Eat MORE to lose weight, with Dr Jessica Turton

Here's how you really lose weight for the long term, by Dr Jessica Turton speaking at Low Carb Down Under. We've included the transcription below the video.

My name is Jessica Turton. I am a dietitian and nutritionist, and I was awarded a PhD by the Faculty of Medicine and Health at the University of Sydney.

I am the director of Ellipse Health, which is home to a team of nutritionists and dietitians who provide individual consulting services to individuals across Australia.

As a dietitian, I am proud to say that I have never once recommended someone "eat less and move more to lose weight".

The way that myself and my team work is to educate our patients on why and how they should eat more of the right types of foods.

Low-calorie diets for weight loss ignore the fundamental reason that we as humans eat food. We eat food to obtain energy and nutrients. We eat food to survive, and we eat food to thrive.

So in this presentation, I'm going to discuss the concept of eating more for weight loss and how doing so may help you improve your relationship with food, boost your metabolism, and support your physical and mental health for good.

If you eat less calories, will you lose weight?

I'm sure most of us in this room have been told by someone before, perhaps a dietitian, a GP, a personal trainer, or a well-intended loved one, to just eat less and move more. The idea is that if we eat fewer calories than we expend each day, we will lose weight. It sounds simple and logical. How could it not work?

And I'll admit, I got sucked into this approach myself back in high school. I was an extremely diligent calorie counter. I used to count the calories in every bite of food that I ate, and it worked. I lost weight. But the more the scales came down, the more I had to restrict my calories to continue seeing progress.

And what I didn't know at the time is that you can't just continue to eat less and move more because calories are not optional. A calorie is a unit of energy in food, and the main sources of energy from our diets are carbohydrates and fats, and to a lesser degree, proteins and alcohol.

We use energy for lots of different things. We need energy for non-exercise activity, like standing, talking, fidgeting, working, socializing, grocery shopping, and so on. We need energy for exercise activity, like yoga, Pilates, walking, resistance training, etc. And we use energy for the digestion and breakdown of food.

The Basal Metabolic Rate

The majority of our energy expenditure is actually attributed to our basal metabolic rate. Our basal or resting metabolic rate is the amount of energy that we burn at rest in a neutral environment.

In other words, this is the amount of energy we require to support our vital functions – our brain, our heart, our liver, our lungs, our sex organs, muscles, skin, and more. Calories are not optional.

When we excessively restrict our intake of calories, there are multiple homeostatic adaptations that occur in our bodies to conserve this precious energy. So it really should come as no surprise that low-calorie dieting can be harmful to our health, and excessive calorie restriction can lead to long-term consequences.

Sure, if we continue to eat less and move more, we probably will lose weight. But will the weight loss be worth it? In most cases, it isn't.

The consequences of dieting

The consequences of low calorie dieting have been well documented since at least 1944.

In this study, Ancel Keys recruited 36 healthy-weight, healthy-minded university students to undergo six months of semi-starvation. The goal of the study was to provide insight into the best refeeding program for starved troops after the war.

The semi-starvation diet consisted of 1,570 calories per day and included foods like potatoes, vegetables, bread, and pasta. Does this sound like semi-starvation to you, or does it sound like Light and Easy?

So, what happened to these men? Well, they lost weight. That was the goal of the study.

But what else happened that researchers weren't necessarily expecting? Aside from decreases in strength, stamina, libido, and concentration, the men developed depression, anxiety, and disordered eating behaviors.

Before the six-month diet, these were healthy-minded men undertaking courses at the university that had nothing to do with food or nutrition. But by the end of the diet, the university programs collapsed because the men couldn't focus on anything other than food, diet, and weight loss.

The next phase of the study was a 3-month rehabilitation phase where there was a gradual increase in calories and a return to baseline body weight. This was then followed by 2 months of unrestricted eating, but in this phase, the men did not just return to normal eating. Many of the men appeared to lose control around food, engaging in extreme overeating, up to 10,000 calories per day.

But these men were not enjoying themselves. They were suffering from headaches, gut distress, fatigue, nausea, and vomiting. These men were binge-eating.

So we must ask ourselves again, is the weight loss worth it? Is it worth the low energy, the anxiety, the depression, the obsession around food and dieting, or a binge-eating disorder?

The effect of low calorie dieting on your resting metabolic rate

And if you're not already convinced, the 1944 study also measured the effects of low-calorie dieting on metabolism. In the initial starvation phase, there was a reduction in resting metabolic rate.

This was somewhat expected because the participants did lose 25% of their body weight. But despite a gradual increase in calories and a return to normal baseline weight, the men experienced a sustained suppression in resting metabolic rate.

Can you reflect on weight loss diets you've done in the past? Did you find it even more difficult to manage your weight after the diet was over? Perhaps you regained the weight plus more despite your best intentions. Maybe your metabolic rate was suppressed.

But some will argue that we are not like the men from the 1940s, and this data can't be applied to today's overweight and obese population. So let's look at a modern example of semi-starvation in participants who are overweight and obese – the ultimate experiment of calorie restriction and weight loss, The Biggest Loser competition.

The Biggest Loser Competition

In this study, researchers examined a sample of Biggest Loser contestants to look at changes in resting metabolic rate. They measured resting metabolic rate at the start of the competition, at the end of the competition, and then six years later.

So let's just focus on changes in body weight and the changes in resting metabolic rate that were measured by the researchers. Okay, so you can see their weight at baseline before commencing the Biggest Loser competition was 148.9 kg. By the end of the competition, they lost almost 60 kg, with the average weight being 90.6 kg.

However, 6 years later, their weight was 131.5 kg, so they had regained almost all of it back.

Chief Note: Fun fact, in 2017 our co-founder Libby Babet was a trainer on the re-launch of The Biggest Loser (called The Biggest Loser: Transformed which took a more holistic approach) for a season before having kids and she took the approach Jessica is recommending (focusing on protein, good fats and nutrient density). All of her contestants have kept off the weight years later.

Now, most people would assume that they got lazy, they lost motivation, they couldn't sustain the diet or exercise programs anymore, and perhaps this is partly true because the competition, at least in my opinion, certainly doesn't encourage sustainable diet or lifestyle habits.

But, I would argue that the main reason these participants regained the weight is because the competition led to a seemingly permanent suppression of their resting metabolic rate.

You can see that RMR at the beginning, before they commenced the competition, was 2,600 calories per day. At the end of The Biggest Loser competition, it had reduced to 1,996 calories per day. 6 years later, despite substantial weight regain, their metabolic rate remained suppressed at 1,936 calories per day.

The researchers concluded that long-term weight loss requires vigilant combat against persistent metabolic adaptation that acts to proportionally counter ongoing efforts to reduce body weight. No wonder weight loss is so hard.

How to lose weight and keep it off

But thankfully, there is a solution. Low-calorie dieting is not the only way to lose weight, and this is where eating more for weight loss comes in. But we're not just talking about eating more of anything. These are the three foundational pillars for a successful "eat more to lose weight" approach.

By eating more protein, you can experience an increase in your resting metabolic rate. Multiple studies have shown that you can burn an additional 200 calories every single day just by eating more protein.

You will also experience an increase in total energy expenditure due to a two-to-threefold greater diet-induced thermogenesis. This is the amount of energy that you burn digesting and metabolizing nutrients.

And by eating more protein, you can experience an increase in your muscle mass. We know that muscle is a major determinant of metabolic health. Generally speaking, the more muscle you have, the more insulin-sensitive you are, the less insulin you have floating around, and the better you are at oxidizing fats for energy.

The next pillar for eating more to lose weight is to replace energy from carbohydrates with energy from fats. This study used a randomised control trial design to compare diets varying in carbohydrates and fats on total energy expenditure. This was done in 162 overweight or obese adults.

This is the composition of the three test diets.

So the high-carb diet had 60% energy coming from carbs and 20% energy coming from fats. The moderate-carb diet had 40% energy coming from carbs and 40% energy coming from fats, and the low-carb diet had 20% energy coming from carbs and 60% energy coming from fats. All three diets were controlled for protein, and they were all isocaloric, so there was no calorie restriction applied.

Compared to the high-carb diet, participants in the low-carb diet expended an extra 209 calories every single day. So you can burn another 200 calories just by replacing energy from carbohydrates with energy from fats.

And the third pillar for eating more to lose weight is to prioritise real food. There are countless reasons why this supports weight management. In terms of nutrient intake, there are certain micronutrients that help your body liberate energy, and these include B vitamins, iron, and magnesium.

So it's not just about calories, carbs, proteins, and fats. The nutrient density of your diet matters for liberating energy and successful weight management.

If you aren't sure what eating more nutrient-dense real foods looks like, then you can download this paper. Dr. Rowena Field and I performed a systematic search of the Australian food composition database to identify the top 10 low-carb sources for each essential micronutrient. So, we provide food lists and a sample meal plan, and it's open access for anyone who wants to check it out.

Eating more to lose weight in practice

So, what does eating more to lose weight look like in practice? At Ellipse Health, we offer a dietitian-delivered weight loss program for individuals who are unable to successfully manage their weight despite low-calorie dieting.

We provide patients with a food list with instructions to eat these foods to satiety. We give them minimum recommendations for proteins and fats to ensure that they are, in fact, eating more.

We provide individualised recommendations to help participants meet energy and micronutrient requirements. Real foods are prioritized, and a personalized supplement plan is developed if it's needed. Education and support are provided.

Here are some of the results from 10 participants who have completed the program. So you can see that 70% of participants are female. The average age at baseline was 62 years. The average follow-up was 61 weeks, so this is by no means a quick fix. You can see calorie intake at baseline was 1,411 calories per day, so this is even less than the 1940s starvation experiment.

Well, it was evident that participants had adapted to these calorie intakes because at baseline, they were not losing any weight. Some of them were even gaining weight on these diets, and most of them had low energy levels. You can see after the diet or at the end of the follow-up period, I should say, the mean intake of calories was 2,190 calories per day.

So this was a clinically meaningful increase. All participants were now consuming over 1,500 calories a day, with some participants having up to or in excess of 3,000 calories per day. This increase in calories was associated with an average weight loss of 10 kg.

Body weight at baseline was 108 kg, and it dropped to 98 kg at follow-up. You can also see that energy levels improved substantially. So at baseline, 0% of participants reported high energy levels. Most of them reported low. But at follow-up, no participant reported low, and 50% reported high energy levels.

Now, you may have noticed that participants 9 and 10 have not yet lost any weight. Participant 9 admitted to following a calorie-restricted diet of 800 calories per day for over 50 years. So as you can imagine, it's going to take a little bit of time for this person to successfully lose weight. The first step is to undo the damage that is done by decades of excessive calorie restriction.

Most people come into this program with their one and only goal to lose weight. But by the end of the program, they realize that the weight loss is simply a side effect of nourishing their bodies.

The improvement in energy, physiological function, cognitive health, and mental health are by far the greatest benefits of this approach.

In conclusion

So to finish, the top candidates for an "eat more to lose weight" approach are people with a history of low-calorie dieting, which we now know is semi-starvation; people who are experiencing low energy levels, disordered eating behaviours, or mental health concerns – these could be signs that your metabolic rate is suppressed; and people who, despite their best dieting efforts, are experiencing a deterioration in their health outcomes.

Maybe you're on a low-carb diet. Maybe you're eating real food. But perhaps you're not eating enough. Thank you.

Chief Summary

1. Eat more protein

All our snacks are high protein, low carb. Fun fact, Jessica is a huge fan of our beef bars.

2. Replace carbohydrates with fats

This does NOT mean getting rid of all carbs, it means getting high quality carbs from vegetables and fruits, and replacing your simple carbs (e.g. white bread, muffins, pastries) with good fats like avocado, nuts, seeds, olive oil, etc. 

3. Focus on nutrient density

This is the key to everything. If you eat nutrient dense foods first, you often won't feel like the junk because you'll be full. Our entire range is incredibly nutrient dense.

To learn more about all of this, please try our Chief Life Challenge.

Or read what Jessica thinks about Red Meat and Eggs