This is about the briefest way I can put this.
A proper review of the topic would be a book or two.
The way I see it – generally for most people, most of the time:
(this is not specific advice to be used without discussion with your personal doctor):
- Be hopeful – the landscape of weight care has changed dramatically and will change more. Substantial health gains may not require substantial weight loss.
- Stop seriously disrupting your appetite/satiety control system. Treating it as a war is not productive.
- Evaluate every aspect of your health, lifestyle and circumstances for all means available to favour improved functioning of your appetite/satiety control system.
- From the start, find out whether you are experiencing glucose load strain.
- Think of and notice the things that interfere with accomplishing the goals above (such as time stress, emotional responses, lack of support). As much as you can, address these – you may need help (e.g. doctor, counsellor)
- Recognize that not everybody can get to the point where their appetite/satiety control system is working well and may need an extra intervention. Nutritional ketosis can be very useful.
- Every one is different. Theories and research will only take you so far – trial and error plays an essential role. Only you can decide what you find to be worthwhile.
1/7 Be hopeful – the landscape of weight care has changed and will change more. Using today’s insights, you may have a much easier time with weight loss and weight control than you imagine. You may have a much more difficult time with weight loss than you imagine. Even without substantial weight loss, you still likely can greatly improve your sense of well-being, your enjoyment of your life and your health. By maintaining your health (including not sacrificing your health for your weight goal) as much as possible, you will be in a better position to benefit from new developments as they come along.
2/7 Stop seriously messing with your body’s weight control system – stop restricting calories, skipping or delaying meals, going hungry, dis-ordered eating and using stimulants such as adrenalin and caffeine to delay meals. If any of these strategies were useful, we would not be in the situation we are now. As a general strategy, loosing weight by going hungry has failed miserably and has probably caused a lot of harm along the way. Stop being at war with your appetite system and learn to work with it. If you have active addictions and eating disorders, your appetite/satiety control system will not have a chance to work properly. Of course, eating disorders and addictions are complex disorders that require much more than a simplistic approach, but learning to eat in ways that promote stable blood sugar and avoid triggering stress hormones can be of some help.
3/7 Evaluate every aspect of your health, lifestyle and circumstances for all means available to favour improved functioning of your appetite/satiety control system. It is a big mistake to focus only on diet and activity. One of the biggest barriers – most people are far more willing to make changes to their food choices than they are to face their need for sleep. As you make changes to address the above goals as much as possible, monitor your response by paying attention to how much you feel a need to eat and how your body composition is responding. If you find over time that the amount of food you need to eat to avoid being hungry is not allowing you to reach your weight health goals, re-evaluate whether you are doing all that you reasonably can to support the function of your appetite/satiety control system. If you are on any medications, review these with your doctor and with your pharmacist to see whether any of them are causing side effects that hinder weight control and consider if there are any changes that could be made.
4/7 From the start, find out whether you are experiencing glucose load strain. That is, whether the amount and/or rate of glucose coming into you body is causing a strain on your health. Is your appetite being driven by swings in blood sugar? Are you showing signs of metabolic syndrome and insulin resistance? Is your fasting blood glucose above normal? Does your blood glucose go up above normal after meals? Do you crave sweets, starches and/or fatty foods that contain sugars/starches? Do you have diabetes or pre-diabetes? All of these things affect the appetite/satiety control system. Any of these effects can be so strong that weight control can, in some people, be very difficult without addressing them. If any of these conditions apply to you, you will likely find it much easier to improve your well-being and your health by adjusting your carbohydrate intake (total amount plus speed) to below your current carbohydrate load tolerance limits.
If you are not showing signs of glucose load strain, you may do well on a low fat, higher carbohydrate eating plan, provided that this focuses on low glycemic index foods. Some people do best focusing on a high volume of low calorie density foods.
5/7 Think of and notice the things that interfere with accomplishing the goals above. As much as possible, deal with these – you may need help with this from friends, family, your doctor, etc. Realize that there may be emotional aspects to address. Do what you can to lessen other burdens in your life so you have the time and energy and focus to undertake the changes needed to improve your health. Consider mind-body practices to cultivate resiliency, such as mindfulness or CBT.
6/7 Recognize that not everybody can get to the point where their appetite/satiety control system is working well enough that they can achieve reasonable weight control goals without sustained hunger or cravings. If it seems that you really are doing what you can and you feel you need some additional strategy, consider the use of nutritional ketosis as a means to help lessen appetite (or for other health reasons). Note: we are talking a moderating effect on appetite, not complete appetite control or lack of hunger. Nutritional ketosis very often helps with appetite control even in people who do not have any difficulties with handling glucose/carbohydrates and would not otherwise have any reason to consider reducing their carbohydrate intake.
For the purpose of completeness, I should mention that other options that might be considered at this point would include obesity management medication (this is not an option in Canada at this point, anyway), a trial of a calorie-restricted diet and weight-management surgery.
7/7 Every one is different. What will be best for you cannot be predicted solely by considering theories and looking at the research. Trial and error plays an essential role. Evaluate your health responses over time and keep adjusting your health practices and medical care according to your individual responses and needs, in context with your personal values and choices. Only you can decide what health habits and interventions you find to be worthwhile. Part of deciding what is worthwhile is to have a realistic, comprehensive and informed understanding of your weight situation and the ways in which that is affecting your well-being and health now and the ways in which reaching various body composition goals might affect your health and quality of life in the future. An extra 25 pounds on your hips and under your skin may not be affecting your physical health a great deal. An extra 15 pounds inside the abdomen of even a “normal weight” person would be considered to be a significant threat.