Why it pays to think small

A small-change weight-control philosophy requires just a tweak — is it effective?

Image by Michael Moriarty from Pixabay

Extra weight doesn’t add on as a tidal wave. Weight is usually gained slowly and steadily, over many years and bit by bit. If you gain just a pound a year, over the decades that adds up to the kind of extra weight that puts you at risk of type 2 diabetes, heart disease and cancer. With two thirds of the adult population overweight or obese, the weight of the nation is a public health urgency, and the US weight loss industry reached a record $78 billion in 2019.

Going on a diet usually starts with a lot of drama. People aim high, pledge to transform their caloric intake, and to exercise big time. And indeed, each year lots of pounds are lost: Many diet plans are successful in helping people shed extra weight. Alas, maintaining that weight loss is an uphill battle and only few avoid weight regain in the long term. Much has been written about why the lost weight seems to bounce back after a few years, despite the strongest of wills. The mechanisms of weight regain are probably many, but one of the thoughts is that it’s hard to stick to dramatic behavior changes. Another is that dramatic weight loss lowers our resting metabolic rate.

The small-change weight-control philosophy requires just a tweak, a caloric reduction of just 100-200 calories, which amounts to taking off just a snack, a little sandwich or a sweetened drink. Multiply this over extended periods and this could reduce obesity over time.

Does this approach work? A new meta-analysis of the literature, published in Obesity Reviews includes 17 studies. The review provides evidence that small changes prevent an average of 0.7-0.9 kg (1.5-2 pounds) of weight gain in the follow up period of 8-14 months. There weren’t trials from which one could draw conclusions about weight loss with the small change regimen.

The findings of this meta-analysis are consistent with another recent systematic review, in which 29 studies and 37,000 people were pooled, and in which small energy deficits resulted in the prevention of approximately 1kg of weight gain (2.2 pounds) over 15 months.

While preventing weight gain of a few pounds yearly seems like no big deal, consider that that’s just about what adults gain each year. The transformation you see in your high school or college reunion didn’t happen over a holiday break, but slowly and incrementally. Adults gain about 1-2 pounds yearly, which really isn’t that much, but this eventually adds up to significant overweight. By that model, if a small change is sustained we could avoid the development of overweight and obesity.

An ounce for prevention

Marathon runners get bragging rights and congrats that the moderate daily jogger does not. 

In much the same way, there isn’t much to talk about when all you took upon yourself is to replace a highly processed snack with fruit, or give up half a muffin, or a sugary drink from now on. This diet doesn’t have a fancy name, there are no books and no products to sell and there’s really not much to share socially – it’s just a tiny absence that carries a small dividend – but with time it can add up to quite a lot.

Considering how difficult and persistent weight loss and weight-loss maintenance can be, taking a conscious small step is an approach that can help all of us prevent further weight gain. 

These small changes won’t immediatly drive overall weight loss in a society already afflicted by widespread overweight, but by eliminating further weight gain, it could, over time, lead to reductions in obesity rates. When adopted early in life, by kids, it takes care of the most worrying sub-population in this epidemic, because the earlier on in life you become overweight the greater your risk of developing obesity and chronic illnesses. 

If you're still looking for a new year resolution, this is a good one to try.

Dr. Ayala