Table of Contents

NUTRIDATE

Volume 31, Issue 4 2020

NUTRIDATE

Volume 31, Issue 4 2020

WHY IS THERE SO MUCH CONFLICTING INFORMATION ON HOW TO EAT AND WHY SO MANY DIFFERENT DIETS? AND, WHY DIETS FAIL

Zoe Nicholson, Accredited Practising Dietitian and Accredited Nutritionist

The terms diet and dieting have become somewhat uncool over the past few years. Instead, the term healthy lifestyle program has become popular, or people may just say they are working on their health. Typically, people diet to lose weight or reduce body fat. While it seems the focus has shifted from weight to health, most (if not all) health pursuits still promise weight loss, and most people partaking in these pursuits expect weight loss.

Figure 1: Although there is a shift from dieting to healthy lifestyle programs, the focus is still on weight loss.

So, what is the problem with this? Well, it’s a very layered and complicated topic and I will just touch on key points – if you’re curious to learn more, you can check out the resource list.

Diets don’t work

There are good reasons people have shied away from using the word diet, the key one being that people are catching on that they simply don’t work. While many people lose weight initially, nearly everyone regains the weight with anywhere from one to two thirds of people ending up heavier over time, which actually suggests dieting is a better predictor of weight gain than weight loss.

You don’t have to look far to find figures that suggest anywhere from 95-97% of dieters regain the weight, therefore, we could say diets fail at least 95% of the time. Think about your favourite electronic device. If a new model came out with a known 95% failure rate, would you want to buy it? No, of course you wouldn’t, but the diet industry is so powerful and persuasive that people keep buying into the next diet even when the last one and the one before that failed them. In fact, American dietitian Evelyn Tribole said, “diets are the only product we buy, that when the product fails, we all blame ourselves and then go buy another version”.

Figure 2: Dieting might be a better predictor of weight gain than weight loss.

In addition to their heroic failure rate, diets rarely deliver what they promise. Typically, people go on a diet to reduce weight or body fat with the aim to reach a BMI in the healthy range and feel better about themselves. Most people only lose 5-10% of their body weight and for the majority, this does not shift their BMI into the so-called healthy weight range.In addition, most people are not satisfied with only a 5-10% weight loss.

This helps explain why there are so many different diets out there, because none of them provide long-term results. Currently, Keto and Intermittent fasting are popular, just like Paleo, quitting sugar and 5:2 fasting were a couple years ago. As a dietitian on the frontline, I am now seeing all the weight regained from these newer diets, and along with this weight regain comes a deep sense of failure and shame, something I’ll touch on shortly.

There is also a fairly simple explanation as to why there is so much conflicting advice on how to eat for “health” – because there are a gazillion different ways of eating well. Why the talking marks? Our culture’s fixation on weight loss has really narrowed down the definition of health and placed an excessive focus on physical health. But our health is so much more complex than our physical state (including body size) and fat bodies can be healthy.

Health also encompasses your mental/emotional state, your social connections and spiritual needs/life values. For many people, the pursuit of health through weight loss may bring an initial sense of feeling better (due in large part to the cultural and external validation as explored in the next section), but too often this is at the expense of the other aspects of health.

Figure 3: When you restrict food you are likely to crave it even more and then overeat.

Example: Emily and Josh decided to cut carbs from their diet, they go to a party and both are feeling fabulous with all the comments from friends about how much weight they’ve lost and how “good” they look. The food on offer is the usual party fare, mini pizzas and quiches, crackers, chips along with some BBQ meat, breads and salads. Emily has a brief freak out as she realises most of the food contains carbs, but Josh suggests they just stick to meat and salad. Both Emily and Josh find themselves struggling to not look at the spread of food, it looks so delicious and it almost feels like the carbs are calling them, taunting them. And in a sense, they are; when you are restricting food enough to lose weight, your brain releases a chemical called Neuropeptide Y, a neurotransmitter that triggers our drive to eat carbohydrates. Food looks better, smells better and tastes better.

This a key reason diets fail – you simply can’t continue to resist food when you’re hungry or not eating enough.That would be like trying to resist getting more air when you’re struggling to breathe. Your body’s need for food is a basic biological drive that you can only override to a point before you must eat. It is not a matter of willpower, it’s a matter of survival.

But let’s get back to the party. In choosing not to go near the food, Emily and Josh find themselves standing alone and not chatting with their friends, but then a friend comes over bringing a plate of food. They try to say no thank you, but then they look at each other and agree to have just the one. The food taste so good – which it does when you’re hungry and especially if you’ve been restricting – and both find themselves going for another. This leads to the “what the hell, I’ve blown it now, I may as well just keep going” effect, something that commonly happens when people break their diet.

This is another key reason diets fail, they are simply not sustainable. At some point you will find yourself in a situation where it is too difficult to avoid certain food, or you simply don’t want to restrict anymore. Imagine travelling the world and not being able to sample all the delicious food each country has to offer.

It’s vital to make the point there is nothing wrong with Emily and Josh choosing to eating the food on offer, the issue is with the thinking “I’ve blown it”, as this is what leads to eating much more than you would have, had you not been restricting in the first place. Both Emily and Josh leave the party feeling stuffed full to point of feeling sick and while they were able to enjoy time with their friends, the experience was marred by now feeling physically uncomfortable and the deep sense of shame starting to creep in over how much they’ve eaten and that they broke their diet.

Let’s talk a little about shame

If you ever feel bad about how your body looks, that is shame. If you ever feel bad about what you’ve eaten, that is shame. We often use the word guilt with food, but guilt means to have done something bad or wrong. Eating something sweet does not make you a bad person and unless you steal the cookie (or kill someone to get it), you have done nothing wrong.

So why do so many people feel so much shame around food and their bodies? Our culture has an obsession with thinness and a deep fear of weight gain. When this is combined with the oversimplification of health being driven by body size, and all the public health messages indicating that “obesity is a major public health crisis”, it’s not hard to see part of the reason why we fear fatness and desire thinness, another key factor explored in the next section.

For Emily and Josh, their pursuit of physical health adversely impacted their mental/emotional health through increasing their shame; feeling bad about themselves. Should they decide to turn down the next party invitation, which sadly some people find themselves doing in order to not break their diet, then this starts to erode social connections – and lack of social connection has a greater impact on health and longevity than body weight.

Why do we idolise thinness so much?

We were born into a culture with a very strong weight bias, where at the most simplistic level, ‘thin is good’ and ‘fat is bad’. Historically, thinner people are portrayed across all sources of media as more attractive, more successful, more worthy and more likeable. Fatter people are generally portrayed as less intelligent, clumsy, ‘the funny person’ and often not taken seriously. On top of this, most people in your life, without meaning to be malicious, will validate this conditioning with judgements about fat bodies. As mentioned, public health messages also validate these beliefs, where BMI is used as an proxy of health despite being an inaccurate indicator.

All this combines to create a strong cultural weight stigma, where people in fat bodies experience constant judgement and discrimination in virtually all situations. There are multiple and complex factors at play here and if you’re keen to learn more, check out books ‘The Beauty Myth’ by Naomi Wolf and ‘Fat is a feminist issue’ by Susie Orbach.

Fortunately, in more recent years and with the various social media platforms, people in fat bodies are reclaiming the word fat to be a descriptor as opposed to a moral failing. They post about weight stigma and discrimination and how this is harmful to health, they show how fat bodies can be healthy and share pictures of themselves or other fat bodies living their lives or wearing fabulous clothing and make-up in the way we usually only see with thin bodies.

There is an evidence-based health paradigm, Health At Every Size (HAES), which advocates for a focus on health without focusing on weight. HAES also has a deep commitment to addressing weight stigma, intersectionality and social justice issues. To learn more, refer to the online HAES fact sheet.

Figure 4: Discrimination against overweight people can lead to a cycle of shame and self-loathing.

Nutrition – a different perspective

Rather than thinking about food as good or bad, healthy or unhealthy, try thinking about food in terms of why you’re choosing it. Are you wanting something to satisfy your hunger and to leave you feeling energised for the next few hours, or are you just wanting something for the taste of it or to enjoy a moment with friends or family?

Food is not just about nutrition, receiving pleasure from food is equally important. A favourite quote of mine from dietitian Ellyn Satter is, “When the joy goes out of eating, nutrition suffers.” To help people eat in a way that is both nourishing and pleasurable, dietitians Evelyn Tribole and Elyse Resch developed an evidence-based approach called Intuitive Eating. This is the approach I use in my practise and it is now being used by many health practitioners to help people develop and nurture a healthy relationship with food and their body.

Intuitive eating focuses on paying attention to appetite cues and how food leaves you feeling (energy and mood wise) and it teaches people to challenge the current diet concepts around food and body weight. Often, the people seeking our help have spent years dieting and trying to manage their weight and they experience tremendous shame and emotional distress around food and their bodies. This experience is much more common in our community than you might think.

If you would like to nurture a healthy relationship with food and your body, the best advice I can give is to tune into your own body, understand your own appetite cues and what food leaves you feeling energised, satisfied and gives you pleasure. Avoid any advice that is restrictive, rigid, or that requires you to follow rules that you can’t always stick to or maintain.

However you choose to eat, it needs to be enjoyable, flexible and maintainable long-term, otherwise it will only ever be short lived and is more likely to leave you feeling bad about yourself. Remember; “When the joy goes out of eating, nutrition suffers.”

Figure 5: “When the joy goes out of eating, nutrition suffers.”

Student activities

1. Why don’t diets work?

2. Why can body mass index (BMI) be a poor measure of overall health?

3. Read “The Weight of the Evidence” in the reading list and then discuss as groups.

4. How many different diets have you heard of? Discuss in your group.

5. Explain intuitive eating.

6. Read this story: https://theconversation.com/is-the-food-industry-conspiring-to-make-you-fat-81537

7. Then discuss the link between ultra-processed food and poor health, as outlined in the other story in this issue, and the problem of dieting.

8. Why is it important to have sustainable dietary habits?

9. Discuss why diets can’t be maintained in the long-term.

10. Read the Health at Every Size fact sheet in the reading list. What factors should be balanced in what you eat?

References and resources

Bacon L, Aphramor, L: Weight Science: Evaluating the evidence for a paradigm shift. BMC Nutrition Journal, 2011.URL: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-9

Mann T, Tomiyama AJ, Westling E et al.Medicare’s search for effective obesity treatments: diets are not the answer. UCLA, 2007.URL: https://escholarship.org/uc/item/2811g3r3

Brown H. The weight of the evidence – It’s time to stop telling fat people to become thin.Medical Examiner, March 24, 2015.URL: https://slate.com/technology/2015/03/diets-do-not-work-the-thin-evidence-that-losing-weight-makes-you-healthier.html

Hobbes M.Everything you know about obesity is wrong.Huffpost, September 19, 2018.URL: https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/

Foster GD, Wadden TA, Vogt RA, Brewer G. What is a reasonable weight loss? Patients’ expectations and evaluations of obesity treatment outcomes. Journal of Consulting and Clinical Psychology. 1997;65(1):79– 85. [PubMed]

Dimensions of Wellness, (UMD) University of Maryland’s Your Guide to Living Well. [Last accessed June 27, 2017]. Available from: https://umwellness.wordpress.com/8-dimensions-of-wellness/

Marano HE.Chemistry and Craving – What and when we eat is profoundly influenced by a brew of chemicals in a specific part of our brain. 1993, reviewed 2016. Psychology Today, URL: https://www.psychologytoday.com/us/articles/199301/chemistry-and-craving

Holt-Lunstad J, Smith TB and Layton JB.Social Relationships and Mortality Risk: A Meta-analytic Review, PLOS Medicine, 2010. URL: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316

Cramer, P and Steinwart T.Thin is good, fat is bad: How early does it begin? Journal of Applied Developmental Psychology, vol.19, no.3: 429-451, 1998.

Health At Every Size® fact sheet, URL: https://www.sizediversityandhealth.org/content.asp?id=161

Intuitive Eating – Registered dietitians Evelyn Tribole and Elyse Resch

Other reading

Body respect by Linda Bacon and Lucy Aphramor

Body of Truth by Harriet Brown

Health At Every Size – the surprising truth about your weight: by Linda Bacon

Fat is a Feminist Issue – Susie Orbach

The Beauty Myth – Naomi Wolf