For weight loss, does ‘slow and steady’ really win the day?

Where weight loss is concerned, the maxim has traditionally be ‘slow and steady wins the day’. I’ve lost count of the number of times I’ve heard that rapid weight loss generally leads to rapid weight regain too. Like a lot of nutritional ‘truths’ though, a recent study suggest that this meme is wildly misleading. If anything, more rapid weight loss appears to lead to better results in the long term.

The study in question was published on-line last week in the International Journal of Behavioral Medicine [1]. In this study, middle-aged women (average age 59) reduced calories and upped their exercise levels to an extent calculated to bring about a weight loss of 0.45 kg (1 lb) a week over a 6-month period. The study participants then engaged in a year-long ‘maintenance’ programme.

The researchers undertook an analysis of the initial rate of weight loss and how they fared in the long term. The women were categorised according to the following criteria:

‘Fast’ losers: initial weight loss of 0.68 kg or more each week
‘Moderate’ losers: initial loss of between 0.23-0.67 kg per week
‘Slow’ lowers: initial loss of less than 0.23 kg per week

At 6 months, the weight loss results of these groups was:

‘Fast’ losers: 13.5 kg
‘Moderate’ losers: 8.9 kg
‘Slow’ lowers: 5.1 kg

At 18 months, the losses were:

‘Fast’ losers: 10.9 kg
‘Moderate’ losers: 7.1 kg
‘Slow’ lowers: 3.7 kg

All these results were statistically significant. In other words, more rapid weight loss initially was associated with better results in the medium and long term. The authors of this study concluded: “Collectively, findings indicate both short- and long-term advantages to fast initial weight loss. Fast weight losers obtained greater weight reduction and long-term maintenance, and were not more susceptible to weight regain than gradual weight losers.”

Now, there are several potential explanation for why more rapid losers did better in the long term. One is, they did more in terms of cutting calories/upping activity. Another is that they had greater propensity to lose weight, say for metabolic reasons (e.g. generally more rapid metabolic rates). It is possible, therefore, that more rapid weight loss does not cause better results (the two things might just be associated with each other).

However, what the results of this study do suggest, that more rapid weight loss is not a barrier to sustained weight loss. If anything, faster weight loss initially may augur well for those looking to the long term.

References:

1. Nackers LM, et al. The Association Between Rate of Initial Weight Loss and Long-Term Success in Obesity Treatment: Does Slow and Steady Win the Race? International Journal of Behavioral Medicine 5 May 2010 [epub ahead of print]

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10 Responses to For weight loss, does ‘slow and steady’ really win the day?

  1. Jamie 10 May 2010 at 12:02 am #

    John,

    Perhaps this is a case where the problem isn’t with rapid weightloss per se. But rather with how that weightloss is brought about. For example, rapid weightloss via say a primal-type eating pattern may be more sustainable compared to rapid weightloss brought about by eating salads & soup whilst undertaking excessive cardiovascular exercise.

    Did the study above allude to how diet was changed in order to achieve calorie restriction?

  2. Craig Burton 11 May 2010 at 12:30 am #

    A gem of a topic and research Dr. Briffa. As this myth can really affect peoples confidence, especially when it comes from family and friends who create doubt in the person by saying ‘you are losing weight too fast – its dangerous and you will just rebound’ In my experience there is nothing better for long term success than getting great results from the get go. That sort of motivation is powerful. However I totally agree with Jaime that the methodology is crucial to sustainability and if people follow a more primal diet (especially restricting those grains) with resistance exercise rather than eating like a rabbit doing excessive cardio then they are on a winner.

  3. Dana 11 May 2010 at 2:46 am #

    What really annoys me about this tidbit of conventional wisdom is that “everybody knows” being fat is unhealthy. You know, if I catch smallpox virus, I know that’s unhealthy. What I want, then, is to get rid of the virus as soon as possible. There ain’t no such thing as recovering from smallpox too quickly.

    What’s so different about obesity? If it’s bad for me to be fat, well, if I’m only losing a pound a week or less, I’m still fat! Nobody says obesity is OK if you’re losing it. Obesity is bad, full stop–that’s the message that is put out there.

    So… Pick one. Either losing fat is OK no matter how fast you do it or obesity doesn’t really matter. That’s how I see it.

  4. Bill 11 May 2010 at 8:02 pm #

    Surely the rate of weight loss is not really a factor.
    The main concern is that the diet should be highly nutritious and supplying all necessary proteins, fats, complex carbs and vitamins.
    The body will find it’s own “set point” over time.
    If simple carbs are minimal, then it doesn’t matter about limiting your calorie intake when it’s from protein and fats.

    That’s my experience anyway.

  5. Richard Feinman 14 May 2010 at 5:27 pm #

    Traditional weight loss advice is like psychoanalysis. Everything else we do in life we try to do as quickly and efficiently as possible. Of course, we understand practically it may not happen as quickly as you want but if you start out with modest goals, it is a self-fulfilling prophecy. In traditional weight loss and psychoanalysis, suddenly you are supposed to go slow. What do these have in common. Generally poor performance and the need for the patient to keep coming back for more sessions. Makes you think there may really be something to subconscious motivation.

  6. Elaine 14 May 2010 at 8:58 pm #

    I think the maxim is aiming to advise people not to go into starvation mode, which sounds like good advice when trying to lose weight.

    I have always heard that up to 2lbs/ week will be enough (and enough of a challenge) for most people who are moderately overweight. Slow and steady is relative to starting body weight, so an obese person could lose 4lbs as they are working so hard to carry the extra weight and still be going ‘slow’.

    It sounds like these people were all on the same diet, so the interesting findings can’t be translated into weight loss advice.

  7. Daniel Wellard 15 May 2010 at 6:47 am #

    What I would like to know, is the notion of muscle wastage when weight loss occurs rapidly. Surely if protein is used as energy during excessive negative energy balance (which I have read, somewhere, cannot remember where) metabolism decreases and weight gain is more likely.

  8. Leigh 20 May 2010 at 1:34 pm #

    I understand that fat is used as storage for many drugs and harmful toxins and that quick weight loss can release them into the body and potentially cause overdose. In all things it appears that a gradual incline is the way to introduce new things to the biology or even the mind, with a view to reaching the optimum with consistency and a certain level of effort until the goal is achieved, afterwhich, maintenance is useful.

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