We live in a society that is overweight and getting heavier. Weight-loss diets are a way of life in American culture. They are so ingrained in our way of life that diet no longer refers to what we eat but we do not eat. This month I have presented the perspective of an academic and a practitioner on why we are so heavy and how we can lose it. Last week a guest blogger provided insight into the hottest diet of 2018 just in time for the new year. This week I will discuss what I have learned this month about obesity and dieting.

Diets

Diets to lose weight come, and they go. As they come in, the merits of the diet are highlighted. As they are adopted, problems associated with the diet become apparent. We learned last week that keto dieters enjoy meals that keep them feeling full as they burn off excess fat. Weight-loss diets tend to work because they are highly restrictive of certain foods and thus highly restrictive of calories. The keto diet dramatically restricts carbohydrates, which is a popular trend to latch on to in today’s environment. It is now becoming apparent that too little carbohydrate may be as dangerous as too much. The secret of the keto diet is that fats become the primary energy source for the body, but it is becoming clear that this diet is a dangerous one and should only be adopted under careful supervision by health professionals. Since such secrets have downsides, popular diets lose their luster, and we look for the next great thing. Based on what I have read, I strongly advise against adopting the ketogenic diet in any form.

Diets recommended by dietitians and nutritionists call for 45-65% of calories from carbohydrates, while the keto diet reduces carbs down to 5% of calories consumed. Any rebalancing of the dietary portfolio of carbohydrates, proteins and fats is likely to lead to dramatic metabolic changes initially, but the long-term consequences are less understood. The Angry Chef attributes the benefits of a new diet to the regression towards the mean. The potential dieter is drawn in by the promise of sudden weight loss, increased energy levels and other benefits. As one abandons a disordered diet to adopt a structured one, it is not surprising that life becomes better, at least in the short term. The struggle then becomes one of maintaining the initiative and following the rules in the longer term.

Thus, diets generally don’t work. The success rate for curing obesity, Mike Gibney tells us in Ever Meet a Fat Fox?, is lower than the success rate for curing cancer. Weight-loss diets have a beginning, a goal that may or may not always be achieved, and an endpoint either in celebration or failure. If the dieter is not careful, when the diet is over pounds start accumulating again. To counter this weight rebound, designers of such diets urge participants to think of the regimen as a change in lifestyle rather than a “diet.” Yoni Freedhoff’s selling point in The Diet Fix is challenging the participant to “live the healthiest life you can enjoy, not the healthiest life you can tolerate.” The problem with such a plan, or any other change in lifestyle, the new diet is not just something to endure until the goal has been achieved but rather a life sentence, albeit on our own terms.

We seem to live in a culture where we need to blame and shame. So where can we place the blame for America’s unhealthy lifestyles?

Blame the person?

Neither Mike Gibney in Ever Seen a Fat Fox? nor Yoni Freedhoff in The Diet Fix are willing to blame any person for becoming fat. Both of them condemn the practice of fat shaming. Each author tends to see the obese person as a victim rather than as a perpetrator. Neither author suggests that obesity is due strictly to a lack of willpower. And yet, the way to prevent or cure obesity for either approach is one person at a time following a prescribed regimen. Gibney puts more store in a role of genetics in the development of obesity than Freedhoff. In the Fat Fox, genes do not cause a person to become fat. Rather, genetics can affect the susceptibility of a person becoming fat who does not balance calorie consumption with physical activity.

Blame the food?

If we can’t blame the person for the growing obesity epidemic, whom can we blame? In the Fat Fox Gibney finds that blaming “unhealthy” foods to be over-simplistic. We live in an obesogenic environment, but it is the overconsumption of calories not necessarily processed food that causes too much weight gain. Freedhoff in The Diet Fix is much more likely to blame the food, particularly food companies for advertising unhealthy foods (lower case ‘f’ foods) causing us to overconsume calories. In his plan we don’t need to restrict specific foods, but we must take responsibility for the amount and types of foods that we eat as we seek to “live the healthiest life we can enjoy.”  He recommends that we be mindful of what we eat and that we refrain from eating at restaurants. Rather, he urges us to cook at home.

Calories and physical activity

Both of these authors believe in calories as the primary factor in body weight. Gibney advises us to be physically active to burn up the calories we overconsume. Freedhoff puts much less emphasis on burning calories through exercise. Rather, he focuses on preventing overeating in the first place. The cost of burning off extra calories through exercise is too great. He also suggests that calories in processed food are more likely to contribute to weight gain than those in foods that are not processed. Gibney does not believe that processed foods per se contribute to weight gain in addition to the calories they contain. His emphasis on exercise is based on the belief that an active lifestyle keeps basal metabolic rate high which is the primary way that we burn our calories.

Ending the obesity pandemic

As an academic, the author of Ever Seen a Fat Fox?, proposes a plan for ending the obesity epidemic, one person at a time. He focuses on prevention rather than curing obesity. The plan relies on calorie reduction and increased physical activity. It sounds good on an individual level, but it does not seem credible as a way to dramatically reduce obesity in society. The Diet Fix also focuses on one person at a time, but Freedhoff seems more concerned about the individual than society. His practice is aimed at getting overweight and obese people to lose weight. Through a regimented program of carefully watching over every calorie we consume, a lifestyle can be changed, and we can become as healthy as we want to be. Each plan could be effective, but they remind me of the old lightbulb joke. It only takes one psychiatrist to change a lightbulb, but the lightbulb has to really want to change. Despite efforts not to blame the person, Gibney’s plan to prevent obesity and Freedhoff’s fix to take pounds off both seem to require willpower.

Personal perspective weight and health

I hold myself personally responsible for my weight and my health. I do not judge others and their weight. I meet every six months with my regular physician, my urologist (I’m an old man), my dentist and my dermatologist (a must for residents of southern Florida). I go to specialists when I need to. After noticing that I had a distended belly after I retired, I went on a diet to lose my Senior 15. I lost about ten pounds on the Sonoma Diet. Later I resumed the diet and lost an additional eight pounds. During my current home-renovation project I have been eating out more than usual, and I have put back on about five pounds over the last twelve weeks. I am in reasonably good health with my blood lipids and other chemical measures in an acceptable range. It looked like I would need to undergo an outpatient procedure last year, but the symptoms cleared up when I lost that eight pounds.

I realize that health is much more than weight or BMI. Having said that, BMI is perhaps the simplest means of getting a perspective on a healthy weight. My current BMI is 24.3. Diagnosed as a borderline diabetic more than 30 years ago, I control my A1c results through diet. I currently live the “healthiest life I can enjoy,” but one without the extreme regimentation called for in The Diet Fix. My biggest health concern other than aging is my microbiome as I have noticed some strange conformations in my toilet bowl from time to time. I started eating more bread as well as more take-out when the home renovation kicked in and my toilet results have improved. Coincidence? Who knows? Not to worry, as I won’t be writing a diet book on the benefits of bread and take-out food.

The only weight-loss diet that I have trusted to follow is the Sonoma Diet. I pursue it somewhat cautiously as it is slightly high in protein and low in carbohydrate for the first ten days. With my borderline-diabetic state I am careful to not go keto. My wife informs me “when I smell like a cow” which I take as producing ketone bodies. Most popular diets are highly restrictive and not conducive to overall health. I believe that restaurant food and packaged foods from the grocery store can be part of a healthy diet that also includes fruits, vegetables, meats and eggs. What is important is that there is a good balance of different food groups as well as dietary carbohydrates, proteins and fats with sufficient vitamins, minerals and dietary fiber.

Speaking of new year’s resolutions on food

Next week: The United States of Excess: Gluttony and the Dark Side of American Exceptionalism