The Stavros Method follows the example of healthy regions and how they are able to maintain their excellent health effortlessly.
The first healthy behavior has to do with activities like exercising. However, there is more to exercising than just going to the gym. There are so many thing you can do right at your home with no equipment, you really don’t need a gym to get a good workout. Also you don’t need to workout that hard to get results.
>>> Healthy behaviors 2, 3 and 4 have to do with your eating habits but not what you eat. You see, proper nutrition has 2 parts. Part one is what you eat, and part two is how you eat.
Most diets and nutritional programs only focus on the foods you eat or don’t eat. But did you know, how you eat effects your weight and health as much if not more than what you eat? You could eat the exact same food, but depending on how you ate it, it could effect your weight and health completely differently.
The 3 healthy eating habits have to do with how you eat. By developing these 3 “how to eat” habits, cravings will become a thing of the past; you will instinctively know when you had enough food to eat without counting calories or measuring your food, and you will not need to be as strict with what you are eating. Pasta, pizza, bread, and other forbidden foods will be back on the menu
100% of my clients who develop these 3 habits, lose weight and improve their health without changing anything they eat.
>>> The 5th healthy habit has to do with what you eat, but just so you know, there is room for junk food. After all, we ate a fair share of junk food when I lived in Greece.
>>> What is also great about these 5 healthy behaviors is that they work with human nature and with a little practice and the right approach they can become completely habitual.
The Stavros Method does more than simply introduce you to these 5 amazing healthy behaviors. See more details here:
It’s understandable when you gain a few pounds after vacation or if you break your ankle and spend six weeks propped on the sofa bingeing obscure British cooking shows (and the chocolate scones to go with them).
But when you can’t zip your jeans for no freaking reason at all — you swear you’re not eating any more or exercising any less — it can feel like there’s some dark magic at play. You may find yourself standing on the bathroom scale, screaming into the void:
“Why am I gaining weight?!”
Deep breath. You got this.
Most likely, there’s something in your life that’s shifted just enough to make a difference, but not so much that you’d notice, says Alexandra Sowa, MD, an obesity specialist and clinical instructor of medicine at NYU Langone Health. “I see this all the time — you may not step on the scale for a while, and you feel like you haven’t changed anything, and all of a sudden you go to the doctor’s office and notice you’ve gained 10 or 20 pounds,” she says.
But that doesn’t mean it’s your destiny to go up another size every year. Here are some of the most likely reasons for unexplained weight gain, and how to stop it in its tracks.
Your insulin levels may be out of whack.
If you’ve been battling weight issues for a while and none of your efforts are moving the needle, make an appointment with your primary care doc or a weight-management physician, who can assess you for insulin resistance or prediabetes. (Your doctor can also test you for hypothyroidism, in which your thyroid gland doesn’t produce enough hormone, slowing down your metabolism and potentially leading to weight gain.)
“Insulin is the hormone that signals the body to pull glucose out of the bloodstream and store it in the muscles, liver, and fat,” explains Tirissa Reid, MD, an obesity medicine specialist at Columbia University Medical Center and Diplomate of the American Board of Obesity Medicine. “But when you’re overweight, the cells don’t recognize the insulin as well, so the pancreas has to pump out more and more — sometimes two or three times the normal amount — until the cells respond.”
(This is also common in women who have polycystic ovary syndrome — a condition in which the egg follicles in the ovaries bunch together to form cysts.) These high insulin levels keep the body in storage mode and make weight loss more difficult, says Dr. Reid. The beginning of this road is insulin resistance — when your pancreas is working overtime, but blood sugar levels are still normal.
All that extra work wears out the pancreas until it can barely do the job of keeping the blood sugar in normal range. Left unchecked, insulin resistance can lead to prediabetes, in which blood-sugar levels are slightly elevated; if that’s not treated, you can develop full-blown type-2 diabetes.
What you can do: The most effective way to reverse this trend is to eat a diet low in refined carbs and added sugars, and to become more physically active, since muscles respond better to insulin after exercise, says Dr. Reid.
She recommends either investing in a fitness tracker or simply using the one that comes with your phone. “People hear you need 10,000 steps each day, which sounds intimidating, but you can also use it just to see where you’re at and make doable increases,” Dr. Reid says. “If you’re at 2,000 steps, try to go up to 2,500 a day next week and continue to increase.”
Swapping to foods with a lower glycemic index (GI) — which means they’re digested more slowly, keeping blood-sugar levels steady — is also important for controlling your insulin levels. Dr. Sowa recommends these lower-GI food swaps: riced cauliflower instead of white rice; zucchini spirals or shirataki noodles (made from plant fiber) instead of pasta; and pumpernickel or stone-ground whole wheat bread instead of white bread or bagels.
Stress and exhaustion are throwing you off.
If you’re up at night worrying about your aging parents, your hormonal teens, and the general crappy state of the world, this can affect your metabolism. “Stress and lack of sleep can cause a cascade of hormonal changes that change your metabolism and affect your sense of hunger and fullness,” Dr. Sowa explains.
Stress pumps up the hormones ghrelin and cortisol, which increase your appetite and can make you crave carbs; at the same time, it dials down the hormone leptin, which helps you feel full. Not surprisingly, a recent Swedish study of 3,872 women over 20 years found that the more stressed you are by work, the likely you are to gain weight. Stress also affects your ability to get a good night’s sleep, and we know that lack of sleep can also throw off your metabolism rates and hunger cues.
What you can do: It’s easy — just fix the world and make everyone around you kinder and more sane.
Hm, maybe not. But you can manage your stress by downloading a free app such as Pacifica, (now Sanvello) which can help you work toward personal goals such as thinking positively and decreasing anxiety by sending you meditations and visualizations to do throughout the day. To sleep more soundly, you already know you should put down your phone, computer, and iPad an hour before bedtime, but new research shows that shutting out all light — including that sliver of moon through your window — can help with both sleep and metabolism.
A study at Northwestern University Feinberg School of Medicine found that after subjects spent just one night of sleeping in a room with dim light, insulin levels the next morning were significantly higher than those who slept in complete darkness, potentially affecting metabolism rates. So consider investing in some good blackout curtains.
Your allergy pills are to blame.
“We’re not 100% sure why, but it’s believed that histamines, chemicals produced by your immune system to fight allergens, have a role in appetite control,” says Dr. Reid. That means that “antihistamines may cause you to eat more,” she says. A large study from Yale University confirmed that there is a correlation between regular prescription antihistamine use and obesity. Dr. Reid points out that some antihistamines such as Benadryl also cause drowsiness, which could make you less apt to exercise.
What you can do: If you suffer from seasonal allergies and are constantly taking antihistamines, talk to your allergist about alternative treatments such as nasal steroid sprays, nasal antihistamines (which have less absorption into the bloodstream, and therefore less effect on hunger), leukotriene inhibitors such as Singulair, or allergy shots, suggests Jeffrey Demain, MD, founder of the Allergy Asthma and Immunology Center of Alaska.
He also says that managing your environment — using a HEPA filter, washing your sheets frequently in hot water, keeping pets out of your bedroom — can help reduce the need for allergy meds. While you’re at it, do an inventory of any prescription medications you’re taking that are known to cause weight gain (including certain antidepressants, beta blockers, corticosteroids, and the birth control shot) and discuss with your doctor if there are equally effective alternatives that don’t affect weight, says Dr. Reid.
Your portions are probably bigger than you think.
Anyone who’s ever sat in a vinyl booth staring down a bowl of pasta big enough for a toddler to swim knows that portion sizes in America are ginormous. But research from the University of Liverpool published last year found that after being served large-size meals outside the home, people tend to serve themselves larger portions up to a week later, meaning supersizing appears to be normalized, says Lisa R. Young, PhD, author of Finally Full, Finally Slim.
Even if your home-cooked portions have crept up only 5% over the last few years, that can be an extra 100 calories a day, which adds up to more than 11 pounds a year, says Lawrence Cheskin, MD, chair of nutrition and food studies at George Mason University. And the official measure of what’s a “serving” isn’t helping.
“The FDA standards for how many ‘servings’ are in a package of food are based on how much food people actually eat, not how much you should eat,” Young explains. For example, to reflect the growing appetites of the American people, a serving of ice cream was increased last year from 1/2 cup to 2/3 cup. More realistic, perhaps, but still more calories than many of us need.
Here’s what to do: First, Young suggests you spend a few days getting a reality check on how much food you’re actually eating at each meal. “When you pour the cereal in the bowl in the morning, pour it back into a measuring cup. What you thought was 1 cup might actually be 3 cups, especially if you’re using a large bowl,” she says.
Also, instead of relying on a government agency (or the chef at your favorite restaurant) at to tell you how much to eat, learn to listen to your own body, says Young. “Serve yourself just one modest portion on a small plate, and when you’re done, wait 20 minutes,” she says. It takes that long for the hormones in your belly to reach your brain and tell it you’re full. If you get to 20 minutes and your stomach is grumbling, have a few more bites.
You’re eating the right thing, but at the wrong time.
Let’s say you switched jobs recently, and dinner is now at 9 p.m. instead of 6:30. Or your new habit of streaming Neflix until the wee hours also involves snacking well past midnight. Even if you’re not eating more, per se, this change might account for the extra poundage.
There’s a delicate dance between your circadian rhythm (the way your body and brain respond to the daily cues of daylight and darkness) and your calorie intake that can mean that same sandwich or bowl of fro-yo that you eat at lunchtime may actually cause more of a weight gain when eaten at night.
A 2017 study at Brigham & Women’s Hospital found that when college students ate food closer to their bedtime — and therefore closer to when the sleep-inducing hormone melatonin was released — they had higher percentages of body fat and a higher body-mass index. The researchers theorize that this is because the amount of energy your body uses to digest and metabolize food drops as your inner clock tells it to get ready to snooze.
What you can do: There are a few life hacks to keep the late-night snacking to a minimum. Dr. Sowa suggests you commit to writing down every bite you eat after dinner: “Whether it’s on a sticky pad or on an app, keeping track of what you’re eating, how much you’re eating, and how you’re feeling when you eat it will hold you accountable for the calories, and it will also help you figure out if you’re truly hungry or just bored,” she says.
She also suggests capping off your evening meal with a brain-and-heart-healthy tablespoon of Fish Oil. “It’s a healthy fat that coats your stomach and makes you feel less hungry later,” she says.
Your “healthy” food is packed with calories.
You could be eating the cleanest, most organic, dietitian-approved variety of plant-based, or ethically farmed food, but that doesn’t mean the calories evaporate into pixie dust when they go in your mouth.
And in fact, research has shown that when you’re eating something healthy — avocados, salad, yogurt, whole grains — part of your attention to fullness tends to turn off. “Even when you’re eating healthy foods, you really have to pay attention to your hunger and satiety signals,” says Véronique Provencher, PhD, professor of nutrition at Université Laval in Quebec City, Canada.
“In several studies we have found that when we perceive a food as healthy it creates a bias in our own judgment, and we think (consciously or not) that we can eat more of it, no problem. We think a salad is healthy, so we feel we can eat as much as we want with as many dressings or toppings as we want.”
What you can do First of all, treat eating like going to the theater, and turn your phone off — and turn away from the computer or TV screen. “We have found when you are eating and working on your computer or watching TV or on a screen you are disconnected from hunger and satiety clues,” says Provencher.
Something else that may help, other experts say, is to become more aware of portion sizes and what’s in your food. Try the Weight Watchers app, which helps you sort out questions like which “healthy” yogurts are full of sugar and calories, and how much avocado you should spread on your toast.
Each birthday you celebrate brings on one undeniable change: your basal resting metabolism (the rate at which your body at rest burns the energy you take in from food) slows down. “It’s not a dramatic drop,” says Dr. Cheskin. “But as you age, you’re probably also getting less active and more tired, and your body tends to lose muscle mass, which burns calories more efficiently than fat.”
So even if you’re eating the exact same amount of food as you did when you were younger, your body is simply not burning it off as effectively as it did during the glory days of your 20s.
Here’s what to do: You can only budge your BMR a little, but there are a few things you can do to make the math work in your favor. The first is to build up your calorie-burning muscle, says fitness expert Michele Olson, PhD, a professor of sports science and physical education at Huntingdon College. “Keep up cardio three times a week for 30 minutes, but add challenging weight training on top of that,” she says.
Olson recommends these exercises that can be done at home. Start with what you can do and build up to 2 sets of 12 of each, every other day.
Chair squats: Sit of the edge of a chair with arms crossed; stand up and sit back down for one rep.
Triceps dips: Sit on the edge of a chair, supporting yourself with your arms, slide off, walking your feet out in front of you a few steps; with knees bent and body below the seat, bend elbows; press up until arms are straight. (Use a chair without wheels!)
Push-ups, from your knees, or full push-ups, if you can.
Another metabolism-boosting strategy: Replace some of the carbohydrates in your diet with proteins, which take more energy to digest, therefore burning off more calories through diet-induced thermogenesis, as well as making you feel fuller for longer.
Dr. Sowa suggests you eat about 100 grams of protein over the course of the day, filling your plate with lean chicken, fish, shrimp, or plant-based proteins such as garbanzo beans, tempeh, and edamame, to give your meals more metabolism bang for your buck. This may only add up to a weight loss of a few pounds a year, but combined with exercise, the cumulative effect can be significant, says Dr. Sowa.
Marisa Cohen is a Contributing Editor in the Hearst Health Newsroom, who has covered health, nutrition, parenting, and the arts for dozens of magazines and web sites over the past two decades.
Blame evolution on our obsession with our weight.Credit:United Press International Photo
It’s a secret shame that countless women feel, but only rarely admit to. “Am I betraying my feminist self by believing I don’t look good in clothes until I lose weight?” a girlfriend texted me a few weeks ago, after agonizing about the fact that she is now a few kilos heavier than she usually is. “I feel like shit about this. I would die if I had a girl and she said that to me.”I feel the same. My friend only told me this (I’m fairly certain) because I’d previously confided in her my own squirmy thoughts about my weight.
Like the shame I feel about having wasted years tallying how much dessert I’ll let myself have or how I feel about myself according to how tight my jeans’ waistband is on any given day. How is this possible, I’ve long wondered, when I’m intelligent enough to know that my culture has brainwashed me into wanting to look thin? And when I know that spending that time on literally anything else would enrich my life, instead of mentally strangling it?
“It’s super common … and a huge part of the difficulty that some people can have psychologically because they feel it’s mutually exclusive,” says Melbourne-based clinical psychologist Stephanie Tan-Kristanto, who has helped many people work through these feelings. “[They think] ‘I must be really terrible, or a bad person because I’m having these thoughts, and I shouldn’t be having these thoughts because I’m too intelligent to be worrying about body image issues’.”
It is an under-acknowledged water-dripping discomfort that many women – and to a lesser extent, men – experience. Because while the destructive nature of eating disorders has long been studied, the embarrassment and shame that come from an unshakeable desire to have a smaller body – when it isn’t accompanied by disordered eating, obsessive exercising, an inability to focus on vocational studies or career, or other signs of a clinical disorder – has not.
If anything, these feelings are getting harder to battle, says Tan-Kristanto, as an increasing amount of celebrities are giving us the expectation that 50 or 60-year-olds can still look, respectively, 30 and 40.And the impact can be significant, and lifelong.
“I think it’s really bad for one’s self-esteem because I’m constantly saying to myself, ‘I’m not good enough, my body’s not good enough, my legs are too big, my stomach’s too flabby’,” says one friend of mine, a 47-year-old entrepreneur and mother of two who has been fighting these feelings for the last 35 years (since she was 12 and her parents told her she was “chubby”). Though she’s long been a healthy weight, and enjoys a wide variety of activities including surfing and dancing, she says: “I can see the amount of time I’ve wasted in my life dieting, and thinking about food so much and counting calories.”
They’re feelings Tan-Kristanto hears a lot from patients, particularly those who present with depression and anxiety. “The shame is a feeling that you are defective,” she says. But there’s a reason so many of us have these feelings: evolution.
“Our brains are hard-wired to be Velcro for negatives and Teflon for positives, so we’re naturally our own biggest critics, regardless of how intelligent or educated we are in many ways,” says Tan-Kristanto, a director of the Australian Clinical Psychology Association. “Our survival and ability to continue living and thriving as a species requires us to be more aware of the dangers in our life. So we need to look for the threats in our life to be able to survive and reproduce.”
In “caveman days” the risk was a sabre-tooth tiger. In modern times, it’s anything that can threaten our ability to fit in, get our next job and find a great partner.
“And all of those things are absolutely related to our weight, and humans being a social species, you know our survival and our thriving is in many ways related to how well we fit in cultures. Obviously the expectations of how we look or what we weigh varies across different cultures and different time periods. But it’s still a universal thing that our appearance and our weight is associated with society accepting us, and fitting into cultures.”
I’d always assumed this is something I’d inevitably age out of, especially once I hit my 60s or 70s.Turns out, not necessarily. “She was in her 80s,” says one woman I know, of a woman she knew who was in debilitating pain. It had become so bad that this elderly woman could barely walk. There was a remedy. A particular medication that would alleviate her pain and give her back the use of her legs. No dice. “It came with a possible two-kilo weight gain,” says the woman I know, explaining why the woman in her 80s rejected the treatment, citing her appearance.
Intense fear of gaining weight is just one indication, says Tan-Kristanto, that a person has moved away from a “somewhat helpful” focus on being healthy to “mal adaptive” behaviours that require psychological intervention. Others include: extreme dissatisfaction with body image, “really low self-esteem”, feeling depressed as a result of appearance, avoiding social situations that involve food, repetitive dieting, skipping meals or fasting and exercising even when injured.
As for the rest of us? We need to do our best to drop our shame. “You can be really intelligent and educated, and understanding of the pressures that society puts on you, and you can still struggle sometimes with body image,” says Tan-Kristanto. Accepting this, she says, frees us up to focus on other parts of our life.
“It helps us to be a little more understanding and compassionate, so we’re not fighting things as much, and not being as stuck or fused with those thoughts. It helps us to look at the bigger picture of things.” So does fighting the stigma of our feelings, by sharing them with friends. “I wouldn’t underestimate the value of [having a friend] say, ‘Thank god, it’s not just me’.”
In the months after having her second child, Sarah found herself fed up. The 40-year-old Seattle resident was cutting carbs and sugar, and exercising regularly, but couldn’t seem to shed the pounds she had put on during pregnancy. So when an email newsletter mentioned a new weight-loss drug called Wegovy, Sarah decided to give it a try. Eight months later, she is out more than $10,000—and down more than 60 lbs.
“Wegovy made losing weight almost effortless,” Sarah, whose name has been changed to protect her identity, told Quartz. “I’m not hungry often anymore and it doesn’t take any willpower to eat less. I simply don’t have any desire to overeat.”
Sarah is one of 125,000 US-based patients now taking Wegovy (whose generic name is semaglutide), a member of a new class of weight-loss drugs. These drugs work differently than the appetite suppressants popular among previous generations of dieters. They are also hitting the market at a different moment: one in which people are more eager than ever for realistic, science-based methods for addressing excess weight, even as a growing faction of activists and doctors voice skepticism of weight as an accurate measure of health.
A new class of weight-loss drug
In the mid-1990s, experiments on Gila monster venom found it contained hormones that could help lower blood sugar. That led to the diabetes drug Ozempic, which ultimately went on the market in 2018. People on that drug discovered a funny side effect: They lost weight.
In 2021, that same compound was approved by the US Food and Drug Administration (FDA) under the name Wegovy for the express purpose of weight loss. Drugs like Wegovy work in more complex ways than simply suppressing appetite, and promise fewer (though not zero) side effects.
Like Wegovy, many of these drugs were originally approved for other conditions; liraglutide (brand name Saxenda for weight loss) was also originally approved as a diabetes drug (Victoza). In fact, semaglutide and liraglutide work similarly in the body: They’re known as GLP-1 receptor agonists because they activate receptors for the glucagon-like peptide-1 (GLP-1) hormone, reducing appetite by slowing digestion and the rate at which the body takes up glucose.
Perhaps most important, the new drug promise significant weight loss. “The previous weight loss drugs were just modestly effective,” says John Buse, an endocrinologist at the University of North Carolina School of Medicine. The average patient would lose 5% of their body weight, in some cases up to 8%. But with semaglutide, he says, “we’ve gotten the kind of weight loss that makes people pay attention: 10-15% of body weight. That’s the average weight loss—half of people are losing more than that. It’s a gamechanger in the conversation…now that we have medicines for which a substantial proportion of patients can expect to lose 30 to 50 lbs.”
In one 68-week pre-approval clinical trial, patients on Wegovy did indeed lose 14.9% of their body weight on average, compared with 2.4% for people on a placebo. (Although, as several writers and scholars have pointedout, the study was funded by Novo Nordisk, which makes Wegovy.) Given the average weight of trial participants—100 kg, or 220 lbs.—that meant weight loss of about 15 kg, or 33 lbs. Other drugs in development have had similar results. In a recent trial for one called tirzepatide from Eli Lilly, more than half of patients lost at least 20% of their body weight—50 lbs. in many cases.
What it takes to lose weight
This new class of drugs is entering a market that at first glance seems ripe for breakthrough. According to the US Centers for Disease Control and Prevention (CDC), 42% of Americans—70 million people—meet the criteria for obesity (having a BMI of 30 or more). At one point or another, most of those people will try a diet and exercise regimen to lose weight.
But a growing body of research shows that diets are not an effective way to lose weight and keep it off. “Obesity is a complex disease… for most people, lifestyle modifications, diet, and exercise are just not enough,” says Katherine Saunders, a doctor at the Comprehensive Weight Control Center at Weill Cornell Medicine and co-founder of Intellihealth, an app-based platform that brings evidence-based obesity treatment to patients.
In part because of that complexity, bariatric surgery has since 2009 been considered the standard of care for patients looking to lose a substantial amount of weight. But these procedures can be invasive and expensive, and can come with significant and long-lasting complications.
The dearth of other options leaves some patients and doctors excited about this new generation of drugs. “Right now, the field is really looking for more efficacy, number one. People will do almost anything to lose weight,” says Buse. “We have more than just surgery now for promoting substantial weight loss. The most exciting thing is that obesity is on the ropes.”
A complicated picture
While hopes are high, the realities of taking these drugs can be more complicated for patients. There are often side effects—the most common for semaglutide and liraglutide are diarrhea, vomiting, and nausea. On Wegovy, Sarah says she’s experienced diarrhea so severe that a few times she had to delay her next dose.
Physicians can sometimes gloss over or downplay those effects. But a visit to dedicatedRedditpages for these drugs shows whole communities of patients struggling to adhere to the regimen when they’re feeling sick, and seeking support from a community to understand whether what seems like a severe reaction is normal. (Novo Nordisk did not respond to a request for comment.)
How well a patient can tolerate a drug “is something we think about quite a lot,” Saunders says. “We always start with lower doses and increase gradually as tolerated. Everyone is different. We keep in close touch with the patient and monitor them closely.”
And while these new drugs are relatively well-studied, there are still unknowns. They seem to help patients keep weight off more reliably than diet and exercise alone, but those benefits fade after people stop taking the drugs, and patients do often regain weight. There are also questions about long-term effects. In 1997, weight loss drug fenfluramine/phentermine (fen-phen) was pulled off the market after it was found to cause heart problems. More recently, Belviq (lorcaserin), which the FDA approved for weight loss in 2012, was pulled from the US market in 2020 because long-term use was found to increase the incidence of various types of cancers.
Even if a patient does want to go on one of these drugs, she might not be able to. Many patients keen to try Wegovy can’t access it at the moment, due to a supply chain issue that its manufacturer doesn’t expect to resolve until later this year. Even then, most US health insurers, including Medicare, do not cover drugs like Wegovy, and paying out of pocket can cost thousands of dollars per month. After Sarah’s doctor told her she doesn’t prescribe Wegovy, Sarah secured a prescription through an online health provider; she pays for it out of pocket.
The lack of insurance coverage is in spite of the fact that the American Medical Association declared obesity to be a disease in 2013. “The conversation around insurance coverage needs to be had with insurance companies, but also with employers,” says Kimberly Gudzune, the medical director for the American Board of Obesity Medicine. “It needs to be seen as an investment in your workforce.” The Treat and Reduce Obesity Act, which would expand Medicare to include obesity treatments, has been introduced to US Congress every year since 2012, but has never passed.
America’s love/hate relationship with weight
Though excess body fat was once considered a sign of wealth or fertility, over the past century a stigma has developed against larger bodies. Today doctors associate excess weight with medical conditions like heart disease, cancer, type 2 diabetes, sleep apnea, osteoarthritis, and depression. Studies also show that life is harder when you move through the world in a larger body. Fat people are less likely to be hired for a job, are paid less, are less likely to getmarried, and are less likely to behappy (though not if they’re living around other fat people). One 2006 study found that 46% of respondents would rather give up one year of life than be obese; 5% said they’d rather lose a limb.
The current state of research makes it impossible to unravel the full complexity of weight and health, but the conversation is starting to accommodate more nuance. Ubiquitous metrics such as body mass index are increasingly understood to be unreliable indicators (though doctors often still use them), and even the language around larger bodies is under review. Many physicians use “obese” to describe people who have excess weight or a BMI over 30, but activists are shying away from the word. “The reason…we are reluctant to use the words ‘overweight’ and ‘obesity’ is that they are made up, they can change,” says Tigress Osborn, a fat activist and chair of the National Association to Advance Fat Acceptance.
In fact, someresearchsuggests that fat may have a protective effect on the body. “The body’s weight-regulating mechanism is about survival. It’s a system with more moving parts than we understand,” says Marilyn Wann, a fat activist and author of the book Fat!So? “Trying to remove weight from an individual or from the population is like trying to take a sledgehammer to the weather—we don’t know the unintended negative consequences we’re going to create.”
There are signs that in the future physicians may be more accepting of bodies of different sizes. But as weight loss drugs get more effective and more available, those cultural gains for body positivity (or body neutrality, or fat acceptance) may also be called into question.
A new relationship between doctors and patients
Overweight patients who come to see Shelly Crane might have an experience they’ve never had before. “I don’t initiate a weight-loss conversation with a patient,” says Crane, a family physician at Advocate Aurora Health in Milwaukee, Wisconsin. Most weight-loss programs come with more risk of harm than good, she says, and there’s not enough evidence that people who do lose weight are healthier in the end.
Crane doesn’t regularly prescribe new drugs for weight loss, though she says more patients are coming in and asking for them lately. Instead, she prefers to keep conversations focused on goals of care. “Patients say, ‘I know I need to lose weight,’ and I say, ‘Why do you think you need to lose weight? What would change in your life if your weight was lower?’” That gives her an opening to talk about health more broadly—how is the patient’s sleep? Their diet? Their mobility? “I try to stay in my sphere of what I’m able to do as a family doctor and really address the root of the health issue as much as I can.”
Crane was drawn to this approach by listening to her patients talk about experiencing size discrimination, and by following the work of fat activists such as Ragen Chastain and Aubrey Gordon. Though she’s been trained in a more integrative style of medicine, her approach toward body acceptance was also shaped by her discovery of intuitive eating during medical school. Since then, she’s been working on deprogramming herself and her colleagues from anti-fat bias.
Crane is part of a burgeoning movement among doctors to improve the treatment of larger patients. For some, that means skipping the dreaded weigh-in, a practice that is somewhat controversial within medicine. Medical organizations like the Association of American Medical Colleges also offer guidelines to reduce anti-fat bias among clinicians.
For doctors, the updated approach at least engenders trust, which can in turn get patients to seek medical care more frequently and improve their overall health. At most, it broadens the definition of what “healthy” means, and looks like.
Some fat activists see this shift as an important step. “The thing we hear most often from the public is, ‘I thought I had this thing, but all the doctor wanted to talk to me about is weight loss, and now the thing is worse,’” Osborn says. “It’s progress to have people in the medical establishment recognizing that there are other healthcare concerns besides weight, if weight is a healthcare concern.”
The hope is that this evolution continues. Activists want more people, in the medical profession and outside of it, to respect their autonomy. That becomes even more pressing in a possible future filled with weight-loss drugs—a future where a person can simply take a drug and stop being fat. “The ease with which I could become smaller—why should I? That should be up to me. Just like, if you believe it’s a medical disorder, the treatment I choose should be up to me,” Osborn says. “Like with anything else, if you believe fat is a disorder, we should let people decide whether people will get treated or not.”
“Fatness isn’t a problem to be solved in and of itself. It is not the root cause of all ills, as much as [medicine] would like to think it is,” Crane says. “We can help people live full, rich lives when we focus on goals of care and not on weight.”
Results of a new weight loss study were published this week, leading to headlines proclaiming intermittent fasting “isn’t a magic diet trick after all”.The researchers aimed to test whether adding a restriction on what time of day you were allowed to eat (or not) to the usual low calorie (or kilojoule) diet led to greater weight loss compared to just following a low calorie diet. They recruited 139 adults whose average weight was 88 kilograms and age 32 years.
The participants were randomised to follow either the low calorie diet that had reduced their usual daily energy intake by 25%, or the same low calorie diet with the addition of a time period during which they were allowed to eat in an eight-hour window between 8am and 4pm each day.This approach is called “time-restricted eating” or a “16-hour intermittent fast”. Both groups received support from health coaches to follow their diets for 12 months.
Results showed that after one year, people in both groups lost 7-10% of their baseline body weight. While the low calorie group lost an average of 6.3 kilograms, the low calorie plus time restricted eating group lost 8 kilograms. Although there was a 1.8 kilogram difference between the groups, it was not a statistically significant difference.
Participants in both groups also had better blood sugar and blood fat levels and improved insulin sensitivity, but again there was no significant differences between groups.
1. It wasn’t based in the US
Most intermittent fasting studies have been conducted in the United States. This trial was done in China and recruited people in Guangzhou, so it provides important data using a culturally sensitive, prescribed calorie restriction over 12 months.
2. It showed small extra time restrictions on eating don’t make much difference
In their normal lives, the participants in Guangzhou had a usual window for daily eating of about 10.5 hours. Studies in other populations, particularly the US, show about 90% of adults have an eating window of 12 hours, with only 10% of adults having an overnight fasting period greater than 12 hours.
For more than 50% of people in countries like the US, the overnight fast is less than nine hours, meaning they eat over a 15 hour time period each day. So in the current study, the time restriction on eating was only minor – at about two hours less per day than what’s usual for people in China. This would not have been too big a difference from usual.
The researchers also reported that in China, the biggest meal is usually eaten in the middle of the day, so that was not influenced by the time restriction. In countries where the evening meal is the biggest or people snack all evening, then time restriction may still be a beneficial way to reduce intake.
A 2020 review of 19 studies that used time-restricted intermittent fasting found it was an effective treatment for adults with obesity, leading to greater loss of body weight and body fat, with significantly lower systolic blood pressure and blood glucose.
3. It showed support is imperative
Both groups in this trial were given a lot of support to adhere to the kilojoule-restricted diet. They were provided with one meal replacement shake per day for the first six months, to make it easier to follow the kilojoule restriction and help improve adherence to the diet.
They also received dietary counselling from trained health coaches for the 12 months of the trial. They received dietary information booklets that included advice on portion size and sample menus. They were encouraged to weigh foods to improve their accuracy in reporting kilojoule intakes and were required to keep a daily log with photographs of foods eaten and the time, using the study app.
They also received follow-up calls or app messages twice a week and met with the health coach individually every two weeks for the first six months. In the second six months, they continued to fill out their dietary records for three days per week and received weekly follow-up telephone calls and app messages and met with a health coach monthly. They also attended monthly health-education sessions.
This was a lot of support and is very important. Receiving long-term support to achieve health behaviour changes typically achieves a weight loss of 3–5% of body weight, which significantly lowers risk of weight-related health conditions, including a 50% lower risk of developing type 2 diabetes over eight years.
4. Even with good adherence, individual weight loss varies
Individual weight loss responses were very variable, even though adherence was high in this trial.
About 84% of participants adhered to the prescribed daily calorie targets and time restricted eating period. Weight loss at 12 months varied from 7.8 to 4.7 kilograms in the low calorie only group, and 9.6 to 6.4 kilograms in the low calorie plus time-restricted eating group.
As we have seen many times previously, this study confirms there is no one best diet for weight loss. It also shows small decreases in the window of time you’re eating probably won’t make a difference to weight loss.