Category Archives: Weight Loss

DIETFITS: Why do dieters succeed or fail? 

Julia Belluz has interesting article at Vox regarding low-fat and low-carb diet success over the course of 12 months. Her focus is on a few individuals who participated and were outliers.

As I read this, I was reminded that successful long-term weight management starts and ends in the kitchen. It also took me back to 2009, when I determined that low-carb diets were just as legitimate as low-fat.

I don’t recall the author mentioning the typical pattern with 12-month weight loss studies: most folks lose significant weight in the first few month, then at six months they start gaining it back. Cuz they go back to their old eating habits. Sure, diets don’t work………..if you don’t follow them.

From Ms. Belluz:

As a longtime health reporter, I see new diet studies just about every week, and I’ve noticed a few patterns emerge from the data. In even the most rigorous scientific experiments, people tend to lose little weight on average. All diets, whether they’re low in fat or carbs, perform about equally miserably on average in the long term.

But there’s always quite a bit of variability among participants in these studies.Just check out this chart from a fascinating February study called DIETFITS, which was published in JAMA by researchers at Stanford.

The randomized controlled trial involved 609 participants who were assigned to follow either a low-carb or a low-fat diet, centered on fresh and high-quality foods, for one year. The study was rigorous; enrollees were educated about food and nutrition at 22 group sessions. They were also closely monitored by researchers, counselors, and dietitians, who checked their weight, waist circumference, blood pressure, cholesterol, and other metabolic measures throughout the year.

Overall, dieters in both groups lost a similar amount of weight on average — 11 pounds in the low-fat group, 13 pounds in the low-carb group — suggesting different diets perform comparably. But as you can see in the chart, hidden within the averages were strong variations in individual responses. Some people lost more than 60 pounds, and others gained more than 20 during the year.

Read the whole thing. It’s not long.

Source: Why do dieters succeed or fail? The answers have little to do with food. – Vox


Nuttin’ But Salads N=1 Experiment: Week 1 Summary


Let’s call this a chef salad (or is it chef’s salad?)

Click to learn what I’m doing.

My wife made nearly all of the salads. I have a few days off from my 12-hour shifts and will try to put at least one new super-salad together.

This is a taco salad. You can’t see much of the spicy hamburger meat under the quacamole. Somewhat time-consuming to make, but delicious.

My initial weight was 175.5 lb (79.8 kg). A week later I’m down to 171.6 lb (78 kg). Rounding off, that’s down 4 lb (1.8 kg). (See postscripts below!)

That 4 pounds can’t all be fat. Most of it must be water loss, lowered intestinal content, and perhaps lowered stores of glycogen in muscle and liver. I doubt any of it is muscle loss because I’m careful to eat adequate protein and am working out with weights twice weekly. From here on out the weight loss will slow dramatically if not stall completely.

Chicken salad with tomatoes and almond slivers

I like the simplicity of eating two large salads a day, and nothing else. In the event I get hungry between meals, I’m allowing another salad or a protein food (meat, eggs, fish, chicken, etc). But I haven’t done that yet. I eat before and after my shifts at the hospital. I’ve successfully fought off the temptations in the Doctor’s Lounge, my employer’s office, and invitations to the nurses’ potluck dinners.

That’s spiralized raw zucchini on top, canned beets on the sides

My wife has been in contact with 30+ folks online about the potential of this type of weight-loss program. Nearly all say “Yeah, I could see this happening, but only if I could have just one regular meal a day.” OK…but if it’s the wrong meal, you ain’t gonna lose weight. And does that meal start you down the slippery slope of noncompliance that ends in failure?

No name

I haven’t done any nutritional analysis yet. Maybe in the coming month.

Fajita salad?

I saw an ad on TV for Jenny Craig yesterday. They promised weight loss “up to 16 pounds in four weeks.” I have a powerful word to describe my opinion on that claim, but in the interest of decorum I’ll just say I’m skeptical. On the other hand, they could have said “up to 160 pound in four weeks” and both claims technically would be accurate. The key is “up to….” Up to includes both zero pounds lost and even weight gain. The average TV viewer is going to hear “up to 16 pounds in four weeks”and think, “Man, that sounds like a great program and I’m really going to lose a lot of weight quick!” But that’s not Jenny Craig’s fault.

Steve Parker, M.D.

PS: The day after I wrote this, my weight was 173.6 lb. So up from 171.6 That’s not an unusual fluctuation for someone my size. Assuming my scale is accurate, the change reflects hydration status, intestinal contents, and recent food intake.

PPS: Weight two days after original post was 173 lb (78.6 kg). The 171.6 above seems to have been a fluke. I’ll revise my first-week weight loss to 2.5 lb (1.1 kg).

This is one I made in a rush just before going to the hospital. I’d never tried canned makerel before – not bad. The red container holds commercial balsamic vinaigrette.

Nuttin’ But Salads: An N=1 Experiment

I could stand to lose about 10 pounds of excess fat. I’m sure my 20-year-old suits would fit better around the waist. Not that I’m overweight or fat. My BMI is 24.4 (weight 175.5 lb and height 5 feet and 11.25 inches. (Damn. I’m only 63 and already have some age-related shrinkage.)

So what I’m going to do for the next 30 days is eat only salads and see what happens. Not bland iceberg lettuce salads with a few tomato wedges drizzled with ranch dressing. No, these will be super-salads, meaning they provide an adequate amount of the myriad nutrients necessary for health. Right now I can tell you this will require variety and supplemental protein compared to the salads most folks visualize.

Salads have a long history of being “diet food.” Yet I can’t think of an extant popular diet based on them.

Any thoughts or predictions?

Steve Parker, M.D.

PS: How could a “nuttin’ but salads” diet lead to weight loss? I’m thinking there are certain foods that make people get fat, and avoiding them may lead to weight loss or prevent excessive weight gain. Certainly there are exceptions, but I’ve noticed the following items make people fat and keep them fat:

  • sugars, particularly if refined and concentrated
  • starches, particularly if refined and concentrated
  • soda pop, pastries, bread in all forms, pizza, candy, chips, cookies, cake, ice cream, pie, pasta, etc.
  • foods that taste too good, leading to over-consumption
  • excessive calories (from any source?)

I’m not sure about potatoes, beans, nuts, cheeses, and rice.

I also wonder if excessive variety may be a problem for many trying to lose weight, leading to too much temptation and experimentation. Maybe it’s good to get sick and tired of always eating the same thing. Maybe all you need is 3–4 different kinds of salads, plus protein food, and 1–2 fruits a day. Add more only when (if ever?) down to goal weight. Make a huge bowl of salad in the AM and eat it at mealtimes 2–3 times a day; make a different salad tomorrow?


How Did Walter White Lose That Weight in “Breaking Bad”?

That’s a guacamole deviled egg.
Photo Copyright: Steve Parker

In 2014 Howard Stern interviewed Bryan Cranston and asked how he lost weight so quickly for his role as Walter White on Breaking Bad:

“Stern: When you had chemo and was getting sick playing the part of Walter White, in order to go through rapid weight loss you deliberately didn’t eat for 10 days? True or false?

Cranston: False.

Stern: How’d you lose all that weight?

Cranston: No carbohydrates. I just took out all the carbohydrates.

Stern: How much weight did you drop?

Cranston: 16 pounds, in ten days.

Stern: Painful?

Cranston: No. The first three days are really hard, ’cause your body’s changing and craving sugar and wants, you know, and then you deprive it of the sugar and it starts burning fat.”

Source: How Walter White lost weight in Breaking Bad, it wasn’t chemo – High Steaks

h/t Tom Naughton

Diet Gets the Weight Off; Exercise Keeps It Off

From The New York Times:

It is a question that plagues all who struggle with weight: Why do some of us manage to keep off lost pounds, while others regain them?

Now, a study of 14 participants from the “Biggest Loser” television show provides an answer: physical activity — and much more of it than public health guidelines suggest.

On average, those who managed to maintain a significant weight loss had 80 minutes a day of moderate activity, like walking, or 35 minutes a day of vigorous exercise, like running.

My patients taught me this lesson years ago.

Cold Exposure May Help You Lose Weight

Well below room temp here

Should be well below room temp here

David Mendosa found a 2016 research report suggesting that cool temperatures may help with weight management by activating our brown fat, which burns more calories. Heat generated by brown fat is derived from glucose and triglycerides. Keep in mind as you read further that a comfortable environment temperature for a clothed human is about 23°C or 73°F. Those temps don’t stress our bodies by requiring us to either generate or dissipate extra body heat.

David writes:

Researchers have discovered that when we get mildly cold, which they define as being cool without shivering, our bodies burn more calories. As a result, managing our weight can be easier.
This is the conclusion of a recent review that two researchers at Maastricht University Medical Center in the Netherlands published in the November 2016 issue of the professional journal Diabetologia. The title of their article, “Combatting type 2 diabetes by turning up the heat,” puzzled me at first.

The title confused me because the study is about turning down the heat in the room we’re in. But then our bodies compensate by turning up their internal heat production.

When our body does this, its energy expenditure increases, ratcheting up our metabolism. Being mildly cold revs up our bodies’ brown fat, which unlike white fat, burns calories instead of storing them.

It’s not quite clear how much cold exposure it takes to turn on your brown fat. From the link above:

Cold acclimation by intermittent exposure to a cool (14–17°C) [57–63°F], or cold (10°C) [50°F] environment resulted in significant increases in NST [non-shivering thermogenesis or heat production] capacity. A 10 day cold acclimation study with 6 hour exposure to 14–15°C [57–59°F] per day was enough to significantly increase NST by 65% on average. A 6 week mild cold acclimation study (daily 2 hour cold exposure at 17°C [63°F]) also resulted in an increase in NST together with a concomitant decrease in body fat mass. The latter two studies also revealed significant increases in BAT [brown adipose tissue] presence and activation. All in all, cold-induced BAT activity is significant in adults and parallels NST. The actual quantitative contributions of BAT and of other tissues (e.g. skeletal muscle) to whole-body NST are, however, not elucidated and await further studies. Furthermore, more information is needed on the duration, timing and temperatures to find out which treatments are most effective with respect to increasing NST.

Furthermore, cold exposure over the course of 10 days increased insulin sensitivity in T2 diabetics by 43%. Eight study subjects, probably in the Netherlands, were exposed to temps of 14–15°C [57–59°F] but I don’t know for how many hours a day. Increased insulin sensitivity should help keep a lid on blood sugar levels and reduce the need for diabetes drugs.

In case you’re elderly, obese, or have type 2 diabetes, be aware that the activation of brown fat by cold exposure is not as robust as in others.

On the other hand, I found evidence that higher ambient temperatures (above 23°C) [73°F] may also help with weight management, regardless of what brown fat is doing.

Science is hard.

Steve Parker, M.D.

PS: Check out my books for more ideas on weight management.


Diets Don’t Work: True or False?