Originally published in Forbes Health.
Countless images of unrealistic body types and “lose weight quick” claims can make rapid weight loss promises from certain fad diets feel all the more enticing. But when it comes to long-term weight loss, success depends on making a variety of sustainable lifestyle changes that benefit your overall well-being.
“No matter what we’re doing, we’re going to need to work on lifestyle, because that’s the foundation of any changes we make,” says Michelle Hauser, M.D., obesity medicine director of the medical weight loss program at the Stanford Lifestyle and Weight Management Center. “About 80% of the chronic diseases we see are related to lifestyle. No matter what weight someone is, making healthy lifestyle changes is going to help them feel better overall.”
Losing 1 to 2 pounds per week is considered safe and sustainable by experts, but specific weight loss goals depend on individual metrics, such as body mass index (BMI), sex and a person’s level of physical activity. After six months, an individual’s focus might shift from weight loss to weight maintenance based on how much weight they lost and unique weight loss goals, according to the National Heart, Blood and Lung Institute.
The Risk of Dieting
Diets promoting strict caloric reduction may enable weight loss at a quicker rate, but potentially at a cost. According to a 2022 review in Frontiers in Nutrition, some fad diets, such as the paleolithic diet, ketogenic diet and detox diets, may pose certain risks to individuals, including:
- Inadequate nutrition due to unreasonable food restrictions, such as removing entire essential food groups like whole grains, legumes and dairy products
- Loss of muscle mass rather than reduction of body fat percentage
- Weight cycling, or the process of losing and regaining weight, also known as the “yo-yo-diet” effect
- A slower metabolism or increased appetite
What’s more, few fad diets have undergone extensive research, meaning there’s little science to support their long-term efficacy and health outcomes.
Continuing to lose weight or maintaining initial weight loss using restrictive dieting can be extremely difficult. “Quick weight loss is almost always temporary weight loss,” says Margaret Schwenke, a certified eating psychology counselor and certified holistic health coach based in Atlanta. Moreover, “yo-yo” dieting can potentially lead to health issues, such as an increased risk of high blood pressure, heart disease and mental health conditions like depression, according to a review in the Bulletin of the National Research Center.
It’s always best to speak with your health care provider or an obesity medicine specialist before beginning a weight loss regimen to ensure the strategies you’re considering are suitable for your unique health and wellness needs.
The Science Behind Weight Loss
An individual must achieve a caloric deficit of 500 to 1,000 calories per day if their goal is to lose 1 to 2 pounds per week, according to the National Lung, Heart and Blood Institute.
However, the weight loss process is complex: Metabolism is based on many factors, such as age, sex, body composition, physical activity levels, stress and sleep, explains Atlanta-based registered dietitian nutritionist and certified diabetes care and education specialist Cheryl Orlansky. “Weight loss is not as simple as calories in versus calories out,” she adds.
A healthy weight loss program must include aerobic exercise, strength training and behavioral changes in addition to caloric restriction to both achieve and maintain an individual’s desired results. “If you diet without exercising, your metabolism slows and muscle mass goes down before you lose fat,” says Dr. Hauser.
Furthermore, the body’s endocrine system actually compensates for sustained caloric deficits, working to increase an individual’s appetite following diet-induced weight loss, according to research in the International Journal of Obesity. Often, people experience a plateau when attempting weight loss, which is a result of the endocrine system operating as biologically designed.
Factors That Contribute to Weight Loss
Individual diet and exercise regimens aren’t the only factors that determine successful weight loss. In fact, weight loss needs to be treated as a long-term, lifestyle goal rather than one that can be achieved in a month with a popular diet, according to Dr. Hauser.
According to Dr. Hauser, the following lifestyle factors influence the success of any weight loss program:
- Diet (both portion control and proper nutrition)
- Physical activity
- Substances (such as alcohol and marijuana)
- Stress levels
- Mental health
- Support systems and relationships
Sleep in particular can play a major role in maintaining a healthy weight, as “anything that disrupts sleep is going to contribute to weight gain,” explains Dr. Hauser. Getting less than seven hours of sleep can disrupt the body’s appetite regulating systems, making higher calorie consumption likely following a night of poor sleep, according to a review in Nutrients. Furthermore, research in the Annals of New York Academy of Sciences suggests that chronic sleep deprivation is linked to high levels of sympathetic nervous system activation, which promotes insulin resistance and can therefore lead to a higher risk of diabetes.
Following the broad fundamentals of a healthy diet can assist in long-term lifestyle changes, such as limiting foods with added sugar and including a variety of fruits, vegetables, whole grains and lean proteins. Dr. Hauser recommends reviewing Harvard’s Healthy Eating Plate, an online tool designed to help users build balanced meals.
She also encourages her patients to enroll in cooking classes even if they’re not necessarily focused on healthy eating. “The more you cook, the healthier you’re likely to be because people tend to make more health-conscious alterations to the meals they prepare themselves, whereas [food served in] restaurants and prepackaged foods [are] optimized for flavor.”
Metabolic disorders, which occur when abnormal chemical reactions disrupt the body’s ability to digest food for energy, can also inhibit weight loss. These disorders include type 1 and type 2 diabetes, cardiovascular disease, kidney disease and obesity.
“We know that obesity is a chronic disease just like diabetes, arterial hypertension or hyperlipidemia,” explains Orlansky. “It’s multifactorial and has a complex disease etiology, which includes genetics, hormones, stress and environment/lifestyle.”
How to Determine Individual Weight Loss Goals
For modest and substantial weight loss journeys alike, an individual’s goals should focus on more than the number on the scale. “Most people come to me with a predetermined idea about how much weight they want to lose,” explains Schwenke. “It’s my job to help my clients understand that the actual work is changing their relationship with food so that they can experience real and lasting change.”
For those individuals living with obesity, Orlansky suggests starting with a goal of losing 5% to 10% of body weight, which may improve several disease indicators. “This [change] means better sleep, increased energy, [lower] blood sugars, reduced blood pressure and maybe [lower] cholesterol,” she explains.
How to Start a Healthy Weight Loss Program
Lifestyle changes geared toward weight loss require long-term, varied approaches that consider individual physiological, psychological, environmental and behavioral influences. The majority of successful weight loss programs are designed to appeal to a person’s deeper motivations, manage expectations and build the cognitive skills required for perseverance when slip-ups inevitably occur, according to the Medical Clinics of North America.
“Weight loss as a short-term focus doesn’t change how a person lives and makes choices,” says Schwenke. “It only gives them rules to follow for a little while, and when those rules are removed, the previous choices come back—along with the weight.”
When starting a new health program, Dr. Hauser recommends identifying and acknowledging individual barriers you experienced in the past. For example, if a lack of time hindered your progress previously, she suggests considering whether you could learn to cook more efficiently.
“Have it be a process,” emphasizes Dr. Hauser. When approaching your plan, remind yourself that you’re a smart and confident human being and adult. “If something isn’t working, it’s not a personal failure. You just need to try a different approach.”
How to Maintain a Healthy Weight
The best way to honor hard-earned weight loss achievements is to maintain the new lifestyle habits you adopt, says Dr. Hauser. With regard to weight loss goals specifically, it may be necessary to add additional modifications that can overcome your body’s innate weight loss resistance mechanisms. Social support, such as establishing a shared lifestyle with family members, as well as creating an environment that supports your long-term goals and limits the number of cues that prompt previous behaviors, can help, according to available research.
“Surround yourself with like-minded people who support healthy eating, a positive mindset and an active lifestyle,” encourages Orlansky. “If your current lifestyle isn’t working for you, then it’s time for change. Lifestyle changes take consistency, mindfulness and time.”
When to See a Health Care Provider
Obesity medicine specialists, as well as registered dietitians and nutritionists, can be useful allies regardless of an individual’s specific fitness and weight loss goals. If you’ve struggled repeatedly to lose weight or simply change your eating habits, these sources of outside help can make all the difference.
For individuals living with obesity, the concern is “less to do with size and more to do with what your health risk factors are at a certain size,” explains Dr. Hauser.
“For people with chronic obesity that have struggled for years trying everything to lose weight, we understand that it takes teamwork and community support to help improve diet, behavior and activity factors,” says Orlansky.
Originally published in Forbes Health.