Without a doubt, maintaining a healthy body weight is beneficial to our health. Being overweight is clearly associated with higher cardiovascular risk and lower quality of life. Through weight loss, we can decrease the bad cholesterol (LDL) and triglyceride levels in our blood and increase the HDL or good cholesterol levels. As was demonstrated in the DPP study, lifestyle changes designed to maintain a healthy bodyweight can prevent the onset of diabetes, while being overweight is associated with high blood pressure, metabolic syndrome, and certain cancers.
Many people are acutely aware of these benefits of weight loss and achievement of a healthy body weight, but the weight loss landscape is cluttered with scores of weight loss diets and programs, making the choice of the best method a feat of mental gymnastics. Just trying to wade through the deep swamp of diets, dietary patterns, and programs can be a turnoff, potent enough to discourage even the most euthanasic weight-weary warriors. But this does not have to be the case. There are only a few core principles that underlie the science of weight loss and management, and if we can master these, losing and keeping off those pounds becomes a cinch.
Contrary to popular belief, weight loss is not simply balancing the “energy-in‒energy-out” equation in favor of the energy-out arm. The body naturally fights weight loss and decreases energy intake to preserve the status quo and to preserve life. The result is that the more weight we lose, the less energy we expend while performing physical activity. And the more we restrict our energy intake, the more our appetite drives us to eat everything in sight. This battle is not just a physical battle, but is also sprinkled with a generous number of psychological stimuli. Consequently, achieving and maintaining weight loss, using only the strength of our God-given will power is like breaking bricks with bare hands. Doable but not a pleasant experience.
A calorie is a calorie, whether is comes from a gram of protein, carbohydrate, fat, or alcohol. And following a specific diet makes no difference to whether we lose and maintain weight loss or not. What really matters is whether we can adhere to the diet, whether we can afford the diet, and whether we are mentally prepared for the process. Countless studies have shown the equivalence in the long-term weight loss effects of low carbohydrate, low fat, low glycemic index, intermittent fasting, keto, and high-protein diets. When compared over the long term, they all produce similar results. It matters not, therefore, which method we choose, but rather these diets are to be seen as tools in a much larger framework of a lifestyle intervention that includes the diet, self-monitoring, exercise, access to information, and behavior modification. Behavior modification is best achieved through the input of a coach, who can provide feedback and guidance and explore our attitudes and beliefs towards food and our activity levels.
To achieve weight loss, diets of 1200 to 1500 kcal are prescribed for persons weighing less than 250lb (113kg) and diets of 1500 to 1800kcl for persons weighing over 250lb. These should be designed to produce a calorie deficit of 500 to 750 kcal/d and should be monitored daily, at first, and weekly thereafter to facilitate adjustments. The initial goal should be a loss of 7 to 10% of the initial body weight. The diet should reflect the Food and Nutrition Board of the Institutes of Medicine (IOM) recommendations for dietary percentage of macronutrients, namely 45-65% carbohydrates, 10-35% protein and 20-25% fat, unless you choose to follow one of the special diets such as a low carb, keto or low-fat diet. The diet should also take into consideration cultural and social preferences to promote adherence, and it is best to consume 70-100 gm of protein a day to prevent loss of lean body mass. It is true that low-carbohydrate diets produce a greater weight loss initially, but like the perennial hare and the tortoise, those following low-fat and other diets eventually catch up. People seeking to lose weight should also increase their activity level by walking an extra 2000 steps a day. This will consume an additional 100 kcal /d. To maintain the weight loss, continued monitoring and documentation of calory intake and activity level, coupled with effective coaching, are most effective.
Reaching and maintaining a healthy body weight is not simply a matter of following a reduced energy intake formula that is lower than our energy output. We need to take into consideration our cultural and learned eating habits and recognize that we are fighting powerful forces of nature designed to prevent starvation and discourage us from denying our bodies the nutrients it needs to survive.
For more information, see:
Lifestyle Modification for Obesity
New Developments in Diet, Physical Activity, and Behavior Therapy
Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin
2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819889/pdf/nihms936584.pdf