Updated: August 26, 2017

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“It is not enough to do your best; you first have to know what to do and then do your best.”

-W. Edwards Deming

Congratulations on taking the first step toward a healthier and leaner you. The information contained here can have a substantial impact on how you look, feel, and function. You may notice quickly that the information presented is not typical of most weight loss books. There are a number of good reasons for our departure from the norm.

The first reason is that most weight loss programs do not produce long-term results.1,2 This is usually due to the overly simplistic view of weight management resulting in recommendations that don’t address many of the factors that are necessary for lasting results. These poor outcomes can also be due to another big problem in the weight loss arena; a variety of over-hyped, over-promised, and usually unsupported recommendations for diet, exercise, and other weight loss “cures”.

Second, weight management is a complex phenomenon1,3-6 influenced by three interconnected factors, (1) biological, (2) psychological, and (3) sociological, referred to as the Bio-Psycho-Social Model7,8. Because body weight regulation is clearly influenced by biological, psychological, and social (BPS) drives, interventions to prevent and reverse excess body fat stores must include all of these. This concept is fairly common in the scientific literature 1, 9-17 and even some books. 18,19 However, even though it is known that these aspects each play an important role, they are rarely studied in a comprehensive manner. Additionally, the BPS concept is often missing in the lay literature regarding weight management. The following few diagrams give a progression of the true complexity of the problem. Please don’t be disheartened or overwhelmed. Although there are many factors that can influence body weight regulation, there are often just a handful of evidence-based interventions that can address most of them. It is these interventions that will be highlighted throughout this book.

the basic view

bio-psycho-social simple

 a bit more detailed view

mind versus metabolism 2

and wow, that’s a lot of stuff view

shift Obesity systems influence diagram

from http://www.shiftn.com/obesity/Full-Map.html

Third, there are no before and after pictures or testimonials of people who have utilized the information we present. This is not to say that a number of people we have worked with over the years or who have read the first edition to this book have not been able to get great results. They have. But, as “emotionally motivating” as anecdotes are, this type of motivation is usually short lived and does not address what really impacts a person’s willpower and self-control (see Testimonials Chapter for more on that). Not to mention that a lot of these pictures and testimonials, that are so common, are fabricated or at least exaggerated.  An additional problem with this type of anecdotal information is it often does not have the ability to reveal what really caused the success of the subject. Therefore, knowing what can help another person will be allusive.* (foot note on external validity) What is also missing from much of this type of success information is long-term data. A person may have been able to follow a certain program for two, three or maybe even six months and lose a significant amount of weight. But, and this is a big but, what happens over the next 6 months or year or two? To be clear, we congratulate those that have had great success, but we caution others from giving much credence to anecdotes. Because of these problems, we focus on presenting information from an evidence-based perspective. There are many people throughout the world who are doing some great research on a variety of topics that are linked to weight management. The research, when done well, helps to elucidate what types of interventions will likely work. This is, by no means, an easy task. For some topics we will be presenting, the supporting evidence does not give a clear picture of 100% certainty, either in general or for certain types of individuals. That is just the way it is. But, there is still plenty of quality evidence that certain strategies are very likely to be helpful. This is also why we sometimes use words like “likely”. “it seems”, and “probably” throughout the text. It is not that we are not confident in what we are presenting; we are very confident and will gladly defend our positions. But, to be overly confident that everything we are saying is incontrovertible is not a position we feel is conducive for increased knowledge and understanding. The scientific-method and Evidence-Based Practice (EBP) is how we approach the weight management problem. These quotes from two recent EBP sources should solidify the above points;

“Evidence-based practice represents both an ideology and a method. The ideology springs from the ethical principle that clients deserve to be provided with the most effective interventions possible. The method of EBP is the way we go about finding and then implementing those interventions….Evidence-based practice represents the practitioner’s commitment to use all means possible to locate the best (most effective) evidence for any given problem at all points of planning and contacts with clients.” (p.451)20

“ …EBP has been defined by Gibbs (2003): ‘Placing the client’s benefits first, evidence-based practitioners adopt a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence’ (p.138)21

This approach is unfortunately not taken by many authors of weight loss books and programs. In fact, it is not adhered to by some health and weight management professionals. This may not make us as popular and will likely reduce our books sales (although that really doesn’t matter as the entire book can be freely accessed on-line), but we just cannot allow ourselves to contribute to the already voluminous amount of fallacious, over-hyped nonsense that comprises the weight loss industry.

It is clear that many people struggle with their weight and there are many legitimate reasons for this struggle. These reasons and the strategies to overcome them are what we hope to clarify with this project.  We appreciate and acknowledge the fact that weight management is difficult and the ability to improve one’s weight and health will often take a sizeable amount of resources; time, effort, and probably money, particularly during the early stages of change. Both time and effort are finite resources for us all and, for many, so is money. This is why we focus on presenting information that is supported by quality evidence (see References). Additionally, our recommendations will likely make a noticeable, real world difference. Our hope is that this will translate into a productive use of your time, effort and monetary resources.

An additional difference in our approach is our “Do This…” section at the beginning of each chapter. This provides a quick overview of the key aspects of each chapter. We hope this format will improve the understanding and application of the information and provide a simple way to review the d0-able portions of our recommendations.

We want to make it clear that this book is not intended for those who are trying to maximize their athletic potential. This information is intended for those who need to lose weight (fat), often a substantial amount, want to lose it relatively quickly, want to maintain a healthy weight, and want to be able to function better in daily life. This does not mean you can’t exercise regularly and improve your overall fitness level along the way. You can. However, losing weight and some of the strategies that can make the process a bit easier and more productive are often not conducive to peak athletic performance.

So, who are we writing for? Our target audience is both inquisitive laymen and industry professionals. We realize writing for these two groups simultaneously can be difficult, but we think we can present the material in a way that is relatable to each group. For some topics, this may require including both a technical and a simplified explanation. For others, the technical explanation will be unavoidable in order to clear up common areas of confusion brought about by oversimplification. Additionally, the desire to have a book to refer our weight management clients to was, and continues to be a driving factor in our writing. With this in mind, we are striving to provide a resource that other professional can use with their clients in confidence.

Changing how you look and feel will take some additional effort and time, although not as much as you might think. To be clear, to be successful, you do not need to become an expert or guru in any of the topics covered, but you most likely will need to acquire some basic knowledge and modify your lifestyle to some degree. You will also need to apply yourself mentally and physically and designate some amount of time to it. Like all things in life worth having, such as being educated, having quality relationships, being a great parent, learning to play a musical instrument well and __________(you fill in the blank) there is a good amount of effort, determination and time needed to attain these rewarding results. There really is no quick fix that does not require effort, time and resolve. Accept it. There is no magic supplement, exercise routine, eating pattern, goal setting format, positive thinking mindset and so on that will cause any real change in weight by itself. The good news is that the basic knowledge and the evidence-based methods for change (the Bio-Psycho-Social model), is what is covered herein. If you have been unsuccessful in achieving and/or maintaining a healthy weight in the past, don’t give up. Many things that we attempt to accomplish will often take repeated attempts before we are able to reach the level of competence we desire.

In conclusion, we feel that if weight loss is your goal, which is highly likely if you are reading this, your approach should be based on the comprehensive Bio-Psycho-Social model of change. The concepts explained herein are best utilized together, particularly for long term success, which is really true success. The positions of chapters does not represent their relative importance because you may need to focus more on certain areas, particularly at first, due to your individual needs. To help guide you on where to begin your journey, we include some basic questions to highlight your major areas of concern and where you should likely focus your efforts (see Chapter 5 – Where to Begin?). However, when it comes to losing weight and keeping it off, we have to stress that the diet, i.e., how many calories you eat, is the most important and exercise, i.e., helping to increase calories burned, is the second most important aspects when it comes to changing how you look. With that said, the ability to get started and be consistent with the diet and exercise, the additional aspects regarding psychology, sleep, and your environment are of paramount importance. At the end of the day, the most important thing, in order for any of the information to be useful, is it must be acted upon. So let’s get started!

To your success in reaching and maintaining a weight that allows you many years of health and vitality,

Jeff Thiboutot and Matt Schoeneberger

 

References

1 – Bray, G. & Champagne, C. Beyond energy balance: There is more to obesity than kilocalories. J  American Dietetic Association 2005; 105: S17-S23.

2 – Douketis, JD et al. Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Inter J Obesity 2005; 29: 1153-1167.

3 – Friedman, J. Modern science versus the stigma of obesity. Nature Med 2004; 10(6): 563-569.

4 – Palou, A. et al. Obesity: molecular bases of a multifactorial problem. Eur J Nutrition 2000; 39: 127-144.

5 – Woods, SC. & Seeley, RJ. Understanding the physiology of obesity: review of recent developments in obesity research. Inter J Obesity 2002; 26 (Suppl 4): S8-S10.

6 – Yang, W et al. Genetic epidemiology of obesity. Epidemiologic Reviews 2007; 29(1): 49-61.

7 – Borrell-Carrió et al. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Annals Family Med 2004; 2(6): 576-582.

8 – Kaplan, D. The next advancement in counseling: The bio-psycho-social model. (n.d.); Retrieved March 15, 2014; from http://counselingoutfitters.com/vistas/vistas05/Vistas05.art03.pdf

9 – Anderson, D. et al (2005). Interventions for weight reduction: Facing the maintenance problem. Inter J Behav Consult Therapy; 1 (4): 276-285.

10 – Berthoud, HR. & Morrison, C. (2008). The brain, appetite, and obesity. Annu Rev Psychol; 59: 55-92.

11 – Cohen, D. (2008). Neurophysiological pathways to obesity: Below awareness and beyond individual control. Diabetes; 57: 1768-1773.

12 – Finegood, D. et al (2010). Implications of the Foresight Obesity System Map for solutions to childhood obesity. Obesity; 18(1): S13-S16.

13 – Hafekost, K. et al (2013). Tackling overweight and obesity: does the public health message match the science? BMC Medicine; 11:41.

14 – MacLean, P. et al (2011). Biology’s response to dieting the impetus for weight regain. Am J Physiol Regul Integr Comp Physiol; 01: R581-R600.

15 – Skelton, J. et al (2006). Obesity and its therapy: From genes to community action. Pediatr Clin North Am; 53(4): 777-794.

16 – Thompson, W. et al (2007). Treatment of obesity. Mayo Clin Proc; 82(1): 93-102

17 – Ulijaszek, S. & Lofink, H. (2006). Obesity in biocultural perspective. Annu Rev Anthropl. 35: 337-360.

18 – Heshmat, S. (2011). Eating behavior and obesity: Behavioral economics strategies for health professionals. Springer. New York.

19 – Power, M. & Schulkin, J. (2009). The evolution of obesity. Johns Hopkins University Press. Baltimore, Maryland.

20 – Bloom, M. et al (2009). Evaluating practice: Guidelines for the accountable professional (6th Ed.). Boston: Allyn and Bacon.

21 – Shlonsky & Gibbs (2004). Will the Real Evidence-Based Practice Please Stand Up? Teaching the Process of Evidence-Based Practice to the Helping Professions. Brief Treatment and Crisis Intervention;4(2):137–153.

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