Should You Eat Often to Lose Weight?

Written by Dr. Steve Chaney on . Posted in current health articles, Health Current Events, Healthy Lifestyle, Lose Weight

6 Small Meals a Day Plan?

Author: Dr. Stephen Chaney

eat like a birdShould you eat often to lose weight?  A friend, your doctor, or your favorite health guru may have told you with some conviction that eating 6 small meals a day, as opposed to 2 or 3 large meals, can help you lose weight. If you are like most people, you are probably wondering whether something so simple might be the secret to permanent weight control. Should you really eat like a bird?

The advocates of eating frequent, small meals argue that large meals cause a much larger spike in insulin resulting in more of the calories being stored as fat. They also argue that a long time between meals leads to excessive hunger and overeating when you do sit down to a meal. The opponents of this idea claim that those arguments are nonsense and that eating frequent meals can cause you to lose track of the calories you have consumed.

The clinical studies on this subject have not been much help. Some studies show that more frequent food consumption during the day is associated with lower body weight, while other studies find no association between frequency of food consumption and weight.

Your friend may have also told you that consuming your calories earlier in the day will help prevent weight gain. You’ve probably heard the saying: “Eat breakfast like a king, lunch like a prince, and dinner like a pauper”. This hypothesis is on a bit stronger footing, but there are far too few studies on the subject.

With both of those concepts in mind, a recent study provides an excellent perspective.

Should You Eat Often to Lose Weight?

A recent study (Aljuiraban et al., Journal of the Academy of Nutrition and Dietetics, 115: 528-536, 2015) used data from the International Study on Macro/Micronutrients and Blood Pressure to evaluate the relationship between frequency of eating and time of eating with caloric density (calories/serving), nutrient quality and BMI (a measure of body weight). The study included 2,696 men and women aged 40 to 59 years from both the United States and England. The dietary data were obtained from each participants on two consecutive days at the beginning of the study and again 3 weeks later.

The results of the study were:

  • BMI was significantly less for those individuals consuming >6 meals per day than for those consuming <4 meals/day.
  • BMI was also significantly less for those individuals consuming their calories early in the day than for those consuming most of their calories late in the day.

What Is The “Rest Of The Story”?

Those of you old enough to have heard the Paul Harvey radio show might remember that he would tell a fairly ordinary story. Then, after the commercial break, he would come back and tell “The Rest Of The Story”, and that was always the most interesting part of the story. This study is no different.

should you eat often to lose weightIf this study had just measured associations with BMI, it would have been just another boring food frequency study that just happened to show an association between more frequent food consumption and lower body weight. However, it also evaluated the association of food frequency and food timing with many other parameters. This was the most interesting part of the study. This was “the rest of the story”.

  • Those individuals consuming >6 meals/day had higher intakes of low fat dairy products, fruits and vegetables and lower intake of alcohol and red meats than those consuming <4 meals/day.
  • Those individuals consuming >6 meals/day also consumed less energy dense foods, fewer total calories, and more nutrient rich foods than those individuals consuming <4 meals/day.
  • Those individuals consuming >6 meals per day were much less likely to have their evening meal at a restaurant or cafeteria than those individuals consuming <4 meals/day.
  • Similarly, those individuals consuming the majority of their calories early in the day also had higher intake of low fat dairy products, fruits and vegetables and lower intake of alcohol and red meat than those consuming the majority of their calories late in the day. They also consumed less energy dense foods, fewer total calories, and more nutrient rich foods.
  • Although the difference was not statistically significant, it is perhaps worth noting that individuals consuming >6 meals/day tended to eat a higher percentage of their calories early in the day compared to individuals consuming <4 meals/day.

In other words, it was not necessarily the frequency or time of eating that was associated with body weight. It could simply have been the quality of the diet that determined body weight. It’s no secret that eating fewer calories, more fresh fruits and vegetable, eating lower fat dairy products, and consuming less alcohol and red meat is associated with a lower body weight. In today’s world of supersized portions, it’s also not surprising that frequently eating your dinner at restaurants is associated with higher weight.

What’s not clear from this study is why there was such a strong association between consuming a healthy, low calorie diet and frequency/timing of eating. It’s also not clear whether this is a universal association, or whether it was unique to this clinical study.

 

The Bottom Line

  • A recent study has shown that BMI was significantly less for those individuals consuming >6 meals per day than for those consuming <4 meals/day. BMI was also significantly less for those individuals consuming the bulk of their calories early in the day compared to those consuming their calories late in the day.
  • In both cases, it turns out that the individuals with lower BMI were also consuming healthier diets as measured by lower calorie intake, greater consumption of fruits, vegetables and low fat dairy and reduced consumption of alcohol and red meats.
  • Consequently, it isn’t clear from this study whether low BMI is associated with frequency of eating, timing of eating, or simply the quality of the diet.
  • The jury is still out on whether consuming frequent, small meals can help you lose weight. This just may be one of those approaches that works better for some people than for others.
  • The preponderance of evidence suggests that consuming the bulk of your calories early in the day may help you lose weight, but the evidence is far from definitive at this point.
  • However, there is universal agreement that eating a healthy, low calorie diet will help you lose weight. My money is with a healthy, low calorie diet.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Trackback from your site.

Leave a comment

Recent Videos From Dr. Steve Chaney

READ THE ARTICLE
READ THE ARTICLE

Latest Article

A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

 

low carb dietTraditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

  • How good was the study?
  • What were its limitations?
  • Are the claims justified?

 

How Was The Study Designed?

low carb diet studyThe investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

  • The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.
  • The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.
  • The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

  • The weight maintenance portion of the study lasted 5 months – much longer than any previous study.
  • All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.
  • The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.
  • Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

 

Do Low-Carb Diets Help Maintain Weight Loss?

low carb diet maintain weight lossThe results were striking:

  • The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.
  • These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.
  • These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

 

What Are The Pros And Cons Of This Study?

low carb diet pros and consThis was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

  • Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.
  • Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.
  • The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

 

low carb diet and youWhat Does This Study Mean For You?

  • This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.
  • In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.
  • The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.
  • This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

 

  • A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.
  • However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.
  • In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.
  • Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

 

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

UA-43257393-1