The Best Online
Calorie Calculator,
According to Science.
But it might not work for you.

Another free online calorie calculator, the Body Weight Planner, is now available to the public after several years of being used as a research tool for scientists at the National Institutes of Health. This one is noteworthy because its algorithms were validated in several controlled weight loss studies in human beings, and because it takes into account a person's slowing metabolism.
 
Kevin Hall, a scientist at the NIH's National Institute of Diabetes and Digestive and Kidney Diseases, created the tool.

Dr. Hall says the 3,500-calorie rule is accurate only if a pound of human fat is burned in a lab.  However, unlike a lab, the body is not a static environment, and instead adapts when a person changes their diet and exercise.

As a person diets and loses weight, the body slows the metabolism in an effort to conserve energy. As a result, eating 500 fewer calories a day leads to slightly less weight loss as time goes on.

Instead of 3,500 fewer calories, over 12 months, a person will need to eat 7,000 fewer calories to burn a pound of fat.

Dr. Hall said that the biggest flaw with the 3,500-calorie-rule is that it assumes weight loss will continue in a linear fashion over time. "That's not the way the body responds. The body is a very dynamic system, and a change in one part of the system always produces changes in other parts.”

He admits that dieters may be “bummed out” by news that they must double their efforts at reducing calories. “But we believe it's better to have an accurate assessment of what you might lose, that way you don't feel like a failure if you don't reach your goal.”

Dr. Hall added that very few people seem to be able to keep losing weight after 12 months.

The BWP calculates how many calories a day a person should eat to achieve their weight loss goals in a certain time (for example, to lose 10 lbs within a year).  The link can always be found here in DietHobby, under RESOURCES, Links, Body weight Calculator - NIH (Timeline Projections).

The NIH bills the planner as a cutting-edge tool that will empower people to take their health into their own hands, but research on the success of such calculators and trackers is mixed.  Although the federal government is to be praised for its official nod toward the utility of trackers and calculators,  human beings themselves are not “simple machines” who operate on a calories in, calories out basis.
 
The assumption is that calories in and calories out are independent of each other.  That is, if you reduce Calories in,  Calories out are not affected.  However, this is untrue.  

DietHobby contains many posts talking about how hard it is to get an accurate ongoing count of  “Calories in”, but getting an accurate ongoing count of “Calories out” is far more difficult.  Most everyone makes an erroneous assumption that the “Calories out” number stays constant.

“Calories out” is not under our conscious control.  There are many metabolically active tissues, including brain, kidneys, heart, liver, etc whose activity is very difficult to measure. There are numerous hormones and enzymes and genetics involved in our individual metabolic processes…and some of these are still undiscovered. 

We make the incorrect assumption that our only variable that changes is the energy we spend in voluntary exercise or activity.  This is also not true.  Basal Energy Expenditure is not stable and can change up or down 50%.  Reducing Calories In reduces Calories Out. They are not independent of each other.

This isn’t news to anyone who has ever seriously tried to lose and maintain weight. A London research study released in July 2015 that tracked 278,982 participants, using electronic health records from 2004 to 2014 estimated that for people with a 30-35 BMI (Stage 1= obesity), an obese man’s chances of reaching a normal body weight (<25 BMI) were 1 in 210 for men, and 1 in 124 for women. For the severely obese-people with a 40+ BMI (Stage 2+ =severe obesity+), only about 8 percent of obese men and 10 percent of obese women were able to lose five percent of their body weights.  Almost all of the participants who achieved weight loss regained it within five years. 

At my highest weight, 24 years ago at age 47, my personal BMI was 52.9  (Stage 4=super-obesity). I have been at-or-near a "normal" BMI for the past 10 years. See ABOUT ME.
 
Calculators can't provide prescriptions for weight loss or protections against regain. They don’t apply equally to every single individual, and are merely averages ... standardized guidelines. The problem is that not all metabolisms, circumstances and eating habits are standardized.
 
For example, if a professional athlete walked at 3 miles per hour speed for a half hour, that athlete would burn calories totally differently than an average non-athlete who was the same exact weight.
 
Many factors are at play when it comes to how people consume and burn calories. Environment matters, for example. Also, everything from stress, to genetics, to cultural influences plus more, can affect an individual’s dietary habits and exercise levels.
 
Emerging research shows that even gut bacteria affects a person's ability to absorb calories. For instance, food may be absorbed as three calories in a lean person and seven calories in an obese person simply because of differences in how gut bacteria breaks down the meal.
Therefore, it is unreasonable to expect ANY calculator to give everyone a full and accurate game plan.

In the video below, Dr. Hall demonstrates how the calculator works by using his own weight loss goals as an example:

Hall, a 44-year-old man who wants to lose 20 pounds off his 5’10, 180-pound frame, is going to have to eat about 2,300 calories per day, provided he sticks to his resolution to walk his dog in the mornings three times a week. Once he reaches his goal weight, he’s going to have to maintain that weight loss by keeping up his dog-walking activity level and eating about 2,600 calories a day.

NOTE: originally posted on 12/1/2015.  Bumped up for new viewers.

The issue of Projections about the Rate of Weight-Loss has been on my mind for a very long time, and so this article is going to be quite long and detailed.  Those who bear with me and press on through, might learn some helpful information, or at least be exposed to something other than empty promises.

The Diet Industry knows that people want to lose their excess fat ASAP, and that people also want to spend as little time possible on a weight-loss Diet.  It takes advantage of that fact by using the diet-of-the-moment’s maximum 1st week weight-loss number as a marketing tool. 

Typical is: “Lose 15 pounds in 7 days”; or 10 pounds or 7 pounds, etc.  We see that ploy used continually in the media.  It is almost impossible to look at any magazine display rack in a supermarket checkout line without seeing a similar Headline.

What is implied by this claim is that the number of the first week’s weight loss is a prediction of weight-loss for the subsequent weeks. Marketing claims: “10 pounds in 1 week”.  People think, “Wow, If I stick to this Diet for just 5 weeks, I can lose 50 pounds.” 

Then, when they don’t experience that rate of weight-loss, they feel disappointed. Upon expressing their disappointment to the medical doctor, the nutritionist, the diet guru, the group leader, the program counselor, or whoever, the most common response is: “YOU didn’t follow the diet correctly.”  People are blamed for their weight-loss failure; while the Diet Industry gets the credit for their weight-loss success.

This is universal. I’ve never seen or participated in ANY diet program that didn’t follow that line of thinking, and during the past 60 years …from adolescence on… I’ve been involved with a great many of them.  I have personal experience with a great many diets and diet programs, and I’ve closely watched the experiences of many hundreds of other people as they dieted.

People WANT TO BELIEVE the claims of rapid weight-loss that they hear, and they desperately hope that they will personally experience rapid weight-loss by following their latest Diet-of-choice.   Some of these rapid weight-loss claims are based on lies; some are based on ignorance; some are based on personal experience together with poor memory; and a few are based on the real results of very unusual people. There are those who make these incorrect rapid weight-loss projections in good faith; who stubbornly hold onto an unreasonable Belief by stubbornly ignoring the overwhelmingly-vast-weight-of-the-evidence stacked up against it. However, the fact is that almost all of those claims are false, and the rest of them are based on factors that don’t apply the the majority of dieters. 

Almost everyone on a Diet, including me, is curious about their own potential rate of weight-loss.  

Here are a few facts to consider.  Typically… all other things being equal…, males lose weight faster than females; younger people lose faster than older people; larger people lose faster than smaller people; fatter people lose faster than thinner people; athletic people lose faster than sedentary people; people who have gained weight after maintaining a lifetime of “normal” weight lose faster than people who’ve been fat for a long time.  When people become lighter, their bodies require less fuel to function, and therefore after successfully dieting, they must continually eat less than they did to maintain their old weight. 

In addition to the facts mentioned above, different people of the same age and same size naturally have different metabolic rates. The two main formulas that cite Metabolic rates, and list weights and calories together, are the Harris-Benedict formula and the Mifflin formula.  These are similar in that their numbers are based on AVERAGES… which means that there are many people ABOVE that number, and many people BELOW that number. The standard deviation of the Harris-Benedict formula is about 14%, and it is not uncommon for people to be 14% above or 14% below that Average number.  Also, the studies include  “Outliers” which are people who are situated away or detached from the main body and differ from all other members of a particular group.  An Outlier has a metabolic rate very much higher or very much lower than the rest of the Group.

It is important to understand that the calculators, charts, graphs and predictions we see online are based on the Averages used in the above-mentioned formulas, and although they are a good place to start, they may not apply exactly to you personally.  AND, even if they apply to YOU personally, it doesn’t mean that they will apply to EVERYONE personally.

I’m going to show you how this works by sharing about ME, personally.  In order to better understand, it would be helpful if you read or re-read the article: ABOUT ME.  Next read or re-read the article: How Fast…How Much…Weight Lost After Gastric Bypass?  This article contains a detailed chart of my rate of weight-loss during the year immediately after my RNY gastric bypass 24 years ago.

The rate of weight-loss that I experienced during the year following weight loss surgery is extremely valuable information because there can be NO QUESTION of whether or not I was “faithful to the diet”.  I had no other physical option, as my body would not allow me to eat in any other way.  No normal “cheating” was possible, and even a very tiniest amount of extra food resulted in severe physical discomfort, i.e. vomiting and/or other painful symptoms.

It is also important, because my diet after a gastric bypass was an extremely low-calorie diet, from less than 300 daily calories to a maximum of around 600-800 daily.  So, ….other than a total water fast… no other diet exists which would cause a faster rate of weight loss for me.

Here is a summary of my numbers (see the chart mentioned above for details).
Start: 271 pounds; End: 161 pounds.

Information from the first 7 months or so is the most relevant for this article.

Before WLS weighed 271
The first week: … week one I lost 17 pounds.
Start of week 2, weighed 254 pounds
Weeks 2-6 (5 week period) I lost 14 lbs for a 2.8 lb average loss per week.
Weeks 7-12 (6 week period) I lost 15 lbs for a 2 ½ lb average loss per week.
Weeks 13-18 (6 week period) I lost 16 lbs for a 2 ½ lb average loss per week
Weeks 19-24 (6 week period) I lost 15 lbs for a 2 ½ lb average loss per week
Weeks 25-30 (6 week period) I lost 14 lbs for a 2 ⅓ lb average loss per week
End of week 30, weighed 180 pounds.

In the weeks that followed, my body was able to tolerate more food, and my weight loss began slowing to a standstill.  Although this information is not all that relevant to this current article, I include it to satisfy those who might be curious.

Start weight 180 
Weeks 31-36 (6 weeks) I lost 3 lbs = ½ lb average loss per week
Weeks 37-42 (6 weeks) I lost 7 lbs = 1 lb average loss per week
Weeks 43-48 (6 weeks) I lost 5 lbs = ½ lb average loss per week
weight 167
Weeks 49-54 (6 weeks) I lost 1 lb = 1/6 lb average loss per week
Weeks 55-60 (6 weeks) I lost 2 lbs = ⅓ lb average loss per week
Weeks 61-64 (4 weeks) I lost 3 lbs = 3/4 lb per week
Final low weight 161.

So, regarding projections about my own future rate of weight-loss, the  information about myself shows that in the 7 or so months immediately following a RNY gastric bypass, which forced me to eat in a very low-calorie manner …. my average rate of weight loss was about 2 ½ pounds per week.

I am still female, and still 5 ft 0 in tall,
however, at this time……
I am 24 years older. I am physically much less active. Instead of being obese between 254-180 pounds, I am now a “normal” weight - 123.  All of these factors make a difference in my metabolic rate. It is now lower. My body now, simply does not need as many calories as it did before.  Because of this, it is unlikely that any type of diet … other than a total water fast… would cause an ongoing weight loss as high as that previous 2 ½ pound weekly average.

There are very few people who have kept exact and detailed long-term records of their weight-loss histories, or had the same diet experiences. So while my information is relevant to me, personally, it might not be all that helpful to others. Keeping all of that past personal information in mind, now I’m going to move on to share about making personal projections for my FUTURE rate of weight-loss on a very-low calorie diet.


This is an visual of my current weight maintenance graph.

My ultimate goal is to keep my weight within my “normal” BMI range.  At times this involves some rather serious dieting.  Currently, I am doing some more experimentation with “The 5-Bite Diet”, which is a very low calorie diet which mimics the volume of eating immediately after a Gastric Bypass.  This morning the scale said that I weigh 123 pounds.

In the next examples, I’m going to be using the Body Weight Planner Tool.  For my detailed discussion of this tool, read or re-read Body Weight Calculator -Timeline Projections. Remember, the numbers in this tool are based on AVERAGES, and people are commonly both Above and Below these Averages.

  Now, I’m going to use the Body Weight Planner Tool to run some calculations in order to see what a “reasonable” timeline projection of my rate of weight-loss would be if:

(1) I went on a “Total Water Fast”;  or 
(2) I followed the 5-bite diet eating only 2 Snickers bars or their equivalent daily (500 calories); or
(3) I followed the 5-bite diet eating only 1 Snickers bar or it’s equivalent daily (250 calories).

This following information is for those people who might be interested in learning how to use this Calculator to find out what a “reasonable” timeline projection might be for their own personal rate of weight-loss.  BTW, in order to force the tool to go under a 1, 000 calorie diet, you have to use the button “Switch to Expert Mode”. 


Scenario One….. A Total Water Fast.

In this example, I use my own numbers, to see how long it would take for me to lose from 123 pounds to a 105 pound goal on a total water fast. 

Notice the graph gives my total daily energy equivalent (TDEE) as 1,110 daily calories.  It says that after I reach 105 pounds that TDEE will drop to 1058 daily calories. In actuality, from my detailed 10 year history of personal records, my actual TDEE is a couple of hundred calories lower than  Average. 

According to this calculator, it would take 32 days of a total water fast for me to reach 105 pounds.



 Above is a graph of that same information.  Note, however, that immediately upon reaching 105 pounds, and starting to eat 1058 calories, there is a projection of an immediate up bounce, due to the increased weight of food/water/salt/waste. This projected up bounce is almost 8 pounds, leaving the final weight result 113.6 pounds.

Scenario Two….. 5-bite diet - 2 snickers bars per day (500 cal)

In this example, I use my own numbers, to see how long it would take for me to lose from 123 pounds to a 105 pound goal on a perfect 5-bite diet of 2 snickers bars or 500 calories per day.  All of these graphs will give me the same TDEE info.

According to this calculator, it would take 95 days of 2x5-bites (2 snicker bars=500 calories) for me to reach 105 pounds.



Above is a graph of that same information.  Note, however, that immediately upon reaching 105 pounds, and starting to eat 1058 calories, the projection of an immediate up bounce, due to the increased weight of food/water/salt/waste is less. This projected up bounce is about 4 pounds, leaving the final weight result 109 pounds.


Scenario Three….. 5-bite diet - 1 snickers bars per day (250 cal)

In this example, I use my own numbers, to see how long it would take for me to lose from 123 pounds to a 105 pound goal on a perfect 5-bite diet of 1 snickers bar (250 calories) per day.  All of these graphs will give me the same TDEE info.

According to this calculator, it would take 55 days of 2x5-bites (1 snicker bars=250 calories) for me to reach 105 pounds.


Above is a graph of that same information.  Note, however, that immediately upon reaching 105 pounds, and starting to eat 1058 calories, the projection of an immediate up bounce, due to the increased weight of food/water/salt/waste is less. This projected up bounce is about 6 pounds, leaving the final weight result 111 pounds.

  What does all this mean?
First, undoubtedly, it it means that I am a compulsive record keeper, who is obsessed about my weight.

Second, the information in the above pictures does not apply universally. It is applicable ONLY to me personally…. and even then… only to the “average” person whose height, weight, sex, age, and activity level numbers match my own. 

Next, the tool I’ve demonstrated can be used by anyone who wants to input their own numbers, and play the game of “how many calories = how fast a weight loss”.

Finally, my wish and hope is that everyone who is interested in their own rate of weight loss, will not simply take the amazingly erroneous weight-loss projections of any “Expert, including any Medical Doctor” as Truth, and then blame themselves for failing, when even despite their very best efforts, their bodies do not meet those impossible-and-unreal rapid-weight-loss standards.

NOTE:  Originally posted in January 2016. Bumped up for new viewers.

A Scientific Study was recently published concluding that an alternate-day fasting diet was NOT superior to a daily calorie restriction diet for Metabolically Healthy Obese Adults with regard to adherence, weight loss, weight maintenance, or improvement in risk indicators for cardiovascular disease (including insulin resistance).

The lead researcher in this study, Dr. Krista Varady, has previously done extensive research on Alternate Day Fasting.  Those studies are currently considered the best scientific authority on Intermittent Fasting, and her previous research findings have often been extensively quoted by the majority of Intermittent Fasting Gurus, including Dr. Jason Fung, author of The Obesity Code (2016) and The Complete Guide to Fasting (2016)

Below is a recent article from TIME. 
 

Fasting Isn’t Better for You Than Regular Dieting
Alexandra Sifferlin   May 01, 2017    TIME

Losing weight is hard, which is why weight loss experts have long searched for different approaches to make it easier for people. One strategy gaining steam is intermittent fasting, where people fast or lower their calories substantially for a short period of time. (This diet plan also has potential lifespan-extending benefits.)

But new research published in JAMA Internal Medicine suggests that the fasting diet may not be the weight loss key it's been hyped up to be.

In the new trial, researchers wanted to know whether people who tried a fasting diet would be more successful than those on a standard diet. They told 100 people with obesity to follow one of three diets for a year. Some were told to cut their calorie consumption by 25% per day—a typical calorie restriction diet—while others did an alternate-day fasting diet, where they ate about 500 calories on “fast” days and whatever they wanted on “feast" days. The last group, which served as the control group, ate what they normally would.

The researchers expected that the people in the fasting group would lose more weight and have an easier time sticking to the diet than regular dieters, but the results didn't reflect that. At the end of the year, people who did the fasting diet and those who just cut calories both lost an average of 13 pounds. However, people in the fasting group actually had a harder time sticking to the diet, and more people in that group dropped out of the study.

“I really thought people would have an easier time and lose more weight on the [intermittent fasting diet] and I was shocked they lost the same amount,” says study author Dr. Krista Varady, an associate professor of nutrition the University of Illinois at Chicago and author of the book The Every-Other-Day Diet. “The take-home message for me is that this diet isn’t for everyone.”

The researchers also did not find significant differences in other health measures between the dieting groups, like blood pressure, heart rate or insulin resistance.

Dr. Varady says that while half of the people in the fasting group "could barely do the diet," there were several people who were very successful, losing between 20 to 50 pounds. Those findings suggest that some people do respond well to the diet.

Still, what works for one person clearly doesn’t work for everyone. “If people have failed other diets, maybe this will work,” Dr. Varady says. “People will pick what diet works best for them."

Below are Excepts from a recent CNN article about this scientific research study. 
 

The study suggests that there is no significant difference between fasting and the other popular weight loss strategy of simply restricting how many daily calories you consume.

Dr. Varady said that, before the study, she thought alternate-day fasting would be an easier diet to adhere to because it allowed for a "break" from dieting every day.

"We were a little bit shocked to see that it was actually the calorie-restriction group that seemed like they could stick better to their daily calorie goals. Whereas the alternate-day fasting group, they were kind of wavering," said Dr. Varady, who authored a book about alternate-day fasting called "The Every-Other-Day Diet."

"Instead of eating the 500 calories on the fasting days, they were eating a couple hundred calories more on those days," she said.

'Not one diet fits everyone'

All in all, the new study showed that alternate-day fasting may be difficult to follow but can be effective in reducing obesity, said Valter Longo, a professor at the University of Southern California and director of the university's Longevity Institute. He was not involved in the study.

However, "because it requires a major effort every other day, it is unlikely to be applicable to the great majority of the obese population, particularly in the absence of the close monitoring carried out in the clinical study," Longo said.

For overweight or obese adults who might be interested in alternate-day fasting as a weight loss approach, Dr. Varady advised taking the time to really determine whether it is the best option.  "I really think people just need to find what works for them," she said. "Not one diet fits everyone."

"I don't think there's anything magical to the diet at all," she said of alternate-day fasting. "I think it's just another way of tricking people into eating less food or helping people to kind of monitor how much food intake there is or how much food they're taking in."

Below is a copy of the published research study.

This study can also be found at:
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2623528

May 1, 2017 

Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults
A Randomized Clinical Trial

John F. Trepanowski, PhD1; Cynthia M. Kroeger, PhD1,2; Adrienne Barnosky, MD1; et al Monica C. Klempel, PhD1; Surabhi Bhutani, PhD1; Kristin K. Hoddy, PhD, RD1; Kelsey Gabel, MS, RD1; Sally Freels, PhD3; Joseph Rigdon, PhD4; Jennifer Rood, PhD5; Eric Ravussin, PhD5; Krista A. Varady, PhD1

Author Affiliations Article Information
JAMA Intern Med. Published online May 1, 2017. doi:10.1001/jamainternmed.2017.0936


Key Points

Question  Is alternate-day fasting more effective for weight loss and weight maintenance compared with daily calorie restriction?

Findings  This randomized clinical trial included 100 metabolically healthy obese adults. Weight loss after 1 year in the alternate-day fasting group (6.0%) was not significantly different from that of the daily calorie restriction group (5.3%), relative to the no-intervention control group.

Meaning  Alternate-day fasting does not produce superior weight loss or weight maintenance compared with daily calorie restriction.

Abstract

Importance  Alternate-day fasting has become increasingly popular, yet, to date, no long-term randomized clinical trials have evaluated its efficacy.

Objective  To compare the effects of alternate-day fasting vs daily calorie restriction on weight loss, weight maintenance, and risk indicators for cardiovascular disease.

Design, Setting, and Participants  A single-center randomized clinical trial of obese adults (18 to 64 years of age; mean body mass index, 34) was conducted between October 1, 2011, and January 15, 2015, at an academic institution in Chicago, Illinois.

Interventions  Participants were randomized to 1 of 3 groups for 1 year: alternate-day fasting (25% of energy needs on fast days; 125% of energy needs on alternating “feast days”), calorie restriction (75% of energy needs every day), or a no-intervention control. The trial involved a 6-month weight-loss phase followed by a 6-month weight-maintenance phase.

Main Outcomes and Measures  The primary outcome was change in body weight. Secondary outcomes were adherence to the dietary intervention and risk indicators for cardiovascular disease.

Results  Among the 100 participants (86 women and 14 men; mean [SD] age, 44 [11] years), the dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), vs the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). Mean weight loss was similar for participants in the alternate-day fasting group and those in the daily calorie restriction group at month 6 (–6.8% [95% CI, –9.1% to –4.5%] vs –6.8% [95% CI, –9.1% to –4.6%]) and month 12 (–6.0% [95% CI, –8.5% to –3.6%] vs –5.3% [95% CI, –7.6% to –3.0%]) relative to those in the control group. Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals. There were no significant differences between the intervention groups in blood pressure, heart rate, triglycerides, fasting glucose, fasting insulin, insulin resistance, C-reactive protein, or homocysteine concentrations at month 6 or 12. Mean high-density lipoprotein cholesterol levels at month 6 significantly increased among the participants in the alternate-day fasting group (6.2 mg/dL [95% CI, 0.1-12.4 mg/dL]), but not at month 12 (1.0 mg/dL [95% CI, –5.9 to 7.8 mg/dL]), relative to those in the daily calorie restriction group. Mean low-density lipoprotein cholesterol levels were significantly elevated by month 12 among the participants in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) compared with those in the daily calorie restriction group.

Conclusions and Relevance  Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction.

Trial Registration  clinicaltrials.gov Identifier: NCT00960505

Introduction

The first-line therapy prescribed to obese patients for weight loss is daily calorie restriction.1 However, many patients find it difficult to adhere to a conventional weight-loss diet because food intake must be limited every day.2 As such, adherence to daily calorie restriction decreases after 1 month and continues to decline thereafter.3- 5 In light of this limitation, another approach that requires individuals to restrict calories only every other day was developed.6 This strategy is called alternate-day fasting and involves a fast day where individuals consume 25% of their usual intake (approximately 500 kcal), alternated with a “feast day” where individuals are permitted to consume food ad libitum. Findings from short-term studies indicate that participants lose 3% to 7% of body weight after 2 to 3 months of alternate-day fasting and experience improvements in lipid profiles, blood pressure, and insulin sensitivity.7- 13

Alternate-day fasting regimens have increased in popularity during the past decade, and several best-selling diet books14,15 have promoted this approach. More than 1 million copies of these books have been sold in the United States and United Kingdom to date. Despite the growing popularity of alternate-day fasting, to our knowledge, no long-term randomized clinical trials have evaluated its efficacy or compared this regimen with a conventional weight-loss diet.

We conducted a 1-year, randomized clinical trial to compare the effects of alternate-day fasting vs daily calorie restriction on body weight and risk indicators for cardiovascular disease. We hypothesized that the participants in the alternate-day fasting group would be more adherent to their diet, achieve greater weight loss, and experience more pronounced improvements in risk indicators for cardiovascular disease during the 6-month weight-loss phase compared with those in the daily calorie restriction group. We also hypothesized that the alternate-day fasting group would better maintain their weight loss and sustain their improvements in risk indicators for cardiovascular disease during the 6-month weight-maintenance phase compared with the daily calorie restriction group.

Methods

Participants

We conducted the trial between October 1, 2011, and January 15, 2015, at the University of Illinois at Chicago. Participants were recruited from the Chicago area by means of flyers placed around the university and were screened via a questionnaire, an assessment of body mass index, and a pregnancy test. Individuals included were men and women between 18 and 65 years of age, with a body mass index between 25.0 and 39.9 (calculated as weight in kilograms divided by height in meters squared) who had previously been sedentary (<60 minutes per week of light activity for the 3 months prior to the study).

Exclusion criteria were a history of cardiovascular disease or type 1 or 2 diabetes, use of medications that could affect study outcomes, unstable weight for 3 months prior to the beginning of the study (>4-kg weight loss or gain), perimenopause or otherwise irregular menstrual cycle, pregnancy, and currently smoking. The protocol was approved by the Office for the Protection of Research Subjects at the University of Illinois at Chicago, and written informed consent was obtained from all participants. The full protocol is available in Supplement 1.

Randomization and Intervention Groups

Participants were randomized in a 1:1:1 ratio to an alternate-day fasting group, daily calorie restriction group, or no-intervention control group. Randomization was performed by a stratified random sampling procedure by sex, age (18-42 years and 43-65 years), and body mass index (25.0-32.5 and 32.6-39.9). Block size ranged from 1 to 11 participants. The active trial duration was 1 year and consisted of a baseline phase (1 month), a weight-loss phase (6 months), and a weight-maintenance phase (6 months) (eFigure 1 in Supplement 2). We chose this design because weight loss typically peaks at 6 months during a lifestyle intervention.16 During the baseline phase, all participants ate their usual diet and maintained a stable weight. Baseline total energy expenditure was measured using doubly labeled water.17 All participants were instructed not to change their physical activity habits throughout the trial (eg, not to join a gym) to avoid potential confounding.

Weight-Loss Phase

Participants in the alternate-day fasting group and those in the daily calorie restriction group were provided with all meals during the first 3 months of the trial and received dietary counseling thereafter (eFigure 1 in Supplement 2). During the 6-month weight-loss phase, the intervention groups were instructed to reduce their energy intake by a mean of 25% per day. To achieve this reduction, the alternate-day fasting group was instructed to consume 25% of baseline energy intake as a lunch (between 12 pm and 2 pm) on fast days and 125% of baseline energy intake split between 3 meals on alternating feast days. The daily calorie restriction group was instructed to consume 75% of baseline energy intake split between 3 meals every day. The provided meals were in accordance with the American Heart Association guidelines18 for macronutrient intake, with 30% of energy as fat, 55% as carbohydrate, and 15% as protein. From months 4 to 6, when food was no longer provided, intervention participants met individually with a dietician or nutritionist weekly to learn how to continue with their diets on their own.

Weight-Maintenance Phase

At the beginning of the 6-month weight-maintenance phase, total daily energy expenditure was reassessed using doubly labeled water.17 Participants were instructed to maintain their body weight during this phase. Participants in the alternate-day fasting group were instructed to consume 50% of energy needs as a lunch on fast days and 150% of energy needs split between 3 meals on alternating feast days. Participants in the daily calorie restriction group were instructed to consume 100% of energy needs split between 3 meals every day. Intervention participants met with the dietician individually each month to learn cognitive behavioral strategies to prevent weight regain19 and received personalized energy targets for weight maintenance based on results from doubly labeled water.

Control Group Protocol

Participants in the control group were instructed to maintain their weight throughout the trial and not to change their eating or physical activity habits. Controls received no food or dietary counseling but visited the research center at the same frequency as the intervention participants (to provide outcome measurements). Controls who completed the 12-month trial received 3 months of free weight-loss counseling and a 12-month gym membership at the end of the study.

Outcome Measures

The primary outcome of the study was change in body weight, which was measured monthly via a digital scale while the participant was in a hospital gown. Fat mass and lean mass were measured every 6 months in the fasted state by dual-energy x-ray absorptiometry (QDR 4500W; Hologic). Visceral fat mass was measured every 6 months by magnetic resonance imaging performed with a 1.5-T magnet (Siemens Vision), and images were analyzed using validated software.20

Mean percentage energy restriction during the weight-loss phase was retrospectively calculated by the intake balance method using doubly labeled water and changes in body composition.21 Physical activity was measured for 7 consecutive days every 6 months using an activity monitor (SenseWear Armband Mini; BodyMedia Inc).22 Dietary intake and adherence to diets was assessed every 3 months with a 7-day food record and analyzed using Nutritionist Pro software (Axxya Systems LLC). Intervention participants were considered to be adherent when their actual energy intake, determined via food records, was within 200 kcal of their prescribed daily energy goal.

Blood samples were obtained following a 12-hour fast every 6 months (collected on the morning after a feast day for the alternate-day fasting group). Secondary outcomes included blood pressure, heart rate, and total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting glucose, fasting insulin, C-reactive protein, and homocysteine concentrations (analytical methods are detailed in the full protocol in Supplement 1). The homeostasis model assessment of insulin resistance was calculated as insulin × glucose/405, where the unit of measure for insulin is in micro-international units per milliliter and the unit of measure for glucose is milligrams per deciliter.23

Statistical Analysis

For the sample size calculation, we estimated that alternate-day fasting would reduce body weight by 15% by month 69,11 and that daily calorie restriction would reduce body weight by 10% by month 6.24 We calculated that 26 participants per group would provide 80% power to detect a significant difference of 5% in body weight between the alternate-day fasting group and the daily calorie restriction group at month 6, using a 2-tailed independent-samples t test with α = .05. We anticipated a dropout rate of 12%. Thus, we initially aimed to recruit 90 participants (30 per group), assuming that 78 participants (26 per group) would complete the trial. We later decided to recruit 100 participants to increase our statistical power because our dropout rate was higher than expected.

Data are shown as mean values (with 95% CIs) unless otherwise noted. A 2-tailed P < .05 was considered statistically significant. Tests for normality were included in the model, and all data were found to be normally distributed. We conducted an intention-to-treat analysis, which included data from all 100 participants who underwent randomization. Results are reported by intention-to-treat analysis unless indicated otherwise. A linear mixed model was used to assess time, diet, and time × diet effects for each outcome. This model provides unbiased estimates of time and treatment effects under a missing-at-random assumption. Time was not assumed to be linear in the model. This strategy allowed for estimation of time and diet effects (and their interaction) without imposing a linear time trend. The analyses were performed using SAS, version 9.4 (SAS Institute, Inc), and R software, version 3.2.2 (R Foundation for Statistical Computing).

Results

Participant Characteristics and Attrition

Of the 222 participants who were screened, 100 (45.0%) were randomly assigned to the diet or control groups, and 69 (69.0% of those assigned) completed the study (Figure 1). The dropout rate was highest in the alternate-day fasting group (13 of 34 [38%]), relative to the daily calorie restriction group (10 of 35 [29%]) and control group (8 of 31 [26%]). More participants in the alternate-day fasting group than in the daily calorie restriction group withdrew owing to difficulties adhering with the diet. All baseline characteristics had comparable distributions between the alternate-day fasting group, the daily calorie restriction group, and the control group (Table 1). The participants were primarily metabolically healthy obese women.

Prescribed vs Actual Energy Intake Determined via Food Records

On the fast day (Figure 2A), participants in the alternate-day fasting group exceeded their prescribed energy goal at months 3 and 6. On the feast day (Figure 2B), participants in the alternate-day fasting group ate less than their prescribed goal at months 3, 6, 9, and 12. Participants in the daily calorie restriction group (Figure 2C) met their prescribed energy goals at months 3, 6, and 12 but ate less than their prescribed goal at month 9. A higher proportion of participants in the daily calorie restriction group were adherent to their energy goals at months 3, 6, 9, and 12 relative to those in the alternate-day fasting group.

Percentage Energy Restriction Determined via Doubly Labeled Water

From baseline to month 6, the alternate-day fasting group achieved a mean (SD) percentage energy restriction of 21% (16%), and the daily calorie restriction group achieved a mean (SD) percentage energy restriction of 24% (16%), with no significant difference between the intervention groups or compared with the control group (eFigure 2 in Supplement 2).

Physical Activity and Dietary Intake

Data on dietary intake are displayed in eTable 1 in Supplement 2. Percentage of energy intake from fat, carbohydrates, and protein did not differ significantly over time in any of the groups. Physical activity, measured as steps per day, did not change during the course of the trial in any group (eTable 2 in Supplement 2). This level of activity is approximately 1000 to 2000 steps per day higher than that of the average overweight or obese adult.25

Weight Loss and Weight Maintenance

Changes in body weight are displayed in Figure 3 and Table 2. Weight loss was not significantly different between the alternate-day fasting group and the daily calorie restriction group at month 6. At the end of the study, total weight loss was –6.0% (95% CI, –8.5% to –3.6%) for the alternate-day fasting group and –5.3% (95% CI, –7.6% to –3.0%) for the daily calorie restriction group, relative to controls, with no significant difference between the intervention groups. Weight regain from months 6 to 12 (–0.8%; 95% CI, –3.2% to 1.7%) was not significantly different between the alternate-day fasting group and the daily calorie restriction group. Moreover, weight regain from months 6 to 12 was not significantly different between the alternate-day fasting group and controls (0.8%; 95% CI, –1.8% to 3.3%), or the daily calorie restriction group and controls (1.5%; 95% CI, –0.8% to 3.9%). Changes in body composition are reported in Table 2. There were no statistically significant differences between the alternate-day fasting group and the daily calorie restriction group for fat mass, lean mass, or visceral fat mass at month 6 or month 12.

Blood Pressure and Heart Rate

Blood pressure was not significantly different between the intervention groups, or relative to controls, at month 6 or month 12 (Table 2). There were also no statistically significant differences in heart rate between the alternate-day fasting group and the daily calorie restriction group at month 6 or month 12 (Table 2).

Plasma Lipids

Changes in plasma lipids during the course of the trial are shown in Table 2. Total cholesterol levels were not significantly different between the intervention groups, or relative to controls, at month 6 or month 12. At month 6, high-density lipoprotein cholesterol levels were significantly elevated in the alternate-day fasting group by 6.2 mg/dL (95% CI, 0.1-12.4 mg/dL) (to convert to millimoles per liter, multiply by 0.0259) vs the daily calorie restriction group, but this effect was no longer observed by month 12. Low-density lipoprotein cholesterol concentrations did not differ significantly between the intervention groups at month 6. At month 12, low-density lipoprotein cholesterol levels significantly increased in the alternate-day fasting group (11.5 mg/dL [95% CI, 1.9-21.1 mg/dL]) (to convert to millimoles per liter, multiply by 0.0259) relative to the daily calorie restriction group. Triglyceride levels did not differ significantly between the intervention groups at month 6 or month 12.

Glucoregulatory and Inflammatory Factors

Changes in glucoregulatory and inflammatory factors are displayed in Table 2. Fasting plasma glucose did not differ significantly between the intervention groups, or relative to controls, at month 6 or month 12. There were also no significant differences in fasting insulin or the homeostasis model assessment of insulin resistance between the intervention groups at month 6 or month 12. High-sensitivity C-reactive protein and homocysteine levels did not differ significantly between the intervention groups, or relative to controls, at month 6 or month 12. We also performed a sensitivity analysis, in which sex and race/ethnicity were included as adjustment covariates in the intention-to-treat mixed model. The inclusion of sex and race/ethnicity did not affect any of the estimated treatment effects reported in Table 2.

Discussion

The results of this randomized clinical trial demonstrated that alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or improvement in risk indicators for cardiovascular disease compared with daily calorie restriction.

Alternate-day fasting has been promoted as a potentially superior alternative to daily calorie restriction under the assumption that it is easier to restrict calories every other day. However, our data from food records, doubly labeled water, and regular weigh-ins indicate that this assumption is not the case. Rather, it appears as though many participants in the alternate-day fasting group converted their diet into de facto calorie restriction as the trial progressed. Moreover, the dropout rate in the alternate-day fasting group (38%) was higher than that in the daily calorie restriction group (29%) and the control group (26%). It was also shown that more participants in the alternate-day fasting group withdrew owing to dissatisfaction with diet compared with those in the daily calorie restriction group (Figure 1).

Taken together, these findings suggest that alternate-day fasting may be less sustainable in the long term, compared with daily calorie restriction, for most obese individuals. Nevertheless, it is still possible that a certain smaller segment of obese individuals may prefer this pattern of energy restriction instead of daily restriction. It will be of interest to examine what behavioral traits (eg, ability to go for long periods without eating) make alternate-day fasting more tolerable for some individuals than others.

To our knowledge, the present study is the longest and largest trial of alternate-day fasting to date. Previous trials of alternate-day fasting reported weight loss of 3% to 7% after 2 to 3 months of diet.7- 13 Adherence was measured in several previous trials and was shown to be high (eg, participants met their calorie goals on approximately 80%-90% of fast days).7,8,10,11 Most of these past studies provided food on the fast day,7,8,10,11 so the provision of food is not a confounder when comparing past findings with present findings. Food was provided to the intervention participants during the first 3 months of the weight-loss phase to promote adherence26 and show participants the types and quantities of foods that they should be eating. Data from the food records indicated that participants frequently ate extra “nonstudy” foods that were purchased from stores or restaurants.

This finding suggests that limiting caloric intake to approximately 500 kcal every other day may have been difficult for many participants early in the intervention. Future work in this area should examine whether this lack of adherence to alternate-day fasting is due to cognitive, environmental, and/or physiological factors. For instance, measuring changes in subjective appetite (hunger and fullness) in conjunction with modulations in appetite hormones (ghrelin, peptide YY, and glucagon-like peptide-1) could offer some insight into why daily calorie restriction may allow for easier adherence compared with alternate-day fasting.

Contrary to our original hypotheses, the participants in the alternate-day fasting group did not experience more pronounced improvements in risk indicators for cardiovascular disease compared with the participants in the daily calorie restriction group. However, the trial included primarily metabolically healthy obese adults. Since many of the participants had normal cholesterol levels and normal blood pressure at baseline, it is not surprising that most risk indicators for cardiovascular disease did not change in response to diet.

Limitations

Our study has several limitations. First, the duration of the maintenance phase was short (6 months). Second, the control group was imperfect, in that they received no food, no counseling, and less attention from study personnel, relative to the intervention groups, which may have confounded our findings. We also failed to include the control group in our initial power calculation. Third, since the dropout rate was higher than anticipated, our power to detect the hypothesized difference of 5% weight loss between the intervention groups at month 6 decreased from 80% to 60%. The higher dropout rate in the alternate-day fasting group may have also introduced a possible selection bias between groups.27 Finally, we enrolled predominantly metabolically healthy obese individuals, which may have hindered the abilities of the interventions to produce greater improvements in our measured cardiovascular disease risk indicators.28,29 The generalizability of our findings is also limited by the enrollment.

Conclusions

The alternate-day fasting diet was not superior to the daily calorie restriction diet with regard to adherence, weight loss, weight maintenance, or improvement in risk indicators for cardiovascular disease.


Article Information

Corresponding Author: Krista A. Varady, PhD, Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W Taylor St, Room 532, Chicago, IL 60612 (varady@uic.edu).

Accepted for Publication: February 26, 2017.

Published Online: May 1, 2017. doi:10.1001/jamainternmed.2017.0936

Author Contributions: Dr Varady had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Trepanowski and Kroeger contributed equally to this work and should be considered co–first authors.

Study concept and design: Kroeger, Varady.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Trepanowski, Kroeger, Varady.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Freels, Rigdon.

Obtained funding: Varady.

Administrative, technical, or material support: Kroeger, Barnosky, Bhutani, Hoddy, Gabel, Rood, Varady.

Study supervision: Varady.

Conflict of Interest Disclosures: Dr Varady reported receiving an advance for the book The Every-Other-Day Diet: The Diet That Lets You Eat All You Want (Half the Time) and Keep the Weight Off, published by Hachette Book Group. No other disclosures were reported.

Funding/Support: This study was supported by grant R01HL106228 from the National Institutes of Health/National Heart, Lung, and Blood Institute and grants P30DK072476 and F32DK107157 from the National Institute of Diabetes and Digestive and Kidney Diseases.

Role of Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication

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2.  Moreira  EA, Most  M, Howard  J, Ravussin  E.  Dietary adherence to long-term controlled feeding in a calorie-restriction study in overweight men and women.  Nutr Clin Pract. 2011;26(3):309-315.PubMedArticle

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7.  Bhutani  S, Klempel  MC, Kroeger  CM, Trepanowski  JF, Varady  KA.  Alternate day fasting and endurance exercise combine to reduce body weight and favorably alter plasma lipids in obese humans.  Obesity (Silver Spring). 2013;21(7):1370-1379.PubMedArticle

8.Hoddy  KK, Kroeger  CM, Trepanowski  JF, Barnosky  A, Bhutani  S, Varady  KA.  Meal timing during alternate day fasting: impact on body weight and cardiovascular disease risk in obese adults.  Obesity (Silver Spring). 2014;22(12):2524-2531.PubMed

9.  Johnson  JB, Summer  W, Cutler  RG,  et al.  Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma  [published correction appears in Free Radic Biol Med. 2007;43(9):1348].  Free Radic Biol Med. 2007;42(5):665-674.PubMedArticle

10.  Klempel  MC, Kroeger  CM, Varady  KA.  Alternate day fasting (ADF) with a high-fat diet produces similar weight loss and cardio-protection as ADF with a low-fat diet.  Metabolism. 2013;62(1):137-143.PubMedArticle

11.  Varady  KA, Bhutani  S, Church  EC, Klempel  MC.  Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults.  Am J Clin Nutr. 2009;90(5):1138-1143.PubMedArticle

12.  Catenacci  VA, Pan  Z, Ostendorf  D,  et al.  A randomized pilot study comparing zero-calorie alternate-day fasting to daily caloric restriction in adults with obesity.  Obesity (Silver Spring). 2016;24(9):1874-1883.PubMedArticle
 

13.  Alhamdan  BA, Garcia-Alvarez  A, Alzahrnai  AH,  et al.  Alternate-day versus daily energy restriction diets: which is more effective for weight loss? a systematic review and meta-analysis.  Obes Sci Pract. 2016;2(3):293-302.PubMedArticle

14.  Mosley  M, Spencer  M.  The Fast Diet. New York, NY: Atria Books; 2012.

15.  The 5:2 Fast Diet For Beginners. Berkeley, CA: Rockridge Press; 2013.

16.  Gardner  CD, Kiazand  A, Alhassan  S,  et al.  Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial.  JAMA. 2007;297(9):969-977.PubMedArticle

17. Ravussin  E, Redman  LM, Rochon  J,  et al; CALERIE Study Group.  A 2-year randomized controlled trial of human caloric restriction: feasibility and effects on predictors of health span and longevity.  J Gerontol A Biol Sci Med Sci. 2015;70(9):1097-1104.PubMedArticle

18.  Eckel  RH, Jakicic  JM, Ard  JD,  et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  Circulation. 2014;129(25)(suppl 2):S76-S99.PubMedArticle

19.  Laliberte  M, McCabe  RE, Taylor  V.  The Cognitive Behavioral Workbook for Weight Management: A Step-by-Step Program. Oakland, CA: New Harbinger Publications; 2009.

20. Demerath  EW, Ritter  KJ, Couch  WA,  et al.  Validity of a new automated software program for visceral adipose tissue estimation.  Int J Obes (Lond). 2007;31(2):285-291.PubMedArticle

21. de Jonge  L, DeLany  JP, Nguyen  T,  et al.  Validation study of energy expenditure and intake during calorie restriction using doubly labeled water and changes in body composition.  Am J Clin Nutr. 2007;85(1):73-79.PubMed

22. Johannsen  DL, Calabro  MA, Stewart  J, Franke  W, Rood  JC, Welk  GJ.  Accuracy of armband monitors for measuring daily energy expenditure in healthy adults.  Med Sci Sports Exerc. 2010;42(11):2134-2140.PubMedArticle

23. Matthews  DR, Hosker  JP, Rudenski  AS, Naylor  BA, Treacher  DF, Turner  RC.  Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;28(7):412-419.PubMedArticle

24. Redman  LM, Rood  J, Anton  SD, Champagne  C, Smith  SR, Ravussin  E; Pennington Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE) Research Team.  Calorie restriction and bone health in young, overweight individuals.  Arch Intern Med. 2008;168(17):1859-1866.PubMedArticle

25. Tudor-Locke  C, Brashear  MM, Johnson  WD, Katzmarzyk  PT.  Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese US men and women.  Int J Behav Nutr Phys Act. 2010;7:60.PubMedArticle

26.Hall  DM, Most  MM.  Dietary adherence in well-controlled feeding studies.  J Am Diet Assoc. 2005;105(8):1285-1288.

27.Hernán  MA, Hernández-Díaz  S, Robins  JM.  A structural approach to selection bias.  Epidemiology. 2004;15(5):615-625.

28.  Janiszewski  PM, Ross  R.  Effects of weight loss among metabolically healthy obese men and women.  Diabetes Care. 2010;33(9):1957-1959.

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No one in life gets away
with avoiding all problems.

Some problems are physical. 
Some problems are mental.
Some problems are the two combined.
If it’s my problem,
I’m the one who has to deal with it.


Defining a problem helps me understand it,
which helps give me
wisdom to know the difference
between what I can change,
and what cannot be changed.

What is a Binge?

The dictionary definition of bingeing is:

• to be immoderately self-indulgent and unrestrained;

  to engage in excessive or uncontrolled indulgence in food or drink.

Bingeing isn’t usually because of lack of self control and weakness.  We binge because of a complex interaction of habit, brain chemistry, and external cues that signal us to eat. This interaction can be overcome, but it's harder to do and takes longer to change than most of us realize.

Current scientific research indicates that bingeing has a physical (PHYSIOLOGICAL) cause, and that mental & emotional (PSYCHOLOGICAL) problems are a RESULT of the condition, not the CAUSE of the condition.

Neuroscientists say that Bingeing is a normal response to Dieting because:  

Metabolic suppression is one of several powerful tools that the brain uses to keep the body within a certain weight range, called the set point. The range, which varies from person to person, is determined by genes and life experience. When dieters’ weight drops below it, they not only burn fewer calories but also produce more hunger-inducing hormones and find eating more rewarding.



The brain’s weight-regulation system considers your set point to be the correct weight for you, whether or not your doctor agrees. If someone starts at 120 pounds and drops to 80, her brain rightfully declares a starvation state of emergency, using every method available to get that weight back up to normal. The same thing happens to someone who starts at 300 pounds and diets down to 200.

Our brains send signals to the rest of our body that it is starving when our weight is below its Set Point range.  A person’s Set Point is determined by a person’s genes and life experience. 

Life experience involves a person’s weight history, because when a person gains and holds “excess” weight, their Set Point can rachet up, and up and up.  (A rachet is a mechanical device consisting of a toothed wheel or rack engaged with a pawl that permits it to move in only one direction.)  

However,  thus far all of the evidence shows that this is a one-way-street survival issue. While Set Points can go up with weight-gain,  they don’t go back down with weight-loss. 

Many body functions are naturally one-way as we grow, age, and experience life.  When our life experience changes our Set Point, it’s like our scars, stretch marks, wrinkles, grey hair etc. in that there is no “natural” way our bodies will revert back to the way they once were.

Weight-loss and maintenance have less to do with motivation and will-power than most people think. In fact it has far more to do with how the individual body adjusts to, and is capable of, resisting a calorie deficit. Putting less fuel in the tank of one's car will always cause the car to drive a shorter distance.  However, the human body adapts to less fuel .... meaning eating fewer calories .... by becoming more ‘efficient’ and running the same distance on less fuel than before. That is the big difference between simple physics and biology.


Is Dieting a form of STARVATION?

The dictionary definition of STARVATION is defined as “to suffer or die from lack of food”. 

To “SUFFER” is defined as “to experience something unpleasant”.  Although we might not be in any danger of dying from lack of food, most Dieting does involve “suffering… from lack of food”.  Therefore, the term “starvation” isn’t completely inaccurate, but, of course, there are a great many different degrees of suffering.

However, most Diet Guru’s, including medical doctors, say that a Dieter is not experiencing “starvation” as long as there is any excess fat left on that person’s body. Excess fat defined as: there is “less than an inch of fat to pinch”, and the body weight is near the bottom border of its 18 BMI “underweight” category. 

This is true for some people, but not ALL people.  Although all human bodies operate in a similar fashion,  there are differences in the ways that they function. The regulatory mechanisms which allow our cells to deal effectively with fluctuations in nutrient supply can vary from person to person, and there is a still a great deal that science has not yet discovered about the body’s inner workings.

Research studies involving lab rodents have demonstrated genetic differences. Certain genetically obese mice will fatten excessively regardless of how little or how much they eat. Some of them, … while dieting, … will consumed their own muscles and organs and die before all of their “excess” fat is gone.

Researcher Jean Mayer reported: “These mice will make fat out of their food under the most unlikely circumstances, even when half starved”.  If starved sufficiently, these animals can be reduced to the same weight as lean mice, but they’ll still be fatter.  They will consume the protein in their muscles and organs rather than surrender the fat in their fat cells. 

When these fat mice are starved, they do not become lean mice…, they become emaciated versions of fat mice.

In 1936 Francis Benedict reported this after fasting a strain of obese mice.  They lost 60 percent of their body fat before they died of starvation, but when they died, they still had five times as much body fat as lean mice that were allowed to eat as much as they desired.

In 1981, M.R.C. Greenwood reported that restricting the diet of an obese strain of rats known as Zucker rats from birth onward, caused those rats to grow fatter by adulthood than their littermates who were allowed to eat to their heart’s content.  These semi-starved Zucker rats had 50% less muscle mass than genetically lean rats, and 30% less muscle mass than the Zucker rats that ate as much as they wanted.  The calorie restricted rats were sacrificing their muscles and organs to make fat.

DietHobby’s BOLG CATEGORIES Research - Science contains additional articles relevant to Set Point and its relationship to weight-gain and maintenance.


If Bingeing is a natural response to Starvation,
why is it considered to be an Eating Disorder?

In the 1960s the medical profession began attributing psychological reasons, rather than physiological reasons to people who overeat to the point of obesity. 

Since that time, there has been a tendency on the part of health professionals to classify every kind of eating outside “moderate eating” as an “eating disorder”.

Eating Disorder Not Otherwise Specified (EDNOS) includes a wide variety of disordered eating patterns. It's often used for people who meet many of the symptoms of anorexia or bulimia but not all. For example, a woman who meets all of the symptoms for anorexia, but still menstruates regularly -- a criteria for an anorexia diagnosis -- would be diagnosed with an “eating disorder not otherwise specified”.

Binge eating disorder (B.E.D.) first appeared in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM, in 1994. Until recent times, “Binge Eating Disorder” was categorized under the umbrella term 'eating disorders not otherwise specified”, or EDNOS for short.  However, in 2013 it was added to the DSM-V as B.E.D., a specified eating disorder.

There are many reasons for this…and one of them is Financial Motivation. Unless a behavior is labeled a “disorder” or an illness, health insurance won’t pay for treatment.

You may call me cynical, but since “Binge Eating Disorder” is far more common than anorexia and bulimia, it has a much larger population base. This means MORE PATIENTS to treat with Therapy, and/or Eating Disorder programs;  MORE MONEY and more profit for that specific health industry field.

Health professionals admit that a Binge Eating Disorder is more than simply eating too much food, and that many obese patients don't have it.  However these medical “experts” still they claim that up to 5 percent of obese patients and 30 percent of patients participating in weight loss programs meet the criteria for binge eating disorder.

In May 2013 the DSM-V, added Binge Eating Disorder to its list of specified eating disorders.  All of the following must be met to meet the diagnostic criteria of B.E.D. 

1.  Recurrent and persistent episodes of binge eating
2.  Binge eating episodes are associated with three (or more) of the following:

•     Eating much more rapidly than normal
  
•     Eating until feeling uncomfortably full
  
•     Eating large amounts of food when not feeling physically hungry
  
•     Eating alone because of being embarrassed by how much one is eating
  
•     Feeling disgusted with oneself, depressed, or very guilty after overeating
  

3.   Marked distress regarding binge eating
4.    Absence of regular compensatory behaviors (such as purging).


Think about it.

Such a diagnosis would fit almost every fat person that I’ve even known.  I’ve been super fat myself, and I’ve known many, many others.  Almost every fat person … and some of those who are not fat … experiences eating occasions where they sense that they have lost control of their eating behavior, AND have strong feelings of embarrassment and guilt after eating an unusually large amount of food when they aren’t physically hungry.

Weekends come every week, vacations and holidays come frequently, other celebrations and special events happen frequently as well.  Plus, most of us experience times of sadness, anxiety, or crisis more frequently than we like.

It is common for almost any person, whether fat or thin,  to engage in excess overeating on these occasions. It is also a very common occurrence for a fat person to “binge out” at least one time a week for months at a time.

The disgust and aversion that modern Society has for fat people pretty much guarantees that fat people will feel embarrassment and guilt because they’ve “failed” to keep from engaging in behavior that contributes to their fat condition.

It is my opinion that, despite the “conditions” that psychologists attach to the “Binge Eating Disorder”, by their proposed definition, almost everyone who engages in excessive or uncontrolled indulgence in food, which is the dictionary definition of Bingeing, could easily fall into the current medical classification of having an “eating disorder”.

I find something really wrong with this reasoning.

For those who are obese, (and normal-weight-dieting-people) bingeing is normal, and not abnormal, eating behavior.

My own experience together with my observation of the dismal long-term success rate 
of “eating disorder” treatments, … especially those that include the use of “Intuitive Eating” as a tool of recovery …  supports my belief that while Therapy is helpful to gain self-understanding of one’s behaviors, and can help one learn alternative behaviors, the underlying conditions causing obesity are not cured through that process.

I see Society’s current label of “Eating Disorder”, and suggested “Treatment”, as simply another attempt to shame fat people into believing that they should eat “normally” and that their body should be a “normal” weight.  It’s one more indoctrination to misinform fat people. It's another way to reinforce the Cultural Lie that only those who are greedy, lazy, or mentally ill are fat, and that if anyone would just “eat healthy” instead of "overeating" or "dieting", they would meet our Culture’s standards of what is a “healthy”, or a  “normal”, or even a “thin” weight.

This is a misplaced effort, because an obese body wants to maintain itself.  It doesn’t want to maintain itself as a Thin body.  It wants to stay Obese.  Bingeing is a natural physiological response to our Culture’s demand that fat people become thin. It is based upon a survival instinct that will never disappear, no matter how thin one becomes, or how much therapy one has.

Once upon a time, there was a fat woman who wanted to become thin.  She began eating less food than her body used day after day, and eventually her body became a size “normal”. 

After she crossed the “finish line” to her weight goal, she slightly relaxed her rigid eating behaviors, but in order to maintain her weight-loss, she paid close attention to the hunger signals from her body, working to eat only when she felt hungry, and to stop as soon as she stopped feeling hungry.

And she lived happily ever after…..
…........... NOT exactly .......….

I advise anyone struggling with - or interested in - maintenance issues to go to DietHobby’s
BLOG CATEGORIES, Research - Science and read the articles that have been scrapbooked there.

The following article was written by Sandra Aamodt, a neuroscientist, author of  “Why Diets Make Us Fat: The Unintended Consequences of Our Obsession With Weight Loss” (2016). It was posted in the New York Times in May 2016. 

Dr. Aamodt makes the point that the problem with Dieting is not Willpower. It’s neuroscience.  I found her book to be well researched, and I believe she accurately states the basic problem.  Dr. Aamodt’s information is extremely valuable, and I recommend her book for people working to maintain weight-loss.  However, although the “solution” to the dieting and maintenance struggle that she proposes could be effective for some people, it is not one …. for various reasons … that I find personally acceptable or one that I’m willing to adopt. 

Why You Can’t Lose Weight on a Diet
                  by Sandra Aamodt

SIX years after dropping an average of 129 pounds on the TV program “The Biggest Loser,” a new study reports, the participants were burning about 500 fewer calories a day than other people their age and size. This helps explain why they had regained 70 percent of their lost weight since the show’s finale. The diet industry reacted defensively, arguing that the participants had lost weight too fast or ate the wrong kinds of food — that diets do work, if you pick the right one.

But this study is just the latest example of research showing that in the long run dieting is rarely effective, doesn’t reliably improve health and does more harm than good. There is a better way to eat.

The root of the problem is not willpower but neuroscience. Metabolic suppression is one of several powerful tools that the brain uses to keep the body within a certain weight range, called the set point. The range, which varies from person to person, is determined by genes and life experience. When dieters’ weight drops below it, they not only burn fewer calories but also produce more hunger-inducing hormones and find eating more rewarding.

The brain’s weight-regulation system considers your set point to be the correct weight for you, whether or not your doctor agrees. If someone starts at 120 pounds and drops to 80, her brain rightfully declares a starvation state of emergency, using every method available to get that weight back up to normal. The same thing happens to someone who starts at 300 pounds and diets down to 200, as the “Biggest Loser” participants discovered.

This coordinated brain response is a major reason that dieters find weight loss so hard to achieve and maintain. For example, men with severe obesity have only one chance in 1,290 of reaching the normal weight range within a year; severely obese women have one chance in 677. A vast majority of those who beat the odds are likely to end up gaining the weight back over the next five years. In private, even the diet industry agrees that weight loss is rarely sustained. A report for members of the industry stated: “In 2002, 231 million Europeans attempted some form of diet. Of these only 1 percent will achieve permanent weight loss.”

The specific “Biggest Loser” diet plan is probably not to blame. A previous study found similar metabolic suppression in people who had lost weight and kept it off for up to six years. Whether weight is lost slowly or quickly has no effect on later regain. Likewise — despite endless debate about the relative value of different approaches — in head-to-head comparisons, diet plans that provide the same calories through different types of food lead to similar weight loss and regain.

As a neuroscientist, I’ve read hundreds of studies on the brain’s ability to fight weight loss. I also know about it from experience. For three decades, starting at age 13, I lost and regained the same 10 or 15 pounds almost every year. On my most serious diet, in my late 20s, I got down to 125 pounds, 30 pounds below my normal weight. I wanted (unwisely) to lose more, but I got stuck. After several months of eating fewer than 800 calories a day and spending an hour at the gym every morning, I hadn’t lost another ounce. When I gave up on losing and switched my goal to maintaining that weight, I started gaining instead.

I was lucky to end up back at my starting weight instead of above it. After about five years, 41 percent of dieters gain back more weight than they lost. Long-term studies show dieters are more likely than non-dieters to become obese over the next one to 15 years.

That’s true in men and women, across ethnic groups, from childhood through middle age. The effect is strongest in those who started in the normal weight range, a group that includes almost half of the female dieters in the United States.

Some experts argue that instead of dieting leading to long-term weight gain, the relationship goes in the other direction: People who are genetically prone to gain weight are more likely to diet.

To test this idea, in a 2012 study, researchers followed over 4,000 twins aged 16 to 25. Dieters were more likely to gain weight than their non-dieting identical twins, suggesting that dieting does indeed increase weight gain even after accounting for genetic background. The difference in weight gain was even larger between fraternal twins, so dieters may also have a higher genetic tendency to gain. The study found that a single diet increased the odds of becoming overweight by a factor of two in men and three in women. Women who had gone on two or more diets during the study were five times as likely to become overweight.

The causal relationship between diets and weight gain can also be tested by studying people with an external motivation to lose weight. Boxers and wrestlers who diet to qualify for their weight classes presumably have no particular genetic predisposition toward obesity. Yet a 2006 study found that elite athletes who competed for Finland in such weight-conscious sports were three times more likely to be obese by age 60 than their peers who competed in other sports.

To test this idea rigorously, researchers could randomly assign people to worry about their weight, but that is hard to do. One program took the opposite approach, though, helping teenage girls who were unhappy with their bodies to become less concerned about their weight. In a randomized trial, the eBody Project, an online program to fight eating disorders by reducing girls’ desire to be thin, led to less dieting and also prevented future weight gain. Girls who participated in the program saw their weight remain stable over the next two years, while their peers without the intervention gained a few pounds.



WHY would dieting lead to weight gain? First, dieting is stressful. Calorie restriction produces stress hormones, which act on fat cells to increase the amount of abdominal fat. Such fat is associated with medical problems like diabetes and heart disease, regardless of overall weight.

Second, weight anxiety and dieting predict later binge eating, as well as weight gain. Girls who labeled themselves as dieters in early adolescence were three times more likely to become overweight over the next four years. Another study found that adolescent girls who dieted frequently were 12 times more likely than non-dieters to binge two years later.

My repeated dieting eventually caught up with me, as this research would predict. When I was in graduate school and under a lot of stress, I started binge eating. I would finish a carton of ice cream or a box of saltines with butter, usually at 3 a.m. The urge to keep eating was intense, even after I had made myself sick. Fortunately, when the stress eased, I was able to stop. At the time, I felt terrible about being out of control, but now I know that binge eating is a common mammalian response to starvation.

Much of what we understand about weight regulation comes from studies of rodents, whose eating habits resemble ours. Mice and rats enjoy the same wide range of foods that we do. When tasty food is plentiful, individual rodents gain different amounts of weight, and the genes that influence weight in people have similar effects in mice. Under stress, rodents eat more sweet and fatty foods. Like us, both laboratory and wild rodents have become fatter over the past few decades.

In the laboratory, rodents learn to binge when deprivation alternates with tasty food — a situation familiar to many dieters. Rats develop binge eating after several weeks consisting of five days of food restriction followed by two days of free access to Oreos. Four days later, a brief stressor leads them to eat almost twice as many Oreos as animals that received the stressor but did not have their diets restricted. A small taste of Oreos can induce deprived animals to binge on regular chow, if nothing else is available. Repeated food deprivation changes dopamine and other neurotransmitters in the brain that govern how animals respond to rewards, which increases their motivation to seek out and eat food. This may explain why the animals binge, especially as these brain changes can last long after the diet is over.

In people, dieting also reduces the influence of the brain’s weight-regulation system by teaching us to rely on rules rather than hunger to control eating. People who eat this way become more vulnerable to external cues telling them what to eat. In the modern environment, many of those cues were invented by marketers to make us eat more, like advertising, supersizing and the all-you-can-eat buffet. Studies show that long-term dieters are more likely to eat for emotional reasons or simply because food is available. When dieters who have long ignored their hunger finally exhaust their willpower, they tend to overeat for all these reasons, leading to weight gain.

Even people who understand the difficulty of long-term weight loss often turn to dieting because they are worried about health problems associated with obesity like heart disease and diabetes. But our culture’s view of obesity as uniquely deadly is mistaken. Low fitness, smoking, high blood pressure, low income and loneliness are all better predictors of early death than obesity. Exercise is especially important: Data from a 2009 study showed that low fitness is responsible for 16 percent to 17 percent of deaths in the United States, while obesity accounts for only 2 percent to 3 percent, once fitness is factored out. Exercise reduces abdominal fat and improves health, even without weight loss. This suggests that overweight people should focus more on exercising than on calorie restriction.

In addition, the evidence that dieting improves people’s health is surprisingly poor. Part of the problem is that no one knows how to get more than a small fraction of people to sustain weight loss for years. The few studies that overcame that hurdle are not encouraging. In a 2013 study of obese and overweight people with diabetes, on average the dieters maintained a 6 percent weight loss for over nine years, but the dieters had a similar number of heart attacks, strokes and deaths from heart disease during that time as the control group. Earlier this year, researchers found that intentional weight loss had no effect on mortality in overweight diabetics followed for 19 years.

Diets often do improve cholesterol, blood sugar and other health markers in the short term, but these gains may result from changes in behavior like exercising and eating more vegetables. Obese people who exercise, eat enough vegetables and don’t smoke are no more likely to die young than normal-weight people with the same habits. A 2013 meta-analysis (which combines the results of multiple studies) found that health improvements in dieters have no relationship to the amount of weight they lose.

If dieting doesn’t work, what should we do instead? I recommend mindful eating — paying attention to signals of hunger and fullness, without judgment, to relearn how to eat only as much as the brain’s weight-regulation system commands.

Relative to chronic dieters, people who eat when they’re hungry and stop when they’re full are less likely to become overweight, maintain more stable weights over time and spend less time thinking about food. Mindful eating also helps people with eating disorders like binge eating learn to eat normally. Depending on the individual’s set point, mindful eating may reduce weight or it may not. Either way, it’s a powerful tool to maintain weight stability, without deprivation.

I finally gave up dieting six years ago, and I’m much happier. I redirected the energy I used to spend on dieting to establishing daily habits of exercise and meditation. I also enjoy food more while worrying about it less, now that it no longer comes with a side order of shame.

I listed Dr. Aamodt’s book in DietHobby’s RESOURCES Books & Tools section with the following comment:

"Why Diets Make Us Fat: The Unintended Consequences of Our Obsession With Weight Loss by Sandra Aamodt PhD (2016).

The author, a neuroscientist and proponent of mindful eating, discusses scientific research on weight and health.  Her central argument is that our body weight tends to settle at "set points" — that 10- to 15-pound range the brain maintains despite repeated efforts to lower it.

Once people see how the set-point theory reflects their dieting experience, they realize that although they don't have the final say on their weight (their brain does), they do have real influence — through exercise and other health-affirming activities — over their health and well-being."

Dr. Aamodt’s information is extremely valuable, and I recommend her book for people working to maintain weight-loss. 

Dr.Sandra Aamodt thinks that you can’t - and shouldn’t - fight back against your Set Point. Her solution is the Behavior of eating mindfully, while following the body’s hunger signals, and to accept whatever weight the body chooses to give you as a Result of that Behavior.

I agree with her opinion that we are stuck with our biological and historical Set Point. However, although the “solution” to the dieting and maintenance struggle that she proposes could be effective for some people, it is not one …. for various reasons … that I find personally acceptable or one that I’m willing to adopt. 

Sandra Aamodt’s personal experience is that of a person who has struggled with being overweight or slightly obese, and not of a person who deals with the struggles caused by a history of extreme, morbid, or severe obesity.  Dr. Aamodt’s personal Set Point might keep her from meeting our culture’s high standards for “thinness”, but her choice not to struggle against it won’t cause her body to become Fat Enough enough to make her a TRUE VICTIM of our fat biased culture. The majority of offensive comments and other behaviors showing open disgust, ridicule, and abuse are primarily reserved for those who are extremely fat. 

The Set Point of someone who has struggled with 10 to 50 excess pounds is very different from the Set Point of someone who has struggled with 100+ excess pounds. Also, someone who has carried 50+ excess pounds for only a year or so is going to have a lower Set Point than someone who has carried that same weight for several years and longer. 

This is the ongoing dilemma for those who are Fat.  It is a situation in which day-after-day, year-after-year, a difficult choice has to be made between two or more alternatives, all of them equally undesirable. 

Each of us must make the eating and behavior choices that will work for us personally in our own individual lives.  Everyone doesn’t value the same things the same way. Food vs. Body Size vs. Desire and everything else that is involved in those categories.  Everyone’s choice is equally valid, despite the fact that those - often difficult - choices can result in making us Thin, Overweight, or Extremely Fat.

My own personal choice is to treat Dieting as a Hobby.  For many, many years I have continually dieted; have been vigilant about what I eat; and have diligently worked against my own body’s Set Point in order to maintain my “reduced fat” body inside the BMI weight range that is labeled “normal”.