April
22, 2003

SPECIAL REPORT: PERSONAL HEALTH

The Diet That Works

What
science tells us about successful weight loss

By TARA
PARKER-POPE
Staff Reporter of
THE WALL STREET JOURNAL

If sticking to a diet were easy, so many of us wouldn't be
so fat.

Everyone knows the formula -- eat less, exercise more --
but few people follow it. It's not for lack of trying. At any given time,
29% of men and 44% of women are on a diet.

But every would-be weight loser faces a slew of powerful
evolutionary forces working to thwart even the most determined dieter. Put
a new food in front of us, and we'll eat it, even if we felt full minutes
earlier. When physical activity starts to burn up calories, a hunger
mechanism kicks in, making us eat more. If we start to lose weight, other
metabolic processes and brain signals make sure our hunger switch stays
on.

"Throughout most of human evolution, we weren't sure where
the next meal was going to come from," says Richard D. Mattes, food and
nutrition professor at Purdue University. "Hunger is a mechanism to ensure
we eat when we find food and that we eat as much of it as we can."

While the strategy worked just fine for the caveman, it's a
problem if you live in a world where food is not only plentiful, but
supersized. Factor in the various social, cultural and economic pressures
to eat, and it seems the average dieter doesn't stand a chance.

So is losing weight impossible? Of course not. People lose
weight and keep it off all the time.

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Exactly how they do it is rooted in a body of scientific
research that teaches us the secrets of a successful diet. Science tells
us the types of foods we should eat, as well as the amounts. It tells us
how to eat, as well as the ways to monitor our diet. It tells us the
little tricks that can make all the difference between success and
failure.

One thing is clear: The basic rules don't change. The only
way to lose weight is to cut calories. The diet gurus sell a lot of books
by making it seem otherwise. But while a given diet plan may tell you to
count the carbs or the fat, your body is still counting calories. It
doesn't matter if they are carb calories or fat calories or protein
calories -- in theory, your body will shed a pound for every 3,500
calories you cut (though in real life, it's not that simple).

So while popular diets promise sugar-busting, fat-flushing,
carb-counting revolutions in weight loss, many of them miss the point. The
diet that works isn't based on a single big idea. Instead, it's a set of
scientifically based tools that are essential to weight loss -- no matter
what particular diet you're following.

Stop Drinking Soda

Over the course of a year, one can of regular cola a day,
at 140 to 150 calories, adds up to more than 50,000 calories, or about 15
pounds.

But calories alone are not what make beverages so
insidious. Liquid calories have the potential to do more damage in terms
of weight gain because they don't make you feel as full. The body simply
doesn't "notice" calories that you drink as much as it does calories from
solid foods -- so you end up consuming far more calories than you would
otherwise. (Liquid diets don't pose the same problem because the drink is
intended as a replacement for other food.)

WEIGHTY NUMBERS

14: Number of
calories in a potato chip

29: Number of
pounds you would gain from eating one extra potato chip
a day for 20 years

19.8: Percentage
of adults who say they are obese

30.5: Percentage
of adults who really are medically obese

30: Percentage by
which people typically underestimate how many calories
they eat

1,795: Average
number of daily calories successful weight losers
probably eat

23: Percentage of
U.S. adults who consume five servings of fruits and
vegetables a day

510: Number of
calories in a plain Panera cinnamon crunch bagel

2: Hours it would
take a 160-pound person to walk off a plain Panera
cinnamon crunch bagel

14: Hours a
160-pound person needs to walk to lose a pound

148: Average
increase in daily calories consumed, compared with 20
years ago

140: Calories in a
regular 12-ounce Coke

10: Diameter, in
inches, of a typical restaurant plate 20 years ago

12: Diameter, in
inches, of a typical restaurant plate today

Sources: Purdue University Department
of Foods and Nutrition; Journal of the American Medical
Association; National Weight Control Registry; U.S. Centers
for Disease Control and Prevention; http://www.panera.com/; http://www.netnutritionist.com/;
U.S. Department of Agriculture; Coca-Cola Co.; American
Institute for Cancer Research

To test this theory, researchers at Purdue, in West
Lafayette, Ind., devised an intriguing study a few years ago comparing
liquid and solid calories. Fifteen participants consumed 450 calories of
soda each day for four weeks and 450 calories of jelly beans during a
different four-week period.

When the researchers tracked eating patterns during the
study period, they discovered that the jelly-bean eaters ate the candy
instead of other food, so their total daily caloric intake didn't change.
But the soda drinkers drank the soda in addition to other foods,
continuing to eat as they always had, so their calories for the month
increased dramatically. As a result, they gained weight during the soda
phase, but maintained their weight during the jelly-bean phase.

Barbara Croft of Worthington, Ohio, knows well the
difference diet cola can make. In February 1999, she weighed 350 pounds.
After being diagnosed with diabetes, she decided to diet. Her first step
was to cut out the eight to 10 Pepsis she drank every day. The drinks
added up to as much as 156 pounds a year.

Ms. Croft, 54 years old, also cut back on her food calories
and started exercising. She lost 200 pounds and has kept it off for 2 1/2
years. "Once you stop the soft drinks," she says, "it immediately makes a
difference."

Write It Down

Doctors have long been fascinated by people who claim to
eat very little but can't lose weight -- people who blame their dieting
problems on metabolism, for instance, or heredity. But for many people,
researchers believe, the problem lies elsewhere.

A New York study monitored a group of obese patients who
complained they couldn't lose weight on 1,200 calories a day. But
researchers found there was nothing metabolically unusual about the
patients. Instead, the study found the group was eating, on average, 47%
more than it claimed and exercising 51% less.

The deception isn't always intentional. "If you ask someone
to recall what they ate that day, I guarantee you a handful of M&M's
is forgotten," says Lawrence J. Cheskin, director of the Johns Hopkins
University weight-management center in Baltimore.

But many studies show dieters who religiously record what
they eat lose more weight and keep it off better than those who don't keep
food records. The more days a person records the food they eat, the
greater the weight loss. A Chicago study looked at eating habits over the
holidays. On average, participants gained 500% more in holiday weeks than
in other weeks. But those who consistently kept food records lost
weight.

Weigh Yourself Often

Most weight-loss programs tell dieters to stay off the
scale so they won't get discouraged by the slow pace of weight loss.

But that conventional wisdom is wrong: Weighing often --
really often -- is one of the keys to successful weight loss. Look at the
members of the National Weight Control Registry, a collection of 4,500
successful dieters who have lost at least 30 pounds and kept it off for a
year. (The average member has lost 66 pounds and kept it off for six
years.) Seventy-five percent of registry members weigh themselves at least
once a week, while 44.5% weigh at least once a day. (To join the registry,
call 1-800-606-NWCR.)

A study of people who lost weight on the Weight Watchers
program showed regular weigh-ins helped dieters react before too much
damage was done. People who used a three-pound gain as a cue to restart
their diets were more likely to have long-term success.

Eat Big Food

A Pennsylvania State University study fed normal-weight
women over two days. The women ate as much as they wanted of different
types of high-calorie and low-calorie foods.

When researchers tallied the women's intake, they found the
women instinctively ate about three pounds of food a day. The calorie
content didn't seem important to the women in determining how much they
ate -- even when it dropped by 30%. In other words, the women seemed
satisfied by a certain volume of food, not calories.

So the trick for the dieter isn't to eat less food, but to
pick foods that pack relatively few calories by weight, says Barbara J.
Rolls, the Penn State nutrition professor and author of the "volumetrics"
diet books. An easy way to do this is to think big. Choose foods that are
bulked up by water or fiber. For instance, for 100 calories, you can eat a
quarter-cup of raisins or two cups of grapes. Adding vegetables can double
the size of a pasta dish without much of a calorie increase.

Soups are also big food -- even though liquid calories
usually don't satisfy hunger. The reason could be psychological, or it may
simply be that soups are more substantive, so the body treats them as a
food.

The difference soup can make is startling. In one study,
women were given 1 1/3 cups of chicken-rice casserole and a 10-ounce glass
of water to drink. Another day, the water was mixed with the casserole,
turning it into 2 1/2 cups of soup. Both portions contained 270
calories.

After the main course, the women could eat other foods. The
casserole group consumed 396 calories for lunch. The soup group stopped at
289 calories. The body, it appears, didn't factor in the water when it was
consumed as a beverage, but bulking up the casserole with water made the
meal more satisfying.

Pay Attention to Portions

Studies of the way children eat during early childhood show
that our eating instincts can change. One study put large portions of
macaroni and cheese in front of two groups of children. The
three-year-olds ate normal amounts, but the five-year-olds ate most of
it.

"We're born with a better ability to listen to bodily
signals than we're later exhibiting," says Dr. Rolls. "Between three and
five, kids are getting rewired for cleaning their plates."

The process continues into adulthood. In one study, Dr.
Rolls switched a popular restaurant dish of baked ziti with a portion that
was 50% larger. Patrons didn't notice the bigger size and ate most of the
dish, consuming 45% more calories than when the portion was smaller. The
lesson: If a dieter doesn't pay attention to portion size, the body won't
either.

Replace a Meal

Counting calories is hard. How many were in the dinner you
made last night, or the meal at the restaurant last week?

That may be one reason several studies have shown that
people who replace several meals a week with portion-controlled foods such
as commercial liquid diets or frozen meals have more success losing weight
and keeping it off.

A Brown University study gave one group of dieters
prepackaged meals, while others were told to cut calories. Some of the
dieters were paid for weight loss, receiving up to $25 a week for losing
weight. Money made no difference in encouraging weight loss. But dieters
who used prepackaged meals lost 31% more weight in the first four months
of the study than those who simply tried to cut calories.

"The best way to induce weight loss is to design a
no-brainer diet," says Thomas Wadden, director of the University of
Pennsylvania weight and eating disorders program. "People don't know how
many calories are in a pepperoni pizza. But you know if you've had a meal
replacement you've had 200 calories. It's the perfect antidote for
supersize portions."

Monotony Works

Most dieters think eating a wide variety of foods is the
key to a successful diet. They're wrong.

The body has different satiety quotients for different
types of foods. The mechanism meant our ancestors could pig out on protein
when they found it, but would still have room for more if they stumbled on
a cache of berries moments later. It's the reason so many of us end
Thanksgiving dinner stuffed with turkey, dressing and sweet potatoes, but
somehow manage to find room for pie. Variety excites the appetite.

For dieters, though, variety is trouble. The more choices
you have, the more you will eat. In laboratory studies, people choosing
from a variety of foods will eat 60% more than those given a single food
-- bad news for dieters who love a good buffet.

Ms. Croft says she eats pretty much the same thing every
day -- egg substitutes and toast for breakfast, tuna fish, a fruit and
vegetable and yogurt for lunch, and three ounces of fish or chicken and a
vegetable for dinner.

"Monotonous is much easier," she says. "The hardest thing
for me is to go to a cocktail party someplace where people are standing
around with food sitting out. That's next to impossible."

But monotonous eaters walk a tightrope. If they feel too
restricted, they will become bored with their diet. As a result, they seek
variety on special occasions -- weekends or holidays -- and then quickly
get back to the more predictable routine.

Watch the Morning Carbs

Losing weight is all about calories. But sticking to a diet
is all about hunger.

There's growing evidence that some carbohydrates make you
hungrier. The worst culprits are those found in refined grain products,
like white bread, doughnuts, bagels and cereals. Your body uses them far
more quickly than slow-release carbs found in most fruits and
vegetables.

Eating bad carbs early in the day -- and many breakfast
foods qualify as bad carbs -- may make matters worse. Some researchers
think carbs in the morning may block the body's ability to keep blood
sugar stable later in the day -- meaning that you stay hungry even if you
have protein for lunch. It may simply be that carbs in the morning are
worse because you have more hours left in the day for hunger to screw up
your diet.

One study, published in the March 1999 issue of the journal
Pediatrics, gave 12 overweight boys instant oatmeal or a vegetable omelet
and fruit for both breakfast and lunch. Later, they ate whatever they
wanted. During the five hours after lunch, the oatmeal boys ate 81% more
calories than the omelet eaters.

Teri Crane, a 57-year-old travel agent in Woodland Hills,
Calif., says cutting carbs, particularly in the morning, has helped her
lose 30 pounds. "I could never figure out why if I ate bread or a doughnut
or waffle for breakfast that I would be starving shortly thereafter," she
says. "I switched to eggs and feel content."

Dieters who don't want eggs every day can switch to egg
whites, yogurt or fruit, or at least try a better-quality carb such as a
high-fiber cereal.

The science is far from conclusive. "You could start a
fistfight at a nutrition meeting on this topic," says Louis J. Aronne,
director of the comprehensive weight-control program at New York
Presbyterian Hospital. Even so, some of his patients have been helped by
cutting out breakfast carbs, he says.

Susan B. Roberts, who runs the Tufts University energy
metabolism laboratory and was a co-author of the omelet study, says more
research is needed. But until then, Dr. Roberts offers a simple rule of
thumb. "If you're hungry two hours after a meal, you're eating the wrong
foods."

Rethink Exercise

Everyone thinks exercise is the only way to lose weight.
But the truth is, it's a lousy way to lose weight. Working out gives you
all kinds of health benefits, but weight loss generally isn't one of
them.

It takes an enormous amount of exercise to burn a
meaningful number of calories. A woman who walks 30 minutes a day, six
days a week, will burn a paltry 830 calories. Theoretically, it would take
her more than four weeks to expend the 3,500 calories needed to lose one
pound.

But the math isn't that simple. When a person starts
exercising, all kinds of compensatory mechanisms kick in to defend body
weight. The natural tendency is to increase eating enough to make up for
the calories lost to exercise.

Even if you resist the hunger pangs, the body finds other
ways to conserve calories. Your walk may be a little slower, or you may
rest on the sofa a moment longer -- all of which eats up all or part of
the caloric deficit created by exercise.

In a May 2000 University of Kansas study, one group of
overweight women exercised for 30 minutes, three days a week. A second
group took two 15-minute brisk walks five days a week. After 18 months of
exercise, the first group lost just 2.1% of its starting weight, while the
second group didn't lose any weight.

"We need to understand what we can get from exercise -- the
worst thing we can do is make false claims," says Joseph E. Donnelly,
director of the energy balance laboratory at the University of Kansas.
"How disappointing is it for a woman to start her 50th exercise program to
find no results for the 50th time? She'll be depressed, eat more and say
'I'll never exercise again,' because she expected too much from it."

What about intense exercise? Another study, presented at
the American College of Sports Medicine last year, put overweight college
students on treadmills for 45 minutes, five days a week, for 16 months. At
the end of the study, women participants had gained more than a pound. Men
fared better, losing about 10 pounds -- but they had to burn the caloric
equivalent of 60 pounds to do it.

Of course, people who combine diet with exercise will lose
weight, but that's because they're dieting. At best, the exercise will
help them lose just a few pounds more than they would have otherwise.

None of this gets you off the hook. While exercise often
won't make you thin, it's generally the only way to keep from getting fat
again.

That's because on any given day, we make small overeating
mistakes we don't even notice. A handful of potato chips or a tablespoon
of salad dressing each has about 100 calories. But a 100-calorie daily
mistake adds up to 10 pounds a year. Regular exercise keeps you from
gaining weight by correcting those small eating mistakes that are
virtually unavoidable.

Exercise also helps redistribute the percentage of lean
mass and fat mass in the body, which can lower risk for a number of health
problems. Lean mass also has a higher metabolic rate, but for most people,
the difference won't be noticeable because they will still need fewer
calories than when they were fat.

The best evidence that exercise makes a difference is found
among the members of the National Weight Control Registry. On average,
successful dieters in the registry spend 2,800 calories a week -- or about
an hour a day -- on exercise.

-- Ms. Parker-Pope, who writes The Wall Street Journal's
weekly Health Journal column, served as contributing editor of this
report.

Write to Tara Parker-Pope at [email-masked]

Updated April 22, 2003

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