Posted by: notdeaddinosaur | August 24, 2010

How to Lose Weight

Eat less.

What?

You heard me. Eat less.

Well, duh. But it’s not that easy.

You’re telling me! Of course not. It may not be easy, but sure is simple. (See previous version of the Laws of the Dinosaur)

Wait a minute. If all there is to losing weight is “eat less”, what about things like bariatric surgery, Weight Watchers, Jenny Craig, Biggest Loser and all that? Isn’t weight loss a multi-billion dollar industry in this country?

Of course. But the final common pathway to every single successful weight loss program is eating less.

Come on, you’re a doctor. There has to be more to it than that.

You want longer words? Here you go: consume fewer calories than your body expends per unit of time.

Now you’re talking. How do I do that?

Eat less.

Arrgh!

Seriously. Weight Watchers is basically a support group combined with weight loss counseling. Their “points” are nothing more than pre-counted calories. Following their program means limiting how many calories you eat. If you do, you’ll lose weight. If it lets you eat the same as you were previously, then you weren’t overweight.

Jenny Craig, NutriSystem, and those “delivery diets” that bring food to your door are also controlling your portions. If you don’t eat more than they let you, presumably less than you were eating before, you will lose weight by eating less.

Bariatric surgery consists of a variety of procedures that either mechanically restrict how much the stomach can hold, or induce a state of malabsorbtion; that is, intentionally causing the body to fail to absorb nutrients; in other words, forcing you to eat less.

What about just exercising more?

That sounds like it might work in theory. Unfortunately, it doesn’t work out that way as a practical matter. It turns out that while exercise is definitely good for you and very important for cardiovascular well-being, it doesn’t really make you lose weight (another reference here). It actually increases your appetite, and you ALWAYS end up eating more than you burned off. Once you’ve lost weight, though, it is indeed the only way to keep the weight off.

Pshaw. How do you know about all this?

I know because I’ve just lost 50 lbs. in about ten months. Everyone keeps telling me how wonderful I look. I’ve gone down at least four clothing sizes. When I go shopping for clothes I feel like a kid with a new toy. I do double-takes when I catch a glimpse of myself in passing windows. I’m wearing white pants, for heavens sake, and they are not making me look fat.

Wow, that’s great. How did you do it?

By eating less.

Dammit! That’s not what I mean. How did you DO it?

By eating less. Sorry. That’s what I’m trying to tell you: there is no other way to lose weight, except to eat less. Sure, there are techie tricks you can use for tracking. Do they work any better than pen and paper? Not really. Whatever it takes to get you to eat less is what is going to work for you if you want to lose weight.

That can’t be all there is to it. C’mon; share your secrets!

Okay. Here are some dirty little secrets about weight loss:

  1. You’re going to be hungry sometimes.
  2. It takes a long time.
  3. You’re going to hit plateaus from time to time.
  4. The less you weigh, the fewer calories your body needs.

So what do you do when those things happen?

Eat even less. If you want to lose weight, it’s the only way to do it.

Really?

Really.


Responses

  1. lol. hear hear!! Wonder why people prefer to think its more complicated than that.

    Now I’m on the gain weight diet Dino Doc. Guess you’ll tell me to eat more right? or is there something more complicated to it?

  2. The advice nobody wants to hear, isn’t it. I’ve lost 40 pounds in the last 5 months, and no one who asks me how wants that answer. I use one of the free food tracking websites, but it all comes down to eating less.

  3. yeah… or exercise way more. You did say it yourself: “consume fewer calories than your body expends per unit of time.” Reason, dear Dino, tells me that “expend more calories than your body consumed per unit of time” would also hold true.

  4. This? Was awesome.

  5. I agree! This is the first time in my life I’ve lost significant weight and in a slow, healthy manner (34lbs and counting). However I think one important ingredient for many people is to eat LOTS of veggies and fiber-rich foods so that they eat fewer calories but still feel somewhat satisfied most of the time. At least that has made a huge difference for me! And for many meals I’m actually eating more. Well, more volume. But yes, fewer calories.

  6. well said! i’m a second year med student, and i’ve seen sooo many people who won’t do what you’ve done- even when they ask me for advice about it. congrats on the weight loss!

  7. Why is it that some patients think we have some secret medication or treatment (or they have some illness causing their weight gain) that we are withholding from them? Ever since Fen-Fen there isn’t any good medicine for obesity. I do dexamethasone suppression tests on some patients and TFTs but never saw correcting hypothyroidism result in significant weight loss.

  8. Thanks, Doc! Great advice!

  9. While I didn’t lose weight once the thyroid issue was corrected, it became possible to lose weight with ordinary levels of calorie restriction and upping my movement.

    That said, one can lose weight when hypothyroid. Hyperemesis for six months will do the trick. I don’t recommend this method, however. (grin)

    The thing that has retrained me on eating is an amphetamine. I probably could have gone on it purely for the appetite suppression for three months, learned how to eat reasonable portions, and gone off it. (If the other condition I was taking it for would go away that simply….) So while people are all impressed, in some ways it’s not me doing it. But I have learned not to eat so much, drink more water, etc.

    I think it’s worth noting that Americans, especially American women, have a really effed-up relationship with food.

  10. Wonderful post!

  11. And by the way, while I am super happy for you and know how hard it is to lose that amount of weight, you are now entering phase two which may be more difficult (statistically speaking) keeping the weight off. So don’t ever and I mean ever – not for a day, not for a week and certainly not for a month – go back to the way you were eating before. Please set your calendar for two years from now so you can post an update for us and please, please be one of the 5% that keeps the weight off for two years.

  12. Grats guys. I’m on 5kg so far. Looking forward to 20 more!

    It IS about eating less. I find cutting out carbs except breakfast cereal helps control my appetite.

    Why its taken me 30 years to get it I’ll never know. The essential factor = determination and Getting Over It.

  13. Good for you.

    It’s the same for my patients, though we weigh their food and strap on grazing muzzles if necessary. Works every time if the owner sticks to the program.

  14. As a fellow general practitioner that also lost a considerable amount of weight over the last 6 months (30 lbs) I am getting a hoot over my patients comments over these last few weeks. The first question is “are you sick?”. I am hoping it is of genuine concern about me but I fear that it might be concern regarding an upcoming inconvenience of me not being available. The second is “how did you do it”. To which I reply “doctors have access to experimental drugs”. They are disappointed to hear my truth telling of “move more, eat less”

    Congrats and good health.

  15. Please do move more, though! Just had a relative staying here, and she lost a huge amount of weight through the eat less route (had her stomach stapled) but she is incapable of walking more than a couple of hundred yards! This means she cannot use the tube system in London, she cannot explore a castle or go shopping in a normal way. She is unable to climb a flight of stairs (behind the person carrying all her lugguage) without resting at the top. Yes, she looks good, but she is practically disabled. She has no muscle development and has to catch taxis to everywhere. This has made her dream holiday a bit of a nightmare, as she is not capable of keeping up with the others on her trip, most of which are older. What is the point of being skinny if you can’t do stuff?

  16. Absolutely spot on! I have lost 58 pounds so far this year and no have a BMI of 24.6. I can’t tell you how many patients and colleagues have asked me “What’s your secret.” “There is no secret,” I tell them (of course), “I simply eat less.”

  17. ” in other words, forcing you to eat less.” A dear friend had one of these procedures not long ago. It’s caused her some problems – she’s lost weight but she was recently telling me about how she eats now, and it does come down to exactly this. She is mechanically restricted and can only eat small amounts of certain kinds of food. For all the other problems it’s caused (some kind of erosion that required the procedure to be reversed then redone some months later – ugh!) I can’t help feeling that a better option would have been….eat less.

  18. Agreed! There are some tricks that can help you eat less, though. One of the easiest is to put away your big dinner plates and use salad plates. It takes far less food to fill a smaller plate and you will eat less by default. Also, make yourself wait 15 minutes before getting up for 2nds. You may still feel hungry after the first serving is gone, but chances are good that after 15 minutes you’ll feel full enough to not need more.

  19. Good for you, Doc!

    I lost a lot of weight (60 lbs) a couple of years ago, and one of the things that really irritated me then was people automatically assuming that I had bariatric surgery. When I told them that no, I did it the old fashioned way by decreasing my caloric intake but increasing the amount of activity I engaged it, most people seemed slightly crestfallen and disappointed.

    I’ve lost more weight since then due to a recently diagnosed Crohn’s disease. Again, people ask me how I did it – and one woman, when I told her it was because of an illness, asked if Crohn’s was contagious and if it was, could I try to pass it on to her. :-/

  20. Terrific advice!

    And I have some advice for alcoholics: don’t drink.

    Just HOW does one go about “eating less” or “not drinking”?

    We’re not gonna discuss that.

    You have to figure it out for yourself.

    Love,

    Kensington MD

  21. If you maintain a 30-pound weight loss for one year or more, you’re eligible to join the National Weight Control Registry. (http://www.nwcr.ws/)

    I’m already a member. :)

    Love,

    Kensington MD

  22. I can’t let this one go.

    I think it’s ridiculous that you’re recommending that people NOT exercise while trying to lose weight, on the grounds that “you ALWAYS end up eating more than you burned off.”

    That’s just flat-out wrong, as you can see if you re-read the article you cited in that paragraph, The article said that “On average, the women in all the groups*, even the control group, lost weight, but the women who exercised — sweating it out with a trainer several days a week for six months — did not lose significantly more weight than the control subjects did.”

    See!!! Even according to the article you cited, it’s NOT true that, as you wrote, “you ALWAYS end up eating more than you burned off” — SOME OF THE WOMEN WHO EXERCISED ALSO LOST WEIGHT. If “you ALWAYS end up eating more than you burned off” that means that you can NEVER lose weight while exercising. Yet in the article, the women were exercising, and they did lose weight (altho’ not more than those who didn’t exercise).

    *”Women in three of the groups were asked to work out with a personal trainer for 72 min., 136 min., and 194 min. per week, respectively, for six months. Women in the fourth cluster, the control group, were told to maintain their usual physical-activity routines.”

    Dr. Dino, you have some ‘splaining to do.

    Love,

    Kensington MD

  23. According to the National Weight Control Registry:

    “98% of Registry participants report that they modified their food intake in some way to lose weight.”

    “94% increased their physical activity, with the most frequently reported form of activity being walking.”

    URL: http://www.nwcr.ws/Research/default.htm

    Wow — 94% lost weight while increasing their physical activity. It sure sounds like people don’t “ALWAYS” end up eating more than they burned off.

    Love,

    K MD

  24. And here I thought being fat was just genetics. Congratulations on walking the walk. Now get out there and walk.

  25. Eat Less. Do More. I’m always telling my kids that when they complain about their waistlines.
    I have been a BMI 20 for most of my adult life (I have a passle of kids so there were times I was of very different proportions). Back in college, when “eating with friends” meant black coffee and a cigarette, my BMI was probably around 17-18. (It isn’t pretty, I don’t recommend it.) And most of my adult life (I’m 48) friends have asked me, how do you do it? And I tell them, I eat less than you do. They don’t like to hear this.
    But then, I remind them that I eat less because I want less, because I am programmed differently from a childhood with a mom who was a weight watchers believer (I once declared in my 1st-grade classroom that “all my mother ever eats is salad”), who NEVER ONCE made us finish what was on our plates, and encouraged us to participate in sports, made us walk to school (even in the rain), to make healthy choices, and of course my genetic disposition is what it is. All these things matter. But really? I eat less. I’m also jumpy, I fidget, I get up and walk around at work, that’s just me. Never could sit still. Even when I’m sitting quietly reading, I twirl my hair, tap my feet… even right now.
    Food CHOICES, not only portion sizes. As
    Michael Pollan, author of In Defense of Food recommends: “Eat food. Not too much. Mostly plants.” “Don’t eat anything your great-great grandmother would not have recognized as food.” As one commenter said, veggies have more volume and will make you feel full, etc..
    Another factor: Consider the investment of energy required to (let’s say) bake bread. If you have to mix it, knead it, wait for it, bake it, clean up afterward… or if you pick it up off the supermarket shelf. Now think about the calories in each slice vs the expenditure to obtain it. See where I’m going with this? … Is it the carbs n that sandwich that are the problem, or maybe???
    Just some musings, one dinosaur to another.
    smc

  26. Exercise suppresses my appetite!
    http://ajpregu.physiology.org/cgi/content/short/296/1/R29

  27. Good job on the weight loss!

  28. As we all know it’s a lot easier to put the dreaded lbs on than get the pesky stuff off !

  29. I’m happy you lost weight and found something that worked for you but…

    As someone for whom weight loss is not so simple, please don’t forget to screen for PCOS and insulin resistance. Both situations where eating less doesn’t yield the hoped for results.

    M

  30. I came across this article today and it reminded me of this blog post: http://www.guardian.co.uk/lifeandstyle/2010/sep/19/exercise-dieting-public-health

    I’ve managed to lose 64 pounds and to keep it off for 6 months now. Eating less is the only way to do it, I agree.

  31. Actually, it is eat fewer, as in fewer calories. I’ve been encouraging patients to eat more veg (or only veg) as these are bulkier per calorie, leading to that sense of fullness we like, while still having fewer calories in.

    I initially was discouraged by the lack of effect of exercise on weight loss (although it is still good for you as regards blood pressure, osteoporosis, etc), but then I realized that it made it easy to explain and focus: eat fewer calories. Shut the pie hole. Just say no.

    Nice post. Enjoying your site.

  32. [...] let’s face it – the Twinkie diet is not going to help you make the habit changes we need to make to keep the weight off in the long term. Before long, I would expect Haub will gain [...]

  33. Very good post. I absolutely love this website. Thanks!


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