Do diets work?

Nearly two-thirds of Americans are overweight or obese. Millions of people at risk for heart disease, high blood pressure, cancer, diabetes, joint problems and more. For those who are trying to lose weight and improve their health, there's certainly no shortage of options, from the new Alli pill which -- as we’ve discussed here -- may make you poop pizza oil -- to the more extreme gastric bypass to good old pounding the pavement (exercising combined with healthy eating.)

By now, I’m sure many of you have heard the recent news that diets, according to the research, at least, don’t work. I was recently asked to write about this topic on the Huffington Post and want to share with you my thoughts. A study just published in the Annals of Internal Medicine reveals that a typical diet helps people peel off an average of six percent of their weight -- usually equivalent to about 10 to 15 pounds. However, most people will regain that weight after five years. Which isn't to say there's no benefit in having lost the weight in the first place -- such a feat may, for instance, help in delaying the onset of diabetes -- but when it comes back, so do the risks associated with it.

Another study, this one in the March 7 issue of the Journal of the American Medical Association, compared four weight-loss diets -- Atkins (very low carbohydrate); Zone (low carbohydrate); Ornish (very high carbohydrate); and a diet called LEARN (low fat, high carbohydrate) -- in 311 premenopausal overweight and obese women. After a year, those following the Atkins diet lost more weight than those following any of the others. For them, their diet worked.

At least it seemed to work. First of all, the Atkins dieters lost an average of 4.7 kg for the year -- not a huge amount of weight (Ornish followers lost 2.6 kg; LEARN, 2.2 kg; Zone, 1.6 kg.) And in a recent Letter to the Editor, George L. Blackburn, MD, PhD, of Harvard Medical School and Steven B. Heymsfield, MD, Global Director for Scientific Affairs for Obesity at Merck & Co, pointed out that weight was either stable or slowly increasing at 12 months in all groups, and that the relatively low overall weight losses were suggestive of patients perhaps misreporting their calorie intake. And really (this is me talking) -- how feasible is it to adhere to a low-carb, high-protein, high-fat diet for life? Sure, if you're in a study under medical supervision, it could work...or if you're a celebrity and have meals delivered to your manse daily, it's a downright snap. But in the real world? No bowls of cereal? Hardly any fruit? Butter and full-fat cheese on hot summer days? Maybe it's just me but I feel like the appeal would quickly diminish, the luxury of eating sausage and eggs day in and day out replaced by a hankering for a frigging banana.

In their letter, Drs. Blackburn and Heymsfield went on to pose this very pertinent question: "Which diet is 'best' remains a far less important question than why diet adherence is so poor..." In other words, maybe we should stop focusing on whether to follow the Friday Fat Flush or Lose 30 Pounds in 30 Days and instead take a look at WHY it's so difficult to stick to any kind of weight loss plan.

Which brings us to the topic of willpower, a concept which comes up over and over when discussing weight loss. The unfortunately pervasive viewpoint among many citizens is that people who are overweight simply lack willpower, that if they could just buck up and control their eating, the pounds would fall off. But in a society where sedentary lifestyles are catered to, high-calorie snack foods are easily available (you can get a Big Mac much faster and for far less money than a cup of strawberries) and restaurant portion sizes are ballooning, personal resolution stands far less of a chance. As well, Binge Eating Disorder was recognized this year as the nation's most common eating disorder, more pervasive than anorexia and bulimia combined. It's a psychiatric problem, not an issue of laziness or gluttony, and more than five million Americans live with the shame of the disease.

For those looking for a quick weight loss fix, more and more options exist -- some medical, others surgical, some downright unheard of. In May, researchers at California's Salk Institute created a so-called "exercise pill," a drug that purportedly tricks the body into thinking it's working out. Kind of like hallucinogens, but instead of pretty colors, your body sees treadmills. The pill works (in mice, a least) by activating a gene that instructs cells to start burning fat. It jumpstarts the metabolism, just like exercise. Mice put on a high-fat diet who received the formula did not gain weight. Scientists involved with the calorie-burning capsule have been quoted as saying they hoped the "metabolic trickery" would pave the way for fresh treatments for obesity, high blood pressure, even heart disease and diabetes.

But such a creation -- even if it were to work in humans, not just mice -- doesn't quench the thirst our bodies have for real, physical movement...does it? Would swallowing a pill be anywhere near as satisfying as going for a run along the lakefront, for breathing deeply through a yoga class, for playing a game of one-on-one with our son or daughter out back? And yes, there are people who, for physical reasons, are unable to exercise vigorously -- for them, it's crucial to try and get any help possible in the fight against obesity and its related diseases. But for the most part, when you ask people who have lost weight and kept it off, regular physical activity is a must. It's as much a part of their day as going to work or brushing their teeth. I interviewed hundreds of women for my book on body image and hear from more on a daily basis and this is one thing that remains consistent: calories in needs to be less than calories burned, and that can often be more easily accomplished by incorporating physical activity -- whether it's choosing the stairs over the elevator at work or riding the stationary bike while watching the evening news.

Which leads me to one last interesting finding: Drs. Caroline R. Richardson and Thomas L. Schwenk of the University of Michigan Medical School have come to the realization that one inventive way to give people a proverbial kick in the pants is to physically write them a prescription for exercise. In a new report, the doctors explain how writing down very specific exercise goals on a prescription pad, such as telling the patient to start with 3,500 steps on Monday, Wednesday and Friday (counting on a pedometer), gradually increasing to, say, 5,000 steps most days. The physician signs his or her name on the work-out Rx with a request for a follow-up in a few months. So basically, "Walk two miles and call me in the morning." I think the idea is fantastic. We can all start filling our "prescriptions" at the local gym, high school track or Mother Nature. Maybe this, combined with new public health measures to tackle obesity and lousy eating habits, will mean less visits to the pharmacy for diabetes and high blood pressure medication.

Do you think such a "prescription for exercise" would help you stay on task or even start up an exercise program? Do you agree with the science showing diets don't work - or have you had great success with, say, Weight Watchers or the Zone (and if so, do you consider them more 'lifestyle changes' that diets'?)

Take care and hope you all enjoyed your weekends!
Leslie

Comments

Bravo and well said! A prescription for exercise is a brilliant idea.
Regarding willpower.
IMHO, the answer to permanent and successful weight loss is unrelated to willpower. Hearing that I don't have willpower makes me feel somehow lacking and flawed.
What I've found is that many many people become and stay successful when they learn how to 1. Eliminate the emotional connection to food and 2. Learn how to eat less and move more.
We've focused so much on eating less (and of course, eating healthier) and exercising. It's time to focus on teaching others and learning how to eliminate emotional eating. Only when we do this will we be able to maintain healthy eating habits with NO STRUGGLING.
By eliminating the struggle to weight loss and by learning how to find other ways to handle our emotions, we'll not only improve our health, we'll improve our entire life...

Wendy, while not discounting your points, for many, the emotional connection to food has been formed by years of dieting. The rush of calories from a binge after weeks of eating less than you wanted to is built into our evolutionary past. Many of the people I've heard finally beating their emotional connection to food have had to un-learn what years of dieting has taught them.

Atkins works great for my husband but I gain weight on it. I read a book about 4 blood types and 4 diets. It makes more sense to me as we are all different. I find that if I stick to my YOGA practice every day it helps, as I tend to stay in the present moment, which helps me be very conscious of what I put in my mouth.
Thanks for your great website
Gypsy Girl
Travelingshoesblog.blogspot.com