Sustainable Weight Loss?

October 21, 2014 in Health, Uncategorized, Weight Management by Joyce Bunderson

I’ve noticed considerable press coverage for a study out of the University of Melbourne and published in The Lancet. In essence the study was trying to discover if more weight is regained after a rapid weight loss or after a gradual weight-loss program. The researchers of this study say that their results found both groups gained the same amount back after three years; and that those results are contrary to the current dietary recommendations to lose weight gradually. Results that defy current standards often make good press.

In my opinion, there are some other issues to consider, before all the dietitians, doctors and other health professionals run out and start recommending a rapid weight loss program.

First, one issue that doesn’t seem to make much of an impact on the researchers of the Lancet article is that both groups regained similar amounts of weigh. So if the entire goal were to lose weight quickly, then definitely the very low calorie (450-800 kcal/day) rapid weight loss group would be the winner. But if the goal is to lose weight and keep it off, both of the groups as defined in this study were equal failures.

Keeping weight off is a lifetime struggle for many people, especially those who have lost a significant amount of weight. To me it’s interesting, that they’re arguing about two groups, neither of which, successfully kept the weight off. The rapid weight loss group, although more of them succeeded in losing at least 12.5% of their bodyweight was as much a failure at keeping the weight off. What’s the point of weight loss, if the subjects don’t keep it off?

One part of the rationale of losing weight slower is that when you don’t go on some drastic weight loss program you have the time to make some permanent changes to your eating and exercising habits. (Let’s face it, going on 450-800 kcal/day is drastic and usually must be supervised by a medical doctor. One problem with rapid weight loss is that it’s almost impossible to remain well nourished on that low of a calorie intake.) Supplying enough calories for your brain to remain functional, thus keeping the body alive and out of trouble is not the only function of eating. Think about it. If you’ve seen pictures of people in concentration camps during wars, they may have survived, but do you think they were healthy? Did they have long-term health problems?

This type of study is very frustrating for me, as I believe that it will get lots of exposure and people who are susceptible to all kinds of quackery will be saying a rapid weight loss is more effective than a more moderate weight loss. Sustainable habits are what weight maintenance is all about. If the weight loss is not accompanied by a change in habits, a sustainable change, then obviously, it is a somewhat futile exercise to lose weight and just put it back on. One of the reasons that professionals who work in weight loss settings encourage moderate weight loss is that they are trying to help the patient develop and keep new habits. The patients are learning how to make new choices; it usually takes some time.

While it is true that a person can go on any of the many different types of rapid weight loss programs and drop lots of weight fast, staying healthy and getting healthier by achieving a lower body mass in the long term is the goal. A second issue is that many of the very rapid weight loss methods put the individual into ketosis, which knocks out hunger. So that’s a big plus for individuals who suffer from hunger during weight loss. While there is still controversy about how harmful being in ketosis is, it seems to me that there’s a very unscientific way to help the dieter make an informed decision regarding going into ketosis or not. If your body works so hard to unload ketones in your breath and urine, ketones mustn’t be healthful for the body – the body needs to rid itself of them. I realize that many dieters on HCG diets and any number of other fluky diets; high protein and very low carbohydrate diets; and the like, strive to get into a state of ketosis. We know that having high ketones has an affect upon the body; certainly that’s why it is used with patients with seizure disorder; but that is all done with close medical supervision for very specific problems – because it has dangers.

Please consider that very rapid weight loss, using very low calorie diets also have serious immediate health risks, including: gallstone formation, irregular heartbeat, and imbalance of electrolytes that keep the body’s muscles and nerves functioning properly. You should not go on a 450 – 800 k/cal diet without medical supervision!

Another issue with the Lancet study is this: rapid weight loss can be very motivating. I understand this, but if the patient doesn’t make sustainable changes in the way they will eat and exercise, I ask again, what’s the point? Why do the researchers think that the patients got better results with the rapid weight loss? If you put it back on, what were the better results? There’s plenty of evidence that people who make big life style changes (for example, stop drinking soda, stop eating fast food, change the diet to include more fruit and vegetables; decrease the volume of their intake; and add exercise to their life) lose weight and keep it off. It’s not glamorous, jazzy or sexy, but the long term is what weight loss is all about – sustainable changes in life style.