Saturday, December 7, 2013

Losing Weight Is Easy. Staving It Off Ain't: A Lesson in High vs. Very High Energy Restrictions - What's More Effective?

If you tried to follow all the "good advice" you can find on the Internet and in the myriad of diet books and ebooks, I can guarantee that you are going to get fatter, not leaner. When it comes to dieting, there is after all nothing worse than doings things by halves... but is this also true for cutting your energy intake by half?
Ok, I freely admit that I have tricked you. Despite the fact that the study at hand is a randomized human study, it is possible that it is not 100% relevant for all of you. After all, the subjects in Lisa M. Nackers, Kathryn R. Middleton, Pamela J. Dubyak, Michael J. Daniels, Stephen D. Anton and Michael G. Perri's latest experiment were not exactly as lean as I would expect most of you are (this reminds me that I wanted to put up a questionnaire).

In other words, the subjects were obese. Whether the fact that they were also female is as grave a difference is something I cannot tell, but in view of the fact that this makes weight loss even harder, I would say it's probably not much of a problem if you are a man (and let's be honest, don't we all have a female friend who is constantly complaining about her weight, guys?)

Inspite of a mean BMI of 37.84kg/m², the relative results of this study will probably apply to a lean person, as well. In other words, if the women in the study at hand were randomized to consume either 1,000 or 1,500 kcal/day per day, I would suggest that a lean man / woman with much lower fat reserves to draw on should never go below 1,500 / 1,200 kcal/day.

So, this is not you, but the results are still intriguing

The important question was and still is now: What's more effective? A high, or a low caloric deficit? As a seasoned SuppVersity student, you will be aware that the "grazing approach to lose weight" in the course of which you reduce your calorie intake by only 5%, to make sure that (a) it's not getting to hard for you, or (b) you are not losing any muscle, will fail miserably and can result in serious deteriorations of your body composition (learn more). But what about the alternatives? Which of them, i.e. the -50% or the -25% diet, is appropriate for the obese ladies and which could be a model for yourself?
No exercise = not necessarily negligence: I know, for physical culturists like you and me, it sounds hilarious that the subjects were not encouraged to actually work out. If we are honest, we all know that this would have been the first thing the participants dropped in the unsupervised phase II of the study. I was thus not negligent to tell the subjects to simply follow the 10,000 steps per day approach as it is recommended by Donelly et al. in their often-cited 2009 ACSM Position Stand.
We know from previous research that lifestyle interventions are capable of inducing weight reduction of 7-10% and corresponding decreases in risk factors for heart disease and diabetes within weeks (DPPRG. 2002; Look AHEAD Research Group. 2010; Butryn. 2011).
"Get Your Protein, Veggies & Fruits and Get Them Regularly: High(er) Meal Frequency (6 à Day) + High(er) Protein Diet Support Weight & Fat Loss on a Diet " | learn more
"Nonetheless, behavioral changes initiated during lifestyle treatment often are poorly maintained and regaining of lost weight is common, thereby diminishing health benefits of weight loss. As a variety of biological and environmental influences make it difficult to maintain large dietary changes, a number of researchers and professional organizations have proposed a ‘‘small change’’ approach to weight management, arguing that small sustainable changes will produce better long-term weight control than larger changes that are unlikely to be sustained.

Alternatively, other researchers have observed that larger initial dietary changes, and the greater, more rapid weight losses they produce, are more likely to reinforce the weight-change process and lead to better long-term weight-loss outcomes." (Nackers. 2013)
In other words, as of now, it's mostly a question of faith, not one of scientific evidence, whether you answer my previous question in favor of the "small change" or the "massive reduction" approach.

Fast and hard, or slow and steady? How would you like it?

Ah, well... this is of course before you've taken a look at the results of this 12 months dietary intervention, of which the researchers speculated that it would demonstrate greater short- and long-term weight losses, and higher rates of weight loss in the metabolically relevant >5% body weight region in the 1,000kcal/day vs. 1,500kcal/day group.

If you do now finally take a peak at the actual results after 6 months with group-care (supervision) and the subsequent unsupervised 6 months "weight maintenance" (mind the inverted commas ;-) phase, what would you tell your chubby female friend she'd do? Cut back drastically or moderately?
Figure 1: Weight loss in the supervised (0-6m) and unsupervised (7-12m) of the study; the %-values indicate the relative difference between the 1,000kcal and the 1,500kcal diets (Nackers. 2013)
If we go by the results of the study at hand, the answer probably is: "Cut back drastically." Someone who is, unlike the ladies in the study at hand, not putting his health at risk if he maintains his current body weight, would yet probably be better off running a "moderate" caloric deficit of 25-30%. This could help him or her minimize the dreaded "fat rebound".

I mean, despite the fact that the post-diet weight gain in the study at hand was less pronounced than the average Internet craze about "yoyo"-dieting would suggest, any form of uncontrolled weight gain after weeks or months of serious dieting could potentially raise your body fat levels to previously unexpected new heights.
You can learn more about dieting at the SuppVersity

Chronic Dieting
➫ Fat Athletes

Diet Down to Below 5% BF

Overtraining & Undereating

Calculate your Energy Intake!

Half As Heavy, Twice As Fat!

5% Energy Deficit Makes You Fat!
For someone who was lean, when he or she started out dieting, the endless circuits of "cut back drastically" <> "gain fat rapidly" certainly entail the risk of making the highly undesirable transition from having a small gut, but enough muscle to make up for that (metabolically), to having the same or even a bigger gut, but no muscular metabolic currency to balance it. That this is very bad news for both your health and sex-appeal is something I shouldn't have to tell you, right (learn more about skinny fats).

 You cannot program weight loss for all!

Even in the study at hand, we can find evidence for one of the fundamental messages researchers who are dabbling with diet and nutrition appear to be too afraid to tell their financiers: There is no magic formula. It is thus not surprising that Nackers et al. observed that a "subset of participants may not benefit from this level [1,000kcal only] of, baseline caloric" (Nackers. 2013) intake.

When we look more closely at the underlying reasons, it becomes clear that the baseline energy intake, which is - even in the morbidly obese - a(n allegedly unreliable) gauge of the basal energy requirements of an individual determined, whether the high caloric deficit worked, or sucked: 
"Breakfast Keeps You Lean" Myth or Mystically True?" | find out
"Participants with 'high' baseline caloric intake ( 2,000 kcal/day) regained more weight during months 7-12 if assigned 1,000 kcal/day than those with 'low' baseline caloric intake (<2,000 kcal/day).

For individuals who consumed 'high' levels of baseline calories, the prescribed intake of 1,000 kcal/day required a reduction in energy consumption of 50% or more — a level that may be unsustainable long term." (Nackers. 2013)
In their discussion of the results, the authors rightly point out that "this findind holds important treatment-matching implications" - implications, every Suppversity reader has been aware of for years:
"At the start of lifestyle interventions, participants reporting 'high' baseline calorie levels may benefit from energy prescriptions based on either a percentage of their baseline intake (e.g., 25-50% reduction) or a projected amount of weight change per week (e.g., 0.50-0.75 kg) rather than a fixed energy intake, such as 1,000 kcal/day." (Nackers. 2013)
With their last suggestion, i.e. the formulation of a "less restrictive calorie goal" for a phase of "extended care treatment" that would be "gradually moving participants from 1,000 to 1,250 to
1,500 kcal/day" that would also allow for one or another "cheat" by providing "acceptable intake goals" instead of inflexible calorie values, Nackers, Middleton, Dubyak, Daniels, Anton, and Perry eventually formulate a bottom line to their study that should look vaguely familiar to all of you for whom this is not the first visit to the SuppVersity.
I am not sure, if you all remember that, but the energy deficit Adelfo Cerame Jr. ran during the contest preps he logged, here at the SuppVersity (read them), was always in the 15-30% range. His success would confirm my previous statement that the "radical approach" (-50%) is only appropriate for those of you who still have a very long way to go.
Bottom line: If you asked me if we can learn something new from the study at hand, I am reluctant to say "Yes, we can!". The notion that obesity requires rapid weight loss even if that implies a larger post-intervention weight (re)gain should after all not be news to any of you.

The experimental confirmation that the weight rebound does not (necessarily) ruin an obese individual's weight loss success, on the other hand, is news. It would argue in favor of an aggressive dietary intervention and - as the scientists point out in their discussion of the results - a staggered return to a lower caloric deficit in the months to come. I mean, despite the upheaval about  Abercrombie & Fitch not offering "plus size" clothes, one thing should be 100% clear: 90kg, which is the average weight of the ladies in the 1,000kcal group after 6 months, is not a normal body weight for a 145cm tall 52 year old woman, right?
References:
  • Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity.Psychiatr Clin North Am. 2011;34:841-859.
  • Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459-471.
  • Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.N Engl J Med. 2002;346:393-403.
  • Nackers LM, Middleton KR, Dubyak PJ, Daniels MJ, Anton SD, Perri MG. Effects of prescribing 1,000 versus 1,500 kilocalories per day in the behavioral treatment of obesity: A randomized trial. Obesity (Silver Spring). 2013 Dec;21(12):2481-7. 
  • The Look AHEAD Research Group. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus. Arch Intern Med. 2010;170:1566-1575.