Mayo Clinic Recommends Slow Speed of Weight Loss

As a general rule, I have heard that those wanting to lose weight should aim for 3 to 4 pounds per week - no more. The Mayo Clinic is recommending 1 to 2 pounds per week to preserve lean muscle tissue.

This from the Mayo Clinic:

When it comes to weight loss, slow and steady wins the race. Fast weight loss is usually followed shortly by rapid weight gain. Besides, 1 pound of fat contains 3,500 calories, so you need to burn 500 more calories than you eat each day to lose just 1 pound a week (500 calories x 7 days). If you're losing more than 1 to 2 pounds a week, it's either water weight or lean tissue you're losing, not fat. Weight loss of 1 to 2 pounds a week may seem like an agonizingly slow pace, but if improving your health is a long-term goal, the speed of your weight loss isn't important.

There is also countless other reasons to aim for a low speed of weight loss. Besides being the healthiest way to go about it, it also seems correlated with maintaining weightloss. At the extreme, there is also the concern with losing weight slow enough to allow your skin a chance to retract - a concern mostly associated with weight loss surgery.

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Scotland's NHS: 90 Minutes Of Vigirous Exercise A Day Needed For Weight Loss

Based on guidelines from the American College of Sports Medicine in Indianapolis, Scotland's National Health Service is calling for 90 minutes of vigirous exercise per day to lose weight and sustain the loss.
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This from the Scotsman:

IT has been revered as the perfect way to keep healthy and stay in shape.

But the traditional 30-minute-a-day exercise target is insufficient and overweight Scots will need a daily 90-minute workout to stand any chance of fighting the flab, according to new public health guidance.

The advice, which GPs and nurses are to pass on to NHS patients, also warns that light housework such as cleaning or dusting, or strolling round the supermarket, must not be counted in the daily exercise regime.

Instead, only "moderate" or "vigorous" activity such as brisk walking, running, swimming and heavy domestic chores like vacuuming, mowing the lawn or painting and decorating count.

And as part of their weekly regime all adults should perform two sessions of weight training exercises.

The updated guidance on exercise targets has been published by the Scottish Government's public health advisory body NHS Health Scotland. The recommended levels of physical activity have been renewed with ambitious new targets following a recent change in international guidelines.

The guidance is being sent out to GPs, practice nurses, health visitors and pharmacists so they can advise members of the public on how to incorporate exercise into their daily lives as part of the NHS drive to reduce the nation's soaring obesity problem.

. . . The guidance document, 'Energising Lives', states that NHS staff must make physical activity a "higher priority", with 60% of men and 70% of women not thought to be taking enough exercise.

It sets out a number of tips that staff can offer to patients. It adds: "You should do at least 30 minutes of moderate-intensity physical activity, above usual activity at work or home, on at least five days of the week. If you are already overweight or obese, then you should aim to do between 60 and 90 minutes on five days of the week."

Approved activities according to the guidance include brisk walking, running, badminton and cycling as well as heavier household and gardening chores such as mowing the lawn and vacuuming.

However, many ordinary activities of "light intensity" such as office work, shopping or cooking do not count towards the daily target. Nor does anything that takes less than 10 minutes, such as taking out the rubbish.

It adds that weight training or stair climbing should be included twice a week and that a range of activities should be aimed for to improve stamina, strength, flexibility and balance.

Last night a spokeswoman for NHS Health Scotland said the document was based on recently updated, internationally recognised guidelines produced by the American College of Sports Medicine in Indianapolis.

She added: "NHS primary care staff felt there was a need for a guide that had appropriate advice for patients. This really spells out what type of exercise to do and making it relate to people's lives. People can interpret it in different ways so this gives examples of what staff can tell patients to do. This is about how to put it into practice.

"It's up to the discretion of the GP or nurse how they use this information. It's not about going to the gym but doing things like gardening to benefit health."

A spokeswoman for the British Medical Association said: "This has to operate in tandem with advice, support and education on healthy eating and making sensible lifestyle choices. In order to make a significant impact on the weight of individuals there has to be a commitment to do as much exercise as possible.

"If somebody is suffering from the medical consequences of being obese or overweight, they may be at risk of chronic heart disease, stroke or have high blood pressure but if they lose weight they are more likely to reduce their health risks. So it may be appropriate to raise the potential for exercise with the patient. That's a discussion that has to take place between the GP and the patient."

Margaret Watt, chairwoman of the Scotland Patients' Association, described the move as "a step in the right direction". However, she warned it would not work unless people were sufficiently motivated. She added: "It's a personal responsibility and people will not be helped unless they want to help themselves."

But Edinburgh-based personal trainer Tracy Griffen said most members of the public would find it far too difficult to meet the targets. She said: "Most people who have not exercised before would struggle even to walk for 90 minutes a day, let alone do weight training.

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The Relationship Between Exercise & Sustaining Weight Loss

It would seem that sustaining weight loss requires approximately an hour of exercise per day, at least 5 days a week. That is the conclusion of a recent long term study reported in the Archives of Internal Medicene, a subsidiary publication of the Journal of American Medicine. It comports with the observation of the National Weight Loss Registry, that of those who have lost significant amounts of weight and kept it off, 90% of them exercise over one hour per day.
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It would seem that in the world of weight loss, the importance of daily exercise in sufficient quantity and vigor cannot be overemphasized. This from the Archives of Internal Medicine:

In addition to limiting calories, overweight and obese women may need to exercise 55 minutes a day for five days per week to sustain a weight loss of 10 percent over two years, according to a report in the July 28 issue of Archives of Internal Medicine . . .

More than 65 percent of U.S. adults are overweight, a public health concern, according to background information in the article. "Among obese adults, long-term weight loss and prevention of weight regain have been less than desired," the authors write. "Therefore, there is a need for more effective interventions." Current recommendations prescribe 30 minutes of moderate physical activity on most days of the week, for a total of 150 minutes per week. However, a growing consensus suggests that more exercise may be needed to enhance long-term weight loss.

To calculate the amount of exercise needed, John M. Jakicic, Ph.D., of the University of Pittsburgh, and colleagues enrolled 201 overweight and obese women in a weight loss intervention between 1999 and 2003. All the women were told to eat between 1,200 and 1,500 calories per day. They were then assigned to one of four groups based on physical activity amount (burning 1,000 calories vs. 2,000 calories per week) and intensity (moderate vs. vigorous). Group meetings focusing on strategies for modifying eating and exercise habits, as well telephone calls with the intervention team, also were conducted over the two-year period.

After six months, women in all four groups had lost an average of 8 percent to 10 percent of their initial body weight. However, most were not able to sustain this weight loss. After two years the women's weight was an average of 5 percent lower than their initial weight, with no difference between groups.

The 24.6 percent of individuals who did maintain a loss of 10 percent or more over two years reported performing more physical activity (an average of 1,835 calories per week, or 275 minutes per week over the baseline level of activity) than those who lost less weight. They also completed more telephone calls with the intervention team, engaged in more eating behaviors recommended for weight control and had a lower intake of dietary fat.

"This clarifies the amount of physical activity that should be targeted for achieving and sustaining this magnitude of weight loss, but also demonstrates the difficulty of sustaining this level of physical activity," the authors write. "Research is needed to improve long-term compliance with this targeted level of physical activity. Moreover, continued contact with the intervention staff and the ability to sustain recommended eating behaviors also may be important contributing factors to maintaining a significant weight loss that exceeds 10 percent of initial body weight, which suggests that physical activity does not function independently of these other behaviors."

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Healty Diets & The Israeli Study

Healthy diets will improve health, even if resulting in only a modest sustained weight loss, according to the NYT analysis of the recent Israeli study of three different diets - low fat, Mediterranean, and low carb - over a two year period. Further, the study is of note because the vast majority of people who started the study completed it - something which the plans authors attribute to diet restrictions that were modest at inception and did not vary throughout the study.
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This from the NYT:

In a tightly controlled dieting experiment, obese people lost an average of just 6 to 10 pounds over two years.

The study, published Thursday in The New England Journal of Medicine, was supposed to determine which of three types of diets works best. Instead, the results highlight the difficulty of weight loss and the fact that most diets do not work well.

The researchers followed 322 dieters, 277 men and 45 women. The dieters were assigned to follow one of three types of diets — a diet with about 30 percent fat, based on American Heart Association guidelines; a Mediterranean diet; and a low-carbohydrate diet based on the Atkins diet plan. The study was partly financed by the Atkins Research Foundation.

The trial was conducted at the Nuclear Research Center in Dimona, Israel, an isolated workplace that has its own medical department.

In addition to regular meetings and telephone calls with dietitians for the participants, the plan included nutrition counseling for spouses and a revamping of the food served in the center’s cafeteria.

Because the center is in an isolated area, the dieters consistently ate lunch, the largest meal of the day, in the company cafeteria, where food was color-coded to help dieters comply with their eating plan.

The biggest weight loss happened in the first five months of the diet — low-fat and Mediterranean dieters lost about 10 pounds, and low-carbohydrate dieters lost 14 pounds.

By the end of two years, all the dieters had regained some, but not all, of the lost weight. The low-fat dieters showed a net loss of six pounds, and the Mediterranean and low-carbohydrate dieters both lost about 10 pounds.

Researchers said the results sound modest, but they said the small weight loss had resulted in improvements in cholesterol and other health markers.

“In order to keep participants on the diet for long term as a way of life, we did not impose extreme diet protocols,” said Iris Shai, the study’s lead author and a registered dietitian at Ben-Gurion University of the Negev at the S. Daniel Abraham International Center for Health and Nutrition. “More dramatic diet protocols could probably reduce more weight for the short term, but participants would have dropped out.”

There were subtle differences in the three diets studied. Men did better on the low-carbohydrate diets, losing 11 pounds compared with about 9 pounds for the Mediterranean diet.

Women fared best on the Mediterranean diet, losing about 14 pounds compared with about 5 pounds on the low-carbohydrate plan.

For all dieters, there were improvements in the ratios of good to bad cholesterol.
“This suggests that healthy diet has beneficial effects beyond weight loss,” Ms. Shai said.

Read the entire article.

As an aside, it seems apparent that significant weight loss cannot be sustained, irrespective of diet, unless accompanied by at least an hour a day of excercise of sufficient rigor to get the endorphins pumping. That seems to be borne out by an analysis done at the National Weight Control Registry of people who have lost significant amounts of their bodyweight and then have kept it off. Over 90% of these people maintain a robust exercise regime of over an hour per day.

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