Rebound Weight Gain Causes Diets To Fail

WHY DIETS LEAD TO REBOUND WEIGHT GAIN AND HOW MEDICALLY SUPERVISED CALORIE RESTRICTION CAN BE BETTER

Rebound Weight Gain causes almost all diets to fail. I have worked to help people avoid this frustrating problem after all the hard work of losing the weight with a diet. And there is a better way!

Successful weight loss does not happen by magic. There are no solutions that take all the burden off your shoulders and eliminate the need for hard work, dedication and perseverance. And yet, clearly some weight loss solutions succeed much more often than others. Diets, by and large, do not work. But what do we mean by “diets”?

Generally, what we mean by diets are temporary changes in one’s nutritional intake that result in a significant calorie intake reduction. There are numerous published diets, fad diets, and many personalized diets that individuals have used before to lose five or ten pounds prior to summer season, for example. By and large, these involve eliminating certain food groups or certain subsets within the diet and, in addition, restricting calories a great deal through certain mechanisms such as simple avoidance or substitution with very narrow list of foods, like raw carrots.

Why don’t diets work? Diets don’t work because they don’t involve a plan to transition to future phases of the diet or to a maintenance program. Diets don’t work because they are not sustainable as eating behaviors beyond a very short term. Diets don’t work because they feel like deprivation and they require a high level of motivation to deprive oneself. This does not last.

And lastly, diets don’t work because they don’t involve creating the right kind of calorie intake that can result in appetite suppression, as well as maintenance of lean body mass. Nearly all diets that people try result in burning of lean body mass or protein mass to an equal or greater degree than burning of the fat mass. When the diet comes to an end, a phenomenon known as rebound weight gain occurs as a result of the hunger and nutrient deprivation experienced by the muscles. So it’s a very powerful biochemical response that leads to an even higher level of hunger and a rapid rebound weight gain.

So if diets don’t work, how can “calorie restriction” work?

Well, calorie restriction can work if it is used properly, if it involves the proper selection of foods, and if it employs the optimal techniques to avoid rebound weight gain. Let’s examine what those are:

First, calorie restriction needs to reduce carbohydrate calories. The most potent stimulus of circulating blood glucose is carbohydrate intake. The carbohydrates stimulate secretion of insulin and leptin into the bloodstream and these surges of hormones cause surges of satiety followed by equally powerful surges of hunger. Protein and fat stimulate these responses to a much less degree. It’s true that protein, and its building blocks, amino acids, do stimulate a rising blood sugar, but it is much less potent in effect than carbohydrate intake. Fats, interestingly, do not stimulate a rise in the blood sugar or insulin. So one of the keys to successful calorie restriction is to limit the carbohydrate intake and try to dampen these surges in circulating blood glucose and the hormones, insulin and leptin. You will then experience less hunger during your calorie restriction. It’s well known, for example, that people on an Atkins type diet that emphasizes protein will feel less hunger and greater satiety over the course of the yearlong dieting attempt than people who attempt to consume a low fat diet that does not restrict carbohydrates. As a result, the diet that restricts carbohydrates and allows more protein, results in somewhat greater weight loss over the course of the year. These findings have been reported in 2007 after a major national trial, and made headline news in the New York Times.

Next principle – protect lean body mass. How do you do this?Two ways:Exercise and protein and vitamin intake. So the key is to try to burn as much fat mass as possible while preserving all the muscle mass that we can. This is best accomplished by adequate intake of protein with a wide variety of amino acids, and an adequate vitamin intake.

Next, you must think of the calorie restriction as a step toward long-term weight loss and this requires developing a transition plan. Ideally, this means setting a number of weeks for the initial calorie restriction component and then having a planned transition to the next phase that is also clearly defined. We are much more likely to comply with the program if the program is clearly defined. That way we know exactly how many days we have to follow one regimen and we know exactly when the transition is to the next regimen.

Next, the calorie restriction program needs to be very well spelled out. This is one reason why meal replacement programs work so well. The “diet” is not open to discussion or debate. It is very clearly laid out for you:Meal replacement shakes and bars through the day at prescribed hours with no substitutions and no variations. Period. Simple.

As a weight reduction program prior to bariatric surgery.

Here is a role that has proven very successful for calorie restriction programs. For successful weight loss surgery to take place, it is best to optimize your condition prior to undergoing surgery. There are numerous studies indicating that if a patient loses weight prior to surgery, their outcome is improved. In addition, there is specific information about calorie restriction resulting in a very advantageous shrinkage of the liver prior to bariatric surgery. The liver shrinkage makes for less cracking and bleeding and less chance of conversion to an open operation. So a four to eight-week program of calorie restriction, ideally using meal replacements, is very helpful for the successful outcomes of weight loss surgery. And the added advantage is that the time frame is very finite. There is a clear transition to the “postsurgical diet” and a clear transition point on the date of surgery after which eating will never be the same again. The vast majority of people who lose weight with a preoperative calorie restriction weight loss program will never see those pounds again in their lifetime.

As a weight reduction “induction” program in a medical weight loss center.

Here, an individual begins his or her weight loss journey with a powerful initial induction program that consists of significant calorie restriction using meal replacements. The choices are eliminated, and a strict regimen of shakes and bars, fluids and vitamins is established. In some centers, prescription appetite suppressants are added. During this phase, the individual loses weight rapidly, usually 2-4 pounds per week. At the end of a 12 week program, a substantial weight loss has occurred. But the only way it will succeed is if the 12 weeks are used learning behaviors that will succeed for the long term. Transition to a plan of slowly introducing real foods occurs next. These real foods contain lower calories and carbohydrates than the individual was consuming under their old bad habits. The best centers teach motivational and will power techniques that enable the person to fight the hunger and stick with the healthier, lower calorie, lower carb meals and snacks. In time, the whole package of induction, behavior techniques, motivational tools, group support, prescription medications, and meal replacements come together for a person to succeed long term. It’s not magic, but it works.

So in summary, calorie restriction does work if used properly. The critical elements are to reduce carbohydrates, maintain protein, amino acid and vitamin intake, exercise is critically important to maintain lean body mass and avoid rebound weight gain. View the calorie restriction as a key step towards a long-term goal of weight loss. Define the calorie restriction time frame very clearly, whether it is four weeks, eight weeks or 24 weeks. Have a clear date on the calendar when the calorie restriction period ends and know what you are transitioning to. This is often a good time for some professional help as it is difficult to craft a healthful and effective long-term maintenance program. Calorie restriction works very well in preoperative weight loss and as a weight loss program to move off of a plateau or to reverse a relapse or period of weight gain. Meal replacements work best as they take away all the choices in the day and the opportunity for cheating or rationalizing extra calorie consumption.

What experiences have you had with calorie restriction?What has worked for you and what has failed for you?

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Dr. Kent Sasse, Medical Director | 75 Pringle Way Suite 804 Reno, NV 89502 | Phone: 775-829-7999

Dr. Kent Sasse serves the entire city of Reno and all the surrounding areas. Dr. Sasse is one of the nation's foremost medical weight loss and bariatric surgical experts.
Dr. Sasse has educated patients about food nutrition and weight loss for many years.

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