Last week we replaced the question “does eating more help you lose weight?” with an even better one: “what regulates our weight in the first place?” And is it even food?
As it relates to nutrition, there are two accepted theories about why some people are in bigger bodies compared to others. We talk about which theory makes sense with our available research, and which one doesn’t – as we continue chatting our way through a review paper from a prominent researcher in the weight loss world.
Melissa breaks down the limitations – and findings – of the current available population studies, as well as diet intervention trials as they relate to weight and diet.
She talks about why Intuitive Eating professionals come to different conclusions about what current research data means compared to weight loss researchers.
Melissa talks about ways you can be open, but critical, to new research findings from the weight loss world so you don’t fall trap to more diet culture thinking.
Melissa also helps you consider what to do instead of dieting, if you agree it’s not effective for your health.
She offers 4 health behaviors that benefit everyone, regardless of body size, and shows you how to work on your nutrition as a lifelong, n-of-1 self-study using your body cues as data to decide which nutrition, movement, and self-care choices best line up with your personal health values.
If you loved this 2 part series – Melissa wants to know! Rate, review, or dm her on Instagram @no.more.guilt to tell her how you are using the episodes in your Intuitive Eating work.
- In this episode Melissa discusses a review paper by Dr. Kevin Hall and colleagues, you can read it here: https://academic.oup.com/ajcn/article/115/5/1243/6522166
- She also mentions a specific meta analysis of 121 dietary intervention trials that was selected as one of the works reviewed in Dr. Hall’s review paper. You can look at the original meta- analysis here: https://www.bmj.com/content/369/bmj.m696
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This episode was sponsored by No More Guilt with Melissa Landry. Reminder that though we are dietitians, we’re not *YOUR* dietitian. Podcasts don’t constitute treatment. If you have concerns about your dieting behaviors, seek out guidance from a medical or mental health professional. And if you’re looking for the process, support, and focus you need to live life without food guilt apply for a coaching program from today’s sponsor. No More Guilt with Melissa Landry is currently enrolling clients into 1:1 programs, group programs, and, recently added a do-it-yourself learning format: the Ex-Dieter’s Guide to No More Guilt.
does eating more help you lose weight? [part two] transcript
Melissa Landry 0:02 Hi there, I'm Melissa, a registered dietitian specialize in intuitive eating for on again off again, chronic dieters, and I'm here to help you take the guilt and stress out of eating so you can be the first in your family to break the diet cycle. I'm interested in helping you unlearn generational diet trauma, so you can be who you are without food guilt. Be sure to follow on Instagram at no more guilt for more support between these episodes. Are you ready? Let's jump in. Hello, welcome back to break the diet cycle. It's been a week since we opened Pandora's box in a pursuit to answer a question that some of you may have seen out in the world, which is, does it help you to lose weight if you eat more? I told you last episode, I find the question confusing at best and problematic at worst. And so what we are in the middle of doing is exploring a research paper by Dr. Kevin Hall. That actually helps us answer that question by asking a better question. So instead of asking, Does eating more help you lose weight? We're going to ask what even regulates weight in the first place? And what does the evidence say about weight regulation over time, if you haven't listened to last week's episode, this would be a great time to pause, go listen to that one. And then jump back right here where you left off. If you were with us last week, I'll remind you we covered a few topics that we're going to just pick up and get running with today. I used to be able to remember everything anyone ever told me at all times. And as I age that is slowly diminishing into the sands of time. So that's you to let me recap you quickly on the topics we covered last time. First, we talked about two different models or theories that exists to describe why some people may be in bigger bodies and others. The first one was the energy balance model. And I made it clear to you that it's not so simple as describing weight regulation as calories in calories out, or eat less move more as diet culture messages it, I guess it's not so simple to say eat more or lose weight either, which is the whole reason why we're here talking about this. The energy balance model is a neutral way of describing labeling how bodies regulate themselves, I don't have a problem with it. So far, we've learned just because we can describe it doesn't mean we can manipulate it, intuitive eating folks and weight loss folks use this theory. The only difference is intuitive eating providers are going to help you make peace and work with your metabolism or body. While weight loss folks believe that they can help you intervene or manipulate the body differences there. The second theory that we talked about was the carbohydrate insulin model, which basically says carbohydrates are the enemy. If you eat too much, and you eat the wrong type, you're going to feel more hungry, you're going to eat more and your weight will be driven up. We're starting to see through different types of research studies that the carbohydrate insulin model doesn't seem to have a lot of repeatable evidence. So we're going to pick up where we left off there. Last episode, we talked about rat studies and genetic studies. And this episode, we're going to move forward talking about population studies. And the world I came from with your dietary intervention studies. By the way, if at any time, you're like, What is she? I don't know the definition. I'm confused. You have permission to DM me on Instagram, no more guilt. Go ahead and ask a question. As you guys know, when you DM me sometimes I post the answers to those questions right on my feed. And we can keep an ongoing conversation because I think this is a pretty meaty topic we've endeavored on today. So feel free to message me with any of your questions as we go go through this. Okay. So what is a population study? A population study says, let's pick a group of people. And let's try to describe this group of people the best we can. So we want to know their age, we want to know their economic status. Or maybe we want to know other aspects that would describe them. And the reason why we are going to do this is so that we can control for any known variables that might be hidden in our population. Population Studies cannot prove causation. So population studies can't say, you know, eating bananas causes diabetes, a population study couldn't really say that. It could say there is an association between eating bananas and diabetes. By the way, guys, that's an example that's not a real thing. Please eat bananas. That is why research studies are going to do their best when it's a population designed to understand who we're talking about. There's a lot of criticism of how that part of the research is done. socio economic status doesn't necessarily encompass one's exposures to racism, their access to medical care, it doesn't necessarily talk about the impact of weight stigma, or other social determinants of health. And so you will see, I think, going forward, more attention to that in the research and at your doctor's offices. But the current state of the research hasn't done a great job of controlling for those factors. So I just want to put that in our minds as we pursue this information. The second thing a population study is going to do is ask a question, right? So, so similar to my silly example, a moment ago, what's the relationship between bananas and diabetes? And if we did that, we might take that population and interview them and say, Hey, how many bananas do you eat a week, except they'd say it nicer than that? I just said it in a way like I caught you in an alley. And I was like, Hey, how many bananas you eating in a week, all confrontational, they would be much more neutral and normal about it than I just was. But you get the point. We need to know how many bananas the population are eating, then they're going to come up with some metric for diabetes in our pretend study, they'll say, Huh, tell me you're a one see that your last Doc's visit. And that's how they're going to try to make a relationship between the number of bananas folks eat and the prevalence of diabetes when they interview them sidebar. This is why BMI is so hard to scrub from population studies, because it's super cheap and super easy to measure height and weight. And so when people get funding, they like BMI, because it's easy to use. Who cares if it's accurate, right? Population Studies are flawed. And they are incredibly important to what we know about nutrition, they have made impacts on public health, especially in nutrition. Sometimes we just need to kind of capture some associations, so that we can make new ideas or hypotheses for dietary intervention trials, which we'll get to in a moment. So this is a stepping stone of research to help us pursue what's going on. Of course, nutrition is incredibly complex health is incredibly complex, human beings are incredibly complex. And as much as we might try to classify in people in these lumps or groups, you will find that what happens is that we make averages of these groups. And sometimes those averages don't necessarily reflect the range of experiences within the groups themselves. Just like when we talked about rat studies, there are limitations to population studies. We're going to continue on our discussion, and we're going to take our information as if it were truth, okay, just like diet culture does, they take those headlines, and they take the data as if it were absolute truth. So we're going to do that today. And we're going to see what Dr. Kevin Hall in the paper we've been reviewing, summarized through his research review. And here's what he found. By doing a review of population studies, he found that the average intake in the US from the average adult shows a, quote, remarkable stability in the intake of calories from carbs, fat, and protein. And so even though the, quote, obesity epidemic is occurring, and there's a lot of concern, when we do these population studies, for all their limitations, we actually see a stabilization in carbs, protein and fat. And that's important, because remember that second theory that said, Oh, well, you know, carbohydrates are probably driving weight gain in populations, and therefore, we need to change how people eat carbs. That's not really showing up at the population level. And further, the study shows that around 2000, there have been improvements in diet quality, like substituting refined for whole grains that's improving in our population as a whole. And there has been a reduction in sugary beverages. There are two possible nuggets here. One is that our dietary intake is like about the same as it's always been. And the other is that maybe it's even improved to have more whole grains and fewer sugary beverages on average. Imagine that. Then we look at physical activity, there are actually not great sets of data related to physical activity on a population level compared to nutrition. Still, one thing that Dr. Hall noted is that urbanization or moving from rural to city areas has increased since 1985. But we don't actually see BMI trending with that. So his his whole thing is like, well, more people are living in cities. And cities would mean that people maybe aren't moving around as much because you know, they're staying in their neighborhoods, they have public transportation, they have cars, maybe the effects of urbanization, right food deserts and fast lifestyles and access to all this palatable food right? Or maybe the built environment isn't as walkable for them. We actually see obesity trends are more are increasing more So in the rural versus urban areas, so he's just kind of pointing out like we don't have a lot of data on physical activity to say one way or the other, if that's driving, weight changes, or weight itself. And furthermore, what we would expect to be happening based on all our theories about why people aren't moving, it's really showing up at the population level. So he finishes this whole thing to say, there are probably a lot more drivers of weight gain than just nutrition and movement. And they would include access to food, economic factors, and he says, technological transitions. I did click in on this, and we'll learn what the heck's up technological transition. I wonder if that encompasses the use of smartphones, you know, work from home, all that different stuff that kind of keeps us more in one place rather than naturally moving to his summary. There is not a lot of evidence that carbohydrate intake explains differences in body weight. And recent trends don't support that carb would be the main driver of the US obesity epidemic, as it is defined. And you're kidding, if I'm not going to remind us the limitations of BMI in all of these studies. When people make blanket statements, like you're not moving enough, you're eating too many carbs, you're eating the wrong number of calories, at least by the population studies, we don't have data to confirm that we're gonna move on to a different type of study. But let's just clock it right here. A lot of morality and biases and judgments and ideas about food and bigger bodies come from studies like these. And then it becomes part of your inner voice, which beats you up 24/7 with guilt about what you are not doing. We're not done reviewing this research. But right now, if you're going, oh my goodness, I care about health. And this pressure I've been putting on myself, it actually doesn't reflect health as we know it in rat studies, genetic studies, and now population studies. So we got to do our work to talk about dietary intervention trials. Next. They're the most powerful research studies, we have to really confirm our thinking. I'm getting brain tingles right now, by the way, and I just want to remind us, though, it does seem tempting to want a black and white answer about nutrition and health and size, and why things are the way they are. But we don't know what we don't know. And I'm building a case for you now to consider that though these data are interesting and definitely worth knowing. And especially if you're interested in it, if it if it like pleases you to learn about this stuff, we don't have enough to point at you and say, Hey, you make sure you're eating more and eat less carbs. All those things that your food police tell you are not so far by our review of the studies here are not rooted in evidence at the generalized level. And what that might mean is that your best bet is actually being aware of nutrition science and read science and research, make an informed guess, and living your life in a way that you are pursuing the way of eating that's going to make you feel your best. And Intuitive Eating is perfectly matched for that type of approach. Because what it does is it says, Hey, like, how are you feeling in your body right now? Not just hunger and fullness? Is the food pleasing you? What are your energy levels? And how does that link to your health values? So if you value diabetes prevention or management, yeah, maybe we want to look at those lab values and experiment in an informed way. Maybe if you're worried about your mobility, we experiment in an informed way. It's not here to say that focusing on the weight is going to necessarily allow you the outcome of weight loss based on what the research says. So a lot of people find peace in that to say, look, I don't know about intuitive eating. It definitely scares me. It's definitely a different approach. But I've seen over and over and over again, not just from my lived experience, but from the research that this way isn't working. So why would I repeat what's not working? Why would I do that? Maybe I can become an expert in myself. Let's switch gears to our next type of study, which are dietary intervention trials. Intervention just means that medicine nutritionist, whatever the researcher is going to come in and prescribe a change. An intervention trial could be a medication, right? So what could happen is one group gets no medicine, they get what's called a placebo. And the other group gets the pill. That's the most basic simple version of an intervention trial, or a randomized control trial. And they complete the intervention and then they they compare what happened with the placebo. What happened with the intervention group? If we see a significant difference, we know that the medication or the pill that we gave actually caused the A lot of removal of a symptom or the treatment or the cure, however we've defined it, it's a little bit easier to do that when the only variable is pill or no pill. It's a lot harder to do that when the variable is not dieting, or dieting, following whatever diet I've prescribed, because that diet is super complex. And it's unlikely based on human nature, that we're going to robotically eat that diet in the exact same way every single day. It's also very difficult for us to control factors such as movement, or, you know, other elements of human health as it relates to nutrition. So incredibly difficult to do randomized control trials, and oh, God love the scientific community. They pursue it anyway. We love scientists for this reason, right? They, they go forth, even when it's hard, even when it's imperfect, I would agree that some data are better than no data, right? We wouldn't say, Well, this was hard. So we're not going to try to study nutrition. That's silly. Why would we do that? I love nutrition science. I was in the research community, I really value the people that do this work. The problem becomes when we allow bias, or we allow our ideas of what's supposed to happen to drive the ship. That's where we find ourselves as we talk about the state of the research. And I'm actually going to use the studies that Dr. Kevin Hall in his review chose and I'm doing this because we have a weight loss researcher who believes in the value of weight loss, this person wants to figure it out. And so I would really, like let's let's talk their language here for a second and say, Alright, well, what studies did you find? And what did you think about the state of dietary intervention trials? There were quite a few that that Dr. Hall mentioned, but I'm going to pick the ones that were most surprising to me. Like I said, I will leave the link for this in the podcast episode, look at it with your own eyes, if it's interesting to you. The first thing that Dr. Hall points to is that a meta analysis of 53 randomized control trials of greater than one year, tried to compare low fat versus high fat dietary interventions, there was no significant difference in the average weight loss between those two diets. When you do a meta analysis, that's a pretty rigorous process, there's a group of people who go through and they say, we're only going to let research trials of really similar properties or similar qualities be part of this. And if they're not, they don't meet the criteria, that study gets booted. It's not part of the analysis, it doesn't matter how good it was, or what it found. There, comparing and collating information of like, with, like 53 trials is a lot of trials. It's a lot of human beings that we're looking at. And we have some confidence that they were rigorously done, they were properly done. And after a year, there were no differences between the low or the high fat diet when it came to weight loss. There was another analysis of 121 trials found that there was no difference in weight loss at six months for low, moderate carb, as well as low fat and usual diet controls. By the way, that 121 meta analysis I clicked in, because he's summarizing to say, like, yeah, there was some modest weight loss, but it didn't matter which diet happened. So I was like, Well, how much weight did these people lose? And when I clicked in on this, I see some very important information here. The weight loss observe was only about five to 10 pounds. And it says right here, no diet significantly improved HDL cholesterol, or C reactive protein, which is an inflammation, marker, and weight loss diminished to 12 months among all the patterns. So Dr. Kevin Hall is summarized and say, Oh, it's six months, there was equal weight loss across all the groups, but at 12 months, that weight loss started to diminish, and there weren't improvements in HDL cholesterol or C reactive protein across any diet. The benefits disappeared. And this is consistent with another trial called the lookahead trial that I talked about on my feed a couple of weeks back that said, Look, even if folks lose weight, modest amounts five to 10 pounds, that doesn't necessarily mean that their cardiovascular risks improve. Fascinating, fascinating, which makes us ask the question, why do we need to solve the problem of weights? If losing weight is difficult to maintain? And it does not improve our outcomes long term? Why do we need to solve that interesting question? The science is a mess all that Dr. Hall could definitively say A was that factors other than macronutrient composition, meaning how much carbs, protein, fat, and factors other than glycemic load, meaning how fast are the carbs hit your bloodstream play important roles in influencing energy intake and our weight status. That's all that he could definitively say. And this is why I kind of like this guy is even though he's thinking inside the weight loss universe, he's one of the few researchers I've come across it actually summarizes things as they are, it doesn't look like carbs, protein, fat or glycemic load, make a big difference. Can you believe? Can you believe Can you believe how much of our eating is organized around the perfect car, the perfect protein, perfect glycemic load, and we don't even have meta analyses to show that that is true. I'm not saying we should not try to improve the health of our population of folks in bigger bodies who face health concerns. I'm saying in a generalized way, how much fat carb protein you're eating, manipulating the glycemic load, cutting your calories, raising your calories, all this tinkering isn't amounting to anything, various levels of research, starting with rat studies, all the way up to dietary intervention trials, we don't have any evidence that says it works reliably, repeatedly. And for all bodies, which is why I'm frustrated that for all my respect for Dr. Hall and his balance summarization of the research coming from his universe, I'm frustrated that he ends his review paper by saying, Look, this energy balance model, I think it's real, it's not so simple as calories in calories out. There are a lot of factors at play, and we don't even know them all, nor how they work. If the scientific community wants to say we've done it, we have a way of describing why some people are bigger than others. Well, we're not there yet. And I agree with him. I even agree when he says carbohydrates aren't the enemy. I think he's right about that. Where I disagree is when he says is that there's something driving obesity. And we need to figure out what is causing this and figure out why some people are bigger than others. He says answering these questions will result in improved public health and medical interventions for prevention and treatment of obesity. And actually, that's not the right takeaway. In my opinion, it's one thing to say we don't have a way of describing why some people are bigger than others. Same for tallness. We don't know why some people are taller than others. We make evolutionary assumptions and we move on with our lives. Where everything falls apart is this idea that if we don't solve it, everyone will be unhealthy. That attitude keeps setting us up for failure, right? We keep getting more studies that tell us the same thing. Instead of creating funding and opportunities for brilliant smart researchers who just hold bias, to have opportunities to actually study what improves the health and well being of folks and bigger bodies that matters to me, it matters to me because my mom is in a bigger body. My clients are in bigger bodies. And I'm tired of watching. Tired of watching them stuck in the balance between making doctors and society feel more comfortable with their size, and choosing their actual comfort. This is what has me saying do better to all the research community. And while we figure out doing better, I know that you are going to be more effective talking back to the food police, that tells you, you are bad, your eating is bad your body is wrong. When you have the research to back you up. It's why I'm so passionate about what I do with clients. It's why I make podcast episodes like this. I know you care about health. And I know that every single message you've ever heard has told you that being in a smaller body and weight loss are the paths for you to achieve health and freedom hasn't been true yet, by your lived experience and looks like the research backs your experience up. When you see people on the internet saying blanket statements like you need to increase your protein or eat more calories to lose weight. Know that they are probably drawing on a theory. They are probably drawing on one or two research trials that maybe take place over six months, or maybe are in association or maybe it just uses a population that doesn't represent you. Be wary of these blanket generalized statements and instead, use what we do know generally speaking to guide your health behaviors. This is the principle of health enhancement that comes from Health at Every Size. So what can we do if we want to improve our health? Some of you may have seen my Venn diagram image where half of the Venn diagram says listen to your body cues. And the other half of the Venn diagram says, work toward your health values. When I work with people, I'm doing two things with them, I'm helping them to hear and listen to their body cues. And I'm helping them blend those cues as signals to tell them how are they doing? How are their food and movement and self care behaviors working for them or not. And if they learn that the behaviors aren't working for them, then I help them to consider that other side of the equation, which is your health values, so that you can blend your current experience with what you want in the future. And you can figure out the action steps to get yourself from where you are to where you want to be. That's exciting to me. And I would say that's how we can approach most things that life. If you can do this around food, you can do it in your career, and your relationships, and your hobbies, and anything that's important to you. So there's so much value in becoming an intuitive eater. You stop repeating the madness of diets, and you learn a new way of being that helps you take your body seriously, take your cue seriously, take your experience seriously. toward health. That's where we come back to something we talked about a couple episodes ago. What is the future you want? What is the future you want? If you want health, get cracking on defining that and then work to identify the behaviors that linked to that health outcome. Sometimes you'll hear on Instagram or for me, what what a smaller person do? You know, if you were in a smaller body and had concerns for cardiovascular health? Weight Loss wasn't on the table wasn't an option? How would you go about it? Would you even care? I appreciate you so much you spent what close to an hour plus geeking out over the research with me. We talked about pretty complex scientific theories. I want you to imagine yourself and like a graduation cap and gown and you can take the tassel from right to left. Is that how you do it? Or is it left to right I forget what the tradition is. At any rate, you've been primed about the different types of research how applicable different types of research already you in your life, and how to just be a better consumer of nutrition information when you're on Instagram scrolling. And if you're doing an intuitive eating journey, right now, you have a little bit more confidence, a little more oomph in your step to trust your body cues and your health values to help you make choices. I know you're probably like slamming your steering wheel right now. Or if you're cleaning, you're like cleaning that one spot over and over again. Because you're like, Why isn't she telling me what the behaviors are? I get it, no diets. But what do I do instead? Please, Melissa, just tell me the answers. Live. There are answers. But they're unique to you. And I'm a dietitian. But I'm not your dietician. And so I'd have to know you better to really say, still, I want to give you some pointers today, we know that there are four behaviors that do link to reduce mortality, or less incidents of death. No matter what size you are, those four behaviors are eating fruits and vegetables consistently and adequately not smoking, alcohol intake, zero to one drinks for women and zero to two drinks for men each day. And lastly, is enough physical activity. If you are saying I want to work on health, those would be a place to start. And if you can't pursue those behaviors, without dieting coming in, and grabbing the steering wheel and leading you towards guilt, extremes deprivation, intuitive eating has steps and you know, things you can do to unlearn that. So you do that stuff effortlessly. Right? It's just like a way of being it's not a diet or a lifestyle, whatever, whatever the new term is. So that's what I want you to think about how are you going to react the next time you're scrolling? And you see someone make that blanket statement? You need to eat more protein, do you that person doesn't know you. And there's nothing from the studies that say that that's going to make an impact on your weight, nothing from the studies that that's going to make an impact on your health. Let's start turning ourselves into what I like to call an n of one study. You are always researching yourself. You have permission to change what's not working you permission to learn new things. And you can root your experience and how you feel that's okay. That's important. My friends this concludes our two part series trying to answer the question Does eating more help you lose weight? I gave you more than you bargained for but I'd much rather you be the kind of person who can think for themselves about nutrition going forward. Hope that helped you helped it make you feel empowered. And if you need more tailoring clarity or support, you know where to find me. Next week, we're going to come back with some more client interviews. So I'll give you a break from my voice in the meanwhile. Be good to your body. Well See you next time You still here? I am too. And the reason for that I was hoping I was hoping if you just have one second, just one second will you go to wherever you're listening this podcast and rate five stars leave review. Maybe even take an extra step and DM me at no more guilt. And let me know what you thought of today's episode if you are finding benefit. Your messages helped me to improve to get this out to more people, so we can keep breaking the diet cycle together. Okay, I'll let you go now. For real. You hang up first. Transcribed by https://otter.ai