GENERAL CASE STUDY OF HOW TO LOSE WEIGHT REALISTICALLY

 Written: 13th December 2021

HOW TO LOSE WEIGHT IN A REALISTIC WAY ?

Summary

There is a lot of conflicting information regarding the best way to lose weight, especially when it comes to diets. A recent study compared different diets and finally revealed that there is no significant difference in their effectiveness in losing weight.

On the other hand, it is recommended to lose weight gradually because rapid weight loss was a risk factor for a faster and more important weight regain. This notion was challenged by a study that compared these two approaches and showed that the speed of weight loss does not influence weight regain.

Ultimately, the important thing is to develop strategies that work best for the patient, so that they can adhere more easily and maintain their efforts over time.

Introduction

It is now well known that obesity is associated with several chronic diseases as well as increased morbidity and mortality.Fortunately, weight loss improves the health outcomes associated with obesity. Therefore, in recent years, considerable effort has been made to identify how to lose weight in a sustainable manner.

However, research has often shown conflicting results, making it difficult for health professionals and the public to navigate the issue. Two particularly controversial areas are dieting and the ideal speed of weight loss

What is the best way to weight loss?

The purpose of this article is to examine these two topics and see what the most recent literature provides.

Weight loss and diet

One of the most important strategies for weight loss is a proper diet. Thus, in the last decade, with the increase in the prevalence of obesity around the world, a myriad of diets have emerged. These diets differ greatly from one another, and one way to classify them is according to their macronutrient composition (protein, carbohydrates and fat):

low-carb diets, for example, the Atkins diet. These diets generally call for less than 40% of total food calories to come from carbohydrates. The principle behind this type of diet is that the low carbohydrate intake is associated with a privileged oxidation of fats. In addition to weight loss, fat metabolism leads to ketosis, which is known to decrease appetite,4 and therefore may improve adherence to energy restriction.

Low-fat diets, for example, the Ornish diet. In this type of diet, it is recommended that 10-20% of total food calories come from fat, with an emphasis on fruits and vegetables. This approach results in a low energy density diet that improves satiety because of the large volume of food that can be consumed.

So-called macronutrient-moderate diets, for example, Weight Watchers diets, which, as the name implies, recommend balanced proportions of protein, carbohydrates, and fat, but with a restriction on portion sizes, and thus calories. The principle behind this type of diet is that variety in macronutrients allows for better adherence to the diet and avoidance of nutritional deficiencies.

Regardless of the class, the number of diets continues to grow and all claim to be the most effective for weight loss. So how do you find your way around ?

So what is the best diet?

In search of the "ideal" diet

A recent study published in JAMA conducted a meta-analysis to estimate the relative effectiveness of different diets that have already been tested in clinical studies for weight loss. The study compared diets by macronutrient composition (carbohydrates, fat and protein), but also between different brand names (e.g., Atkins, Ornish, etc.).

The meta-analysis included 59 articles that identified 48 clinical trials, including a total of 7286 participants (mean weight 94.1 kg, median BMI 33.7 kg/m2). Eleven different brands of diets were compared.

The parameters studied were weight loss and BMI at six and 12 months of follow-up. In analyzing the results, the study took into account physical activity and other behavioral supports provided in some of the clinical trials.

The study found that when comparing diets by macronutrient concentration, at six and 12 months of follow-up, low-carbohydrate and low-fat diets showed the best results, with an advantage for low-carbohydrate diets. However, the difference between these two diets was not significant.

Slow versus rapid weight loss

A recent Australian study sought to compare progressive weight loss, as recommended by current guidelines worldwide, with rapid weight loss in terms of rate of weight loss and maintenance over time.

The trial included 200 obese adults (BMI 30-45 kg/m²) who were randomly assigned to either the 12-week rapid weight loss programme or the 36-week progressive weight loss programme. The target weight loss was ≥12.5% of body weight. Participants who successfully achieved the target weight then moved on to phase 2, a three-year weight maintenance diet.

The results show that participants in the rapid loss group were more likely to achieve the target weight loss: 81% of participants vs. 50% in the gradual loss group. Most importantly, it was found that the initial rate of weight loss did not affect the degree or speed of weight regain among participants: weight regain was about 71% in both groups after three years.

Average changes in weight and BMI over the course of the study for all participants who completed the programme

Other factors influencing weight regain

This study also sought to investigate the effect of the rate of weight loss on blood levels of the hormones leptin and ghrelin, both of which play an important role in the regulation of food intake and body weight.

Leptin is secreted by adipose tissue and inhibits food intake while increasing energy expenditure.14 In this study, it was observed that leptin levels decreased more with the rapid weight loss programme in phase 1. In both groups, leptin levels increased in phase 2. Of particular note, in participants who regained ≥75% of the weight lost at the end of phase 2 (n = 45), a significant increase in leptin concentrations independent of the initial rate of weight loss. Those who regained less than 25% of lost weight (n = 15) had leptin levels remain below baseline.

This result suggests a hypothesis for future treatments. Could it be that patients who regain weight have a resistance to leptin?

As for ghrelin, it is produced mainly by the stomach, and stimulates food intake and decreases energy expenditure.15 There was no significant difference in the mean fasting ghrelin concentration in the two groups: it increased after weight loss and remained somewhat elevated in phase 2 (table 3). Again, antighrelin treatment might be a good way to lose weight in the long term.

Another parameter investigated in this study is the 3-β-hydroxybutyrate level, which is related to the concentration of circulating ketone bodies, known to suppress appetite. It was measured at 5 and 10% weight loss in phase 1, and was found to be significantly higher in the rapid weight loss group. However, this difference disappeared at the end of phase 1.

Discussion

This study challenges the widely held notion that rapid weight loss is associated with greater and faster weight regain compared to gradual weight loss. Indeed, it was found that weight regain was identical regardless of the initial rate of weight loss.

Rapid weight loss appears to be particularly attractive as more patients reach their target weight. However, encouraging all people to adopt such programmes is not advisable as they may have harmful effects, for example increased loss of muscle mass. Also, in patients with eating disorders, this type of restrictive diet should not be prescribed. In addition, a very low calorie diet can also lead to deficiencies of certain essential nutrients. These programmes should always be carefully supervised by professionals experienced in the treatment of obesity.

Obviously, people respond in different ways to different diets and there is still little knowledge to decide what may be more successful, with what strategy. But in any case, rapid weight loss programmes are not a long-term solution and do not solve the problem of long-term maintenance of weight loss.

The high hormone levels associated with weight regain suggest another reason for losing weight!

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