Diets don’t work - Real or Rumour? - Iza Trengove
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| medium.com |
Fed-up with dieting that produces no weight loss? Or even results in weight gain? New evidence affirms that diets don't work and asserts that the best way to lose weight is to listen to your body.
To help you decide what works best for you, top experts share surprising facts about food and mood and Sunette shares her story about the pain of being locked in a fat body.
Eliana Dawood, chief dietician of Tara The H.Moross Hospital, looks at why some diets fail.
IS BODY MASS INDEX A GOOD INDICATOR OF HEALTH?
Body Mass Index (BMI) is flawed yet it is a common parameter against which we measure our state of health. It does not differentiate between gender, body composition, muscle mass or wasting and loss of bone density. “Overweight” and “obesity” are commonly understood medical terms which are denoted by specific BMI ranges. These categories may pathologise having a certain body size and may be of little significance when determining someone’s health status as there is no precise weight at which you will be considered to be unhealthy with certainty.
Body Mass Index (BMI) is flawed yet it is a common parameter against which we measure our state of health. It does not differentiate between gender, body composition, muscle mass or wasting and loss of bone density. “Overweight” and “obesity” are commonly understood medical terms which are denoted by specific BMI ranges. These categories may pathologise having a certain body size and may be of little significance when determining someone’s health status as there is no precise weight at which you will be considered to be unhealthy with certainty.
WHAT ABOUT DIETING AND HEALTH?
When we think of achieving health we often focus mainly on our appearance and weight-loss but overlook our psychological health and well-being. Studies have shown that dieting has been associated with impulsivity, weight gain, decreased metabolism, low self-esteem, greater psychological dysfunction, and body dissatisfaction. The truth of the matter is that the majority of diets don’t work. Calories-in versus calories-out is an extreme over-simplification of how our bodies work.
WHY DO DIETS OFTEN FAIL?
Restrained eating is the deliberate restriction of food intake to intentionally prevent weight gain or to promote weight-loss. Following diets and eating in this way can lead to over-eating and bingeing as a consequence of feeling physical and psychological deprivation. Guilt, shame, and a sense of failure of not being able to stick to a specific diet may further contribute to keeping one stuck in a vicious dieting cycle.
There is evidence that suggests that our brain has its own sense of what our body should weigh. Our body will always work towards bringing us back to this ‘set point’. Our brain regulates our metabolism, hunger and activity to keep our weight stable as internal and external conditions change. Therefore when we are dieting our bodies perceive themselves to be going through famine and will respond instinctively by decreasing our metabolism and increasing our appetite, amongst other responses. Over time, dieting very rarely leads to sustained weight loss and often leads to weight regain and an increase in weight over time (weight cycling). Our bodies are not meant to be at a certain weight if we need to engage in extreme behaviour to be at that weight. Human bodies are meant to be diverse, coming in many different shapes and sizes as determined primarily by genetic factors, but also by our environment. Trying constantly to fit into a shape that is not ours can be likened to trying to squeeze into a size four shoe when our natural shoe size is a five. We need to hold in mind that willpower cannot override biology and that with each new diet we undertake, our ‘set point’ shifts upwards.
WHAT IS AN ALTERNATIVE TO DIETING?
The simple answer is going back to basics. This is no easy feat as our eating has become more disordered over time and our concept of ‘normal eating’ has been severely distorted by diet culture. The Health at Every size (HAES) approach contends that everyone can improve their health regardless of their current body size and that this can be achieved independent of weight loss. Intuitive eating is aligned to HAES and guides you in creating a healthy relationship with food, mind and body. In short, dieting has become common practice yet overweight and obesity are on the rise.
Sandton Psychiatrist, Dr. Rykie Liebenberg describes obesity as an addiction which can be treated successfully. She also advocates healthy eating and exercise.
HOW DO YOU DEFINE BEING OVERWEIGHT OR BEING OBESE?
There are two methods that are commonly used to determine whether one is over- weight or not. They are body mass index (BMI) and waist circumference. BMI uses weight and height to determine whether an adult is within the normal weight range. It is calculated by dividing weight by the square of height. If one’s BMI is over 30 one is obese and over 35 one is morbidly obese. Measuring one’s weight circumference is often a preferred way of determining whether one is over-weight since BMI does not distinguish between the proportion of weight due to fat or muscle. Carrying excess fat around one’s middle is more of a health risk than when the weight is on one’s hips or thighs. This could predict if one is a cardio-vascular or type 2 diabetes risk.
When we think of achieving health we often focus mainly on our appearance and weight-loss but overlook our psychological health and well-being. Studies have shown that dieting has been associated with impulsivity, weight gain, decreased metabolism, low self-esteem, greater psychological dysfunction, and body dissatisfaction. The truth of the matter is that the majority of diets don’t work. Calories-in versus calories-out is an extreme over-simplification of how our bodies work.
WHY DO DIETS OFTEN FAIL?
Restrained eating is the deliberate restriction of food intake to intentionally prevent weight gain or to promote weight-loss. Following diets and eating in this way can lead to over-eating and bingeing as a consequence of feeling physical and psychological deprivation. Guilt, shame, and a sense of failure of not being able to stick to a specific diet may further contribute to keeping one stuck in a vicious dieting cycle.
There is evidence that suggests that our brain has its own sense of what our body should weigh. Our body will always work towards bringing us back to this ‘set point’. Our brain regulates our metabolism, hunger and activity to keep our weight stable as internal and external conditions change. Therefore when we are dieting our bodies perceive themselves to be going through famine and will respond instinctively by decreasing our metabolism and increasing our appetite, amongst other responses. Over time, dieting very rarely leads to sustained weight loss and often leads to weight regain and an increase in weight over time (weight cycling). Our bodies are not meant to be at a certain weight if we need to engage in extreme behaviour to be at that weight. Human bodies are meant to be diverse, coming in many different shapes and sizes as determined primarily by genetic factors, but also by our environment. Trying constantly to fit into a shape that is not ours can be likened to trying to squeeze into a size four shoe when our natural shoe size is a five. We need to hold in mind that willpower cannot override biology and that with each new diet we undertake, our ‘set point’ shifts upwards.
WHAT IS AN ALTERNATIVE TO DIETING?
The simple answer is going back to basics. This is no easy feat as our eating has become more disordered over time and our concept of ‘normal eating’ has been severely distorted by diet culture. The Health at Every size (HAES) approach contends that everyone can improve their health regardless of their current body size and that this can be achieved independent of weight loss. Intuitive eating is aligned to HAES and guides you in creating a healthy relationship with food, mind and body. In short, dieting has become common practice yet overweight and obesity are on the rise.
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HOW DO YOU DEFINE BEING OVERWEIGHT OR BEING OBESE?
There are two methods that are commonly used to determine whether one is over- weight or not. They are body mass index (BMI) and waist circumference. BMI uses weight and height to determine whether an adult is within the normal weight range. It is calculated by dividing weight by the square of height. If one’s BMI is over 30 one is obese and over 35 one is morbidly obese. Measuring one’s weight circumference is often a preferred way of determining whether one is over-weight since BMI does not distinguish between the proportion of weight due to fat or muscle. Carrying excess fat around one’s middle is more of a health risk than when the weight is on one’s hips or thighs. This could predict if one is a cardio-vascular or type 2 diabetes risk.
WHAT ARE THE MAJOR CAUSES OF BEING OVERWEIGHT?
The causes are many and complex. On a simple level it means one is eating more calories than one burn. How fast one burns calories could be influenced by one’s genes and lifestyle. Some people are genetically more likely to snack and never feel full. Other conditions that could cause obesity are manic, anxious or attention deficit behaviour. If food is used as a reward it could be difficult to break the habit. All carbohydrates are broken down to sugar, and sugar is very addictive.
IS IT A MATTER OF CALORIES IN AND CALORIES OUT?
No, it depends on your DNA. DNA testing can determine whether one is more likely to become obese or not. Many South Africans have inherited a gene that predisposes them to develop diabetes.
They are what is called carbohydrate resistant (CR) and pre-diabetic. If one is carbohydrate resistant one’s body is unable effectively to use the break-down product from carbohydrates which is glucose or sugar. This eventually gets stored in one’s blood cells and causes weight gain. A low carbohydrate high fat (LCHF) diet would be more suitable to lose weight.
CAN STRESS CAUSE BELLY FAT?
Yes, since stress encourages the body to go into “flight or fight” mode. This stimulates the production of a stress hormone called cortisol. Cortisol affects fat distribution by storing fat around one’s middle. Those who have a psychological vulnerability to stress may continuously over-produce cortisol which causes abdominal fat. This condition could lead to cardio-vascular problems.
The causes are many and complex. On a simple level it means one is eating more calories than one burn. How fast one burns calories could be influenced by one’s genes and lifestyle. Some people are genetically more likely to snack and never feel full. Other conditions that could cause obesity are manic, anxious or attention deficit behaviour. If food is used as a reward it could be difficult to break the habit. All carbohydrates are broken down to sugar, and sugar is very addictive.
IS IT A MATTER OF CALORIES IN AND CALORIES OUT?
No, it depends on your DNA. DNA testing can determine whether one is more likely to become obese or not. Many South Africans have inherited a gene that predisposes them to develop diabetes.
They are what is called carbohydrate resistant (CR) and pre-diabetic. If one is carbohydrate resistant one’s body is unable effectively to use the break-down product from carbohydrates which is glucose or sugar. This eventually gets stored in one’s blood cells and causes weight gain. A low carbohydrate high fat (LCHF) diet would be more suitable to lose weight.
CAN STRESS CAUSE BELLY FAT?
Yes, since stress encourages the body to go into “flight or fight” mode. This stimulates the production of a stress hormone called cortisol. Cortisol affects fat distribution by storing fat around one’s middle. Those who have a psychological vulnerability to stress may continuously over-produce cortisol which causes abdominal fat. This condition could lead to cardio-vascular problems.
IF DIETING DOESN’T WORK, CAN ONE SEEK PSYCHOLOGICAL HELP?
Obesity is an addiction similar to alcoholism. If one is an alcoholic one can stop using alcohol but unfortunately we all need food to survive. Cognitive Behavioural Therapy (CBT) is an acknowledged treatment that has been successful in treating obesity. It focuses on a
person's thoughts, beliefs, and attitudes that affect one’s feelings and actions. It looks at the way one thinks and how that might affect the way one acts. One may have attached positive or negative emotions to particular situations based on one’s past experience which then influences how one will behave in similar situations in the future. CBT patients learn how to identify why they eat, when they eat and what they eat. CBT identifies negative past responses and develops more positive thoughts and actions. CBT helps one to develop a more active and responsible role in one’s lifestyle and to react in a more productive manner towards challenges.
Mindfulness training is also becoming a popular treatment for overweight patients. The practice focusses on being aware of the present moment rather than being lost in thought, thinking about the past or the future. Both CBT and Mindfulness encourage one to be aware of one’s thoughts and feelings rather than to push them away or ignore them. Mindfulness training teaches one to use all one’s senses and savour, feel and live in the moment. This helps one to be aware of portion size and recognise when one is full. It helps patients make healthier food decisions and lifestyle choices.
person's thoughts, beliefs, and attitudes that affect one’s feelings and actions. It looks at the way one thinks and how that might affect the way one acts. One may have attached positive or negative emotions to particular situations based on one’s past experience which then influences how one will behave in similar situations in the future. CBT patients learn how to identify why they eat, when they eat and what they eat. CBT identifies negative past responses and develops more positive thoughts and actions. CBT helps one to develop a more active and responsible role in one’s lifestyle and to react in a more productive manner towards challenges.
Mindfulness training is also becoming a popular treatment for overweight patients. The practice focusses on being aware of the present moment rather than being lost in thought, thinking about the past or the future. Both CBT and Mindfulness encourage one to be aware of one’s thoughts and feelings rather than to push them away or ignore them. Mindfulness training teaches one to use all one’s senses and savour, feel and live in the moment. This helps one to be aware of portion size and recognise when one is full. It helps patients make healthier food decisions and lifestyle choices.
HOW BIG IS THE PROBLEM
Weight problems and obesity are the worst they’ve been in human history. It has become a global epidemic. In SA 70% of women and 13% of children are overweight. It has become one of the major causes of strokes and heart disease. If one has eaten badly all one’s life it eventually catches up with one. It is important that one eats healthy fresh food and less sugar and exercises regularly.
Weight problems and obesity are the worst they’ve been in human history. It has become a global epidemic. In SA 70% of women and 13% of children are overweight. It has become one of the major causes of strokes and heart disease. If one has eaten badly all one’s life it eventually catches up with one. It is important that one eats healthy fresh food and less sugar and exercises regularly.
Counselling psychologist Dr Dianne Preddy who’s been in private practice for 30 years elaborates on how eating disorders and nurturing can be connected.
CAN YOU HELP SOMEONE LOSE WEIGHT?
As a Buddhist, I take a holistic approach to the human condition. I look at the physical, emotional, mental, social, values and the higher consciousness. These work together and affect the choices one makes. In addition, one’s willpower is vital.
Obesity or over-weight could be hormonal or physical or results of side-effects of medication. If none of these is the cause, then there's the psychological aspect of over- eating. If there are anxiety and despair around food and the relationship with the mother, the baby could eventually associate food with anxiety and the need to survive. This could develop into a pattern of over-eating to nurture oneself and compensate for the sense of deprivation. Those fortunate enough to have had an intimate and nurturing experience with their mothers are likely to have a positive relationship with food. There is often also a spiritual element to overeating. Individuals see food as a symbol of love - as symbol of god. All of these things are tied together. During therapy, the role of food in a family is important to look at. Was it used as a reward? It’s important to examine one’s emotions and mood when making food choices. Diets don’t work because they are inanimate objects, they can’t work and can’t do anything. It’s about physically resisting food, understanding and coping with one’s emotions in other ways than eating. As a psychologist one can help a patient examine all these levels or consciousness. Therapy would involve learning how to separate these elements and how to fill the void not with food but with a sense of who you are and one’s own purpose.
Sunette (not her real name) has tried numerous diets unsuccessfully. She gives a tragic account of how being overweight has had a detrimental effect on her life, to the point of being life-threatening.
I was born in 1948. Looking back on my life, I have to say that food has been my master. It determined where I went socially, if the occasion involved eating. I was naturally apprehensive, afraid that I, afraid that I would binge. I spent many months various diets, but I would them during the week and over the weekends. So I always put back lost fat and more. My mother did not have a balanced approach to food. She was always fat and self-conscious about her weight. I grew up disliking healthy food and loving junk. I would feel sick eating vegetables. I would feed these to the dog under the table. I was still in primary school when my mother gave me my first appetite suppressant. She was on them and thought that it helped her in her battle with over-eating. I remember being on some or other diet since age 6 or 7, but that did not deter me from eating secretly. Of the formal meals we had at home, I would eat the steak and chops, but nothing else.
My tertiary education years essentially followed the same pattern. At res, I lived on pies and coca cola. I studied Physical Education in the hope that it would persuade me to be thin. In 1982 I went to consult a Dr. Flax who gave me weight-loss injections. I lost 37 pounds in a month. I felt gorgeous but still my cravings were so strong that I put the lost weight back on within a month and more. I saw many dieticians and psychologists through the years and joined overeaters anonymous. Nothing helped I remained hungry. I don’t believe I eat a lot.
My size has made travelling impossible. I struggle to get onto a bus, or to use a shower in a hotel room and as a result seldom go to public places. I now weigh 130 kg, whereas my ideal weight is less than 80kg. My weight spins out of control which depresses me so much I feel I could kill. I was in a life partnership but my partner never stopped criticising my weight.
Five years ago I was diagnosed with cancer of the kidney. After it was removed I had to eat less protein and more starch to avoid renal failure. I have now reached a point that is frightening. I am told that my health is in danger to the extent of being life- threatening.
I recently went to my GP because I was depressed and run down. I had blood tests and was hospitalised for five days. My doctor has been treating me since then. I now inject myself daily with Victoza which helps control blood sugar and insulin levels and promotes weight loss. Now, for the first time in years, I can tie my shoelaces and do some exercises.I walk with a trolley for 20 minutes daily. I understand that it is all a matter of a mind change. I hated veggies and had to do a paradigm shift. Now I actually enjoy them. I now feel focused to try and normalise my eating habits. I do not want my life to be as dictated to by food as it has been.
As a Buddhist, I take a holistic approach to the human condition. I look at the physical, emotional, mental, social, values and the higher consciousness. These work together and affect the choices one makes. In addition, one’s willpower is vital.
Obesity or over-weight could be hormonal or physical or results of side-effects of medication. If none of these is the cause, then there's the psychological aspect of over- eating. If there are anxiety and despair around food and the relationship with the mother, the baby could eventually associate food with anxiety and the need to survive. This could develop into a pattern of over-eating to nurture oneself and compensate for the sense of deprivation. Those fortunate enough to have had an intimate and nurturing experience with their mothers are likely to have a positive relationship with food. There is often also a spiritual element to overeating. Individuals see food as a symbol of love - as symbol of god. All of these things are tied together. During therapy, the role of food in a family is important to look at. Was it used as a reward? It’s important to examine one’s emotions and mood when making food choices. Diets don’t work because they are inanimate objects, they can’t work and can’t do anything. It’s about physically resisting food, understanding and coping with one’s emotions in other ways than eating. As a psychologist one can help a patient examine all these levels or consciousness. Therapy would involve learning how to separate these elements and how to fill the void not with food but with a sense of who you are and one’s own purpose.
Sunette (not her real name) has tried numerous diets unsuccessfully. She gives a tragic account of how being overweight has had a detrimental effect on her life, to the point of being life-threatening.
I was born in 1948. Looking back on my life, I have to say that food has been my master. It determined where I went socially, if the occasion involved eating. I was naturally apprehensive, afraid that I, afraid that I would binge. I spent many months various diets, but I would them during the week and over the weekends. So I always put back lost fat and more. My mother did not have a balanced approach to food. She was always fat and self-conscious about her weight. I grew up disliking healthy food and loving junk. I would feel sick eating vegetables. I would feed these to the dog under the table. I was still in primary school when my mother gave me my first appetite suppressant. She was on them and thought that it helped her in her battle with over-eating. I remember being on some or other diet since age 6 or 7, but that did not deter me from eating secretly. Of the formal meals we had at home, I would eat the steak and chops, but nothing else.
My tertiary education years essentially followed the same pattern. At res, I lived on pies and coca cola. I studied Physical Education in the hope that it would persuade me to be thin. In 1982 I went to consult a Dr. Flax who gave me weight-loss injections. I lost 37 pounds in a month. I felt gorgeous but still my cravings were so strong that I put the lost weight back on within a month and more. I saw many dieticians and psychologists through the years and joined overeaters anonymous. Nothing helped I remained hungry. I don’t believe I eat a lot.
My size has made travelling impossible. I struggle to get onto a bus, or to use a shower in a hotel room and as a result seldom go to public places. I now weigh 130 kg, whereas my ideal weight is less than 80kg. My weight spins out of control which depresses me so much I feel I could kill. I was in a life partnership but my partner never stopped criticising my weight.
Five years ago I was diagnosed with cancer of the kidney. After it was removed I had to eat less protein and more starch to avoid renal failure. I have now reached a point that is frightening. I am told that my health is in danger to the extent of being life- threatening.
I recently went to my GP because I was depressed and run down. I had blood tests and was hospitalised for five days. My doctor has been treating me since then. I now inject myself daily with Victoza which helps control blood sugar and insulin levels and promotes weight loss. Now, for the first time in years, I can tie my shoelaces and do some exercises.I walk with a trolley for 20 minutes daily. I understand that it is all a matter of a mind change. I hated veggies and had to do a paradigm shift. Now I actually enjoy them. I now feel focused to try and normalise my eating habits. I do not want my life to be as dictated to by food as it has been.
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