Goal setting vs diet plans: What helps most?

Most people have at least a vague sense of what it means to eat well.  Eat less, move more. Less fast food, more veggies.  There’s no news flash there, yet with most Americans overweight or obese, clearly knowing that isn’t enough.  “Diets” don’t do the trick on a long-term basis, either, with research showing that most people regain what they lose AND 2/3 of people gain even more than that back.  Even more disturbingly, a 2012 study showed that very low calorie diets cause lasting hormonal changes that make weight maintenance even harder.

This absolutely matches what I’ve seen from clients.  When I first became a dietitian I was, indeed, guilty of giving people diet plans.  People would follow them, lose a few pounds, and usually within 3-6 months, fall off the wagon and gain it all right back and some extra, too.

Obviously, that’s not what I want for my clients or anyone!  Ideally, what we work on are steps you’ll still be taking a year from now, 5 years from now, even decades from now.

Now use more of a coaching and goal setting model with clients, which is based around identifying the strengths and weaknesses in the diet and then developing specific and measurable goals for getting where you need and want to go.  Often it’s identifying healthier foods that you like to add in, brainstorming ways of getting more movement, looking at ways to manage portions, and so on. I also often provide sample recipes for meals, ideas for snacks. For many, it can be looking at labels, portion control, mindfulness techniques, stress management tips, etc. as well as encouragement, structure and support. My job is also help make these changes work for YOU: in your life, with your time constraints, with your food preferences, your medical needs, monetary constraints, etc.

This was summed up nicely by Madelyn Fernstrom, PhD, founder and director of the Weight Management Center at the University of Pittsburgh and diet and nutrition editor for NBC’s Today show: “‘Diets don’t work’ is only half the story. Lifestyle change will work if you have realistic expectations, good support, and choose a plan that you can stick with — a plan that will give you moderate change over a long time.”

For more reading on dieting, here are a few research articles on topic:

Mann, T. Medicare’s search for effective obesity treatments: Diets are not the answer. Am. Psychologist, 2007; 62(3): 220-233.

Sumithran et AL. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med 2011 Oct 27 (full text)

Neumark-Sztainer D. et al. Obesity, disordered eating,and eating disorders in a longitudinal study of adolescents: how do dieters fare five years later? J Am Diet Assoc. 2006;106(4):559-568.

Katan, Martijn B. Weight-Loss Diets for the Prevention and Treatment of Obesity NEJM 2009 360:923-925.(full text)

Field AE et al. Relation Between Dieting and Weight Change Among Preadolescents and Adolescents. Pediatrics, 2003 112:900-906.  (full text)