September 9, 2013

Welcomed ‘Call for End to the Diet Debate’

Just before I departed for a week’s vacation and last blast of summer I spotted an intriguing tweet about the article A Call for an End to the Diet Debate in the August 21, 2013 issue of Journal of the American Medical Association (JAMA).  I clicked to the recap in the tweet and was further intrigued. I recognized the name of the first author, Sherry Pagoto, PhD. Ah yes, I follow her on Twitter (@drsherrypagoto).

After arriving at our first home away from home in Asheville North Carolina and enjoying a yummy and healthy dinner of sushi, I sat down to digest the article...and sushi. 

It warmed my heart. Thank you Drs Pagoto and Appelhans! I applaud your efforts and absolutely concur with your sentiments. They echo those I penned over a year ago in a blog titled How Much Carb, Protein or Fat? Does it Really Matter for Weight Loss or Keeping Pounds Off? and continue to speak about.   


Below I’ve summarized what I believe are the most important points made in the JAMA article which call to “end the pursuit of the ‘ideal’ diet for weight loss and disease prevention” and the “dietary debate in the scientific community and reported in the media about the optimal macronutrient-focused weight loss diet…” (translated that’s the ideal mix of carbohydrate, protein and fat for weight loss).

  • The authors state [the debates] “sheds little light on the treatment of obesity and may mislead the public regarding proper weight management.”
  • They note in weight loss and disease prevention it’s NOT the differences in macronutrients but, “the degree to which participants continued in the program or met goals for physical activity and diet…” Yes, sort of a duh! You’d think we’ve got this message by now and are ready to put the message into action (aka our healthcare dollars) in providing ongoing support and education to people pursuing weight management. 
  • The authors conjecture that this debate continues for two reasons: "1) to feed the multibillion dollar fad diet industry, and 2) the poor adherence and weight regain cited to reinforce the message that diets don’t work."
  • The authors note, that the research on how much of each nutrient is best, “…most likely will not produce findings that would significantly advance the science of obesity.” Yet, as the authors point out later in the article, “Although research specifically focused on improving adherence is ongoing, the number of studies being conducted is small compared with head-to-head macronutrient-focused diet comparison studies.” This is clearly the converse of what’s in the interest of individuals’ and the public’s health as well as our finite healthcare dollars!
  • The authors make their their point about peoples’ need for long term ongoing support by discussing several of the diabetes prevention studies conducted in the U.S. and internationally, including the Diabetes Prevention Program I’ve discussed here.
  • The authors draw a parallel worth equating that we ofent don't - the need for continuation of therapies (aka medications) for their continued beneficial effect on chronic diseases (like diabetes, high blood pressure, etc.) and the need for ongoing behavioral intervention for obesity treatment if we are to realize long term success.
  • The macronutrient content, the authors state, “…is only one of many factors influencing adherence.” Later in the article the authors add, “the pursuit of the ideal macronutrient content diet is unidimensional, ignoring 2 of the 3 major components of standard lifestyle interventions: behavioral modification and exercise.” They conclude, “Because behavioral adherence is much more important than diet composition, the best approach is to counsel patients to choose a dietary plan they find easiest to adhere to in the long term.” Here, here!

I’ll conclude this blog as I did the one I wrote just about a year ago: It’s time to stop spending research dollars we can’t afford to squander to continue on this inane quest to answer the question about the ideal mix of macronutrients for weight control. Instead let’s spend these precious dollars translating our learnings about the valuable health benefits of losing those few pounds and keeping them off into programs that reach the masses of people who need support to reach their health goals and beyond.

Then let’s take some dollars and use them to address and change our food environment. At the end of the day that’s what will truly make it easier for all of us to not gain weight in the first place and for those who’ve lost weight, keep those unwanted pounds off.

(End note: I wrote this blog as I sat in a shopping mall food court while a young member of my family and friend were clothes shopping. Needless to say my blood pressure rose as I observed parents feeding already overweight kids loads of not-so-healthy foods...and too much of it. We’ve got lots of work to do educating parents where they live - in shopping malls, supermarkets and more.)