How Does a Change in Eating Patterns Affect Patients with Obesity?
— By Dawn M. Sweet, Ph.D
The holiday season presents additional challenges for persons with obesity.
With the holidays approaching and temperatures turning cooler, many of us will alter our energy intake and physical activity levels. During the holiday season, which extends from mid-November to mid-January1 our weekly routines are disrupted by temptations such as alcohol, unhealthy, energy-dense foods, the festive holiday attitude and the relaxed atmosphere of social gatherings with friends and family.2
As reported in a 2018 study,2 weight gain is accelerated during the holiday season, with modest weight gains from 0.8 lbs. to 2.2lbs., and a consistent finding of a weight gain that is closer to two pounds. One study3 found that just on Christmas Day alone, we might consume as many as 6,000 calories, or three times the recommend daily caloric intake. While two pounds and a single 6,000 calorie day may not seem like that much, if one were to extrapolate out, this weight gain and high caloric intake can add up over time.
Even the most stalwart and vigilant among us may fall under the spell cast by the festive holiday season and the relaxed celebrations with friends and family. For persons with obesity, the holidays’ access to energy-dense food and repeated exposure to unhealthy options and large portion sizes may present challenges even for those who are most committed to their Low Calorie or Very Low Calorie Diet (VLCD).
Watching Weight through the Holiday Season
A 2018 study investigated the effects of an intervention designed to promote restraint in energy consumption.2 Participants in the experimental group (N = 136) were instructed to weight themselves each day at the same time wearing (or not wearing) similarly weighted clothing and to record their weight. This was done to prime self-monitoring and habit formation. Participants in the experimental group were also instructed to reflect on their weight trajectory, and they were provided with 10 tips for weight management. Participants in the control group (N = 136) were offered only a brochure about leading a healthy lifestyle. Following the baseline weigh-in, participants in the experimental group lost more weight than those in the control group, though the loss in body fat was not significant. Those in the experimental group also showed significant increases in cognitive restraint with respect to eating.
In a 16-week longitudinal study,1 researchers investigated whether an increase in body weight was due to an increase in energy intake. Specifically, researchers examined body weight, body composition, energy balance components, and behavioral measures eight weeks before the holidays (September 15 – November 25) and eight weeks during the holidays (November 25 – January 15). Anthropomorphic data were collected along with stable isotopic labeled water, urine samples, and total body water. Additionally, subjective appetite ratings and blood samples were collected in conjunction with psychometric measures. Results of this study suggest that weight gain could be attributed to body water. The authors speculate that glycogen, which is a component or fat and hydrated with water, may explain the weight gain because of daily variation in carbohydrate intake which causes water retention. The authors further speculate that stress and more meals outside the home, i.e., meals not prepared by study participants, may have also contributed to weight gain. Specifically, they suggest that being in a “food cue rich environment” most likely influenced weight gain and suggest intervention strategies to help mitigate the temptations of these environments.
Consider a VLCD to Help Patients Mitigate Holiday Weight Gain
As the holiday season approaches, clinicians should consider working with their patients to develop strategies — such as sticking to an eating schedule, daily weigh-ins and recording their weight, and limiting meals eaten outside their home — to help manage the temptations of social gatherings and resisting the intake of energy-dense foods. Clinicians should consider acknowledging temptation and stress of the holiday season and recommend not only a Very Low Calorie Diet or Low Calorie Diets (LCD), meal replacement options, and lifestyle changes, but also stress management tools.