The #1 Dieting Mistake—Use It To Lose It
Yoni Freedhoff, MD is an assistant professor of family medicine at the University of Ottawa; the founder and medical director of the Bariatric Medical Institute, for non-surgical weight management; author of the best-seller The Diet Fix: Why Diets Fail and How to Make Yours Work; and writer of the award-winning blog Weighty Matters.
Honest Health News: In your experience, what is the biggest mistake people make that prevents them from losing weight and then keeping it off?
YF: The most common mistake is the notion that suffering is a prerequisite to success."The most common dieting mistake is the notion that suffering is a prerequisite to success."From my experience, if you don’t like the life you’re living while you’re losing weight, you’re virtually certain to gain it back. To keep the weight you lose off long-term, I think you need to genuinely like your life when you’re eating fewer calories.
HHN: How can people who love to eat curb their calories without suffering?
YF: The first step is to prevent your hunger, to minimize that physiological drive to eat. If you’re not hungry, it’s easier to make healthier choices and not feel shortchanged by the consequences of those choices.
In essence, you want to be choosing foods with your brain, and not with your body.
Controlling Your Hunger
HHN: In The Diet Fix, you explain, "If you regularly battle with hunger, there are 100 million years of evolution telling you what to do. Evolutionarily, our genes and physiology still function as if the next meal might never come," as if we must eat now to survive. Can science also teach us how to out-trick our hard-wiring?
YF: In our clinical practice, these two approaches help people the most in controlling their hunger:1Eat multiple, frequent meals and snacks, about every 2 ½ — 3 ½ hours2Eat enough protein and calories at each meal and snack: 20+ grams of protein at every meal, and 10+ grams of protein and 150+ calories per snack
The studies on protein are clear: Protein is more filling than the other macronutrients, fat or carbohydrates. That’s why including protein with every meal and snack is crucial.
I recommend beginning the day with a protein-rich breakfast."Many people eat cereal for breakfast and then struggle with dietary control throughout the day."Instead, many people have cereal, and then struggle with dietary control throughout the day. The dietary choices you make in the morning can affect your entire day, including your night-time eating.
HHN: Why do you recommend 20+ grams of protein at every meal and 10+ grams of protein at every snack? Do these protein targets reflect the scientific literature on satiety?
YF: To be honest, it’s not as precise as all that.
Most of the literature would say that getting 25% of your calories from protein will provide some satiety benefit. From working with thousands of people, though, I’ve found it’s easier for patients to achieve a minimum amount of protein than it is to hit a particular percentage target. Twenty grams/meal and 10 grams/snack have been more effective ways to implement the recommendation.
HHN: Would that same principle hold true regarding your recommendation that to increase satiety and exert greater control, people eat every 2 ½ — 3 ½ hours?
YF: That’s also in part the practicality of eating. Some people aren’t particularly predisposed to breakfast and/or don’t want to put the time aside to have a large, protein-rich meal every morning. It’s easier to encourage them to split up their meals and snacks so they’re eating protein earlier and throughout the day.
But really, there’s no hard and fast rule. Studies in the medical literature support every style of eating. Some say having 3 meals and several snacks is superior; some say 3 square meals; some will say just 2 meals is best. You can find what you want to endorse your particular practice.
HHN: Your book discusses the appetite-inhibiting hormone leptin, which signals the hypothalamus, the brain’s hunger center, that our bodies have had enough to eat. Does scientific research show what foods we can eat to produce more leptin?
YF: The research on using leptin as a weight management tool has been rather disappointing. One drug company did produce recombinant leptin for trials. While giving people leptin made sense on paper, in practice it only helped a very small number of individuals who had a very specific mutation. Today researchers are investigating whether leptin may be valuable in maintaining weight loss, but I have yet to see anything exciting or conclusive.
What’s Best for the Individual You
HHN: Does the particular weight-loss regimen matter for satiety and comfortable losing weight? Will cutting out fewer calories and taking longer to reach their goal help more people to successfully sustain lost weight?
YF: There is no gold standard in terms of treatment plans, programs, or diets. That’s another area in which various studies support different findings. People have lost weight on pretty much every program out there.
Different individuals also do better on different diets, low carb or low fat or vegan or Paleo. You want to find the program that suits you best and which you can maintain long-term.
Anyone who’s on a diet, ask yourself: Can I live with this program the rest of my life? If the answer is no, that should give you pause to consider whether it’s the right program for you.
HHN: Are there also individual differences in weight management? If 100 people who are the same age, gender, height and weight eat equivalently, will some people gain or lose more weight than others?
YF: Yes, people’s fuel efficiencies do differ. Some people can eat practically whatever they want and don’t struggle with weight, and other folks seem to eat very little and gain easily. Caloric excess doesn’t have the same impact on each of us.
That said, sometimes people are mistaken in believing that they’re not eating enough to warrant their extra weight. Usually they’re basing that on the volume of the food"It is possible to eat very small volumes of food with very high volumes of calories."they’re eating rather than the calories of those foods. Ultimately, the currency of weight is calories. If you’re eating more calories than you’re burning off, you will gain weight. And it is possible to eat very small volumes of food with very high volumes of calories. As one example, just 1 tablespoon of olive oil contains 120 calories.
HHN: The recent personalized diet finding, by Israeli researchers, that 800 people who ate the same breakfast had immense variation in blood sugar responses must not have surprised you.
YF: Ultimately we all have different responses to food. Yet, just like all cars have their individual fuel economies, our own car can perform better or worse than its published fuel economy, depending on how we drive it.
Similarly, if you’re trying to lose or maintain weight, your goal is to craft and cultivate the dietary strategies that work best for your satiety and control.
To do this well, I recommend using a food diary—a powerful tool to help you identify patterns you wouldn’t be able to see unless you collected this data.
Diet Detecting with a Food Diary
HHN: How does a food diary work?
YF: Simply record the foods you eat and when, and rate, on a scale of 1 — 10, how difficult each day is in terms of dietary control and choice. Your diary should never be an instrument for self-judgment. It’s a means for you to explore the impact of different food strategies on your life.
It’s natural to indulge sometimes, for social or celebratory reasons, such as on a birthday or anniversary or Thanksgiving. But when there’s no evident rationale to overeat and you struggle with cravings,"How are you eating on the days you’re struggling vs. the days you’re not?"you might give the day a 7, 8, 9, or 10 rating of difficulty. In my office, patients typically talk about those hard days, but when I ask them, "Are there days when you’re in total control?" they’ll say "Yes." Then the objective is to look for patterns: What are they doing on the days they’re struggling vs. the days they’re not?
Sometimes the reason isn’t obvious. Maybe some days they’re just hungrier. But more often than not, people will notice patterns:"More often than not, people will notice patterns: If I wait too long between lunch and dinner…"If I miss breakfast… If I have this vs. that for breakfast… If I don’t have protein… If I wait too long between lunch and dinner… Sometimes they’ll try out a different dietary strategy, such as moving from multiple meals and snacks to eating 3 meals a day. Then they see what patterns help them feel the fullest and enable them to have the greatest degree of control.
Ultimately, the goal is not to cultivate the willpower required to deny foods that are riskier for weight, but rather, to cultivate the willpower and the knowledge to organize your day in a manner that leaves you not craving those foods.
HHN: Is there anything else you’d like to say about how we can satiate our hunger and avert formidable cravings?
YF: I think it’s important not to avoid so-called "forbidden foods" if you love them."I think it’s important not to avoid so-called 'forbidden foods' if you love them."Now there are experts who disagree with me, but in my practice I haven’t had good experiences with blind restriction. Quite the opposite: I find that when people deny themselves things they want, even if it’s easy at first, over time that can cultivate an artificial hunger which can precipitate like a snowball and can become the very thing that sinks their weight-loss efforts altogether.
Practicing "Thoughtful Indulgence"
HHN: How do you can lose weight and live more healthfully while incorporating "forbidden foods" into your diet?
YF: You cultivate what I call "thoughtful indulgence" by asking yourself two questions:
1. Is this food really worth it?
2. If yes, what’s the smallest amount of this food I’ll need to be happily satisfied?
Earlier we talked about how calories are a kind of currency."Consider calorie counts with indulgences the same way you’d consider price tags with shopping indulgences."You can consider calorie counts with indulgences the same way you’d consider price tags with shopping indulgences. Among the variables are "How much does it cost?," "What can I afford?," "What's my spending been like lately?," "How much do I really want it?"
The key to doing this well is not being hungry when you’re asking these questions. You cannot be thoughtful when you’re hungry. Anyone who’s ever gone to the supermarket hungry knows that.
In addition, most of us are not inclined to ask, "How much of this food do I need to be happily satisfied?" Asking ourselves this second big question can go a long way in controlling weight all by itself.
Also, know that a small amount of indulgence isn’t going to set you back. There are approximately 3500 calories in a pound, so even if you consume 1,000 additional calories one day, it won’t add up to even 1/3 of a pound!
HHN: What’s the best way to approach "thoughtful indulgence" at a party?
YF: Showing up hungry is a bad plan. You’ll do much better if you’re full when you get there. We often tell people to pre-eat, to have all their meals and snacks and then an additional snack before heading to the party.
Also, try to go easy on the alcohol. That’s going to change your resolve, and it’s also likely to make you hungry, because alcohol is an appetite stimulant.
HHN: How do you suggest practicing "thoughtful indulgence" at a restaurant?
YF: Pick out a handful of menu items you think you’ll actually enjoy, and then order the one with the fewest calories. Don’t order the lowest caloric item on the menu, because that’s not comfortably sustainable.
Also, because alcohol will increase your appetite, resist the urge to get drinks before you order your meal. If you want a drink, order it after you’ve finished eating.
One more thing: If the restaurant furnishes calorie information and"Because alcohol will increase your appetite, resist the urge to get drinks before you order your meal."you’re tracking calories, add another 20% to the number they provided. Research shows that restaurants typically underreport calories and/or give customers larger portions than the standard serving sizes used for calorie counts.
Exercise-Weight Loss Misunderstandings
HHN: Do you suggest any specific weight-loss app or site to track diet and exercise?
YF: I like to use different apps for healthy dieting and for exercising. They’re really two separate behaviors, not the same thing in and of themselves.
Exercise is important for health, sleep, mood, and energy"Only 20% of a person’s weight is likely determined by fitness; about 80% comes from diet."benefits, but unfortunately it doesn’t lead to a lot of weight loss. Physical activity just doesn’t burn as many calories as would be fair. Only 20% of a person’s weight is likely determined by fitness; the vast majority, about 80%, comes from diet.
HHN: Why doesn’t exercise help substantially with weight loss?
YF: Exercise typically makes people feel hungry and/or virtuous. In either case, most folks feel they need to or are entitled to eat more afterwards, and then the weight loss benefits largely disappear.
Unless you’re doing an awful lot of exercise, exercise calories don’t need to be replaced. For the average person, the whole notion of refueling for recovery is usually just marketing to make you buy products. It’s not even necessarily good for your health.
HHN: I was also fascinated to learn in your book that many fitness machines grossly overestimate the calories you’re burning. To make the calorie losses look larger, they include the calories you’d be losing just by breathing. As a result, people mistakenly think they’ve burned more calories than they did.
YF: Yes, this can be an issue. Still, I like fitness trackers for folks who respond well to the concept of the "quantified self." Personally I log my fitness with Fitocracy.
For diet monitoring, our office uses My Fitness Pal. It’s not perfect; it may tell you to eat less and less without any regard for your happiness, fullness, or comfort. But I think it’s the easiest app to use out there.
We ourselves are launching a one-on-one coaching app whereby we’ll be able to work with patients remotely, wherever they may be. Hopefully we’ll release it this winter, certainly spring at the latest.
Focusing on Big Ticket Items
HHN: Is there anything else you’d like to say to help readers achieve long-term weight-loss?
YF: One of the problems in today’s society is we make the little stuff too incredibly important. And I just don’t think it is.
Instead of stressing about how many calories we ate today, or that we just indulged in a "forbidden food," let’s attend to healthy living as a whole, by focusing on the big-ticket items:
- Reducing the ultra processed foods in our diet
- Making cooking an important part of our lives
- Cultivating our relationships
- Sleeping well
- Eating sufficient protein
- Not eating or drinking calories we don’t love
After all, food can be a delight and a comfort in our lives. We can and should live a life that includes foods for pleasure and celebration.
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