Most of us have struggled with our weight at some point in our lives. We think we know what it takes to lose weight – move more, eat less. But that path is difficult, it hurts and it has variable success. In the end we may be left wondering, is it even worth it?

But there may be a better path to long-term weight loss, and it is worth it. 

Being overweight or obese significantly increases your risk for many serious diseases and health conditions including heart disease, stroke, type 2 diabetes, some cancers, mental illness, low quality of life, dementia and overall mortality. According to 2014 data from the National Health and Nutrition Examination Survey (NHANES), more than 2 in 3 adults are considered to be overweight or have obesity. That statistic has even increased over the last five years. 

Unfortunately, healthcare hasn’t served us well when it comes to helping us lose weight. Most weight loss programs fail to help most people lose weight and keep it off long-term. This might be partly because they’ve been operating on a model of weight gain and obesity that could be, well, wrong.

“Lifestyle change programs that focus on diet and exercise are considered a gold standard for obesity treatment and prevention. Despite their initial success, many of these interventions are less robust in the long-term. Although participants lose an average of 7% to 10% of initial body weight, they tend to regain one-third of this lost weight within a year after treatment, and by 5 years, approximately half of all participants will return to their original weight.” – Khoury et al., 2018

Calorie Counting Fails

The process of losing weight with calorie counting and macronutrient tracking is often overwhelming. While it works for some people, many others try for years unsuccessfully to lose weight using this approach. Calorie counting is both restrictive as well as time-consuming. It also doesn’t intrinsically foster long-term changes in eating habits.

“With my patients, I try to simplify the concept of weight loss,” said Dr. Cecily A. Clark-Ganheart, a board-certified OBGYN, maternal-fetal medicine and obesity medicine physician. Clark-Ganheart specializes in working with obese women who are hoping to get pregnant in the future and thus don’t qualify for weight loss surgery. Yet the patients she works with, who often weigh 300 pounds and more, are losing just as much weight as they would with surgery – and they are keeping it off. 

The first concept that Dr. Clark-Ganheart discusses with her patients is meal timing or intermittent fasting. She works with her patients to help them identify where and when their energy intake is coming from, and she helps them slowly cut out snacking and lengthen their overnight fasting window in order to bring down their blood sugar and insulin levels (more on that shortly!).

“Most people I work with don’t initially have a sense of how much they eat, how often they eat, what types of foods they eat or how often they are drinking calorie-dense beverages like juice and soda,” Dr. Clark-Ganheart said. “We also typically find that when they are snacking, they aren’t eating apples or asparagus, but rather chips and pre-packaged foods that aren’t very nutritious. So we work together to set out a plan based on what each individual feels they can reasonably achieve, whether that’s cutting down their snacks or moving up their normal dinner time by an hour or two to incorporate intermittent fasting. The idea of not eating around the clock is intimidating for some people at first, so we introduce it gradually.”

Meal timing is a factor that is completely ignored by most traditional models of obesity. But when combined with moderate carbohydrate restriction (around or under 100 grams of carbohydrates per day), reduced meal frequency such as in the practice of prolonged overnight fasting for 12 to 18 hours has been helping Clark-Ganheart’s patients lose up to and more than 10% of their body weight within just a few months. She has many patients who have achieved more than 100 pounds of weight loss. The most surprising thing is that these patients overwhelmingly report reduced hunger levels.

How can you eat less, eat less often and be less hungry? Storage and satiety hormones, chemical messengers in the body including insulin and leptin, are a critical piece of this puzzle.

A New Model of Obesity

“According to the conventional model of obesity, the main message is to eat less, move more,” said Cara Ebbeling, an internationally-recognized expert in interventional nutrition research and co-director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital. “The idea [according to the conventional model] is that obesity is driven by high energy intake and low energy expenditure, which increases availability of metabolic fuels and promotes deposition of fat. That model suggests that if you simply eat less and move more, the problem will go away.”

But a long history of failed obesity-prevention and weight loss programs, along with a lot of research, tells us this is not the case. The idea that weight is simply about calories in versus calories burned is outdated. Ebbeling and colleagues have been investigating a new model, called the carbohydrate-insulin model of obesity. The idea is that carbohydrates, particularly from refined sources and sugar, promote fat storage in large part through their impact on insulin. 

When you eat foods that contain carbohydrates, your digestive system begins processing these foods and releasing broken down sugars, like glucose, into your bloodstream. In response, your body prepares to shuttle these sugars around your body for use as fuel and for storage. This happens more quickly with the easily digestible carbohydrates found in foods that have been processed and are low in dietary fiber – such as breads, white rice, potato products, pasta, chips, pastries and sugar sweetened beverages.

One of the first steps in the process of shuttling sugars around your body for burning and storage is the release of insulin from the pancreas. 

Insulin is a hormone, a chemical messenger created by your pancreas in response to your intake of food. Insulin helps transport sugar (glucose) from your blood into your cells and tissues. Insulin also acts as a storage hormone – it controls the level of sugar in your bloodstream, which increases after you eat, by driving this sugar out of your bloodstream and into your fat cells for storage for example.

“After you eat carbohydrates, you secrete insulin,” Ebbeling said. “Insulin is a storage hormone that sends your metabolic fuels towards storage. It ushers glucose into your cells and causes a decrease in circulating glucose. What happens when this occurs? You may feel hungry and lethargic, so that you eat more and move less. According to the carbohydrate-insulin model of obesity, excess dietary intake and inadequate physical activity may be the results, rather than the drivers, of obesity.”

In other words, eating excess carbohydrates, especially easily digestible ones like refined carbs and sugars, doesn’t just tell your body via the messenger of insulin to store excess nutrients in your fat cells. It also leads to the inevitable “sugar crash” that leaves you craving more carbs, quickly feeling hungry again, feeling tired and unlikely to exercise.

In a small trial with overweight and obese men, researchers found that a high glycemic meal caused blood sugar levels to rise to more than double the levels observed after a low glycemic meal. Both meals had the same amount of calories. The high glycemic meal also led to a greater drop in blood sugar four hours after the meal, resulting in greater hunger levels. The high glycemic meal even produced greater brain activity in an area associated with reward behavior, desire, satiety and cravings! 

If you’ve ever eaten a high carb meal only to feel starving just a few hours later, you aren’t alone.

“When insulin levels are high, calories from metabolic fuels, such as sugars released from dietary carbohydrate during digestion, are stored in fat cells rather than burned for energy,” Ebbeling said.

What creates high insulin levels? High intake of carbohydrates for one thing. But insulin resistance is another factor. Insulin resistance, a condition that can lead to diabetes, happens when your cells essentially go “numb” to insulin, or become resistant to its activity. When your cells become insulin resistant, your pancreas has to pump out more and more insulin to control your blood sugar levels. This is because insulin resistant cells don’t easily open their doors to glucose. 

An unhealthy diet, fat accumulation especially in the abdominal area, stress, sleep disruption and inflammation are factors that can predispose you to insulin resistance. 

Some people also seem to secrete insulin from their pancreas at naturally higher levels than do other people. There may be a genetic basis to this. But for anyone who tends to have relatively high insulin levels around the clock, a low carbohydrate or low glycemic load diet may be critically important in helping to prevent obesity.

Glycemic index and glycemic load are two measures of how much a given food impacts your blood sugar and by extension your insulin levels. A food’s glycemic index (GI) is a score that measures how much and how quickly that food makes your blood sugar rise. The score ranges from 0-100, with pure sugar water having a value of 100. Glycemic load takes into account the amount of carbohydrates available in a typical serving size of a given food, as well as the glycemic index of the food. 

Foods that have a low glycemic index (including foods with lots of dietary fiber) and/or that are low in carbohydrates have a low glycemic load. Eating these foods as opposed to foods that have a high glycemic load means that you won’t be spiking your blood sugar – and your insulin – to levels that make you more likely to store away your metabolic fuels, to feel lethargic and in the end to gain weight.

In a 2007 study, Ebbeling and colleagues compared a low glycemic load diet with a healthy low fat diet. They found that a low glycemic load diet was especially important for weight loss in people who secreted higher levels of insulin starting out. People who had an insulin level above average at 30 minutes into an oral glucose tolerance test lost more weight when they followed a low glycemic load diet, 13 pounds in 18 months, compared with their counterparts who followed a healthy low fat diet and lost only 2.5 pounds. These data lend support to the carbohydrate-insulin model of obesity.

What does this mean for you?

These findings suggest that if you tend to secrete insulin at higher levels, it may be especially important for you to follow a low glycemic load diet. Pending further research, your doctor is unlikely to measure your insulin level for the purpose of prescribing a diet. However, there are some telltale signs of high insulin secretion, including an accumulation of trunk or abdominal fat. Carrying weight around your midsection may therefore be an indication that you could benefit from following a low glycemic load diet.

Regardless of your normal insulin levels after eating, however, eating low glycemic load foods can help you lose weight and reduce your risk of cardiovascular disease.

“I don’t think there is any downside to following this diet, which we have been prescribing for a while now,” Ebbeling said. “It is a middle-of-the-road diet in terms of carbohydrate intake, neither very high (like conventional low-fat diets) nor very low (like a keto diet).”

The low glycemic load diet Ebbeling and colleagues have used in their studies consists of approximately 40% of daily calories from carbohydrates. However, the sources of these carbohydrates are carefully selected to minimize impacts on blood sugar – and thus insulin levels.

“Using a plate model, we advise children and families to designate half of the plate for non-starchy vegetables and fruit; a quarter for protein; a quarter for beans, starchy vegetables, or whole grains; and then to add healthful fat such as oil, nuts, seeds or avocado,” Ebbeling said. “Non-starchy vegetables are the foundation of this diet – they are low in carbohydrate and have a negligible glycemic index.”

Protein is the most satiating of the macronutrients (carbs, proteins and fats), meaning that a diet rich in plant-sourced proteins such as legumes can be very helpful in promoting weight loss while having a low impact on blood sugar. 

Bolster a Healthy Diet with Exercise, Mindfulness, Sleep and Fasting

A healthy diet is a critical factor in any weight loss or obesity prevention program. The first steps toward healthier eating are often eliminating sugar-sweetened beverages as much as possible and replacing processed foods with non-starchy vegetables and whole fruits. If you are looking to lose weight, healthy eating patterns should be a primary focus – along with appropriate attention to getting adequate physical activity and sleep, and minimizing sedentary time and stress. 

These other lifestyle factors can contribute to high insulin levels. This is a problem for weight gain as we’ve seen, but insulin also acts as a signal that keeps our cells from resting and repairing themselves. 

So, what’s next?

A Weight Loss Plan Based on Five Pillars of Health

Below we’ve outlined health practices that have been shown in a variety of interventional and observational studies to be associated with weight loss. Many of them also fall in line with the 5 Pillars of Health in the LIFE Extend app – nutrition, exercise, mindfulness, sleep and intermittent fasting. 

1. Replace sugar-sweetened beverages with water and sugar-free beverages.

To achieve weight loss that you can sustain, it is typically better to focus on positive habits that you can make into a lifestyle as opposed to restricting your diet. The one exception to this rule is for simple sugars and sugar-sweetened beverages. Sugar sweetened beverages include soda, juices, energy drinks, sweetened teas and other drinks with sugars added. Cutting these out and replacing them with water (and alternatives like unsweetened tea and coffee) is one of the most important things you can do to protect yourself against obesity and diabetes. 

“Sugar-sweetened beverages are very high in carbohydrates, glycemic index and glycemic load,” Ebbeling said. “When working with children and their families, sugar-sweetened beverages are the first thing we suggest they eliminate if they want to lose weight. The scientific literature is clear that sugar-sweetened beverages are a big culprit when it comes to weight gain.”

2. Eat a diet rich in low glycemic plant-based foods.

A healthy eating plan can both help you lose weight and help you maintain a healthy weight. The Dietary Guidelines for Americans 2015–2020 defines a healthy eating plan as one that incorporates primarily fruits, vegetables, whole grains and dairy products, and that includes healthy sources of protein – beans/legumes, lean meats, poultry, fish, eggs and nuts. 

The Guidelines also recommend that people follow an eating plan that is low in added sugars, salt (sodium), cholesterol and trans fats, to prevent chronic disease. But apart from minimizing sugars, salt and trans fats, try to focus on adding more healthy foods into your diet as opposed to cutting out certain “bad” foods. This will also help to keep you motivated as you make progress toward healthier eating. The guilt of “slipping” and eating foods you’ve cut out of your diet can be unnecessarily demotivating and demoralizing.

For example, eating more fruits and vegetables, regardless of any other dietary changes, typically helps people avoid weight gain and obesity. There are likely many reasons for this. One is that fruits and vegetables contain dietary fibers that can decrease hunger levels; eating more plant-based dietary fibers helps you feel more full and likely to consume fewer calories from unhealthy and processed foods. In other words, if you eat an apple first when you feel like having a snack, you’ll have less “room” for sugary baked goods even if you do still reach for them afterwards. 

During one 12-year study following the health and eating patterns of women in the field of nursing, researchers found unsurprisingly that women tended to gain weight with aging. However, women who increased their intake of fruits and vegetables over time (up to as much as 9 servings or cups per day) were nearly one third less likely to gain significant weight or become obese.

Non-starchy vegetables and whole fruits are also relatively low glycemic index and low glycemic load, meaning that they have a low impact on your blood sugar levels. This turns out to be an important aspect of how fruit and vegetable intake can help you achieve and maintain a healthy weight. A low glycemic index diet is one that incorporates foods that won’t spike your blood sugar to unhealthy levels that can promote inflammation and weight gain through insulin activity. 

Low glycemic index and low carbohydrate diets may even help you burn more energy at rest as you lose weight. This goes back to the idea that carbohydrate intake activates the storage hormone insulin, which shuttles sugars toward storage instead of burning. In a 2012 study, overweight and obese young adults on a low carb diet burned per day the equivalent energy of one hour of moderate-intensity physical activity* (300 kcal) more than did adults on a low fat diet.

*Note that this doesn’t mean that a low carb diet negates the need for exercise, which provides many other health benefits apart from burning calories.

Chronically high blood sugar and insulin levels can also make your cells less sensitive to the satiety hormone leptin. This yet again leads to greater hunger levels and a tendency to gain, or regain, weight. 

A low glycemic diet, along with physical activity, consumption of fiber-rich plants, stress reduction and healthy levels of sleep, can help prevent leptin resistance as well as keep blood sugar levels in a healthy range. The result? You keep your hunger levels in check and your body remains good at burning fuels, not just storing them away!

To follow a low glycemic diet:

• Fill half of your plate at each meal with non-starchy vegetables and fruits. 
• Fill a quarter of your plate at each meal with clean proteins. 
• Fill a quarter of your plate at each meal with beans, whole grains and/or starchy vegetables.
• Also enjoy sources of healthy oils including olive oil, nuts and seeds.

Learn more about low glycemic load foods and how fruits and veggies fit in here.

3. Create a food-safe environment in your home.

Keep energy-dense snacks off of the counter and out of view, while stocking up on fresh fruit. Remove processed snacks like cookies, granola/energy bars and chips from your pantry. Give them away if you need to!

“Creating a food-safe home is an important piece of the puzzle for preventing weight gain or promoting weight loss,” Ebbeling said. “When healthful foods are the only options available at home, it is much easier to stick with an eating plan.”

4. Start walking an extra 30 minutes each day.

Walk the dog, walk to work, walk on your lunch break, park and walk – anything that gets you moving more. 

Exercise may not be an effective intervention for substantial weight loss, but it is critical in helping you maintain your weight loss and in improving other aspects of your heart and metabolic health. Exercise such as walking can also be an activity that allows you to take time for yourself, be outside and de-stress, which in turn helps improve your health.

Also, when we lose weight on a diet that still supplies plenty of energy in the form of carbohydrates, our muscles can end up adapting by not burning as much energy. Exercise can help keep your muscles burning plenty of energy while you lose weight! This makes it easier to maintain your weight loss.

Get walking with this 12-week walking schedule from the Mayo Clinic. Join a friend in logging and sharing your daily walking minutes in our social LIFE Extend app!

5. Practice intermittent fasting.

Intermittent fasting is the practice of going hours at a time without consuming any calories. It often involves a daily cycle of fasting and feeding. Fasting overnight for 12-16 hours, and practicing longer fasts on occasion, can improve your blood sugar control and promote weight loss. 

Intermittent fasting targets key mechanisms in the carbohydrate-insulin model of obesity. It is fundamentally a practice that gives your body a break from glucose signaling and, you guessed it, insulin! By lowering your glucose and therefore your insulin levels over the course of 12 or more hours, intermittent fasting allows your body to enter a mode of burning fuels instead of storing them away. 

By drastically lowering your insulin levels on a temporary but regular basis, intermittent fasting can also improve your insulin sensitivity, lower your inflammation levels and keep your energy levels high – even when you don’t combine it with a low glycemic load or low carb diet! But together, a low glycemic plant foods diet and a daily fasting schedule can prevent some of the underlying metabolic changes that increase the risk of diabetes, obesity and cardiovascular disease.

Learn more about fasting for weight loss here.

6. Practice mindfulness, for example mindful eating.

Stress, especially chronic stress, is a major driver of weight gain as well as high blood pressure, insulin resistance and high blood sugar levels. But how, exactly, does stress do this? Your body responds similarly to all different kinds of stressors, including psychological ones. Stressful triggers, whether from a looming work deadline or a fight with a loved one, are processed by your brain. Your brain then sends electrical and chemical signals out to the rest of your body to help deal with the stress. This stress response makes your heart beat faster, makes your body break down stored fuels for energy, and generally gets your body ready to “fight, flight or flee.” 

The problem is that when stress is chronic – for example, when you ruminate or dwell on negative thoughts – lines of communication between your brain and your body can get crossed and go haywire. This can result in inflammation and insulin resistance, a condition you’ll remember from earlier where your cells are resistant to the action of the hormone insulin. Insulin resistance leads to further inflammation and an inability to keep your blood sugar levels in a healthy range. The result? You tend to gain weight while feeling lethargic and unlikely to exercise, along with other health issues. 

Stress can have other direct impacts on your eating patterns. Emotional or stress eating is a real phenomenon and is a risk factor for obesity. Stress often leads to us grabbing the closest available, most energy-dense foods we can find. Stress can also promote overeating. This is part of the reason why managing our emotions and stress levels is critical to maintaining a healthy weight.

The good news about stress and weight gain is that there are many strategies for stress management that can help us lose weight even when we don’t consciously change our diet. Mindfulness is one of these strategies.

When we can’t recognize our body’s internal cues related to hunger and satiety, we tend to eat outside of when and how much we biologically need to. We may eat when we are emotional or stressed, when other people around us are eating, when we are bored or simply when it is “time” to eat. 

Can you guess what most people’s top concern is when they consider a new weight loss intervention focused on diet? Based on feedback we get from our own LIFE Fasting Tracker users, they are most concerned that they will be extremely hungry and that this hunger will put them in a bad mood! Mindful awareness activities that focus on breathing and increased awareness of one’s own hunger cues and triggers that drive overeating can help people be more successful in their weight loss journey.

Formal meditation practice and informal mindfulness exercises in daily life, including mindful breathing and mindful eating, improve obesity-related eating behaviors such as emotional eating, binge-eating and restrained eating (avoiding certain foods as “bad”). Mindfulness meditation can help us better regulate our emotions and manage and recover from stress. It can also help us better recognize our automatic reactions and cravings and manage these with self-compassion instead of judgement. Instead of getting mad at ourselves for cheating or failing at a diet, mindful eating encourages us to consume the foods in the amounts that help us feel and perform our best.

In a 2018 review of 18 different scientific studies, people participating in mindfulness-based treatments lost about the same amount of weight – 8-10 pounds on average – as people who participated in programs focused on diet and exercise. But people practicing mindfulness had more sustained weight loss. 

“As the body’s biological stress response has been associated with increased feelings of hunger, preference for high fat and high sugar foods, and abdominal fat deposition, mindfulness meditation has also been proposed as a potentially useful intervention for individuals attempting to lose weight.” – Katterman et al., 2014

To practice mindful eating, enjoy your meals slowly and thoroughly in the company of others without screen distractions. Eating this way will help you better tune into what your body really wants and needs. 

Get started with mindful eating here and here. Tune into your hunger levels with this guided meditation.

7. Get more consistent sleep.

Inadequate sleep and staying up late are often triggers for overeating and eating foods with lots of sugar. Sleep loss also makes your body less able to keep blood sugar levels in a healthy range.

Sleep loss can also contribute to inflammation, stress and stress eating, which make full circle by predisposing us to insulin resistance!

Learn more about sleep for weight loss here.

 

Start tracking the 5 Pillars for health and weight loss – fasting, nutrition, exercise, sleep and mindfulness – and visualize your progress in the LIFE Extend app today.