BEYOND COUNTING CALORIES

Focusing solely on calories leads to restriction and feelings of guilt about mealtime. Here’s what actually works.

Your new fad diet isn’t working. The number on the scale hasn’t budged in weeks, and you’re starting to burn out—you can’t imagine eating another sad salad at your desk. All this calorie counting and restriction seemed to work in your favor at first, but lately, you want to throw out all the rules and hide out in the pantry. So you ditch the diet, only to restart the whole cycle a few months later.

If you find yourself hoping to lose weight but totally frustrated with the process, you’re not alone. A 2019 study by researchers from Columbia University surveyed nearly 500 women, 73 percent of whom reported losing and regaining a minimum of 10 pounds at least once. Other women said they’d lost and gained weight back up to 20 times in their lives.

Of the 17 percent of adults who report being on a “special diet,” most follow the same protocol: calorie restriction. While you’d be hardpressed to find a weight-loss program that doesn’t spit out a daily calorie goal to follow, more and more studies suggest restrictive dieting isn’t just frustrating; it’s also not a realistic way to reduce weight or ensure long-term health. According to a 2020 study in the British Medical Journal, many of the most popular diet programs can lead to initial weight loss—but almost all the positive effects people experience disappear after a year

That’s why many doctors and nutrition experts encourage a more holistic approach: a balanced, nourishing eating plan that includes all food groups, accompanied by a healthy, active lifestyle. Weight loss may come a bit slower when you’re not crunching the numbers, but as you throw calorie counting to the wind, you’ll enjoy the benefits of long-term health— and you can still enjoy your dessert.

WHY FAD DIETS FAIL

The premise of most traditional weight-loss diets is the same: Cut calories to shed pounds. Scientifically speaking, the approach makes sense: The body needs to burn more calories than it consumes to lose weight.  Theoretically, if you cut 3,500 calories a week, you could lose a pound during that time period; the greater the restriction, the more you could lose.

While this approach may work at first, experts say weight loss is more complicated than meticulously logging everything you eat. Jessica Shapiro, RD, CDN, associate wellness and nutrition manager at Montefiore Health System in New York City, says a person’s individual genetics , metabolism , gut bacteria, stress levels, and even sleep routine can all impact their weight (and the ability to lose it). Food choices play another important rolr in weight loss. According to Shapiro, not every calorie you consume is created equal. For example, a cup of blueberries and 13 gummy bears contain about the same number of calories. But while blueberries contain vitamins, fiber, and antioxidants, candy is totally devoid of important nutrients. Plus, because berries contain fiber, the body burns through the sugar content more slowly, allowing you to stay satiated longer. Simple sugars, like candy, cause blood sugar to spike and fall—and once your blood sugar levels plummet, you’ll only crave and eat more sugar, which could interfere with weight-loss goals (and potentially increase your risk for type 2 diabetes).

Even if your calories are mostly nutrient-rich foods, eating too few calories could be counterproductive, triggering your body to hold onto weight instead of  losing it, says Laura Bridge, MD, an internal medicine specialist at the Ohio State University Wexner Medical Center. The human body evolved to survive when food choices were slim, so Dr. Bridge says a state of deprivation can signal a person’s metabolism to slow down so the body holds onto calories and fat.

There’s an important psychological component at play, too. Restricting food groups or calories can incite a counterproductive pendulum swing. “If you tell yourself you can’t have something, chances are, you’ll give into cravings, eat more than you want to, feel guilty, and repeat the cycle,” says Garrett Swisher, RD, LD, a registered dietitian at Indiana University Health.

Along with deterring weight loss, weight cycling can negatively impact long-term health. For example, the 2019 study from Columbia found women who practiced “yo-yo dieting” had more risk factors for cardiovascular problems. Limiting what you eat could also put you at risk for malnourishment. Carolyn Kaloostian, MD, MPH, a family medicine specialist with Keck Medicine of the University of Southern California, says if a patient follows a restrictive eating plan, she worries about their vitamin and mineral intake.

Then, there are the mental effects of deprivation. To keep weight off, Dr. Bridge says, you’d have to maintain the same calorie restriction long-term, and being on a strict diet can take a major toll on emotional well-being—it’s hard to enjoy food and social events when certain foods are “bad.” Experts link weight cycling with psychological distress, and Shapiro says calorie counting can also increase people’s risk of disordered eating, body dysmorphia, and mental health concerns.

If restrictive dieting doesn’t work, why are so many people willing to make themselves miserable trying? According to Leah Groppo, RD, CDCES, a clinical dietitian with Stanford Health Care, many people prefer the instant gratification of an immediate change rather than the hard, slow work of making long-term lifestyle changes—and that’s precisely the problem.

To reap the benefits of long-term health, including weight loss, requires long-term behavior change. That won’t be easy if you’re miserable all the time. “If someone is following a diet for their long-term health and well-being, they have to find a way to make it enjoyable,” Swisher says. “You want these changes to be something people can maintain long term.”

HEALTH AT EVERY SIZE

Before you start reevaluating your eating plan for weight loss, address your mindset. The first thing to remember: Thin doesn’t always mean healthy. While some studies link obesity with an increased chronic disease risk, Dr. Bridge says she’s generally more concerned about a person’s overall health than their body mass index or the number on the scale—and that people at higher weights can be as healthy as thinner individuals. For example, she says, people at higher weights can have the same risk of mortality and health complications as someone with a lower BMI if they eat nutritious food and exercise frequently.

That’s one reason Swisher discourages focusing on cultural ideals that suggest being skinny is healthier or more attractive. Some people may simply have higher weights as a natural “set point”—the weight at which someone is comfortable and can maintain without excessive effort. Everyone’s set point is different, he says, and it’s likely tied to genetics. “This weight may not be the weight the media portrays we should be, but for our health and mental well-being, this is the weight that is best for us,” Swisher says. And if you try to work past your set point, he adds, you could be trying to achieve an unrealistic goal.

If your BMI is interfering with your ability to exercise or function in everyday life, for example, then it could be helpful to lose weight for your overall well-being. “But for the majority of us, the number on the scale is just one piece of the picture, and not necessarily the most important one,” Shapiro says.

Rather than attempting to quantify your health with your BMI, Dr. Bridge encourages considering other important metrics. How are your mental health and your relationships? Are you thriving in your work and personal life? Do you have energy to do all the things you want to do? What are your cholesterol, blood pressure, and blood sugar like? If you’re concerned about any of those areas, then talk with your doctor about your overall health and if a sustainable method of weight loss could be part of improving it.

A HEALTHIER WAY TO LOSE WEIGHT

If your doctor gives you the OK to try losing weight, a healthy mental framework is essential for long-term results. Rather than focusing on all the things you can’t or shouldn’t have, aim for positive framing—for  example, think about what you can eat and how those foods will encourage your well-being. “Two diets can be similar, but one has a restrictive spirit and the other has a more structured spirit to it,” says David Creel, PhD, RD, a psychologist and registered dietitian in the Bariatric & Metabolic Institute at Cleveland Clinic. “From a psychological standpoint, that difference is rea l ly i mpor t a nt .” Dr. Ka loost ia n u sua l ly tailors eating plans to patients’ unique risk factors— for example, if a patient is at risk for heart disease, she might encourage more low-cholesterol foods, and if a patient is pre-diabetic, an eating plan that minimizes sugar might work better. She also considers people’s lifestyles and what they can realistically maintain over time.

Once you and your medical provider identify what type of eating plan is best for you, think about how you can adjust your existing routine to fit it in. Groppo says when she works with people who want to lose weight, she encourages them to take stock of their habits. For example, if she chats with a client who’s so busy they rely on fast food for many meals, she’ll help them brainstorm convenient-but-nutritious meals.

While you may need to tweak your routine a bit, Swisher recommends including all categories of food in your eating plan. Diversity of food isn’t just important for nutrition; it can also help with weight loss. Shapiro suggests mixing protein, fat, and carbohydrates at meals to slow down their absorption, keep blood sugar levels steady, and prevent sugar cravings down the road. Creel suggests lots of vegetables, lean cuts of meat, plenty of whole grains, and some dairy and healthy fats as core components of a balanced eating plan. Rather than focusing on calorie content, think more about food quality. “When you focus on healthful foods, your body functions better and you crowd out unhealthier food,” Shapiro says. According to a 2019 study in Cell Metabolism, people tend to naturally consume fewer calories when they eat whole foods rather than ultra-processed foods.

A mindful eating approach can help promote health, too: Try to focus on inner cues, like your own hunger, rather than what’s left on your plate. “There’s a lot of research that says if we eat too fast or we’re distracted while eating, we’ll eat more than we ought to, and we won’t enjoy it,” Dr. Kaloostian says. Listening to your body also means enjoying the occasional treat. Dr. Kaloostian encourages a moderate approach: For example, rather than eating a donut every morning for breakfast or having a glass of wine at night, you could save those things for special occasions.

In addition, Creel says exercise is a critical component of keeping weight off. While diet yields a lot more weight loss than exercise in the short run, studies by the National Weight Control Registry suggest keeping weight off requires both a healthy diet and plenty of exercise. “The body is much better at burning calories when you’re physically active,” Creel says. Habit changes might lead to slower change, but Groppo says consistent, small changes are far better for chronic disease management than losing weight fast. For instance, a method called the Diabetes Prevention Program encourages people to lose 5 t o 7 percent of  their body weight over the course of six months through healthier eating and more exercise—and that amount can lower people’s blood sugar enough to reduce their risk of diabetes. “Gym and weight-loss culture feed on this idea that you have to implement drastic changes to be healthy, but when you look at the research, you may not need such drastic changes as people tell you,” Groppo says.

No matter where you are in your health journey, keep your primary care provider involved every step of the way. Dr. Kaloostian says a good PCP will help you define and achieve realistic goals for your longterm health based on who you are as a person. And as you focus on nourishing your body, be kind to yourself—and never adopt an eating plan that compromises well-being in other areas of your life. “How you eat shouldn’t be burning you out or making you feel worse,” says Dr. Kaloostian. “If it is, then it’s not the right approach for you.”