Outsmarting the Weight Loss Paradoxes

It is no secret that weight loss is challenging for many people. Why?  The short answer is our brain and behaviors tend to form paradoxes in the face of most weight loss attempts. Paradox #1 concerns some of the intentional and habitual behaviors that affect short-term weight loss, while paradox #2 concerns behaviors, hormones, and mindsets that affect long-term weight loss or weight maintenance.

Paradox #1:

Set points for energy intake and output can be hard to change.

The physics of weight loss is dependent on a discrepancy between calories consumed and calories burned but it is nearly impossible to consciously control how many calories are consumed or burned in a given day. This is because the majority of our behaviors during the day are not driven by conscious intentions but by habit, and habit is geared to maintain homeostasis.

  1. We eat more than we realize when we are intentionally trying to limit our food intake. For example: plate portions can grow a little larger than usual, we “don’t count” the extra snack or bit of food we eat in passing between tasks.
  2. We reduce our energy expenditure in small ways when our energy intake goes down. For example: you might fidget less during the day or perform fewer household tasks or shorten the length of time you spend walking the dog; even while you may be consciously trying to increase your physical activity through intentional exercise like going to the gym or a yoga class. A 2012 study published in JAMA showed this effect in groups of adolescents following low-fat, low-glycemic or low-carb diets to achieve a 10-15% weight loss. Interestingly, in this study resting energy expenditure was most negatively affected by the low-fat diet.

Paradox #2:

In order to lose weight, one must have a healthy brain that maintains a balance between the limbic system, which houses the pleasure-reward pathway and is responsible for the generation of cravings in response to stress or need, and the prefrontal cortex, which houses our conscious decision-making, long-term planning and inhibition control (the ability to say no to something or ignore a craving). But the ability to maintain this balance is easily and quickly compromised by stress, including the stress of deprivation and starvation.

  1. The pleasure and reward circuitry of the brain. Image courtesy of the NIH.

    Most dieting attempts are inherently stressful to the body because they rely on reducing food intake to the point that the body’s stress response is activated. Even the best quality food will only provide blood sugar to keep your body fueled for about 3-4 hours, then other hormonal mechanisms take over to manage the delivery of blood sugar to tissues. Those other hormones include adrenaline and cortisol, both of which can compromise the brain’s ability to manage decision-making and the ability to keep denying oneself food or the comfort derived from food.

  2. Stress, particularly adrenaline stimulated by falling blood sugar levels and starvation, reduces the blood flow to the prefrontal cortex where conscious decision-making and inhibition control come from. This means that an unintended consequence of many weight loss attempts is that they actually leave us more vulnerable to food cravings by decreasing our inhibition control.
    • Different people will have different susceptibilities to this particularly mechanism. Genetics, the degree of stress a person is under, from both physical and emotional causes, and the diversity of an individual’s ability to manage their stress (e.g. those who use food as a primary coping mechanism will be more vulnerable than those who have experience and confidence using an array of stress coping mechanisms).

      Sugar is more than just sweet, it’s stress-relieving. Photo by Moyan Brenn.

  3. Sugar is not just a “treat” for many people. Sugar biochemically decreases the degree to which cortisol, one the stress hormones, affects this brain as was seen in a recent study published in the Journal of Clinical Endocrinology and Metabolism. This is a probable reason sugar and sweet things are used as a stress coping mechanism and why people crave sweets when they experience stress.  It can, quite literally, be a form of self-medication and stress management.
    • If an attempt at weight loss removes this coping mechanism, then not only may the individual attempting to lose weight experience more stress due to the nature of their weight loss strategy, but they will experience that stress more acutely and powerfully because one of the tools they had previously used to blunt the effect of stress on their brain is unavailable. And that in turn can set them up for sugar and food cravings.

So how do we outsmart the paradoxes?

Outsmarting Paradox #1

Awareness, planning and feedback

Awareness: Knowing that our habitual behaviors drives us towards homeostasis, keeping things just they way they are, it’s helpful to find ways to keep our decisions about food and what we eat in the sight of our conscious attention. Plenty of studies show that keeping track of what you eat with a food journal helps people lose weight and maintain weight loss more successfully than just winging it. This is because it enforces awareness about the choices you are making throughout the day and allows you to be accountable to yourself and others, if you are sharing this information with someone else who is supporting you in your weight loss efforts. And research suggests that using online food journals or apps is as effective as more traditional handwritten journals.

A trip to the library can do wonders for meal-planning inspiration. Photo by Lauren Friedman.

Planning: Knowing that our ability to make decisions supporting our long-term goals rather than our short-term cravings is compromised by hunger and deprivation, it’s beneficial to minimize the number of decisions you need to make about what to eat. This is where meal planning comes in. If you know what and when you are going to eat ahead of time, you will feel more secure exercising your inhibition control when a craving arises and have fewer opportunities for making spontaneous stress-driven decisions that are at odds with your weight loss goal.  For low-glycemic recipes and meal-planning ideas geared towards supporting brain health and decision-making visit my Pinterest boards.

A fitbit can track the number of steps taken throughout the day. Photo by Ian Dick.

Feedback: Knowing that we can subconsciously decrease our daily activity levels in response to decreased energy intake, it is helpful to have a way of measuring what our daily activity levels are on a regular basis. This way our efforts to increase our physical activity, such as going to the gym, are not in vain. One simple way to do this is to use a pedometer to keep track of your daily step count to make sure it is not subtly falling over time. It can also be helpful to log other types of small activities, such as gardening or housework, that might not be well captured by a pedometer.

Tips for the busy person: Programs that provide specific eating plans, or even provide specific meals and snacks, can be a reasonable strategy for out-smarting this paradox, at least in the short term. If you don’t feel as though you have the time and energy to create your own meal plans and do daily journaling, there are a number of programs that can do some of that work for you to get your started. These can be particularly helpful for people who feel overwhelmed by decision-making or do not feel they have a good instinctual sense of how to create and then follow a specific meal plan.

Outsmarting Paradox #2

Pushing the boundaries of pleasure, strengthening your stress response, and tackling trauma

Pushing the boundaries of pleasure:  people use food to reward themselves on a regular basis, whether it’s at certain times of day, like a 2 PM cookie to get you through an afternoon of work, or in response to certain events, like watching a favorite show on TV or celebrating a birthday. The pleasure-reward pathway in the brain is schedule- and event-driven, you can’t just take away rewards or alter your reward schedule and expect this part of the brain not to notice.  For long-term weight loss  the brain needs to be experienced in receiving pleasure from a variety of activities. We are reward-driven beings; it is part of our nature.  And developing a sense of reward from activities can take practice. That might sound odd, because it seems that rewarding behaviors are inherently rewarding. But the truth is the more we practice something, the better we like it. So if you are shifting your reliance on reward for food, you need to develop a schedule or program for building reward in other areas of your life.

  1. One big mistake people make when they substitute food rewards for other rewards during a weight loss program is that they withhold their new reward from themselves until they meet a particular weight loss goal. For example, someone might decide the will use an hour-long massage as a reward for losing 5 lbs.  This is a mistake because that’s not how the old reward system worked, instead it’s doubling down on depravation: you can’t have the thing you want (massage) until you finish denying yourself the other things you want (food rewards). The only thing this reinforces is that deprivation is hard and ultimately untenable. That’s not the lesson most people are meaning to teach themselves.

    Scheduling rewards is essential. Photo courtesy of Oliver Symens.

  2. The key to learning to experience more pleasure is to practice often. If you like massage, for example, practice receiving it on a regular schedule so that it supports your reward center on a regular basis and keeps you from feeling acute deprivation from your changing behaviors around your food rewards. That is how you teach your brain that there is an abundance of ways to be nourished and rewarded outside of food.

Strengthening your stress response: this similar to the concept of strengthening your reward pathways. In fact, many of the reward activities can become stress response activities. A stress response activity is something  you know will help you feel better in the face of stress.  You know it will because you have practiced it enough to know it provides pleasure under normal circumstances, and then practiced it more while under stress until it becomes a reflexive response to stress, something that your body craves to make you feel better.

  1. Walking for 5-10 minutes is enough to improve stress levels and reduce cravings. Image by Peter Blanchard.

    One of my favorite examples of this is exercise.  I make myself get up and take a 10 minute walk when I’m feeling a little stressed at least once a day, even if I don’t necessarily feel so stressed that I need to (or necessarily want to) take a break from work. Why? Because habitually walking when I experience a little trains my brain to make a connection between walking and stress relief. And the consequence of that is that later on, when something really stressful happens, my reflex response is to want to move to release the stress. How do I know this works? One, because my body has done this type of training before with chocolate and I successfully (and unintentionally) trained myself to want chocolate when I am stressed. And because I know intellectually that there are multitudes of ways that exercise improves mood and attenuates stress. If you are interested in knowing more about the ways that exercise benefits the brain, I cannot recommend the book Spark by John Ratey, MD highly enough.  Dr. Ratey is a psychiatrist whose practice and research focuses on how exercise supports mental health. Anytime I need motivation to move or exercise more, I can read a chapter and then next thing I know I absolutely cannot wait to exercise again. You can listen here to a free reading of the audiobook.

  2. Biofeedback is another powerful tool for redirecting how your nervous system responds to stress. Over a series of 4 – 8 visits you can learn to use your breathing and your posture to send calming signals to your brain, which can keep your long-term plans in sight even when events around you are stressful. Check out our biofeedback page for more information.

Tackling trauma: There is a complex relationship between trauma and weight gain, some of which is mediated the brain’s relationship to stress and food detailed above. One of the most important studies to shed light on this relationship is the ACES study. It’s received a lot of attention in the media for providing insight into the relationship between adverse childhood experiences, including common events such as the loss of a parent through death or divorce/separation, and health concerns later in life. The ACES study was started after clinicians running a weight loss program realized that an unexpectedly high number of participants started dropping out of the trial after successfully losing weight and wanted to find out why.  If you are interested in knowing more about the ACES study or seeing what your ACES score is, I recommend reading the ACES Too High News.

Miranda Marti is a naturopathic physician who specializes in the mind-body relationship and supporting long-term recovery from chemical and behavioral addictions, including complicated relationships with food and eating.  She is an advocate for body positivity and believes in health at every size.

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