The Ultimate Weight Loss Cheat Sheet

Apparently there’s such a thing as “too much information.” And finding a simple, coherent and simple answer to the question “How do I lose weight?” is the perfect example of that. Weight loss research has produced more contradictory headlines than almost any other area in nutrition science. Eat a big breakfast, eat no breakfast, fast for 16 hours, don’t fast ever…it’s…a lot. We put together the most common questions people ask when it comes to losing weight. And we found answers by the researchers who studied them directly. 

Start with a big glass of water

Lemon if it gets you to drink it.

Drinking water before meals may help with weight loss. In a randomized controlled trial conducted in Birmingham, England, 84 adults with obesity recruited from general practices were assigned to preload with 500 ml (about 17 ounces) of water 30 minutes before their main meals or not. After 12 weeks, those in the water-drinking group lost an average of 1.3 kg (about 3 pounds) more than those who didn’t drink the extra water. 27 percent of participants in the water-drinking group lost at least 5 percent of their starting body weight, compared with 5 percent in the other group.

In that same trial, participants also reported how often they actually did it. Those who drank water before all three meals came out 3.6 kg (8 lb) ahead of those who managed it once a day or not at all, though that compares what people reported doing rather than two randomized groups.

It works because it blunts hunger and reduces overall food intake, not necessarily from any change in metabolic rate.

Claims that drinking water with lemon boosts your metabolism and encourages your body to burn more fat have been around forever, but studies comparing lemon water with plain water find no difference in fat oxidation, metabolic rate, or satiety. There’s no clinical trial that compares drinking water with both lemon and a dash of sea salt to plain water. If you enjoy the taste, go ahead and do it, and you may be more likely to make a habit of drinking a big glass before meals if it tastes good. Keep in mind that sea salt is an electrolyte and not a fat-loss magic bullet, and it’s not a good idea for people with high blood pressure or kidney trouble.

“Participants who were instructed to consume 500 ml of water 30 min before main meals lost 1.3 kg more than the comparator group.”— Helen M. Parretti, PhD, University of Birmingham · Obesity, 2015 · randomized controlled trial, n=84, 12 weeks

Step on the scale

Every day — not every week.

Among people who have actually kept weight off, the most common habit is weighing yourself daily. This way you’ll be able to detect a small increase in weight, say 2 or 3 pounds and nip it in the bud before it snowballs into a more substantial weight increase. If you were to wait a week to weigh-in, chances are, your weight would have drifted noticeably. National Weight Control Registry members monitor their weight consistently. They also have a consistent eating pattern during the weekend and weekdays. The goal is not to obsess about the number but use it as a tool to modify behavior if necessary.

“To maintain their weight loss, members report engaging in high levels of physical activity (~1 h/d), eating a low-calorie, low-fat diet, eating breakfast regularly, self-monitoring weight, and maintaining a consistent eating pattern across weekdays and weekends.”— Rena R. Wing, PhD, Alpert Medical School of Brown University; James O. Hill, PhD, University of Colorado

Eat protein first

Lead with it, then eat the rest.

Breakfast does not magically burn more calories when consumed by itself, but having something in the morning helps keep you in deficit by dinnertime. National Weight Control Registry members eat breakfast regularly. Make sure to include a source of protein in your morning meal. While it’s important to reach a certain amount of protein each day, about 0.7 to 1 gram per pound of body weight, that is a daily total across all of your meals, not a target for breakfast.

“In this 12-month weight loss diet study, there was no significant difference in weight change between a healthy low-fat diet vs a healthy low-carbohydrate diet, and neither genotype pattern nor baseline insulin secretion was associated with the dietary effects on weight loss.”— Christopher D. Gardner, PhD, Rehnborg Farquhar Professor of Medicine, Stanford University

Fill up on fiber

The other half of feeling full.

Your total calorie intake is what determines how much fat you lose. It’s the quality of those calories, whether they promote feeling full and staying full, that will determine if you’ll be able to adhere to an energy deficit for long enough to matter.

Fiber promotes satiety, meaning it makes it easier to manage energy intake and lose weight. Fiber increases the bulk of food with very few calories. In addition, the presence of fiber in food causes your body to signal satiety earlier, meaning that you’ll stop eating sooner. Feeling full means that you’re less likely to snack between meals, helping you maintain an energy deficit and burn more than you’re eating.

“Whereas carbohydrate restriction led to sustained increases in fat oxidation and loss of 53 ± 6 g/day of body fat, fat oxidation was unchanged by fat restriction, leading to 89 ± 6 g/day of fat loss.”— Kevin D. Hall, PhD, Senior Investigator, National Institute of Diabetes and Digestive and Kidney Diseases, NIH

Bank your hour of movement

About an hour a day, whenever it fits.

Exercise is an excellent habit for your health, but not so great for fat loss. It can’t out-do poor eating, as a handful of trips to the gym won’t overcome a poor diet. Research by Herman Pontzer of Duke University indicates that human energy use is relatively fixed, because people burn about the same number of calories whether they are active or not. Where exercise shines in weight loss is in maintaining it. Members of the National Weight Control Registry exercise about an hour a day to keep their weight off. Exercise helps to keep the pounds you’ve already lost from creeping back on. It’s a habit to pick up or maintain once you lose the weight you want to lose, not necessarily the solution for losing weight in the first place. And, as with dieting, it’s the daily activity and long-term consistency, not necessarily the intensity, that counts.

“Our data indicate that, contrary to received wisdom, humans tend to burn the same number of calories regardless of how physically active they are.”— Herman Pontzer, PhD, Associate Professor of Evolutionary Anthropology, Duke University

“Exercise to stay healthy and vital; focus on diet to look after your weight.”— Herman Pontzer, PhD, Duke University

Lift something

Or you lose muscle along with the fat.

When you’re eating fewer calories, it’s important that any weight you lose isn’t coming from muscle. Maintaining muscle is important while dieting because it keeps your metabolism from falling further than it has to. To help with this, incorporate resistance training into your routine. Lifting will help you maintain muscle, especially if you are eating enough protein.

Eat the same on Saturday as you do on Wednesday

Weekend drift is where most deficits quietly disappear.

Diets commonly fall apart not on the workdays but across Friday, Saturday and Sunday, and then get patched with a promise to begin again on Monday. A deficit that only runs Monday to Friday is a deficit that operates about 71 percent of the time, because the weekend is two days out of seven, close to a third of the week.

Have the same eating pattern on weekends that you have on weekdays. People in the National Weight Control Registry, a group of people who have lost a substantial amount of weight and kept it off, report having the same dietary pattern on weekends and weekdays. They don’t have one set of food rules for weekdays and another for weekends. Having similar food choices on Saturday and Wednesday takes away the opportunity to justify eating too much. Consistent healthy eating saves you from losing your deficit on weekends and saves willpower as there are no decisions to make.

“After individuals have successfully maintained their weight loss for 2–5 years, the chance of longer-term success greatly increases.”— Wing & Hill, National Weight Control Registry

Wind the stress down

Cortisol decides where the fat goes.

Stress influences body mass through actual endocrine changes as well as eating. Women with a greater waist-to-hip ratio, which indicates more abdominal fat, produce more cortisol in response to a stressful event than women with a smaller waist-to-hip ratio. Elissa Epel and colleagues found that lean women with higher ratios did not habituate to repeated stressors: They showed high cortisol responses to each new stressor. Dieting itself is a stressor, UCLA’s A. Janet Tomiyama points out, and stressors can increase cortisol, which in turn impedes weight loss. Cutting harder when you are already stressed tends to backfire.

“Women with a high waist-to-hip ratio secreted significantly more cortisol during stress than women with a low waist-to-hip ratio. Lean women with central fat distribution lacked habituation to stress, continuing to produce elevated cortisol on repeated exposure.”— Elissa Epel, PhD et al., Yale University

“Stress eating, elevated cortisol, disrupted sleep, and reduced motivation to exercise all converge as pathways linking chronic stress to weight gain — and dieting itself is a stressor that can elevate cortisol and counteract weight loss.”— A. Janet Tomiyama, PhD, Professor of Psychology, UCLA

Sleep seven to nine hours

Treat it as an intervention, not a luxury.

In one study, researchers at Stanford looked at the connection between sleep patterns and hormone levels. Shahrad Taheri and Emmanuel Mignot and colleagues found that those who customarily slept an average of 5 hours had 15.5 percent lower leptin levels and 14.9 percent higher ghrelin levels than those who slept an average of 8 hours. This difference held true regardless of BMI. The appetite-suppressing hormone leptin decreases and the hunger-stimulating hormone ghrelin increases, leaving you more likely to crave food whether or not you’ve eaten a balanced, healthy diet during the day. Get adequate sleep, between 7 and 9 hours each night, for a more balanced approach to controlling your appetite.

“Short sleep was associated with low leptin … with a predicted 15.5% lower leptin for habitual sleep of 5 h versus 8 h, and high ghrelin, with a predicted 14.9% higher ghrelin for sleep of 5 h versus 8 h, independent of BMI.”— Shahrad Taheri, PhD et al., with Emmanuel Mignot, MD, PhD, Stanford Center for Sleep Sciences

“In Western societies, where chronic sleep restriction is common and food is widely available, changes in appetite regulatory hormones with sleep curtailment may contribute to obesity.”— Taheri, Mignot et al., Stanford

Your deficit

About 500 kcal a day under maintenance.

Eat about 500 calories a day less than you need to maintain your current weight and you’ll lose roughly a pound of fat a week. Kevin Hall at the NIH has shown that the body acts to minimize differences in body fat between diets that hold calories the same but vary the fat and the carbs. In short, how many of your calories come from fats and carbs barely matters. Everything else just helps make that one number easier to live with.

Your framework

Low-carb, low-fat, fasting — optional.

Sure, you’ll see rapid results in the beginning with a low-carb diet, but you’re losing water, not fat. In a study led by Stanford’s Christopher Gardner, healthy low-fat and healthy low-carb fared equally over 12 months for weight loss, and any difference in losing fat disappeared at month 12. Intermittent fasting also boils down to eating less, and University of Illinois Chicago’s Krista Varady has shown that alternate-day fasting is no better or worse for losing and keeping off weight and protecting the heart than restricting calories each day. Find a plan you’ll still be running in 6 months.

“The mean 12-month weight change was -5.3 kg for the healthy low-fat diet vs -6.0 kg for the healthy low-carbohydrate diet — a mean between-group difference of 0.7 kg [95% CI, -0.2 to 1.6 kg].”— Christopher D. Gardner, PhD, Stanford University

“The body acts to minimize body fat differences with prolonged isocaloric diets varying in carbohydrate and fat.”— Kevin D. Hall, PhD, NIH

“Both IECR [intermittent energy and carbohydrate restriction] groups had greater reductions in body fat compared with the DER [daily energy restriction] group… In the short term, IECR is superior to DER with respect to improved insulin sensitivity and body fat reduction.”— Michelle Harvie, PhD, Genesis Breast Cancer Prevention Centre, Manchester; co-authored by Mark P. Mattson, PhD, National Institute on Aging, NIH

“Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs. daily calorie restriction.”— Krista A. Varady, PhD, Professor of Nutrition, University of Illinois Chicago

The stall

Metabolic adaptation, not failure.

Within weeks of putting yourself into a calorie deficit, your body fights back. You follow through, but the scale refuses to budge.

Kevin Hall and his colleagues at the NIH followed up with contestants from reality show The Biggest Loser 6 years after filming ended, after they’d lost an average of 128 lb. Even then, they were burning an average of 704 fewer calories each day than other people their size. Hall calls this effect metabolic adaptation. This term describes your body’s persistent, proportional resistance to your continued attempts to lose weight.

This doesn’t mean that you’ve gone wrong. It means your body has readjusted, trying to hold on to fat.

“Metabolic adaptation persists over time and is likely a proportional, but incomplete, response to contemporaneous efforts to reduce body weight.”— Kevin D. Hall, PhD, NIH, et al.

“Long-term weight loss requires vigilant combat against persistent metabolic adaptation that acts to proportionally counter ongoing efforts to reduce body weight.”— Kevin D. Hall, PhD, NIH

Reset the number

Every 10 lb lost.

As you’ve been losing weight, your body’s caloric requirements decrease. So the deficit that was sufficient to produce results becomes inadequate. And the culprit isn’t your metabolism. There’s been no slowing down.

Herman Pontzer and 80 co-authors from 29 countries have been studying energy expenditure across the lifespan. Accounting for fat-free mass, Pontzer reports that metabolism stays constant from ages 20 to 60, even through pregnancy, declining only after 60. What changed in midlife was everything around the metabolism, not the metabolism itself.

“Fat-free mass-adjusted expenditure accelerates rapidly in neonates to ~50% above adult values at ~1 year; declines slowly to adult levels by ~20 years; remains stable in adulthood (20 to 60 years), even during pregnancy; then declines in older adults.”— Herman Pontzer, PhD, Duke University, and 80 co-authors across 29 countries

“These changes shed light on human development and aging and should help shape nutrition and health strategies across the life span.”— Pontzer et al.

When it is not willpower

Hunger is a biology problem too.

Two decades of appetite science have shown that hunger is a system of hormones run by the brain rather than a rumble in the stomach. Leptin, for instance, signals energy status to the brain, countering ghrelin by suppressing appetite. Priya Sumithran and Joseph Proietto of the University of Melbourne, Australia, along with colleagues, conducted a study to look at the physiological response to weight loss and regain. Their findings, published in the New England Journal of Medicine in 2011, have important implications for your own efforts to lose weight.

50 people living with obesity or overweight participated in the study. The group followed a very-low-energy diet for 10 weeks. Hormone levels were measured at baseline, 10 weeks and 62 weeks. At the 62-week time-point, the authors found ghrelin, an appetite-stimulating hormone that rises before meals, was still elevated and leptin and other satiety hormones were still suppressed. Subjects also reported greater hunger compared to baseline.

So if you’ve been down this road before, only to regain the weight you’d lost, remember, it’s not your fault. Sustainable approaches to weight management make sense, as do interventions that help to counteract hunger like adequate sleep, fiber, protein, and resistance training.

Do calories matter — or does what you eat matter more?

Overall caloric intake will determine how much fat you can lose. Nutritional quality will determine how easy it is to stay under this amount without relying on willpower alone. Foods high in protein and fiber will keep you feeling more full and satisfied. Get enough of those and you can eat less and not constantly think about food.

Is going low-carb the fastest way to actually lose fat?

Those who lose weight faster on a low-carb diet are losing water, not fat. In a 12-month study done at Stanford by Christopher Gardner, no significant differences were seen in weight change on a healthy, low-fat diet compared to a healthy, low-carb diet. And any difference in body-fat loss disappears by 12 months. Choose whichever diet works for you and that you can stick with.

Does intermittent fasting actually work — or is it just skipping meals with a name?

Intermittent fasting works because it causes people to eat fewer calories. Nothing more. Narrowing your window of opportunity doesn’t have some innate advantage. Meal timing does not change the number of calories your body burns. In one study of alternate-day fasting run by Krista Varady of the University of Illinois Chicago, alternate-day fasting was not any better than an ordinary daily calorie-restriction diet in terms of ease of compliance, total weight loss, ability to maintain that weight loss over time or cardiovascular health. It’s okay to implement time-restricted eating if limiting your eating hours is easier for you than limiting portions at every meal.

Why does weight loss always seem to stall after the first few weeks?

Your metabolism adapts to a diet within weeks, and NIH researcher Kevin Hall has shown this adaptation persists for years and pushes back in proportion to how much weight you are trying to lose. Former contestants on The Biggest Loser, for instance, lost an average of 128 lb, but 6 years later they were burning 704 fewer calories per day than people of the same size who hadn’t lost an equivalent amount. Rather than slashing calories when you reach a plateau, try recalculating the deficit each time your weight-loss efforts stall.

Does metabolism slow down in your 30s and 40s — or is that a myth?

Research by Herman Pontzer and 80 co-authors across 29 countries has shown that metabolism does not slow during your 30s and 40s, contrary to widespread belief. When corrected for changes in fat-free mass, it actually remains steady from age 20 to 60 and during pregnancy. Metabolism really does slow, but only after age 60. When pondering changes in weight in your 30s and 40s, forget metabolism and focus on changes in lifestyle.

How much does poor sleep actually affect your weight?

In a study by Shahrad Taheri, Emmanuel Mignot and colleagues at Stanford, habitual 5 hour sleep predicted 15.5 percent lower leptin, which suppresses appetite, as well as 14.9 percent higher ghrelin, which increases appetite, compared to habitual 8 hour sleep, regardless of BMI. Short sleep moves both hunger-regulating hormones the wrong way at once and increases feelings of hunger irrespective of how much one has eaten. Getting 7 to 9 hours a night is what keeps these two hormones balanced.

Can stress literally make it harder to lose weight?

Cortisol works against weight loss, changing how and where you store fat. Women with a higher waist-to-hip ratio produce significantly more cortisol in response to stressors than women with a lower ratio, Elissa Epel and colleagues found. A. Janet Tomiyama at UCLA found that dieting is a stressor and can increase your cortisol levels and undo any weight loss. You can’t necessarily control your genetic predisposition in this area, but you can control how well you manage your stress and sleep. Paying attention to those factors could help more than cutting back an extra 200 calories.

Is constant hunger a willpower problem or a biology problem?

In a clinical trial Priya Sumithran, Joseph Proietto and their colleagues at the University of Melbourne followed a group of people who had recently lost weight, and found that one year later their levels of ghrelin were still abnormally high, their levels of satiety hormones abnormally low, and they reported feeling hungrier than they had before going on the diet. Feeling hungry isn’t a moral failing, as there are legitimate physiological reasons for it. If you’re getting enough protein and fiber, sleeping adequately, doing resistance training, and still feel hungrier than normal, talk to your doctor.

Does exercise actually help you lose weight — or is it really all about diet?

Diet rather than exercise is what controls weight loss. A workout alone causes only modest weight loss. Researcher Herman Pontzer at Duke University has found that although people expend different amounts of energy during exercise, total energy expenditure during a day remains fairly constant. However, exercise is important for good health and helps people to maintain their lower weights, with National Weight Control Registry members engaging in an average of about an hour of physical activity per day.

What do people who actually keep the weight off long-term do differently?

Studies of successful maintainers indicate that these people do a handful of unglamorous things on a daily basis. Members of the National Weight Control Registry get about an hour of exercise each day, eat a low-calorie, low-fat diet, eat breakfast regularly, monitor their weight and eat pretty much the same on weekends as they do during the week. Wing and Hill report that once people have maintained a loss for 2 to 5 years, the chance of long-term success greatly increases. You don’t need to implement all of them at once. Pick two you can sustain and stay with them.

Kaelyn Johnson, MPH, R.D.

Kaelyn Johnson is a Registered Dietitian from Southern California who has worked as a clinical dietitian and is now a freelance writer. She has written for WebMD, produced an e-book, and written case studies for healthcare practitioners.