JAMA's Obesity Issue: Old News and New Ideas
Six years ago, when JAMA last published a theme issue on obesity, there was optimism that progress was being made in preventing and treating obesity. As time has passed, so too has the optimism, as reports continued to show that the prevalence of obesity was increasing and, most important, rapidly increasing in children.
This issue vividly illustrates modern medicine's cultural divide between failed dogma and new (or at least newly-rediscovered) ideas regarding obesity, diet, and metabolic health.
Let's start with the first opinion piece, Counting Calories as an Approach to Achieve Weight Control:
The increasing prevalence of overweight and obesity in the United States has been well documented. Although there are many reasons for this increase, one important factor is the change in eating habits over the past several decades. For instance, many people frequently eat meals and snacks purchased from fast food restaurants, which often provide foods that contain high amounts of calories, fat, and sodium. For decades there have been numerous recommendations for weight loss involving specific diets, special foods, exercise programs, medications, and surgery. All of these have been shown to promote weight loss. The various well-known diets all result in similar amounts of weight loss but only if the individual adheres to the diet, resulting in fewer calories ingested.
In so many words, "any diet will work if you cut calories".
This statement may be true -- but only in the short term. Assuming that immediate results for a time-limited "diet" will result in sustained health improvement and long-term healthy weight is an incredibly damaging myth -- closely related to "all calories are created equal", and "calories in, calories out".
Here's an instructive article refuting this myth: researchers followed participants from The Biggest Loser's 2009 season over six years following the show, demonstrating that all but one contestant regained weight. Critically, all of the contestants saw their basal metabolic rates plummet after their season of dramatic weight loss through calorie restriction and exercise. So as their metabolism slowed down in response to starving themselves, their bodies fought to regain lost weight.
Don't fall victim to these myths. The best "diet" isn't one that you follow for a few months in an effort to lose a few pounds. Redefine, and own, the word "diet". Your diet is simply the food you choose to eat. The best diet for you is the diet that helps you maintain health, and a healthy weight, without feeling deprived or constantly battling hunger and cravings.
For people eager to reverse metabolic disease and diabetes, this JAMA theme issue also highlights an area of increasing popularity: ketogenic diets, which when combined with intermittent fasting, have proven to be powerful tools for reversing these damaging diseases.
By replacing sugars and simple carbohydrates with healthy fats and protein that help us feel full, and focusing on real, nutrient-dense foods, researchers like Dr. David Ludwig are finding that these lower-carbohydrate diets spur weight loss without the deprivation of counting calories, or the "yo-yo" effect of a slowing metabolic rate.
Is there a "best diet" for people who struggle with health, weight, and feeling their best? Research and personal experience suggest that a two fundamental changes are particularly valuable:
- Eat real food -- food without labels, and minimally-processed foods with easily-recognized ingredients.
- Avoid added sugar and concentrated / refined carbohydrates.
Beyond these simple steps are a world of possibilities to explore. There's no perfect diet for everyone, but everyone should be on a journey to discover which foods help you feel your best.