The average person gains about one to two pounds a year.2 When distilled to its simplest form, weight gain occurs anytime calories in exceed calories out—that is, a positive energy balance or gap.
The six weeks from Thanksgiving to New Year’s is an especially vulnerable time for weight gain. In a 2000 study of 195 subjects, the average person gained about one pound during the holiday season. When these subjects were followed up with six months later, there was no statistically significant loss of peri-holiday weight gain. This holiday pound may seem trivial (and keep in mind these subjects gained weight despite being closely watched in a weight-gain study). But this weight appears hard to shed and results in much of the weight gained during adulthood.
However, unlike my Thanksgiving gorging, the hallmark of obesity is the small but frequent positive energy gaps, that is, days of 50 to 100 calories of intake greater than use. Over the course of the year, these small daily caloric gaps are anabolically transformed into pounds.
Resolve to Lose
By now, like me, many of you may have added a holiday pound or two. This may be in addition to a nefarious pound or two added throughout the rest of the year. As you ponder scribing your annual resolutions, consider making weight loss a top priority for your patients and yourself, if appropriate.
Unfortunately no magic bullet will turn your New Year’s resolution into reality, just hard work. The key is to tilt the energy balance toward weight loss by reducing caloric intake and increasing activity. Fortunately this can be done in non-Draconian ways. Just as weight gain can snowball from small daily caloric overdoses, it can be removed the same way. Instead of setting or recommending insurmountable goals to your patients—like reducing intake to 1,000 calories a day or adhering to a triathletic training regimen—the CDC suggests a simpler, more sustainable approach to shedding those pounds, namely tipping your energy balance to a negative 150 calories per day.
A net negative energy balance of 150 calories per day will at worst stabilize your weight (depending on your current energy balance) and at best net five to 10 pounds of weight loss per year. For most this can result from something as simple as switching your daily Coke to a Diet Coke. Even more ground can be gained by reducing portion size. The super-sizing of the American menu over the past 20 years is one of the prime drivers of the obesity epidemic (see Table 1, p. 64). Consider cutting back in small ways. For example, continue to enjoy that gourmet chocolate chip cookie but downsize it to a smaller version and reduce your intake by 150 to 200 calories.
As important as reducing caloric intake is the need for activity. Adding moderate amounts of exercise five days a week can burn an additional 150 calories per day, reducing overall weight by another five to 10 pounds in a year. This can include things like walking for 30 minutes, swimming for 20 minutes, or biking for 15 minutes. More adventurous (dancing for 30 minutes), parental (pushing a stroller for 30 minutes), agricultural (gardening for 30 minutes), or chore-oriented (shoveling 15 minutes) options also help.
Much to the dismay of my cousin Mike, who bet that I’d eat at least half the piece of Thanksgiving pie, I put down my fork. After packing away a winter’s worth of calories I was feeling diaphoretic and pathetic. I wobbled away from the table and began charting my course to redemption. It would begin the next day with an apple instead of a bagel, an extra hour at the gym—and a trip to the cleaners to get those buttons replaced. TH