Why is my weight loss diet not causing me to lose weight?
New patients to my practice often say that they can't lose weight no matter what they do. They chalk this up to a bad metabolism or to something that must be extremely dysfunctional about them. Over the years, however, I'm hard pressed to remember anyone who was not able to lose weight once they began an effective diet. No matter how impossible weight loss had seemed, it became possible once the diet was properly adjusted. Naturally, this result assumes that the dieter follows the diet as prescribed.
Why then the frustration and why do diets seem to fail? Here is what I've come to believe (followed by some suggestions that may help):
1. Diets Fail Because We Fail to Understand What They Are
I like to think of dieting as a completely unnatural act. If you could revisit ancient times, you would not find any humans forcing themselves to lose weight. Having a bit of extra fat would have conveyed a survival advantage, so why would anyone have wanted to get rid of it? Our twenty-first century bodies still behave this way. In fact, they seem to completely ignore weight as we gain it.
Knowing the body's propensity to correct imbalances, one would think that increasing fat would cause the appetite to shut down, or prompt the release of a cascade of hormones that would dissipate the excess. But that doesn't happen. Perhaps the reason is this; since it was always a good thing to store extra fat, we never developed any mechanisms for aborting weight gain.
Since the body ignores our fat, how can we create weight loss? We do it by recreating the ancient situation that would have forced the body to notice its own fat. That situation would be a significant food shortage. In actuality, a modern weight loss diet is simply the process of tricking the body into believing that there is a famine in the outside world. Once the body gets the idea that there is very little food coming in, it suddenly wakes up to the presence of stored fat and starts to use it up. This state of awakening was doubtlessly designed as a survival response hundreds of thousands of years ago. Let's call this bodily state: "The Ancient Famine Response."
Next, let's think about what would have constituted normal eating for these same ancestors. Since they hunted and gathered, they probably had ample food one day and very little another. To adjust to this, human bodies developed a very flexible system for using food. If food is in short supply, the body can slow down , burn fewer calories, and be more efficient. If we eat more, the body can speed up. These mechanisms allowed our ancestors to stay at stable weight even when food intake fluctuated. Let's call that the "Normal Ancient State".
Most of us start a diet with all intentions of following the rules exactly. That works! We lose weight because we are consistently telling the body that there is very little food coming. We've mimicked the “Ancient Famine Response." But we soon start to get creative. We eat things which seem to be minor, but aren't on plan. We eat a bit more than we should. Or, we don't eat on some days and eat more on others. All of these behaviors put us back into the "Normal Ancient State". It's true that we are eating less than we did before the diet, but we are not losing. That's because food intake is intermittent and not sufficiently restrictive. The body adjusts, lowers its burn and keeps weight stable, just as it's programmed to do.
Suggestion: Pick a diet that you can follow to the letter. Stay as compliant as you possibly can. Resist the temptation to go off the diet on some days and resume on others.
2. We Don't Have a Way to Get Calories Low Enough
In our practice, we create weight loss with a diet that has approximately 1200 calories. Larger women and/or men may use 1500 calories or so. This sounds simple, but it isn't. Calorie counting is complete guesswork in the modern world. Using packaged foods which have known caloric content can help. Once you start eating out in restaurants, as most of us do, counting becomes impossible. Although I do not like processed foods, dieting may be a good time to use them. If you can construct a diet from bars, supplements, frozen diet entrees, low fat dairy products and other foods which have calories already listed, you can be pretty sure of the number of calories you are getting.
In our program, we use three diet shakes or bars (each 160 cals) per day and have patients eat a dinner which is composed of a small piece of lean animal protein (chicken, fish, meat), a large mixed vegetable salad, a big portion of cooked green vegetables, a piece of fruit, and a 100 cal fat free pudding. You can work out your own plan, but knowing that you are getting the right calorie count is important.
Suggestion: If You Aren't Losing, Check Your Calories. Make more use of foods which have calorie labels. Try to avoid eating out if it is scuttling your weight loss.
3. We Don't Get Our Insulin Low Enough
Insulin is a mega-important hormone for dieters because it stores fat. It not only puts fat away into the fat cells, but it also stands guard outside the cells to make sure the fat stays put. Only by lowering your insulin levels can you break down fat. Imagine insulin as a jailer that keeps the prisoners trapped. Put him to sleep and they can escape.
Insulin is made whenever we eat starch or sugar because those two things turn into blood sugar once they are absorbed. (Insulin's other job is to control the levels of blood sugar). Dieters have already intuited the role of insulin. What is the first thing they do when they start a diet? They begin with salad and chicken breast. They eliminate bread, pasta, crackers, rice and dessert. Insulin goes to sleep and weight loss follows. But before long, the carb addiction begins to howl. That piece of pita doesn't have that many calories. That rice cake is a diet thing, right? Wrong. This part isn't about calories. Wake up your insulin enough and you won't lose weight.
Suggestion: Keep starch and sugar to a bare minimum when dieting. (This works for maintenance too!).
4. We Rely Too Much on Exercise as a Weight Loss Creator
Exercise is great. I love it! But alone, it will not cause weight loss (unless you are running the ultra-marathon or something). Remember the Ancient Famine Response: unless you create a consistent state of calorie reduction, you won't lose. In my practice I have many skilled tennis players, marathon runners, volley ball enthusiasts, and other athletes. If exercise caused weight loss, they would not be visiting me to get off the 30 extra pounds they've accumulated. Be especially careful with the temptation to over-exercise. This can create hunger and entitlement (as in, "I earned that bag of M and M's"). Exercise by all means, but during weight loss, put most of your faith in calorie reduction that is consistent and calculable.
Suggestion: During weight loss, think of exercise as secondary to caloric reduction.
Remember this: magazine covers would lead you to believe that weight loss is simple and that pretty much everyone in America is having their pounds "melt off". This is the big lie. Weight loss is tough and takes a tough effort. What remains true is that the rewards for this effort are great; the endpoint incredibly worthwhile. So keep at it and always congratulate yourself for taking on such an important and challenging task.