3 Facts About Weight Control
Weight control is possible, in spite of it all -- and that revelation has something to do with ice skates, and swim fins. We'll get back to that.
Unintentional weight gain in the modern world is easy, and intentional weight loss is hard. Weight control over time is even harder. That's unfortunate for most of us -- unfair, even -- but it's true just the same.
We got a reality check on that very topic recently when we learned that the participants in "The Biggest Loser" generally tend to gain back their weight when the lights dim and the cameras stop rolling. We got another when we learned that despite all of our efforts, obesity rates are still rising in the U.S. among women and children, and holding steady at best among men.
But we already had ample reason to know the challenges of weight control, and for reasons beyond our own skin in the game. There are more overweight than overtly hungry Homo sapiens on the planet. Obesity rates are high, rising and represent a majority in almost every country with the resources that make it possible: access to surplus calories and modern, labor-sparing technologies of all varieties. In other words, what we know is that when people can get fat, they generally do.
And we even know why. As Daniel Lieberman, a professor of evolutionary biology at Harvard puts it bluntly and bracingly in his book, "The Story of the Human Body," "An evolutionary perspective predicts that most diets and fitness programs will fail, as they do, because we still don't know how to counter once-adaptive primal instincts to eat donuts and take the elevator."
[See: 7 Diet Mistakes Sabotaging Your Weight Loss.]
But of course, our plight is at least one step worse than that. We are not just working to overcome modern happenstance that we don't know how to counter. We are also working to overcome the willful manipulations of whole industries that profit by countering our weight control designs. That is certainly true of Big Food, which exploits our "primal instincts" with almost extravagant abandon. It is true of Big Pharma, which seems to prefer we succumb to those primal vulnerabilities and then seek out their wares for help than navigate around those vulnerabilities in the first place. It is true of modern industry in general, which keeps propagating inventions, which in turn keep propagating new necessities, most of which further obviate the use of our own muscles.
So here we are, and weight control is hard. But it is, as noted, possible, and several recent themes in the research literature have genuine potential to help us get there from here.
1. Calories do count.
For many of us, there was never any doubt about this, nor any particular mystery attached to calories. Their basic relevance was, and is, very comparable to that of firewood, or coal, or gasoline. The more fuel you have, the more stored energy there is to release. In the case of wood or coal, when combusted, they send out heat and flame for warmth or to power an engine. In the case of gasoline, it drives the pistons of a car. In the case of calories, they run the human body, one function of which is to transfer any surplus energy into storage for a rainy day.
This has all been perfectly clear all along, but for some reason that never made much sense to me, we managed to turn calories into a controversy. Recent studies looking explicitly at the effects of calorie restriction -- not a change in dietary composition, just calorie restriction -- found significant impacts on weight and health. They are a timely reminder that calories count.
That by no means suggests that counting calories is the best way to regulate the total. In fact, it's not for most people. I rarely recommend it, and I have never relied on that method myself. Rather, the calories it takes to feel full vary inversely with the overall quality of the foods we choose. Simple, wholesome, nutrient-dense foods fill us up on fewer calories. Highly-processed foods and drinks maximize the calories required before we feel full, and not accidentally. The quantity of calories consumed absolutely counts, while the quality of our diet is the best way to regulate that daily tally and not go hungry.
[See: The 10 Best Diets for Healthy Eating.]
2. Macronutrient thresholds don't count (much).
Despite literal decades of noisy salesmanship and proselytism, the reality all along has been that the world's healthiest, longest-lived populations vary widely in their native macronutrient thresholds. Some of the world's best diets are quite high in fat and relatively lower in carbohydrate; some are very low in fat and relatively higher in carbohydrate; and there is some variation across a more limited range for protein, too. The latest addition to this routinely overlooked reality check comes in the form of metabolic ward and randomized controlled trial research comparing diets designed to vary in macronutrient composition and not much else. The basic conclusion is that the differences don't matter much. That means that diets of wholesome foods in sensible combinations can be comparably good for weight and health alike, and that we all have the option of shopping the theme. Arguments that there is only one right choice are, in a word, bunk.
3. It takes feet and forks.
There has been much attention in the research literature of late to the particulars of energy balance. Exercise, by itself, is generally ineffective at producing weight loss because it is so easy for most of us to out-eat the calories we burn. On the other hand, we know that energy balance is dynamic, not static; our calorie requirements change as our weight changes. The prevailing conclusion is that controlling calories in is essential to weight loss, while adjusting calories out is generally crucial for lasting weight control, in part because exercise can compensate for a fall in our calorie needs as our weight decreases. Since we also know that exercise is fundamental to health, and since finding health beats just losing weight, weight control should always be an enterprise of both feet and forks.
Which brings us back to the proposition heralded at the start: Weight control is possible, in spite of it all. We know this because, as noted, there are real-world populations that enjoy vitality and longevity, and have done for generations, because their cultures get the formula right. The combination of a sensible diet and moderate exercise works wonders in the context of intervention trials, and also works at the population level, and stands the test of decades. And we even know that individuals who lose weight and keep it off just keep on keeping on with regular activity, and generally sensible dietary choices.
What do ice skates and swim fins have to do with it? Well, consider that human beings are no more natively adapted to skate or swim well than to resist doughnuts or elevators. We use tools to enhance our abilities. If we learn to use the tools, and use them well, they can help a lot. But what if we use them badly? Well, then they may not help at all. Worse, they might do actual harm. If, subject to the slick marketing of the ice skate sellers, we all wear skates at the beach, we are sure to keep the lifeguards busy. Similarly, we are apt to keep our orthopedists busy if we buy swim fins for the ice rink. But such is the power of good salesmanship -- it talks you out of the obvious. And then, when we are disappointed that things went badly, it's an opportunity to sell us something new, with the promise that it will make it all better.
Subject to a constant cacophony of sales pitches, we've been buying just such nonsense for weight control for decades, and all know the result of that. It's time to tune out the din and discord, and put the tools we have to better use.
The best way to control calorie quantity is with food quality. Choose foods consciously, and always go for the simplest, least processed option. Items with a one-word ingredient list (think broccoli or blueberries) tend to be best of all, but when there is more to the decision than that, call upon some food label literacy (no, it's not just for kids!) to get the job done.
Be active at every opportunity. Stand intermittently. Walk to get the blood flowing and to clear your head. Take the stairs. Dance. And for that matter, skate and swim. It all adds up.
[See: Easy Ways to Get 10,000 Steps a Day.]
In a modern world that makes weight gain so easy for bodies adapted to very different circumstances, weight control is hard. But it isn't complicated. Competing theories and claims may make it seem so, but they serve the sellers -- not us, the buyers. So, stop buying the complexity argument, and all the wrong tools. Keep it simple. Choose wholesome foods and move your body. Weight control is unlikely to be easy, but for most of us, it certainly is possible.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the director of Yale University's Yale-Griffin Prevention Research Center, which he founded in 1998, and current president of the American College of Lifestyle Medicine. He earned his Bachelor of Arts from Dartmouth College in 1984, his medical degree from the Albert Einstein College of Medicine in 1988 and his master's degree in public health from the Yale University School of Public Health in 1993. He completed sequential residency training in internal medicine and preventive medicine/public health. He is a two-time diplomate of the American Board of Internal Medicine and a board-certified specialist in preventive medicine/public health. He holds two honorary doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters and 15 books, including multiple editions of leading textbooks in both preventive medicine and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.
