18. Sacks, Frank, et al. Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. 2009.
19. Kerksick, Chad M, et al. “Changes in Weight Loss, Body Composition and Cardiovascular Disease Risk after Altering Macronutrient Distributions during a Regular Exercise Program in Obese Women.” Nutrition Journal, vol. 9, no. 1, 22 Nov. 2010, 10.1186/1475-2891-9-59. Accessed 18 Oct. 2021.
20. Catenacci, Victoria A., et al. “A Randomized Pilot Study Comparing Zero-Calorie Alternate-Day Fasting to Daily Caloric Restriction in Adults with Obesity.” Obesity, vol. 24, no. 9, 29 Aug. 2016, pp. 1874–1883, 10.1002/oby.21581. Accessed 18 Oct. 2021.
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24. Wing, Rena, and James Hill. SUCCESSFUL WEIGHT LOSS MAINTENANCE
25. Anderson, James W, et al. “Long-Term Weight-Loss Maintenance: A Meta-Analysis of US Studies.” The American Journal of Clinical Nutrition, vol. 74, no. 5, 1 Nov. 2001, pp. 579–584, academic.oup.com/ajcn/article/74/5/579/4737391, 10.1093/ajcn/74.5.579. Accessed 13 Dec. 2019.
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