The size of an adult woman’s palm is equal to somewhere between one-fourth and one-half cup depending on her basic frame size. 

Bariatric surgeon, Dr. Duc Vuong, says that his patients should always serve themselves only a very small portion of food, and that the entire amount of the food on their plate for their meal should be no larger than the palm of their hand. 

He makes an exception for salads consisting of ONLY green leafy vegetables, and says for a meal that consists of only raw leafy vegetables, the portion can be as large as the entire hand.  This recommendation is based on the fact that during the first 6 months or so after a person has Weight Loss Surgery, the stomach pouch will only stretch to about the size of the palm of the hand.

Dr. V talks about this in his Facebook videos.  He calls the rule, 2x2x1. The circumference of this food volume is the length of 4 fingers across the palm of the hand, and the height of the food volume is 1 finger. 


In his videos he demonstrates the concept of 2x2, by placing two fingers on one-half his palm, then two fingers on the other one-half of his palm.  Essentially, a “sleeve” gastric surgery results in a rectangular thin pouch (2x2), while a “RNY” gastric surgery results in about the same size square (2x2).

For a long time I’ve been working to eat very small food portions, and now I’m experimenting to see if I can tolerate eating meals that are only as large as the palm of my hand. 

This morning I found that two Splenda packages exactly fit the palm of my hand.  So I took some photos of the packages, my hand, my plate and my breakfast. 

Below is a photo of that process.

I learned that a portion of food the size of the palm of my hand
is even smaller than I previously believed.




Here's how a meal the size of my palm should look on my different size plates.

I've posted a great many of my actual meals here at DietHobby under the Heading at the top of the page, RESOURCES, Photo Gallery.  Those of you who are interested in Portion Control might want to take a look at the photos posted under various meal categories there.

Dr. Duc Vuong, the Support Surgeon

Five points made by Dr. V, a bariatric surgeon,
in his recent Facebook video: "How Much to Eat?"
(Recommending the amount of food-intake after gastric bypass surgery)

1. Palm of Your Hand - a complete meal should be about the size of the palm of your hand.
   
   
2. You Plate Your Own Food - Use a Very Small Plate - a small Teacup saucer size Plate
   
   
3. 2x2x1 - The circumference of this food volume is the length of 4 fingers across the palm of your hand, and the height of the food volume is 1 finger. 
   
   
4. Salad = the size of your whole hand. A leafy green salad is an exception to the 2x2x1 rule because it is a raw vegetable with very little density.
   
   
5. Don’t Trust Your Brain!   Your brain wants you to eat more. Before eating, portion out an amount of food that is ONLY the size of the palm of your hand. Unless you do this, despite what your brain tells you, the amount of food that you will wind up eating will be more than the size of the palm of your hand. 
   

Note: Originally posted in May 2017 - Bumped up for new viewers.

Whatever method one chooses
as a “Diet”…

including Diets that are called:

• “Way-of-Eating”,
  
• “Lifestyle-change”, or 
  
• “Non-Diet”

… this Truth always remains.



 When a body with excess fat consistently takes in LESS food
(meaning: calories within one or more of the three macronutrients)
THAN IT USES as energy, that body will access stored fat for energy.

The process of losing excess fat takes a long time.

Weight-loss diets ultimately fail approximately 95% of the time.  This means that most people fail to lose very much weight on any type of diet, and very few manage to maintain any long-term weight loss.

Losing weight and losing fat isn’t exactly the same thing. However most doctors, nutritionists, dietitians ... and the people who follow their advice ... don’t clearly distinguish the process of reducing body fat from the process of reducing body weight.

Most people sort of KNOW that body weight and body fat are different, and vaguely understand that the scale can register body weight higher due to “water gain”.

 To understand the difference between these two things, it is important to understand that there are two principal components of body weight. We can label these two: constant weight and variable weight.

• The variable weight is a sum of all the digestive fluids inside the GI tract, the undigested foods already in the stomach and the small intestine, the stools inside the large intestine, and water, which can be safely lost with sweat, urine, and perspiration. These variable components of body weight normally represent between 7 and 30 pounds, depending on one’s original diet, one’s current weight, and one’s digestive health.
  
  
• The constant weight is everything else — the remaining fluids, such as the blood plasma and lymph, the weight of one’s skin, bones, internal organs, muscles, and adipose tissue, or body fat. Of course, body fat is actually the only substance in the body one actually wants to get rid of.
  
  
• Variable weight swings from day to day depending on the amount of foods and fluids one consumes and expels, workload, and environment. A day on the beach, an hour in the hot tub, or an intense workout in a sweat suit, for example, can reduce one’s body weight by several pounds simply from sweating.
  
  
• Constant weight remains stable for longer stretches of time because loss of body fat is quite slow on any diet, and requires a considerable time to produce measurable and permanent results.
  
  
• In practical terms, when anyone starts a weight loss program, the first 7 to 20 pounds of weight reduction are almost exclusively made up from the following components:
  
  (a) A reduction in the total weight of foods that have been consumed over the past few days.
  
  (b) A reduction in digestive fluids. As soon as one starts eating less, the body reduces the amount of saliva, gastric, and pancreatic juices involved in digestion. This amount can range from 5 to 7 quarts per day, and may be halved by the reduced calorie diet.
  
  (c) A loss of water throughout the body, particularly with urine. This happens because reduced calorie diets have a pronounced diuretic and dehydration effect.
  
  (d) Loss of stools from the bowels. As one reduces food intake, particularly fiber, the total volume of stools inside the large intestine may drop three to five times.

  The total of all of the above can be termed a phantom weight loss.

While the covers of diet books, magazines, and diet plans tend to ignore this fact of human physiology, it is actually the BASIS of their promises of quick weight-loss from to seven to twenty pounds.

The loss of phantom weight during the first two weeks or so of any dietary change, also explains why so many people yo-yo back to their original weight as soon as they stop dieting … the cumulative weight of foods, digestive juices, water, and stools start coming back the moment one returns to one’s regular diet.

Even a quick reduction of the waistline is a popular diet hoax: because as one’s stomach, intestines, and bowels clear out their respective contents, the waistline around them can then shrink down a few sizes, even though practically all the body fat remains exactly where it was before commencing the diet.

That claim of a weight loss plateau is another gimmick intended to absolve weight loss counselors from any responsibility for their advice, and to blame us and our metabolisms for an inability to lose weight. The simple truth is … if or when … after months of dieting effort … a person simply cannot overcome a weight loss plateau that seems to have started after the first few weeks of losing weight, … it means that person has lost the initial phantom weight, but not body fat. This is happening because their food intake (whatever it may be) is providing them with the exact amount of energy that their body requires to be that body size.

 In Summary:

• Anyone commencing a reduced calorie diet will demonstrate an appreciable loss of weight, but this is not a loss of actual body fat, but a loss of phantom weight related to the much smaller intake of foods and fluids.
  
  
• Weight loss diets that have a pronounced diuretic and dehydrating effect may demonstrate an even larger phantom weight loss at the expense of body fluids. One can accomplish pretty much the exact same effect by restricting fluid intake or sweating out in a sauna.
  
  
• Reaching a weight loss plateau normally means simply that one has lost only phantom weight, but has not lost and won’t lose any body fat…without additional restrictions on their food intake.
  
  
• A rapid weight rebound shortly after resuming a regular diet simply means that one has simply restored the weight of fluids, undigested foods, and stools in one’s body back to their original volume.

 So, why don’t all those diet books talk about this?

Probably two reasons. First, their authors simply may not know or may not want to know about this unwanted phenomenon. Second, telling readers the truth — that it actually takes a LOT of time and a LOT of effort to lose body fat — gets in the way of selling no-sacrifice diet books, cookbooks, classes, tests, diet-branded foods and snacks.

However, here’s the hard truth: If one is thinking of losing weight, the lost weight needs to be the fat under the skin, not undigested foods, fluids, and stools inside the gut. Losing actual body fat takes time, because even on a very low calorie diet the best almost anyone can count on is losing just a very few fat ounces (under 60 to 90 grams) daily.

 The next natural questions are:

1. How long does it take to lose real body fat?
2. How much Effort is required to do that?
   

 The Simple answers to these questions are:

1. A long time.
2. A whole lot.
   

 AND, In order to KEEP that fat from returning,
it will take a similar amount of Effort, … FOREVER.
 

Note: Originally posted on April 3, 2013.  Bumped up for new viewers.

At the end of the day:
Calorie Restriction
equals
Calorie Restriction.

See the article below from Dr. Arya Sharma, who is one of the world’s top medical obesity specialists.

Dr. Sharma is highly respected by obesity researchers, health professionals. His opinions are based on many years of extensive obesity research as well as many years of practical experience with obese patients. 

Alternate Day Fasting Is No Better Than Any Other Fad Diet
                   by Dr. Arya Sharma,  July 11, 2017

It seems that every year someone else comes up with a diet that can supposedly conquer obesity and all other health problems of civilization.

In almost every case, the diet is based on some “new” insight into how our bodies function, or how our ancestors (read – hunters gatherers (never mind that they only lived to be 35) ate, or how modern foods are killing us (never mind that the average person has never lived longer than ever before), or how (insert remote population here) lives today with no chronic disease.

Throw in some scientific terms like “ketogenic”, “guten”, “anti-oxidant”, “fructose”, or “insulin”, add some level of restriction and unusual foods, and (most importantly) get celebrity endorsement and “testimonials” and you have a best-seller (and a successful speaking career) ready to go.

The problem is that, no matter what the “scientific” (sounding) theories suggest, there is little evidence that the enthusiastic promises of any of these hold up under the cold light of scientific study.

Therefore, I am not the least surprised that the same holds true for the much hyped “alternative-day fasting diet”, which supposedly is best for us, because it mimics how our pre-historic ancestors apparently made it to the ripe age of 35 without obesity and heart attacks.

Thus, a year-long randomized controlled study by John Trepanowski and colleagues, published in JAMA Internal Medicine, shows that alternate day fasting is evidently no better in producing superior adherence, weight loss, weight maintenance, or cardioprotection compared to good old daily calorie restriction (which also produces modest long-term results at best).

In fact, the alternate day fasting group had significantly more dropouts than both the daily calorie restriction and control group (38% vs. 29% and 26% respectively). Mean weight loss was virtually identical between both intervention groups (~6 Kg).

Purists of course will instantly criticize that the study did not actually test alternative-day fasting, as more people dropped out and most of the participants who stayed in that group actually ate more than prescribed on fast days, and less than prescribed on feast days – but that is exactly the point of this kind of study – to test whether the proposed diet works in “real life”, because no one in “real life” can ever be expected to be perfectly compliant with any diet. In fact, again, as this study shows, the more “restrictive” the diet (and, yes, starving yourself every other day is “restrictive”), the greater the dropout rate.

Unfortunately, what counts in real life is not what people SHOULD be doing, but what people actually do.

The question really is not whether or not alternate-day fasting is better for someone trying to lose weight but rather, whether or not “recommending” someone follows an alternate-day fasting plan (and them trying to follow it the best they can) is better for them. The clear answer from this study is “no”.

So why are all diets the same (in that virtually all of them provide a rather modest degree of long-term weight loss)?

My guess is that no diet (or behavior for that matter) has the capability of fundamentally changing the body’s biology that acts to protect and restore body fat in the long-term. Irrespective of whether a diet leads to weight loss in the short term and irrespective of how it does so (or how slow or fast), ultimately no diet manages to “reset” the body-weight set point to a lower level, that would biologically “stabilize” weight loss in the long-term.

Thus, the amount of long-term weight loss that can be achieved by dieting is always in the same (rather modest) ballpark and it is often only a matter of time before the biology wins out and put all the weight back on.

Clearly, I am not holding my breath for the next diet that comes along that promises to be better than everything we’ve had before.

My advice to patients is, do what works for you, but do not expect miracles – just find the diet you can happily live on and stick to it.

Dr. Arya M. Sharma, MD, PhD, FRCPC is a medical doctor and university professor of medicine and obesity research.  His research focuses on the evidence-based prevention and management of obesity and its complications.

He has authored and co-authored more than 350 scientific articles and has lectured widely throughout the world on the etiology and management of obesity and related cardiovascular disorders. Dr. Sharma is regularly featured as a medical expert in national and international TV and print media and maintains a widely read obesity blog at www.drsharma.ca.

I have been observing and experimenting with various forms of Intermittent Fasting since early 2006, which was BEFORE the best-selling intermittent fasting books… including… JUDDD, ADF, EatStopEat, 5/2, and EOD ... were published.  And BEFORE the concept of Intermittent Fasting as a diet became famous on the internet.

This past 12 years, I’ve closely watched many diet “experts” talk about the latest fasting research, while providing their own anecdotal evidence.   I’ve seen both of these offered as evidence to prove the "expert's"  own opinions about the subject. 

As an attorney, I’ve been trained to notice when people improperly characterize evidence, especially when they misstate evidence or misquote a witness in order to prove a point they are trying to make.

This is something that is commonly done by diet “experts”.  Unfortunately even medical doctors whose overall medical expertise and opinions I tend to respect, sometimes engage in this type of Behavior, and apply valid scientific research incorrectly in order to support “a hypothesis with zero proof, which is really no more than that expert’s own wishful thinking.”

For example, even Dr. Jason Fung, who appears to be a very dedicated, well-educated, and experienced medical expert specializing in the area of Diabetes, …(and who is extensively quoted here in the Fasting Blog Category section of DietHobby as an intermittent fasting expert) … sometimes improperly characterizes research evidence in order to prove points which appear to be merely based on his “wishful thinking” due to the lack of valid supporting evidence.

One of Dr. Fung’s hypothesis is that people cannot lose weight by using “calorie restriction”, but that they can lose weight by using “Intermittent fasting”, and he claims that there is a very big difference between these two behaviors.  As evidence for this principle, he often compares scientific Research about Biggest Loser Contestants, who he labels as “Calorie Restricting”, versus scientific Research about Gastric Bypass Participants, who he labels as “Fasting”.

Of course, the main problem with the Comparison is that BOTH of these weight-loss methods are based on Calorie Restriction in that Post-gastric bypass, participants do not “Fast”.  They do not go without eating. After weight-loss surgery they eat small amounts of food daily.  First, they ingest liquid food, then soft food, and then go on to firm food. 

During the first year after my own open RNY gastric bypass, 25 years ago, my experience was similar to what everyone else commonly reports.  I ate between 300 and 600 calories per day … which was as much food as my body would tolerate at the time.  I did not fast.  I did not consciously “restrict calories”,  but instead focused on eating only the amounts and kinds of food that would prevent me from lying on my bed with dry heaves.  I did not fast. My surgery restricted calories for me.

Since both of these forms of eating behavior leading to weight-loss were based on Calorie Restriction, Dr. Fung misstated the evidence which he provided as proof for his hypothesis.  As a result, his hypothesis lacks proof.  This reduces it back to his own personal “wishful thinking”.   Over the past several years, Dr. Fung has failed to address or provide any explanation for this error, even though I have seen it pointed out to him on several different occasions.

I find it interesting that Dr. Fung also relies heavily on Dr Krista Varady’s past scientific research on Intermittent Fasting to prove that Intermittent Fasting is superior to Calorie Restriction… although in her own words .... Dr. Varady says that Intermittent Fasting is a form of "Calorie-Restriction".

 When Dr. Varady was interviewed about this recent research study which is the subject of Dr. Sharma’s article, she said:

“I really thought people would have an easier time and lose more weight on the [intermittent fasting diet] and I was shocked they lost the same amount,” says study author Dr. Krista Varady, an associate professor of nutrition the University of Illinois at Chicago and author of the book The Every-Other-Day Diet. “The take-home message for me is that this diet isn’t for everyone.”

"I don't think there's anything magical to the diet at all," she said of alternate-day fasting. "I think it's just another way of tricking people into eating less food or helping people to kind of monitor how much food intake there is or how much food they're taking in."

You can find the complete study in my previous article: “Fasting is No Better For You Than Regular Calorie Restriction - new Scientific Study”.

For obese or reduced-obese people, weight-loss or maintenance of weight-loss takes an ongoing Awareness of their eating Behaviors and the Results of those eating Behaviors.

It requires consistently following SOME METHOD of conscious eating Behavior that restricts calories to an amount which is the same-or-less as the amount used by that individual body....

....Together with a consistent and precise METHOD of measuring the ongoing weight Results of that eating Behavior. 

Here, the “rose” represents a thin or normal-sized body.

The “thorn” is restricted calorie eating (Behavior),
and a scale or other measuring tool (Result).

Obese or reduced-obese people who are not courageous enough to “grasp the thorn” need to abandon their desire for the “rose”, which is a thin or normal-sized body.

Reality, take it or leave it,

But I won’t be joining those who choose to spend their lives in the Forest waiting for the Unicorns to appear.

When we talk about plateaus we are talking about lack of WEIGHT loss, but the goal is really FAT loss.  Unfortunately, weight and fat loss don't coincide, especially at the beginning of a diet when the body’s water balance is altered by the smaller amounts of food or new foods that you are eating.

During the first few weeks of losing weight, a rapid drop is normal. In part, this is because when you cut calories, the body gets needed energy initially by releasing its stores of glycogen, a type of carbohydrate found in the muscles and liver. Glycogen is partly made of water, so when glycogen is burned for energy, it releases water, resulting in weight loss that's mostly water. This effect is only temporary.

Everyone wants, and hopes for, fast weight-loss. Unscrupulous “experts” … in books and advertising ... promise dieters more weight-loss than is possible.  It is only possible for the human body to lose a certain limited average amount of fat per week. 

Also the sharp decrease in weight that often happens during the first week or two of dieting raises false and unrealistic expectations that this fast initial weight-loss rate will continue throughout the following weeks.

It’s an unfortunate fact that the bodies of most women max out at an average of about 2 pounds of fat loss a week, and even this only happens with very active dieting. 

Below are calculator chart examples demonstrating this fact. So if you have 20 pounds of real fat to get rid of,  it will probably take at least 10 weeks, and it often takes 20 or 30 weeks for even a very successful dieter to lose 20 pounds of fat.

After dieting for a while, a woman’s weight can go up and down by 3 pounds between one day and the next ... because of changes in hydration and water balance, ... and for some women, menstrual cycle hormones make water change weight even more than this.

This daily change in water weight makes it genuinely hard to see the comparatively small loss of an ongoing one or two pounds of fat loss per week. 

There are many of methods of dieting … including low-calorie, low-fat, low-carb, high-fat, ketogenic, intermittent fasting (i.e. everything from fasting between meals to long-term fasting), whole foods, unprocessed foods, food exchanges, portion control etc. 

However, cutting calories is the basis for every effective weight-loss diet because the only way to lose actual fat is to consistently get one’s calorie intake lower than one’s calorie expenditure.

So for weight-loss the average daily calorie number is the bottom line.

After weight-loss stalls, in order to continue losing weight, one must create a consistent calorie deficit until reaching desired goal. This means one needs to start paying attention to how many calories are consumed and how many are burned.

The best way to begin figuring out how many calories your body is burning is to use an online calorie calculator that gives you the average calorie burn for someone your age and size.  

These calculators are based on mathematical formulas, and a mathematical formula will not necessarily provide an accurate calorie number result for an individual ..... because that number is always the result of AVERAGING. 

It is very common for people of the same size, age, and activity level to be up to 15% lower or higher than the stated averaged number, and some people will have even a larger percentage of deviation up or down.

Mifflin is currently considered to be the most accurate of these formulas, and that is the one I normally use to run calorie burn numbers.

Here’s a link to a Mifflin online calorie calculator. 

For more Accuracy,
 ....  when I use a calculator to run the Mifflin formula calorie numbers ...
I always enter a person’s activity level as “Sedentary” because using the inexact numbers provided as "Activity calories" greatly increases the chances of an incorrect result.

Exercise has many benefits, but recent research has proven that, despite the marketing claims by the fitness industry, weight-loss usually isn’t one of them.

It is an unfortunate mistake to over-estimate one’s activity level when calculating one’s calories, because while being guided by a calorie number that is too low could result in additional weight LOSS, ... being guided by a calorie number that is too high can result in actual weight GAIN.

Getting an individual calorie burn number from an online calculator is a good place to START, but it is always important to recognize and remember that YOUR own personal calorie burn could be a lot lower than the number given.

Earlier in this article, I stated that that the bodies of most woman max out at an average of about 2 pounds of fat loss per week, and even this only happens with very active dieting.  People who dispute this unpopular truth aren’t doing the math.



 

The pictured charts above show calorie calculations for a 50 year old female, 5’4” tall.  These calculations show her Maximum Average Weekly weight-loss potential:

At 170 pounds.......
..........eat only 651 calories daily to lose 2 lbs per week

At 150 pounds……
..........eat only 542 calories daily to lose 2 lbs per week

At 130 pounds….
.........eat only 434 calories daily to lose 2 lbs per week.

Remember, all of these calorie numbers are Averages, in that some women of that age and size will have numbers that are Lower or Higher.  Unfortunately, the burn rate numbers of most dieters tend to be either average or lower than average.   This is because most women with a higher burn rate have bodies that are better able to maintain a “normal” weight without dieting.

The term “plateau” is commonly used to describe the fact that weight loss has come to a halt before it was intended.

Sometimes this happens because people forget to adjust their caloric intake down as they lose weight, or they don’t adjust it down enough. People also generally get some muscle loss along with fat loss, which makes their metabolic rate a bit less than they expected it to be.

Sometimes after having some weight-loss success people get a bit more relaxed with the way they track their food intake. They don’t notice some of the things they eat; or they begin to guess at their portion sizes instead of measuring them ... which leads to additional food eaten and a higher calorie intake.

Also, illness, injury or medications can sometimes have an effect on the way someone does or doesn’t lose weight.

An ongoing calorie deficit will always cause fat loss in every human body… eventually. 

Obesity expert, Dr. Yoni Freedhoff, M.D. says that physiologically, “Plateaus” don’t actually exist.   He says that although it is common for people to experience several weeks, or even a month or more without seeing weight-loss, …. that “unless it is a temporary trick of the scale, …. if you’re not losing, either you’re burning fewer calories than you think; you’re eating more than you think; or some combination thereof”.

The way to track your calorie intake is to accurately count the calories in every bite of your food intake.

Until you get into the habit of doing this, it can seem time-consuming and tedious, but research studies have shown that the more regularly a dieter keeps a food log, the more weight they lose.