Telling patients to diet and exercise isn’t enough. Here’s what you can do instead.

Medical literature is full of studies showing that most diets don’t encourage long-term weight loss. In fact, the majority of diets lead to weight gain. Most people end up gaining back the few pounds they’ve lost within a year of dieting — plus a few extra pounds on top of that.

There are many theories for why this happens. An article from the New England Journal of Medicine points out that months after initial weight loss, “levels of the circulating mediators of appetite that encourage weight regain after diet-induced weight loss do not revert to the levels recorded before weight loss.” Another study demonstrated that low-calorie diets lead to increased cortisol levels and psychological stress, two factors directly linked to weight gain. Their conclusion was that dieting “may be deleterious to psychological well-being and biological functioning.”

The current guidelines for exercising are just as ineffective. Most physicians tell their patients to walk thirty to forty minutes, three to four times a week. The American Heart Association takes a more rigorous approach to exercising by recommending “at least 30 minutes of moderate-intensity aerobic activity at least five days per week for a total of 150 minutes.”

If you think about it, though, this is the wrong advice. An exercise program is a good start, but it doesn’t go far enough. If a patient spends eight hours a day, five days a week, sitting in front of a computer at work, and an additional three or four hours sitting in front of a television at home, a thirty-minute work out five times a week is not going to be good enough. Studies out of Blue Zones — regions in the world with high concentrations of centenarians — show that longevity and health are related to eating the right foods and leading an active lifestyle, not dieting and exercising. These robust, energetic, and highly functioning elderly populations eat the right things (e.g., fruits, vegetables, whole grains) and stay away from the wrong things (e.g., processed foods, soda, fried cooking). They don’t necessarily engage in a regimented exercise program, but rather engage in constant moderate physical activity. They lead social and spiritual lives. They integrate themselves into their communities. They put family ahead of everything else.

The concept of losing weight by limiting a person’s caloric intake never really made sense. If you starve yourself by consuming half the calories your body requires in an attempt to lose weight, you’re going to be too tired to be active. But if you eat the right things and don’t focus on the exact number of calories you’re consuming, then you’re likely to have enough energy to lead an active and social life. We shouldn’t recommend that our patients “diet and exercise.” Rather, we should encourage them to engage in healthy living. The concept of healthy living is about following simple daily habits. Instead of focusing on what foods you need to stay away from (i.e., on what things you need to deprive your body of) as most diets do, healthy living emphasizes the lifestyle choices we should be making in order to ensure that we lead happy, healthy, and productive lives.

There are concrete, simple steps we can instruct our patients to follow that are incredibly effective:

  • Don’t smoke. Smoking causes half of all cancers and increases your risk for heart attacks and strokes.
  • If you’re thirsty, drink water. Sodas have chemicals, and if you’ve switched from regular to diet, sugar-free, or zero-calorie drinks, you’ve been fooled. It is not the calories you need to avoid; it’s the chemicals.
  • Limit your alcohol intake. Theoretically, you shouldn’t be drinking at all. But if you don’t want to deprive yourself, limit yourself to one glass of red wine. The antioxidants and resveratrol in red wine are believed to increase HDL (the good cholesterol), decrease LDL (the bad cholesterol), protect your body from arterial damage, and reduce inflammation and blood clotting.
  • Be active. If you eat every day, you should be active every day. It doesn’t have to be strenuous exercise; as long as you engage in some type of physical activity and vary your workouts, you’ll be on your way to a healthy life.
  • Eat smart. If it lives in a vending machine, don’t eat it. Stay away from processed foods. Eat locally grown organic fruits and vegetables. Have as much salad as you want, but limit the amount of dressing. If you crave carbohydrates, have some nuts or whole grains. Limit the amount of animal protein you ingest.
  • Sleep. Shoot for eight hours of sleep, but at the minimum make sure you get six hours. The less you sleep, the higher your risk for accidents, weight gain, infection, and depression. Lack of sleep has also been linked to a decreased libido.
  • Minimize stress. Keep in mind that what gets filtered into your brain will eventually affect your health and outlook on life. Simplify your life. Keep your time checking email, watching television, talking on your cell phone, Tweeting, and updating your Facebook status to a minimum. Less is best. Have a positive attitude. If watching the news gives you angina, stop watching.

As physicians, we want our patients to lead happy and healthy lives. But telling patients to simply “diet and exercise” is irresponsible and inefficient. We need to provide our patients with concrete goals, like those listed above, in order for them to start taking control of their own lives. We need to remind our patients that an ounce of prevention is worth a pound of cure. We need to encourage them to put down the soda and reach for a glass of water, to put down the sandwich and grab a salad, and to put down the remote control and go for a walk.

Their future depends on it.

Alberto Hazan is an emergency physician and author of Dr. Vigilante and The League of Freaks series. Jordana Haber is an emergency physician.  This article originally appeared on the Doctor Blog.

Image credit:

View 6 Comments >

Most Popular

Join 147,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
✓ Join 148,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.