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Weight loss

There are a lot of fat Americans—66 percent of adults are overweight or obese1. For children and teenagers, 17 percent are overweight and on their way to becoming obese. Are you overweight? Find out by consulting the table below. You’re overweight if your Body Mass Index (BMI) is higher than 25 kg/m2. You’re obese if it’s higher than 30 kg/m2. For example, if your height is 5’7, you’re overweight if you weigh more than 160 pounds. You’re obese if you weigh more than 192 pounds. You’re too skinny if you weigh less than 118 pounds. Note that elite athletes may have a BMI greater than 25 kg/m2, but it’s still healthy because their weight comes from muscle and not fat.

FOR BMI = 18.5
FOR BMI = 25
FOR BMI = 30
 5’0 95 128 154
 5’1 98 132 159
 5’2 101 137 164
 5’3 104 141 169
 5’4 108 146 175
 5’5 111 150 180
 5’6 115 155 186
 5’7 118 160 192
 5’8 122 164 197
 5’9 125 169 203
 5’10 129 174 209
 5’11 132 179 215
 6’0 136 184 221
 6’1 140 190 227
 6’2 144 195 234
 6’3 148 200 240
 6’4 152 205 246

Fat Chance
Obesity is a major cause of disease, including diabetes, heart disease, arthritis, stroke, and cancer2. It also affects mental health—obese people are more likely to suffer from anxiety, depression, and low self-esteem. Socially, they are teased, bullied, and discriminated against in school, work, and life. By the time they reach adulthood, overweight teenagers are less likely to marry, finish fewer years of education, and have lower incomes than non-overweight people.

With these serious consequences, it’s no wonder that Americans spend $33 billion a year on weight loss products and services3. At any given time, 29 percent of men and 44 percent of women are trying to lose weight. So why are there still so many fat people? Part of the problem is ignorance. In a survey of 12,000 adults, 78 percent were classified as obese but claimed their eating habits were “somewhat healthy” or “very healthy.”4 Likewise, 40 percent said they performed “vigorous physical activity for at least 20 minutes a day, three or more times per week.” Fat people believe they’re leading a healthy lifestyle, but they’re actually not. If they were, they wouldn’t be fat.

The other problem is information overload. There are literally hundreds of diets to choose from. Low-fat, low-carb, high protein, vegetarian, cabbage soup, Atkins, Zone, Slim-fast, South Beach, Jenny Craig, Weight Watchers, the list goes on. It seems like a new diet is invented every month. And once you’ve picked a diet, it’s hard to stick with it. Some diets leave you hungry all the time, while others make you feel tired and sluggish. Some make you pay for expensive powders, shakes, pills, and packaged foods. Your pocketbook gets thinner, but your body stays the same. It’s only a matter of time before your new diet fails, and you regain all of the weight you lost plus a bit more. The purpose of this article is to teach you how to lose weight and keep it off forever.

The second day of a diet is always easier than the first. By the second day you’re off it.
-Jackie Gleason

Paleolithic Diet
There is only one scientifically-proven diet that is healthy for weight loss, and will work for the rest of your life. It is the diet that your ancestors ate for millions of years. It is the diet that your body is designed to eat. I’m referring to the Paleolithic diet of lean protein, and fresh fruits and vegetables.

Once you start the Paleolithic diet, you will lose several pounds in the first 3–5 days, mainly from water loss5. Over the next 6 months, you will lose about 10–15 pounds, even if you don’t exercise or decrease your calorie intake. But if you do exercise and eat slightly less, you will lose about 30–75 pounds, depending on your starting weight. You’ve heard claims like this before. But only the Paleolithic diet is based on solid science. Let’s dig deeper and find out exactly why it works.

The Paleo diet is a lifelong way of eating that will normalize weight in everyone.
-Loren Cordain

Feel Full
To lose weight, you must either eat fewer calories or burn more calories than you eat. To eat fewer calories, the most extreme diet would be to stop eating. But you wouldn’t be able to keep it up for long because hunger pains would soon force you to eat. Your hunger drive is incredibly strong, which is why there are stories of desperate, ship-wrecked people turning to cannibalism.

This is the problem with diets that limit calories and portion size. You’re always hungry, and it’s only a matter of time before your willpower gives out. Then you binge on food and eat back all of the calories you lost. Also, you’ve tricked your body into thinking it’s starving, so it holds on tightly to new calories. The overall effect is yo-yo weight swings that leave you fatter than before.

With lean protein, and fresh fruits and vegetables, you can eat as much as you want, and still lower your calorie intake. Fruits and vegetables contain a lot of water and fiber that fill up your stomach, and satisfy your appetite faster. In a review of 40 studies on vegetarian diets, researchers from the Physicians Committee for Responsible Medicine found that people on high-fiber vegetarian diets lost weight at the rate of about 1 pound per week, without exercise or calorie-counting6. They lost weight without feeling hungry because they ate as much fruits and vegetables as they wanted.

Protein is even better than fruits and vegetables when it comes to satisfying hunger7. In a study from the University of Washington, researchers found that participants lost an average of 11 pounds over 12 weeks when they increased their protein intake from 15 percent to 30 percent of their diet8. They felt full even though they were eating 441 fewer calories per day.

In a similar study from the Rowett Research Institute, British volunteers ate either a high-protein, high-fat, or high-carbohydrate meal for breakfast9. Researchers monitored volunteers’ feelings of hunger over the next 24 hours. The high-protein breakfast suppressed hunger pangs better than fat or carbohydrates.

Protein is very effective at suppressing ghrelin, a hormone in your gut that stimulates appetite10. In the first 3 hours after a meal, carbohydrates lower ghrelin levels more than protein. But there is a rebound effect in the following 3 hours, which does not happen with protein. When you eat a meal of lean protein and fresh fruits and vegetables, the fruits and vegetables make you feel full faster, and the protein helps you stay full longer. You’ll naturally lose weight because you’re eating fewer calories.

Thermic Effect
Protein has another weight-loss advantage called the “thermic effect.” It takes more energy to digest protein than fats or carbohydrates. So even if you eat the same amount of total calories, a protein meal will result in fewer calories after digestion. In a 4-week study from the American University of Beirut, volunteers ate the same total number of calories, but some ate a high-protein diet, while others ate a high-carbohydrate diet11. All the food was catered, and researchers carefully watched the volunteers to ensure they ate all of the food they were given. Average weight loss was 13 pounds with the high-carbohydrate diet, and 18 pounds with the high-protein diet. The extra 5 pounds of weight loss was due to the thermic effect.

How to Eat
To lose weight, you should change what you eat, and also how you eat. Researchers from the University of Massachusetts’ Medical School found that people who skipped breakfast were almost five times more likely to become obese12. At the University of Texas, researchers found that eating in the morning reduced the total amount of calories that people ate over the course of a day13.

In addition to eating breakfast, you should eat smaller meals throughout the day. A study from the University of Toronto compared the effects of eating eight small meals a day versus three large ones14. Participants who spread out their meals had 13 percent lower LDL cholesterol levels, 4 percent lower blood sugar levels, and 28 percent lower insulin levels. Small frequent meals release sugar more steadily into your bloodstream, and improve your health15.

In Japan, the Okinawan islanders live by the motto “hara hachi bu,” which loosely translates to “eat until you are eight parts full [out of ten].”16 Your stomach’s stretch receptors take about 20 minutes to accurately tell your brain how full you are. You’re eating too much if you eat until you feel 100 percent full. Over time, your stomach stretches out, and you have to eat more to get the same feeling of fullness.

To lengthen thy Life, lessen thy meals.
-Benjamin Franklin

By itself, exercise is a slow way to lose weight. You have to burn 3,500 calories to lose 1 pound of fat. For a 150-pound woman, 30 minutes of jogging only burns 200 calories. At this rate, it would take 17 consecutive days of exercise to lose 1 pound, and half a year to lose 10 pounds.
In a review of 23 studies on exercise and weight loss, researchers from Brown University found that exercise-only programs resulted in an average weight loss of 5.3 pounds, compared to 23.5 pounds for diet-only programs17. The combination of diet and exercise resulted in a weight loss of 24.2 pounds. Exercise is an important part of a healthy weight-loss program. But as personal trainers like to say, “You can’t out-exercise a bad diet.”

The best type of exercise for weight loss is interval training. In a study from the University of New South Wales, women exercised with stationary bicycles three times a week for 15 weeks18. The first group pedaled steadily for 40 minutes per session. The second group pedaled as fast as they could for 8 seconds, followed by 12 seconds of slow pedaling. They repeated this interval cycling up to 60 times per 20-minute session. At the beginning, some participants could only interval train for 5 minutes. But by the end of 2 weeks, all women were able to exercise for the full 20 minutes.
At the end of 15 weeks, the interval trainers lost an average of 5.5 pounds of fat mass, mainly from their thighs and butt. In contrast, the steady trainers gained 0.9 pounds in fat mass, despite exercising for twice as long as the interval trainers. Steve Boutcher was the senior researcher on the study. He explained, “Intermittent sprinting produces high levels of chemical compounds called catecholamines, which allow more fat to be burned from under the skin and within the exercising muscles. The resulting increase in fat oxidation drives the greater weight loss.”19

Change Your Environment
To maintain your new diet and exercise habits, it helps to change your environment and remove temptations. Researchers from the University of Illinois tempted secretaries with chocolate candies20. Secretaries ate eight chocolates a day when the candies were in a clear bowl on their desk, but only three chocolates a day when they were out of sight and far away.

Television is another source of temptation. After a hard day’s work, it’s easier to watch TV than exercise. In a 6-year study from the Harvard School of Public Health, researchers analyzed the lifestyle habits of women who started off healthy but ended up obese21. Each 2-hour-per-day increment in TV watching was associated with a 23 percent increased risk of obesity, and a 14 percent increased risk of diabetes. In contrast, 1 hour a day of brisk walking was associated with 24 percent less obesity, and 34 percent less diabetes. Cancel your cable TV subscription, and invest the money in a good pair of running shoes.

It’s important to remove temptations because most people only have a limited amount of self-control. Researchers from Case Western University found that dieters were more likely to break their diet if they were tempted with unhealthy food22. Similarly, smokers on a diet were more likely to eat ice cream after they stopped smoking for 24 hours. Self-control is like money. The more you spend, the less you have for a rainy day.

Fat-proof Your Fridge
  1. Throw out all of your unhealthy food.
  2. Stock your cupboards with healthy snacks such as nuts, dried fruit, and trail mix.
  3. Stock your refrigerator with fresh fruits and vegetables.
  4. Stock your freezer with lean protein.

Keep It Off
It takes determination to lose weight, and even more determination to keep it off. On average, only 30 percent of overweight people maintain a weight loss of 10 percent of their maximum weight for more than a year. To find out what makes these people successful, the National Weight Control Registry (NWCR) was established to record their weight loss strategies23. The typical NWCR participant is someone who’s lost 66 pounds, and kept it off for more than 5 years.

What’s their secret? Almost 90 percent achieve their weight loss through a combination of diet and exercise. Their diets are low in fat and refined carbohydrates. On average, subjects eat a total of five meals and snacks per day. They eat fast food less than once a week. The average amount of exercise is 1 hour per day. The most common activities are brisk walking (77 percent), cycling (21 percent), and weight lifting (20 percent). To monitor their progress, 44 percent weigh themselves at least once a day. Another 31 percent weigh themselves at least once a week. Watching out for weight gain helps prevent a major relapse.

Track Your Lifestyle
  1. Every day, weigh yourself and write down your weight on a calendar.
  2. Record how many Paleolithic and non-Paleolithic meals and snacks you eat.
  3. Record how many minutes of exercise you do.

Half the Man He Used to Be
The world’s fattest man lost nearly half his body weight24. How did he do it? At 1,257 pounds, Manuel Uribe was so fat that he couldn’t get out of bed. It took a special crane to get him out of his house. Fed up with being fat, Manuel decided to get professional help. An international team of doctors and nutritionists prescribed a high protein/low carbohydrate diet, and lots of exercise. Instead of eggs, rice, beans, and tortillas for breakfast, he switched to meals such as fish soup, grapefruit, and peanuts. After 2 years of determined effort, Manuel lost 570 pounds. Savoring his success, he said, “I’m going to throw a big party. I’m getting out of my house and going for a walk.” If Manuel can do it, so can you.

  1. Ogden CL et al. (2006). Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 295:1549–1555.
  2. Wyatt SB et al. (2006). Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci. 331(4):166–174.
  3. Serdula MK et al. (1999). Prevalence of attempting weight loss and strategies for controlling weight. JAMA. 282(14):1353–1358.
  4. Wilkins D. (2006). Lifestyle and obesity: how occasional indulgences shape a nation’s waistline. Thomson Medstat.
  5. Cordain L. (2002). The Paleo diet: lose weight and get healthy by eating the food you were designed to eat. John Wiley & Sons.
  6. Berkow SE, Barnard N. (2006). Vegetarian diets and weight status. Nutr Rev. 64(4):175–88.
  7. Porrini M et al. (1995). Effects of physical and chemical characteristics of food on specific and general satiety. Physiology & Behavior. 57(3):461–468.
  8. Weigle DS et al. (2006). A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin and ghrelin concentrations. Am J Clin Nutr. 82:41–8.
  9. Stubbs RJ et al. (1996). Breakfasts high in protein, fat or carbohydrate: effect on within-day appetite and energy balance. Eur J Clin Nutr. 50:409–417.
  10. Foster-Schubert KE et al. (2008). Acyl and total ghrelin are suppressed strongly by ingested proteins, weakly by lipids, and biphasically by carbohydrates. J Clin Endocrin Metab. Published online January 15.
  11. Baba NH et al. (1999). High protein vs high carbohydrate hypoenergetic diet for the treatment of obese hyperinsulinemic subjects. International Journal of Obesity. 23:1202–1206.
  12. Ma Y et al. (2003). Association between eating patterns and obesity in a free-living US adult population. Am J Epidemiol. 158:85–92.
  13. De Castro JM. (2004). The time of day of food intake influences overall intake in humans. J Nutr. 134:104–111.
  14. Rolls BJ, Morris EL, and Roe LS. (2002). Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr. 76:1207–13.
  15. Jenkins DJ et al. (1989). Nibbling versus gorging: metabolic advantages of increased meal frequency. N Engl J Med. 321: 929–34.
  16. Willcox BJ, Willcox DC, Suzuki M. (2001). The Okinawa Program: how the world’s longest-lived people achieve everlasting health—and how you can too. Clarkson Potter.
  17. Wing RR. (1999). Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 31(11):S547–S552.
  18. Trapp EG et al. (2008). The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women. International Journal of Obesity. 32:684–691.
  19. University of New South Wales. (2007). How to burn more fat, with less effort. January 23, 2007.
  20. Wansink B, Painter JE, Lee YK. (2006). The office candy dish: proximity’s influence on estimated and actual consumption. Int J Obes. 30:871–875.
  21. Hu FB et al. (2003). Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 289:1785–1791.
  22. Muraven M, Baumeister RF. (2000). Self-regulation and depletion of limited resources: Does self-control resemble a muscle? Psychological Bulletin. 126(2):247–259.
  23. Wing RR, and Hill JO. (2001). Successful weight loss maintenance. Annu Rev Nutr. 21:323–41.
  24. Elsworth C. (2008). Diet halves body weight of fattest man. Telegraph.co.uk. February 26, 2008.

Copyright © 2009 by Paul Lem, M.D.
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