WBUR is contemplating a second season of "The Magic Pill," the award-winning podcast we produced in 2016 to help listeners change how they feel about exercise. Many listeners asked us to consider a sequel about food and eating, and we think we've found the perfect new partner for our main host, lifestyle medicine pioneer Dr. Eddie Phillips. She's 23-year-old Juna (pronounced Yoona) Gjata.
In this prequel post, Juna takes a look at New Year's resolutions, and in her typical style, tries to fight the demons of diet with good evidence, humor and high energy. And in the pilot episode below, she lays out the all-too-familiar dilemma summed up as "Doomed if you diet, doomed if you don't." Please give us feedback in the comments section, including what you'd most like to hear about in other episodes. And Happy New Year...
-- CommonHealth Editor Carey Goldberg
Oh, joy! Another article posted just before New Year’s Eve about how we all make the same resolutions to lose weight, we all go too hard in the first week, and then we all give up.
Insert sensible advice here about taking a more measured approach. Include some stuff about making lasting change, and maybe a few studies to support your more rational (but blatantly unsexy) words of wisdom.
This is the formula for basically every health article written around New Year’s each year. At this point in my life, I’m not sure which article is more useless to me: the one claiming to have found the new magic diet, or the one preaching sensible lifestyle changes from a high horse 65 feet in the air. I mean, the fad diet articles never seem to work, but at least they let me pick out bikinis in peace as I dream of my soon-to-be beach-ready body.
We all know that a majority of us are overweight or obese, and that most of us try to lose weight and fail. But there has to be someone, somewhere, who has successfully lost weight and maintained it. Right?
Although this person may seem like a glorious unicorn to the rest of us plain old barn horses, it turns out there’s an actual unicorn registry, as it were. That’s right. The phenomenon of successful long-term weight loss is so rare that we had to go out and create a registry just to prove to ourselves that it does, against all anecdotes, exist. Just kidding... mostly...
A food-restricted diet works extremely well to get the weight off. It works extremely poorly to keep the weight off.Dr. Jim Hill
The National Weight Control Registry was started in 1994 by Dr. Rena Wing of Brown University's Warren Alpert Medical School and Dr. James O. Hill of the University of Colorado. The registry is the “largest prospective investigation of long-term successful weight loss maintenance” — the key word there being maintenance. The purpose of this registry was to figure out what these people, these unicorns, were doing differently that was allowing them to successfully lose weight and successfully keep it off.
Perhaps if there were some secret potion of apple cider vinegar and goji berries they were bathing in, we could all start brewing it...? To find out what the registry can teach us about actually doing that thing you say you will do every year, I spoke with Dr. Hill (FYI, he said I can call him Jim, so basically, we’re besties now).
So according to the registry, what do we know about the success rate of long-term weight loss?
What we've found is, if you define success as maintaining at least a 10 percent weight loss, about 20 percent of the people trying to lose weight were achieving that. Now, that's not curing obesity, but we know that maintaining at least a 10 percent weight loss significantly improves health and various health markers. But, it's true that most people who lose weight aren't able to maintain at least a 10 percent weight loss.
It seems that dieting is people's go-to weight loss strategy. Is dieting an effective way to lose weight?
Let's first of all define the term diet: The way I think we're talking about diet here is restricting food in some form to lose weight. A food-restricted diet works extremely well to get the weight off. It works extremely poorly to keep the weight off.
Exercise is absolutely the number one factor that predicts success.Dr. Jim Hill
So the problem is that if you look at weight loss as a short-term thing, diets work. If you look at weight loss as a long-term thing, food restriction clearly does not work. And we have decades of research showing that.
And what does the registry tell us about exercise and long-term weight loss?
If you want to try to lose weight and keep it off with diet alone, the chances of you succeeding are very low. In the registry, only 9 percent of successful people say they hardly ever exercise. Ninety-one percent say they exercise at a pretty high level. You can continue to food restrict, but people get tired of food restricting and get hungry. You want to eat. This is where exercise takes over in keeping the weight off. Exercise is absolutely the number one factor that predicts success.
So, according to the registry, what do people who successfully keep the weight off do differently from the rest of us?
What we see in our programs over and over is that the people that are successful in the long term aren’t just food restricting. They are doing levels of physical activity to match food intake.
They don't restrict food, but they eat smarter. They exercise so that they’re insulin sensitive. They have a healthy metabolism. This might surprise you, but we tell people that the goal in losing weight and keeping it off is to eat as many calories as possible. Now to do that, and not gain weight, you have to burn those calories, you have to get in the gym and lift weights.
So what exactly do you need to do to lose the weight and keep it off?
You use diet to get the weight off. Although physical activity can help a little bit with weight loss, you’ve got to do a lot of it to make a difference. In fact, what you're really doing when you start exercising is you're fixing your metabolism.
People who are sedentary and overweight have a dysfunctional metabolism. Their metabolism is not good at switching between fuel sources such as carbs, fats, and protein. So, if you lose weight by food restriction and at the same time you're exercising to fix your metabolism, then you're in a better state to keep the weight off.
So the key is getting weight off with diet, fixing your metabolism through exercise, then maintaining a level of exercise that allows you to eat enough calories during the day that you're satisfied. Maybe not a number of calories that you would love to eat, but a number of calories that you can continue over the course of your life.
Most of us know we should be eating better and exercising, but even though we want to lose weight, we don’t execute on these goals. Why is it so hard for us to act consistently, and how can we get ourselves to do what we set out to do?
This is where a lot of our work is, really in the area of what we call motivation and mindset. One of the things that we found that's very important to people who make long-term changes is finding the right motivation.
We asked people, 'Why do you want to lose weight?' The number one reason is to get healthy. That's not the real reason. When we probe people, we find that the real motivation for a lifestyle change relates to deeper, emotional kinds of things.
The second thing, after determining your 'why,' is mindset: helping people think differently. What we find is that a lot of people use their weight as an excuse not to really engage in life, so we help them create an identity shift. People need to think of themselves in a different way, almost as a different person. You're not labeling yourself as this fat person anymore. That's not your identity. You need to craft a different identity for you.
Knowing what you know from the registry, what would you say to a person who has perhaps yo-yo dieted in the past, has lost and regained weight multiple times, and is looking to make this time the final and true push for a permanent change?
The first step is realizing that this is a long-term, forever thing, not a short-term 'get weight off as quickly as I can' thing. If you go out and try to lose weight fast, you are most likely going to gain it back. Most people have lost hundreds of pounds over their lifetime. It’s not going to work if you don’t find a way to live your life that you can stick with forever, because if you quit doing it, you’re going to be back to the way you were before.
The second thing is to think about it like this: There is a weight-loss phase and a weight-loss maintenance phase. Yes, food restriction is one of the best tools you can use to get the weight off, but you can’t do that forever. The way you can be successful, and even be happier, is by achieving a level of exercise each day that allows you to maintain a diet that is satisfying for you.
And the third thing is, you have to work on who you are. Who are you in life? Why are you doing this? How can you align your values with the way you are treating yourself?
Readers, what do you think of Dr. Hill's advice? And most importantly, what's your feedback on the podcast? You can sign up for the first season of "The Magic Pill," and receive 21 brief but uplifting episodes delivered daily to your inbox, here.