Health and wellness concepts and applications

Eating for Good Health - Safe Weight Loss vs. Fad Dieting

This paper explores the need for safe weight loss and healthy eating, as opposed to the fad diets often featured on television, in newspapers and in magazines. For the purposes of this paper, healthy eating is defined according to the standards set out by the U.S. government in its 2000 guidelines on nutrition.

The diet industry globally makes millions of dollars each year. Brands such as Slim-Fast, Slimmers World and Weight Watchers are household names throughout the world and a new diet craze surfaces every few months, helped along by media coverage and the cult of celebrity as a-list stars and lesser mortals in the public eye rush to promote themselves as perfect beings with lifestyles worth emulating. The latest figures published by the U.S. government show a rising incidence of weight problems in the U.S.A. with 31 per cent of adults now classed as obese, along with almost 15 per cent of those aged between six and 19, plus 10 per cent of preschool children. It is clear from such statistics that there is a strong need for advice to Americans on weight loss and healthy eating if the growing problem of overweight is to be turned around for our future health. Excess weight not only harms the individual, putting them at risk of many different life-threatening conditions, but also costs the healthcare system dear. In the UK, for example, there has been talk in the media of refusing to treat smokers and the overweight since their risk of developing health problems is higher and waiting lists for operations are a major issue that has tripped up successive governments.

When considering the subject of safe dieting, we should first look at what constitutes a healthy diet. A healthy diet can be defined as a balanced diet with sufficient nutrients to maintain good health (and a stable weight). In this paper we will follow the definition for a balanced diet as set out in the guide Nutrition and Health: Dietary Guidelines for Americans. For the purposes of this paper, we will define fad diets as fashionable dietary regimes that promote weight loss rather than moderate, balanced eating for good health. We will focus on two contrasting approaches to reducing diets in particular: the diet plans devised by Dr. Robert Atkins, which focus on reducing carbohydrate intake; and the programs devised by diet gurus such as Dr. Dean Ornish in the U.S.A. And Rosemary Conley in the UK, which focus on an ultra-low fat intake as the best way to lose weight. We will compare and contrast these weight-loss strategies and examine the evidence for and against these approaches to reduction dieting.

In examining safe weight loss, it is necessary to look at how the government defines being overweight and obese in the guidelines mentioned above - and how healthy (or unhealthy) weight is measured. Body mass index (BMI) is a commonly used measure of body weight and is used in the government guidelines produced every five years. BMI is calculated from weight divided by height in meters squared - so someone weighing 100 lbs and with a height of 2 meters (approx. 6 feet) would have a BMI of 25. The risks of heart disease, according to the guidelines, are higher for women with a waist size of 35 or over and for men whose waist measures more than 40 inches. The guidelines also suggests that if BMI reaches 25, further weight gain should be avoided. A BMI of up to 25 is widely considered to be a normal healthy weight, although some people may have a high proportion of muscle and this does increase the healthy range of BMI accordingly.

The government guidelines are not restricted to simply talking about healthy eating, but rather set out by suggesting that a healthy lifestyle should also be maintained through taking regular exercise. The guidelines at no point endorse crash diets, but rather stress the value of long-term changes to eating habits backed up by regular exercise in order to increase the basal metabolic rate - allowing the body to burn calories faster. The guidelines also lay out the suggested levels of exercise that should be taken at different ages. The health benefits listed, aside from weight management, include lowered risk of coronary heart disease or osteoporosis. Many of the well-known 'brand names' in the diet industry - such as Weight Watchers and Slimmers World - take a similar approach to weight management. As do some 'fad' diets, including Atkins, Ornish and Conley. Slimming clubs often suggest that their members continue to attend meetings for weeks, or even months, after they have achieved their desired weight loss. For many seeking to lose weight, their focus is entirely on that goal throughout their period on a reduction diet and it is only therefore once weight loss goals have been achieved that they start learning to live more healthily and avoid regaining the weight they have shed.

Most people already know that the human body requires a balance of different foods for health. Many people learn the basics about vitamins and minerals and the effects of being deficient in these from their high school science studies. Some may even be aware of more detail - such as the need to get the nine essential amino acids that our bodies cannot make for themselves from our food and the protective potential of fish oils against coronary heart disease. The food pyramid, which is a visual representation of the main food groups and recommended portions within a balanced diet, helps make the government guidelines on healthy eating easier to remember. According to the pyramid we need a daily intake in the right proportions of all the food groups listed in order to have a balanced diet.

The food pyramid suggests: eat fats, oils and sweets sparingly; we should have 2-3 servings of milk, yogurt or cheese (dairy); 2-3 servings of meat, fish, poultry, dry beans, nuts or eggs (protein); 3-5 servings of vegetables; 2-4 servings of fruit; and 6-11 servings of bread, cereal, rice or pasta (carbohydrates). A serving in the dairy group consists of a cup of milk or yogurt; 1.5oz of natural cheese (such as Cheddar); or 2oz of processed cheese. A serving in the protein group is 2-3oz of cooked lean meat, poultry, or fish. Half a cup of cooked dry beans or half a cup of tofu counts as 1oz of lean meat. Two and a half ounces of soy burger or 1 egg counts as 1oz of lean meat. Two tablespoons of peanut butter or a third of a cup of nuts counts as 1oz of meat. A serving in the vegetable group is 1 cup of leafy vegetables, half a cup of other cooked vegetables or three-quarters of a cup of vegetable juice. A serving in the fruit group is a medium apple, banana, orange or pear, half a cup of chopped, canned or cooked fruit or three-quarters of a cup of fruit juice. A serving in the carbohydrates group is counted as a slice of bread, half a cup of cooked rice, cereal or pasta or about a cup of ready-to-eat cereal. The guidelines also point out that people have different nutritional needs at various stages of life. Groups such as pregnant women, the elderly, young children and teens have different needs. Adult men and teens, for example, require more carbohydrates, fruit and vegetables than younger children, women and elderly people. Pregnant women, or women hoping to become pregnant also require folic acid. Those over 50 and teens also require more calcium, so should eat more dairy produce (while choosing low-fat options to keep saturated fat levels down). Our needs change according to our age and how active we are and this is why the guidelines set out both the food pyramid for general suggestions on the right mix of foods to eat and add specific recommendations for different groups of the population.

We now move on to examine the first of the 'fad' diet approaches we will discuss - the plans devised by Dr. Robert Atkins. In his books and on his website, Atkins suggests following a low-carbohydrate diet to deliberately induces lipolysis (the breakdown of stored fat) and ketosis (breakdown of fat stores into ketone bodies, which are then used for fuel). The Atkins diet program is broken down into four phases.

The first of these is induction, which lasts for a minimum of 14 days. During this phase, dieters are encouraged to eat fat and protein freely and restrict intake of carbohydrates to 20 grams per day. In this phase, dieters are also told to avoid legumes (which combine protein and carbohydrates). This makes the Atkins diet program impossible, for vegetarians to follow, since legumes are a major source of protein for both lacto-vegetarians and vegans! Fruit, pasta, starchy vegetables and all dairy produce aside from cheese, cream or butter are also off limits in this phase. The second phase is called ongoing weight loss and this continues until the dieter has reached within 5-10 pounds of their desired weight. In this phase of the plan, carbohydrate intake is increased by 5 grams a week and in the order suggested in the diet plan. In the third phase, pre-maintenance, carbohydrate intake is increased by 10 grams a week and once again in the order laid down by the plan. In the final phase, lifetime maintenance, dieters learn to control their eating and maintain weight for life. This means a lifetime of following a similar regime as the dieter did throughout the plan, counting carbohydrates and sticking to a diet rich in fats and proteins.

A low-carbohydrate diet such as Atkins must be viewed with caution. Government recommendations clearly state that a balanced diet should include all food groups on the food pyramid and in the proportions suggested. The government guidelines also suggest that no more than 10 per cent of body weight should be lost within six months without there being some risk to health (such as the lack of menstruation often suffered by anorexics!) Carbohydrates have several functions in the body: they are broken down to provide energy and heat and stored as fat. They also spare proteins from being used to provide energy and heat - which happens when there is an inadequate supply of carbohydrates, depriving the body of nutrients derived from proteins (such as nitrogen from the breakdown of amino acids). Atkins and other such diet gurus claim that the body cannot handle high blood sugar that comes from eating carbohydrates and this leads to excess insulin secretion, which somehow creates a craving for more carbohydrates. Eating anything causes an increase in blood sugar - insulin is secreted when proteins are eaten, for instance. If we look at the advice given to diabetics controlling their condition through eating, these people are encouraged to cut down their intake of simple carbohydrates and choose complex carbohydrates instead, not to dramatically increase their protein and fat intake! The authors of high-protein, low-carbohydrate diets tend to ignore facts like these when they talk about healthful nutrition. It might also be added at this point that 'banning' certain foods surely only encourages those seeking to lose weight to crave restricted foods all the more, which then leads to talk of 'addiction' to certain foods. it's a popular notion right now that people are addicted to sugars in their diet and many fad diets seem to talk about carbohydrate addiction in the same way as they would alcoholism or drug addiction. Then there's the question about encouraging dieters to eat more red meat when this in turn increases levels of saturated fat in the diet. Of course we need fats in the diet, but saturated fats have been proven to increase the risk of coronary heart disease through increasing blood cholesterol levels. There's also a proven link between red meat and colorectal cancer. The American Dietetic Association also points out that: "high-protein, low-carbohydrate diets tend to be low in calcium and fiber, as well as healthy phytochemicals (plant chemicals). Some authors of fad diets advise taking vitamin-mineral supplements to replace lost nutrients. However, supplements should 'bridge the gap' in healthy eating and not be used as a replacement for nutrient-rich foods." Looking at the Atkins Center website, there is a whole section dedicated to products to use in conjunction with the program - from food bars and low-carbohydrate ready meals to a host of supplements - is this perhaps a case of marketing drive over the drive for health?

Another favorite fad diet approach to weight loss is ultra-low-fat eating. In the U.S.A., the name Dean Ornish is synonymous with this kind of reduction dieting and in the UK, diet guru Rosemary Conley has sold millions of books and other products, with regular TV appearances since her first book hit the shelves in the 1980s. Ornish has written several books, both for coronary heart disease patients and for reduction dieting. The Ornish approach to dieting means a vegetarian diet, with a fat intake of around 10 grams per day. Government guidelines suggest no more than 30 grams of fat should be eaten in a day - so Ornish's suggested reduction in fact consumption is dramatic. The Ornish regime means excluding all cooking oils and animal products aside from non-fat milk and yogurt. High-fat plant foods such as avocados and nuts and seeds are also off limits for those following Ornish's diet plans. In his book Eight More, Weigh Less - based on his Life Choice Plan - the author suggests that dieters 'graze' throughout the day rather than stick to three large meals and it differs from other weight-loss diets in that the amount of food that can be eaten is not restricted. This diet program is an adapted form of the diet devised by Ornish for reduction of blood pressure and blood cholesterol in coronary patients, but is marketed as a weight-loss plan. In common with other approaches to dieting, Ornish and others like him (such as Conley in the UK) also talk about exercise and other positive lifestyle changes such as smoking cessation and stress reduction techniques.

On his website, Ornish states that the reason for cutting down on fat from the diet is that breaking down fat for use as energy burns more calories than cutting carbohydrates. He also suggests that regaining weight is often caused by eating less food: "You can eat fewer calories by consuming less food. That's why you can lose weight on any diet, but it's hard to keep it off because you feel hungry and deprived. An easier way to consume fewer calories is to eat less fat, because fat has nine calories/gram whereas protein and carbohydrates have only four."