Can a pill prevent or treat high blood pressure, diabetes, high cholesterol, heart disease, depression, and even dementia? What if ample proof existed that this extensively researched pill is effective, practically free, and has no bad side effects? This powerful medicine exists-intensive lifestyle change. Its active ingredients are physical activity and drastic improvements in diet, and it works amazingly well. If it were an actual pill, millions would clamor for it, and a pharmaceutical company would reap massive profits. Intensive lifestyle change is doable, sensible, and essential for good health.
The Core Components of Intensive Lifestyle Change
Intensive lifestyle change programs emphasize nutrition and exercise and address psychological factors like loneliness, isolation, depression, and anger. Research shows emotional and social health is associated with a reduced risk of disease and premature death. Connection, intimacy, and love are also important.
A typical intensive lifestyle change program includes:
- Nine weeks of nutrition and meal prep instruction on a plant-based, low-refined-carb and low-trans-fat diet, as well as shared meals with the group.
- Recommendations for and guidance in three to five hours of moderate physical activity, along with two or three strength-training sessions per week.
- Stress management, communications skills, and relaxation instruction.
- A support group.
The overall message is that an intensive lifestyle change program won't work if it's just "ordered" by doctors or if patients are expected to engage with it based on threats and warnings. Any lifestyle change has to be meaningful and pleasurable for people to want to continue them for the rest of their lives.
Pioneering Approaches to Lifestyle Change
Physician and researcher Dr. Dean Ornish is a pioneer of intensive lifestyle change. His program emphasizes nutrition, exercise, and psychological factors. Any increase in physical activity is desirable, and patients can follow specific recommendations from their physical therapists, doctors, or trainers.
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The Mayo Clinic Diet: A Habit-Focused Approach
The Mayo Clinic Diet is the official weight-loss program developed by Mayo Clinic experts. The program focuses on eating delicious healthy foods and increasing physical activity. The best way to keep weight off for good is to change your lifestyle and adopt new habits that you enjoy and can stick with.
Phases of the Mayo Clinic Diet
The Mayo Clinic Diet program is designed to help reshape your lifestyle by adopting healthy new habits and breaking unhealthy old ones. It focuses on changing your daily routine by adding and breaking habits that can affect your weight. Simple habits, such as eating more fruits and vegetables, not eating while you watch TV, and moving your body for 30 minutes a day, can help you lose weight.
The Mayo Clinic Diet has two phases:
Lose It! This two-week phase jump-starts weight loss, potentially leading to a loss of 6 to 10 pounds in a safe and healthy way. The focus is on lifestyle habits associated with weight, adding five healthy habits, breaking five unhealthy habits, and adopting five bonus healthy habits.
Live It! This phase is a lifelong approach to health. You learn more about food choices, portion sizes, menu planning, physical activity, exercise, and sticking to healthy habits. You may continue to see a steady weight loss of 1 to 2 pounds a week until you reach your goal weight.
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Key Principles of the Mayo Clinic Diet
The Mayo Clinic Diet makes healthy eating easy by teaching you how to estimate portion sizes and plan meals. The program doesn't require you to be precise about counting calories. Mayo Clinic experts designed the Mayo Clinic Healthy Weight Pyramid to help you eat foods that are filling but low in calories. Each of the food groups in the pyramid emphasizes health-promoting choices.
The program recommends getting at least 30 minutes of physical activity every day and even more exercise for further health benefits and weight loss. It provides an exercise plan with easy-to-follow walking and resistance exercises that will help maximize fat loss and boost mental well-being. If you've been inactive or you have a medical condition, talk to your doctor or health care provider before starting a new physical activity program.
The Mayo Clinic Diet provides a choice of five different eating styles at several calorie levels. You can have sweets but no more than 75 calories a day. For practicality, consider thinking of your sweets calories over the course of a week.
Safety and Considerations
Most people can lose weight on almost any diet plan that restricts calories, at least in the short term. The Mayo Clinic Diet is generally safe for most adults. For most people, eating lots of fruits and vegetables is a good thing because these foods provide your body with important nutrients and fiber. Also, the natural sugar in fruit does affect your carbohydrate intake, especially if you eat a lot of fruit. This may temporarily raise your blood sugar or certain blood fats. If you have diabetes or any other health conditions or concerns, work with your doctor to adjust the Mayo Clinic Diet for your situation. For example, people with diabetes should aim for more vegetables than fruits, if possible.
Consumer Reports Survey: Insights from Dieters
A new survey of thousands of dieters and their experiences with a wide array of commercial and do-it-yourself weight-loss programs rated diets based on people's overall satisfaction with the programs and the typical amount of weight dieters said they lost.
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Key Findings from the Survey
- An app rules! It received a reader satisfaction score of 83 out of a possible 100.
- The Paleo Diet is based on a book that instructs dieters to eat like a caveman, consuming lean meats, fish, seafood, fruit and non-starchy vegetables, and avoiding cereal grains, legumes, dairy products, and processed foods.
- Weight Watchers is the people's choice. A whopping 43 percent of respondents said they signed up for Weight Watchers. The second most popular plan, a generic low-carb (non-Atkins) diet, was chosen by 13 percent of respondents.
- People using the low-calorie Medifast program lost more weight than those on other diets: 20 to 43 pounds for men and 14 to 40 pounds for women.
- Both men and women reported that they lost a similar percentage of their starting body weight. But men, who started off heavier, lost more pounds than women.
- There was only a weak relationship between actual weight loss and subscribers' satisfaction with the various diets. Instead, they gave higher marks to the diets that helped them maintain their weight loss and prescribed lifestyle changes that were easy to make.
- Significant weight loss is possible on all plans. Almost 80 percent of the respondents who reported their starting and after-diet weight lost a significant number of pounds. The median loss was about 18 pounds for men and 15 pounds for women, which was enough to move many from obese to overweight or from overweight to a healthy weight. And they did it on all 13 diets.
- The diets were as varied as online and app programs and Jenny Craig, which offers a selection of commercial options that rely on branded meal replacements.
- People lost weight on diets such as Weight Watchers and MyFitnessPal that restrict the amounts but not the types of food you eat. They also lost weight on diets such as Paleo and Atkins that do the opposite, restricting what you eat but not how much.
- Dieters listed their inability to get motivated for exercise as a top weight-loss barrier.
Expert Perspectives on Dieting
"There's not one single solution to losing weight," says Chris N. Sciamanna, M.D., M.P.H., professor of medicine at Penn State College of Medicine and a consultant on this project. "People get bored. The best strategy for would-be dieters may be to select a diet based on your personal preference."
"What works for one person is not necessarily going to work for someone else," says Alice H. Lichtenstein, D.Sc., director of the Cardiovascular Nutrition Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. "If the first try doesn't work, don't give up."
The Importance of Self-Monitoring
"Everyone should try using self-monitoring, by tracking calories eaten and physical activity," Sciamanna says. "It really works. It's a pillar of behavioral science."
Keeping a food diary used to involve toting around a calorie guide and a notepad. A survey respondent who lost more than 40 pounds using MyFitnessPal said the nutritionist he consulted "gave me a bunch of paperwork to log my daily intake. Using an app on the phone seemed like a smarter/easier way to do it. It worked for me."
Weight Loss Expectations and Diet Variety
Although readers who finished their diets lost weight, they had hoped to lose even more. Weight Watchers dieters were fairly typical in this regard: Respondents wanted to lose an average of 40 pounds, but only 13 percent succeeded in getting within 5 pounds of their goal weight. Falling short of expectations clearly disappointed our readers. And in that our readers were successful. Almost 45 percent of respondents lost 10 percent or more of their starting body weight.
Some diets on our list are built around eliminating or severely restricting major categories of food. Those include the Atkins Diet, the Paleo Diet, the initial stages of the South Beach Diet, and the catchall category of generic "low-carb diet." Of those, the Paleo Diet was the best-liked, with reader satisfaction scores significantly higher than for the others. But to some, the restrictiveness is what makes those diets appealing.
"The low-carb diets are often restricted in quality, but not quantity," Sciamanna says.
By contrast, Weight Watchers, MyFitnessPal, and SparkPeople got high reader scores for dietary variety.
"We don't believe it's practical for people to follow rigid diet recommendations long-term," says Mike Lee, co-founder of MyFitnessPal. "If you want to have a glass of wine at dinner, you can eat a lighter lunch or go for a run."
Safety and Medical Considerations
There is medical consensus that weight loss can be done safely if calorie intake is reduced enough to achieve an average 1-to-3-pound weight loss per week.
"Although weight loss is safe for most healthy individuals, everyone reacts differently, and if you have special problems like diabetes or heart disease, it's a good idea to consult with your doctor," says Sachiko St. Jeor, R.D., Ph.D., professor emeritus of internal medicine at the University of Nevada School of Medicine, a consultant on this project. "If you lose weight too fast, you may have unexpected medical complications."
Commercial Meal-Replacement Diets
Three of the commercial diets in our Ratings-Jenny Craig, Medifast, and Nutrisystem-are built around membership and the use of branded, packaged, portion-controlled meals and foods such as bars and shakes. Those foods are supplemented by your own groceries, including fresh fruits and vegetables. Readers on Medifast, Jenny Craig, or Nutrisystem were significantly more likely to report that they relied exclusively on products and advice from their plan while dieting. Slim-Fast also uses meal replacements but isn't in this category because as a group our Slim-Fast dieters took a more do-it-yourself approach, integrating advice or products from other diet plans.
The commercial meal-replacement diets got middle-of-the-road marks or lower for food variety. But a significant minority of dieters-17 percent on Jenny Craig, 23 percent on Medifast, and 38 percent on Nutrisystem-didn't like the taste of the prefab foods. And about one in five of the dieters on those plans said that the cost was higher than they had been led to believe. In the first three months on the plans, Jenny Craig clients spent a median of $809, Medifast dieters $677, and Nutrisystem customers $582.
Still, our consultants say, those diets may be a good choice for the growing number of Americans who rarely cook, whether out of lack of interest and knowledge or because they're too busy.
"Cooking feels incredibly labor-intensive for a lot of people," Sciamanna says.
Lifestyle Changes and Self-Control
Those who said their diet had lifestyle changes that were easy to incorporate into their daily lives were more likely to be satisfied than those who didn't. On that factor, MyFitnessPal particularly excelled. Respondents were also more satisfied with diets that taught them general self-control strategies and encouraged them to eat more fruits and vegetables. Weight Watchers, the Paleo Diet, the Mediterranean Diet, and the Glycemic Index Diet received top marks for encouraging fruit and vegetable consumption.
Readers who attended in-person Weight Watchers group meetings had slightly higher overall satisfaction scores. And a much higher percentage who went to the meetings reported that Weight Watchers had taught them self-control strategies.
Sciamanna says those results make sense: "When you go to a group, you get accountability to another human being and the belief that change is possible, because when you look around, you see that somebody is doing well. I think face-to-face programs are never going to go away because they're probably always going to do better. I'd be shocked if it were otherwise."
The Impact of Starting Weight
Starting weight seems to affect the amount of pounds dieters can expect to lose. For example, the men in our survey, who on average started out with higher body mass, lost more pounds than the women did. Another possible reason for variation is that some dieters stayed on their plan longer than others. Because dieters had such varying experiences, we present the typical range of weight lost for men and women for each diet. The small percentage who gained weight were excluded. The diets are listed in alphabetical order, within plan types.
Prioritizing Weight Maintenance
Before even trying to lose weight, practice the strategies that can help you keep the pounds off. Michaela Kiernan, Ph.D., a senior research scientist at the Stanford University School of Medicine, actually tested that idea in a clinical trial and found that it worked.
Half of the overweight women in the study got the usual treatment-they followed a weight-loss program for 20 weeks, then for eight weeks received standard advice on how to maintain their weight loss. The other half did it in reverse: They got eight weeks of advanced training in weight maintenance strategies, then tried to lose weight.
The results were stunning. Both groups lost the same amount of weight after 28 weeks. But a year later, those in the "maintenance first" group had regained an average of only about 20 percent of the weight they had lost; those in the usual-treatment group had regained an average of 43 percent.
Pre-Maintenance Strategies
Here are some of the pre-maintenance strategies Kiernan suggests:
Weigh yourself every day for several weeks to see how your weight fluctuates. Once you know your pattern, you won't panic if your weight goes up by a pound or two or even three from one day to the next (which, it turns out, is pretty common).
Pick a target 5-pound weight range that accounts for those fluctuations, and try to stay within it for several more weeks. If your weight drops to the bottom of your range, you can eat a bit extra to bring it back up.
It's not always smart to settle for low-calorie versions of high-calorie foods that make you yearn for the real thing. Try something that tastes completely different but is still satisfying, such as salsa on your baked potato instead of sour cream. You'll need to experiment a bit.
Learn to eat your favorite high-calorie treats mindfully, in moderation, without thinking of it as a slip-up.
Practice disruptions ahead of time.
Addressing Emotional Triggers
The idea that negative emotions can trigger overeating is so embedded in our culture that it has spawned its own visual cliché: the heroine of the chick flick who has endured a romantic disappointment sitting in bed and spooning ice cream straight from the carton.
The cliché reflects a real problem. Respondents to our diet survey said they had less success keeping weight off if their diet plan didn't address the emotional triggers to overeating.
It turns out that psychologists couldn't agree more. As a companion to our survey of dieters, we worked with the American Psychological Association to survey 1,328 licensed psychologists on how they dealt with patients' weight and weight-loss challenges. They repeatedly identified emotional factors as not only an important factor in clients' weight problems but also the major barrier to overcoming them.
Helpful Strategies for Addressing Emotional Triggers
Asked what they found helpful, seven of 10 psychologists identified these three strategies as "excellent" or "good":
Cognitive therapy: Cognitive therapy helps people identify and correct thoughts that lead to unhelpful emotions and behaviors. For example, someone who eats a cookie at a party might blame it on a lack of willpower, conclude she'll never get the weight off, then proceed to eat more cookies. Cognitive therapy would teach the person to think of the cookie as a one-time-only slip-up, because everybody makes mistakes.
Problem-solving: Problem-solving is aimed at overcoming barriers to weight loss. A patient who says he's too tired after work to go to the gym might consider alternatives, such as a walk at lunchtime or working out in the morning.
Mindfulness training: Mindfulness training is an approach that trains people to allow negative thoughts and emotions to come and go without dwelling on them, and instead concentrate on enjoying the moment.
Many psychologists said they collaborated with other professionals to help clients with weight problems.