Sunday, 1 June 2014

Stop dieting now. PLEASE!!

STOP DIETING NOW. Please. With a significant and growing proportion of our population now overweight or obese, I’m urging you, please, don’t go on any more diets.
Now before you think I’ve lost my mind, let me explain why.

You may have read my previous post on why "one-size-doesn't-fit-all" when it comes to diets. One of the points I make in that post is that the word "diet" traditionally just meant the food we eat every day, our daily menu so to speak. But in modern times this word has been charged with so much more meaning (and judgement). We now refer to a "diet" as a restriction of our food, as a set of rules or choices, as a formula or requirement to eat a certain way, and the implication that by "dieting" we are somehow restricting or depriving ourselves. And finally there is the Diet with a capital D - the food plan that comes with a name, a trademark, a book, a TV show, a range of supplements and a one true faith to believe in, often with a cult like fervour and a celebrity to endorse it. And in many cases it is sold as the one, the only, way to eat. Diet has become a dirty four letter word and can fill people with fear and dread.

So if we agree on that definition, and knowing that I'm a doctor and I want you to be as healthy as possible, then why don't I want you to go on a diet?

Firstly, "diets" make you gain weight. Yes, you heard right. I'm not talking about gaining weight during the 12 weeks you are doing the particular plan on the internet or the 60 days you follow the book or the three months you attend the meetings. Most diets, no matter how intense or how crazy, will help you lose weight during that time. I'm talking about afterwards. People who follow a restrictive "diet" generally end up fatter than people who don't in the long run.

The weight-amplifying effect of dieting was evaluated in a study in 2011 based  on over
2,000 sets of twins from Finland. The results indicate that dieting itself, independent of genetics, is significantly associated with accelerated weight gain and increased the risk of becoming overweight.  The researchers concluded, “It is now well established that the more people engage in dieting, the more they gain weight in the long-term.” This study adds to a body of research which shows that dieting and the ensuing cycling of losing weight, re-gaining weight, and gaining more weight with each subsequent diet, ratchets the baseline weight up even higher, beyond the original weight.

How does this work? The first issue is that very low calorie diets can cause the body to lose a disproportionate amount of muscle mass (which is not the type of weight that any one wants to lose).  People are happy because they lose weight fast (on the scales) and look smaller but it is our muscle mass that actually burns the most calories for us in the background. Lose fat AND muscle and you end up thinner, but utilising less and less energy on a daily basis and therefore require less and less calories just to stay the same. After a while the weight loss slows, then stops then people start to re-gain weight even if they are eating the same amount. Do this cycle enough times and you end up with someone who is strictly dieting AND overweight at the same time.

Secondly, extreme caloric restrictions are a physical stress on your body.  In patients on  low calorie diets (and interestingly also in patients on a ketogenic low carbohydrate diets) some studies have shown markedly increased levels of cortisol, a stress hormone. Cortisol raises blood sugar, and stimulates laying down of fat, especially around your abdomen where  it is most dangerous. The other metabolic effects of "dieting" can also cause a change in the hormones that control satiety and hunger - patients are more preoccupied with food, feel more hungry and are less likely to feel full, and this can continue for some time after their "diet" is over. 

The statistical bottom line is that the vast majority of short term diets don't work. Sure you will lose weight short term (probably water, fat and muscle), but within 2 years the vast majority of people are the same weight if not heavier than they were before. Funny enough, we seem to know this intuitively, yet we still try keep getting back on the diet cycle. A current Australian weight loss company are using a celebrity in their advertisements who previously and publicly lost a significant amount of weight on their program, has regained it, and is now on their new TV campaign starting again, because she "knows it works". Really? Depends on your definition of "works" I guess.  Her weight gain is nothing to be ashamed of and is not her fault, in fact its almost standard for any short term extreme diet, but I find it interesting that it is part of the TV commercial to sell the program. How many people do you know that have weight problems that say they are going to weight watchers again or signing up for another 12 week body transformation program again "because it worked last time". Did it really? If it worked, why do you need to sign up again?

Blogger Ragen Chastain actually describes this really well. She says "I think the diet industry continues to be so successful is that they have found a way to take credit for the (typically successful) short term results of dieting, but blame the client for the  (typically unsuccessful) long term results. They know that almost everyone can lose some weight in the short term on almost any diet.  They also know that their 5 year success rate is less than 5% but somehow they managed to convince people that the other 95% just didn’t doing it right, and should buy their product again.  And we do!"

So if I don't want you to diet, what do I want you to do?

1. Firstly I want you to avoid a fad diet. According to the Better Health Channel Victoria, A fad diet generally has some or all of the following features: 

  • Promises a quick fix
  • Promotes 'magic' foods or combinations of foods
  • Implies that food can change body chemistry
  • Excludes or severely restricts food groups or nutrients, such as carbohydrates
  • Has rigid rules that focus on weight loss
  • Makes claims based on a single study or testimonials only.
  • Is anything that you cannot maintain for the rest of your life without restriction, unhappiness or difficulty
2.  I would encourage you not to focus on a diet but instead on a healthy eating plan. My eating prinicples are listed on my blog here, but the general principles for any health eating plan include:
  • Plenty of vegetables, legumes and fruits.
  • A variety of grains preferably wholegrain, low glycaemc index and minimally processed
  • Lean meat, fish, poultry or alternative sources of lean protein.
  • Milk, yoghurts, cheeses or alternatives sources of calcium.
  • Plenty of water.
  • A moderate amount of total fat and limited saturated fat.
  • A limited amount of salt.
  • A limited amount of processed and refined sugars, and food and drinks containing added sugars. In particular, limit sugar-sweetened beverages.
  • Limited alcohol intake, if you choose to drink.
  • Portion sizes appropriate to your size, age and exercise level.
  • Flexibility to enjoy treats in moderation.
3.  I would like you to try and be mindful of your eating, responsive to your body and don't follow strict eating plans that are not tailored for you. No diet or meal plan from a book or off the internet could possibly “know” your hunger and fullness levels, or what satisfies you.   Only you know your eating triggers, your personal likes and dislikes of food, and how foods impact on you physically and emotionally. If you need more structure and support than general principles, then I would encourage you to see a qualified dietitian to have an individual plan tailored for you.

4. Whatever changes you make, make them for life. Don't start doing something you can't continue. Don't get suckered into short term fixes, supplements or snake oil unless you plan to do it forever. Because when you stop these extreme measures, you may be worse off than if you never started. Small, sustainable changes are the key to long term success.

5.  Be realistic and focus on the process. Patients who eat a balanced diet and exercise regularly are healthier than those who don't, no matter what their weight is. Obesity is much more complex than just calories in versus calories out - environmental, cultural, genetic and epigenetic, health, socio-economic and lifestyle factors all contribute. So don't focus on the numbers too much. Concentrate on making healthy choices every day. Chances are you will lose weight in a slow and sustainable way and keep it off and get closer to a healthy weight for you. But no matter how much weight you ultimately  lose, you will definitely be healthier, and isn't that the ultimate goal?

Lyndal @ Lean Green and Healthy

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