Diets. We’ve all tried one, and we probably all know someone who is on one. Paleo, Keto, Low-carb, 5:2 fasting, Blood-sugar, No-Sugar, Atkins, The Cambridge Plan, Slimming World...this list could easily fill a page. Not surprisingly, the availability of health-focused gadgets, apps and devices (think Fitbits and MyFitnessPal) is also at an all-time high. Yet the majority of diets are clearly not having their desired effect as evidenced but the obesity epidemic and an ever increasing burden of chronic disease. As a species, we have never been sicker.
So amidst all the anecdotal gushings about the latest and greatest diet, what we (and scientists, health professionals and public health economists) really want to know is whether an optimal diet for weight management and metabolic health really exists? A look at the science would suggest not. Some diets may induce greater or faster weight loss or better body composition within a given time period, but the long-term efficacy of a diet (sustained weight loss maintenance post 6 months) cannot be guaranteed with any diet plan.
So why don’t diets work in the long term? Evidence suggests that, independent of the nature of the diet, optimising adherence to the diet is the most important factor for longterm sustained weight loss success. However, there are many factors which challenge the successful adherence to diets including the obesogenic environment we live in, social pressure and basic human nature. Diets by their very design, and paired with our obesogenic environment, are guaranteed to make us feel incompetent. Just having the label of being on a diet suggests that we are not good enough just the way we are and drives feelings of low self esteem and lack of self acceptance. Ironically, these feelings in turn can lead to emotional overeating and disordered eating, thereby exacerbating the very problem that the diet was originally started for. When we inevitably fail to adhere to our diet we blame ourselves, and this fosters feelings of guilt and feeds the cycle of low self worth again leading to further emotional eating and misery. So is it the thriving diet culture in the UK paired with a lack of emotional and psychological support during weight loss which is actually driving the obesity epidemic?
Perhaps the answer to diets lies in the population that is not being tested, prodded and starved; those that maintain a healthy weight. So what are they doing? They are more likely to engage in health-promoting activities and behaviours; regular exercise, regular consumption of fruit and vegetables, low consumption of nutrient-poor energy-dense foods. They are managing to navigate within an obesogenic environment. Most importantly, the vast majority are not dieting, they are not binge eating, and they are not using food as an emotional crutch. It would be interesting to look at the mental health, emotional intelligence and general life outlook of these people in order to find answers that could help those unable to sustain weight loss.
So if diets don’t work, what should health professionals, dieticians and nutritionists be offering to ensure long term weight maintenance? A growing trend is the ‘Non-Diet Approach’ which focuses on the psychological and behavioural aspects that influence our health. Weight loss is not the main focus of the Non-Diet Approach but it occurs as a side-effect of positive behavioural change. Behavioural change is neither quick nor easy, and it requires going through a period of often uncomfortable self-assessment and change. But the outcomes, in addition to weight loss, are worth it; increased self-confidence, satisfaction about taking control of your health, moving away from viewing exercise as punishment, a greater appreciation and enjoyment of life, and an increased ability to manage stress. Ultimately, the way we approach weight maintenance, and the language and strategies we use, need to change in order to overcome the spiral of negative health consequences our current diet culture is creating.