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Newswise — Low fat or low carbs? South Beach or Atkins? Weight Watchers or Jenny Craig?
Maybe you've tried them all. It's even likely they all worked at first, until suddenly you seemed to hit a wall. With the increasing prevalence of obesity in the United States, what's a desperate dieter to do?
"A lot of diets work, in terms of inducing weight loss. What is more difficult is for diets to ensure weight maintenance after people have lost their weight. Any time you change your diet and reduce calorie intake, you're going to lose weight. How fast that happens depends on how much of a calorie restriction there is," says endocrinologist David Schteingart, M.D., associate director of the General Clinical Research Center at the University of Michigan Health System.
When you start a diet, your body changes the way it metabolizes nutrients, adjusting to the lowered carbohydrate intake or lower fat intake. If you're following a low-carb regimen, for example, the body finds its energy by metabolizing protein or fat instead.
After a few months of the same very strict diet, the thyroid hormone levels change, triggering a need to conserve energy. This slows down the rate of weight loss, which explains that plateau all dieters struggle though. The plateau can also be a sign that your resolve is flagging and you're starting to slip on your diet. Either way, it's important to push through the plateau, Schteingart says.
"Usually what we recommend is that people re-examine how they're eating and their level of physical activity. Don't give up, because usually the plateaus last for awhile and then people start losing weight again," says Schteingart, a professor of internal medicine at the U-M Medical School.
But what about those low-carb diets? Do they really work? Schteingart says he's seen patients succeed at losing weight and keeping it off using low-carb diets. Carb-heavy diets tend to make people hungrier, because carbs are absorbed faster than protein and fat. High-fat and high-protein diets, which are absorbed more slowly, keep people satisfied longer.
"People who are on very low-carbohydrate diets tend to feel tired. Carbohydrates provide a quick source of energy, and you need energy for muscle metabolism. So your endurance may be decreased by low carbohydrate intake because the body has to use fat to provide energy for muscle contraction," Schteingart says.
The idea behind limiting carbohydrates is that a high-carb diet may stimulate insulin secretion. Together with obesity, this may worsen insulin resistance and cause the pancreas to secrete more insulin. A condition called metabolic syndrome results from insulin resistance and is associated with abnormally high cholesterol, diabetes and hypertension.
"What the low carbohydrate diets might do is decrease insulin resistance, decrease insulin secretion and reverse some of the metabolic consequences of obesity," Schteingart says.
Low-fat diets, meanwhile, can prevent cardiovascular diseases from developing by lowering blood cholesterol and triglyceride levels. A low-fat diet may actually help reverse the build-up of plaques in the arteries that lead to heart attacks or stroke.
The theory behind a low-fat diet is that there are 9 calories per gram of fat, compared to 4 calories per gram of protein or carbohydrate. So you're getting more calories in a small volume of food. By limiting fat intake, you can avoid eating as many calories.
"The problem with low-fat diets over the past decade is that they've promoted relatively high carbohydrate foods, and people end up eating as many calories " or more calories " as they were eating before they started the diet. That helps explain the increase in obesity, in spite of the fact that people are aware of the need to control food intake by restricting fat," Schteingart says.
No matter which diet you follow, when weight is lost, some of it is burned off as energy. If not enough energy is coming in, the body pulls it from the tissues in which it's stored.
"It's the same as if you had a bank account but stopped earning money: You begin to draw the money from your bank account to be able to live," Schteingart says. "The same thing happens in a way if you're in a calorie deficit situation: You begin to use your tissues " first carbohydrate, then fat and ultimately protein " as a source of energy."
Don't expect drastic weight change overnight. It's likely taken you years to gain weight; weight loss is best slow and steady as well. Losing three-quarters of a pound to two pounds a week, and no more than three pounds a week, is ideal. It's also important to set realistic goals.
"We usually encourage weight loss to a good, healthy functional level. That may be losing only 30 or 40 pounds. You may still be overweight if you measure yourself against ideal weight charts, but it may not be reasonable for somebody who has been overweight all their lives to go from 250 pounds to 140 pounds. On the other hand, they could be much healthier by losing significant amounts of weight and keeping their blood pressure and their blood sugars in adequate control," Schteingart says.
Once you lose weight, maintaining that weight loss is key. Schteingart suggests continuing to limit calorie intake and continuing an exercise program.
Get started
Schteingart advises working with a doctor or nutritionist to lose weight. This person can help create a diet and exercise plan tailored to your health and lifestyle. Here are some basic tips to get you started:
"¢ Restructure your meals, eliminating mindless eating, foods with no nutritional purpose, snacking and even alcohol.
"¢ Avoid eating in response to emotions, such as being lonely, sad, bored or stressed.
"¢ Begin a physical exercise program. Look for activities you enjoy so you're likely to keep at it.
"¢ Focus on what you're eating. Get rid of distractions such as TV and don't try to scarf down a meal while you're driving.
"¢ Don't skip meals. In the long run, you'll make yourself too hungry and can end up bingeing on too much food at once.
"¢ Get your friends and family to support you. Don't let other people pressure you into eating when you're not hungry.
Choose a safe weight-loss program
Here are some questions to ask before committing to a weight-loss program:
"¢ How does the program work? Consider whether you prefer individual or group counseling or support classes. Do you need to buy specific foods or supplements? Look for a program that encourages physical activity and is sensitive to your lifestyle or cultural needs.
"¢ Is the staff qualified? Consider the training, experience and certification of program leaders.
"¢ Are there any risks? Some programs directly involve working with a medical professional. Others include interaction with your regular doctor to coordinate any medical or prescription needs.
"¢ How much money will you have to spend on the program? There may be fees for weekly meetings, medical tests or follow-up programs.
"¢ Will it work? Find out how much weight the average participant loses and whether people tend to keep weight off.
Resources
Exercise and obesity: http://www.med.umich.edu/1libr/aha/aha_exercise_crs.htm
Making healthy choices: http://familydoctor.org/x4927.xml
Losing weight: http://www.nhlbi.nih.gov/health/public/heart/other/chdblack/embrace1.htm
Carbohydrate addiction: http://www.americanheart.org/presenter.jhtml?identifier=4467
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