Ideally, a healthy body is comprised of about 55-60 percent water, 10-20 percent muscle and lean tissue, 6-8 percent bone minerals and about 18 (men) or 22 (women) percent fat. When fat reserves rise higher than desired and weight loss is indicated, many diet options can be considered. However, the tried and true equation has been:
Cutting calories + Increasing activity + maintaining this lifestyle for life = healthy weight
Dietitians from the American Dietetic Association (ADA) and other nutrition professionals have long held the belief that it's not what you eat, it's how much. Based on this belief, any eating plan can achieve weight loss as long as eating is balanced and sensible and moderate exercise is included. Today, sensible eating has become defined as one that is low in fat, sugar, cholesterol and salt and rich in whole grains and lean proteins much like the DASH diet plan. Now a growing number of researchers are looking at the idea that perhaps the source of calories is just as important as the number. Do their findings show that not all calories are created equal?
In a 2009 Swedish study, investigators tested this theory. Volunteers consumed 20 extra calories per half pound of body weight from either candy or peanuts. This meant that someone weighing 150 pounds would over consume by 1,300 additional calories a day. After two weeks of this daily overconsumption, you would expect weight gain to occur in both groups. They found the peanut snackers did gain a small amount of weight, but it was only a third of the amount gained by the candy snackers. More surprising was the additional increase in waist circumference, rise in cholesterol and overall body fat that was also experienced by the candy snacking group.
So what was the biggest reason for the difference in responses? The insulin response initiated by the simple carbohydrates found in the candy is felt to be the biggest contributor. As blood sugar levels rise, the body responds with more insulin in an attempt to maintain normal blood glucose levels. When extra glucose and extra insulin are both present, they become packaged for storage in body fat for future energy use. Since peanuts do not contain simple carbohydrates, they did not initiate the same insulin response or increase in reserved energy storage. The peanut group experienced another benefit, which was a rise in resting metabolism. This increase in the body's ability to burn calories also limits weight gain because more energy is being burned so it doesn't need to be stored. If studies like this show composition is important, why do many health professionals continue to insist that eating a variety of foods and cutting back on total calories and increasing activity is the key to weight loss success? Based on my professional and personal experience, I believe the answer is easy. They are both right.
For health professionals, a regular or standard diet is one that provides the body with the energy it needs through protein, carbohydrate, and fat, with vitamins, minerals, trace elements, and water from a variety of foods from all food groups to maintain optimal nutritional health. It assumes health and is geared to maintain health. In a state of optimal nutritional health, when five to ten pounds have been acquired from overconsumption, simply changing the number of calories from the variety of foods typically consumed allows for changes in energy usage and body fat storage. Weight loss occurs when less energy is provided to the body from an exogenous (external) source like food causing the body to use endogenous (internal) sources (fat reserves) to supply the energy the body requires.
A therapeutic diet is a regular diet modified or adjusted to accommodate specific physical or metabolic limitations. The modifications may need to be in consistency, specific nutrients, energy or fluid levels, the timing of meals or the elimination of certain foods. A low sodium diet, a diabetic or carbohydrate controlled diet, a low or high protein diet, a low fat diet or a low cholesterol diet are all examples of a modified or therapeutic diet. In an ideal situation, a Registered Dietitian provides a modified diet that has been specifically designed to meet the nutritional needs of the recipient. Sometimes people choose to follow modified diets on their own by limiting carbohydrates, enhancing protein or restricting complete food groups. These self imposed modified diets are not always properly balanced to meet the bodies metabolic needs which can cause alternative and less efficient metabolic pathways to be used by the body. Weight loss in these situations (in my experience) becomes based more on the how the body responses to the composition of the exogenous energy source than in the amount of energy provided.
As a Clinical Dietitian, I dealt with people coping with end-stage-organ disease or who had received a solid organ (kidney, pancreas, or liver) transplant. They were all on a therapeutic diet of one type or another. If they only focused on the number of calories and not the composition of those calories, their bodies did not respond well related to weight loss goals. The key to success was finding the correct balance of nutrients based on their specific body needs. Accomplishing that was more of an art than a science and success came more from individualized adjustments in food composition than from strictly following calculated calorie totals.
The Bottom Line
Nutrition professionals have long held the belief that changing the number of calories you consume and being more active is all that is necessary to lose weight. For people of normal health who are only a few pounds over their typical weight, this is true. However, as we become heavier and heavier and have a variety of medical conditions, that may no longer be true for all. More and more studies are showing it is not only how much you eat but what you eat that influences weight control success.
More and more people every year need to modify their diets for sodium, fat, sugar, or all of the above. This means we are no longer following the long-standing "regular" diet of our parents' or grandparents' generation. Today, how we make those adjustments can have a direct impact on our weight loss success or add to our frustration. If you are having trouble meeting your weight loss goals and only focusing on total calories you eat and are following a modified diet of one type or another, making composition changes may be your key to success. Learning to adjust your macronutrient (carbohydrates, proteins, fats) composition in your diet while maintaining in a healthy range can help you find the right combination for your body that will help you move toward your weight loss goals.
What do you think about the Swedish study? What has your weight loss journey shown to be true for you? Does calorie adjustments alone do the trick or is diet composition the key to your success.
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