All primary care doctors deal with the diet and weight issues of their patients. Some write diet books that their colleagues scan with rolled eyes at the dubious advice or at the standard fare they serve up gratis in their own practices. Mindful of this tradition, my future medical memoir, “Great Expectorations,” will include at least one such chapter: “Dr. Stone’s 120-Year Diet Guarantee.”
One hundred and twenty years represents the maximum human life span. The champ of super-centenarians, Marie Calment, survived 122 years, though some suspect “foul play,” if the term applies to shenanigans to make oneself appear older. Regretfully, I confess that even rigorous adherence to the Stone diet won’t get you to Marie’s magic 122. The real lesson is common sense diet and health rule number one: If it sounds too good to be true, it probably is. Get thin quick schemes, like their cousins, get rich quick schemes, are likely charlatanism.
The Stone diet makes up in truth what it lacks in ambition. Losing weight isn’t easy. Even weight maintenance challenges the majority that enjoys eating and drinking. Like you! Untold thousands of years of evolution in calorie scarce environments selected our ability to rapidly store weight to survive during unpredictably lean months or years. In modern America caloric scarcity occurs rarely and usually by choice.
A slice of cheesecake demonstrates the problem. It might provide 1000 calories and can be eaten in five minutes. For the average 70 kilo/155 pound person, it would take four hours on a stationery cycle to burnt it off. I tell patients that losing weight is like draining a bathtub with a slow drain. Keep tossing in a big bucket of water and it never drains.
The hard math is that you need to burn about 3500 calories, or avoid eating that much, to lose a pound. An average individual expending about 2200 calories daily could avoid 500 on a strict 1700 calorie diet. After a week, that would amount to a pound. Toss in that slice of cheesecake and the five minutes of joy costs two days’ effort and almost one third of the weight loss. The hard lesson is that successful weight loss efforts must be unrelenting. Yes, you can splurge. A single scoop of ice cream at 140 calories offers a reasonable alternative.
The second “cheesecake lesson” is that you can’t overeat and plan to “burn it off.” You won’t do four hours of cycling to do that. Not that exercise isn’t important. The 250 calories you burn in half an hour of cycling won’t mean much as a one-off. But do it three times weekly for a year and you’d burn nearly 40,000 calories. That’s well over ten pounds. So, exercise is important for weight loss, but only in the long run. It also offers health benefits beyond weight.
Over my medical career I’ve seen diets based on every conceivable notion. These include restrictions on diet components, like low-carb or low-fat, diets with meal substitutes and time restricted diets among many others. What works best? Studies suggest that one’s adherence to the diet, not the diet itself, is the key. My suspicion is that dieting comes down to mere accounting: calories in versus calories burned. Most diets are just strategies to bring caloric intake down below expenditures. If they provide basic nutrients, it probably doesn’t make much difference.
My patients seem to do best with low carb diets: cutting out sugary foods like candies and cookies along with pasta, bread, rice and potatoes. It’s a lot to give up, but you can still get nutrition and enjoyment from fruits, vegetables and high protein foods like chicken, fish, eggs and dairy foods. An additional plus is that fiber in the fruit and veggies is a “freebie.” It fills you up without additional calories.
A final suggestion I make to my struggling dieters is to be pro-active and “spoil” their appetites. Bags of peeled carrots or apple slices can help. Pop a few an hour before meal and it reduces the “momentum eating” impulse. Fiber foods also keep us from reaching for high-calorie alternatives, like cookies.
So, do bariatric surgery or Ozempic offer alternatives to the dismal tyranny of calorie counting? That weighty issue is a subject for another column.
Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network and a practicing internist and geriatrician with Cedars Sinai Medical Group. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.