The Weight Loss Pyramid of Success!
Based on the work of Dr. Eric Helms, PhD, a hierarchy of importance has been proposed when it comes to setting up a dietary intervention for weight loss. The main idea is that weight loss can be most efficiently achieved by understanding the relationship between the different factors that impact body weight through dietary change. This understanding is absolutely KEY for achieving healthy weight loss and maintaining a healthy body weight and avoiding the pitfalls of crash diets, fad diets, and dietary mis-information promoted widely in the media.
1) Adherence/Sustainability
The most important factor, though often overlooked, in any dietary pattern is sustainability. If something is effective, but far too difficult to stick to over the long haul it is not a good plan (i.e. restrictive fad-diets). Compliance is the key factor in any intervention, but especially dietary, because our diet is very habitual and habits take repeated, consistent, and deliberate effort to form and to break.
2) Energy balance
Energy balance is the next most important factor in any diet whose aim is to achieve a reduction in body weight and body fat. This means that weight loss will not occur without being in a calorie deficit (consuming less than we are burning off). This has been proven time and time again in studies (1,2,3,4,5). Any diet that results in weight loss does so by reducing calories, even if unintentionally. This is how diets like the ‘cabbage soup diet” work. Furthermore, the dramatically low protein content in a diet like that will result in a loss of lean muscle, making diets like this a shockingly poor choice for a number of health reasons.
3) Macronutrients
Macro-nutrients are proteins, carbohydrates and fat in the foods we eat. The ratio of each can have an impact on body composition much more so than weight itself. For example, it is very possible to have zero carbs in the diet but if we are still consuming too many calories, we will not lose weight. For body composition the most important macronutrient is protein, which helps us retain lean muscle mass while we lose weight from fat storage (6.7).
4) Micronutrients
Micro-nutrients refer to vitamins, minerals, and nutrients like anti-oxidants in the diet, which are found in whole food sources (i.e. vitamins in potatoes, grains, fat). More importantly, fruits and vegetables are very rich sources of micro-nutrients. If we are consuming enough fruits and vegetables daily, we can be reasonably sure we are getting enough micro-nutrients in our diet to keep us healthy while losing weight.
5) Meal Timing
Meal timing is minimally important for weight loss. Many proponents of intermittent fasting (IF) may disagree based on their personal experience; however, the science is clear that total calories are the clear winner when it comes to weight change. That being said, meal timing may make it easier (i.e. enhance compliance – see #1) to stick to their daily calorie target. For Example, one person may find that they are able to skip breakfast without feeling overly hungry and get by on 1-2 meals per day with good energy and less cravings. By cutting out one meal, this person decreased their total daily calories with this approach, and will see this reflected in changes on the scale. Another person however, may find their appetite is much higher in the morning, and that by trying to skip breakfast they end up overeating calories at lunch and dinner. This person may actually eat more calories with IF than if they ate 3 balanced smaller meals per day. Nevertheless, it is important to regulate our meal timing by eating at the same times every day as this helps ingrain habits and prevents over-eating from snacking and unpredictable meals.
6) Supplementation
Please notice that supplementation is at the very top of the pyramid. This means that it is the least important factor in weight management. In some cases, supplements may help reduce hunger cravings or increase energy while dieting, but they are never 100% necessary for losing weight, keeping it off and achieving an optimal body composition.
In conclusion, the nutrition pyramid allows us a framework to understand the most important and less important components of weight loss and weight management from a dietary perspective, and this understanding imparts freedom in to choose what works best for us as individuals and also empowers us to avoid falling prey to fad diets and marketing.
If you have questions about the weight loss pyramid of success or want to know how to implement it as part of a comprehensive weight loss plan for your health and wellness, book an appointment today!
References:
1. Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. N Engl J Med. 2009 February 26; 360(9): 859–873. doi:10.1056/NEJMoa0804748.
2. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association with Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. JAMA. 2018 Feb 20;319(7):667-679. doi: 10.1001/jama.2018.0245.
3. Obesity Energetics: Body Weight Regulation and the Effects of Diet Composition. Gastroenterology.2017 May;152(7):1718-1727.e3.doi: 10.1053/j.gastro.2017.01.052. Epub 2017 Feb 11.
4. Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults: A Meta-Analysis. JAMA. 2014 Sep 3;312(9):923-33.doi: 10.1001/jama.2014.10397.
5. American association of clinical endocrinologists and american college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. 2016.
6. Preserving Healthy Muscle during Weight Loss. Adv Nutr. 2017 May; 8(3): 511–519. Published online 2017 May 5. doi: 10.3945/an.116.014506
7. Protein-Sparing Modified Fast Diet: Efficacy, Safety and Clinical Use—Literature Review (summary)