I'll drop a few sources at the end of this post for reference, but the following info comes from the listed sources and some personal research. Im an expert in population level health and wellness, but I am not a doctor, so please dont take my word as gospel.
TL:DR - rapid weight loss produces a greater improvement in lipid and blood sugar measures in the short term. Gradual weight loss produces better body composition results (more fat loss, less lean body mass loss). Both rapid and gradual weight loss are about the same for long term maintenance and weight regain.
Should you lose weight gradually (about a lb a week) or rapidly (+2 lbs a week)? Which is healthier? Which is sustainable? Which has the best long term outcomes? Conventional wisfom, and what gets shared on this sub more often than not, is that slow and steady wins the race. If you pick a modest weight loss target, or calorie deficit of say 500 cals a week, youll be more likely to stick with it, see better results overall, and be more likely to retain your weight loss. Our current understanding is more nuanced, and like most things in life, the "correct" answer is highly individualized.
In a study comparing 1-1.5lb (gradual) a week deficits vs 2-3 lbs (rapid) a week deficits, both groups lost roughly 5kgs of body weight during the study. However, the reduction in fat mass as a % of body weight was roughly double in the gradual camp. Conversely, total cholesterol declined by about 10% in the rapid camp vs a small increase in the gradual camp. The rapid weight loss camp also saw a better improvement in insulin sensitivity.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5702468/
In another study, comparing rapid weight loss (only consuming 450-800kcals a day) vs gradual weight loss (500kcal a day deficit) saw significantly more people in the rapid camp lose at least 12.5% of their body weight compared to gradual. Far more participants dropped out of the gradual group than the rapid. After a 2 year maintenance period, both groups regained about 70% of the lost weight, with no significant difference between the two groups. Essentially, you were more likely to lose weight with a huge deficit, more likely to stick with it, and no more likely to regain the weight that was lost. A big point of speculation here is that the rapid weight loss group had more motivation to stick with their diet during the cutting phase.
https://www.sciencedirect.com/science/article/abs/pii/S2213858714702001
Putting this together, when you decide on your goals, and when you work with your doctor, its important to know what you want to achieve. Its very important to get some baseline bloodwork. If you have hyperlipidemia, or are prediabetic, it might be better to push conventional wisdom and start with a larger initial calorie deficit. If youre trying to preserve muscle mass, or even add muscle as you diet, a gradual approach is probably better. The long term goal is usually to establish sustainable practices. You epuld naturally intuit that gradual weight loss makes more sense, but current literature suggests it doesn't really matter what approach you take when it comes to long term maintenance. Motivation is a huge factor and a lot of people are motivated by seeing the scale move every day/week.
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