Wednesday, June 17, 2015

Diet and Anti-Diet

Instead of reading diet books, lately I've been reading what might be called “anti-diet” books by Michael Pollan, Harriet Brown, Brian Wansink, Traci Mann, and Paul Campos. These books claim that we've all been sold a bill of goods when it comes to weight loss. Almost nobody can, through calorie restriction, go from an obese weight to an approved weight and maintain it for a lifetime. Sooner or later, the body's instinct for survival will overcome whatever intentions you have, unless you have an eating disorder. Consider these statistics:

1. Only 20% of dieters lose more than 10% of their body weight while dieting. Most dieters hit a plateau that stops their weight loss unless they cut back their calorie intake ever more severely, as the body reacts to what it reads as starvation. By this standard, I did pretty well. I lost about 13% of my body weight before I hit the impassable plateau. I tried to further cut back on my calories, but just couldn't. I could go on very low calorie diets when I was young; I suspect the diabetes drugs make it really hard to go too far, or maybe it's just the effect of age.

2. Only 20% of dieters maintain weight loss for more than two years. Over five years the number shrinks to 5%. Virtually anyone can lose weight temporarily by cutting back calorie intake. However, virtually no one can maintain a restricted calorie intake voluntarily for years on end. Again, by this standard I was a very successful dieter, even though I was trying very hard to “change my eating habits” rather than “diet” per se. I kept the weight off for pretty close to five years, although my memory is hazy about exactly when I reached my lowest weight, and when the weight started coming back. The most frustrating thing is that I didn't go back to my old eating habits--I still was eating healthy enough that I had to eat separately from my husband—I just started thinking about other things in my life. It takes 24/7 monitoring to keep weight off, which is why people mostly fail. Not to mention the question of whether or not that is a worthwhile focus for one's life.

3. Over 80% of dieters not only gain back the weight they lost, but they put on additional pounds. This is the familiar and well-known, “yo-yo effect” of dieting. That is, for most people, dieting results in weight gain over the long term. So, like most other people who try it, I am ten pounds heavier than I was before I started. I'm fearful to lose weight again lest I end up even fatter a few years down the road. Before my weight loss, I had pretty much stabilized for over a decade. The kicker is that I eat healthier now, at a heavier weight, than I did back then. I certainly exercise more.

4. Dieting causes cortisol levels to rise, indicating stress and causing the body to retain fat. This has a number of unhealthy psychological effects, such as an obsession with food, disordered eating, mood swings, irritability, and depression. I've been experiencing a great deal of anxiety over the issue even though I'm not dieting. My stress levels go up big time when medical appointments draw near, fearing that the issue of weight will come up. Or just fearing what I'll see when I step on the scale.

5. Willpower is a myth: Virtually no one, aside from those who have an eating disorder, is able to resist foods that are both desirable and available indefinitely. However, making such foods less available has an impact. This isn't just making excuses for the weak – studies are pretty consistent that, everyone is weak, no matter what they weigh. Now, there are people who simply don't like chocolate or pasta or sweets, but that has nothing to do with willpower. I dislike yogurt, so I really can't claim any special prizes for self-discipline when I don't eat it. Brian Wansink, among others, has been advocating the manipulation of the environment to discourage overeating, rather than the steely determination of willpower, which will inevitably weaken and fold.

6. Exercise does a variety of things that are good for the human mind and body, but it does little to maintain healthy body weight. We'd be better off if we could separate the encouragement of healthy exercise from the vain hope of weight loss. I don't know if studies have been done, but I'd be willing to bet a major reason exercise programs are abandoned is because the diets that very often accompany them have crashed and burned. That certainly happened to me more than once. These days I try hard to keep up with the exercise, even though it is more difficult when I am heavier.

7. The most radical idea of all: Excess weight is not as detrimental to health as is commonly believed, and the moral panic surrounding obesity is primarily driven, not by science, but by current tastes and mores and the profit that can be made from anxious, and repeatedly failing, dieters. It's a perfect racket – if a diet fails, blame the dieter, not the diet, so the customer keeps coming back. We pretend it's about health, but it's really about the fashionable obsession with thinness, and even doctors are influenced by this bias.

8. Finally, there is the simple truth that we don't know how to make fat people thin in the long run. It is not simply “calories in, calories out” – the human body and brain are complex, and so are eating behaviors and the way the body responds to food.

Dieting is a lie, even when you use euphemisms like "changing your eating habits" or "chronic restrained eating". Every study on the subject from the 1940s onward has consistently come to the same conclusions concerning the use of structured eating patterns to achieve weight loss. If any other treatment had so poor a record, the medical establishment would have dismissed it as quackery long ago. We'd do as well treating our obesity with homeopathy, colon cleansing, or the laying on of hands. In fact, those alternatives might very well do better, because they induce less stress.

So, that's it. Millions of people are agonizing and obsessing over their weight and what to eat, with damaged body image and facing very real discrimination over something that they really have little control over--not to mention those who diet their way into eating disorders that threaten their health in a more serious way that fat does. Exactly who does this benefit outside of those who make money in the weight loss industry?

Count me as one of the obsessors. I'm very aware of this trap of being expected to do the impossible or you are seen as lazy, stupid, and disgusting. The “sitting on the couch eating bon-bons” cliché about fat people just doesn't apply to me – nor to most fat people. I like my food, but I've never been a binge eater;I don't care if I ever eat fast food (except for a weakness for hot dogs); I eat healthy snacks like fruit and cheese; I buy non-processed food from local farmers when I can; for the last decade I've put strict limits on sweets; and finally, I exercise most days. However, I'm finding myself very confused about what “normal” or “moderate” eating is. Eat when you're hungry and stop when you're full? Or are your instincts untrustworthy and need to be either ignored or tricked? The government advice has gone from a pyramid with grains at its base to a plate that is supposed to be half-covered with fruits and vegetables. How can carbohydrates be so horrible when they have been the basis of the human diet ever since we learned how to plant seeds into dirt? Who am I supposed to believe with the advice, even medical and government advice, is shifting all the time? That is, what am I supposed to do even if I'm not dieting and just trying to eat healthy?

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