Milly Gaines
Dieting has become a common practice, with many people turning to calorie-restricted diets to lose weight. However, the effectiveness of dieting as a long-term solution for obesity is questionable. While short-term dieting can lead to initial weight loss, studies suggest that dieting often results in weight gain over time. This may be due to a range of biological, psychosocial, educational, and environmental factors. External motivations for dieting can also lead to a waning of effort and a relapse into old habits. Instead of focusing solely on weight loss, a shift towards intrinsically meaningful motivations, such as improving overall health, can lead to better long-term outcomes. Sustainable improvements in diet quality and physical activity are recommended for the management of obesity, even if they do not lead to major weight loss.
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What You'll Learn
Long-term dieting may lead to weight gain
Additionally, calorie restriction and muscle mass loss can cause a decrease in metabolism, making it easier to regain weight once a person returns to their usual eating pattern. This is known as "yo-yo dieting", and it can negatively affect metabolism, making it harder to maintain weight loss in the long term. The body has a "weight set point", a programmed weight that the body aims to maintain. When weight gain occurs gradually, the set point can also increase gradually, making it challenging to maintain a lower weight.
The diet industry generates billions of dollars, yet weight loss diets often do not lead to long-term success. In one study, only 12% of participants maintained a loss of at least 75% of their original weight after three years, while 40% gained back more weight than they had lost. Another study found that women who lost weight during a six-month program weighed, on average, 7.9 pounds more than their starting weight five years later.
Rather than focusing on dieting, shifting the emphasis to optimizing health through nourishing food choices can be beneficial. Eating mindfully, exercising regularly, and making sustainable improvements in diet quality and physical activity can lead to better health outcomes, even without significant weight loss.
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Calorie-restricted diets
Several studies have investigated the impact of calorie-restricted diets on weight management. One study randomly assigned 139 obese patients to either time-restricted eating or daily calorie restriction. The time-restriction group was instructed to eat only between 8:00 a.m. and 4:00 p.m., in addition to reducing their calorie intake. After 12 months, the time-restriction group lost more weight on average than the daily-calorie-restriction group, with a mean weight loss of 8.0 kg compared to 6.3 kg.
Another study by Cai et al. found that a 12-week time-restricted eating program resulted in modest weight loss in 97 patients with nonalcoholic fatty liver disease. Similarly, Cienfuegos et al. observed a 3% weight loss in 20 obese patients over a 10-week intervention when they reduced their caloric intake by 550 calories per day. However, Lowe et al. found that time-restricted eating with ad libitum intake did not lead to significant weight loss or waist circumference reduction in 116 obese adults over 12 weeks.
While calorie-restricted diets can be effective in the short term, long-term success often involves aligning motivations with personal values and preferences. Lifestyle changes, such as improving diet quality and increasing physical activity, are more sustainable and can lead to improved health even without major weight loss. Additionally, external motivations may drive short-term weight loss but rarely lead to long-lasting determination. Thus, it is important to shift the focus from weight loss alone to intrinsically meaningful areas, such as health improvement, to achieve better long-term outcomes.
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Diet composition and efficacy
Several studies have compared the efficacy of different diets, including Atkins, Weight Watchers, South Beach, and Zone. These studies have shown modest and comparable weight loss across the different diets. However, it is important to note that these studies have limitations, such as including participants with chronic diseases and not assessing the long-term effects beyond one year.
One study compared the Atkins, Weight Watchers, South Beach, and Zone diets and found a modest and comparable weight loss across all diets. This suggests that the specific diet composition may not be as important as adhering to a healthy eating pattern. Another study compared the long-term effects of different diet categories (MM, LFHC, and HFLC) and found that all diets resulted in a significant weight loss of about 5 kg and a significant drop in BMI of 2 kg/m2 at 12-24 months follow-up. The HFLC diet showed slightly better results, with a larger weight loss and BMI reduction.
While diets can help with short-term weight loss, long-term success rates are often poor. Many studies have shown that dieting can lead to weight gain over time, known as the "yo-yo effect." This may be due to a variety of biological, psychosocial, educational, and environmental factors that influence individual responses to diets. Additionally, dieting can lead to a strained relationship with food and, in some cases, contribute to the development of eating disorders.
To improve the efficacy of diets for obesity management, a comprehensive approach is necessary. This includes not only the diet composition but also addressing lifestyle habits and underlying motivations. For example, shifting the focus from weight loss to health improvement can lead to better long-term outcomes. Additionally, sustainable improvements in diet quality, such as adopting a Mediterranean eating pattern that focuses on healthy fats, whole grains, legumes, nuts, fruits, and vegetables, can be beneficial. Physical activity and behavioral strategies, such as self-monitoring and frequent weighing, are also important components of a comprehensive approach to obesity management.
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Individual results and weight loss plateaus
Weight loss plateaus are a common and inevitable part of the weight loss journey. A weight loss plateau refers to a period during which an individual temporarily stops losing weight, despite adhering to their diet and exercise regimen. This can be frustrating and demoralizing for people trying to lose weight, and it can lead to discouragement.
There are several physiological reasons why weight loss plateaus occur. One theory, the dynamic equilibrium model, suggests that the body actively works to defend its prior state, adjusting hunger and metabolic rate to favour weight regain when caloric intake is reduced. This is supported by the observation that a decrease in weight is accompanied by a progressive reduction in metabolic rate, making continued weight loss difficult. Additionally, biological adaptations and hormonal changes that occur during weight loss can lead to reduced energy levels and endurance, decreased fat oxidation, and increased hunger.
The set point theory proposes that body weight is regulated around a genetically predetermined set point. This theory explains the body's resistance to weight changes through altered metabolism and appetite regulation. However, it does not account for the influence of environmental and social factors on obesity rates. On the other hand, the settling point theory takes into account these external influences on body weight and better explains the recent obesity epidemic.
To overcome weight loss plateaus, individuals can consider various strategies. One approach is to reduce carbohydrate intake, as some evidence suggests that low-carb diets may help reduce hunger and make it easier to eat less without feeling deprived. Additionally, exercise, particularly aerobic training, has been shown to counteract the decrease in metabolic rate associated with weight loss. For those with continued obesity despite initial weight loss, pharmacotherapy with GLP-1 receptor agonists or other anti-obesity medications may be beneficial, especially when combined with behavioural interventions. These medications can reduce hunger and increase satiety, potentially leading to more sustained weight loss.
It is important to remember that weight loss is a complex and highly individual process, influenced by biological, psychosocial, educational, and environmental factors. As such, physicians should encourage patients to focus on sustainable improvements in diet quality and physical activity rather than solely on weight loss as the metric of success. Even without major weight loss, these lifestyle changes can lead to improved health outcomes.
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Health optimisation over dieting
Dieting is often associated with short-term weight loss, but it rarely leads to long-lasting results or health optimisation. Instead of focusing solely on weight loss, a more holistic approach that prioritises overall health and well-being is more effective and sustainable. This involves making sustainable improvements in diet quality, physical activity, sleep, stress management, and social conditions.
Optimising health over dieting means shifting the focus from weight loss to health improvement. This can include increasing physical activity, consistently eating a balanced and nutritious diet, and making lifestyle changes that improve overall health. For example, instead of drastically reducing calorie intake, a person can focus on consuming a nutritionally adequate diet with a balance of macronutrients, including dietary fibre, carbohydrates, protein, and healthy fats. This approach nurtures and protects the body and can lead to sustainable weight loss and improved health outcomes.
A key aspect of health optimisation is tailoring dietary strategies to individual needs. This means recognising that healthy diets are unique to each person and depend on various factors such as age, sex, cultural background, and personal preferences. For example, while some people may benefit from a higher protein and lower carbohydrate approach, others may find success with a plant-based or Mediterranean-style diet. The focus should be on the overall health benefits of the diet, including the nurturing of gut microbiota, rather than solely on weight loss.
Sleep is another critical component of health optimisation. Sleep deprivation can hinder weight loss efforts and contribute to the global obesity problem. Adequate sleep, typically 7-8 hours for adults, is necessary to regulate hunger and support fat oxidation. Additionally, addressing mental health issues and stress management is essential, as they are strong risk factors for obesity. Behavioural strategies, such as frequent self-monitoring and self-weighing, can also be beneficial for initiating weight loss and maintaining long-term success.
Finally, health optimisation goes beyond individual efforts. It involves societal changes such as educating the public on healthy diets, improving the quality of ultra-processed foods, and providing clear and transparent food labelling. Employers also play a role in promoting health optimisation by ensuring adequate leisure time and breaks for employees to consume healthy meals. By addressing obesity from a holistic perspective, individuals, healthcare professionals, and society can work together to improve health outcomes and reduce the prevalence of obesity.
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Frequently asked questions
Long-term dieting can help with obesity, but only when accompanied by a comprehensive lifestyle change. This includes an increase in physical activity, a shift in focus from dieting to eating nourishing foods, and a change in eating patterns.
Long-term success rates for weight loss diets are generally poor, with many studies suggesting that dieting can lead to weight gain over time. However, some studies have shown that dieting can help most people lose at least a small amount of weight in the short term.
Apart from the risk of weight gain, long-term dieting can also lead to a deterioration in one's relationship with food, with some developing binge eating disorders or body dysmorphia.
Alternatives to dieting include shifting the focus from weight loss to optimizing health, choosing nourishing foods, eating mindfully, and exercising regularly.
Lifestyle changes that can help with obesity in the long term include increasing physical activity, consistently eating breakfast, and making sustainable improvements in diet quality.
