Month: September 2021

In a perfect world, indulging in a daily portion of French fries instead of almonds would be a simple choice, and no negative consequences would stem from selecting the salty, deep-fried option.

But a Harvard expert says we should take the findings of a new study supporting this scenario with, er, a grain of salt. This potato industry-funded research suggests there’s no significant difference between eating a 300-calorie serving of French fries and a 300-calorie serving of almonds every day for a month, in terms of weight gain or other markers for diabetes risk.

Perhaps snacking on fried potato slivers instead of protein-packed almonds won’t nudge the scale in the short term, but that doesn’t make the decision equally as healthy, says Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. Crunchy, satisfying almonds deliver health benefits, including lowering “bad” LDL cholesterol. Over the long haul, they’re a far better option to help ward off chronic illnesses — including diabetes — or delay their complications.

“We’ve learned from many studies over the past two decades that weight loss studies lasting less than a year are likely to give misleading results, so a study lasting only 30 days is less than useless,” Dr. Willett says. “For example, studies of six months or less show that low-fat diets reduce body weight, but studies lasting one year or longer show the opposite.”

What health-related factors did the study measure?

The study was published in the American Journal of Clinical Nutrition. The researchers randomly split a group of 165 adults (average age 30; 68% women) into three groups for 30 days and assigned them to eat a daily 300-calorie portion of one of the following:

• almonds, roasted and salted (about 1/3 cup)
• plain French fries (medium serving)
• French fries seasoned with herbs and spices (medium serving).

Researchers provided participants with 30 single-day portions of their food item, telling them to incorporate it into their daily diet but offering no additional instructions to change diet or activity levels to offset the 300-calorie intake.

The amount of fat in participants’ bodies was measured, along with total weight, blood sugar, insulin, and hemoglobin A1C (a longer-term reflection of blood sugar levels) at both the start and end of the month. Five participants from each group also underwent post-meal testing to evaluate short-term blood sugar responses.

Weight isn’t all that matters to health

After 30 days, changes in the amount of body fat and total body weight were similar among the French fry and almond groups. So were glucose and insulin levels measured through blood tests after fasting.

One key difference emerged, however: participants in the French fry sub-group had higher blood glucose and insulin levels just after eating their fries compared with the almond eaters.

It’s tempting to conclude there’s not much difference between fries and almonds — it’s the calories that count. But closer reading reinforces the notion that two items generally placed on opposite ends of the healthy food spectrum are still farther apart than study findings might have us believe.

“The one clear finding was that consumption of French fries increased blood glucose and insulin secretion much more than did almonds,” Dr. Willett says. “This is consistent with long-term studies showing that consumption of potatoes is associated with an increased risk of type 2 diabetes, especially when compared to whole grains.”

In today’s calorie-rich, ultra-processed, movement-sparing, chronic stress-inducing, so-called “toxic” environment, losing weight is hard work. But implementing a healthy and sustainable approach that keeps the weight off is even harder.

Short-term weight loss can be easier than long-term weight maintenance

Most of us can successfully achieve weight loss in the short term. But those who hop from one fad diet to the next often experience the metabolic roller coaster known as yo-yo dieting that jacks up our hunger hormones, plummets our metabolic rates, and causes a vicious spiral of weight loss followed by regain. Even most medical interventions to help treat obesity produce the typical trajectory of rapid weight loss followed by weight plateau and then progressive weight regain. In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained. This means that based on our best estimates, only one in five individuals who is overweight is successful in long-term weight loss.

What is so special about weight loss maintainers?

Based on studies from the National Weight Control Registry, a database of more than 4,000 individuals who have maintained at least 10% body weight loss for at least one year, we have insight into some tried and true tactics. These include various energy intake-reducing behaviors — limiting calorie-dense foods and sugar-sweetened beverages, portion control and a consistent eating pattern across days, increased fruit and vegetable consumption — as well as being physically active for at least an hour per day.

This makes sense and is consistent across the scientific literature. Any successful weight loss necessitates tipping and keeping the scale toward greater energy expenditure and less energy intake (a net negative energy balance). But how do these people actually sustain those weight loss-promoting behaviors over time, in order to build a lifestyle that does not leave them feeling persistently deprived, lethargic, and hangry (hungry + angry)?

The most important determinants of weight loss maintenance are those that cement changes in behavior. As more recent evidence confirms, the proper psychology for weight loss is critical for regulating the physiology that supports weight loss.

Self-regulation and self-efficacy are key to long-term success

Only recently have we started to evaluate the psychological and cognitive determinants of weight loss maintenance. We all have anecdotal evidence from family, friends, and colleagues. But systematically collecting, processing, and analyzing the qualitative experiences, strategies, and challenges from successful weight loss maintainers is difficult.

The data to date confirm the importance of self-regulation, and in particular self-monitoring of the day-to-day behaviors that drive energy intake and energy expenditure, especially eating behaviors. Those who have high self-efficacy (belief in your capacity to execute certain behaviors) for exercise in particular are more successful at sustaining weight loss. And more recently, researchers have been decoding elements of the proper mindset that instills high self-efficacy for the larger constellation of important weight management behaviors.

One recent study used machine learning and natural language processing to identify the major behavioral themes — motivations, strategies, struggles, and successes — that were consistent across a group of over 6,000 people who had successfully lost and maintained over 9 kilograms (about 20 pounds) of weight for at least a year. Among this large group, they consistently advised perseverance in the face of setbacks, and consistency in food tracking and monitoring eating behaviors, as key behavior strategies. And most of them stayed motivated by reflecting on their improved health and appearance at their lower weight.

Studies about successful weight loss miss many people

The evidence suggests that age, gender, and socioeconomic status are not significant factors in predicting weight loss maintenance. But most weight loss studies oversubscribe white, educated, and midlevel income-earning females. Given that the prevalence of obesity and its related comorbidities is disproportionately higher in more socially disadvantaged and historically marginalized populations, we need richer, more representative data to paint a full and inclusive picture of a successful weight loss psychology. We need to better understand the lived experience of all people so that we can determine the most powerful and unique motivations, effective behavioral strategies, and likely challenges and setbacks, particularly the environmental determinants that dictate the opportunities and barriers for engaging in and maintaining a healthier lifestyle.

Maintaining weight requires multiple tools, training, and support

What we can say for certain is that for any and all of us, maintaining weight loss necessitates getting comfortable with discomfort — the discomfort of occasionally feeling hungry, of exercising instead of stress eating, of honestly deciphering reward-seeking versus real hunger, and resisting the ubiquitous lure of ultrapalatable foods. This is no easy task, as it often goes against environmental cues, cultural customs, family upbringing, social influences, and our genetic wiring. In order to help each other achieve health and weight loss in our modern environment, we need to learn and practice the psychological tools that help us not only accept, but eventually embrace, this inevitable discomfort.

Two things I have accomplished, in different realms, seem like they would require entirely different skill sets, yet I have discovered an unexpected overlap. The first is overcoming a vicious addiction to prescription painkillers, and the second is training to be a health and wellness coach. The common skills and practices of these two experiences include

• a focus on gratitude for what is going well in my life and for those around me
• mindfulness and presence in the moment
• engaging in healthy habits: exercise, good nutrition, and, ideally, sleep (not my specialty!)
• connection with others, open and honest communication, and empathy, including self-empathy.

Additionally, a critical component to attaining the serenity and focus one needs to be a wellness coach, and to move past an addiction, is learning how to recognize and defuse the cognitive distortions that we all employ. Cognitive distortions are internal mental filters or biases that increase our misery, fuel our anxiety, and make us feel bad about ourselves. Our brains are continually processing lots of information. To deal with this, our brains seek shortcuts to cut down our mental burden. Sometimes these shortcuts are helpful, yet in other circumstances — such as with these unhelpful cognitive filters — they can cause more harm than good.

Unhelpful thinking and why we do it

Ruminative thinking — negative thought patterns that loop repeatedly in our minds — is common in many psychiatric disorders. This type of thinking also contributes to the unhappiness and alienation that many people feel. One certainly doesn’t have to have a psychiatric diagnosis to ruminate unhelpfully. Most of us do this to a certain extent in response to our anxieties about certain situations and challenges. Rumination can represent an ongoing attempt to come up with insight or solutions to problems we are concerned about. Unfortunately, with the presence of these cognitive filters, it can devolve into a counterproductive and depression-worsening type of brooding. These unhelpful filters make whatever life circumstances we find ourselves in that much more anxiety-provoking and challenging.

What are unhelpful cognitive distortions?

The main cognitive distortions are as follows (and some of them overlap):

• Black-and-white (or all-or-nothing) thinking: I never have anything interesting to say.
• Jumping to conclusions (or mind-reading): The doctor is going to tell me I have cancer.
• Personalization: Our team lost because of me.
• Should-ing and must-ing (using language that is self-critical that puts a lot of pressure on you): I should be losing weight.
• Mental filter (focusing on the negative, such as the one aspect of a health change which you didn’t do well): I am terrible at getting enough sleep.
• Overgeneralization: I’ll never find a partner.
• Magnification and minimization (magnifying the negative, minimizing the positive): It was just one healthy meal.
• Fortune-telling: My cholesterol is going to be sky-high.
• Comparison (comparing just one part of your performance or situation to another’s, which you don’t really know, so that it makes you appear in a negative light): All of my coworkers are happier than me.
• Catastrophizing (combination of fortune-telling and all-or-nothing thinking; blowing things out of proportion): This spot on my skin is probably skin cancer; I’ll be dead soon.
• Labeling: I’m just not a healthy person.
• Disqualifying the positive: I answered that well, but it was a lucky guess.

Emotional reasoning and not considering the facts

Finally, many of us engage in emotional reasoning, a process in which our negative feelings about ourselves inform our thoughts, as if they were factually based, in the absence of any facts to support these unpleasant feelings. In other words, your emotions and feelings about a situation become your actual view of the situation, regardless of any information to the contrary. Emotional reasoning often employs many of the other cognitive filters to sustain it, such as catastrophizing and disqualifying the positive. Examples of this may be thinking:

• I’m a whale, even if you are losing weight
• I’m an awful student, even if you are getting some good grades
• My partner is cheating on me, even if there is no evidence for this (jealousy is defining your reality)
• Nobody likes me, even if you have friends (loneliness informs your thinking).

How do you challenge and change cognitive distortions?

A big part of dismantling our cognitive distortions is simply being aware of them and paying attention to how we are framing things to ourselves. Good mental habits are as important as good physical habits. If we frame things in a healthy, positive way, we almost certainly will experience less anxiety and isolation. This doesn’t mean that we ignore problems, challenges, or feelings, just that we approach them with a can-do attitude instead of letting our thoughts and feelings amplify our anxiety.

As someone who used to be an expert in getting tripped up by all these filters, I’ve learned to remind myself that whatever comes up, I’ll deal with it as well as I can. I try to trust my future self to cope, in an effective way, with whatever life will throw my way. As such, there’s no reason to worry about potential future problems in the here and now. If I worry about what might happen, then I have two problems: whatever hypothetical challenge that might not even come up in the future and a lot of unhelpful anxiety to contend with. As they say in the science fiction masterpiece Dune, “fear is the mind-killer.” Being anxious or afraid certainly makes me less effective, no matter what I’m trying to accomplish.

A wise therapist once told me, as an example, if someone cuts you off in traffic, they are just cutting off a random car, not you, because they have no idea who you are. So there’s no reason to take it personally. To personalize situations like this just makes you upset. If you don’t take it personally, it changes it from “jerk cut me off” to “people should drive more safely.”

I also avoid unnecessary catastrophizing (though this can be difficult when thinking about all that is happening in our world, including climate change). Above all, I try not to slip into emotional reasoning. None of us are devoid of all emotions that could undermine our logical processes. Everyone backslides and falls into old habits. We aim for progress, not perfection.

If you can set yourself free from these unhelpful cognitive filters, you will be more successful, more relaxed, and more able to enjoy your relationships.

Getting support to managing cognitive distortions

If you need assistance with challenging cognitive distortions, professionals such as therapists and coaches are skilled at helping people change unhelpful ways of thinking. If you are unable to find or afford a therapist or a coach, there are other resources available, such as apps to help with mindfulness and cognitive behavioral therapy, mutual support groups, group therapy or group coaching (which can be less expensive than individual treatment), employee assistance programs through your job, or online communities. Your primary care doctor or your health insurance may help connect you with other resources.

Most people want to feel energized and experience a sense of vitality. In the 1970s, Dr. John Travis created a spectrum of wellness, with illness on one side, a point of neutrality in the middle (when a person has no signs or symptoms of disease), and on the other side wellness.

Wellness is a state of health and flourishing beyond simply not experiencing illness. In this state people feel confident, open to challenges, curious, and thirsty for action. They are thriving. People who experience wellness may seek to hike a mountain, read a new book, learn how to play a new instrument, or actively connect with new people.

The most common health conditions facing people today include heart disease, stroke, diabetes, and cancer. When people are experiencing these (and other) conditions, they fall into the illness side of the spectrum. Lifestyle factors that put you at risk for developing these conditions include smoking, alcohol substance use disorder, lack of exercise, sleep deprivation, and a diet rich in processed foods, sugar, saturated fat, and artificial flavors. An unhealthy weight is another factor that can put one at risk for these conditions, especially carrying extra weight around your midsection.

To move to the wellness side of the spectrum, you can include more movement in your day; enjoy a whole-food (unprocessed), plant-predominant style of eating; avoid smoking; sleep seven to nine hours a night; practice stress reduction techniques like deep breathing, yoga, meditation, tai chi, and mindfulness; and spend time with family and friends.

Think about what your body can do for you — and what you can do for your body

People of many sizes and shapes can be healthy and well, especially when they are connected to a calm mind that is practicing mindfulness, self-compassion, and a growth mindset. A body that is in the neutral point on the wellness spectrum can move to the side of thriving and flourishing when healthy lifestyle habits are adopted and sustained, and that has little to do with your body’s shape or size.

The body neutrality movement emphasizes the incredible functions, actions, and physiology of our bodies without regard for how our bodies look. We can see, hear, smell, taste, and feel. We can jump, skip, sing, hug, and dance. Our muscles have mitochondria that give us energy.

Our digestive system is one example of the wondrous process of the body. The digestive system has billions of microbes living in it that help us to ferment fiber from vegetables, fruits, and whole grains, and create short-chain fatty acids that help us with energy metabolism, glucose metabolism, lipid metabolism, inflammation, immunity, and more. This is why it’s important to eat fiber, including whole grains, vegetables, and fruits.

Connected to our bodies are our brains, and they are full of neurons (brain cells), synapses (connections), neurochemicals, and hormones that help to protect brain cells and make new ones. Moving our bodies helps to increase these chemicals. In addition, moving our bodies regularly helps us to increase serotonin, which may help us feel less anxious and depressed. Hugging increases oxytocin in the brain, and this “love hormone” helps us feel a sense of belonging and bonding. The body’s actions have a powerful impact on the brain, and vice versa.

Body positivity versus body neutrality

Body positivity is a movement that invites people to appreciate the body size and shape they have now without worrying about unrealistic body standards. With body positivity, society’s unhealthy standards for body shapes and sizes are challenged. It’s also important to remember that cultural norms and what’s considered an ideal body change with time.

The goal with body positivity is to honor and appreciate all body types, especially your own body. Feeling confident about the way you look feels good and can be empowering.

With body neutrality, the focus is on the function of your body: finding happiness and fulfillment, appreciating the power of our muscles, the strength of our bones, the protection our skin offers, and the rewards of the dopamine system in our brains. Connecting with friends and family, reaching small, meaningful goals, and enjoying physical activity are healthy ways to approach your body. A focus on finding pleasure in the wellness journey will serve your body — at any size — and your brain.

Remember all the things your body can do for you

• Transport you from one place to another (quickly or slowly)
• Release neurochemicals that give you pleasure, like from hugging a loved one
• Move your arms and/or legs with joy following the rhythm and beat of music
• Take deep breaths to calm your mind
• Perform stretches that release endorphins
• Practice yoga, tai chi, or qigong, which can help calm the body and mind.