Nutritional Pearls: Sitting Less and Moving More

A 29-year-old man presents to your clinic with a recent weight loss of 11 kg. He works from home and sits in front of his computer all day. He is wondering what he can do in his spare time to help him maintain his weight loss.

How would you advise your patient?

(Answer and discussion on next page)

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for warfarin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine, associate professor of medicine at Tulane University in New Orleans, and faculty chair of the all-new Certified Culinary Medicine Specialist program.

Answer: More physical activity is key for maintaining weight loss.

The Research

It is one thing to lose a significant amount of weight (meaning 5% or more of starting body weight). Research shows that nearly any diet, fad or evidence-based, will result in fairly rapid weight loss if people stick to the plan. Therefore, why keto/Atkins, intermittent fasting, and other fad diets are so popular.

The problem, from a long-term health standpoint, is keeping the weight off.

The good news is that, while there is quite a bit of research interest in helping people lose weight, there is just as much interest in understanding the lifestyle strategies of those who do lose weight and manage to keep it off for at least a year.

In a recent article in Obesity,¹ researchers at California Polytechnic, San Luis Obispo received funding from Weight Watchers to survey the habits of more than 4900 people with clinically normal weight and had lost at least 9 kg (using Weight Watchers) and kept it off for at least 1 year.

As a control group, the researchers recruited 650 adult men and women via online and in-person channels including Facebook, ResearchMatch, and the California Polytechnic Center for Health Research. All participants reported having a body mass index of at least 30 kg/m2 (clinically obese) and having maintained that weight for at least 1 year.

The researchers were primarily interested in how much time the participants spent sitting, with an additional interest in what they were doing while sitting––playing video games vs working or study, for example––as well as the amount of time they spent exercising, such as walking, running, or more strenuous physical activity. What and how much they ate was of secondary importance.

All participants responded to 2 different surveys. The first is known as the Multicontext Sitting Time Questionnaire (MSTQ), which measured "time spent sitting during weekdays and weekends and doing activities such as working, reading, studying, watching television or movies, playing video games, computer time, sleeping, and inactive transportation."

The second survey assessed the participant's home environment, focusing on what the survey terms "sedentary-promoting items in the home," including video game consoles, televisions, VCRs, DVD players, recorders, desktop and laptop computers, as well as cell phones.

The researchers theorized that those who maintained their weight loss for more than 1 year would spend less time sitting than those who were obese (the control group), expend more calories through physical activity than those in the control group, and would have fewer "sedentary-promoting items in the home" than the control group.

The Results

To the researchers’ surprise, there was no significant difference in the number of "sedentary-promoting items in the home" between those who maintained their weight loss vs the control group. For example, they had largely the same number of television sets in the home or bedroom.

What was a significant difference between the 2 groups was that the participants who maintained their weight loss spent about 1 hour less per day in nonwork-related sitting "while using a computer or playing a video game.”

Further, they consumed about 300 fewer calories per day, on average, than those in the control group and burned more than twice as many calories through physical activity each week than the control group.

What This Means For You

It is no surprise that those who had maintained a significant weight loss were consuming fewer calories vs those who were clinically obese, but you might expect a bigger difference between the 2 than just about 300 calories per day. More physical activity seems to be key for the participants who maintained their weight loss. Less time spent sitting was simply an indicator of more activity, which was further evidence for the importance of physical activity.

Reference:

1. Roake J, Phelan S, Alarcon N, Keadle SK, Rethorst CD, Foster GD. Sitting time, type, and context among long-term weight-loss maintainers. Obesity (Silver Spring). 2021;29(6):1067-1073. https://doi.org/10.1002/oby.23148