Why Diets Fail

Jane Brody's New York Times column this week talks about a series of articles  in The Lancet, a medical journal.  Three of the four articles are focused on public health and the obesity pandemic. The third, of greatest interest to me, focuses on quantifying weight changes based on energy in versus energy out.  (I'd like to save the world, of course, but how about me first!)  Because I am a geek and because I wanted to avoid all chores and other problems for a while, I flopped on the couch this morning and read the actual Lancet article on this quantification.

So guess what? Existing projections of how much weight you should lose by cutting calories or upping exercise are wrong, and overestimate weight loss.  Well, duh. We knew that, those of us out here in the trenches of the weight wars. The sophistication they have added to the calculations isn't overwhelming:  very fat people lose weight more quickly than others for a given cut in food or increase in exercise, simply because it takes more calories to maintain their body weight (they burn more calories while lying on the couch) and because they burn more calories during aerobic exercise (it takes more calories to move those big bodies). As your weight declines, you lose that effect and so it takes cutting out more calories or upping exercise even more to continue to lose at the same weight.

(They do not include in their model any assumption that exercise leads to greater muscle mass which burns more calories - they include the relative burns of fat versus muscle, and assume the fat goes away as weight loss occurs, but explicitly do not include any increase in absolute muscle mass. They say it's probably not a big deal for aerobic exercise. Very fat people have to have muscles just to move, of course. I know I've added muscle, not just relatively but absolutely, but I do quite a bit of weight training.)

An additional conclusions they reach which I have to quote because I can't follow all of how they got there:  when there is a lot of fat to lose, you will lose faster by adding exercise, but after a certain level of exercise has been added, there is more benefit to cutting food than to adding more exercise.  Going beyond the math, they suggest it does make sense to "go on a diet" - have a big, artificial restriction in food - at the beginning of a weight loss program, because otherwise their model's predictions of how long it will take to get to goal is very discouraging. Most books I've read of popular diets follow that approach - lose, then taper off towards maintenance.

They spend some time looking at plateaus. They note that many dieters reach a plateau after eight months, and speculate on why.  Apparently no in-patient studies go beyond six months, and they say only in-patient studies are accurate for food intake and exercise records - "diaries are notoriously inaccurate". Because there is no change in the math they have calculated during the six months, they don't think there is a sudden change at month seven or eight to account for the plateau. Instead, they note there is a lag between adding food and gaining weight back, and they hypothesize most "free-living" (their term) dieters stop being rigorous in their diets after a few months, but the weight loss continues and so they think they are ok doing that, but it finally catches up with them and they plateau on the scale with no additional cheating going on. This is a second answer to "why doesn't what I do now work the way it used to?".

There is a side-bar on whether diet composition (eg high carb versus low carb) makes a difference.  There is a very grudging tone to any discussion about whether low carb works - there really is a prejudice out there - it's not just purely scientific. They say several studies support that low carb leads to greater weight loss, "at least in the short term". They offer some possible reasons for this: (1) physiology at the cell / molecule level means (I think they say just like Atkins et al) that carbs take less energy to turn into fat; (2) eating protein means you feel more energetic and thus burn more calories; and (3) high protein, low carb may lead to more satisfaction with your diet and therefore fewer calories consumed. They go on to say that since diet logs lie there is no way to tell what people are actually eating. They go on to conclude that any effect from composition doesn't matter over the long term (based on what?) and so they say it doesn't matter over the short term either and a calorie is a calorie is a decent rule of thumb. I don't exactly get this.

So how might I use this information? I don't know. The very short takeaway for me is that if I want to lose weight, I have to keep up the exercise, but I really have to cut calories, and even then it will take a long time.

Sigh. I think I actually knew that already.

Reset

One of the things I really like about the WW program is the way the points you use just reset. There are daily points, and no matter how much you eat in a day, the points start over tomorrow.

This is relevant because I have my worst time in the evenings during the week. I'm all alone with my dog, and she thinks frequent trips back to the kitchen are wonderful. No matter how tired I am, I have to have my little snack while sitting down and reading or writing in the quiet and solitude. Sadly, my resolve is at its weakest then, and that leads to incidents like the one last night involving chocolate Jo-Jos. Sigh.

But every morning is a new day. I mark off my excesses against my weekly budget for excesses (and how lovely a concept is that!) and start over in the morning with a fresh budget. And the daily budget is just fine all by itself. It doesn't require constant self denial to stay on it- instead, it forces a constant focus on fruits and vegetables to eat well while within the allowance. I have yet to prove whether the allowances will really lead to weight loss for me, especially when I use the weekly points. It feels more like maintenance, but I've now got less than 15 pounds to go and so that is probably right. There should be a tapering off of restrictions in order to get used to maintenance. The problem with that is it's hard to see any progress.

I'm thinking another cabbage family blitz is in the cards fir me, perhaps starting this weekend. Wish me luck.


Sherbert update

That's Two in a Row

Tracking, that is. It makes me so much more conscious of what I'm doing.


- iPhone uPdate

Back to Tracking

Score a tiny victory for one day of tracking with WW on-line. I have a big box of cookies from Trader Joe's in the house (bought for but not eaten by young house guests). Here I am at the end of a stress filled day, my most vulnerable condition, and I looked up their points and put them in BEFORE eating them. Kept me below my point totals for the day. Hooray.


Sherbert update

Weight Watchers on Vacation

I'm really enjoying this placid slow time on vacation. But, if I don't want to undo the blitz, I'm going to have to be more actively paying attention to my eating and activity.  I like WW because it lets me reset each day, and gives me flex for the week.  My WW week starts on Monday, so I went back and tracked yesterday, and intend to keep it up for the rest of the week. I drove down on Saturday and I'm ignoring my eating for those two days.

But--- I get 29 points a day, plus 49 extra points to use over the course of the week, plus any activity points I can earn.  Yesterday, I made carb-heavy choices, which means point-heavy choices.  A grand total of 47 points for the whole day!!!  I better get out there walking the beach to earn lots more activity points - maybe even a jog - to get back to a stage where I can still have my daily beer and daily single piece of chocolate.  I'm going to have to get to the supermarket for more fruit as well.  I have some convenient snacks lying around, but they are not point-friendly selections.

TO my day! Excelsior!

Decision Fatigue

There is a particularly interesting article in the New York Times about making decisions. Basically, it's really tiring, you have a budget of how many you can effectively make during the day. Exersizing willpower is effectively making a choice, like going to the buffet and restricting yourself to salad instead of the yummy orange chicken. Carrying your lunch in a bag eliminates the need to make a decision and thus conserves your willpower. A shot of sugar helps you make more effective decisions. Eating an apple on the way home from work should help me make better dinner decisions. My interest in cognitive behavior therapy and needing to have some structure in the diet and exercise world makes sense with this perspective: making a rule not to eat doughnuts means "no choice" and making an appointment to exercise means "no choice". It also explains what I know so intuitively about days with lots of meetings. If I am running them, they are very very tiring.

I'll link to the article when I get the regular computer up and running later.
UPDATE: Here is the link

Sherbert update

Location:Topsail Beach

The Scale Is Broken, Long Live the Scale!

I remained suspicious of the remarkable numbers showing on my scale. Wednesday, it had been down 5.5 pounds from Tuesday. Thursday, my scale read the same, but when I weighed myself at the gym, I got a higher reading. However, I hadn't used the gym scale before (an old-style doctor's office with sliding bars for the the weights) and the readings varied by clothes, shoes, and time taken. But Friday, my home scale was down another four pounds and that just wasn't credible. So Saturday, just before I left the house for the gym I weighed myself in clothes and shoes, and then immediately got on the scale in the gym ten minutes later. EIGHT POUNDS DIFFERENT!!!  Clearly the home scale is broken.  I don't get how a scale "breaks" but it is twelve years old, dirty, big, and I decided it was time to go shopping.

I have a lovely sleek new electronic glass and metal scale with a WW logo on it. (Bed, Bath and Beyond, $29).  Besides weight, it purports to tell me fat percent, water percent, BMI, and bone density.  Except when I read the pamphlet, it basically said all those other readings are very unreliable.  The main thing is, it works for my weight, I can read the number without wearing my glasses, I like how it looks, and it fits in my room.

Living for a couple of days thinking I might be near my ultimate weight loss goal stimulated some new thoughts, which I may write about at another time. Now, I simply want to note that the blitz actually did more or less what I hoped it would, really. Moved me through the plateau and onto a new downward trajectory. The trend is real but fragile. My most recent accurate readings are the lowest in six months.

This graph shows the plateau since February. The light line are my daily weights and the dark line shows the weekly average, taken on Saturdays. The total vertical range of this graph is ten pounds (I had to change the scale to get my latest weight on it!).  It's so clear how I've been bouncing around in this same space. This last week, I filled in my bogus data points with estimates from the gym, and yesterday and this morning are real on my new scale. I think I'm breaking through the barrier. This is what I need to keep myself motivated and moving forward.

The main change I've incorporated since my first four day all cabbage all the time phase is I'm trying to organize every meal around the vegetables. Start with that, rather than start with the meat.  I'm using meat more as a flavoring than a mainstay of the meal. My snacks are fruit, not nuts or cheese or something more starchy.  Thank goodness for peach season!  And apples are just starting to appear locally. I'm keeping with the WW on-line - I like the point totals, and that certainly keeps me vegetable and fruit focused.  Maybe because of the points, I've limited myself to a single dove dark square for a single point, every night.

And yet, it hasn't been all green.  I had dinner out with friends Friday night - the dinner was 31 weight watcher's points when my daily allowance is 29. (Shouldn't have had the piece of garlic bread - six points! And I didn't need to consume the whole piece of salmon - it was big enough to cut in half and set some aside to take home.)  Yesterday, I had an ice cream cone. Could have saved some points by having it in a cup, but the ice cream itself was worth it.

So I'm feeling quite optimistic and in control. This week, I'll be able to manage my eating mostly on my own with kids doing their own thing. Next week:  the family at the beach. Our tradition is not to eat out, so it'll just be controlling the beer and ice cream, and making sure we have fruit and easy vegetables in the house.