Dear Doctor: Yes, it’s totally predicable, but my New Year’s resolution was to lose 15 pounds. I wanted to do the keto diet, but my friend (a physician assistant) said to concentrate on healthy eating instead. What do you think? Does it really have to be a choice between weight loss or wellness?
Dear Reader: You’re asking an excellent question, and you are far from alone in your quandary. Since the holidays, we’ve seen an increase in the number of stories on this very topic. Where once post-holiday diet discussions focused on austerity and sheer willpower, the conversation has shifted to health and well-being. Sure, restrictive eating plans like the ketogenic diet, which revolves around fat and protein, still hold sway. It’s hard to argue with the allure of eating bacon, cheese, meat and butter and still losing weight. When you look at the history of dieting, which stretches back thousands of years, we humans have always sought one magic formula to make weight loss easy, fast and painless.
Now, however, the tide is turning. The term “wellness” has quietly migrated from the medical world and into common usage. Even Weight Watchers, the venerable diet company, has rebranded itself to WW, in one fell swoop erasing its decades-long connection to restrictive eating.
Still, simply switching to a healthful diet does not automatically translate into weight loss. The connection between how much energy we take in and how much energy we expend remains. Consistently overeat, even on a healthful diet, and you’ll gain weight.
In our experience, the approach to weight loss that has the best odds of success is a plan that is gradual, deliberate and long-term. That’s not nearly as gratifying as the high-protein blitz that sends the numbers on the scale into a nosedive, but it also has lower odds of the rebound weight gain that often leaves dieters heavier than when they started.
We agree with your friend that your initial focus should be on a healthful and well-balanced diet. But we don’t think that when you get up tomorrow morning, you have to face a brand-new dietary landscape. Instead, start with a clear-eyed assessment of what you actually do eat. Keeping a food diary for one week — a relentlessly honest one — is an eye-opener. Write not only what you eat, but also how much and at what time. We guarantee that a pattern will emerge, including days and times that you find yourself most susceptible to poor choices. Once you know that the doughnut you easily ignored at breakfast sings a siren song at 3 p.m., you can plan ahead with a healthful substitute.
Make any dietary changes gradually. (And please, do add an exercise component to your plan.)
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
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