#StripTheNonsense Archives | Page 3 of 6 | Online Dietitian, Helping You Eat Happy

Is Intermittent Fasting Effective for Weight Loss?

Firstly, what is Intermittent fasting (IF)? IF is a pattern of eating that alternates between periods of fasting and eating. The fasts can be:

Daily (e.g fasting for 16hours and allowing an 8-hour eating window)
Weekly (e.g. fasting for 24hours 1-2 days per week)
Yearly (e.g. fasting for 3-5 days once or twice a year).

These diets have a strong media presence and have been linked with many celebrities. They seem to be popular because of their simple nature.

There are typically two goals for people who fast. Either weight loss, or optimisation of health markers, with or without weight loss.

Can Intermittent fasting help with either of these goals?

Weight loss can occur simply as a result of a shorter feeding window leading to reduced calorie intake. The research that we have to date, has shown no significant differences in weight loss, blood fat concentrations, blood sugar levels and insulin levels in those who engage in continuous restriction (the type that characterises other diets), compared to IF (1, 2). *

The longer-term effects (beyond 12 months) of this approach remain unclear, and further research is therefore required.

What are some of the benefits of avoiding eating before bedtime?

Late-night eating is typically defined as eating past 8 pm. There is some research that may support the benefits of eating the biggest calorie meal earlier in the day on blood fats and blood sugar levels, but much of the research we have around nighttime eating is conducted in shift workers who have quite extreme patterns.

It’s important to highlight the huge amount of class privilege that comes with being able to choose the timing of eating. Some people can’t even eat consistently, because they can’t afford it.

Humans are complex, and putting time restrictions on eating is often not practical and does not allow the individual to honour their natural hunger signals. As a clinician, I encourage individuals to pursue what feels and works best for them.

So if not intermittent fasting, what would you recommend to control weight?

There is limited evidence to support the long-term benefits of weight loss. Whilst we know that weight loss is possible in the short term, there is overwhelming evidence that shows any form of intentional weight loss has no long-term success.

Regardless of the degree of initial weight loss seen with lifestyle intervention, most weight is regained within a 2 year period, and by 5 years the majority of people are at their pre-intervention weight.

We’re often led to believe that dieting in any form is pretty safe and harmless. However, what we’ve now come to know through research, and clinical experience, is that dieting can lead to all sorts of complex mental and physical issues. Common issues include things like binge eating, feeling addicted to certain foods, anxiety, stress and shame around food, eating disorders and disordered eating, weight yo-yoing, or weight increasing with each and every diet attempt.

For this reason, I take a Non-Diet approach and weight inclusive approach to nutrition (Intuitive Eating) which is an evidenced-based practice that supports the pursuit of health without focusing on weight or body size. This approach supports health-promoting lifestyle which have been proven to improve health regardless of changes in body weight.

If you’re wanting to get started on this journey, sign up to my FREE 7-steps to find food peace and food freedom.

References:

1) https://www.ncbi.nlm.nih.gov/pubmed/27338458

2) https://www.ncbi.nlm.nih.gov/pubmed/29419624

Gut Health Testing Kits – Expert Opinion

Gut health is an exciting area, and there’s tons of emerging research. You might be wondering how we can best manage our relationship with food, whilst juggling the improving gut health?

Why do we care about gut health?

Our guts do a whole lot of important work. Our small intestines play a role in up-taking nutrients from the food we eat and then shuttling those nutrients around for use in the rest of the body. The large intestine is important to maintaining fluid and electrolyte metabolism (like salt, potassium, and magnesium) while also digesting the more fibrous foods we like to eat. Both the small and large intestine are home to bacteria that help maintain our internal ecosystem. These bacteria are thought to play a role in: The digestion of nutrients, our ability to fight infections (most of our immune system is located in the gut!), and are thought to play a role in our mental health as well.

Principle no.10 of Intuitive Eating (IE) is “honour your health with gentle nutrition”. There’s a reason that this principle is last. So if you’re still working through your relationship with food, keep working through the principles! “Healthy eating” really needs to be put on the back-burner for a short while – I know this might sound a little odd coming from a Dietitian.

In light of ‘honouring health’, Atlas Biomed asked me to try out their microbiome testing kit. They’re on a mission to drive the movement towards preventive healthcare with technology that helps people understand their gut. They’re the only company in the UK to have MHRA approval to sell gut tests directly to consumers – this means they are regulated for safety, quality, and effectiveness and are supported by Gov.uk.

After receiving my home test kit, I posted a very small sample of my poop off to the lab in a pre-paid box. My results came back in 5 weeks. I was fascinated to see that my microbiome diversity level was just above average, that I’m a “veggie muncher”, and that my risk of certain disease is “average” to “low”. It was also interesting to see the long lists of the bacteria in my gut!

So what’s the low down? Are these tests worth your money? I will let you decide.

Pros:

It’s fascinating to get a glimpse into the diversity of bugs in my gut.
It could be interesting to compare test results month on month.

Cons:

No standards of ‘normal and healthy’ exist for the gut microbiota.
When assessing risk of disease based on gut microbiome, there’s a huge chicken-and-egg question involved.
There is little understanding for what healthcare professionals can recommend off the back of these results that would be different to current dietary recommendations for health individuals which are to increase our variety of fibre containing foods.
The recommendation and insight could be triggering for someone with disordered eating/eating disorders.

What will change for me off the back of this? Not much! As per the current recommendations to improve gut bacteria in a healthy individual, I will continue to be a “veggie muncher”, finding tasty and exciting ways to add different fruits, veggies and fibrous foods to my diet amongst munching on other tasty fun foods too!

So now you may be wondering, what can you do specifically to support your gut health outside of taking a test?

Here are 4 dietary strategies to support your gut

1. Enjoy those fruits and veggies! Fruits and vegetables are high in vitamins, minerals, and fiber that not only support our gut health but support our whole body. Incorporating a few fruit and vegetable sources throughout the day has been shown to promote the health of your gut. Consuming increased amounts of these foods have been shown to be associated with lower risks of colon cancer too!

2. In addition to increasing dietary fiber through fruits and vegetables, you can increase dietary fibre through the consumption of whole grains! Oats, whole grain breads, brown rice, and quinoa are all examples of whole grains you could give a try.

3. Probiotics are another means of improving gut health. When you think probiotics, think fermentation! These foods include yogurt, kimchi, kefir, miso, and sauerkraut. These are microorganisms that support gut health. Some health-food stores may sell probiotics in a pill form, but they are rather expensive. We also don’t know what combination of these microorganisms and at what dose are necessary to promote health and what microorganisms don’t really help. Therefore, for healthy individuals, it is recommended to take a food-first approach and include probiotics from food sources rather than a pill.

4. We have discussed probiotics and how having those in your diet are good for your gut health, but what supports probiotics? Prebiotics are microorganisms that support the health of the probiotics, which ultimately support us. Not all fiber sources are prebiotics but most prebiotics are a source of fibre.* Sources of prebiotics include many different fruits and vegetables, like; apricots, dates, dried figs and mango, watermelon, asparagus, beetroot, leeks, okra, onions, almonds, pistachios, rye, spelt, cashews, chamomile tea, silken tofu, fennel tea, and legumes.

One thing that is unique about the Atlas Biomed microbiome test is that they remove some of the guess work for you. They were able to provide me with some more insight into my own personal microbiome diversity and made recommendations on which foods I could opt to include in my diet to increase the diversity of my microbiome. It looks like meals with marrow, pumpkin, garlic, and walnut are on the cards for me!

If you want to know more ways to support not only your gut health, but your overall health through gentle nutrition, seek out the help of your local registered dietitian. Because this article cannot replace individualised recommendations. We would love to help!

*Hannah D. Holscher (2017) Dietary fiber and prebiotics and the gastrointestinal microbiota, Gut Microbes, 8:2, 172-184, DOI: 10.1080/19490976.2017.1290756

Note: This article was written as a paid partnership with Atlas Biomed.

Game Changers: Expert Opinion Piece

The Game Changers is a Netflix documentary. It follows the winner of The Ultimate Fighter, James Wilks. He was on a quest to find out how nutrition could improve recovery and performance, after suffering a major injury. The movie features several professional athletes, all touting a vegan or “plant-based” diet.

The main message of the film: Plant-based diets are the key to athletic achievement and health.

This is quite a loaded message, so we will break down some of the documentary’s main points here.

Is the Game Changers credible?

Pseudoscience has become commonplace in the wellness industry. So it can be difficult to differentiate what’s fact from fiction, and who to listen to.

Some of the core principles behind credibility include:

1) Ensuring the information provided is not out of the remit of the person providing it. (E.g. a personal trainer providing advice on nutrition without training or qualifications). One of the first big impact statements of the Game Changers documentary is when Wilkes describes becoming injured after a sparring match. He subsequently spends 1,000 hours studying peered reviewed articles on how nutrition can improve recovery. The statement was used to create credibility. Yet, all I could think about is the process that it takes to become an expert in nutrition or a registered dietitian.

2) Providing complete information. This means:

Providing information on the context
Not presenting personal experience as fact
Providing supportive evidence from credible sources, with references
Providing appropriate caveats to allow the reader to go away and make an informed decision
Any conflict of interest or sponsorship should be stated

As you will read below, this was not the case for The Game Changers.

3) Offering a balanced critique. This means providing information in a tone that is not overly biased, emotional or exaggerated towards one argument. To also have content proofed by an unbiased party to check claims for being exaggerated. The documentary was very much one-sided. It did not address other arguments for where a Vegan diet might not be appropriate. Or other confounding factors that can affect the claims made.

While Wilkes read about nutrition for quite some time, it cannot be compared to the education a qualified nutrition expert receives.

Often times in our culture, people who live in fit bodies give nutrition advice. It is accepted by the general public because it is assumed their leanness correlates to their nutritional expertise. This is one of the many ways in which our biases or internalised human preferences manifest in our everyday lives.

When seeking nutritional advice, Registered Dietitians and Registered Nutritionists are educated professionals in the field. While Wilkes meant well, this documentary could’ve been a lot more factual. Especially had they collaborated with more experts in the complex field of nutrition.

Let’s discuss some of the claims, faults, and truths of the Game Changers Movie.

Are eating plants good for us?

Of course! Nutrition experts have been saying this for years! But, to eat more plants, you don’t have to become a vegan or vegetarian. Plants and whole grains are high in dietary fibre. These are associated with reduced cholesterol and a reduced risk of heart disease.

While some may pursue a meatless diet to protect the earth, others may pursue this diet to justify disordered behaviours. This can be problematic. Eating a vegan or vegetarian diet is not for everyone, but that doesn’t mean if you eat meat you cannot also eat plants!

Will transitioning to a plant-based diet give you more athletic endurance?

The film features an ultra-runner, a fight between Nate Diaz and Conor McGregor, and even football players. When these athletes made the switch to a plant-based diet, they found they had more endurance and energy. But, it’s likely that they were eating more carbohydrates than they were before. This is because plant-based protein sources tend to contain more carbohydrates.

Plant-based sources of protein like beans, pulses and other starches do not contain all the essential amino acids that our bodies need. To achieve a balanced diet, a variety of plant-based protein sources are required. These plant-based protein sources, tend to naturally contain more carbohydrates. So eating a low-carbohydrate vegan diet would be next to impossible.

In our society, carbohydrates get a lot of heat. Often athletes eat too few carbohydrates out of a cultural fear that carbohydrates will slow them down. If these “plant-based” athletes ate more carbohydrates from the start, it’s possible they would’ve seen similar athletic benefits.

What about the doctors featured in Game Changers who swear by vegan diets?

Several physicians featured in this film have a financial stake in vegan diets. They profit in their own entrepreneurial adventures when the vegan diet succeeds. This is a conflict of interest. For example, Dr. Ornish, Ornish Lifestyle Medicine, has authored several books. He swears by a low-fat, high carbohydrate, vegetarian diet. Over the years he’s faced a lot of criticism for his claims that can come off as alarmist.

Dietitians exist as allied health professionals because doctors don’t typically receive the training required to deliver nutrition advice. Medical schools usually provide as little as one nutrition course. Physicians are medical experts, but once again this film missed the opportunity to hear from a nutritional expert.

Does eating meat hurt how blood flows throughout the body?

Some football players from the Miami Dolphins were asked to eat either a bean or meat burrito. They tested the effect of a plant-based versus meat-based burrito on the blood composition of the players.

It appeared that the athletes had their blood drawn soon after eating (not in a fasted state). This was then taken in vials to a centrifuge. In a non-surprising outcome, their non-fasted blood draws showed greater fat content in the blood of players who ate the higher fat, meat-based burritos.

So what’s going on here?

When we eat, food travels from our mouth to the oesophagus, stomach, and then to the small intestine. As it travels, it is broken down by acid and enzymes. Once broken down and in the small intestines, the food is taken up by the bloodstream for transport so that it may be used by the body. It is no shock that the group who ate more fat had fat in their bloodstream not long after digesting their burritos.

The film goes on to cite a study which tells us hamburgers hurt endothelial function (the lining of our blood vessels). Asker Jeukendrup, PhD, a world-leading expert in sports nutrition critiqued this. He notes that the hamburger study which was hyped in the Game Changers film had only eleven participants. In research, this number of people is not enough to make claims about all humans.

The study which was not fully explained in the film, actually found that eating avocado, offset the effects of the hamburger. This was left out of the documentary. Also, the study was funded by the Avocado industry, which means there is a conflict of interest.

(A conflict of interest means that financial or other personal considerations may compromise, or have the appearance of compromising a researcher’s professional judgment in conducting or reporting research).

Does eating plants help endothelial function?

There is some evidence to support that plants high in nitrates, like beets, can dilate (make wider) our blood vessels. This means ingesting something beetroot juice can widen blood vessels and improves blood flow. This is something sports dietitians have known for some time and have recommended to athletes on a case-by-case basis.

Can I get enough protein on a vegan or vegetarian diet?

Of course! Our culture does place a huge emphasis on meat to get “big and strong”. But we can definitely meet our protein needs without animal products. It can be a challenging task, so prior to making the switch, it’s recommended to start small. It’s also possible to seek the advice of a registered dietitian or registered nutritionist for help.

Is a plant-based diet vegan?

The movie never defines what they mean by “plant-based”. Is it vegetarian? Is it vegan? Is it mostly plants with some meat? Who knows! The athletes seem to use the terminology interchangeably and this is a major flaw.

Nutrition can be tricky and it’s not all black and white. It takes time, many lessons in statistics and expertise to read and understand scientific literature.

Take home message from the Game Changers:

Veganism and vegetarianism are acceptable ways to eat.
Veganism and vegetarianism are not for everyone.
Eating more of the plants we like to eat, regardless of whether we eat meat, is good for our health.
Documentaries like The Game Changers or What the Health are often sensationalised and use language that can be fear-mongering.
While studies have found there to be a reduced risk of certain health conditions when following a vegetarian or vegan diet, this is observational data. This means that large groups of people are followed/observed over time and associations are made. This sort of data cannot speculate that the vegan diet caused the person to be more healthy or have reduced risk of certain health conditions. We can only make associations. We also know from population data that those who follow vegan-based diets, then to be more “health-conscious” in general. So is it all about the diet? Or is it that they engage in other health-promoting behaviours? For example not smoking, moving more, using strategies to reduce stress etc.

My final thoughts trickle down to my public health roots. I would like to point out that having the resources to eat an entirely vegan diet requires privilege.

It can be costly to buy fresh produce, have access to that sort of food, and have the proper utensils/appliances to be able to cook the foods you buy.

Is being vegan good for the environment? Yes.

Is it feasible for everyone? Absolutely not.

Does being vegan make you more moral? Nope.

The way you eat holds no moral value. Everyone’s circumstances are different and so a decision to pursue a meatless diet is an individual one.

Why All Food is Guilt Free

This is the smell of warmth and love: Fresh waffles topped with strawberries and sugar, eaten from the high-top chair at the bar in the kitchen of my grandmother’s house, topped off with a heaping pile of whipped cream. A lot of the memories we hold are centred around food, yet so much of our culture is bent on enjoying as little of it as possible, creating food guilt. This is a concept we should explore further.

Food holds a ton of significance in our lives, both nutritionally and culturally. Yet, we tend to label foods as being a “guilty pleasure” or simply good or bad. Here’s a secret that the diet industry doesn’t want us to know: Food isn’t something that can hold a moral value. Our right to enjoy and savour food is equivalent to our right to breathe.

When one is released from the chains of chronic dieting, food rules go out the window.

Without food rules a few things happen:

1) Food becomes neutral. No more “good” or “bad.

2) The binge-restrict cycle comes to a halt. Food restriction or the idea of restriction nearly always precedes binge-like behaviours.

3) Freedom. Without food rules, it becomes much easier to tune into your body and figure out what it is you really need in that moment.

Without food rules, the guilt and fear of “empty” calories becomes a non-issue.

But of course, there’s always some guy in the back that yells, “BUT WHAT ABOUT WHITE BREAD?”

We’ll use this question to break down a couple of myths about white bread as well as [insert any food that you’ve labeled as being bad or “empty” in the past here].

Mmmmmm Pizza…

To begin, a slice of white bread contains carbohydrates. Carbohydrates are our brains preferred energy source. Therefore, eating a slice of white bread is literally brain fuel. Next, bread is typically full of extra nutrients added in a process called fortification. Therefore, bread is a good source of various vitamins and minerals that are important to everything from producing and maintaining the cells of our body to the production of cells that carry oxygen to our brain.

But hold up. Let’s rewind a second.

Even if white bread didn’t contain those extra snazzy vitamins and minerals and let’s say for kicks and giggles, that it didn’t have any other nutrients in it (which is impossible but bear with me). It still would be guilt free.

Why is that?

Well, food holds more purpose than nourishment alone.

Think about it, events important to our varying cultures and religions usually have one universal focal point: food. Food is social. Food is religious. Food is comfort after a crap day of work. Food is a memory of cooking Belgian waffles in the kitchen with Grandma and the smell of fresh strawberries soaked in sugar overnight.

Food is so much more than a vessel for calories and vitamins. It is meant to be enjoyed; our survival depends on food being enjoyable.

When it is all said and done, nutrient content doesn’t matter. In the framework of intuitive eating, folks are able to recognise when and what to eat.

As a personal example, if I have a few days that I don’t get much fibre, I notice I don’t feel so hot. So, I work on including extra veggies and whole grains when it serves me. I also recognise that if I only eat salads for lunch all week, I crave and seek out foods that are more nutrient dense. If I eat too much ice cream, I feel sick. But with intuitive eating, I know I can buy more ice-cream whenever I want, so the urge to eat past what’s comfortable gets dampened.

To help, here are some diagrams that demonstrate what a day with intuitive eating looks like.

Finally, for some additional clarity, here is a list of actual “bad” foods and “good” foods:

Without good or bad food, all food becomes guilt free. When something is a necessity for life, it is not guilty. Our urge and need to eat is a survival mechanism. There is no need to fight against our biology. If you are someone who struggles to know what to eat check out a few of these articles:

Intuitive Eating Tips for those Starting Out

Eating for Weight Loss or Eating for Happiness?

How to Start Intuitive Eating

Eating for Weight Loss or Eating for Happiness?

What do you think would happen if you stopped relying on external tools to tell you what to eat, when to eat and how much to eat (aka calorie counting, food tracking, points systems etc.)? If your thought process looks like this one you are not alone:

For most, the absence of rules and regulations leads them to believe that the above image will be their fate. But, if restriction really worked, wouldn’t we all be thin by now? It is estimated that 57% of women have been on a diet in the past year! In reality, we know dieting/restriction in and of itself leads to that feeling of a loss of control around food. The real progression should look like this:

As we learned in our last article Why Can’t I Keep The Weight Off, the reason for this progression, is actually linked to our bodies own survival mechanisms. To our bodies, no matter their size, restriction equates to famine. Famine brings on hormonal responses that make us hungrier and increase food seeking behaviour. No, your body does not understand that the latest fad diet isn’t a famine. No, your body doesn’t understand that the latest “lifestyle change” is not a famine.

Restriction is Dangerous and Damaging

A good way to know if you are ready to stop feeling consumed by guilt around what you should and shouldn’t be eating, is if you are able to recognise the less obvious forms of restrictions that may be harming you. According to Evelyn Tribole and Elyse Resch, the founders of Intuitive Eating, recognising and acknowledging the harms dieting and restriction has caused you is the first step to dropping the problematic diet mentality.

Pursuit of Weight Loss can Interfere with your Physical and Emotional Well-being

When has the pursuit of weight loss interfered with your ability to enjoy life? Here are some common examples:

Ordering the less appealing menu item or skipping a night out altogether to avoid the more appealing foods.
Losing weight on your diet, receiving compliments and feeling shame in seeing people when the weight came back on.

Think about the ways dieting has caused you harm. If you are still unsure if you are ready to make the jump away from dieting, here is a quiz to help you decide.

No diets? What now?!

Maybe you’re someone who says to themselves, “Hey, dieting really messed up my life, I am ready to leave it, but I don’t know what to do next.”

This is where intuitive eating comes in. This is an evidenced-based way of eating and it is designed to help you feel better around food. By honouring your health and respecting your internal cues, you honour and respect your body. Starting intuitive eating can be tricky, but we have the resources to help support you. When we start honouring our hunger, quit labelling foods as being good and bad, and most importantly, show ourselves compassion and forgiveness, we can begin to listen to our body’s internal cues.

The State of the Science

For a lot of people, the news that “diets don’t result in long term weight loss” and that intuitive eating may be a better way to safely support health is a shocker. Who would’ve known that intuitive eating has over 100 published studies to support its use? Who would have known that scientific literature reviews examining the long-term impacts of dieting, would find that weight loss isn’t really related to positive health outcomes.*

That paper, published in 2013 by Janet Tomiyama echoes that of a similar paper that says, “The results for the treatment for obesity are remarkably similar and remarkably poor.” ** What the authors meant by that statement: The results of studies examining dieting were similar in that people wouldn’t maintain weight loss over time and these results were found in virtually all of the studies the authors examined.

The Futility of Dieting Is Not New News

This was a study done by Stunkard A. et al. in 1959. That’s right 1959. We’ve seen the opposite impact of what dieting is intended to do: the most predictive outcome of dieting being weight regain over time. We see this in long-term review studies of dieting dating back from 1959 to the present. Yet, dieting is still promoted by many healthcare providers.

References

*Tomiyama, A. J., Ahlstrom, B., & Mann, T. (2013). Long-term effects of dieting: Is weight loss related to health? Social and Personality Psychology Compass, 7(12), 861-877.

**Stunkard A & McLaren-Hume M. The results of treatment for obesity: a review of the literature and report of a series. Arch. Intern. Med. 103:79-85, 1959.

Why Can’t I Keep The Weight Off?

It feels like everyone and their brother has been at this place: They’ve gone on a diet, lost some weight, and despite their best efforts, the weight and more may have come back on. With this, family or their doctor may have said, “Well, they probably just got tired of the diet” or say something silly about willpower. But is the answer really that simple? Why is it that most people can’t keep it off?

There is an idea called set-point theory and it theorises that every unique individual has a weight range their body likes to be at. Some people’s bodies may stay at the lower end of the spectrum while other bodies may stick to a higher size.

This idea is a bold statement.

How could potentially a body be meant to be large?

A multibillion-dollar diet industry has even been built upon this idea that large is unhealthy and we must become smaller for the sake of health.

But if set point theory is true, wouldn’t that mean some people are just high weight and that is that?

Let’s see what the science says…

The Science of our body weight

Scientists have noticed for some time that our weight loss methods aren’t effective in the long term. In a study published twenty-five years ago, scientists who recognised the futility of dieting decided to see what happened when they made subjects in two groups either lose 10% of their body weight or gain 10%.* After measuring how much energy the participants used (like how many calories they needed in a day) they divided the groups and measured how their energy needs changed after weight loss or gain.

The results?

In the first group, after gaining 10% of their body weight, something happened. Their bodies adjusted how much energy they were using. The weight gain was correlated with their bodies using up more energy than they were previously. The participants fell back down to their usual weight. Those who lost 10% of their body weight saw the opposite effect. Their bodies started using less energy. The participants in the weight loss group once again went back to their usual weight.

In summary: The energy usage of the study participants bodies changed to either be more or less efficient so the participants would bounce back to their usual size.

This study was back in 1995. That could mean one of two things:

It is now outdated
It was an early indication that body size management was much more complex than diet and exercise.

In more recent years, scientific studies have not only found similar results to the 1995 study but have gone a little further.

More Science – The Biggest Loser Show

There is a famous study that looked at the metabolism changes of participants who were on the television show, The Biggest Loser. For those of you who are unfamiliar with the show, it is a weight loss competition. In this study, we saw further indication for set-point theory, but also realised that set point, rather than being a single number, is on a sliding scale and may change with years of dieting.

The participants in the study had all, but one person, regain a significant amount of weight back by the time of the 6-year follow-up.**

The one participant who hadn’t regained a significant amount of weight had a medical procedure called a gastric bypass or weight loss surgery. There is some scientific thought that for an unknown reason, a gastric bypass impacts the body’s ability to use energy differently than from standard dieting. They were more likely to keep the weight off (you can read additional information on bariatric surgery at the bottom of this article).

Regardless, the important findings of this study showed that the participants who hadn’t received gastric bypass surgery had changes to their metabolism that seemed bent on having them not keep the weight off. Those who had the most, “success” over time at maintaining their weight-loss, had proportionally greater slowing of their metabolism. In other words, they needed consume fewer and fewer calories as time went on in order to keep it off.

In summary: Their bodies were bent on altering their metabolisms to stop them maintaining the lower size. Keeping off the weight loss therefore required an extreme amount of attentiveness. We see that the longer the weight loss is maintained, the greater the human body will try and counteract that loss through the slowing of the metabolism.

Other factors involved in maintaining body size include shifts in hormones such as ghrelin, a hormone related to hunger. Ghrelin increases during weight loss causing increased hunger, designed to make us eat more and store more body fat. These are survival mechanisms when it comes down to it. Your body doesn’t know the difference between a long-term famine or a short-term diet.

What about genetics?

One way for scientists to control for genetic influences in their work is to study twins. One example of this is a scientific research article entitled, “Does dieting make you fat? A twin study”.*** The twins that partook in intentional weight loss pursuits gained more weight over time than their twin. In females, this result was even steeper. With every attempt of intentional weight loss, the researchers saw proportionally greater weight gain. These results didn’t change after the researchers controlled for factors like BMI, social class, and smoking.

In summary: The study concluded that more dieting resulted in more weight regain. These findings provided further indication that dieting had the opposite result of its intent.

What about NEEDING weight loss for Type 2 Diabetes management?

This is interesting in the context of conditions like type 2 diabetes where intentional weight loss is a normal recommendation for treatment. An intensive lifestyle study aimed at weight loss in the scenario of type 2 diabetes was actually discontinued. Why you ask? The efforts were labeled as “futile” by the researchers after the intervention had not impacted rates of heart disease related outcomes.****

In fact, we know that since there isn’t a method of sustainably maintaining a lower size, regain after dieting will likely occur. According to Lauren Newman, RD.

“Weight cycling (yo-yoing) increases insulin resistance and I never see that acknowledged in the diabetes world.”

Weight cycling occurs with repeated weight gain and loss over time. If there isn’t a scientifically proven weight loss diet to work, we are essentially sending these patients down a path of yo-yo dieting without considering the consequences yo-yoing holds to insulin resistance.

Overall, due to our body’s complicated mechanisms of maintaining our present body size, there seems to be minimal chance of keeping the weight off. Efforts should be put into behaviours that can be controlled, such as dietary changes, participating in joyful movement, stopping smoking, and reducing alcohol intakes. Body size is not a behaviour.

In summary

Difficulty in keeping the weight off can be due to a multitude of factors: from the discontinuation of the diet due to unsustainability, genetic conditions, to of course set-point theory.

In the consideration of the achievability of keeping the weight off, the set-point theory cannot be overlooked. We know our body changes in response to restriction and excess, that dieting is associated with greater weight gain over time, and that in the long-term diets fail 95-97% of the time.

All of this information should come together to indicate that our bodies will fall where they want to fall in the context of food freedom. Unrestricted eating in the intuitive eating framework is an opportunity for folks to land on their body’s current set point in way that protects mental and physical well-being. Our bodies are meant to change and adapt over time. Set-points are not a notion of one stable number, but rather the acknowledgement that at different points of your life, after facing varying and unique exposures, your body will make adaptations to achieve the size it is comfortable being.

References

*Rudolph L, Rosenbaum M, Hirsch J. Changes in Energy Expenditure Resulting from Altered Body Weight. New England Journal of Medicine. 1995;333(6):399-399. doi:10.1056/nejm199508103330628.

**Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity. 2016;24(8):1612-1619. doi:10.1002/oby.21538.

***Pietiläinen KH, Saarni SE, Kaprio J, Rissanen A. Does dieting make you fat? A twin study. International Journal of Obesity. 2011;36(3):456-464. doi:10.1038/ijo.2011.160.

****Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. New England Journal of Medicine. 2014;370(19):1866-1866. doi:10.1056/nejmx140022.

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