Presumptions about Obesity, Part 3

Posted: Apr 10 in Medical Weight Loss News by Dr. Lazarus

This is a continuation of our discussion of weight loss myths, perceptions, and facts. Unlike the myths we discussed in part one and part two of this series, which we know are just not true, it is just as important to recognize that there are many widely held beliefs regarding obesity that we just don’t have the scientific evidence to support. These beliefs or presumptions may or may not be true.

Presumption #1: Regularly eating breakfast prevents obesity.

Two good studies have been done to assess this. Although we definitely recommend eating a good breakfast, especially one with protein, and individuals maintaining large amounts of weight loss from the National Weight Control Registry report breakfast eating as a primary habit, studies were unable to show that eating or skipping breakfast impacted weight. My belief and experience is that eating breakfast is important; however, we don’t have the scientific evidence to prove this.

Presumption #2: Eating more fruits and vegetables will result in weight loss.

It is true that eating fruits and vegetables has health benefits; however, in the absence of other behavioral changes, simply increasing fruit and vegetable consumption has not been shown to result in weight loss. In fact, some of our most effective weight loss strategies like the use of meal replacements produce large amounts of weight loss quickly while reducing or eliminating fruit and vegetable consumption. Optifast full meal replacement programs are one example of this, which we have successfully used to achieve weight losses of 50, 100, 150 and even 193 pounds without the individual consuming fruits or vegetables.

While it would stand to reason that filling up on low-calorie, healthy natural foods leaves less room for all the junk that most Americans eat, increasing fruit and vegetable consumption has unfortunately not been shown to be an effective treatment strategy for an individual with a weight problem.

I find this discussion in the NEJM to be very interesting. I often meet very heavy individuals eating tons of fruits and vegetables, often in the form of a “smoothie” with their fancy new blender. A lot of these smoothie concoctions can have 500-1000 calories or even more, and unfortunately don’t offer a lot in terms of increasing satiety (sense of fullness). I often advise those individuals that eating all these healthy foods is great, but to concentrate on eating whole foods, not blending them, and on combining them with protein.

While I don’t have the scientific evidence to show that this is more effective than other approaches, it has certainly been our experience that eating protein with every meal and snack is very satiating and seems to stave off the late afternoon and evening munchies. So, what is my take? That’s easy. Shoot for 5 servings of non-starchy vegetables, have at least 30 grams of protein for breakfast, lunch and dinner, 15 g in a morning snack and 15 g more in an afternoon snack. Oh, and maybe a fruit.

Presumption #3: Weight cycling (“yo-yo dieting”) is associated with increased risk of dying.

Current studies do not support this association. Another study published last year dispelled the myth that “yo-yo dieters” were less likely to be successful with future weight loss attempts. Indeed, most individuals battling with the chronic disease of obesity have lost and gained weight numerous times in their lives – current data suggest no association between prior weight loss attempts and the ability to lose weight on the current attempt. This NEJM article also casts doubt on the presumption that losing and gaining would result in worsened health outcome. Telling an individual this is like telling somebody battling with nicotine addiction that stopping and restarting is actually worse than just continuing to smoke! I say that because even small amounts of weight loss provide huge health benefits. For an individual who keeps gaining and losing, health benefits are at least accruing while the weight is down. Psychologically, it may be another story…

Remember, for an individual who has a weight problem, weight gain is a normal part of EVERY weight loss program. Let’s try and keep those gains to a minimum and the losses to a maximum. It is my opinion that a regular weighing schedule and carefully written out action plan is worth its weight in gold during weight loss maintenance. If you haven’t devised an active maintenance strategy, or if you are an individual who has regained some or all of what was lost, there is no better time than now to see me, set some new goals and objectives that are appropriate for you and draw up an active maintenance strategy so you can enjoy the benefits of maintaining a lower weight again this year.

Next time, we’ll continue our discussion of the presumptions we have about weight loss.

Written by Dr. Ethan Lazarus