Detailed Food Records Predict Weight Loss Outcomes
Monday, November 4, 2013
Anyone, who believes that losing weight (let alone keeping it off) is easy, simply does not know what he is talking about.
It clearly takes a considerable degree of focus and dedication to overcome the intricate, complex, and highly redundant physiology that nature has put in place to defend our body weight (at whatever level it happens to be) – after all, you are trying to get your cortex to run your hypothalamus!
Thus, it is no surprise that, in a recent analysis of the Look AHEAD study by Adam Tsai and colleagues published in OBESITY, the level of detail that participants were able to provide in their food records, was strongly predictive of the amount of weight lost at one year.
This analysis included 549 participants at four centres, whereby detail and completeness of food records during the screening period for the study, was determined by the number of words and Arabic numerals (numbers) recorded per day, the number of eating episodes per day, and days per week where physical activity was noted.
In multivariable analysis, individuals who recorded 20-26, 27-33, and ≥34 words per day lost 9.12%, 11.40%, and 12.08% of initial weight, compared to 8.98% for individuals who recorded less than 20 words per day.
These finding are by no means surprising or unexpected – the more you obsess about your food and activity levels the more likely you may be able to reign in your hypothalamus (at least for the time that you are making this a priority).
Indeed, there are many “dieters” who take this to extremes, measuring and weighing every morsel they ingest whilst keeping detailed inventories of every step they take. I am sure, we all know people who tweet this information out to the world and post their daily activity levels to social networks – somewhat obsessive-compulsive behaviour if you ask me.
On the other hand, if that is what it takes to override and keep in check your physiology, then I guess that’s what it takes.
Only, I can see why this may not work for most people – especially for those, for whom obsessing about food records may not be the number one priority in their lives – I may be wrong but my guess is that this may well be the vast majority of people out there.
So, if anything, this study once again demonstrates the amount of effort it takes to override your “natural” eating behaviour.
As always, I don’t worry too much about those who can do this – they’ll be just fine. I am far more concerned about the many, for who this degree of obsession is simply not an option or part of their character.
At least let us recognise food records for what they are – a tool that can make the daunting task of reigning in your hypothalamus somewhat manageable.
But, as any tool, it only works if you actually use it – in fact, this study shows what I would call a clear dose-effect relationship – the more effort you put into keeping your records, the better the outcomes.
I’d certainly like to hear about your experience with food and activity records and the methods you use to accomplish this. I’d also like to hear about some of the challenges those of you face, for whom this simply does not seem to work.
@DrSharma
Edmonton, AB
Tsai AG, Fabricatore AN, Wadden TA, Higginbotham AJ, Anderson A, Foreyt J, Hill JO, Jeffery R, Gluck ME, Lipkin EW, Reeves RS, Van Dorsten B, & the Behavioral Run-in Ancillary Study Group of the Look AHEAD Research Group (2013). Readiness redefined: A behavioral task during screening predicted 1-year weight loss in the look AHEAD study. Obesity (Silver Spring, Md.) PMID: 24151217
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Monday, November 4, 2013
I tracked food mostly and some activity to lose weight 7 years ago – 50 lbs. I resorted back to tracking for 2 – 3 weeks a while ago to take off 4 pounds again. I use Sparkpeople – it makes it easier to track. Other than that I eat from a limited menu and pretty much how much I want/need. I eat nuts, fruit, veggies and meat, eggs and very little cheese.
Monday, November 4, 2013
I found a food record to be too difficult to keep for me because I cook from scratch and don’t follow recipes. If I opened a can of soup, I could write down the calories. If I cooked a batch of really good bean soup with less sodium than in canned and the addition of collard greens, trying to track calories was basically a nightmare. If I were really trying to track calories, I’d have to have a diet that varied less and relied more on processed food, which I don’t think is as healthy. However, I am someone who is happy to maintain my weight (which I am doing) and am not trying to lose, so eating intuitively supports that.
I have to admit, though, that if I were wanting to reel in my consumption of certain foods, a food diary would help. I’d probably hesitate to eat some things if I had to look at them in my food diary afterward, and the moment’s thought of needing to write it down would probably derail unthinking eating.
Monday, November 4, 2013
I’ve used food logs. intermittently, almost my entire life to modify my eating habits. There are times when I do feel all it does is focus on food and make me hungrier for the “forbidden” items but most of the time it’s a good wake up call for expanding serving sizes and junk food drift. This is only a concern rather than a true problem for me so I can see how it would be intensely aggravating if you were surrounded by people who think losing weight is easy.
I can totally understand why people succeed on things like herbal magic because it’s a less intense form of food logging. I really think food logging can only work long term if you also modify what you’re eating ie. substitute something more healthy for milkshakes rather than just having a smaller serving. That’s just an opinion though.
Monday, November 4, 2013
I have keep food logs, and, to be honest, I absolutely hate doing it. But I have to say, it works! Sometimes I won’t eat anything just because then I would have to write it down! Laziness wins.
Monday, November 4, 2013
I recall reading here (or perhaps in a businss magazine) that concentrating on an act of deprivation actually interferes with other aspects of our ability to think. In the experiment people were give a plate of cookies and a math problem. People who were allowed to have a cookie scored better on the problem than those who were told “not” to eat a cookie. The hypothesis, which appeared proven, was that resisting the temptation took up so much working memory / brain power, that it interfered in the mathmatical operations. The test was done in relationship to exposing employees to the opportunity to cheat.
The blog post above seems related to me. Trying to write down everything you eat in a day and remain constantly vigilant that it is within the right range of calories interferes with the ability to remember your to-do list, or perform other daily, non-habitual functions. From personal experience, I can attest that the more difficult my work becomes, the less able I am to remember to write down my food or exercise. Fortunately my eating habits are sufficient ordinary, that I don’t wildly overeat when I don’t journal, but when I try and estimate in hindsite, I am almost always over what I had hoped I had eaten.
So it seems that in addition to the physiology fighting weight loss, the memory / brain is also interfering by making the mental resistance to food sufficiently distuptive of cognitive activities as to make it unpleasant or even impossible.
Monday, November 4, 2013
I agree with your article. I have consistently recorded all of my daily food intake into a software journal successfully every day since 9/20/2004. Today that journal tells me that out of 3333 days I have zero missing data. I am now in my late 60s. After a lifetime of obesity and yo-yo dieting, 21 years ago I had an RNY. I lost from 271 lbs to 160 lbs (5’0″ height). I maintained in the 160s for about 3 years, my weight crept up to the 190’s which I worked hard to eat little enough to maintain for the following 8 years. On 9/20/2004 I began recording all of my food intake into a computer software journal, and after about 16 months I reached my goal weight of normal at 115 lbs. (5’0″ height) For the 8 years since that time I have continued working hard to restrict my food intake in order to successfully maintain that weight, and have done so – except for a continual creep upwards. I am now 125 lbs (5’0″ height). Every day I work very hard to accurately record everything I eat, and believe that outside of a lab noone could do better. For the past 5 years, each year, I’ve averaged a daily calorie verage of around 1050 years, but have still been gaining a slight amount each year. I am a sedentary elderly female whose primary additional exercise is walking 20 min to an hour several times a week. I’ve tried increasing my activity levels with more formal exercise, however, those experiments have not helped with weight-loss or weight maintenance. For me, engaging in additional exercise merely results in an inevitable reduction in the rest of my overall activity for the remainder of my time.
Monday, November 4, 2013
Edit correction to my above post. My records show that “For the past 5 years, during each year, my daily calorie AVERAGE has been around 1050 calories.”
Monday, November 4, 2013
It worked for me in “reigning in my hypothalamus” Dr. Sharma. LOL. I got ahold of my regain and realized that I was eating the equivalent of my days-worth of calories in snacks. I food journal at least 3/4 of the time, and I’ve kept my weight within 5 lbs of my lowest body weight since June 2013.
Monday, November 4, 2013
Thank you for this blogpost, Dr. Sharma. As I’ve been recently learning a few things here and there about how the brain works, and how different types of information are processed in different parts of the brain, I had quite a giggle and an ‘AHA!’ moment when you mentioned we were trying to have our cortex run our hypothalamus. I think just that little tidbit of information will help put some of my issues with food into a perspective, every time I struggle.
As for the food journaling, it is an activity that doesn’t work for me, because it makes me focus too much on food. The problem is that I have binge eating disorder, and when I diet, focus so much on food, etc, I make food like this obsession, and I make myself prone to deprivation, binging episodes, and giving food more importance in my life than it needs. So instead, I try to eat with awareness (intuitive eating), and with some moderation and knowledge in the back of my mind of calories and things I need… but not to an obsessive degree. I’ve gone from 243 lbs (at my highest weight) to 183, so I don’t think I’m doing too bad. 🙂
Journaling might be a good, and helpful tool for some, but I don’t think it’s for everyone. Perhaps a better alternative (which I have done from time to time) might be to journal for a day or so, once in a while, if one isn’t sure about what kinds of calories one is consuming, and to get an idea of the game — but personally, I would certainly not do it every day, if one has an eating disorder.
Again, though, thank you for the new perspective. 🙂 It is much appreciated.
Monday, November 4, 2013
I would agree the best success comes when you keep a food diary. You cannot track all your food requirements in your head. That being said it is the one tool I absolutely hate using.
To make this task easier, I use the app “Fitness Pal” on my iPad. It helps with gathering all the necessary information. At the end of the day I will input my diet and review how I’ve done.
Personally I can always lose weight when I maintain a food diary. Making time to do one is not always easy.
Monday, November 4, 2013
Ah, your preconceptions are showing!
Of course, it’s quite possible that most folks who assiduously track food details do so precisely because they’ve found it’s helpful *for them.” Thus the “dose-effect” relationship you reference.
Not because they’re OCD and obsess, as you suggest several times.
No argument some folks have psychiatric conditions diagnosed or not that contribute; but assuming that’s the default explanation seems more a matter of personal opinion than evidence.
Consider a perhaps likelier scenario: at first, they didn’t track at all…then they tracked a little…that helped a bit…they tracked more, that helped more…and a self-reinforcing cycle began that led to increased food tracking AND increased sustainable weight loss.
Finally, it’s interesting that you’d characterize sharing hyperdetail with a support network as “somewhat obsessive-compulsive” when for many it’s not dysfunctional at all.
Rather, it’s a key part of getting support, ideas and feedback from peers to help you deal successfully with a chronic health challenge. For example, athletes with diabetes routinely share fueling, insulin dosage and blood sugar details on social networks, right down to fractional units of insulin, grams of resistant starch vs simple sugars, and curves graphically displaying blood sugar activity during exercise.
Monday, November 4, 2013
Aps such as My Fitness Pal are becomming popular and they provide information that can be helpful. However careful counting of calories in and out could easily trigger obsessive or disordered eating habits. When I am asked about these aps I make the suggestion to use it for a week periodically to give a snapshot for comparison rather than using it every day.
Monday, November 4, 2013
I agree 100%. In my weight loss journey, I have always had more success when I was diligent about recording my food intake. After reading your post about changing behaviours, I decided to make consistent recording a behaviour that I would strive for. That means no lying!
Monday, November 4, 2013
It has been my personal and anecdotal experience that keeping records of my food intake and exercise output has had a positive short term effect on my weight but a far more serious and deleterious effect on my weight and, perhaps more importantly, my psyche in the long term. My experience with this is primarily via Weight Watchers. According to that plan one must track and eat a certain amount of food and to eat more or less can be detrimental to one’s weightloss goals. Also, food may or may not be swapped in for energy output and one is to track this as well. At first, when doing all of this, I feel a great sense of control. However, as time goes on, and as weightloss naturally becomes slower, I become increasingly rigid about the plan. It then seems the plan is ruling me instead of me ruling the plan. I obsess over every morsel and every step taken. I begin to fear food while simultaneously obsessing over when I can have some. I start to play mental games to outwit the plan which leads to further guilt and a sense of inability to conform. The idea of “good” and “bad” foods begins to take hold and the obsession builds over which foods I can get enough of to satisfy me or which I can have but then must endure hunger later. The obsession grows until my entire waking hours are filled with thoughts of tracking and planning and planning and tracking. This inevitably leads to a blow out and a reaction that leads to weight gain and increased self-loathing.
As you note in your blog, some people don’t have time or inclination to track. But, and I don’t think I’m alone, it’s not just a matter of time or inclination but of harmful psychological side effects emerging from, as you say, this obsessive-compulsive behaviour. Having to closely monitor all of one’s food intake and, by association, linking it to a sense of being “good” or “bad” is extremely harmful to me, and possibly others. It is also exhausting and, I believe, actually limits more fruitful mental processes.
Monday, November 4, 2013
Of course this is only a 1 year study focusing on the amount of weight lost, not at all on weight loss maintenance over 5+ years…. Studies have shown that metabolic rate slows with lower caloric intake plans so that even when participants are moved to a ‘maintenance’ plan (http://www.ncbi.nlm.nih.gov/pubmed/23126426), their weight increases in most cases.
So, whether food diaries really make significant difference in the long-term is another topic. Also many studies show that the weight lost especially on very low carb diets is largely water and protein vs body fat and that the regain weight post diet is largely fat mass, so in the end many patients end up at a lower weight but higher body fat level and with more weight loss resistance after these diets.
So what’s the answer? This is the tough part, I still think that maintaining and focusing on health rather than weight is a much better alternative than weight cycling physically and psychologically (yo-yo dieting, losing and regaining over and over…)….
Monday, November 4, 2013
Three rules to make the diary more useful:
1. put it in the diary before you eat it.
2. do not eat it if it is not in the diary.
3. the amount is important; therefore, weight and caloric density.
Monday, November 4, 2013
Uggh. I HATE journaling my food. But that’s likely why weight comes back after diet ends. Sigh. But I have to admit, I am not always honest in my amounts listed. Guess I have a couple of issues to get over soon…..sigh…..
Monday, November 4, 2013
Carmen, your post sounds exactlly like my experience. I start to feel anxious and guilty if I don’t write everything in my journal as if the journal is some kind of magic wand that will make the weight come off. But the journal, kept mostly assiduously over the last ten years demonstrates that no amount of journalling and control will stop my metabolism to reacting entirely predictably, to a long term low calorie diet. It’s just plain slow.
Monday, November 4, 2013
I am waiting for a low vision friendly on-line food and activity log program. One my husband has used with great success, and I have used with good progress in the past has said it plans for the next iteration to tackle scalability of fonts in all aspects of its program rather than just log results, so if it does so to a degree where I find it functional again I will let Dr. Sharma know for helping others with vision problems.
Meanwhile, I am again gaining muscle and losing weight at about 2 pounds per week despite vision related problems by doing three types of things, some for only two or three weeks so far with weight read only recently when jeans began fitting loosely, so I got a very happy surprise a few days ago when I weighed 6 pounds less and then tried on some clothing that fit for the first time in a half year ever since my eye surgery.
1. The first is partly not under my control. My brain is learning to more ignore my worse eye and that is reducing vision caused nausea that felt like hunger, but meanwhile infusing water with fresh ginger reduces nausea, too.
2. The second approach I am using is to largely replace meat and carbohydrate servings with more legume, vegetable, and fruit servings. Currently, I am usually having 7 to 10 such servings daily. As before, my carbs, though reduced, are typically complex ones like whole grains.
3. The third is an exercise change because having a large eye bleb created means that I can no longer do the heavy weight lifting and some other intense exercises I used to love to do. Light exercise proved insufficient. I have read that fidgeting burns many Calories, but I am not a fidgeter. So, I created artificial fidgeting. When using my iPad on the bed I kneel on a large exercise ball and move almost constantly. We moved my lap top high enough for me to now see (upper chest height) and I play music and move in place (figure 8s, helices, and similar in place dance moves snarfed from belly dancing) when I use that machine. Also, I still do some exercises deemed safe for my eye like using my folding elliptical machine and lifting lighter weights (lighter for me personally). My rule is that I have no television unless I am also exercising, except when I am ill with worse than a cold.
When a log that is friendly for poor vision exists I look forward to adding that, too, given that it helped me some in the past, but meanwhile I have stopped gaining and rebegun losing, so I think adding a log will mostly serve for self-awareness and self-discipline.
Monday, November 4, 2013
I agree with those who point out the downside of ‘obsessing’ over food intake and calories, as well as with the comments about the dangers of doing so for those with eating disorders. Keeping track for a week once in awhile is helpful for some people, though I recommend they set goals such as eating at least 3x per day, including a variety of foods from all 4 food groups in most meals etc.
One comment about the methodology used in the study. In my experience, some people restrict their food intake so much that that is the reason they have so few words/numbers on their food record. I’ve advised some clients to eat more in order to lose weight (and of course to improve their nutritional status!).
Monday, November 4, 2013
My top weight at 5’7″ was 288 about ten years ago, when I was in my early 40s. In the last six years I have been able to stay under 265, usually in the 250s, through various means behavioral, spiritual, nutritional, exercise-related, etc. In Overeaters Anonymous since June, I have lost about 15 pounds, exactly three pounds a month, and for the last month I have carefully recorded everything with fitday.com, aiming for 1800 calories, 30% from fat (10% or less from animal fat), about 50-55% carbs (mostly from whole foods, not processed), and about 15-20% protein. I think I’m seeing how my body doesn’t want me to lose further, since I’m running a very large calorie deficit, “on paper,” but not responding commensurately in weight loss. However, this calorie level is sustainable for me–I don’t feel too hungry unless I “spend” my calories unwisely on highly-palatable processed foods that trigger cravings. I hope that “slow and steady” is going to work for me for a while yet before I have to cut calories significantly.
Monday, November 4, 2013
Anonymous: I struggle despite using a very detailed food record, weighing foods in grams, etc. The drive to eat is very difficult for me to override–I use distraction, try herbal tea (with Stevia or other low-cal sweetener), Walden Farms products, etc. I try carb cycling at times, too. I have to make sure my calories don’t get too low, or my metabolism will be suppressed. When I try to eat more, my appetite is stimulated excessively. Quite honestly, it’s exhausting (added to always taking the stairs, working out with intervals and weights, etc.) I would welcome a safe drug to suppress my appetite and/or boost my metabolism to help me stabilize/maintain.
Monday, November 4, 2013
When I use my fitness tracking app on my phone, diligently then I always lose weight. You can see the patterns of when I’m really paying attention and losing weight, and then the “blank” days…weeks.. where obviously I didn’t see the point of entering in that pizza I ate. (The whole pizza). During the “blank” days my weight has always increased.
Apps are very easy and free, myfitnesspal and sparkpeople are great tools and very easy to use on your computer or smartphone.
To use these tools a person absolutely must be obsessive about it, you need to be entering a tracking throughout the day, at work, at dinner with friends, when with your kids.
Unlike our obsession with social media, using these trackers, or just paper diaries, are still a very lonely, “me and my shadow” endeavor and thus does not insulate us against our emotional hurdles along the way. Spark tries to create a community support system to combat this issue.
The combination of tracking plus weekly socialized weigh-ins seems to have the highest success rate of all. No offense to companies doing this already, but I would love to see local community health centers offer this for free or extremely low-cost.
Tuesday, November 5, 2013
It would be hugely helpful if I could remember my intention to diet for more than 2 hours. Don’t think that’s ever happened.
My problem with socialized weigh-in programs is they fulfill many of the same needs as religious observance without the depth. If I’m going to go to confession, I want to run through the breaking of the 10 commandments, beatitudes and committing the 7 deadly sins as well as what I should have done but didn’t all in one go and get absolution and a prayer penance. Thomas Aquinas said it was a sin to eat too soon, too expensively, too much, too eagerly, too daintily, too wildly. How did he miss the sin of eating without recording what, where, when, how much, in what mood, etc.?
Friday, November 8, 2013
I don’t need food tracking to tell me not to visit the vending machine at work. The time I spend entering what I eat is better spent reading short stories or poetry.
Besides, as someone said above, it’s a pain to track when you cook from scratch and don’t follow a recipe. Especially when I’m not the one doing the cooking. I try to ask my husband what he put in the fish stew and he can barely remember.
Sunday, November 10, 2013
Couple of things, MyFitnessPal is my tracker of choice because you can add in your own recipes and it works with my FitBit and Aria scale. I use food logging like Rebecca and fredt, log most of it in the morning (breakfast, lunch and day snacks) then don’t eat if it’s not listed. That way I only have to log a couple times a day.
Also Sukie, check the setting menu for your device, with my tablet I can scale up and down the font size for all apps.
Tuesday, November 12, 2013
Food tracking keeps us aligned with “mindful eating”. I think for those of us who are completely out of touch with our portions and our mindless snacks here or there can really benefit from tracking. The research definitely backs this up time and time again. Yes, it is hard, yes it can make a person “obsessive” (at least for a while). My HOPE is that eventually the portions become habits and the mindfulness becomes a way of life. Then I won’t need to rely on the logs to know whether I ate the right things in the right amounts or not.
Friday, November 29, 2013
Like others, i have tracked for years, maybe close to a decade, and have made it simple and effective. My food/exercise/weight log is in an Excel spreadsheet that also includes my grocery list, to-do list, cooking/cooked food list. I estimate a lot – all cups of milk are 100 calories, not 90 or 110- and include a buffer that assumes I’ve underestimated by 20%. I don’t have very complicated meals – often will eat the same thing a few days in a row and copy-paste from the previous day. It helps to structure my eating – midday I might look at what I’ve eaten and add or subtract protein/ vegetables/ fruit from my dinner and snack plans. Or if I have had a day or two of low-protein I will remember to make a high-protein meal. For me, shorter and simpler is better – I want to be able to glance at the overall trend of the last few days/week to adjust how I’m eating today. The best part is that my math seems to work – if my numbers predict a 2 pound loss this month, it shows up on the scale soon after.
Sunday, December 29, 2013
The weight loss program that helped me the most was Herbal Magic. I don’t think it was the herbs I took or the limited diet I ate as much as it was the logging I did in my daily journal and the act of going to Herbal Magic to go over it with one of the counsellors there. I became very aware that if I went daily to see the counselor there, I had success. If I missed a day or had a week of only 3 out of 5 day visits, then I wasn’t as successful. I truly believe it was the journalling and face to face accountability that helped me to find success with weight loss. However, prior to beginnig an exercise program, the Herbal Magic I was attending began placing pressure on those of us who were simply “maintaining” our weight and began a campaign of threats and pressure if we weren’t showing weight loss results regularly…(this meant that they weren’t “selling” their herbal components while we were in maintenance…)” I quit going then because the pressure was causing me to feel negative and that I had failed.
Friday, February 7, 2014
Fruits and vegetables are very good source for weight loss. Because it is full of proteins and vitamins and it helps to improve metabolism level. Also it is very good source for maintaining body weight.