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I am working on a presentation for an upcoming conference. It's a lot of work, and in general I enjoy doing it, but because I am so busy doing so much other stuff it is hard to find the time. I am always late submitting my PowerPoint slides (physician meetings are ALL about the slides). When I say always late, that means Every. Single. Time. I can't remember if the PowerPoint has ever been in by the deadline.
Getting started is the key, and once I do get started the process tends to flow fairly well. It's easier if it is a topic that I choose, especially if I find it interesting. The title of the presentation that I am working on now is "Diet Strategies for Weight Loss and Better Nutrition." That seems straightforward enough, but the first problem is that I don't recall agreeing to that as a subject - even though I am on the planning committee for the meeting. (Honestly, I probably wasn't paying attention, or as is more often the case, it seemed like a good idea at the time.)
Second, it's a straightforward title, but it's actually a deceptive topic. The "Weight Loss" part of the title is what has kept me from getting started. For those of you who follow DrGourmet.com, you know that in the last few years we have worked to spend more time discussing better nutrition and not necessarily weight loss. It is not that weight loss isn't important (it is) but losing weight is challenging and frustrating for most folks. In working with patients over the years I have found that they can and do lose weight, but my experience and the literature says that it is only half of the equation, with the other 50% being the quality of the food we consume.
For most of us, just eating a healthier diet can move the needle quickly on blood pressure, blood sugar, cholesterol, need for medication, well being, and energy. The best nutrition research shows that losing weight is doable, but we can be healthier just by following Mediterranean diet principles, and for most of us those small, slow, incremental changes work well for both overall health - and ultimately weight loss.
When I begin building the slide deck for a talk I think of it as a story outline. It takes some time to develop that story and I usually start by framing it with some of my previous slides and then add in a lot of random content that seems to fit. Only after I get a critical mass does it begin to take shape into the story. Sometimes that happens quickly and other times I have to create 100 pages to end up with a PowerPoint that is only 30 slides long.
The first part of "Diet Strategies for Weight Loss and Better Nutrition" is a review of just that: effective strategies for weight loss. I forget sometimes how much research I read, how interesting it is, and how impactful it can be for people's lives. I believe that it is because when I read the journals or write columns it's a singular task. Only by looking through the body of research can one get the whole picture. We read headlines every day that say "If you just do X, you will lose weight," but, in truth, there is no one single magic bullet strategy that will help you lose weight. Instead, it's a combination of strategies.
Here are a few strategies that seem to recur across the research landscape:
1. Macronutrients don't matter. It doesn't matter whether you eat low carbohydrate, low fat, high protein, high fat, high carbohydrate, or any other mix of macronutrients. Everyone who goes on some sort of calorie-controlled diet loses weight – about 7% to 10% of their starting body weight in the first 6 months to a year.
2. Weight maintenance is key to think about on Day 1. There are lot of good strategies for weight loss, but if you are going to keep it off, you need to think about making a permanent change and not simply "going on a diet."
3. The five most common strategies for success: Smaller portions, reducing the overall food eaten, more fruits and vegetables, fewer fatty foods and no sugar-sweetened beverages.
4. Exercise. That same study showed that the difference between a successful loser and an unsuccessful one was exercise. That is supported by dozens of other studies and over 46% of successful losers exercised 30 minutes or more each day and about another 45% said that they added some physical activity to their daily routine.
5. Eating about the same amount of calories per day works.
6. Keeping a food diary works. Keeping an online diary works even better, and in one study those using the Internet lost 50% more weight than those using a pen and paper. Interestingly, people seem to like keeping a pen and paper diary more than an online food diary.
7. Taking a picture of what you eat works as well as a food diary. It appears that keeping a photo diary works by making folks think about what they are going to consume before they eat.
8. Weighing yourself every day makes it more likely you will lose weight.
9. Portion size matters. A lot. In every study I reviewed, consuming smaller portions works and this doesn't matter whether it is plate size, bowl size, the size of the actual serving, or the packaging.
10. Yo-yo dieting doesn't seem to matter as much as we thought. If you lose and gain and then lose again, you are still better off than if you never lost weight in the first place.
I didn't set out for this column to be ten items. It just worked out that way. There are easily 10 times this many strategies, but these are ones that both seem to be verified in repeat research and are also easily doable for most of us.
Back to the PowerPoint.
Timothy S. Harlan, M.D.