Moderation is Evidence-Based


I have a rather revolutionary opinion on what the primary goal of any weight loss program should be (well, I don’t think it’s revolutionary, but I’ve been told it is by others…). And that opinion flies in the face of human nature. Human nature wants immediate and dramatic results. Unfortunately, immediate and dramatic results often come at the expense of long-term metabolic health, and lead to equally immediate and dramatic weight regain once one stops doing the things that produced the immediate and dramatic results. And rest assured, one WILL stop eventually, because the things that produce immediate and dramatic results are rarely sustainable or safe.

No, as far as I’m concerned, the primary goals of any weight loss program (aside from weight loss of course) should be:

-preservation of lean mass (muscle, bone, organ)
-preservation of metabolic health (which lean mass preservation supports)
-successful long-term (ie, permanent) maintenance of a healthy weight once it is achieved

The methods that promote those goals end up being, by most people’s standards, pretty moderate.

Extreme Diets Produce Extreme Results

You know what they say, ‘everything in moderation’? Moderation catches a lot of flack in the fad diet world. We’ve got gurus declaring entire food and macronutrient groups off limits, other gurus advocating replacing multiple meals a day with powdered supplements, others recommending inhumanely low calorie intakes, and now I’m seeing more and more extreme mono-diets (diets consisting of only one food such as potatoes, fruit, milk or even just water, perhaps with a splash of flavor from spices, or broth). Any of these techniques can produce rapid weight loss for a number of reasons: dehydration, extreme calorie deficit producing loss of lean mass along with fat, low palatability producing a spontaneous calorie reduction, etc. Unfortunately, along with rapid weight loss frequently comes loss of lean mass (1, 2) and a reduction in resting metabolic rate (RMR) (3), which together prime the body for subsequent rapid fat gain when ‘normal’ eating behaviors are resumed. In other words, losing lean mass and depressing one’s RMR are a great way to get fatter in the long run.

If a person can reach a healthy weight with lean mass and RMR intact, they stand a much better chance of maintaining that loss in the long-term. So how do we minimize lean mass loss and protect metabolic function? There is a massive body of evidence supporting exercise during weight loss a means to preserve both lean mass AND healthy metabolic function. In my opinion, any successful weight loss program will prioritize supporting the establishment of habitual regular physical activity, and will progress at a pace that will allow for the preservation of the greatest degree of lean mass as possible. See what I did there? Framed healthy weight loss as a process of sustaining and supporting, rather than reducing and restricting. This is an important distinction.

Preservation of Lean Mass

The results of this study indicate that slow weight loss preserves lean mass better than rapid weight loss. To keep weight loss at a pace that supports lean mass preservation, the calorie deficit needs to be very modest. The larger the calorie deficit, the greater the percentage of weight lost will be lean mass.

Resistance training during weight loss also preserves lean mass. This study indicates that while creating a calorie deficit through food restriction produces a greater total weight loss, creating a deficit through physical activity actually produces a greater loss of fat, and preserves lean mass. This study on 118 women examined the body composition results from weight loss produced either by diet alone, or by diet and exercise. Each group lost about the same amount of weight, but the diet plus exercise group lost more fat, and didn’t lose any lean mass. Exercise in general, and resistance training specifically, protect lean mass during weight loss and so are an essential component of any program aimed at promoting long-term success.

Preserving Healthy Metabolic Function

While there are myriad aspects of metabolic health, the one I’m most concerned with for this post is resting metabolic rate (RMR), the amount of energy the body expends at rest. Total body weight is one determinant of RMR, and so weight loss generally will produce a drop in RMR. However, it appears that exercise can mitigate that drop. This study (that I linked above) even suggests a minor increase in RMR over the control group in the diet plus exercise group. This one also indicates that resistance training can increase RMR, even in the context of weight loss. The last thing anyone should want is to get to a healthy weight but find themselves with an RMR in the toilet. When RMR is depressed, calorie intake must be kept low to prevent weight regain. Who wants to be on a diet for the rest of their life? With strength training and slow weight loss via a very modest calorie deficit, RMR can stay high enough to afford a humane and sustainable calorie intake once a healthy weight is achieved.

Successful Long-Term Maintenance

We’ve looked at ways to preserve lean mass and RMR during weight loss, now lets look at ways to support long term maintenance once a healthy weight is achieved. The National Weight Control Registry, which tracks people who’ve successfully lost and kept off weight, shows that in addition to making permanent changes in diet (I’ll talk about diet a little more in a minute), virtually everyone who is successful at maintaining weight loss exercises regularly. This study indicates that the more active a person is during weight loss, the less likely they are to regain lost weight. I suspect this is due to both improved metabolic function and the establishment of habitual exercise. Exercise protects RMR and lean mass, AND promotes successful maintenance.

What about diet? In my opinion, diet should be as expansive and unrestrictive as possible while still allowing for (slow) weight loss. This means maintaining a very modest calorie deficit (I prefer a deficit of 500 calories or less), and only restricting foods, food groups and macronutrients if there is a real medical need. In this study, including a daily treat had no negative effect on weight loss and body composition results. In this one, altering the diet to be less restrictive produced a greater adherence to an exercise program, improving the subject’s weight loss outcomes:

“…exercise regimens of moderate to high level of intensity proved counter-productive as weight-reducing strategies for an obese sedentary subject. This was due to the limited energy reserves (specifically, muscle glycogen) available to such individuals. However, when the diet was changed from a balanced composition to one that was highly loaded with carbohydrates, it became possible to sustain the intense exercise regimen over the experimental period, and achieve a significant drop in body weight. The results underscore the significant interaction effects between diet composition and physical activity, and emphasize the critical role that diet composition can have in exercise-based treatment interventions.”

The lesson here: to promote the important goals of lean mass and RMR preservation, and long term successful weight maintenance, regular exercise needs to be an integral part of any successful weight loss program. To promote adherence to an exercise program, diet should be as moderate and sustainable as possible while still allowing slow weight loss. As this review of obesity literature concluded:

“While energy restriction in isolation is an effective short-term strategy for rapid and substantial weight loss, it results in a reduction of both fat and muscle mass and therefore ultimately predisposes one to an unfavorable body composition. Aerobic exercise promotes beneficial changes in whole-body metabolism and reduces fat mass, while resistance exercise preserves lean (muscle) mass. Current evidence strongly supports the inclusion of resistance and aerobic exercise to complement mild energy-restricted high-protein diets (note from me: protein, like exercise, helps preserve lean mass, so be sure you’re getting plenty) for healthy weight loss as a primary intervention for [obesity].”

 

Rapid results are appealing, but more often than not they are short-term, and in the end losing weight quickly can sabotage your lean mass and RMR. There is a great deal of consensus in the scientific community that exercise and moderation in diet are the safest, most sustainable interventions for long term weight loss success. My own results certainly support this, by creating a very modest calorie deficit and prioritizing physical activity, I’ve been able to reach and maintain a healthy weight without any drastic or extreme dietary or exercise measures. Moderation in diet and exercise have worked for me, and work for my clients. And moderation is supported by a massive body of scientific evidence. Moderation isn’t sexy, but it works.

If you’d like to read more, please check out my new eBook, Taking Up Space. I discuss all these concepts and more, and provide guidelines for implementing them into your life.

23 thoughts on “Moderation is Evidence-Based

  1. Thank you. This is what I keep telling myself, though it’s hard to take, sometimes. I see people around me losing weight quickly, and I’m plodding along, losing inches slowly (I really don’t like to focus on weight). I’ve greatly increased the amount of weight I can lift/push since June – with some muscles it has doubled or more — but the fat loss comes slowly. I really want the extra inches off NOW, but I know from past history that when I’ve lost weight quickly I just put it right back on. Sometimes I just need a little affirmation that this is the way to do it.

  2. Well hell, there you go being all smart again and stuff. Have you ever addressed the fallacies of specific diets in your blog, like the HCG diet? I have several friends who swear by it, but something tells me eating 500 calories a day just ain’t right. Proponents say that by adding hormone drops or injections, you are telling the body to shed stored fat rather than lean mass. I’d love to hear your thoughts on this since it’s hard to dissuade people from something when they see fast and immediate results (even though logic dictates the results won’t be sustained long-term).

  3. With re: protein – I seem to recall “high protein” in scientific studies being not actually as high protein as say weightlifters will prescribe, more in the range of 75-100 grams rather than over 120 grams. Any idea if that bears out with the studies you cite? Also, I have a feeling a lot of people will read “high protein” and automatically link it to “lower carb/fat,” when I think the point researchers are trying to make is not so much a diet that has so much protein it eclipses other macros, but just that it isn’t a *low* protein diet, like less than 65 grams a day.

    One of the reasons moderation isn’t sexy is, I think, because there’s nothing “compelling” to believe in – the purpose of such belief being to keep you adhering to the program. When your heart and mind are on the same page (because you’ve been “convinced” by how much “sense” the diet or “way of eating” makes, like paleo, low-carb, vegan, raw, fruitarian, carnivorous etc) and you’ve got a nice handful of dogma to ensure your continued certainty, then you don’t have to think – or take responsibility for every single choice you make.

    Moderation (which is the inevitable result of something like intuitive eating) requires a little more. Trust and presence. Both of which are difficult if you hate yourself, think you’re flawed, and buy into the idea that there are experts out there who just want what’s best for YOU even though their entire program is designed to make money for THEM. That’s why I laugh whenever someone accuses you, Amber, of being another guru out to sell something – you have a job, like, in real life. You’re not taking any more coaching clients, and from comments here and on facebook, it doesn’t exactly sound like you coach hundreds of people every week or even want to. Your “sales” page seems like you put some stuff up for sale just in case anyone wanted to thank you for all the FREE info by buying something off you, which is not actually how gurus work, it’s how supporting an online presence works. Ugh!

    Anyway, thanks again for a great post.

  4. Great, great post. GoKaleo, your online presence and posts always keep me trucking in the right direction. I’ve been really trying to get this right. After a 70lb weight gain following eating disorders, I lost about 20lbs in 7 months with this mantra: do not go hungry (meaning put cOnscious effort in not under eating – something easy to do when you’ve had an eating disorder in the past) and move in ways you can, when you can. Well, it’s been quite effective, far from drastic, and I bet I didn’t lose a bit of muscle but rather gained some. I’ve not been restricting anything, and basically eating what pleases me. It feels so good! Have at least another 20 to go, hopefully it will
    happen in the same way than it did for the first 20!

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  6. Thank you, Amber, for showing us the light! I think that moderation *should* be compelling for people to believe in. The reason so many people I know (myself included) go (or went) looking for that next miracle diet is because they know there’s something they want to fix. They want to lose weight, sure, but most of them are tired of thinking about food all of the time and having to contend with intense cravings they just can’t escape for long no matter which crazy new health fad they try. You feel certifiably crazy. Like something’s wrong with you. Like you’re weak. Like you’re a failure or like you’re giving up if you give in and eat some food that isn’t allowed on this new diet fad. Already-skinny people and doctors who don’t even know what you’ve been eating or how much you’ve been exercising say stupid things to you like “you just need to eat healthier” or “you just need to work out more” or ask “have you tried keeping a food diary?” PLEASE. Like we don’t sit there and panic about every morsel of food that goes into our mouths, “good” OR “bad.” Like we don’t agonize over complicated mental formulas that we’ve created to figure out how many hours of exercise we need in order to work off the piddly 1200-1400 calories our new “healthy” diet allowed us. Was I good enough? Did I work hard enough? Was that actually bad? If I skip eating fruit, can I eat the ice cream I’m craving? What have I done today to make me feel proud?? AHHHH! Guess what eating the proper amount of good food and using moderation does to your headspace? It frees you from *all* of that! No more craziness. No more feeling weak because you couldn’t stop yourself from eating something, because, guess what, you’re allowed to eat. No more trying to be 100% perfect every moment for the rest of your life. No more exercising yourself to death in some grim battle against your own life. Moderation is *damn* sexy!

  7. I lost 50 lbs in 4 months on one of these extreme diets as I needed a kick start but before I started I checked out maintenance to see if it was do able. Over the next 8 months I started working out and lost 20 more lbs. I have kept it off for almost 3 years. I now run and do triathlons, eat healthy and don’t care what the scale says. I needed an extreme kick start but I knew I had to change my lifestyle and food choices or it would not matter. No matter what you do, you have to make changes in order to keep it up. It’s now a lifestyle for me, not a diet.

  8. Thank you for breaking down some of these scientific studies into layman’s terms! Another great post! I need these reminders that this is the key to my long term success, and in the end it will all be so much less work (in fact it is less work now).

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  10. Thank you for your blog! I was wondering how you feel about cleanses? I completely agree in regards to fad diets, but do you consider a cleanse a fad diet? I would like to do a juice cleanse but am not doing it to lose weight.

  11. Great article! You eloquently put what I frequently try to tell people, and provided the evidence to back it up. Brilliant.

  12. Thank you, Go Kaleo, for your blog and your message. I came across your blog recently and started reading it. It is so inspiring! I love what you have to offer. I am so excited about your message and the things you have written. You are great! Please please keep doing what you are doing!

  13. The diet industry, just like any other corporate industry, wants profits here and now. No better way to do that than to advocate a diet that is way below our dietary needs–this is just another crash diet in different packaging. No talk about long term sustainable weight loss, because Harper might lose $$$ from dieters who want that quick fix. Thankfully you come in to put people’s heads on straight! Like you said, moderation isn’t sexy, but it works in the long term…not just for a wedding or pool party two weeks away but for a lifetime.

  14. Love it! Excellent article. Of course what you are saying ISN’T revolutionary, but it has been so SO LONG since we have heard these things or thought this way (myself included) that it is like hearing an idea from a distant past that we gave up on long ago. I seriously feel like there is light bulb going on in my head that I am REALLY excited to share with my clients. Now……to get them to believe it! AAAahhhhh!!!! Keep beatin’ that drum. 🙂

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  17. I love your approach to weight-loss, thank you for the information you shared. Especially the idea of adjusting the ‘diet’ to everyone’s personal calorie needs was helpful.

    Although compared to average people I am very health conscious, my life changed dramatically in the last year that made it difficult to keep many of my healthy practices and I had some additional stress. Despite regular exercise (vigorous yoga practice 2-3 hours 4 times a week at least, walking, cycling), I gained weight. So I started a conscious weight-loss. I am just experimenting with adding a few elements, rather a personal flavour to your approach.

    I consider eating

    – more raw food, less dairy, hardly any bread
    – no sweets
    – eat when I am hungry, often, as much as I feel without being too much full, but all healthy food
    – every day a bit more exercise than I used to (preferably something different from what I already do, calisthenics aerobic sorts)

    Well, from the list you can guess sweets are kind of a weakness, that’s why I am radical with it. The rest of the points come from some experience with my body:

    I was eating raw for four month before my life changed last year and I felt fantastic with it. After, moving to another country cut me from many of my raw resources, its quite a long time to rebuild them.

    Doing physical work I need my muscles, and stamina, so spending even more time with exercise seems a good place to go.

    Eating more raw food, less dairy, hardly any bread leaves me with fewer calories than I was supposed to have according to the calculator, so I really should eat as much as I like.

    After a week, my experience is that my daily energy usage is somewhere between 2600-2800, and eating when I am hungry, often, as much as I feel without being too much full, but all healthy food, gets me to 1500 calories on average. My protein intake is fairly low, and I am a bit low on carbon-hydrates. These later two needs some investigation, how could be increased with raw foods.

    Well, this is what I found out to do if you are already living a fairly healthy life, but wanna loose some weight.

    I am really curious of your opinion about it.

    All the bests,

    Timi

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