Stepping Stones (Photo credit: Rich Jacques)
Is it Time to Change the Default First Option?
If so, what would that be?
Satiety-Focused Weight Health is a conceptual framework that can be used to organize one’s approach to weight control, in the aftermath of the era of reliance on calorie restricted dieting.
I think that as of now we have the knowledge and interventions to make satiety-focused weight health preferable as the default first option to consider for the majority of those whose health is being affected by excess body fat and/or by fat within the abdomen (including, that is, people within the normal weight range who are “metabolically obese”).
First solve the hunger – then consider the weight.
The core conceptual shift – Calorie restriction can block weight control success. For many people, the path to their weight control goals requires fully letting go of calorie restrictive diets and behaviors, at least for a period of time.
The line of thinking goes like this:
- If you want to reduce the amount of food energy eaten (relative to energy requirements), there are only two options. You can try to work with or influence the functioning of the appetite/satiety system so that it signals for less food, or
- you can try to impose your will power over your response to the appetite control system – that is, refrain from eating despite hunger – also known as calorie restriction.
- Research has confirmed that calorie restricted dieting, although useful for some, is not a productive strategy over the long term for most people. Imposing control has not delivered on its theoretical promise.
- This leaves us with the strategy of looking for ways to reduce the hunger drive and/or improve the satiety value that comes from the amount of calories consumed. This is now the available path. Since the only other path is to impose calorie restriction, a person’s best hope is to use all available and personally-acceptable means to achieve this – to the degree that this is practical and sustainable.
- With a person’s best weight control asset recognized to be the best understanding and balanced functioning of their innate appetite/satiety control system, all things that interfere with that are counter-productive. A person can’t learn to understand and work with their appetite/satiety control system while at the same time acting in ways that disrupt or provoke that system – such as skipping or skimping meals, using caffeine or stress hormones to suppress appetite or refraining from eating when hungry.
“Solving” the hunger is not possible while the focus is on immediate weight loss.
Satiety-focused strategies have come from behind to emerge as a powerful set of tools. We now have enough knowledge base to make a satiety-focused approach to weight health a successful approach for many people. When it is not enough on its own, the next step is to consider moving on to level 2 and level 3 interventions, while still valuing the central importance of avoiding excess hunger and optimizing satiety.
The value of a satiety-focused approach has been under-recognized in large part because of the pervasiveness of calorie-restrictive dieting and behaviors, which have been adopted by large numbers of the population as ingrained chronic behaviours. Therefore, it is not possible to evaluate the true usefulness of satiety-focused strategies for an individual unless there has been active, intentional, informed avoidance of calorie restriction in all it’s forms.
This entails a fundamental shift in thinking. Hunger and cravings when trying to eat less are seen, not as an unpleasant nuisance, but as fundamentally disruptive to the process of achieving weight control goals.
Your body intends to be in charge of how much you eat. You have an incredibly complex, multi-layered and redundant fundamental body management and survival system referred to as the body weight control system, which is expressed through the appetite/satiety control system. We are barely scratching the surface in understanding this system and how it works. (You can find preliminary descriptions of this system and diagrams of our current concepts of how it works – but be advised that these are all early “sketches”, no matter what other impression you might be given.)
It turns out that your hunger drive can be pushed up by many things, some of which you can take control of and change. Your ability to feel adequately fed with the food you’ve eaten is also something that can be influenced by many things other than the energy (calorie) amount of the food itself.
Calorie-restricted dieting, with it’s inherent hunger, has been the default treatment recommendation for weight loss. We now know that this approach, although helpful for some people, in general has been stunningly ineffective. There is also reason to be concerned that it might, in some people, actually be harmful in that it can cause disrupted eating patterns, lowered metabolic rate, (unjustified) feelings of personal failure, distrust of medical/nutritional advice, and so on. (See link below to the previous post on this topic.)
You cannot win a fight with an ancient, extremely complex basic body system that is wrapped into every part of your functioning – it’s better to make nice.
Millions and millions of people had made repeated efforts to control their food intake by using their will-power to over-ride the signals from their body weight control system. This often results in short-term wins that are tantalizingly misleading. Over the longer term, your body fights back. Research has shown repeatedly that the short term weight losses are a false promise, for most people. Although some people have made this approach work for them, for most people this approach brings poor results after the first weeks or months. The false promise of the weight loss in the first weeks or months has been wrongly interpreted as a valid indicator of how the weight loss could be expected to proceed over time. For most of the people most of the time, it is more realistic to see this initial weight loss phase as a temporary situation that the body will muster its resources to fight against.
Calories control the skirmishes, but satiety ultimately determines the winning or loosing of the game.
Satiety-Focused Weight Health – overview
“Satiety-focused Weight Health” is a conceptual framework on which to build an approach to:
- supporting each individual’s efforts to attain and maintain a body composition and weight
- that is most compatible with their long-term health,
- in the context of their goals, their choices, their individual circumstances and their inherent body tendencies.
General health, individual circumstance, over-all quality of life and individual goals take precedence over total body fat when considering body composition targets.
If reduction in body fat stores is desirable and this is not occurring, interventions are chosen that are designed to facilitate achieving satisfactory satiety and freedom from sustained hunger while undergoing weight loss. Failure to see improvement in body fat levels over time is a valuable feedback from the body that more needs to be done to reduce appetite drive and facilitate satiety. Any attempt to impose a calorie cap will ruin this essential feedback and sabotage progress towards a successful long-term strategy (which will actually be composed of a combination of strategies).
The same model is applied when the goal is stabilisation of weight in the face of a trend to weight gain. This model can also be used when the target goal is “food peace” – that is, relief from chronic struggles with hunger and cravings.
In this model, sustained or excess hunger is regarded as a symptom requiring attention, investigation and problem-solving. Sustained or excess hunger is also regarded as counter-productive, and something to be responded to by eating. Therefore, when eating according to one’s appetite, the determination of whether hunger/appetite is excess is made principally by tracking changes in body composition as accurately as possible with today’s limited tools.
Of course, as part of general weight control recommendations coming from agencies and health practitioners, every effort is already being taken to help with hunger as much as possible during weight loss interventions. The shift is in the concept going from (1) the calorie cap being the prime and beneficial intervention, with hunger being addressed secondarily as much as possible within the calorie cap to (2) the achievement of satiety while body energy stores remain stable or intentionally decrease as the prime and beneficial target.
The key to unlock the great potential of this approach is the recognition that calorie restrictive dieting and behaviors can severely undermine or fully block success.
All those involved in the field of weight control have been increasing their focus on appetite and satiety.
The writing has been on the wall now for some time about the failures of the calorie restriction (go hungry) approach. More and more attention has been given to understanding the things that affect body weight control. There has been a lot of research into what things push people’s appetite up (for example, certain medications, sleep deprivation). Research also is aimed at understanding which foods or eating habits or patterns result in the most feelings of satiety for the least amount of calories consumed. For example, when people take in a lot of calories as sugary drinks, their bodies tend to not “notice” those calories fully in terms of how much else they consume afterwards. Obesity management medications and obesity management surgeries are also oriented to helping people feel less hunger (appetite) and more satiety from a given amount of food energy consumed (or consumed and absorbed in the digestive tract).
Experts in obesity management are moving away from the focus on calorie restricted dieting. However, this has not trickled down much yet from the realm of the “obesity experts” to the doctors, nutritionists, nurses and so on that most people see as part of their health care team. And you’ll still see endless books and magazine articles describing diets that are one form or another of calorie restriction (often cleverly disguised).
This major shift within the field of obesity medicine* is reflected in a ground-breaking program released in Canada in 2012. This program is called “The 5As of Obesity Management”. (Links below) One core of the new approach that this program teaches is the focus on finding ways to reduce excess “drivers” of appetite and identifying and correcting factors that disbalance the appetite/satiety control system. The purpose of developing this program and a set of educational materials is to get this message out to the general community of health care providers and the public. The old days of “give diet sheet first, ask questions later” are gone, or should be.
This program is a remarkable development and I highly recommend that you have a look at the video at the bottom of this post and consider learning more. It is a bold statement that we really are in a new era and it is past time to ditch old ways.
To be continued … First, solve the hunger. (Part 3 of this series)
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* obesity medicine is also called “bariatric medicine” – note that’s not the surgeons, who practice bariatric surgery.
The Canadian Obesity Network developed the tool kit “The 5As of Obesity Management”. This excellent set of resources is presented on their web site on their Resources page, on the tab “5As” LINK
On the page, click on “View 5As Presentation (pdf)” for much more information than is presented in the video.
The set of resources is sold for a modest fee and is intended for use in clinical offices.
Video introduction to “The 5As of Obesity Management” (5 min.) Highly recommended. This is a great video to share with your doctor and all members of your health care team.
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