Failing at weight loss_wellocracy

You’ve tried every popular weight loss diet under the sun — from high-protein, low-carb to high-carb, low-fat and everything in between — but still haven’t been able to lose weight and keep it off.  Nevertheless, you (and millions of others like you) keep searching for the one “perfect” diet.  Stop!

Chances are, it’s not the diet that’s preventing you from achieving your weight loss goals, according Sherry Pagoto, PhD, a weight management clinician and associate professor of preventive medicine at the University of Massachusetts Medical School.  Dr. Pagoto cites several well-done studies that have compared trendy diets that vary in macronutrient composition, that is, with different percentages of carbohydrate, protein and fat.  Her point? “They all show that there’s no significant difference between these diets in terms of success rates,” she explains. “Instead, success was determined by how well the dieter was able to adhere to and stick to the diet, which as it turned out, had very little to do with the diet per se.” 

It’s not just the public that’s fixated on finding the one true diet. It’s also become an obsession among many nutritionists and other medical professionals. In “A Call for an End to the Diet Debates,” a recent commentary co-written with Bradley M. Appelhans, PhD, and published last August in the Journal of the American Medical Association, Dr. Pagoto asserts that the current focus on the macronutrient composition of diets is overlooking the real problem — lifestyle. “We need to start thinking of ways to target the context of the dieter, the behavior of the dieter, not diet itself,” she explains.

Much of Dr. Pagoto’s work revolves around helping people overcome the barriers that are preventing them from living a healthier lifestyle. In addition to working with obese and overweight patients in her practice, Dr. Pagoto writes the Shrink blog for Psychology Today, as well as her own blog, FU Diet: The Science of Weight Loss, Nutrition and Fitness. (As you can see, she’s not a big fan of diets!)

We asked Dr. Pagoto five questions on diet, weight loss and behavior.

In your JAMA commentary, you said that researchers need to stop searching for the perfect diet, and instead, start looking at the “biological, behavioral and environmental factors” that influence lifestyle change. Specifically, what aspects of diet and behavior do you think need to be further explored?

SP: I think we really need to understand the factors that interfere with people’s attempts to live healthier lifestyles and start designing interventions that improve upon behavioral modification strategies, including self-monitoring, stress management, dealing with emotional eating, goal setting and problem solving. I think that we need to be focusing on how to enhance the efficacy of these kinds of behavioral modification strategies, instead of trying to constantly enhance the diet.

Wellocracy is dedicated to teaching people about using trackers and other tools to stay healthy. How can these tools help people better manage their diet and weight?

SP: The power of the mobile phone is that it’s in your hand all day long, and so to that extent it can become the purveyor of behavioral modification 24/7.  Right now, for my patients, I’m the purveyor of behavior modification but they don’t have access to me all day long. They see me once a week, if that. I can’t be there in the moment when they’re at a decision point and they’re struggling with stress, or they’re having a challenge around managing their time. We talk about it after the fact, in the hope that the next time this happens, it will go better. If they can have access to something that was effective at helping them modify their behavior in the moment, when they’re struggling, that could make a big difference.  There may be ways to get the mobile phone to do more sophisticated behavioral modifications to help them navigate the barriers to succeeding on a diet as they come up.

What are some of the barriers that interfere with someone’s ability to stay on a weight loss program?

SP: An example might be stress – many of the patients that I work with start off with the best of intentions, but stress gets in the way and it thwarts their goals. It’s got nothing to do with carbohydrates, protein and fat. It has more to do with how they’re managing various aspects of their life! Time management is another. My patients will tell me, ‘Life got in the way,’ and I will ask, ‘What does that really mean that your life got in the way? Three weeks have gone by and you had trouble exercising more than twice.  What’s going on with that? Or, you want to cook healthy meals but you haven’t been able to get to the grocery store?’ We end up talking about those things. We do have some strategies, but that science hasn’t advanced so much. I think that’s where we can see the greatest advancement and I think mobile technology and other technology can be really helpful to that end.

As part of your FUDiet website, you post interviews with people, “real biggest losers,” who have lost a significant amount of weight and kept it off. Did you find any common denominators there in terms of behavior?

SP: There wasn’t a specific diet that came out of this either, but calorie tracking is a big common theme. People are doing self-monitoring and many of them are using mobile apps to keep track. They are also leveraging social media through their social network to help garner support for their weight loss. So having the support of others I think is really important too. It’s essential to have people who are either doing it along with you, or are really in your corner in a way that is really supportive and not judgmental or critical or undermining in any way.

The other common theme is that many of the successful dieters are doing community race events as a way to motivate them to exercise. They’re scheduling 5Ks, 10Ks, and other races all year round. Continuously over time, they increase the difficulty level of the events that they do. It’s not just the 30 minutes a day type of recommendation — they’re   approaching exercise from a training mentality. What I mean by that is they’re not sort of auto-pilot exercising, like ‘I go to the gym four times a week and do a little bit of this and a little bit of that.’ They’re continuously growing their exercise program, increasing their endurance and their strength. They try to see how far they can take it. I noticed that almost every single one of them is like that. If you’re doing that level of exercise, you really are impacting your energy balance, meaning calories in calories out. They still need to watch what they eat, but burning 300-400 calories while exercising allows you to eat a bit more while achieving your calorie goal.