This is a cut and paste of an online chat with Edward Phillips, a physician who specialises in lifestyle health at Harvard Medical School, Massachusetts General Hospital and other institutions.
Q. The way we compute calories is over 100 years old. Is it obsolete?
A. Calories are simply a measure of energy. The calculations are still accurate. Expend more than you take in and you will lose weight.
A. Why is it so difficult to stay on a completely razor edge diet, such as raw veggies and a vegan attitude?
A. It is difficult to stay on a razor edge diet likely because it may be very different from your current diet.
Q. What are some of the most common mistakes that people make when trying to lose or maintain their weight?
A. The most common mistake is to make too radical a change in an effort to lose weight quickly. Think long-term sustainable changes. Another big failure in attempting weight loss is attempting too large a goal. 5-10% weight loss is sufficient for significant health gains. Another cause of failure in weight loss is not realising that the new way of eating needs to be permanent. If you resume eating like you did before the diet you will reliably regain the weight.
Q. Are the claims of low-carbs diets accurate?
A. I would not necessarily avoid or reduce any certain food group such as going low-carb. Better to balance the entire diet and cut back.
Q. What is the relative importance between regular sport (let's say bicycling 6 hours per week) and nutrition?
A. Maintaining adequate Physical Activity (at least 2.5 hours per week) is critical to general health. Exercise is necessary but not sufficient for weight loss. Successful losers all maintain high levels of activity weekly.
Q. Since fibre does not enter into the digestion process and it is calculated at 12 kcal/gram, is this accurate???
A. Fibre is still digested unless you are eating something like grass that we are not equipped to eat.
Q. Dr. Phillips, for people who aren't accustomed to regular physical activity, does it help to start slowly? Or jump right in?
A. The goal is 150 minutes per week. It is ok to increase up to this level in a measured manner increasing your activity by 10% per week. Physical activity/exercise is protective for many of the health problems of being overweight.
Q. What are some of the most common misconceptions about weight loss and why is it that sometimes a person can maintain their diet/exercise the same for weeks, but lose more weight some weeks than others?
A. Weight loss will vary week by week. When exercising another component is change in body composition, i.e. increased muscle mass, so it is probably best to look at body composition, losing fat and increasing muscle rather than just looking at the scale.
Q. What tools do you use to motivate people to make/maintain behaviour change? Changing these things can be tough. What do you find are some effective motivating factors? Thinking about health? How good one will feel?
A. I am a big fan of Health Coaching to help establish your 'value' for the proposed change in your behavior. Motivation needs to be 'activated' in the individual by aligning what you find most valuable in your life and agreeing to small initial, sustainable changes. Working with Lifestyle Medicine doctors or health coaches will help with accountability.
Q. What about Weight Watchers? I know a handful of people lately who are having success at least over several months with it.
A. Weight Watchers is one of the more well-established and sane programs available. The social support is critical for many of us.
Q. What should people be asking their doctors?
A. I would ask my doctor if my weight is ideal. Ask for help and suggestions. Unfortunately many doctors are reluctant to ask or discuss weight with their patients.
Q. So it sounds like it might be up to the patient to start the conversation with their doctor about lifestyle changes and weight management?
A. Yes the patient should bring this up as a concern. Too many of us think it is ok to continue to gain weight. Not so.
Q. What are your thoughts on sites like MyFitnessPal, which give users an allotted amount of calories to consume (i.e. 1200 calories/day)?
A. I am a big fan of the many apps and pedometers that track your eating and activity. If it feels right and you are motivated give it a try.
Q. Can a person succeed on a low calorie diet if the nutritional value of the food is very high or will the bod still go into starvation mode?
A. Your body is seeking sufficient energy (calories) regardless of the quality. Of course healthier food is always better. Don't starve yourself in an attempt to lose weight quickly. It simply won't work.
Final thoughts:
As a start become more conscious about your eating and take the time to plan out your meals. Packing up leftovers in advance, buying food in frozen form, and carrying your lunch are all part of meal planning.
Make the initial change something that is small but achievable (e.g. carrying your lunch once per week). As you achieve the first goal your self-confidence will improve. Now move on to the next goal.
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