Exercise for Weight Loss?

No.
Exercise for exercise. Exercise for a long, healthy, active live.
Exercise for functional capacity, mood stability, improved attention and learning.
Exercise to prevent disease. Exercise to improve your quality of life.
Exercise because not exercising increases your risk of all causes of death and all disease states.

If you exercise only because you think it will help you lose weight, and exercise is your only weight loss strategy, chances are you won't lose weight. And then you will think exercise failed you. You will be wrong. Exercise is the sine qua non of health; it will never fail you. if you do it for the right reasons.  There are many reasons, see the first paragraph and the research studies below.

If you want to lose weight, change your eating patterns. Many people need to lose weight.
If you want to be healthy, exercise - daily.. Everyone, regardless of their weight status, needs to do this.

(NB. this was posted a few weeks later http://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories)

Janssen, I., & LeBlanc, A. G. (2010). Review Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International Journal of Behavioral nutrition and physical activity, 7(40), 1-16.

Nocon, M., Hiemann, T., Müller-Riemenschneider, F., Thalau, F., Roll, S., & Willich, S. N. (2008). Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. European Journal of Cardiovascular Prevention & Rehabilitation, 15(3), 239-246.

Penedo, F. J., & Dahn, J. R. (2005a). Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Current opinion in psychiatry, 18(2), 189-193.

 Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Canadian medical association journal, 174(6), 801-809.

Resisting a challenging food environment

As the years have progressed and research findings amassed, it has become obvious to most people – experts and non-experts – that obesity is not caused by one thing. However, certain factors seem to have a greater impact on whether or not a person consumes more calories than they need or burn than others. For example, genetics have less of an impact than lack of physical activity. And a combination of risk factors intensifies the impact of any one. For example, a genetic risk, not exercising (or being sedentary), being female and using antidepressants is a perfect storm for gaining weight.

The risk factor that my research and my public health efforts focus on is the environment – the food environment, which I define as anywhere we make a decision about what to eat immediately or what to buy to cook or eat at home.  Within this huge food decision space, individual level factors (knowledge, stress, social and family norms, income) interact to make it harder for some to ‘resist’ what is sometimes called a toxic or obesogenic (obesity causing) environment.

To advance my goals – reducing caloric excess in the population - I support policy that aims to change the environment. Policy that changes the space where we make so many food (and beverage) decisions. I have spoken a lot about information policy, but that doesn’t directly change the environment (indirectly it could lead restaurants to supply lower calorie meals through a change in recipes or serving sizes). Strategies/laws that directly change the environment would include the failed NYC serving cap on sodas.  Other strategies, softer ones some will say, fall into the category of ‘choice architecture.’ In other words, someone (and this someone can be a contentious issue) decides that in order to help a person choose the healthier (? – definition pending) option, this healthier option needs to be easier to access or displayed more attractively than the non-healthy one. For example, instead of the huge display of 50 cent white bread at the front of the store, the owner places a display of whole wheat bread. Strategies that I am particular enamored with include taxes (price manipulations), zoning restrictions (do we need 10 fast food restaurants w/in a mile of a neighborhood or school?), and advertising constraints (do transit busses really need to advertise 2 dozen donuts for the price of 1?). The point of these efforts is to change perceptions about food consumption and the pressure to consume more food than we need. The changes of what is normal developed in response to our environment over the past 30 years. We have new social norms.

Changing the environment means reducing the amount of or display of ‘desirable’ foods.

I hadn’t realized that what I was talking about is also called ‘desire reduction.’ In other words, if the things – no the triggers - that lead us to overconsume calories are taken away, then our desire to overconsume is reduced. Take my donut example. If the ads for donuts are taken off the bus, then this might reduce my desire to go buy donuts. Certainly, if your work place bans junk food at office meetings, this would reduce the desire to eat those junk foods. I like these strategies because they attempt to reverse something that happened without our asking it to happen. The environment changed around us and what was normal changed. Now it is ‘normal’ to be served supersized meals. It is ‘normal’ to sit for hours. It is ‘normal’ to drink a 20 ounce sugary beverage or an 8 ounce glass of wine. And pushing back against the new normal in our social context is often met with shock and disapproval. Still, this push back, this resistance, is yet another strategy – an individual level strategy that some people promote. I am not convinced. 

The ‘new’ term for this type of individual level strategy or intervention is ‘desire resistance.’ I became familiar with both of these terms (desire reduction and desire resistance, but not the concepts) only recently, when I read an article by Dutton, Fontaine and Allison (abstract here).  I am a pretty big fan of Dr. Allison, he is the co-director along with Dr. Fontaine, of the Nutrition Obesity Research Center at the University of Alabama, and I pay attention to what he has to say. This is one of the few times I disagree with him.

In their discussion of desire resistance, the authors offer this example of the skills an individual might need to posses in order to resist their ‘internal desires’ or ‘external challenges’ (eg those brownies someone left in the break room):

“Desire resistance skills include strategies such as self-monitoring, meal planning, asking for social support, wearing a physical activity monitor, cognitive restructuring, making a public social commitment, and preparing oneself to anticipate, tolerate, and accept feelings of deprivation when they are encountered.”

I understand that the authors are advocating for both desire reduction and desire resistance, but desire resistance, to me, is going back to the individual focus that others have already found to be extremely challenging. Programs that work at this level usually do not produce lasting change. Yes, there is some evidence that teaching people to count calories or plan their meals will work for the short term and maybe in the long term, for some people, but it is rare. In my experience and in the literature, finding people who can actively, consistently and perpetually resist this 'in your face, food pushing society’ is unusual. I AM one of those people, so if I am against desire resistance as an obesity prevention strategy, it’s worth noting!

This idea of resisting cues to eat calorically dense foods or drinks, or any food or drink when you are not hungry, reminds me of the time I spent teaching people how to resist the trigger to smoke a cigarette when they were trying to quit. What worked the best was when there were LESS triggers. In other words, successful quitters are more likely to be around others who did not smoke, work and recreate in smoke free environments and live in a ‘space’ where smoking is not ‘normal.’ The environmental changes – and taxes on tobacco – have done far more to assist in smoking cessation than all the desire resistance programs!

It’s also ironic to me that in the Allison article, where the authors introduce the desire reduction and desire resistance terms, that they also point to the 2010 Recommendations from the US Surgeon General regarding obesity prevention as misguided. They note that most of the strategies are in the desire reduction category, as if that were a bad thing. I see it as a response to the years – decades – of efforts that did not include the environment at all. Still, in the end, the authors suggest that both strategies – reduce desire by modifying the space and increase resistance by teaching skills – be employed. And in their closing comments they make a valid, important point. The same point is true with smoking or in their example, managing anger, and it is: there is no world in which all temptation or triggers will be absent at all times. In those situations where temptations exist, a person will either indulge, relapse or resist.

Personally, I plan to do a little indulgence in a few days…. Thanksgiving here I come!

Calorie Stealth

Calories, calories, calories. That is all this girl talks about… well, mostly true. I also talk about making sure that you are as physically active as possible (that means sit less) and that you try to exercise every day. And a few other things, like not smoking or tanning… and, well by now, you can fill in the rest yourselves.

So YES, calories.  First, restaurant (and similar venue) menu labeling is coming and I have noticed an increasing number of commercials that include a calorie count within the TV (or internet) ad.  Here is the most recent:

Second, I want to pass along a ‘be on the lookout’ note:

Little Bites and mini donuts are not low calorie options, but calling something little bites sure makes you think so. Right? Actually, a serving of Little Bites muffins has 180 calories, a regular muffin 190 and a 'mini' cake 260.  All of these are made by Entenmann’s. TastyKake sells mini-donuts with over 200 cals per serving. Take home message: read the calorie AND serving size information regardless of the words, light, little, diet, mini, good for you, all natural, organic...etc.

And back to the lemonade: 240 calories for a beverage is a bit much… more than half those calories are from sugar - 39 grams or about 10 teaspoons. The rest is from protein and fat, which comes from the milk. Below is the ingredients list from ChickfilA. The ingredients in the “Icedream” read like a chemistry book.

Frosted Lemonade: Icedream (whole milk, sugar, nonfat dry milk, artificial flavor, corn starch, mono & diglycerides, microcrystalline cellulose, carrageenan, guar gum, Yellow 5 & 6), water, freshly-squeezed lemon juice, sugar.

Diet Frosted Lemonade: Icedream (whole milk, sugar, nonfat dry milk, artificial flavor, corn starch, mono & diglycerides, microcrystalline cellulose, carrageenan, guar gum, Yellow 5 & 6), water, freshly-squeezed lemon juice, Splenda® (dextrose, maltodextrin, sucralose).

SO – the picture above, with the 240 calories, that is the diet one…. the regular lemonade has 330 calories and 63g of sugar (16 teaspoons). Sigh…and by sigh, I mean that's crazy! (PS I didn't see the fine print in the picture at first, “starting at…. 240 cals.”)

Learning how to maintain a healthy weight - from our pets

It is not a secret. We have obese cats and dogs, a good many of them. And I will gander a guess - an educated one, I've read research - that pets gain weight when we give them people food - in addition to their pet food.  I have also read that ad libitum feeding is better than intermittent feeding. Pets - maybe the study was on cats - eat less when the food is left for them all day (I'm sure it was cats, dogs are sort of dumb), than when the food is presented and taken away. Sound familiar?  Its a bit of a take on restriction and forbidden foods - if you think you wont' get to eat that again, you want to eat a lot of it when you have the chance, especially, it seems, if you are a cat.

Anyways, I recently adopted one, a cat, after not having one for several years. My cat will not get people food - ever. I did buy him some treats though - good for his teeth.  And imagine my surprise (delight even) at this label instruction:

As with any treat, always adjust amount of main meal to compensate for calories delivered by treats.

In addition, the label tells you how many calories per treat, and how many treats a day your cat should have based on his or her weight.  But the instruction to compensate is priceless and relevant: you can't just keep adding calories - even good ones - and not expect to gain weight.

If its important for a cat, isn't it important for you?  Sure - have a glass of wine, but those 150 to 200 calories COUNT towards your daily total, they are not supposed to be 'add ons' - you must compensate... pretend you're a cat.

I am referencing Feline Greenies, BTW, and my cat likes them - in moderation!

What about those Fruits and Vegetables? It depends....

I have seen more than one study challenging the utility - and even sensibility - of recommending an increase in the consumption of fruits and vegetables as a means to maintain or lose weight.  In the US, the recommendation is either just a general eat more or a more specific eat at least 5 servings.  In other countries, for example Australia, the recommendation is 2 fruits and 5 vegetables.  Walter Willett and the folks at HSPH recommend more vegetables than fruit.  

To be clear, non-starchy vegetables, specifically, and some fruits have been shown to improve health, possibly through their antioxidant properties.  But recently, using Eat More Fruits and Vegetables as an obesity prevention/treatment strategy, has come into question.  I have been concerned about the recommendation for some time, and that is why I promote Willett’s new food pyramid over the USDAs food guidance.

My concerns about fruit and vegetable promotion and all food related promotion is that people don’t hear, because its seldom said, eat more of this (x) INSTEAD of that (x).  People do not get the message that adding health promoting foods such as fruits, vegetables, whole grains, healthy oils, fish, etc. needs to be qualified.  The healthy foods are particular and only stay healthy if they remain nutrient dense (e.g., potatoes are a starchy vegetable which we do NOT need to increase, and kale is GREAT, kale cooked in fat back/butter is NOT GREAT).

Of course, fruits and vegetable calories are of a higher nutritional value than ones from chips, hotdogs and soda, but 1) the choice of fruit (e.g., a plum vs kiwi) or vegetable, 2) the preparation of that fruit or vegetable, 3) the size of that fruit or vegetable (i.e., jumbo fruits (bananas, oranges, apples = 2 or 3 servings), and 4) the overall amount of calories consumed will determine if adding fruits and vegetables to ones diet aids in weight loss.  The bulky, nutritious, fiber rich peppers, summer squash, onions and mushrooms should bulk up one's plate and reduce the caloric density of a meal– these foods should replace (or reduce) meat and pasta for instance.

Two studies released this month,(Charlton et al., 2014; Kaiser et al., 2014), found that increasing fruit and vegetable intake did not lead to weight loss and in some instances, led to weight gain.  The Kaiser et al study used robust criteria to evaluate randomized control trials (RCT) and though the RCTs themselves had limitations, the review of them was sound.  In the authors’ words, the upshot is this…. 

Purchasing and preparation barriers need to be addressed.  Interventions should provide more instruction on how to prepare vegetables in such a way as to not increase their energy content (such as not preparing vegetables with fat (eg not frying or serving with butter)… and….Although many fruits and vegetables [F/V] have demonstrable positive health benefits, recommending increased F/V consumption to treat or prevent obesity without explicitly combining with methods to reduce intake of other energy sources is unwarranted (Kaiser, et al).

One of the main reasons I started my You Tube channel was to show people how to cook foods without turning them into calorically dense meals or snacks.  So, do eat more fruits and vegetables as you eat LESS meats, breads, and desserts.

Charlton, K., Kowal, P., Soriano, M. M., Williams, S., Banks, E., Vo, K., & Byles, J. (2014). Fruit and Vegetable Intake and Body Mass Index in a Large Sample of Middle-Aged Australian Men and Women. Nutrients, 6(6), 2305-2319.

Kaiser, K. A., Brown, A. W., Brown, M. M. B., Shikany, J. M., Mattes, R. D., & Allison, D. B. (2014). Increased fruit and vegetable intake has no discernible effect on weight loss: a systematic review and meta-analysis. The American journal of clinical nutrition, 100(2), 567-576.

Cocoa and Weight: What do mice have to do with it?

I regularly consume cakes and cookies made with pure cocoa powder.  I choose cocoa powder because I understand that it contains substances (e.g., antioxidants, polyphenols, flavanols) that promote health similar to the way fruits and vegetables do.  I also choose it because it adds great flavor - a wonderfully rich chocolate taste - acts like a leavening agent (and therefore must be one, because my cakes and cookies with cocoa are fluffier than those without it), and adds only a small amount of calories.

I do not add cocoa to my foods because I think it will allow me to eat a calorically dense high fat diet without consequence.  In other words, I would never read the headline Eating Chocolate Keeps You Thin and 1) believe it, or 2) start eating a lot of chocolate. So when I saw this actual headline: “Eat Chocolate to Get Thin? Study Touts Cocoa for Weight Loss,” in Forbes magazine, I decided to find and read the actual research. The study was published in the Journal of Agricultural and Food Chemistry.  The study subjects in were not people and they were not given cocoa in the sense that you and I know cocoa.

I have just finished reading – really reading – my first scientific study in which the subjects were animals, mice in this case.  The details on the mice were fascinating: where the mice came from, how they were kept (i.e., the type of cage, the number of mice to a cage, the air temperature, the humidity, and the cage cleaning schedule), how their body composition was measured, how they were fed, tested for glucose and insulin tolerance, and finally euthanized and autopsied.  Well ok, the killing of the mice was not at all fascinating; it sort of broke my heart a little.

As I said, the study was published in a chemistry journal, so I am trying to simplify something I can only begin to grasp.  The scientists in this study (Dorenkott, et al 2014) began by explaining that the chemical properties of cocoa have shown health promoting effects in previous animal studies, but the exact mechanism of effect is not fully understood (e.g., if mice who consumed cocoa had less heart attacks than mice who did not consume cocoa is it because the cocoa reduced plaque buildup? lowered LDL cholesterol? raised HDL?).  In addition, researchers have not identified the specific part of cocoa that is creating the positive outcome.

Cocoa is rich in a compound called flavanol, which researchers believe drives its health promoting or disease inhibiting effects. Flavanol breaks down into several other components and in this study, the researchers wanted to compare cocoa extract and three fractions from the extract: polymer rich, oligomer rich, and monomer rich fractions. The researchers were specifically testing how these 4 substances influenced weight and body fat (i.e., obesity markers); and glucose/insulin tolerance (i.e., diabetes markers).  

This was a feeding study, not a weight loss study and the mice were NOT put on diets.

In order to compare the 4 substances, the researchers fed a group of mice one of six diets.  Each cage of mice was randomly assigned to one of six diets: a low fat diet with no cocoa ‘parts,’ a high fat diet with no cocoa ‘parts,’ a high fat diet with cocoa extract, a high fat diet with a monomer rich fraction, a high fat diet with a polymer rich fraction or a high fat diet with an oligomer rich fraction. Staff prepared and weighed the food before providing it to the mice. At the end of each of 12 weeks, the food was removed (if left over) and weighed again – similar to a plate waste analysis – and fresh food was provided.  The researchers placed the exact same amount of calories in each cage, but the mice on the low fat diets consumed more total grams of food.  I expect this is because the number of calories per gram is higher in a high fat diet. 

What I described sounds like the ideal controlled experiment. The mice could NOT cheat on their diet and were not aware of which study condition they were in.  All the mice lived in the same ‘neighborhood.’  The mice did not self-report their food intake or weight and every mouse was tested with the same calibrated device.  The study lasted 3 months, which is enough time to get an idea of an effect; and because it was an experiment, we can be confident that any difference in the outcomes was due to diet type.

Still, even in this near perfect situation there was an issue regarding the dietary intake.  As already noted, there was more food intake (by weight) in the low fat diet.  In addition, the texture of the diets was different.  Texture can influence diet likability and accuracy of the plate waste measurement.  The low fat diet was a powder-based diet; calories were in the powder and the powder was hard to clean from the feeders.  Some of the powdered feed could have dispensed into the cage uneaten and unnoticed by staff.  So, as a consumer of research, keep in mind this limitation.  It is possible that the low fat mice did eat fewer calories than the high fat mice even though the study was set up so that the calories would be the same. 

The high fat diet mice all ate the same amount of food – across the 5 high fat diets.  This is important because in other studies, one concern has been that the cocoa extract/fraction was making the food less enjoyable, leading the mice to eat less food and therefore gain less weight because they were consuming fewer calories (not because cocoa was limiting their weight gain).  In this study, the researchers are confident that the calorie intake was the same, so any differences in actual body weight, body fat and diabetic markers is attributed to whichever supplemented diet (if any) showed such differences.

I may have a limited understanding of the chemistry of cocoa, but the graphs showed a clear difference in outcomes between any high fat diet and the low fat diet. The mice on the high fat diets gained more weight and increased their body fat more under any of the cocoa conditions than the low fat diet mice.  There were a few subtle differences between the diets on the diabetic markers.  The low fat mice always had the best outcomes (e.g., lower fasting blood glucose), but in some cases one or more of the high fat diets with supplementation was equal to the low fat diet or one of the high fat supplement conditions was better than the high fat diet without any cocoa substance.   The high fat diet without any cocoa substances was always worse than the low fat diet.  Remember when I say diet, I mean meal plan; the mice were fed a high number of calories in order to cause weight gain they were not ‘dieting.’  

The researchers will be following up on the oligomer rich cocoa fraction as it showed the most promise in this study.

An important side that I want to point out is that the researchers justified the study by stating as fact that high fat diets are detrimental to health because they lead to obesity and metabolic dysfunction.  This leaves me wondering why we still debate the pros and cons of a high fat diet and why we are using our resources to find fixes for things we could change.  Is the goal of the research to give people a cocoa extract pill that allows them to eat a high fat diet without jeopardizing their health?  I suppose that makes sense if the high fat diet refuses to die; we will need alternative measures to improve health outcomes. 

The researchers killed and autopsied the mice at the end of the 12 weeks.  I find that the most disturbing part of this study – the headline should be, “Mice die so you can keep eating a high fat diet.’

Dorenkott, M. R., Griffin, L. E., Goodrich, K. M., Thompson-Witrick, K. A., Fundaro, G., Ye, L., ... & Neilson, A. P. (2014). Oligomeric cocoa procyanidins possess enhanced bioactivity compared to monomeric and polymeric cocoa procyanidins for preventing the development of obesity, insulin resistance, and impaired glucose tolerance during high-fat feeding. Journal of agricultural and food chemistry.

McDonalds and Twinkies.. Ridiculous Ideas from educated people

Two unusual diets that led to weight loss and the improvement of metabolic profiles have been in the news lately.  In an earlier draft of this paragraph, I was harsh in calling out both dieters – a science teacher and a nutrition professor. I felt and still feel that they should be mindful of their positions of influence and temper their enthusiasm for diets that are probably unhealthy and suspiciously fad-like.  In addition, both men offer simplistic explanations for obesity and unrealistic advice for groups they appear to be judging.

In the first example, a high school science teacher, John Cisna, eats meals from McDonald’s for 90 days, loses weight, and improves his metabolic profile (i.e., his blood fat and cholesterol levels). Mr. Cisna refers to his self-imposed diet as an experiment and determines that the choices people make, not the food sold at McDonalds, makes them fat. 

Mr. Cisna is correct; our choices have everything to do with our outcomes.  He is incorrect in assuming that everyone has the same choices available to them. In his pseudo experiment (more on that in a moment), he had his students choose his daily meals within certain parameters.  The parameters were that he consume 2000 calories a day and stay within the recommended daily allowances of certain macronutrients (e.g., total and saturated fat).  The local McDonald’s franchise covered the cost of the meals.  In news stories about his 90 day diet, Mr. Cisna points out that he had to be smart about what he was doing.  If he ate a high fat breakfast, he would have to choose a lower fat lunch or dinner in order to stay within his parameters. This is exactly what the Dietary Guidelines for Americans tell us to do, and what so many of us have trouble doing.  Mr. Cisna is an educated man with above average numeracy who had 3 people watching the numbers with him. He was also able to make choices among all price ranges. In some of Mr. Cisna’s interviews, he suggests that people who blame McDonalds for their obesity lack self-control. I do not expect, nor should he, that the average McDonald’s customer has his same math skills or assistants to help them track their calories. And tracking calories and other macronutrient amounts IS important. We already know from scientific study that fast food and sit down restaurants generally serve foods that contain at least a half a day’s worth of calories, fat, sugar and salt.  People who obtain most or all of their meals from fast food and sit down restaurants, especially in the absence of nutrition labeling – and math skill - are at great risk for consuming a diet that is harmful to their health. 

In addition to controlling his calories, which he did not do before the McDonald’s diet, he also began exercising for 45 minutes a day.  

Mr. Cisna’s diet plan was not an experiment and we cannot make causal inferences from his personal results. An experiment by definition requires multiple subjects randomized into treatment conditions, including one in which nothing changes.  In most situations, if a person reduces their caloric intake and increases their exercise they will begin to lose weight and this initial weight loss will improve their metabolic profile, especially if they are following the recommended nutritional guidelines.  Because Mr. Cisna’s 90-day diet was not in any way an experiment, I am left with a few questions: What would happen if he did this for 90 more days?  What if he ate at McDonald’s but did not have the nutrition information available to help him stay within his parameters?  What if he had very little money with which to purchase the food?  What would happen if a woman followed his exact plan?  Or a younger person or an older person or a person of a different ethnicity?  What if he did this for 6 mos. or a year or for his whole life, as some seem pressured to do?   

In the second example, a nutrition professor, Dr. Mark Haub, eats Twinkies, etc., for 10 weeks, loses weight and improves his metabolic profile. He refers to his diet as a class project stemming from his teachings in nutrition.  I am just aghast by this, but as I researched him a little further, I saw that his doctorate is not in nutrition; it is in exercise science/physiology.  Dr. Haub has also been vocal about his results and suggests that the convenience store diet – something people living in food deserts might be forced into – are not necessarily bad and will not lead to obesity– as long as one makes the right choices.  

I feel that Dr. Haub’s extrapolations are out of place and far too simplistic.  It feels like an example of an over educated, privileged person suggesting he knows what an ‘other’ less privileged person is experiencing.  

He claims that his convenience store diet, which for him meant that 2/3 of his calories came from snack foods, caused his weight loss and improved his metabolic profile.  Like Mr. Cisna, Haub did not conduct an experiment and headlines misrepresent what he actually did. 

Professor Haub consumed a lot of sugary, processed snacks similar to and including Twinkies, but he also ate some vegetables, took a multivitamin and drank protein shakes.  In addition, and this is huge, he reduced the amount of calories that he consumed - from 2600 to 1800.  

I have the same concerns and questions about this diet as I did the McDonald’s one.  I suspect that the reason for Dr. Haub’s weight loss is that he reduced his intake by 800 calories.  (He has told reporters that he monitored this closely by writing down everything he ate.) I further suspect - and evidence supports - that over time, a diet high in processed, sugary cakes will lead to metabolic irregularities and poor health.  Lastly, and most importantly, he made a statement to one reporter that he wanted to be able to say that the diet was unhealthy, but the “data doesn’t support that.”  The data do not support anything… it was not an experiment or a quasi-experiment.  It was not research – there are no ‘data’. 

Both Dr. Haub and Mr. Cisna put themselves on a diet to lose weight.  During the time that they were on the diets, counting calories and exercising, they lost about 30 pounds each.  This weight loss may have triggered improvement in their metabolic profiles as well – this is an assumption because we do not have a counter-factual or comparison group.  It makes sense that the weight loss did cause the improvement. It does not make sense to suggest that a long-term diet of processed foods high in sugar or fried foods high in fat and sodium is health promoting.  Science already tells us that there are adverse consequences to this kind of diet pattern.  Both men’s claims as presented in the media are misleading. Cisna did not eat McDonalds without careful attention to calories and the macro-nutrient content of his meals, his choices were not limited by cost and he significantly increased his exercise. Dr. Haub’s diet included vegetables, protein shakes and vitamins; this is not similar to a diet consumed by someone who has limited income and has to eat most of their meals from a convenience store.  

In my opinion, the headlines and the diets they report are pure sensationalism.  Please, choose your calories from foods with health promoting properties, like those recommended by the Nutrition Source at Harvard.

Easy Weight Loss

Sorry, there is no such thing. My headline should be, “Weight Loss Not Easy,” but then fewer people would read the post - and people need to read this post.  Right now, masses of people are searching for that one pill, powder, or cream that will melt away excess fat with no behavioral change required.  Said pill, powder, cream DOES NOT EXIST.  It does not! Think about this carefully.  There are more overweight/obese adults in the United States and similar countries than there are normal weight adults. Because excess fat is associated with disease and being overweight can affect ones physical and psychological health, a simple remedy would be groundbreaking.  If this remedy currently existed, 70% of the US would not be overweight.

Products promising weight loss – fast, substantial, permanent, and painless – are simply fraudulent.  Unfortunately, the makers of these products do not have to submit them to clinical trials where efficacy is established or to post market trials where effectiveness is established – i.e., the FDA does not regulate the products.   However, the companies that sell supplements/weight loss products must tell the truth about them in advertisements. 

Truth in advertising is a law and the Federal Trade Commission (FTC) is responsible for its enforcement.  The FTC is understaffed and it takes years for them to get a falsely advertised product off the market.  The FTC went after 4 companies this week – read here, and has started the year with increased efforts to protect consumers, updating their guidance to both businesses and consumers for the first time since 2003.

I like the guidance the FTC provides to businesses, because in their communication to them, the FTC enlists the support of businesses and suggests that by screening the ads that they publish, businesses are protecting themselves from being associated with a ‘bad’ company – an unscrupulous company.  This is a good strategy because if media polices the ads, the FTC caseload could be reduced.  The FTC could go after and prosecute violators quicker.  I will benefit, too.  There will be fewer sensational, commercials that raise my blood pressure.

The FTC encourages media to stop and think about an ad before publishing or airing it. They offer 7 ‘gut checks’, but I can be more concise.  If an advertisement sounds too good to be true, it is too good to be true. You cannot lose weight if you do not change something about your eating and activity: the number of calories you consume, the type of calories you consume, the amount of exercise you do, the type of exercise you do. It is best to address all of these, but research suggests that diet alone will work to some extent.

You can read all the claims for businesses to watch out for here.

The scientific study of fat gain and loss is dynamic.  It feels like we learn something new every day, and indeed some of the things we believed to be true are not.  (I didn’t ‘know’ this before grad school, but in science things are never proven, only disproved).  Nutrition scientists once thought that all fat was bad in excess, but that no longer appears to be true.  They, and we – the public, also believed that a calorie is a calorie, but that truism is under current scrutiny as well.  I tell you this because I know many of you have become frustrated with and distrustful of science.  That is no reason to turn to supplement makers, I assure you; the makers of weight loss supplements deserve much less of your trust.  The fact that we are learning more about fat gain and loss through science is a good thing.  One of the most important new findings is that being over fat – as a population or as individuals – is caused by multiple factors.  Researchers have not identified all the factors, and the ones they have identified are not completely understood.   But we know some things in the aggregate.  For example, calories (amount and type) matter most and genetics matter least (by matter, I mean the amount of impact these factors have on body fatness).  Somewhere in between these two extremes is the amount and type of physical activity one engages in and metabolism.  An important note about metabolism is this:  an individual’s metabolism is affected by what and how much he or she has eaten over his or her lifetime and the amount of body fat he or she has carried.  In other words, a metabolism can become dysfunctional and this individual dysfunction makes it hard for anyone to prescribe generic weight loss advice - not everyone who cuts their calories and increases exercise will have the same results.  This is the painful truth.  In addition, I’d like to disavow you of the notion of a set point weight.  Instead, consider this: if a person does a certain thing and loses 10 pounds but then stops doing that certain thing, their weight will return to its previous level.  That is not destiny – the weight returned to its previous level for a specific reason – a person’s actions. 

In summary and in closing, no diet supplement leads to easy weight loss.  In the absence of disease, body fat does not melt away. Please consider this before you spend your money and invest your hopes in a weight loss supplement. The FTC is cracking down on companies who market products as if the products were weight loss miracles, and is asking businesses to give ads a ‘gut check’ before they agree to publish them.  Losing excess body fat is important and safe ways to do so exist.  One way to maintain a healthy weight is to follow the guidelines suggested by the Harvard Nutrition Source and to commit to daily or near daily exercise that increases your heart rate for 30 or more minutes.

Putting Diets to the Test

As a new year begins, it will be hard to avoid diet propaganda. I call it propaganda because in my review of the weight loss literature, I find very little evidence that diets are effective for the majority of people who try them. [In contrast, adopting a certain diet pattern (e.g., Mediterranean or plant based) as a life style is health promoting.] 

In some ways, diets are like medication and this may explain why diets fail.  First, like hypertension medication, diets work as long as you ‘take’ them and few diets are palatable or tolerable enough to 'take' forever. Second, like medication for serious mental illnesses, the side effects may be so harsh that the people who need the medicine most cannot tolerate it; like a diet which causes an excess amount of flatulence.  Third, the medication regimen may feel more tedious than the immediate or future disease complications seems to warrant; like drinking vinegar after every meal. Lastly, like pain medications, diets may need tweaking in order to remain effective; once weight is lost, a person requires fewer calories to maintain the new weight.  

Diets are not medications however; they are behavioral modifications or interventions. Considering the above analogies, a successful behavioral intervention for weight loss is as much dependent on the person as it is the intervention. To be successful, the intervention/diet needs to be one that a person is able to follow (with occasional adjustment) without mental or physical anguish for their entire life.  A person could not return to unrestrained eating or reduce their level of physical activity and expect the benefit of said diet to continue.  

Another important factor regarding diets is the amount of weight loss necessary for an individual or sponsor (e.g., government, worksite, researcher) to consider the diet ‘successful.’ Scholars Tomiyama, Ahlstrom and Mann recently raised this issue in an article they wrote for the journal Frontiers in Psychology.  In their article, they suggest holding behavioral interventions, including diets, to the same standards of evidential effect as medications (i.e., FDA approval).  Recall that a drug company has to proceed through certain steps when requesting a new drug application.  It has to show a drug:

• is safe, usually done first in animal studies 
• has limited side effects (ones that are outweighed by the benefit of the medicine)
• addresses an issue or disease that significantly impairs health or quality of life
•  is better than an existing drug for this particular disease 

•  the new drug has to be more effective, have less severe side effects or both  
•  or the regimen for the new drug has to be easier to tolerate than the current treatment (e.g., a once a month injection for osteoporosis treatment vs a daily or weekly pill taken on an empty stomach) 

Drug companies usually start a drug application with the intention of treating only one disease, but they must identify the disease.  Testing goes from the lab, to small groups, to large clinical trials, and then to post market evaluation. 

Imagine the same process for a diet intervention and include efficacy and effectiveness markers, as Tomiyama and colleagues suggest.  A diet intervention (or drug) is efficacious when it works in a lab under controlled conditions and effective when it works in the real world under less than ideal situations –where people might not follow every instruction, every time.  This is where diets seem to fail the most.

Tomiyama and colleagues give a thorough commentary on using FDA standards to test behavioral interventions and they use obesity as their example.  I was able to access the full article after clicking this link and then the tab on the right that says ‘provisional pdf.’ If this idea (testing interventions with the same rigor as testing new medications) intrigues you, I strongly recommend you read the original article.  

My last thought regards something the authors did not mention in comparison to drug trials, but which I would add – marketing and labeling.  A drug company can only market a drug to treat the condition tested in clinical trials.  In addition, marketing material and product labels must include information on side effects; instruct people how to take the drug, and state that not everyone will have the same benefit or side effects when using it.  I would be happy to see this sort of disclosure with diet programs, and expect that if such a high standard were required, most diets would fail to reach ‘market.’

Instead of trying a diet program or worse, diet supplement you see advertised in the coming weeks, why not read more about a health promoting pattern of eating from Harvard’s Nutrition Source – here.

Tomiyama A, Ahlstrom B and Mann T (2013). Evaluating eating behavior treatments by FDA standards. Front. Psychol. 4:1009. doi: 10.3389/fpsyg.2013.01009