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Setting Reasonable Goals

Traditionally, weight loss goals were based on reaching an ideal weight, as defined by height-weight charts. More recently, 10% reductions in body weight have been suggested as successful outcomes. There are many factors that support such a change in thinking. Perhaps the most compelling is that many weight-related conditions, such as diabetes and high blood pressure, are significantly improved with weight losses of 5-10%, even if individuals remain considerably overweight. [Please see our article, "The Health Benefits of Modest Weight Loss."] Although the success of a 10% weight loss has been endorsed by expert panels and governmental guidelines, it is unclear whether persons attempting to lose weight agree with this view.

Our Patients’ Perspective

Recently, my colleagues and I at the University of Pennsylvania asked 60 women beginning a weight loss program “What is your goal weight?” We also asked them for a weight that fit the following four descriptions:

Dream Weight: A weight you would choose if you could weigh whatever you wanted.

Happy Weight: This is not as ideal as the dream weight. It is a weight, however, that you would be happy to achieve.

Acceptable Weight: A weight that you would not be particularly happy with, but one that you could accept since it is less than your current weight.

Disappointed Weight: A weight that is less than your current weight, but one that you could not view as successful in any way. You would be disappointed if this were your weight after the program.

We compared our patients’ responses to the new modest weight loss recommendations discussed above. What a difference! Our patients, who weighed an average of 218 pounds, chose an average goal weight of 149 pounds — a 69 pound weight loss! This represented a 32% reduction in body weight, an amount three times greater than the 10% recommendation. Even more surprising was the amount of weight loss that participants felt was necessary for success. A 37 pound weight loss (a 17% reduction) was “disappointing and not successful in any way.” and a 55 pound weight loss (a 25% reduction) was only “acceptable, but not one that I would be happy with.” Given these high expectations, it wasn’t surprising that almost half (47%) of our patients did not even achieve their “Disappointed Weight” after 48 weeks of treatment! The average weight loss that our patients achieved was 35 pounds (a 16% reduction). This study suggests that most people beginning weight loss programs have goals that are unattainable. No treatment, except surgery, produces the weight losses (32% reduction) desired by our study participants.

Consequences of Unrealistic Goals

Unrealistic goals leave many people feeling unsuccessful even after significant weight loss. Rather than feeling proud of their weight loss and developing skills to maintain it, many can only focus on how much more they have to lose. Despite feeling better physically and psychologically, the patients in our study were not satisfied with their weight after treatment. This is an example of a well-known psychological truth: satisfaction with any outcome is determined by the difference between what actually happened and what was expected to happen. Our study found that people’s satisfaction with their weight was more related to how close they came to their goal weight (chosen before the program began) than it was to their actual weight loss. So, people 10 pounds from their goal were more satisfied than those who were 20 pounds from their goal, no matter how much weight they lost. We are concerned that dissatisfaction with weight loss, combined with frustration when unrealistic goals are not achieved, will lead to overly aggressive methods to lose weight, perceived failure, abandonment of weight control efforts, and eventual weight regain.

Snooze and You Might Lose! (Weight)

Can sleeping more help you lose weight? At first, the idea seems counterintuitive. But research shows that sleep deprivation can cause hormonal and metabolic changes that can lead to weight gain. Plus, when you’re feeling sluggish, you’re more likely to crave empty calories like chips or cookies—and less likely to have the energy to hit the gym.

Below, Orfeu Buxton, PhD, an instructor of medicine at Brigham and Women’s Hospital in Boston, and Jana Klauer, MD, a research fellow at the New York Obesity Research Center of St. Luke’s-Roosevelt Hospital, discuss the complex relationship between sleep and body weight.

How can sleeping too little affect body weight?
JANA KLAUER, MD: When we sleep too little, we produce more cortisol, the stress hormone in the body. Cortisol, in turn, causes the release of insulin and higher insulin levels are associated with increased weight because insulin is a hormone that promotes fat storage.

ORFEU BUXTON: Another factor associated with sleep restriction that might lead to increase in weight is increased hunger. It seems as if the body responds to sleep restriction by craving more fuel. Leptin is a molecule secreted by fat cells and conveys a satiety signal that says, “There’s enough fuel on board.” With sleep restriction, even when the level of activity and the amount of calories are constant, the body says, “I need more food.” This is inappropriate and may lead to overeating and potentially to obesity in the long term.

What other effects does sleep restriction have on the body?
ORFEU BUXTON: From sleep restriction experiments it’s clear that, with just a week of sleep loss, sleeping only four hours a night, insulin levels are higher and the ability of blood sugar to be used is dramatically altered. And these changes developed in healthy young adults in just a week of sleep loss. The alterations of blood sugar metabolism are termed “impaired glucose tolerance.” and this is one of the early stages on the way towards full-blown diabetes. Habitual sleep restriction could play a very important role in increasing risk for diabetes later in life, especially if maintained over many years and decades, much like a sedentary lifestyle or poor eating habits. It’s not something that catches up with you in a week or in two weeks, but it’s something that over decades can shorten your life.

How can sleeping too much affect body weight?
ORFEU BUXTON: It’s not clear that sleeping too much has anything to do with increasing body weight. There have been some studies that have associated very long sleep duration (like 10 hours or more) on a regular basis, with obesity or weight gain or even increased mortality. It’s not clear at all that it was the sleep that did that, or if sleep was a symptom of some unknown health problem.

How does sleep loss affect your food choices?
JANA KLAUER, MD: When the body’s rested, you think clearly and you don’t have reduced energy and you’re more apt, under those circumstances, to make wise nutritional choices and to select something that’s healthy for your body. When you’re sleep-deprived, you want to go for an empty calorie energy boost and usually those are carbohydrates that are very low in nutrients and very high in calories.

What is the connection between sleep and exercise?
JANA KLAUER, MD: You might be more tired and you won’t give your workout the intensity that you normally would or maybe you’ll skip your workout. If you’re going to be exercising, you need to rest. When someone switches their sleep pattern to one of increased deep sleep, they wake up renewed. They don’t put off going to the gym; they get out of bed, put on their gym clothes and go out the door and exercise. And exercise will help you to sleep deeper and really get into that deep slow-wave sleep. It is a cycle, and exercise will help them to sleep better that night, so I think each kind of helps the other.

Could poor sleep be another risk factor for obesity?
JANA KLAUER, MD: Sleep is just as important as nutrition and exercise in a healthy diet plan. It’s very important to give yourself adequate sleep. Americans sleep, during the workweek, an average of 6 hours and 54 minutes and, on the weekends, they add about 40 extra minutes per day. So we do go around a little sleep-deprived.

ORFEU BUXTON, MD: Poor sleep or restricted sleep can potentially be seen as a symptom of a stressful or unhealthy lifestyle. Adequate sleep is a sign of a balanced lifestyle along with diet and exercise. It’s been an important recognition that sufficient sleep is important for good health.

To Keep the Weight Off, Try an Honest Scale

If you are trying to lose some weight and keep it off, stepping on a scale every day may help more than hurt, say researchers.

Although it may not be pleasant to see where that bag of potato chips wound up, a new study found that weighing yourself every day may help you keep minor fluctuations under control. In addition, meeting with a weight-loss counselor, either in person or on the Internet, may help to motivate you to keep the weight off.

“The years immediately following weight loss poses the greatest risk for weight regain.” said Dr. Rena Wing, study author and director of the weight control center at Brown University, “Thus, a major problem is the treatment of obesity is prevention of [gaining back the weight].”

For the study, which was presented at an obesity conference, 291 people who had lost at least 10 percent of their body weight in the last two years were counseled on diet and exercise and divided into three groups.

Two of the groups met either online or in-person with a weight-loss counselor every week for four weeks and then monthly for a total of one-and-a-half years. All of the participants had to submit weekly weight reports and were notified if they had gained five pounds or more. The third group only received monthly newsletters on weight loss.

At the end of the study, the researchers found that 46 percent of participants who had in-person counseling and 55 percent of the participants who had counseling via the Internet had regained at least five pounds. Those who went without counseling fared worse—nearly three-fourths regained a significant amount of weight.

While the power of weight-loss counseling has been known for some time, Dr. Gary Foster, clinical director of the weight and eating disorders program at the University of Pennsylvania, was surprised by how well online support groups worked. “If you can do that well with the Internet, it makes counseling so much more available.” he said.

Wing also found that there was a strong connection between the regular use of a scale and the ability to keep off the lost pounds. In fact, 61 percent of the patients who weighed themselves once a day were able to keep their weight off, while only 32 percent of the less-frequent scale-steppers were able to.

“The scale gives you feedback and allows you to reverse small weight gains before they become big weight gains.” said Foster.

Other means for monitoring weight gain, like trying on a pair of jeans, tend to be more subjective. A person can make excuses, claiming that the jeans were stiff from the wash or that they shrunk, said Foster.

But a scale is undisputable, said Foster. “It is a reality check.”

Men Want Steak - Women Want Cake

What’s your ultimate comfort food? A huge ice cream sundae dripping with hot fudge or a juicy, tender T-bone steak?

A new study, published in Physiology and Behavior, confirms the old stereotype: women tend to comfort themselves with sweet-tasting foods when they are feeling down. But it also reveals that men prefer meat as their comfort food. And unlike women, they eat mostly when they are feeling at their best.

“In the past, comfort food was considered primarily as a strategy to alleviate stress, sadness and other negative emotions.” said Dr. Jordan LeBel, associate professor at Cornell University’s School of Hotel Administration. “Ensuring emotional well-being is still the goal, but pleasure and positive emotions can also determine food choice, especially in men.”

What’s your ultimate comfort food? A huge ice cream sundae dripping with hot fudge or a juicy, tender T-bone steak?

A new study, published in Physiology and Behavior, confirms the old stereotype: women tend to comfort themselves with sweet-tasting foods when they are feeling down. But it also reveals that men prefer meat as their comfort food. And unlike women, they eat mostly when they are feeling at their best.

“In the past, comfort food was considered primarily as a strategy to alleviate stress, sadness and other negative emotions.” said Dr. Jordan LeBel, associate professor at Cornell University’s School of Hotel Administration. “Ensuring emotional well-being is still the goal, but pleasure and positive emotions can also determine food choice, especially in men.”