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Small Changes Foster Permanent Weight Loss

After reading my article relating how severe dieting creates the “perfect storm” for rapidly regaining lost weight (http://www.cbass.com/Loseslow-regainfast.htm), Dr. Richard Winett alerted us to a study led by Lesley D. Lutes supporting my contention that weight loss is more likely to be sustained if the loss is achieved with small, gradual adjustments in calorie intake and physical activity. The study was reported in the Annals of Behavioral Medicine on June 21, 2008. (Lutes did the study for her doctoral dissertation with Winett as her chair.) The contrast in the regiment I wrote about and the one in the Lutes study is like night and day. Participants in the first study lost 10% of their body weight on an 800-calorie liquid diet in two months or less. Participants in the Lutes study ate two or three times as much and lost 5% in four months.

The subjects who lost 10% of their bodyweight in two months or less experienced an almost uncontrollable urge to eat. Let’s look at what happened in the Lutes study.   

Fifty nine overweight or obese men and women were randomly divided into three groups: standard or traditional, ASPIRE, and control.

The standard treatment group focused on education. Participants met for 20 minutes weekly with a nutritionist, who explained government recommendations for diet and physical activity. The women in the group were encouraged to reduce daily calories to 1,600 or less, and the men were encouraged to limit intake to 2,000 calories or less. Both were encouraged to engage in at least 30 minutes of physical activity (walking for example) on most days of the week. All members of the group received approximately 5 hours of behavioral counseling. 

The ASPIRE (Aspiring for Lifelong Health) group focused on small, cumulative, participant-chosen changes in diet and physical activity. They met weekly, one on one, with a lifestyle coach for about 20 minutes. After establishing individual baseline calorie intake and expenditures for each participant, the coaches helped them choose diet and activity goals involving small changes each week. Daily calorie intake goals ranged from 1,500 to 2,200 for women and 1,900 to 2,600 for men. The women were encouraged to cut daily calories by 200 to 500, and men by 200 to 600. They stressed small, manageable changes and substitutions “such as increasing fruits and vegetables and whole grains, decreasing high fat dairy and meat products, soft drinks, higher calorie snacks, and portion sizes, and maintaining consistent consumption.” For physical activity, participants were given pedometers to first assess their current activity level (steps per day), and then set weekly goals to slowly increase steps to eventually reach 3,000 a day over baseline, up to a total of 10,000 steps daily. Each participant kept a record of daily steps and calorie intake. As in the standard program, individual counseling totaled about 5 hours.

The control group participants were told to continue life as usual.

The main difference in the two treatment groups was the rate of change. The traditional group was encouraged to cut calories and up activity to fixed levels—and hold the course. The ASPIRE group, on the other hand, was encouraged to reduce calories gradually and increase activity gradually, until reaching desirable levels in both.

Both treatment protocols continued for 16-weeks, at which time changes in weight, waist size, and intra-abdominal fat were calculated. (Abdominal fat was determined using dual energy X-ray absorptiometry, DEXA.) Participants were then told to continue on their own for an additional 3 months, when their results were again recorded.

Here’s what happened.

The ASPIRE group lost significantly more weight on average than the standard and control groups: 10 pounds (5% of bodyweight), 2.5 pounds, and negligible, respectively. Significantly, the greater loss in the ASPIRE group was maintained for the 3 month follow-up period. The much smaller loss by the standard group was also maintained. The ASPIRE group, however, trumped that by losing an additional half pound during the follow-up period.

The researchers didn’t attempt to explain why the ASPIRE group lost 4 times as much as the Standard group, preferring to focus on maintenance of the loss during the follow-up period. I’ll offer an explanation in a moment. First, however, let’s look at the other outcome measurements.

The changes in waist size and intra-abdominal fat were also significantly different. The ASPIRE group lost 6.8 cm in waist circumference and 2.8 percentage points  in trunk fat, compared to reductions of 0.42 cm and 0.84%, respectively, for the standard group. There was no change in the control group. Again, the ASPIRE group continued to shrink during the 3-month follow-up, waist size going down an additional 0.4 cm, for a total loss of – 7.2 cm. (For an unexplained reason, probably a statistical glitch, trunk fat percentage in the ASPIRE group went up by a hair, 0.8%; the standard group also went up 0.38 %.)

These changes are important, because belly fat is a significant risk factor. Less fat in and around the waist not only improves appearance, it lowers your risk of heart disease, cancer, and other diseases; for details see http://www.cbass.com/Deepfatdeadly.htm

The researchers hypothesized that weight loss produced by “small but cumulative changes” would be “easier to sustain.” The study referred to above and discussed here last month explained why: Large changes in diet and rapid weight loss set off powerful physiological changes that virtually mandate that we put the weight back on. Extreme diet regimens cause a rapid decline in the satiety hormone leptin, creating hunger that cries out to be satisfied.

I believe that also explains why the ASPIRE group lost 4 times as much weight and substantially more belly fat than the standard group. The gradual changes in diet and activity didn’t set off survival mechanisms in the body which act to protect and maintain body fat. The body is much more amenable to giving up weight—especially storage fat essential to survival—when there are no abrupt changes in diet and activity to set off alarm bells. (Again, see the study discussed here last month: http://www.cbass.com/Loseslow-regainfast.htm )

The gradual approach used by Lutes and her colleagues, in my view, is eminently sensible. Regrettably, standard or traditional advice has often been vague (eat smaller portions and be more active) or calculated to achieve large initial weight loss. Unfortunately, many people want fast results, not realizing that rapid weight loss almost guaranties long-term failure. Perhaps that is changing.

To avoid confusion, we waited until now to mention that both the traditional and the ASPIRE groups completed the same structured aerobic and resistance training regimen. The training was included to insure that the two treatment groups would be well matched, isolating the changes in diet and activity levels and increasing the significance of the weight and fat loss differences. While it’s not stressed in the report, the training routines were unique and very successful. Let’s look at that next.

Brief Routines Produce Big Results

Participants in both treatment groups trained twice a week under the supervision of a personal trainer. Training sessions included a 10-12 minute graded exercise protocol (GXP) to improve aerobic fitness (treadmill or cycle ergometer), a 15-20 minute resistance training protocol, and 5-minutes of stretching. Total time for each training session was 40-45 minutes. As noted earlier, both groups were encouraged to engage in some form of physical activity such as walking most days of the week.

These twice-a-week sessions produced the following results after 16-weeks and a total of only 24 hours of actual training time: Aerobic fitness (oxygen uptake capacity) improved 5 ml kg min and total strength improved 110 % (based on total weight lifted on 8 air-powered Keiser machines).

Richard Winett, who was also a member of the research team, found these results even more impressive than the sustained weight loss. “To me of greater interest than the weight loss is the very good strength increases from a low volume 2/wk resistance training program and the increase in fitness of about 1.5 METs from the brief Graded Exercise Protocol (GXP),” he wrote in an email. “Overall there’s a very important synergistic effect when you reasonably and appropriately eat nutritiously, do brief but challenging training, and walk most days of the week. The best illustration of this synergistic effect is the loss of intra-abdominal fat and reduction in waist circumference, a huge plus from the standpoint of health.”

Remember, of course, that the greatest loss in weight and visceral fat was in the ASPIRE group where the changes in diet and activity were gradual. The training results were outstanding in both groups (the above figures are for the combined groups), but the carryover to weight and fat loss was only in the ASPIRE group.

The take home message: Outstanding results in performance and fat loss come from brief but challenging training combined with gradual changes in calorie intake and overall activity level. You’ll enjoy it more—and Mother Nature will cooperate with your efforts.

(You'll find brief training routines and specific examples of small meal changes in Great Expectations: http://www.cbass.com/GreatExpectations.htm )

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