CHILDHOOD OBESITY December 2014 j Volume 10, Number 6 ª Mary Ann Liebert, Inc. DOI: 10.1089/chi.2014.1063
EDITORIAL
Why Dieting Should Die David L. Katz, MD, MPH, FACPM, FACP
n November 11, 2014, Circulation: Cardiovascular Quality and Outcomes published a systematic review of diets for weight loss and improving cardiac risk measures.1 My editorial counterpart there and Yale colleague, Dr. Harlan Krumholz, kindly invited me to opine on the study in a commentary, which I did.2 There were important limitations to the study, but those were already grist for another mill. For our purposes here, the punch line will suffice: Despite grandiose claims of superiority, no particular diet was demonstrably better than another, and none appeared to be very sustainable. At the 12-month mark, recidivism was common. By 24 months, it was the rule and lasting success, very much the exception. Other studies on the topic3,4 have also questioned the contended superiority of any given diet over others. Research, and, for that matter, conventional wisdom, generally inveigh against dieting for this rather fundamental reason: It tends not to work. Dieting, often described as ‘‘going on’’ a diet, with the clear implication of plans to go back ‘‘off,’’ is, by its very nature, a short-term fix to the permanent challenge of eating well and establishing energy balance. Short fixes are ill advised for long problems. One might make the case on the basis of probable failure, then, that dieting—as it has historically been done— should die. But with this Journal, I think we can make a stronger case still—one not dependent on the latest study, nor even the weight of damning evidence from intervention trials. Dieting is not only a quick fix, it is generally a go-it-alone fix as well. Few parents go ‘‘on’’ diets and take children with them. Is leaving children out of the formula for getting to a healthy weight anything other than a cultural anachronism, and an abdication, in an age of hyperendemic childhood obesity?5 Presuming the expected answers to those rhetorical questions, we might make a case against dieting on the basis of such fundamentals as epidemiology and demography. We might even invoke philosophy, courtesy of John Donne,6 and note that no one is an island. We might, finally, invoke the basic responsibility of caring adults for the welfare of children. People generally diet alone. But parents and children live it together. Food—its role in sustenance, pleasure,
O
health, and weight control—should accommodate that reality. Dieting often represents, for individuals and the population, the perennial triumph of misguided hope over the genuine illumination of experience. If every quick-fix diet to come down the pike before now left the multitudes in need of the new one, what is the probability that the new one won’t just take its place on the same long, lamentable list? No formal training in statistics is needed to know that it is just about zero. Diets represent a willful suspension of common sense, in fact. The very same, sensible souls among us who know to step away from our credit cards when confronted with pitches for get-rich-quick schemes7 reach for them instead when the equally specious ‘‘getthin-quick’’ pitch comes along. Dieting has been tried rather generously by our culture, and the verdict is not flattering. Perpetuating a method proven so robustly to be a massive failure is, at best, foolish. It is fatalistic as well. Dieting shifts control from us to someone else offering to direct the destiny of our health and weight with their particular contention or theory.8 Given the cacophony of such competing theories, the likelihood that any one of them is the ‘‘right’’ one for any one of us, let alone for all of us, is rather remote. Surrendering a thoughtful, proven approach to the promotion of health9 and control of weight10 to the vagaries of this pop culture proselytism is a dubious leap of faith. We are jumping into the din, hoping the particular peddler of our specific salvation du jour will catch us this time. Alas, we will just fall—because they are on their way to the bank to cash our check. And, finally, what is the likelihood that a sound nutrition education program for children11 will have any meaningful impact on family behavior when mom or dad (or both) is, at any given moment, on a diet? Just about none, of course, and so it is that hope—for families to find health together— dies. The distraction of quick-fix diets kills the opportunity to leverage effective programming—in schools, at the worksite, or elsewhere—to influence a family, which is the fundamental unit of culture. When individuals try to change and their families don’t come along, change is generally
Editor-in-Chief, Childhood Obesity; Director, Yale University Prevention Research Center, Griffin Hospital, Derby, CT. 443
444
EDITORIAL
unsustainable. When families change, it is the entry-level expression of culture change—and that lasts. In unity, there is strength. Dieting kills unity—because we tend to diet alone. As noted, few dieters bring along their spouses, let alone their children. The failure to adopt and apply what is clearly true about eating and living well for lasting health and weight control siphons years from life, and life from years. We generally refer to things that take years from our lives as.fatal. Some are immediately so, others a bit slower, and others slower still. A lifestyle at odds with health is generally a slow killer, but that is cold comfort—because long before it kills us prematurely, such a lifestyle encumbers us with chronic maladies that take life out of our years.12 Dieting, as we have traditionally done it, is fatal to a better hope for the future of our children. It is fatal to the promise of lifestyle as universal medicine13; to the eradication of chronic disease eight times in ten; to the addition of years to life and life to years. It is fatal to the better medical destiny we might bequeath to our children if weight control and health were approached with a blend of science and sense, rather than fatalism and folly; if we pursued health by living it together, not dieting alone. They do not ‘‘diet’’ in the Blue Zones14; they live well. The fundamentals of healthful living and weight control are far less mysterious and far more accessible than we allow ourselves to think; there is just a mountain of marketing and malarkey between here and there. There is the suspension of sense, the denial of science, and profit-driven predation. There is fatalism, and there is folly. But the power to say ‘‘enough!’’ resides with each of us. We could move on, and dieting could die. Our efforts to engage our children in eating well and being active, together and permanently, rather than losing weight alone and fast, would increase our own chances of meaningful success and satisfy a basic parental responsibility. Dieting must die so that families may rediscover the strength of unity and live better.
References 1. Atallah R, Filion KB, Wakil SM, et al. Long-term effects of 4 popular diets on weight loss and cardiovascular risk factors: A systematic review of randomized controlled trials. Circ Cardiovasc
2.
3.
4.
5. 6. 7.
8. 9. 10. 11.
12.
13.
14.
Qual Outcomes 2014 Nov 11. pii: CIRCOUTCOMES.113.000723. [Epub ahead of print] Katz DL. Diets, diatribes, and a dearth of data. Circ Cardiovasc Qual Outcomes 2014 Nov 11. pii: CIRCOUTCOMES.114.001458. [Epub ahead of print] Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: A randomized trial. JAMA 2005; 293:43–53. Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: The A TO Z Weight Loss Study: A randomized trial. JAMA 2007;297: 969–977. Katz DL. Childhood obesity trends: Time for champagne? Child Obes 2014;10:189–191. Donne J. No man is an island. 2003. Available at www.poemhunter .com/poem/no-man-is-an-island Last accessed November 17, 2014. Katz DL. Health sucks. Huffington Post. 2013 ( June 7). Available at www.huffingtonpost.com/david-katz-md/personal-health_b_ 3405078.html Last accessed November 17, 2014. Katz DL. Competing dietary claims for weight loss: Finding the forest through truculent trees. Annu Rev Public Health 2005;26:61–88. Katz DL, Meller S. Can we say what diet is best for health? Annu Rev Public Health 2014;35:83–103. The National Weight Control Registry. Home page. 2014. Available at www.nwcr.ws Last accessed November 17, 2014. Katz DL, Katz CS, Treu JA, et al. Teaching healthful food choices to elementary school students and their parents: The Nutrition Detectives program. J Sch Health 2011;81:21–28. The Lancet. The Lancet Global Burden of Disease Study 2010. 2012. Available at www.thelancet.com/themed/global-burden-ofdisease Last accessed November 17, 2014. Sagner M, Katz D, Egger G, et al. Lifestyle medicine potential for reversing a world of chronic disease epidemics: From cell to community. Int J Clin Pract 2014;68:1289–1292. The Blue Zones. Available at www.bluezones.com Last accessed November 17, 2014.
Address correspondence to: David L. Katz, MD, MPH, FACPM, FACP Editor-in-Chief, Childhood Obesity Director, Yale University Prevention Research Center Griffin Hospital, 2nd Floor 130 Division Street Derby, CT 06418 E-mail: [email protected]
EDITORIAL
Why Dieting Should Die David L. Katz, MD, MPH, FACPM, FACP
n November 11, 2014, Circulation: Cardiovascular Quality and Outcomes published a systematic review of diets for weight loss and improving cardiac risk measures.1 My editorial counterpart there and Yale colleague, Dr. Harlan Krumholz, kindly invited me to opine on the study in a commentary, which I did.2 There were important limitations to the study, but those were already grist for another mill. For our purposes here, the punch line will suffice: Despite grandiose claims of superiority, no particular diet was demonstrably better than another, and none appeared to be very sustainable. At the 12-month mark, recidivism was common. By 24 months, it was the rule and lasting success, very much the exception. Other studies on the topic3,4 have also questioned the contended superiority of any given diet over others. Research, and, for that matter, conventional wisdom, generally inveigh against dieting for this rather fundamental reason: It tends not to work. Dieting, often described as ‘‘going on’’ a diet, with the clear implication of plans to go back ‘‘off,’’ is, by its very nature, a short-term fix to the permanent challenge of eating well and establishing energy balance. Short fixes are ill advised for long problems. One might make the case on the basis of probable failure, then, that dieting—as it has historically been done— should die. But with this Journal, I think we can make a stronger case still—one not dependent on the latest study, nor even the weight of damning evidence from intervention trials. Dieting is not only a quick fix, it is generally a go-it-alone fix as well. Few parents go ‘‘on’’ diets and take children with them. Is leaving children out of the formula for getting to a healthy weight anything other than a cultural anachronism, and an abdication, in an age of hyperendemic childhood obesity?5 Presuming the expected answers to those rhetorical questions, we might make a case against dieting on the basis of such fundamentals as epidemiology and demography. We might even invoke philosophy, courtesy of John Donne,6 and note that no one is an island. We might, finally, invoke the basic responsibility of caring adults for the welfare of children. People generally diet alone. But parents and children live it together. Food—its role in sustenance, pleasure,
O
health, and weight control—should accommodate that reality. Dieting often represents, for individuals and the population, the perennial triumph of misguided hope over the genuine illumination of experience. If every quick-fix diet to come down the pike before now left the multitudes in need of the new one, what is the probability that the new one won’t just take its place on the same long, lamentable list? No formal training in statistics is needed to know that it is just about zero. Diets represent a willful suspension of common sense, in fact. The very same, sensible souls among us who know to step away from our credit cards when confronted with pitches for get-rich-quick schemes7 reach for them instead when the equally specious ‘‘getthin-quick’’ pitch comes along. Dieting has been tried rather generously by our culture, and the verdict is not flattering. Perpetuating a method proven so robustly to be a massive failure is, at best, foolish. It is fatalistic as well. Dieting shifts control from us to someone else offering to direct the destiny of our health and weight with their particular contention or theory.8 Given the cacophony of such competing theories, the likelihood that any one of them is the ‘‘right’’ one for any one of us, let alone for all of us, is rather remote. Surrendering a thoughtful, proven approach to the promotion of health9 and control of weight10 to the vagaries of this pop culture proselytism is a dubious leap of faith. We are jumping into the din, hoping the particular peddler of our specific salvation du jour will catch us this time. Alas, we will just fall—because they are on their way to the bank to cash our check. And, finally, what is the likelihood that a sound nutrition education program for children11 will have any meaningful impact on family behavior when mom or dad (or both) is, at any given moment, on a diet? Just about none, of course, and so it is that hope—for families to find health together— dies. The distraction of quick-fix diets kills the opportunity to leverage effective programming—in schools, at the worksite, or elsewhere—to influence a family, which is the fundamental unit of culture. When individuals try to change and their families don’t come along, change is generally
Editor-in-Chief, Childhood Obesity; Director, Yale University Prevention Research Center, Griffin Hospital, Derby, CT. 443
444
EDITORIAL
unsustainable. When families change, it is the entry-level expression of culture change—and that lasts. In unity, there is strength. Dieting kills unity—because we tend to diet alone. As noted, few dieters bring along their spouses, let alone their children. The failure to adopt and apply what is clearly true about eating and living well for lasting health and weight control siphons years from life, and life from years. We generally refer to things that take years from our lives as.fatal. Some are immediately so, others a bit slower, and others slower still. A lifestyle at odds with health is generally a slow killer, but that is cold comfort—because long before it kills us prematurely, such a lifestyle encumbers us with chronic maladies that take life out of our years.12 Dieting, as we have traditionally done it, is fatal to a better hope for the future of our children. It is fatal to the promise of lifestyle as universal medicine13; to the eradication of chronic disease eight times in ten; to the addition of years to life and life to years. It is fatal to the better medical destiny we might bequeath to our children if weight control and health were approached with a blend of science and sense, rather than fatalism and folly; if we pursued health by living it together, not dieting alone. They do not ‘‘diet’’ in the Blue Zones14; they live well. The fundamentals of healthful living and weight control are far less mysterious and far more accessible than we allow ourselves to think; there is just a mountain of marketing and malarkey between here and there. There is the suspension of sense, the denial of science, and profit-driven predation. There is fatalism, and there is folly. But the power to say ‘‘enough!’’ resides with each of us. We could move on, and dieting could die. Our efforts to engage our children in eating well and being active, together and permanently, rather than losing weight alone and fast, would increase our own chances of meaningful success and satisfy a basic parental responsibility. Dieting must die so that families may rediscover the strength of unity and live better.
References 1. Atallah R, Filion KB, Wakil SM, et al. Long-term effects of 4 popular diets on weight loss and cardiovascular risk factors: A systematic review of randomized controlled trials. Circ Cardiovasc
2.
3.
4.
5. 6. 7.
8. 9. 10. 11.
12.
13.
14.
Qual Outcomes 2014 Nov 11. pii: CIRCOUTCOMES.113.000723. [Epub ahead of print] Katz DL. Diets, diatribes, and a dearth of data. Circ Cardiovasc Qual Outcomes 2014 Nov 11. pii: CIRCOUTCOMES.114.001458. [Epub ahead of print] Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: A randomized trial. JAMA 2005; 293:43–53. Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: The A TO Z Weight Loss Study: A randomized trial. JAMA 2007;297: 969–977. Katz DL. Childhood obesity trends: Time for champagne? Child Obes 2014;10:189–191. Donne J. No man is an island. 2003. Available at www.poemhunter .com/poem/no-man-is-an-island Last accessed November 17, 2014. Katz DL. Health sucks. Huffington Post. 2013 ( June 7). Available at www.huffingtonpost.com/david-katz-md/personal-health_b_ 3405078.html Last accessed November 17, 2014. Katz DL. Competing dietary claims for weight loss: Finding the forest through truculent trees. Annu Rev Public Health 2005;26:61–88. Katz DL, Meller S. Can we say what diet is best for health? Annu Rev Public Health 2014;35:83–103. The National Weight Control Registry. Home page. 2014. Available at www.nwcr.ws Last accessed November 17, 2014. Katz DL, Katz CS, Treu JA, et al. Teaching healthful food choices to elementary school students and their parents: The Nutrition Detectives program. J Sch Health 2011;81:21–28. The Lancet. The Lancet Global Burden of Disease Study 2010. 2012. Available at www.thelancet.com/themed/global-burden-ofdisease Last accessed November 17, 2014. Sagner M, Katz D, Egger G, et al. Lifestyle medicine potential for reversing a world of chronic disease epidemics: From cell to community. Int J Clin Pract 2014;68:1289–1292. The Blue Zones. Available at www.bluezones.com Last accessed November 17, 2014.
Address correspondence to: David L. Katz, MD, MPH, FACPM, FACP Editor-in-Chief, Childhood Obesity Director, Yale University Prevention Research Center Griffin Hospital, 2nd Floor 130 Division Street Derby, CT 06418 E-mail: [email protected]
