Diets are big business and they come in many packages like diet programs, books, videos, products (including creams, gadgets, drugs, supplements, drinks, foods, etc.), and there are the health clubs, clinics, centers, and even surgery. In fact, in 2004 the weight-loss market was worth $46.3 billion and according to a recent study done by Marketdata Enterprises, the estimated value of the U.S. diet market in 2008 was $58.6 billion. That's an increase of $12.3 billion in only four years. With all of this money being spent, are Americans leaner or healthier? Do diets work? Do they offer hope or hype in our quest to get fit?
According to JAMA (The Journal of the American Medical Association) Issue: August 27, 2008, "unhealthy diet and physical inactivity are second only to tobacco as underlying causes of death."
John LaRosa of Marketdata, one of the leading researchers of the diet industry, recently informed me "the number of U.S. dieters is estimated at 72 million. Sixty-six percent of the American population is overweight or obese (both combined — total 151 million adults). The share that's obese (BMI 30+) is 31% (71 million)."
Childhood obesity in the U.S. is growing at an alarming rate, with one out of three kids now considered overweight or obese. Statistics on eating disorders are just as alarming when it is estimated that 5-10% of American teenage girls and women (i.e., 5-10 million) and one million boys and men are struggling with eating disorders including anorexia, bulimia, binge eating disorder, or borderline conditions. At least 50,000 individuals will die as a direct result of their eating disorder.
At any given time two-thirds of all American adults are on a diet. Of those, 29 percent are men and 44 percent are women. Yet, only five percent of dieters will keep the weight off. In fact, most will actually regain their lost weight, plus more. With all the money being spent on diets and diet products, Americans aren't losing weight. According to the U.S. Surgeon General, overweight and obesity has reached epidemic levels. One of the main reasons dieters fail at their "get fit" attempts and remain a statistic is because they choose "fad diets" as opposed to a balanced, healthy diet. In fact the weight-loss industry makes its billions because "millions succumb to 'quick-fix' claims, seeking a (non-existent) effortless weight-loss method."
An article was recently brought to my attention, "More Evidence That Diets Don't Work," written by Tara Parker-Pope (July 16, 2008) of The New York Times and based on a study done by the New England Journal of Medicine. In this study (which was funded in part by the Atkins Research Foundation) they compared the effectiveness of three types of diet programs: low-fat diet, Mediterranean diet, and low-carbohydrate diet.
During my research to write this piece, I came across another article from the same writer, Tara Parker-Pope (July 17, 2008), entitled, "Healthy Diets Shown to Have Benefit Despite Modest Weight Loss." This article was also a response to the same study done by the New England Journal of Medicine. I was a little confused on how two articles, written by the same person and the result of the same dieting experiment, could come up with two titles, which at first glance seemed to contradict each other. However, Ms. Parker-Pope's summaries were similar in that they both reflected that all three of these diet programs had some benefit; of the 300 moderately obese people, the average weight loss was 6-10 pounds and that there were improvements in cholesterol and other health markers. But her criticism seems legitimate, "dieters put forth tremendous effort and reap very little benefit".
In my own review of this study I found that they concluded, "Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets." They also stated that at the end of two years, the low-fat dieters had a net loss of six pounds while the Mediterranean and low-carbohydrate dieters both lost 10 pounds. Another interesting conclusion was that women tended to lose more weight on the Mediterranean diet. In further analysis I did find some issues.
First, this study only addresses three protocols (diet programs). On the low-fat diet, which was based on American Heart Association guidelines, the women consumed 1500 calories and 30% came from fat (which equals 50 grams of fat per day), while the men consumed 1800 calories and 30% from fat (which equals 60 grams of fat per day). Is this considered low fat? Maybe for the men and 50 grams of fat would be much better for a maintenance plan.
On the Mediterranean diet, the women consumed 1500 calories per, 58 grams of fat; men 1800 calories per day, 70 grams of fat. This diet is high in vegetables and low in red meats, but included poultry and fish. The Mediterranean diet makes sense (a good choice of plans), however, if you are interested in losing weight, total calories (even if they are wholesome) do become relevant as well as the nutrient ratio.
The low-carbohydrate diet was based on the Atkins Diet and was modified to include vegetarian types of protein and fats, while avoiding trans fats. How can this be considered a true outcome of the Atkins Diet that advocates the consumption of a lot of beef and highly processed foods like bacon, cream, butter, etc. (which contain high amounts of saturated and trans fats, sodium, and preservatives)? There were no restrictions on calories, which leaves me wondering how many calories were consumed each day. If both groups consumed the same caloric and carbohydrate intake, this would explain why the men lost more weight on this protocol. The other problem is that when you reduce carbohydrate intake (complex carbs), you actually lose glycogen, thus you will see your weight drop on the scale. So was this weight reduction from body fat or was it water weight? And how can anyone function on 20 grams of carbs per day? I would not want to be around that group!
The study noted that at "the end of two years, all dieters had regained some, but not all, of the lost weight," but there was only a four-pound difference. Was this an actual weight gain or did the weight loss stabilize? According to this study, "the maximum weight reduction was achieved during the first six months; this followed by the maintenance phase or partial rebound and a plateau." Any time you implement a diet plan that changes daily calories either by total or type (and nutrient ratio), there will be an immediate weight loss that will stabilize over time. As your body adapts to a particular weight-loss diet, it makes it more difficult to lose weight.
The study concluded that "the Mediterranean diet and low-carb diets produced weight loss and confirmed that each had favorable effects on; lipids, glycemic control, metabolism, as wells as cardiovascular benefits". However, the study did point out that some have not been "conclusively demonstrated," while others lack long-term studies.
I did notice that waist measurements were monitored (which does help in evaluating results) and they noted that all groups had a significant decrease in waist circumference. It would have been nice to see statistics on the actual body fat percentage and not just total weight loss.
I was also left with a few questions. What type — if any — of processed foods were eaten? They used a "validated questionnaire" to assess physical activity. What does that mean? Did they exercise? Lastly, I wonder if there was 24-hour surveillance to make sure no one deviated from their diet and consumed some M&Ms or donuts.
I researched another study which was done by JAMA that compared the four popular diets (40 people in each and their effectives on weight loss and cardiac risk factors): Atkins, Ornish, Weight Watchers, and Zone diets. This study found that each of these diets reduced body weight with no significant differences between diets. All of these diets achieved modest changes, but varied in regards to improvement in cardiac risk factors after one year. It was noted that results occurred only for those individuals who could sustain a high dietary adherence level, noting that dietary adherence rates were low. They also admitted to having to rely on self-reporting of dietary intake and adherence, therefore making it subjective.
Studies like these are a great resource, but keep in mind when it comes to dieting, there are many variables that can affect the outcome of a study of this nature, i.e. age, sex, activity level, exercise, health issues and previous dieting history. Also, since these studies are done in a controlled setting, rather than the real world, it may not represent a true picture on how diets actually impact a dieter in real life. These studies also seem to create more uncertainty on an already perplexing topic!
Confusion: So, which is it? Do diets work or don't they? Is it the type of diet you are analyzing that can make the statement "diets don't work" become a fact? Is it the diet that you can follow and sustain that will make it work better? Maybe our expectations of a diet should be clear and realistic — thus we can make a better judgment. It seems to me that the word "diet" is the target of criticism and creates a lot of confusion. Is diet a bad four-letter word? If you eat food (or liquids), you're on a diet. Diet is defined as "food or drink regularly consumed," or "a controlled intake of food and drink designed for weight loss, for health or religious reasons, or to control a medical condition."
Even in these studies their reports showed that the diets analyzed did have results (both in health and weight loss), although minimal, and if sustained over a certain period of time may not have that much worth. Further research should be done to see how diets (even if they did result in weight loss) impact health (good and bad) over the long haul.
Hype: We should specify which diets don't work. Unhealthy diets don't work. Restrictive and unbalanced diets don't work. Starvation diets don't work. Fake food diets don't work. Diet pills don't work. Massive supplement intake diets don't work. Fad (lose weight fast) diets don't work. We should confront the real issue; most diet programs and products offer quick-fix solutions and are basically gimmicks full of false promises, magic potions, and misleading propaganda. As a fitness expert for over 27 years, I've seen diets come and go (and some recycled) and have witnessed first-hand, the damage done by "trend diets." No sensible diet will ever compromise your physical or mental health for the sake of looking good. In fact, you don't have to starve, deprive yourself, settle for fake food, lose your sanity and health, or take pills to lose weight and get into great shape! I know that getting and staying healthy and fit involves a lifestyle of the "proper diet and exercise regimen."
Hope: The good news is that diets do work, and there is a rise in sound (proper) diet programs that will help you lose weight and gain health. There are now widely accepted, well-researched nutritional principles found in most well respected, leading diet programs, ones that do not offer quick-fix solutions that are found in so-called "fad" diets. Most fitness experts, nutritionists, diet gurus, and well-informed doctors agree that we should consume clean and wholesome foods and liquids to attain low body fat and vibrant health. We should eliminate junk food, fast food, fried food, and highly processed food. The real debate begins over how many calories we should consume each day and the nutrient ratio. The other debate exists over whether it is better to be a vegetarian or vegan — or not! Most also agree that fat loss is where it's at, not just weight loss, that real and lasting weight-loss results don't happen over night, and getting fit is best accomplished when you include exercise. According the Web MD, "proven weight-management strategies include a balanced diet with reduced calories with a regular exercise regimen."
Prevention is best when it comes to being healthy and fit; however, if you've never been taught proper eating habits, you want to lose a few pounds, you've become overweight, obese or find yourself facing health issues, you may need to seek out a diet program.
So how do we find hope instead of hype? How do we escape becoming a victim and end up victorious? How can we spot the real and from the fake (fad) diets, locate the healthy from the unhealthy, and uncover a diet that is based on sound nutrition, is effective, safe, healthy, and long-term? First, educate yourself on nutrition. That way you will be able to detect a fake diet and you can chose one that is safe and healthy. Second, stay away from diets (programs and products) that are marketed with any type of a "get fit fast" tone — anything that is labeled easy or effortless, as magical or a miracle. Third, seek out a diet that you will stick with and that offers a maintenance strategy — that way you will succeed both short- and long-term. Lastly, exercise!