Updated: Apr 4, 2020
As two thirds of Americans are overweight or obese and many are trying to do something about it, the need for balanced information has never been more pivotal. Many books have been penned with different paths to weight loss focusing on one component of the diet. Carbs are depicted as enemies of our souls and fats are still a part of the evil keeping us from looking our best. Despite the increasing focus on dieting and weight loss with more TV shows, podcasts, and best-selling diet books having emerged, our obesity statistics have remained the same for over a decade. Clearly, whatever we’re doing isn’t enough.
The problem of obesity is multifaceted including but not limited to a lack of culturally tailored information for minority communities, stigmatizing being overweight or obese and adopting erroneous ideas that people who are “fat” are so because of laziness, and providing people with snippets of information that support the claims of fitness experts and authors in the absence of providing a recommendation that's comprehensive and valid.
Black women have been affected by this more than women of other races and as a result, our obesity rates are even higher at over 50%. Much of what we know about healthy weight is based on studies not inclusive of minority communities. The body mass index (BMI) equation used to classify people as being normal, overweight, or obese was developed in a white, upper middle class community showing correlations between BMI and chest pain, a symptom of heart disease. The BMI is a useful tool and being obese is associated with an increased risk of death from heart disease and all causes; however, these relationships vary slightly based on race in that the risk of heart disease doesn’t increase for black women until a BMI of 28 is reached compared with a BMI of 25 for white women. Yet, many aren’t aware of this and still tell black women to strive to maintain a BMI of less than 25. When attempting to lose weight, it's important to set appropriate weight goals.
What you eat is most important (even more than exercise) when it comes to weight loss. To lose weight, you have to create what’s called a “negative caloric balance.” This means you should consume fewer calories than what is required for your resting metabolism (most of your daily caloric expenditure), exercise, and a small portion for the caloric expenditure during the digestion of food. You don’t have to cut out any particular food item in order to create this. You could continue your current diet and simply eat less of the food on your plate during each meal. A 500 calorie reduction per day is effective for eliciting gradual weight loss. But some say you have to cut out the carbs including rice, potatoes, pasta, bread, and sweets or you have to cut your fat to lose weight. The truth is you can lose weight even eating balanced diet consisting of carbs (including desserts from time to time), fats, and protein.
Studies have compared diets over the years finding minimal differences in weight loss between them. One study in the Journal of the American Medical Association (JAMA) compared Weight Watchers (WW), Atkins, Ornish (vegetarian with limited dairy), and Zone diets and found no differences in weight loss between the diets after a year. The primary determinant of weight loss success was how well the participants adhered to the diet. Take-home messages are 1) any diet that restricts calories will also result in weight loss and 2) when trying to lose weight, it's most important to choose a diet you can follow.
Healthy eating and eating for weight loss are two different conversations. You should limit your sugar, sodium, and fat intake as a part of a healthy diet. But to lose weight, you could likely eat twinkies all day as long as your total calories at the end of the day were significantly less than are required for your current body weight and metabolic needs (this is not recommended, however). I attended a conference in Austin recently and one of the speakers, Deborah Kesten, MPH, explained the Whole Person Integrative Eating Model covering common causes of overeating including, emotional eating (eating when stressed), obsessing about healthy foods, not tasting and enjoying food, not giving thanks before a meal, and eating alone. None of the causes of overeating included eating carbs or fats. I think this is a good start for anyone trying to lose weight: focus on balance not restriction.