The Epidemic Of Chronic Weight Gain And Rising Obesity
There are many reasons why we in the US and other western nations, and now also underdeveloped countries, have experienced a rising tide of obesity. We do eat more calories than in the 1950s –in some surveys, the American adult eats 500-700 calories more per day than 70 years ago. And yes, we are more sedentary. Our jobs are increasingly desk and computer-centered, with factory, farming, and manual jobs on the decrease or partially automated.
One of the biggest factors in our collective weight gain may be the changes in food processing and availability of food-like products, which produce addictive behavior, more hunger, and are so rapidly absorbed into the bloodstream that our blood sugars rise and fall repeatedly throughout the day, creating instability in glucose levels that tell the brain we need to fuel up again immediately. No one is suggesting we go backward and scrub our clothing over a sink, but we do need to manage the health consequences and costs of becoming a heavier and less healthy society, as well as figure out how to stall and hopefully reverse the trend.
The Link Between Weight Gain And Aging
Many of us begin a slow weight gain in our 20s and 30s that creeps upward, decade over decade…despite the fact that we are not doing anything that differently or “terribly wrong”. Almost 50% of us are overweight and 10% are obese. Some of us appear thin but are actually “under muscled” and have excess fat inside our abdominal space and around organs, called visceral fat, with chronic health problems that travel with high body fat such as high cholesterol, hypertension, inflammation, and many others. One hour of exercise doesn’t compensate metabolically for 15 hours of sitting.
With aging we gradually lose muscle mass, 3-5% per decade, accelerating at age 60 and even more rapidly at age 70 (15% loss per decade!), leaving us with a smaller “glucose sink” and a smaller metabolic engine. The same eating patterns that worked at age 30 typically will not work at age 50. However, a common reason for gradual weight gain may be this: something we call “uneven” eating – we eat almost half of our food from restaurants or takeout, vary our schedules (which creates hunger), snack irregularly, and although we might be pretty consistent and careful during the week, we often take the weekends off. And to top it off, we deal with an industrialized food supply, toxic oils, hidden sugars, and food engineered to make us eat more!
What Is Flexible Dieting?
If you have ever followed a nutrition guru into the latest diet fad or master cleanse, lost and regained the same weight multiple times, or worry that you can’t live without certain “banned” foods, flexible dieting may be for you. “Flexible eating” might be the preferred term, rather than flexible dieting because it describes a method of meal planning that can adapt to changes in your energy expenditure over time, and it can work for the rest of your life. Many professional athletes, bodybuilders, and nutrition experts use and teach this quantitative approach, and it has been around in one form or another since the 1950s.
Most people are familiar with Weight Watchers, which is an early version of flexible dieting, however, Weight Watchers does not specify protein intake, and recommendations are based on charts and average metabolic rates. A practitioner of flexible dieting will consider activity and fitness level, muscle mass, and adjust weekly based on results. The patient will learn how much to eat of their preferred foods, whether they are home or out. The goal of flexible dieting is to maintain muscle mass and lose mostly body fat. But flexible dieting can also be used to build muscle mass or for maintenance.
Many popular diet plans, when put into clinical trials where body composition is actually measured (including Weight Watchers, unfortunately) show that 30%-40% of the weight loss is actually lean tissue – mostly muscle. Muscle loss is a prescription for rebound weight gain, as our metabolic rate slows down with less muscle mass, and our caloric need shrinks. Flexible dieting, if practiced correctly, will track muscle and fat, incrementally raise or lower protein grams, will periodically “refeed” to avoid metabolic adaptation, and will include some strength training so that muscle is maintained. Maintaining lean tissue is one of the secrets to long-term control.
Even the new “miracle” weight loss injections (Ozempic, Wegovy, Mounjaro, for example) which have produced dramatic results for many weight loss-resistant patients, uniformly produce large amounts of lean muscle loss and uniformly result in regaining the weight once off the drug for one-two years. The STEP 1 and SUSTAIN 8 trials, where body composition was followed by DEXA Scan, showed that a scary 40% of the weight lost was lean muscle. If fat loss is dramatic, the overall effect can be a desperately needed decrease in body size, improved mobility, and some overall metabolic benefit, but patients with already low muscle mass (called sarcopenia) should be identified and begin a program to counter the lost muscle, which could later contribute to fragility and falls. Flexible dieting can also be a good fit following a dramatic weight loss, putting in place an eating plan that will stand up to long-term scrutiny.
What’s The Difference Between Rigid Dieting And Flexible Dieting?
“Rigid dieting” refers to an eating plan that restricts particular foods or food groups (for example, keto, paleo, vegan, gluten-free dairy-free) and may or may not be portion or calorie-controlled. Patients often report when they “break” rigid diets, they have difficulty getting back “on” the plan and crave foods that are not allowed. Flexible dieting, by contrast, is a plan that allows most foods, promotes clean eating, favors inclusion over exclusion, and then gives a “budget” for grams of protein, fat, and carbohydrates for the day.
Flexible eating can take you off the roller coaster, away from purchased food products or pre-packaged programs. It can save you thousands of dollars in nutritionist fees, program fees, and medical bills. There is a learning curve to become efficient, but the payoffs are substantial: we learn how much to eat no matter where we are or what we are presented with, as options. Flexible dieting is associated with a healthier attitude towards food and less tendency towards disordered eating and body image. It is also an excellent way to maintain lean tissue while losing mostly fat. It is completely adjustable, and it might actually take a few weeks to find the “sweet spot” of your macro settings.
There are several programs that certify coaches and nutritionists, and it is important to work with someone who can collaborate with medical-level metabolic testing, body composition testing, and lab review. We feel that once a patient is educated to avoid disease-promoting foods, such as overly sweetened foods, industrial seed oils, or heavily processed foods, they can make choices that fit their preferences while controlling portion sizes precisely to achieve specific daily goals. A bad day or cheat meal is treated calmly, sometimes even programmed in, and the eating plan continues as before with the next meal.
What Are the Goals of Flexible Dieting?
The goal is to find a way of eating that will work long-term, produce results, and avoid labeling certain foods as forbidden or intrinsically good or bad. We focus on the overall diet as being good or working as opposed to targeting a specific food. We also teach our patients how to adjust calories and macronutrients up or down so over time, they can take charge of their own eating plans. We also have “macro coaching” available for those who want to be coached weekly for the first 12 weeks in which we use apps, a digital scale, and barcode scanning to start out.
Flexible Dieting: A New Lifestyle That Puts You In Charge
Flexible dieting is not a fad, it is a new lifestyle. When you become well-versed in your body’s needs, you can absolutely operate without apps or tools when needed. The goal is independence, with lifelong good habits that promote optimal wellness, and then room for playing when those opportunities come around.
Rigid vs. flexible dieting: association with eating disorder symptoms in nonobese women by Tiffany M. Stewart, Donald A. Williamson, Marney A. White: https://www.sciencedirect.com/science/article/abs/pii/S0195666301904453
Impact of Semaglutide on Body Composition in Adults With Overweight or Obesity: Exploratory Analysis of the STEP 1 Study by John P H Wilding, DM, FRCP, Rachel L Batterham, MD, PhD, Salvatore Calanna, PhD, Luc F Van Gaal, MD,PhD, Barbara M McGowan, MD, PhD, Julio Rosenstock, MD, Marie T D Tran, MD, PhD, Sean Wharton, MD, PharmD, Koutaro Yokote, MD, PhD, Niels Zeuthen, MSc, and Robert F Kushner, MD: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089287/
Flexible Dieting: A Science-Based, Reality-Tested Method for Achieving and Maintaining Your Optimal Physique, Performance and Health by Alan Aragon: https://www.goodreads.com/book/show/60549985-flexible-dieting?from_search=true&from_srp=true&qid=2e0yP4c2eF&rank=1