Health: Weight and dieting

Thoughts on gaining weight and losing weight – and comments on various “diets” and why they may or may not work, and the secret to success might be to identify why you are gaining weight?

• Background
• DIETS
• Exercise
• Since most diets do not work, what is the Secret?
• What do you think is the source of your excess calories?
• Summary

And: Consider talking to your doctor for advice on weight and weight loss, possible referrals to specialists, medical solutions and more.

Background

I was overweight in elementary school. I was the 3rd of 4 kids, with my 2 older brothers being 5 and 7 years older than me. Thus, when I was say, 10, they were in their teens.

2 of my siblings had health conditions, one of which would not be discovered until decades later, that resulted in their being very skinny at the time. I suspect my Mom, wishing to do the best for them, made sure we had plenty of homemade cookies and lots of food around. I remember one summer frequently having ice cream for an afternoon snack (my grandfather had worked for a national dairy company and my Dad sort of grew up with lots of dairy products). I remember grazing on homemade chocolate chip cookies. These were not healthy snacks – they were very high calorie – and I ate more than I needed. By 4th grade, I was quite overweight.

In 6th grade, I suffered a skull fracture and traumatic brain injury and didn’t eat for a period and lost most of the excess weight. But slowly I regained some, and by 8th grade, I was on a “diet” to lose weight. That diet worked and I mostly kept it off because I was then a growing teen, and physically active.

But eventually, like most adults with a busy job and a family, my physical activity gradually reduced – and I began to put on weight again. I remained active, mostly jogging, when I could.

For a while I was on a medication that has a known side effect of weight gain (many medicines can do that). And this can be a source of weight gain for some people.

Fast forward to the pandemic and public health directives closed my access to health care just as I injured my foot; 10 weeks later I was finally permitted to see a doctor and was diagnosed with a stress fracture and a partially torn tendon. Too late to do much, I spent much of the next 7 months sitting due to the pain. This led to weight gain and muscle wasting – the muscle weakening exposed an unknown problem – osteoarthritis of the knee. By early 2021, I could not walk more than 200 feet. (Thanks to a genius physical therapist, and several months of therapy exercises, I was able to walk 5 miles 5 months later.)

For comparison, in early 2020, I was jogging 3x per week and visiting the city gym about 3x per week. But prohibited from accessing necessary health care, my health deteriorated. At one point my weight went up by 25 to 30 pounds, later dropping back part way.

Due to osteoarthritis, I need to reduce weight – a 10% body weight reduction can, for many people, resolve many or most issues with OA.

“DIETS”

Over the years, I read numerous “diet” books and followed various approaches. Today I think most diet books miss the target, for reasons I’ll explain in a bit (hint you need to first think about what caused your weight gain – see below)

Of the various diets, here are some that I tried, sometimes more than once:

• Low calorie/calorie reduction. This approach tends not to be sustainable as you feel hungry too much of the time. And it frequently involves “calorie counting” which can be complicated and not very accurate. This method works for some but doubt you can live with an app or spreadsheet to calculate your calories for the long term.
• Low carb/high protein. I did this twice, each time for a month, and I did lose actual weight (not just water loss). But this was non-sustainable for me. If this works for you, consider the recipe books from George Stella – he’s a chef, not a doctor writing a cookbook. And Stella’s food is good.
• Carb cycling. This sometimes appears under other names such as “fast metabolism” but it’s basically a few days on a very low-fat diet, then a few days on low carb, and then a few days on a mixed diet of modest carbs, protein and fat. This approach did work, and since you “cycle” through the phases, it can be sustainable for many. The problem I had is I would end up with leftovers I could not use until I came back around to the same “phase” of the diet in a week. I suspect most people lose weight on low carb days, and possibly lose weight on very low fat days as they may also be low calorie. Over the course of a week, you eat a fairly balanced diet too.
• “No flour, no sugar”. The later Peter Gott, MD, proposed this back in the late 1960s, and went on to write a bestselling book with those words as a title. I did this for six months and lost 14 pounds during a period when I was not exercising. This approach to eating is described by the 4-word title! Eat whole grains, vegetables, low fat meat, and keep your fat consumption low. The rules are simple and it is easy to follow and is sustainable. Weight loss is slow, but that’s okay.
• Paleo-diet. I had a doctor suggest this to me. It’s based on a theory of what we think ancient people’s ate (we really don’t know what they ate) and boils down to sort of a low carb diet with vegetables. I know people who lost weight on the paleo-diet and they really liked it. But I never figured out a simple set of rules, making it hard to follow and stick with it. Maybe I did not do it correctly.
• Vegan diet, as in “How not to diet”. I like the ideas, and I like vegetarian recipes, but I gained weight! My body has something different about it such that this did not work, perhaps. After doing this, however, I now prefer to eat much less meat than I did before – probably having some meat just a couple of times per week now.
• DASH Diet – Promoted for blood pressure and heart health and diabetes. Never tried this.
• Mediterranean Diet – pretty reasonable once you figure out the concepts – possibly easier to get some Portuguese, Italian and Spanish cookbooks and just go from there. Not a fast way to lose weight but a sustainable way of eating. Eat vegetables, whole grains like rice, low fat meats.

Even if a “diet” works, almost all dieters gain back much of the weight they lost after ending the “diet”. This is why a “diet” is not a solution unless you have a plan to continue onto a sustainable weight strategy after ending the diet.

That latter point is also key – many of the above “diets” are not sustainable.

Exercise

My experience is exercise, even a lot of exercise does not lead to weight loss. But it does prevent weight gain. One theory is exercise burns up blood sugar and makes us hungry. The result is exercise leads to us eat more than if we did not exercise! On the other hand, I never gained weight when doing consistent exercise, and building muscle mass may result in your body burning more calories even when at rest. Exercise has other benefits as well. I think we should do exercise regardless of diet!

I’ve learned exercise does not have to be the 30-minute run, or 60-minute walk, or a long session in a gym. Exercise can also come in an accumulation of short bursts. For me that can be walking up and down the stairs at my house ten times. Or lifting some hand weights for a few minutes or using exercise/resistance bands. Having a relatively dumb “smart watch” has shown me how to get more steps in each day.

While making dinner and waiting for something to simmer, I go lift hand weights or do some knee exercises.

While I still like to go out for long duration exercise, I now realize that I can also get decent exercise by accumulating many small activities.

Since most “diets” do not work, what is the secret?

Do not think about losing weight but ask, why am I gaining weight?

That is the key – figure out why you are gaining weight.

I had 3 sources of easy and seemingly invisible calories and this was “my diet problem”. I did not figure this out until recently.

• Homemade lattes, one or two per day. At one point, I was using a giant mug that held about 12-14 oz of latte. That is over 200 calories of milk! And too often, I topped it off with a little half and half or cream. All of a sudden that was 300 calories – each! My first step was switch to an 8-ounce cup. I later stopped drinking caffeinated coffee and my daily desire for a latte vanished, eliminating a lot of daily calories.
• Cheese. I was a cheese-aholic. I had sliced, sharp cheese slices every day – in fact, a couple of cheese slices on a Wasa cracker was a near daily dessert. Cheese adds calories really fast – and one of these crackers with cheese could be 150-200 calories or more! Now, I cut way back on cheese consumption, indulging once or twice per week and having lower calorie cheeses such as mozzarella or pepper-jack. (Cheese is a genetic thing for me – my great grandfather was a professional cheesemaker, and my grandfather won a gold medal for cheese making at the World’s Fair early in the 20th century.)
• Snacks. My wife loves tortilla chips. There was always an open bag on the kitchen counter. I knew from past experience, when I grazed on tortilla chips, I gained weight. Every time. She’s cut back her consumption of tortilla chips and we no longer keep snacks on the counter – keeping them out of sight removes temptation.

I also had an issue with portion sizes – something I did not realize until I visited another country, late in life, and discovered that only in the U.S. have we “supersized” everything. Lattes are 12-21 ounces, while in Europe, they are generally 8 ounces. Restaurant portions in the U.S. – particularly at Asian, Mexican and Indian restaurants tend to be huge – while other countries serve smaller portions. Over time we train ourselves into viewing a “normal” portion as one of these oversized plates. And we end up eating too much – even when we mostly cook our own food, at home.

For some people, their weakness may be something else or weight gain as a side effect of medication – or drinking sodas every day, or multiple cups of tea with cream and sugar, or the free cookies or cupcakes at work or just eating larger portion sizes than you need … it can be anything. Mental health issues such as untreated depression can lead to weight gain; but treated depression can lead to weight gain too because some anti-depressants may lead to weight gain!

Your goal is to identify the source of excess calories.

A “diet diary” for a week or two may be helpful. You have to log every single item you eat and when you ate it. From this diary, you might spot patterns that are the source of excess calories.

What do you think might be your source of excess calories?

It takes remarkably few excess calories to gain weight. Just 100-150 extra calories per day can lead to 15 pounds of weight gain in a year. That one pound or more per month is very gradual and we don’t even notice it until we are 30 pounds overweight! How much are 100-150 calories?

• One tablespoon of butter – used in cooking or on toast is 100 calories!
• One tablespoon of cream cheese is over 50 calories! Two are over 100!
• One slice of bread can be up to 100 calories!
• Two tablespoons of strawberry jam are 100 calories
• One slice of buttered bread with ham can be 400 calories!
• A grande latte is about 200 calories (more if you add flavorings)
• A grande chai tea latte is 225 calories

It is amazing that our weight may be set by something as tiny as one or two extra tablespoons of food per day.

Once you have your weaknesses identified and under control, then think about weight loss.

Some approaches, like low carb/high protein result in rapid weight loss, particularly for those who have a lot of weight to lose. Low carb can be a good first step for one or more months but for many, this way of eating is not sustainable long term. A side effect is that after eating low carb/high protein for just a week or two, this ends sugar cravings, making future weight loss easier. High protein diets also act as a natural appetite suppressant – you just find yourself not so hungry, grazing and over eating.

If you do a low carb diet for a bit, after the initial low carb phase, switch to a sustainable diet scheme, such as “no flour, no sugar” or the Mediterranean diet, or vegetarian or paleo, if that is what your prefer.

But ultimately, you need to figure out how to eat fewer calories, longer term, and/or burn up calories. Reminder – exercise can be helpful but if just makes you hungry and you then eat too much, you are not succeeding.

Most of the above diets are “fad” or “specialty” diets – whereas an approach that has a variety of foods, watches out for portion sizes and excess snacking – is what likely works long term. As in forever.

Talk To Your Doctor

Losing weight is hard and it is presumptuous to assume everyone can identify the problem and a find a sustainable solution on your own.

Excess weight is a medical problem – which can lead to other health problems including joint arthritis (especially in the hips and knees), Type 2 diabetes, heart problems, strokes, non-alcoholic fatty liver, depression – and generally making life more difficult while carrying excess pounds.

Consider making an appointment just for a weight conversation with your doctor. I had informal conversations initiated by my doctor, but always when I was seeing my doctor for a different medical problem. There was not an opportunity to focus on the weight issue. That’s why it may be wise to make an appointment to exclusively discuss one’s weight challenges.

Your doctor might be able to advise you on recommended weight loss strategies, might refer you to a weight loss specialist or clinic, or might consider medication issues. This could include that some medications you may be taking can lead to weight gain, or could include prescribing medications that may assist with weight loss.

The hardest step may be admitting we can’t do this by ourselves – and need help. Once you get over that and make the call and appointment, it gets easier from there.

Summary

• First, try to figure out why you gained weight. This is important!
• Second, consider a “diet” to get your weight loss journey started.
• Third, then switch over to a sustainable eating style that works for you.
• For me, a sustainable diet tends to not rule out all foods – and allows you to “cheat” infrequently. As Dr. Gott explained in his “No flour, no sugar” approach, once or twice a month due to work situations, he’d likely eat a regular bread sandwich – or perhaps a piece of cake at grandkid’s birthday party – it happens.

Disclaimer – I am not trained in any field of health care (except medical informatics, but that’s information systems, not people). My comments are my observations from experience and should not be considered health information or advice. If you are striving to lose weight, it is a good idea to ask your doctor for suggestions. Your doctor might suggest visiting a weight loss specialist or clinic for guidance.