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).
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.
"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.
"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
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)
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)|
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.
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:
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:
"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).
"Breakfast Keeps You Lean" Myth or Mystically True?" | find out
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)
"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.
- 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.