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Obesity Myth #3: Weight Lost Slowly is Easier to Keep Off

Continuing in my discussion of the obesity myths, presumptions and facts, published recently in the New England Journal of Medicine, today’s myth is about the rate of weight loss.

As the authors put it:

“Large, rapid weight loss is associated with poorer long-term weight outcomes than is slow, gradual weight loss.”

This “myth” is attributed to

“…a reaction to the adverse effects of nutritionally insufficient very-low-calorie diets (<800 kcal per day) in the 1960s; the belief has persisted, has been repeated in textbooks and recommendations from health authorities, and has been offered as a rule by dietitians.”

This reaction would be no surprise, as in those days, the very-low-calorie diets due to inadequate protein content (and perhaps a few other nutritional deficiencies) did result in rapid loss of lean tissue, thereby reducing metabolic rates beyond what may have been expected with a more gradual nutritionally balance weight loss.

In contrast, today’s low-calorie formula diets are generally high in protein and nutritionally balanced (except perhaps for fibre) and have in fact been shown in some cases to preserve lean body mass compared to simply eating less.

As regular reader of these pages may recall, I have previously written about situations where rapid weight loss with the use of low-caloric diets (900 Cal/day) may be indicated and in fact beneficial for patient management.

Nevertheless, as the authors point out, when comparing longer-term outcome data (a couple of years and beyond), it does not appear that people, who lose large amounts of weight rapidly have any less (or greater) chances of keeping weight off, than those who lose weight slowly.

Obviously, as with any diet, the ultimate question is really, whether or not patients can live on a restrictive caloric intake (and a rather high amount of physical activity) in the long-term.

As I recently pointed out in my discussion of the findings of the National Weight Control Registry, maintaining a significant amount of weight loss, is ongoing hard work and not everyone can be a Mark, Julie, Gertrude or Janice.

Thus, although one may well assume that the more radical changes required to precipitate faster weight loss are less likely to be sustainable than more moderate and gradual changes, we must recognise that the effort to keep a given amount of weight off is the same irrespective of whether this weight was lost fast or slow.

Edmonton, AB


  1. Weight lost rapidly is typically done through extreme measures that are very difficult to stick to, which is a big risk for weight regain.

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  2. There’s a bit of apples compared to oranges going on here. “Rapid weight loss” can be losing 10 pounds in one month due to the flu or to changing diet and exercise. Being sick does not result in long-term weight loss, alas. Changing diet and exercise does. Back in December 2010 (BMI 36,) it was wonderful to lose the first 10 pounds in just one month. Now, following the same regimen, I’ve maintained a BMI of 27 for 16 months. The memory of that first glorious month helped as weight loss slowed then stopped.

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  3. I think that extreme measures to lose weight are workable – as long as the dieter uses them as a kickstart, on the understanding that they will eventually need to transition to a more sustainable way of eating. As “Anonymous” says, extreme measures are very difficult to stick to, and the blogosphere is full of people who are trying, and failing, to stick to an extreme program.

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  4. After bariatric surgery in Dcember, I find I am losing quickly – unfortunately I am having a difficult time getting all required protein in. Is there a minimum amount that would maintain lean muscle mass as well as preserve metabolism? My prescribed protein amount is 75-85g.

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  5. Enjoying the process. God’s really been pressing on me to relish and savor the process, not just the final product. This mornings quiet time was on Isaiah 35 The Joy of the Redeemed.
    “Strengthen the feeble hands, steady the knees that give way; say to those with fearful hearts, “Be strong, do not fear; your God will come, He will come with vengeance; with divine retribution He will come to save you.”
    It’s a journey on the Highway of Holiness. Taking the time, walking through the trials and weeding out the underlying causes for the areas in our life that are holding us back. Stopping the detours and pressing on towards the goal. Forgetting what’s behind, the failures or missteps of yesterday. AMEN!
    click here

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