Thursday, March 25, 2010

Will Dieting Make You Fat?

I have often heard from my patients that with previous weight loss attempts they not only gained all of their weight back but in fact gained additional pounds, making them heavier than they ever were before – in other words, they report to have dieted themselves “fat”.

Does this in fact happen? Is excess weight gain perhaps even a natural consequence of trying to control your weight by dieting?

This question was now addressed by Jennifer Savage and Leann Birch from Pennsylvania State University in a study published this month in OBESITY.

A total of 176 women were assessed at baseline and followed over four years. Three groups of women were identified: those making no effort to control their weights (N; 23%), those using healthy strategies (H; 43%) and those using both healthy and unhealthy strategies (H+U; 35%).

Despite adjustment for numerous confounders like education, income, and initial BMI, women using both healthy and unhealthy strategies (H+U) gained significantly more weight (4.56 kg) than the N group (1.51 kg) and H group (1.02 kg) over the four year observation period.

Interestingly, these differences were already apparent in the third year, when the H+U group gained significantly more weight (2.86 kg) than the H group (0.03 kg) and N group (0.44 kg).

Perhaps not surprisingly, the H+U weight control group had higher scores on weight concerns, dietary restraint, and had poorer eating attitudes than women in the H or N groups.

Healthy strategies included reducing calories and amount of food, eliminating sweets, junk food and snacks, increasing activity, eating more fruit and vegetables, eating less fat or less high-carb foods, and eating less meat.

Unhealthy strategies included skipping meals, using diet pills, liquid diets, appetite suppressants, laxatives, enemas, diuretics, and fasting.

These findings suggest that self-reported weight control attempts do not necessarily lead to large weight gains, but using unhealthy strategies to control weight does.

As the authors point out, the main reason that women who used healthy weight control strategies were probably more successful was simply because these strategies are more sustainable than the unhealthy strategies like fasting, skipping meals or using liquid diets or pills, which may simply lead to loss of control, overeating and excess weight gain over time.

Another important aspect of this study noted by the authors is that women with greater weight concerns were apparently more likely to engage in unhealthy practices thus setting themselves up for greater weight gain in the long run. This point, if validated in other studies, clearly sends a warning that simply promoting weight concerns may actually exacerbate weight problems in the long run.

Thus, providing proper guidance on healthy weight loss strategies is essential to avoid making the problem worse than it already is.

On the other hand, the study also shows that women who adopt healthy weight control techniques can very much minimise weight gain over time, even if no actual weight is lost in the long run.

AMS
Edmonton, Alberta

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5 Responses to “Will Dieting Make You Fat?”

  1. Anonymous says:

    So the answer is NO, dieting does NOT make you fat.
    The DIET in the study will minimize weight gain.

    Comparatively low calories, low amount of food, no sweets , no junk, lots of fruit, lots of vegs, little fat, little meat, little high-carb, – yes, this is a DIET.

    The study identified this as a successful weight control diet, though not a weight LOSS diet.
    In fact, the “healthy strategy” group, dieting as above and active, did BETTER than the “no effort” group – they gained only 1.02 kg compared to 1.51 kg.

    The study also identified counter-productive strategies that eventually caused weight gain (fasting, drugs etc)

    This study did not identify successful strategies that lead to losing weight and maintaining the weight loss, but that doesn’t mean that those strategies don’t exist, or can’t be researched and developed.

    I propose that weight regain, even extra weight gained, is caused not by the dieting, but by ceasing to diet when weight loss is achieved. People do not realize how little food they need.

    This is especially so if they have lost a lot of weight and the diet to maintain that new weight is much less than they used to eat to maintain the old higher weight. If they go back to the diet that maintained the old high weight, they will regain weight until they are that weight again. Because they were so used to eating so much to gain and to maintain a high weight, the ordinary amount of food they now need feels like an extreme deprivation.

    And if people feel they are in extreme deprivation – even if that isn’t true – they can use that as an excuse to overeat.

    If people lost a lot of weight, they may also be calculating what food they need on an unreasonable basis. They may use calculations based on height and sex, not considering their age, activity level, the shift in muscle:fat proportion after weight loss, or a change in metabolism due to overweight and subsequent weight loss. They may think ‘I’ll be back to the weight I was 15 years ago, so I’ll eat the way I should have eaten back then to stay at that weight.”

    Even if they follow a diet that on paper is a maintenance diet for their height and sex, the very fact that they were obese and then lost weight may mean that they now need fewer calories, or a particular ratio of nutrients, or supplements for certain nutrients, or a particular schedule, for example to avoid blood sugar swings on a limited diet.

    At this point good intentions aren’t enough, because without help from a doctor trained in the metabolic effects of obesity and weight loss, the person is unlikely to develop a diet that takes into consideration the new food needs of the post-weight-loss body.
    If nutrition needs aren’t met, the probable result is just eating too much to try to get what is needed to feel ok, gaining weight, and concluding that staying at this new weight is impossible. A doctor’s help can keep calorie levels low enough to maintain the new weight, while providing any needed nutritional supplements.

  2. Anna says:

    Great article! This is confirming what most women who have dieted for years know but don’t want to acknowledge. Thankyou so much for posting this.

  3. Hortense says:

    In fact, the “healthy strategy” group, dieting as above and active, did BETTER than the “no effort” group – they gained only 1.02 kg compared to 1.51 kg.

    Ooh, a whole pound. I think I’ll stick to doing nothing.

  4. wriggles says:

    This study did not identify successful strategies that lead to losing weight and maintaining the weight loss, but that doesn’t mean that those strategies….. can’t be researched and developed.

    Yep, maybe this will start when we decide to move on from weight loss diets.

  5. Jennifer says:

    I am surprised Dr. Sharma focused on the “healthy” diet group as being an example of successful weight management. In terms of a return for effort, I’d say the ‘do nothing’ group were the clear winners! It does make me think that I’m kind of stuck with my fat, since dieting seems pretty pointless in light of this, but at least if I carry on as is, I’m not likely to gain a whole lot more!

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