An assistant professor of family medicine at the University of Ottawa, Freedhoff is founder and medical director of the Bariatric Medical Institute, which provides nonsurgical weight management. When he began his work in 2004, he told patients they should stick close to the practices of the National Weight Control Registry (NWCR). This large group of self-selected weight-loss stars has dropped more than 30 pounds and retained the loss for more than five years. Many registry members follow a low-fat diet, and walk an hour or more per day. They also tend to eat breakfast, weigh themselves weekly, and monitor television time.
A few years later, Freedhoff began loosening up. “I’m not nearly as rigid now as I was then,” he says. “Our patients had some initial weight loss on the NWCR program, but the recidivism rate was high. We changed because we realized we were treating people by numbers, not as individuals. It’s arrogant to think that there’s one right way for everybody.”
Because the most successful weight-loss strategies are those people can maintain, Freedhoff restructured his program to keep patients engaged. He moved away from numbers like body mass index (BMI) and body-fat percentage. He preached that perfection was not the aim, and that few would lose every possible pound. Better to focus on more realistic goals.
“We started to use a term I coined, ‘Best Weight,’” he says. “That’s whatever weight you reach when you are living the healthiest life that you honestly enjoy. When you let go of the numbers, people tend to take more pride in their efforts, and that helps them stick with the efforts.”
Last August, Freedhoff and National Institutes of Health mathematician and obesity researcher Kevin Hall published a paper in the British medical journal, The Lancet, outlining the "trajectory" of most weight-loss efforts.
They explained that, yes, it is possible for motivated dieters to lose a pound to 1.5 pounds per week for the first month or so. But that rate of weight-loss soon slows. Then it bottoms out at about six months. After that, the pounds begin creeping back.
They further explained that, in this case, the initial weight-loss comes from a calorie cutback of 700 to 800 calories per day. Few people can maintain this restrictive eating pattern for long, however. At six months, the average calorie deficit has declined to about 150 calories per day, and the weight soon climbs. After two years, weight has returned to about where it was at the one-month mark of the diet.
“Our findings strongly suggest that weight-loss programs should not be short-term efforts,” says Hall. “Rather, they take persistent lifestyle changes. The primary determinant of success is sustained adherence to healthy changes in diet and physical activity.”
Hall is a bit of an ivory-tower academic type, but Freedhoff works “in the trenches,” as he puts it. Since what he observed on a daily basis closely matched what he read in various research reports, Freedhoff figured it was time to try something different. Besides, anyone could see that the usual dietary advice of a decade ago wasn’t working.
Of course, Freedhoff doesn’t tell patients they can eat as much as they want. Calories still count. But no one has to actually tally us his or her daily calorie total, and Freedhoff doesn’t insist on restriction. He also contends that it’s a myth that dieting should be difficult. A diet has to include foods you enjoy.
“Eating food is one of the most basic human pleasures,” he notes. “If a diet causes suffering, you’re not going to stick with it. Desiring certain foods doesn’t mean you lack willpower. It’s just a sign of the human condition.”
Freedhoff and Hall are agnostic when it comes to picking a best diet for weight loss. They believe weight-loss can only succeed when it’s part of a long-term plan. They note that exercise improves many health measures even if it doesn’t add substantially to weight loss. The American Heart Association and other medical groups have determined that a modest weight-loss, as little as three to five percent, can lead to “clinically meaningful” improvements in glucose, cholesterol and blood pressure.
Freedhoff admits he has compiled no rigorous data to show his new approach works better than the old. But he’s convinced of its merit. “I believe we’re seeing less recidivism than we used to,” he says. “And for sure, happiness has increased. The staff is happier, and our patients are happier.”
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