Will a high protein Paleo or Atkins-style diet lead to more weight loss than a low-fat diet? Or perhaps a Mediterranean diet with olive oil and fish is the way to go? Sherry Pagoto, a weight management clinician and associate professor of preventive medicine at the University of Massachusetts Medical School, believes these are the wrong questions to ask.
Instead, researchers should be trying to determine what really works to help people permanently change their eating and exercise habits to lose and keep off excess weight over the long haul, Pagoto wrote in a commentary she coauthored Tuesday in the Journal of the American Medical Association.
She bases her conclusions on a review of four meta-analyses that combined various diet studies to see whether any diet plans stood out as stars. These analyses found that the weight loss differences among dieters using different plans were small – typically 1 to 4 pounds — and that the biggest predictor of long-term success was whether dieters were able to stick with the plan permanently.
“Maybe we should shift our focus from what people should be eating — in terms of the ideal carb, fat, and protein ratio — to what is it that enables them to change their behavior for good,’’ Pagoto told me.
An obvious first step to weight loss success: requiring people to make as few changes as possible, so that they don’t feel deprived and desperate to go back to their old ways. Meat lovers, for example, might thrive on a Paleo diet or Atkins, Pagoto said, while pasta fans might get more sustained weight loss from a low-fat Ornish-style eating plan.
Beyond that, people need to understand social, environmental, and emotional barriers preventing them from making healthful changes. Is their spouse or best friend sabotaging their efforts to pass up dessert or a burger and fries from their favorite fast-food joint? Do they deal with a bad day of work by hitting their pantry instead of their treadmill?
Pagoto said she sees a lot of patients in her clinic who have a hard time losing excess pounds because they suffer from depression, yet only a handful of trials have tried to identify effective strategies for helping depressed obese patients lose weight.
Often, weight loss counseling needs to be tailored to someone’s individual issues and needs, which can’t be covered in a quick counseling session in a doctor’s office. Unfortunately, a federal health law mandate requiring coverage for behavioral counseling to treat obesity doesn’t extend that coverage to anyone who’s not associated with a physician’s practice.
Weekly counseling sessions with registered dietitians, fitness coaches, or psychologists are likely the most effective way to help people implement and stick with changes to reverse obesity, Pagoto said. Studies suggest that those who were most likely to retain lost pounds started with multiple behavioral sessions followed by monthly and then twice yearly visits with weight loss counselors.
Unfortunately in the real world, patients usually need to pay for these multiple visits out of their own pockets.
The weight loss clinic at the University of Massachusetts Memorial Center charges $800 for a 15-week program and monthly maintenance visits. That’s about the cost of a high-end gym membership, but it’s often not affordable for those on a tight budget.
A bill introduced in Congress last June would extend coverage to such clinics. Pagoto believes that’s the only real way to reverse the obesity problem in this country — not determining the best diet for weight loss.