Putting Diets to the Test

As a new year begins, it will be hard to avoid diet propaganda. I call it propaganda because in my review of the weight loss literature, I find very little evidence that diets are effective for the majority of people who try them. [In contrast, adopting a certain diet pattern (e.g., Mediterranean or plant based) as a life style is health promoting.] 

In some ways, diets are like medication and this may explain why diets fail.  First, like hypertension medication, diets work as long as you ‘take’ them and few diets are palatable or tolerable enough to 'take' forever. Second, like medication for serious mental illnesses, the side effects may be so harsh that the people who need the medicine most cannot tolerate it; like a diet which causes an excess amount of flatulence.  Third, the medication regimen may feel more tedious than the immediate or future disease complications seems to warrant; like drinking vinegar after every meal. Lastly, like pain medications, diets may need tweaking in order to remain effective; once weight is lost, a person requires fewer calories to maintain the new weight.  

Diets are not medications however; they are behavioral modifications or interventions. Considering the above analogies, a successful behavioral intervention for weight loss is as much dependent on the person as it is the intervention. To be successful, the intervention/diet needs to be one that a person is able to follow (with occasional adjustment) without mental or physical anguish for their entire life.  A person could not return to unrestrained eating or reduce their level of physical activity and expect the benefit of said diet to continue.  

Another important factor regarding diets is the amount of weight loss necessary for an individual or sponsor (e.g., government, worksite, researcher) to consider the diet ‘successful.’ Scholars Tomiyama, Ahlstrom and Mann recently raised this issue in an article they wrote for the journal Frontiers in Psychology.  In their article, they suggest holding behavioral interventions, including diets, to the same standards of evidential effect as medications (i.e., FDA approval).  Recall that a drug company has to proceed through certain steps when requesting a new drug application.  It has to show a drug:

• is safe, usually done first in animal studies 
• has limited side effects (ones that are outweighed by the benefit of the medicine)
• addresses an issue or disease that significantly impairs health or quality of life
•  is better than an existing drug for this particular disease 

•  the new drug has to be more effective, have less severe side effects or both  
•  or the regimen for the new drug has to be easier to tolerate than the current treatment (e.g., a once a month injection for osteoporosis treatment vs a daily or weekly pill taken on an empty stomach) 

Drug companies usually start a drug application with the intention of treating only one disease, but they must identify the disease.  Testing goes from the lab, to small groups, to large clinical trials, and then to post market evaluation. 

Imagine the same process for a diet intervention and include efficacy and effectiveness markers, as Tomiyama and colleagues suggest.  A diet intervention (or drug) is efficacious when it works in a lab under controlled conditions and effective when it works in the real world under less than ideal situations –where people might not follow every instruction, every time.  This is where diets seem to fail the most.

Tomiyama and colleagues give a thorough commentary on using FDA standards to test behavioral interventions and they use obesity as their example.  I was able to access the full article after clicking this link and then the tab on the right that says ‘provisional pdf.’ If this idea (testing interventions with the same rigor as testing new medications) intrigues you, I strongly recommend you read the original article.  

My last thought regards something the authors did not mention in comparison to drug trials, but which I would add – marketing and labeling.  A drug company can only market a drug to treat the condition tested in clinical trials.  In addition, marketing material and product labels must include information on side effects; instruct people how to take the drug, and state that not everyone will have the same benefit or side effects when using it.  I would be happy to see this sort of disclosure with diet programs, and expect that if such a high standard were required, most diets would fail to reach ‘market.’

Instead of trying a diet program or worse, diet supplement you see advertised in the coming weeks, why not read more about a health promoting pattern of eating from Harvard’s Nutrition Source – here.

Tomiyama A, Ahlstrom B and Mann T (2013). Evaluating eating behavior treatments by FDA standards. Front. Psychol. 4:1009. doi: 10.3389/fpsyg.2013.01009

Misinformed or in Denial

I am not sure which it is (lack of info or aversion to restriction) but the products displayed in the pictures below are not the answer to anyone's weight problems.  Instead, the only scientifically proven safe and effective way to manage weight is through energy balance. If weight loss is necessary, and for most of us it is, then a negative balance must occur.  This means that the energy you take in is less than you need to maintain the current weight.  You can eat less (the strongest factor) or exercise more or both.  The only problem with this approach is that most people, without the help of experts (not those on TV or in fashion mags, but licensed nutritionists or health educators), do not know how many calories they are consuming now (energy in) or how many calories are burned in the exercise that they do. 
Also, the change in calories in or out has to be consistent every day.  If you are going to exercise more to lose weight, you must do the extra every day and you must not eat more because you have exercised!
Imagine that you know you are eating 2000 calories a day now - for the next year you might try eating 1800 calories a day (but you have to know the amount of calories in the food you eat) and/or, you are walking 20 minutes a day now, and to lose weight you double that to 40 minutes a day, you have to do that EVERY day. 
It is much easier to get 200 calories off your plate than to burn them so I suggest you learn about food. I also recently reviewed an article which discussed effective strategies and the ONLY commercial program on the list was Weight Watchers.
 However, for your health, mood, aging, fitness and such - I and other health promotion specialists, recommend daily exercise.
But the most important thing, for anyone is that they Do NOT get tricked into buying the scam products seen here !!

Whatever it takes??  Seriously??   It takes eating less that is what it takes!

Really Large/X Large?? Because a size small makes sense??

Magnets do NOT cause weight loss...

When in Scotland

When in Scotland, we might follow the advice we hear on their radio stations.  I have never been to Scotland.  My father's family tree does include Scotland,  and my favorite batch of books centers on a Scotsman named James Fraser.  Which may explain why I like to listen to their radio shows.

I enjoy shows from the BBC radio Scotland from time to time and did so as I was falling asleep last night.  The news program staff interviewed some persons on the streets about plans for dieting in the new year.  They also had  a nutrition professor from the University of Glasgow as their in studio guest. 

I stored (in my brain for safe keeping) two specific bits of information to share with you today.  They are truths we already know, but it doesn't hurt to repeat them and to show that they are universal concepts.

The professor noted that ALL diets work.  They work because they cut calories and they do so in any number of ways, some more bizarre than others.  The problem is what happens when the diet ends.  Losing weight is possible with a diet, maintaining a healthy weight takes more of a lifestyle approach.

A lady who spoke to the news team about her weight loss goals said that she thought it would be good to eat warm thick soups.  The professor concurred and suggested that people start the day with porridge which is filling but low in calories.  He noted how he recently had a bowl of porridge for breakfast and went skiing until the mid afternoon.

I don't have porridge, but I have oat bran and it IS filling. It has the lower of the calories of my four or five normal breakfasts but is the most satiating and takes the longest to eat.  Here is a You Tube video I made some time ago - for the oatbran breakfast.   Remember, oat bran and porridge would be foods that are whole grains which keep our blood sugar levels nice and even for many hours.   They are complex carbs.

Healthy Me V 2.0

Again blogging from the plane – spent a few days in Massachusetts and got my fill of cold and snow. This time I flew out of Tampa and Providence. I did not lose any of my food and even made it through security with a six ounce container of yogurt. I had a few light cheese wedges, a small snack container of hummus, grapes, a peeled orange, veggie lunch meat, a slice of pizza, crackers, a pita wrap, granola bars, etc. I am telling you this so you might take your lunch box the next time you travel. It saves calories and dollars.

Before boarding the plane this morning, I picked up a print copy of USA today as I have read all my research articles and needed a blog idea. So if you have not seen the paper today, let me tell you about their 2010 wellness challenge.

USA Today has contracted with a nutritionist to create a plan to help people lose ten pounds in ten weeks. That is a very realistic and safe goal of a pound a week. The program is supported through on line tools and recipes. Participants are of course directed to cut their calories and to begin a walking program. The challenge does appear to be geared towards persons who have been sedentary and overweight for some time. Today two people who had volunteered to test the proposed challenge, were highlighted. Each Monday the paper will run a story about people following their plan.

I do not like this as much as Weight Watchers, but it certainly looks sound and doable for “beginners”. I like that it suggests 1500 calories for women and 1800 for men as just a possible place to start. Most people can lose weight on this amount. I like that the program suggests no less than five meals a day and offers meal plans on the website.

Perhaps the most important statement in the article is that a person cannot moderate their calories without having a general idea of what they are consuming now. One of the persons in the story thought he was consuming thousands of calories a day, and he likely was as it is easy to do. If you are eating 3000 cals a day now, then it is going to make sense for you to go to 2500 or 2000 next, NOT to 1500.

There are so many resources and tools that aid in calorie evaluation. Of course, my favorites are also reputable and they are the USDA Nutrient Data Base which has no frills and no “diet” advice, etc… and the Stand Up and Eat site from the Cooper Institute which does also have tools for obtaining and maintaining the ideal “you” weight.

I did not get the sense that USA Today was calling their plan a diet, but it does sound like something temporary. Eating well and watching your weight cannot be a temporary endeavor. People are fond of saying, esp. when they want to treat themselves, “Everything in Moderation.” Okay, sure, everything in moderation, and some things require a little more moderation than others so be mindful.

For those who are active now, say getting 40-60 minutes of cardio most days of the week, and still find themselves with 10 -40 too many pounds, I encourage you to take a few days worth of a food diary and then decide where you can cut 200-500 calories from your day. If HOWEVER, you are already on a very low calorie 1300 or below regimen, something else is going on – see a nutritionist. Also, if you are doing the exact same physical activity/exercise at the exact same pace, duration and effort as you have done for more than six months – that too needs an adjustment.

Just so you know – this healthy lifestyle thing is dynamic. Meaning it should be evolving and ever changing. One does need to reevaluate every now and again – and maybe you need an upgrade to Healthy Me version 2.0!