Many people have experienced rapid weight loss through food poisoning or a seasonal illness, but you can also become underweight through injury, as Lynne explains:
“You can lose weight through an injury that has used muscle and body fat to recover and repair itself, such as a burn. Even something like a head injury from an accident has a high energy requirement. Pre-existing conditions such as cystic fibrosis or epidermolysis bullosa have high inflammatory responses, so people with these kinds of disabilities consume large amounts of energy, and are often very underweight.”
Should you ever need to put some pounds on, a reliable way is to drink high protein / energy milkshakes in between meals. These can be prescribed from a doctor or dietitian, or you can buy some in health shops. Making your own may be cheaper, and it’s probably preferable, as some of the prescribed drinks are not the easiest things to gulp down.
You could get quite creative making your own milkshakes or hot chocolates, adding different ice creams and creams to taste. Adding protein powders tops up the goodness in these drinks too, and if properly stirred in, unflavoured powders are not noticeable. Milky puddings like custard and rice pudding or even full-fat yoghurts also make a nourishing – and comforting – addition to your menu. Snacking on nuts can be beneficial as they’re packed with protein, energy, vitamins and minerals, and they don’t fill you up, so won’t spoil your meals.
A careful balance also needs to be met with physical activity and exercise. You cannot avoid running around, going to work and generally living, so it is important the food you are taking in is sufficient to keep you going, like fuelling a machine. Yet by doing too little you could lay down too much fat, and while some fat is necessary, you need a balance between gaining fat and muscle.
People who have to gain weight may be scoffed at for saying how much more difficult it is than losing, but it’s true. It’s a hard slog that takes a long time, especially when you’re low in energy and tired and still recovering from something. Possibly the only people who gain weight joyously are film actors. Gaining 30lbs for a million dollar film role would be preferable than regaining weight lost through chemotherapy or some such.
Boxes of Krispy Kremes aside, if you have been through it, what would you recommend for increasing your mass, should any readers ever need to? Do you have any secret recipes for high protein milkshakes, or a filling dessert that’ll bring you back to health? Do share – or on second thoughts perhaps you’d better just make enough for everyone …
- How to Gain Weight the Healthy Way
- Being Underweight May Be About More Than Just Not Eating Enough
- Being Underweight Can Lead to Health Problems
- Here’s How to Gain Weight in a Healthy Way
- So You Got Sick and Lost a Few Pounds
- 5 Ways to Gain Weight In a Healthy Way
- Healthy Ways to Gain Weight If You’re Underweight
- Path to improved wellness
- Things to consider
- Why Do You Regain Weight After Losing It?
- How Long Does It Take For You to Regain Weight Back?
- Maintaining Weight Loss After You’ve Reached Your Goal
- Why do dieters regain weight?
- What does calorie deprivation do?
- What is the role of willpower?
- Why is weight regain misunderstood?
- What should people do?
How to Gain Weight the Healthy Way
Being overweight gets a lot of attention — and deservedly so. It’s a serious health risk for both adults and children, leading to soaring rates of type 2 diabetes, heart disease, and stroke, among other health problems. But being underweight can lead to just as many and just as serious problems as weighing too much.
Being underweight, according to the Centers for Disease Control and Prevention (CDC) is defined as having a body mass index (BMI) under 18.5. It means you’re not getting the calories you need — and you may be missing out on key vitamins and nutrients your body needs, too. Weighing too little can lead to growth problems (especially in kids and teens), fragile or weak bones, a weakened immune system, anemia, fertility problems, and a host of other complications.
Also, a study published in April 2014 in the journal BioMed Central Public Health found that underweight individuals have an increased risk of dying from external causes, such as accidents or suicide, compared with individuals who were not underweight. The study followed more than 31,500 individuals, including 945 who were underweight, for 32 years.
This article breaks down everything that can cause people to be underweight, the health problems associated with being underweight, and ways to gain weight that are safe and healthy.
Being Underweight May Be About More Than Just Not Eating Enough
Being underweight can be a result of not eating enough calories, or it can be a result of other health problems, says Eric Feigl-Ding, PhD, nutrition scientist at the Harvard T.H. Chan School of Public Health in Boston. Some of those problems can cause an individual to lose their appetite, consume fewer calories, and lose weight, while other problems cause weight loss even if someone doesn’t change their eating patterns.
Some common causes of being underweight include:
Genetics Some people are born with a naturally speedy metabolism or small appetite, meaning they are less likely to be heavier than others.
Being Very Physically Active Lots of physical activity means you burn more calories than people who are not as active. If you’re an athlete, work out a lot, or work in a job where you’re very active, you likely require more calories on any given day to fuel your body than you would if you were less active.
Illnesses Many conditions, including thyroid problems, diabetes, digestive diseases — like Crohn’s disease or irritable bowel syndrome — and cancer, can cause individuals to become underweight. Your doctor can help identify other symptoms and make the right diagnosis if this is the case for you.
Some Medication Prescription and over-the-counter drugs may cause nausea and weight loss, or reduce appetite, which can lead to weight loss.
Stress Feeling stressed, overwhelmed, or constantly worried can affect appetite and weight loss. These feelings can be caused by work, relationships, or another life event.
Depression and Other Psychological Issues Depression, anxiety, and any mental health condition can interfere with healthy eating patterns and appetite — and affect weight.
Body Image Issues Body image fears and distortions can quickly turn into an eating disorder, which can lead to weight problems and nutritional deficiencies.
Smoking Smoking can dampen appetite, making smokers more likely to be underweight, Dr. Feigl Ding says.
Being Underweight Can Lead to Health Problems
“People who are underweight are often not quite healthy, though this doesn’t mean that by definition being underweight means that you’re sick,” Feigl-Ding says. But there are some health issues that can be directly caused by being underweight. They include:
Compromised Immune System People who are very thin due to compromised nutrition or malnutrition can’t store energy, making it tougher to fight off infection.
Delayed Growth and Development Kids and teens need energy and nutrients, which they get in food, to grow and develop, both physically and mentally.
Compromised Fertility Women with very low BMI may stop menstruating or have irregular periods, which may make becoming pregnant more difficult, Feigl-Ding says.
Osteoporosis The risk for more brittle bones and bone loss — the definition of osteoporosis — is higher in thinner people, in part because of possible deficiency of vitamin D and calcium. But also the thinner you are, the less mineral-building good stress you put on your bones, which helps to strengthen them and protect against deterioration.
Anemia A very thin person’s diet may be lacking in iron, resulting in anemia.
Here’s How to Gain Weight in a Healthy Way
To gain weight, you’ll need to consume more calories than you burn off, so that means you need to eat more. But overdoing it on cheeseburgers, french fries, and chocolate croissants — though it may increase your calorie intake — isn’t going to do your long-term health any favors, and may cause stomachaches or headaches if you’re not used to eating those types, combinations, or volumes of food.
First, think about how you eat. Do you consume food off your plate until you’re not hungry anymore, or until you’re full? “Often, people who are very thin stop eating when they no longer feel hungry,” says Feigl-Ding. But if you want to put on some weight, concentrate on eating until you actually feel full; you’ll end up consuming more calories that way. The idea is not to binge or gorge, but to amp up how much you eat each sitting, he says.
You should also aim to put the pounds on slowly and consistently. Too quick, and you may be putting too much stress on your metabolism, which can also throw it out of whack and make it even tougher to conserve calories — meaning it will start to burn off those extra calories you want to keep. “Think about if house movers dumped a whole load of boxes in your living room; it would take a while to unpack, and you might be overwhelmed,” explains Feigl-Ding.
It’s also important that you focus on good-for-you, nutrient-dense foods, particularly those that are high in calories, like nuts, dried fruits, some dairy, and starches, when you’re filling your plate and snacking.
Here are some tips for gaining weight safely if you are underweight:
Don’t just consider calories. Try to make most things you consume nutrient dense, not just high calorie. “Load up on good carbs, like whole grains and lean protein,” says Feigl-Ding.
Eat more often. If you find you fill up fast, eating five or six meals a day can help you add in calories without being overwhelmed. Some or all of the meals can be smaller as long as you’re upping the total number of calories you’re consuming by the end of the day.
Eat fat — the good kind. Unsaturated fats are both high in calories and nutrient dense. Foods high in unsaturated fats include avocados and nuts. Try adding avocados to sandwiches and snacking on or adding nuts to salads.
Add calories when you can. Sprinkle some high-calorie nuts in a salad or extra cheese in eggs to up the calorie (and nutrient!) content.
Drinks matter. Avoid sugar-laden drinks, like soda and sweetened tea and coffee. These fluids’ calories are “wasted” because they have no nutrient value, and can stop you from consuming other, healthy food. The exception would be nutritious drinks, like smoothies (just keep out added sugars) or plain milk.
Lift weights. Building muscle through a strength-training routine can help you add pounds, and exercise itself can be a good appetite stimulant.
Finally, if you’re underweight and want to gain weight, consult with your doctor or healthcare provider to help you find the best strategy for you. Eating patterns are likely to play an important role in your weight gain plan, but it’s also important to remember that if it’s medication, an illness, or other underlying problem that’s causing you to be underweight, eating differently may not solve the problem.
So You Got Sick and Lost a Few Pounds
Last week I spent most of my time being vomited and pooped on, and cleaning/laundering other things which had been vomited and pooped on. Let’s just say it wasn’t one of my high points. Both Sweaty Baby & Sweaty Kid came down with some terrible, head-spinning-360-degrees, Exorcist kind of sickness. That’s Sweaty Kid to the left… I pretty much didn’t leave the house for almost 96 hours and could barely get hand to mouth to feed myself, resorting to quick carbs and cup after cup of coffee.
Upside? I lost a pound or two.
Downside? Seriously, do I have to revisit the whole getting vomited and pooped on thing?
Not dramatic enough? Did I mention that cleaning the furniture/children/floor took priority over cleaning myself? OK, maybe TMI..
Now, getting back to that pound or two that I lost. When you are sick or otherwise incapacitated (as when caring for a sick relative although not really sick yourself), it is normal to lose a bit of weight as you’ll generally consume fewer calories than you would normally consume to maintain your weight. If you are ill for more than a few days, this can be a marked weight loss. Sick for a week and it might be as much as 4-5 pounds. Sick longer and you should really be speaking with your doctor, not your personal trainer.
If you’ve been sick and you’re not interested in losing weight, increase your calories for the week after an illness and you can easily regain any pounds lost. But if, like me, you’re happy to see the number dip down on the scale a bit, you might be wondering whether you can maintain that “sickness weight loss”.
First, you should know that approximately half of the weight you’ll lose when sick is fluid weight, so you can expect to gain back about half of what you’ve lost within a day or two of recovering.
Here are a few tips if you’d like to hang on to that lower weight and you’re feeling back to your old self:
1. Head to the gym. Or out for a walk or jog. Or do one of the various home workouts available on my . Your body is fatigued, maybe a bit weak and probably a little stiff. Ease into it but begin exercising immediately, and focus especially on cardiovascular activities during the first 1-2 weeks to help you build your endurance back up and strength training to wake up those stiff muscles and rev your metabolism back up from its previous zombie-like levels. Not feeling up to much? That’s okay! Small daily workouts will do you better in the metabolism department than a couple of strenuous 2-hour gym visits, anyway. Consistency is key as you get active again.
2. Get your fluids. If you weren’t eating, you likely weren’t hydrating well enough, even if you were drinking water, juice, tea, Gatorade – whatever you were thirsty for while sick. The truth is, a major portion of our fluids come from healthy foods like fruits and vegetables. Incorporate watery foods like soups, milk, yogurt, and lots of citrus fruits, melon, and salad vegetables which have a high water content. These foods will not only hydrate you, they tend to be relatively low in calories while still high in nutrients, so they’ll help satisfy you, hydrate you and keep your calories low enough to maintain that weight loss.
3. Watch your binge reflex. After not eating much for a few days (or more) you may find your appetite is smaller than normal. On the other hand, you may find you are ravenous and find it difficult to control your eating as your body tries to recoup calories lost. Ease yourself back into a full, healthy diet and focus on nutrient-rich but lighter fare like salads, soups, lean meats and fishes and fibrous veggies, fruits and nuts & seeds (which can also help get your digestive system moving happily again if you’re feeling a little, um… backed up). Eat to your hunger level, not to your appetite. Eat frequently and aim for smaller meals, as your stomach has probably shrunk a bit. You’ll be more comfortable and more likely to keep off those pounds lost.
Lucky for me, I’ve found a week of body-fluid-showers seemed to have had some sort of permanent effect on my appetite. Or maybe it’s the smell of puke that just won’t seem to leave the house.
After a week in the house with the kids, though, I am trying to keep an eye on my “wine reflex.”
Just a note here: if you are suffering an extended period of illness and losing a great deal of weight or are experiencing very rapid and unintentional weight loss, please consult your doctor.
5 Ways to Gain Weight In a Healthy Way
Most of the people I meet ask for my advice about how to lose weight, but some of my clients are actually trying to pack on pounds, and it’s not as simple as it may seem. Every once in a while I’ll read about an actor who had to gain weight for a role, and they talk about how awesome it was to down pints of ice cream, pasta, bread, cheeseburgers, and doughnuts. That’s one way to gain weight, but it’s not the best way. (Related: More Women Are Trying to Gain Weight Through Diet and Exercise)
I sometimes work with clients who’ve lost weight due to dental surgery, a digestive problem, stress, or an illness, and are trying to get back to a healthy weight. And as a sports nutritionist, I also work with pro athletes who tend to lose weight over the course of a grueling season. In all of these cases, the goal is to gain weight while optimizing health-and there’s a science to it. After all, the old phrase “you are what you eat” is absolutely true-nutrients from food are literally the raw materials your body uses to construct new cells. A junk food–filled diet devoid of nutrients doesn’t give your body much to work with. I always say it’s like constructing a house with cardboard and tape instead of bricks and mortar. In other words, it’s not just about calories.
Here are five “good gain” rules I share with my clients:
1. Don’t let more than four hours go by without eating.
Your body needs a continuous supply of energy since it’s like an engine that’s always turned on (your heart is always beating, blood is circulating, your brain and muscles are working). When you skip meals, you deprive your body of the fuel it needs to keep going. The result is a dip into your energy piggy bank, which unfortunately includes muscle mass. The best way to prevent your body from losing any important tissue is to eat regular meals, spaced about three to five hours apart. If you’re trying to gain new muscle tissue, meal timing is especially critical. Sometimes my clients tell me they “eat all the time,” but when they actually start keeping a food journal they realize just how erratic their patterns are. Consistency is key. (Related: The Muscle-Building Foods to Eat for More Definition)
2. Eat several foods at once.
Always aim for at least three food groups. Instead of just a banana or a handful of nuts, top a few slices of whole-grain toast with almond butter and banana slices (which, BTW, is Khloé Kardashian’s go-to post-workout breakfast), along with a glass of organic skim milk or a milk substitute. A wider variety provides your body with a broader spectrum of nutrients to work with throughout the day.
3. Eat healthy, but dense foods.
The best way to rack up extra nutrition without having to eat huge quantities of food or resort to junk is to choose nutrient-rich foods that pack a lot of carbohydrates, protein, or fat into a small serving. Dried fruit is a great example. With the water removed, the portion shrinks by about 75 percent, so a cup of grapes turns into a quarter cup of raisins. Just be sure to look for dried fruits with no added sugar or preservatives. For another nourishing, power-packed snack, fold rolled oats, dark chocolate chips, and minced dried fruit into almond butter. Spoon out portions about the diameter of a quarter, roll them into little balls, wrap in waxed paper, and snack on them throughout the day. (Related: 3 Easy-to-Make Protein Ball Recipes That Will Replace Those Boring Bars)
4. Drink your food.
Liquids aren’t as filling as solid food, so when you’re trying to gain weight, they can add nutrition without making you feel stuffed or bloated. Good choices include 100 percent fruit juice, organic skim milk or milk alternatives (such as organic soy, or hemp), and smoothies. Smoothies are ideal (over milkshakes) because you can bolster them with all kinds of good stuff, like wheat germ, nut butter, carrot juice, and protein powder. (Try Emma Stone’s high-calorie, post-workout smoothie for gaining lean muscle.)
5. Eat right before bed.
A lot of our healing, repair, and regeneration takes place while we sleep. It’s like rush hour for building muscle and lean tissue, so eating a healthy snack right before bed ensures a fresh supply of nutrients that are available to “go to work” inside the body. A great option that won’t leave you feeling stuffed might be a small bowl of pasta salad made with 100 percent whole-grain pasta (wheat or a gluten-free alternative), vinaigrette made with extra-virgin olive oil, chopped or shredded veggies, and a lean protein such as beans, chopped chicken breast, or an organic crumbled cheese.
Healthy Ways to Gain Weight If You’re Underweight
Weight loss is a serious issue in the United States. Consumers constantly see advertisements and news reports on trendy diets, flashy products, and magic pills promising to help them lose weight.
Given that the ongoing “battle of the bulge” is front and center for so many people, being too thin may seem like a good problem to have. But the reality is that being underweight can cause health problems.
Path to improved wellness
Fat has a bad reputation for causing people to be overweight and obese. However, not all fat is bad. In fact, breaking down and storing energy (calories) as fat is good. It’s just one of the many ways the body uses food to function, heal, and grow.
Stored energy from fat helps you get through a strenuous job or workout. It plays a key role in brain development, and in preventing inflammation (swelling) and blood clots. Fat contributes to healthy hair and skin, as well.
You can determine whether you are underweight by using a Body Mass Index (BMI) calculator. This online tool considers your weight, height, age, and gender to calculate a score. If your BMI is less than 18.5, you are underweight. Your doctor also can help determine if you’re underweight based on your height, weight, what you eat, and your activity level.
Your doctor may put you on a weight gain program if you are underweight. However, this is not permission to go crazy with junk food. Healthy weight gain requires a balanced approach, just like a weight loss program.
Eating junk food may result in weight gain. However, it will not satisfy the nutrition your body needs. Even if the fat, sugar, and salt in junk food doesn’t result as extra weight, it can still harm your body. For a healthy weight gain, the following tips can help:
- Add healthy calories. You don’t need to drastically change your diet. You can increase calories by adding nut or seed toppings, cheese, and healthy side dishes. Try almonds, sunflower seeds, fruit, or whole-grain, wheat toast.
- Go nutrient dense. Instead of eating empty calories and junk food, eat foods that are rich in nutrients. Consider high-protein meats, which can help you to build muscle. Also, choose nutritious carbohydrates, such as brown rice and other whole grains. This helps ensure your body is receiving as much nourishment as possible, even if you’re dealing with a reduced appetite.
- Snack away. Enjoy snacks that contain plenty of protein and healthy carbohydrates. Consider options like trail mix, protein bars or drinks, and crackers with hummus or peanut butter. Also, enjoy snacks that contain “good fats,” which are important for a healthy heart. Examples include nuts and avocados.
- Eat mini-meals. If you’re struggling with a poor appetite, due to medical or emotional issues, eating large amounts of food may not seem appealing. Consider eating smaller meals throughout the day to increase your calorie intake.
- Bulk up. While too much aerobic exercise will burn calories and work against your weight goal, strength training can help. This includes weightlifting or yoga. You gain weight by building muscle.
Before beginning a weight gain program, talk to your doctor. Being underweight may be due to an underlying health problem. It won’t be corrected by diet changes. Your doctor will be able to help you track your progress. He or she will make sure that healthy changes are taking place.
Things to consider
People who are underweight typically are not getting enough calories to fuel their bodies. Often, they are also suffering from malnutrition. Malnutrition means you are not taking in enough vitamins and minerals from your food. If you’re underweight, you may be at risk for the following health issues:
- Delayed growth and development. This is especially true in children and teens, whose bodies need plenty of nutrients to grow and stay healthy.
- Fragile bones. A deficiency in vitamin D and calcium, along with low body weight, can lead to weak bones and osteoporosis.
- Weakened immune system. When you don’t get enough nutrients, your body cannot store energy. This makes it difficult to fight illness. It may also be difficult for your immune system to recover after being sick.
- Anemia. This condition can be caused by not having enough of the vitamins iron, folate, and B12. This can cause dizziness, fatigue, and headaches.
- Fertility issues. In women, low body weight can lead to irregular periods, lack of periods, and infertility.
- Hair loss. Low body weight can cause hair to thin and fall out easily. It also can cause dry, thin skin and health issues with teeth and gums.
Many underweight people are physically healthy. Low body weight is due to a variety of causes, including:
- Genetics. If you’ve been thin since high school and it runs in your family, it’s likely that you were born with a higher-than-usual metabolism. You also may have a naturally small appetite.
- High physical activity. If you’re an athlete, you probably know that frequent workouts can affect your body weight. However, high physical activity also can be a part of an active job or an energetic personality. If you’re on your feet a lot, you may burn more calories than people who are more sedentary (inactive).
- Illness. Being sick can affect your appetite and your body’s ability to use and store food. If you’ve recently lost a lot of weight without trying, it may be a sign of disease, such as thyroid problems, diabetes, digestive diseases, or even cancer. Talk to your doctor about sudden weight loss.
- Medicines. Certain prescription medicines can cause nausea and weight loss. Some treatments, such as chemotherapy, can reduce appetite and worsen weight loss from illness.
- Psychological issues. Our mental well being affects every part of our lives. Things like stress and depression can disrupt healthy eating habits. Severe body image fears and distortions can lead to eating disorders. If you’re suffering from damaging emotional issues, talk to your doctor. He or she can help you get the care, assistance, or counseling you may need.
Questions to ask your doctor
- How do I gain weight if I’m not hungry?
- Is being underweight more serious for babies?
- What are some affordable, healthy foods to help me gain weight?
- Should I stop exercising if I am underweight?
- Should I stop taking my prescription medicine if I am underweight?
- National Heart, Lung, and Blood Institute, Calculate Your Body Mass Index
- U.S. National Library of Medicine, Body Weight
How long it takes for you to get to your goal weight all depends on your body and your weight-loss methods. Generally, you can healthily lose half a pound to two pounds in a week, Jim White, RD, owner of Jim White Fitness and Nutrition Studios and ACSM-certified personal trainer, told POPSUGAR in a previous interview. So, after five weeks, you may see a loss of up to 10 pounds. It’s also all about sustainability (which we’ll touch on more later). Put simply, if you start a routine of restrictive dieting and working out that you can’t maintain in the long-term, maintaining the weight you’ve lost will be incredibly difficult. Ahead, we spoke to two experts on why it’s easier to regain weight after you’ve shed pounds and how to avoid it.
Why Do You Regain Weight After Losing It?
Your metabolism actually slows down when you lose weight. Eduardo Grunvald, MD, FACP, medical director of the UC San Diego Weight Management Program, explained that our bodies are biologically evolved to defend against weight loss, not weight gain. “When your metabolism is slowed down and your hormones are telling your brain to eat more, it is much easier to wind up with a calorie surplus than it is to have a calorie deficit during weight loss. In other words, it takes a lot of effort to fight our biology, but not too much effort to help it do what it wants to do, regain the lost weight.”
Dr. Grunvald said that there is some evidence that when you regain lost weight, you’re actually going to gain a higher percentage of fat mass than you started with. It’s not completely clear why that is, he said, but “it may be that your appetite and weight regulation centers in the brain are hyper-stimulated until your fat mass or lean body mass returns to baseline. When that happens, you’ve already gained a lot of fat mass back.” Plus, as he mentioned before, it’s easy to eat in a calorie surplus after weight loss because your metabolism has already slowed down.
Holly Lofton, MD, director of the Medical Weight Management Program at NYU Langone Health, further explained, “The body is essentially designed or evolved to tolerate only certain amounts of famine, aka caloric restriction, before it starts slowing metabolism down and, thus, we stop losing weight and we gain it.” Your body goes into preservation mode and increases your hunger hormone, too, she said. When you lose weight, your body still works the same physiologically and will respond to food and exercise the same way it did before, “but there’s less of you,” she noted, “so your caloric requirements are lower.” If you wind up eating more when you actually need fewer calories, the weight will come back on. Here’s one way to calculate how many calories you should be eating per day for maintenance.
Going off of that, if you’ve reverted back to your old lifestyle habits, or just stopped working out and/or eating well, your body will respond accordingly. “If you’ve lost weight and now your lifestyle changes in the wrong direction, then you’re going to see very rapid weight regain,” Dr. Grunvald said. “Most people tend to think about weight loss as a finite endeavor, where you’re going to lose weight in six months and then you’ll be good. And that’s usually not the case because as soon as you stop the vigilance, your weight will usually come right back up.”
How Long Does It Take For You to Regain Weight Back?
Dr. Grunvald said it depends on the person and the circumstances, but if you’ve reverted back to your old habits, you’ll gain the weight back “a lot faster” than you originally lost it. Dr. Lofton agreed that if you weren’t actively trying to maintain your weight after you reached your goal, you’d gain the weight back much faster than if you tried maintaining it. It’s hard to say exactly, Dr. Lofton admitted, but “definitely within less than a year, you can regain all of the weight back.”
She also pointed to a study published in the New England Journal of Medicine that showed that even people (overweight or obese) who tried to maintain their weight, after going on a partial liquid diet for 10 weeks and being given strict, personalized instructions for calories to eat and exercise to do afterward, regained a majority of the weight back within a year follow-up period. The authors of the study wrote that their findings, which delve into appetite and hormones, suggest that a “high rate of relapse among obese people who have lost weight has a strong physiological basis and is not simply the result of the voluntary resumption of old habits.” (It’s important to note that those patients underwent a rather short-term and intense diet regimen; they didn’t lose weight over the course of a year or longer.)
Maintaining Weight Loss After You’ve Reached Your Goal
Dr. Grunvald said that people who’ve lost weight and kept it off for a long time find success in increasing their physical activity — this is based on data collected from the National Weight Control Registry (which he talked more about with us in a previous interview). Dr. Lofton agreed that increasing your activity is a good idea.
She explained, “Your metabolism is slower because you’re a smaller person so, as you’re losing weight, you need to create a deficit.” When you’re trying to maintain the weight, you have to stay isocaloric, meaning you don’t need a caloric deficit by burning more calories than you take in; you just need to be consistent in how many calories you’re eating. “If that’s 1,200 calories and one day you eat 1,300, it’s not a big deal if you’re exercising 200 off every day,” Dr. Lofton said, adding, “So even if you have those days where you eat a little bit more, if you’ve created some deficit with exercising, it can all even out over the course of a week or a month.”
But, if you eat over your calories a little bit every day without considerable amount of exercise, that will lead to weight increase over time, Dr. Lofton said. “Even if you had 10 M&M’s a day, over a year that’s going to lead to 10 pounds weight gain. So that’s a small change in calorie intake that can lead to a big change in weight,” she explained. “Whereas if you’re exercising, you can create some sort of deficit where you can afford those extra calories on some days.” Dr. Lofton also noted that though your metabolism slows down when you lose weight, you can boost it after the fact by gaining muscle.
A few slip-ups won’t hurt you — though, again, it depends on a lot of factors and depends on the person, Dr. Grunvald noted, stressing that you really need to be vigilant if you’re looking to maintain your weight. “Weight loss is a chronic management effort. It’s a marathon, not a sprint,” he said. For example, he pointed out, some people will get frustrated if they reach a weight-loss plateau — which you can get out of by adjusting your exercise routine and/or calorie intake — and will give up on their weight-loss goals altogether.
From the beginning of your weight-loss journey, pick diet changes that work best for you and ones that you can easily maintain after you’ve reached your goal. Do the same for your workout regimen. That also goes for maintenance, too, as mentioned earlier. This way, your body won’t be shocked if you want to increase your activity along with your calorie intake post-weight-loss, Dr. Lofton noted. And, Dr. Grunvald concluded, “People have to find the right balance between leading a healthy lifestyle, but not making themselves miserable so that they can’t keep up with the behavior changes.” Sounds good to us.
Image Source: Getty / Guido Mieth
Why do dieters regain weight?
(Photo: Lisa Miller) Traci Mann is professor of psychology at the University of Minnesota. She received her PhD in 1995 from Stanford University and spent the early years of her career on the faculty at UCLA. She moved to the University of Minnesota in 2007 and started the Health and Eating Lab, which applies basic research in social psychology to health problems in individuals’ daily lives, primarily in the area of dieting and the self-control of eating. She is the past president of the Social Personality and Health Network, and the author of “Secrets from the Eating Lab: The Science of Weight Loss, the Myth of Willpower and Why You Should Never Diet Again” (2015).
It is well established that dieters are able to lose weight in the short run, but tend to gain it back over time. In 2007, the graduate students in my Psychology of Eating seminar and I did a painstaking review of every randomized controlled trial of diets we could find that included a follow-up of at least two years (Mann et al., 2007). Janet Tomiyama, Britt Ahlstrom, and I updated it in 2013 with studies we had missed, as well as newer ones (Tomiyama, Ahlstrom, & Mann, 2013). The results were clear. Although dieters in the studies had lost weight in the first nine to 12 months, over the next two to five years, they had gained back all but an average of 2.1 of those pounds. Participants in the non-dieting waitlist control groups gained weight during those same years, but an average of just 1.2 pounds. The dieters had little benefit to show for their efforts, and the non-dieters did not seem harmed by their lack of effort. In sum, it appears that weight regain is the typical long-term response to dieting, rather than the exception.
The real question is why do dieters regain the weight they lose? They are motivated to maintain their lost weight, and they have the skills to enact the necessary eating behaviors, as they did so when they lost the weight. When dieters regain weight, is it because they are too weak-willed to continue restricting their food intake, or is it because their body physiologically defends a genetically-based set weight? The answer is somewhere in between those explanations and is easily misunderstood: In brief, calorie deprivation leads to changes in hormones, metabolism, and cognitive/attentional functions that make it difficult to enact the behaviors needed to keep weight off.
What does calorie deprivation do?
In response to calorie deprivation, levels of leptin, considered the satiety hormone, decrease, and levels of ghrelin, thought of as the hunger hormone, increase (reviewed in Greenway, 2015; Maclean, Bergouignan, Cornier, & Jackman, 2011). Therefore individuals in a deprived state experience more hunger, and feelings of hunger remain increased for deprived individuals even after eating a regular meal (Doucet, St-Pierre, Alméras, & Tremblay, 2003).
The most fundamental physiological adaptation to calorie deprivation is a reduction in energy expenditure (that is, in the amount of calories burned; reviewed in Greenway, 2015; Maclean et al., 2011). This reduction is due to two factors. First, after sufficient calorie deprivation, weight is lost, and therefore less energy is needed to “run” the smaller body, and less energy is expended to move the smaller body during exercise (Leibel, Rosenbaum, & Hirsch, 1995). Second, and beyond the changes resulting from the smaller body, metabolism becomes more efficient, allowing the body to survive on less energy than similar sized bodies that were not calorie deprived (e.g., Camps, Verhoef, & Westerterp, 2013; DeLany, Kelley, Hames, Jakicic, & Goodpaster, 2014). Therefore, to continue losing weight, the individual must consume even fewer calories than during the initial stages of the diet. Dieters who are unaware of this metabolic adaptation and don’t alter their diet accordingly will stop losing weight, may start to regain, and will likely be puzzled and discouraged. From their perspective they are still doing everything right – everything that already led to weight loss – and it is no longer working. Their friends and family members may erroneously conclude that they have been cheating on their diet.
In theory, exercise should prevent or overcome these effects of calorie deprivation, and studies with rodent models do find that adding physical activity to a diet improves weight loss maintenance (e.g., MacLean et al., 2009). Human studies generally find that exercise alone leads to less weight loss than diets alone, and that adding exercise to diets leads to slightly more weight loss initially, but does no better in preventing weight regain over time (reviewed in Washburn et al., 2014). This is likely due to low levels of adherence to the assigned physical activity over the long term (MacLean et al., 2015), as when these studies ignore the study conditions participants were randomly assigned to, they find that the amount of actual exercise participants maintain does correlate with weight loss maintenance (e.g., DeLany et al., 2014; Jakicic, Marcus, Lang, & Janney, 2008).
Calorie deprivation also leads to changes in a variety of cognitive and attentional functions such that dieters become preferentially focused on food. A preoccupation with thoughts of food was one of the most pronounced responses to calorie deprivation in a classic study of conscientious objectors to WWII who volunteered to be semi-starved for six months (Keys, Brozek, Henschel, Mickelsen, & Taylor, 1950). The volunteers spent much of their time talking about foods, planning future meals, reading cookbooks and even considering new careers in food-related fields.
Studies that assess attentional focus and attentional capture with eye tracking methods (Castellanos et al., 2009), the attentional blink paradigm (Piech, Pastorino, & Zald, 2010), or dot probe tasks (Placanica, Faunce, & Soames Job, 2002) find that people’s attention is biased toward food stimuli when they are calorie deprived. Brain imaging studies find increased activity in areas relevant for attention when calorie deprived individuals are shown images of palatable foods (compared to images of water or non-palatable foods; Stice, Burger, & Yokum, 2013).
It’s not the case that preferential attention to food leads to negative reactions to food. On the contrary, brain imaging studies also find increased activity in reward-relevant areas (Stice et al., 2013). Other studies find that when calorie deprived, people have improved smell functioning (Cameron, Goldfield, & Doucet, 2012), report that food tastes more palatable and are willing to work harder to earn it (Cameron, Goldfield, Finlayson, Blundell, & Doucet, 2014).
Research shows that the effects of calorie deprivation last a long time – at least through the last measurement points studies have included. For example, the conscientious objectors who agreed to go on starvation diets still had overly efficient metabolic rates and preoccupations with food thoughts a year after their starvation period ended (Keys et al., 1950). Contestants on the television show “The Biggest Loser,” who lost an average of 128 pounds in 30 weeks, still maintained the metabolic effects of calorie deprivation even six years later (Fothergill et al., 2016). Are these lengthy consequences due to the extreme nature of these diets, and if not, is everyone who has dieted in at least the last six years already suffering the effects of calorie deprivation?
What is the role of willpower?
Self-control (which I use synonymously with willpower here) is “the capacity to alter or override dominant response tendencies and to regulate behavior, thoughts, and emotions” (de Ridder, Lensvelt-Mulders, Finkenauer, Stok, & Baumeister, 2012, p. 77). It tends to be a statistically significant predictor of body mass index (BMI) in longitudinal studies that measure self-control in children and then measure weight from three (Duckworth, Tsukayama, & Geier, 2010) to 30 years later (Schlam, Wilson, Shoda, Mischel, & Ayduk, 2013).
It is clear that self-control plays some role in weight, but it is also important to appreciate that this role is quite small, explaining from 1 to 4 percent of the variance in BMI in these studies. It’s not the case that self-control is simply an unreliable or poor measure in general. The same measures of self-control in these studies do powerfully predict large proportions of variance in other outcomes, including, for example, 32 percent of the variance in scores on the quantitative SAT, and 28 percent of the variance in scores on a measure of coping resiliency (Mischel, Shoda, & Rodriguez, 1989), as well as 45 percent of the variance in eighth grade GPA (Duckworth & Seligman, 2005). Similarly, a meta-analysis found that a commonly used self-report measure of self-control was more powerful in predicting outcomes in the domains of school achievement, well-being (which included self-esteem, happiness and depressed mood), and even interpersonal functioning (which included relationship commitment, loyalty tendencies and perceived support), than in eating and weight (de Ridder et al., 2012).
In sum, self-control matters for weight, but not as much as one might expect, and not as much as it matters for other types of activities. This limited relationship between self-control and BMI may be partly due to a unique feature of controlling eating (or other consumption behaviors), compared to controlling other behaviors (e.g., retaining focus on one’s schoolwork). With eating, failures of self-control erase prior successes. For example, foods in the immediate environment (say, cookies on one’s kitchen counter) may need to be resisted repeatedly, each time one notices them. If an individual resists them ten times during one evening, but succumbs and eats one on the eleventh encounter, there is nothing to show for the ten successes. The relationship between willpower and consumption may be lower than expected because people with weaker willpower (who presumably succumb on an earlier encounter) and people with stronger willpower (who presumably succumb on a later encounter) have similar outcomes: they ate the tempting food. Note that this is not the case with controlling one’s attention to schoolwork – a single failure of focus (such as a few minutes of goofing off) does not erase the effects of many previous minutes of successful focus – the work accomplished does not disappear due to the brief lapse.
Why is weight regain misunderstood?
Calorie deprivation leads to physiological, neural, and attentional changes, and those changes make it difficult to engage in the behaviors necessary to keep weight off. But since those changes do not directly cause weight to return, it is still possible to keep weight off, which a minority of dieters do. This possibility allows people to discount the powerful role of these changes, and instead to argue that if people regain the weight, it must be due to their poor self-control. And because the changes ultimately do operate through eating behavior, the weight regain does seem to be the fault of the apparently weak-willed dieter. As many people have said to me about failed dieters, “they’re still the ones holding the fork.” The key misunderstanding here is the different physical and cognitive context in which dieters hold the fork compared to non-dieters: they feel hungrier, their attention is biased toward food, they find food tastier, and they get more reinforcement from it. Plus they need to consume an even smaller quantity of food than earlier in the diet (as well as less than a non-dieter of the same size), because their more efficient metabolism is burning fewer calories. So dieters don’t necessarily have worse willpower than non-dieters, but calorie deprivation has put them in a situation that requires much more willpower in order to successfully limit consumption.
What should people do?
Because I do research in this area, people inevitably ask me for diet advice. I generally recommend avoiding restrictive dieting, since for the majority of dieters, the weight loss is unlikely to be maintained, and people can be healthy at most weights if they engage in healthy behaviors (Loef & Walach, 2012). Studies show that mortality rates for individuals who are physically fit do not differ by weight category (i.e., normal weight, overweight, or obese; Gaesser, Tucker, Jarrett, & Angadi, 2015), and that engaging in four healthy habits (eating five or more servings fruits/vegetables per day, limiting alcohol consumption, not smoking, and exercising over 12 times per month) minimizes weight-based differences in mortality (Matheson, King, & Everett, 2012).
Therefore, instead of dieting, I recommend engaging in the other healthy behaviors, and in recent years, my lab has focused on strategies to promote vegetable eating without worrying about reducing calories. Our most successful strategy aims to minimize the “competition” vegetables get from less healthy and more liked foods. Instead of having these foods side by side on a plate, we moved the vegetables to their own separate course, before the meal. If vegetables are eaten before other foods are visible or available, they may not be passed over for tastier options. This strategy was successful when used with adults who were watching videos in a lab setting (Redden et al., 2015), and it led to dramatic increases in vegetable consumption among elementary school children who were served vegetables before they entered the cafeteria for lunch (Elsbernd et al., 2016).
In addition to increasing vegetable consumption, there are certain unhealthy foods that should be minimized (although it is not necessary to forbid them entirely), including added sugars, refined grains, and highly processed foods. We have found that we can help people reduce their sugar consumption in coffee with a simple mindfulness intervention, and this intervention was more effective than the typically recommended strategy of gradually reducing sugar (Lenne & Mann, 2017). A new study supports this approach to healthy eating (increasing vegetable consumption and decreasing certain unhealthy foods without monitoring calories), but the long-term effects are not yet known (Gardner et al., 2018).
The work from my lab described here was funded by the NIH (R01-MH063795, R01-HL088887), the Engdahl Family Foundation from the University of Minnesota, and by the Cornell University Department of Applied Engineering and Management (under 59-5000-0-0090 from the Economic Research Service, United States Department of Agriculture). I thank my collaborators on these projects, including Janet Tomiyama, Andrew Ward, Zata Vickers, Marla Reicks, Joseph Redden, Richie Lenne, Elton Mykerezi, and Stephanie Elsbsernd.