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General

What Actually Reading that Fast vs. Slow Weight Loss Study Taught Me

Posted October 16, 2014 by Yoni Freedhoff

I imagine this one will be all over the news today, and superficially I can certainly see why – a new study reportedly proves that if you lose weight fast or slow, 3 years later, regardless of the speed you lost your weight, you’ll have gained back the same amount. This of course flies in the face of the advice that slow and steady wins the weight loss race.

Read the actual paper and the story becomes far less exciting.

In brief, study participants were randomized to either lose weight quickly with an all-liquid meal replacement shake program (Optifast), or to lose weight slowly using that same Optifast shake to replace one to two meals daily. Once a target weight loss of 15% was reached all patients who got there were then instructed to follow Australia’s national dietary guidelines and to see a dietitian once every 3 months for the next 3 years.

Over that same 3 year period, everyone, regardless of whether they lost weight with Optifast quickly, or lost weight with Optifast slowly, regained the same amount of weight when following Australia’s national dietary guidelines – guidelines not even remotely designed for weight management or satiety (15% protein, 30% fat, 55-60% carbs) – while being provided with very little in the way of ongoing support.

Put another way, being prescribed a weight loss program that involves zero changes to lifestyle (aside from drinking shakes in place of meals), and then once weight is lost quickly or slowly, being told to follow a diet not designed in any way shape or form for weight management while receiving infrequent ongoing support, is clearly equally ineffective.

The fact that weight lost comes back when the intervention you undertook to lose the weight is stopped is anything but surprising, and yet that is precisely what was done with both the rapid losers and the slow losers. That there was no difference in their rate of regain speaks more to the authors’ failure of recognizing obesity as a chronic condition, which like any chronic condition, returns once treatment is stopped, than it does to the speed participants lost weight using weight loss interventions that they were explicitly instructed to stop once their weight was lost.

The more weight you’d like to permanently lose, the more of your life you’ll need to permanently change. All this study proves is that temporary changes lead to only temporary results and that what matters to your longterm success isn’t the speed with which you lose your weight, but whether you lose your weight with a lifestyle that you enjoy enough to sustain.

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Children

The Recipe for the Perfect Family Meal

Posted October 14, 2014 by Yoni Freedhoff

Yesterday a fascinating new study published in Pediatrics. Researchers studied the video recordings of 120 families’ meals for over a week to try to tease out what family meal factors were most associated with overweight and obesity in children. Not only were where the meals taking place studied, but also who was there, how long they lasted, and then what sort of interpersonal relationships were seen at the table (both between parents, between parents and kids, and between kids themselves).

Before I get to the results it goes without saying that these results can’t distinguish between cause and effect – meaning that it’s unclear if the relationships described by the study, if adopted, would in fact prevent weight gain (or lead to loss). That said, given how easy and straightforward many are, I thought it would be worthwhile to publish a simple recipe for healthful family meals based on the study’s findings.

The Perfect Family Meal

  1. Takes place in the kitchen
  2. Lasts for 18 minutes or longer
  3. Has at least one (or ideally both) parents present
  4. Is consumed alongside attentive, warm and supportive conversation
  5. Includes a positive discussion of the foods involved (not a discussion in terms of weight or good/bad, but rather such things as where the food came from, what it might be like to grow it, other meals that might be enjoyable from similar/same ingredients, etc.)

and while not found to be significant in the study I’d still add:

       6.  No screens (TV, phones, or other).

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Children

Another Meta-Analysis Confirms that Kids Can’t Outrun Their Forks

Posted September 24, 2014 by Yoni Freedhoff

Wouldn’t it be great if childhood obesity could be tackled with PE classes and after-school sports?

Unfortunately believing or wanting something to be true doesn’t make it so and study after study looking at the impact of activity levels on children’s weights demonstrate that while incredibly good for their health, exercising doesn’t tip the needle on the kids’ scales.

Well add this meta-analysis to the mix. Published in Preventive Medicine the authors pulled randomized controlled trials of 6 months or longer in duration that looked at the impact physical activity interventions had on body mass index, blood pressure, total cholesterol and triglycerides. In total there were 11 such trials that together included 10,748 children.

The results were pretty clear. 6 month or longer physical activity interventions weren’t associated with reductions in BMI, but they may have a positive impact on the kids’ blood pressures and triglycerides.

Yes, I know I’m a broken record, but for the record, weight is lost in kitchens, health is gained in gyms.

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General

More on Why The Biggest Loser Contestants Are Doomed To Fail

Posted September 22, 2014 by Yoni Freedhoff

I’ve written a great deal about The Biggest Loser.

I’ve covered the fact that according to previous contestants the vast majority gain their weight back, I’ve covered the metabolic slow down that occurs consequent to the show, I’ve covered the cruelty of the show’s inclusion of children, I’ve covered how watching the show actively discourages viewers from exercising, and I’ve covered the ethics of being a physician involved in its production.

Today I’ll leave you with this tidbit.

In a study published early online last week in the journal Obesity, when compared with matched gastric bypass patients, following their respective losses, contestants on The Biggest Loser had 5x less circulating leptin in their bloodstreams.

Leptin, in case you aren’t aware, is one of the body’s primary satiety (fullness) hormones.

With 5x less circulating leptin, and metabolisms that are slowed down twice as much as their gastric bypass counterparts’, it’s no small wonder the majority of The Biggest Loser’s contestants are reported to have gained their weights back as it’s tough to be a metabolic slug and be hungry.

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