Refuse To Regain

Life on the Island

by Barbara Berkeley, MD

No man is an island entire of itself; every man is a piece of the continent, a part of the main….. John Donne, 1572-1631

As John Donne famously observed, each of us is connected to the other and to the larger world.  In free societies, our belief in personal liberty often obscures this point.  We are free to choose, or so we believe. But our freedoms are enormously affected by the influence of the culture in which we are immersed, by the very connections that make us human.  Are we choosing or are we being led?  At no time is this question more pertinent than in an election year.  Our political choices are based on the information we learn from PACs, Super PACs, newspapers, TV pundits, the opinions of friends, and finally...our own observation.  How free is our choice?  Pure freedom of choice depends on the degree to which we want to unearth and establish the unvarnished, un-spun truth.  This kind of fact-finding requires a serious amount of focus, time, and commitment. 

And so it is with our dietary choices.  We may feel that we have the freedom to choose how we eat.  We are certainly told that we do.  If we choose to eat badly, it’s our own fault isn’t it?   But I observe a quite different reality.  In fact, our freedom is severely tested and influenced by the enormous weight of a food culture that condones, encourages, and normalizes a quite different message.  Eating is a sport, a right, an ultimate enjoyment to which we are all entitled.  Further, modern food is not bad... it’s GOOD.  It is only our choice that is poor.  Swimming away from that cultural current can be like opposing the force of the ocean.   The water looks calm, but we are actually caught in a rip tide.

This is the reason that making an analogy between successful maintenance and life on an island so appeals to me.  In order to avoid the influence of the food culture, we have to absent ourselves from it.  We have to live, to some degree, outside of it.

How is this done?  Some do it by becoming fierce proponents of diets that don't look anything like the modern American plate: vegan, vegetarian, paleo.  Others become immersed in the world of nutrition and fitness.  They blog, take courses, become trainers, write books, become experts.  But for the vast majority of maintainers, it's a matter of applying a set of mental blinders.  They doggedly focus on the road ahead, follow their plan, and try not to be overwhelmed by the flood of food messaging.

Maintainers can feel both proud and lonely.  They sit on an island while the rest of the world swims in a sea of food all around them.  Often, it’s hard to avoid jumping back in the water.  It looks like so much fun that it’s easy to forget what it took to get up on dry land.  It's hard to remember that we once felt like we were drowning. 

Since we are social beings, connected to one another whether we want to be or not, it’s easier to stay on our island if we know that we are not alone.  Those who belong to a diet subculture (like the vegans, vegetarians and primalists referenced above) have websites, books, and mentors to follow.  But for all maintainers, a vital task is finding other people who live on the island.

As you know, I run a monthly group for maintainers in the Cleveland area.   After a couple of years of meetings, those of us who participate have discovered that we never run out of things to say.  For many in the group, the maintenance of a significant weight loss is the defining challenge of their lives.  They never tire of discussing the process.  They also enjoy sharing their observations of what’s going on off-island. Viewed through the eye of the group, the behavior of the rest of the world seems nonsensical at times, almost incredible.

Month after month we repeat the truth to one another.  It’s the truth of our island culture, not the truth of the world according to the Food Network.  We congratulate each other, support each other when we venture a bit to close to the water’s edge.  It is an enterprise that I highly recommend to those of you who are maintaining out there on your own.  I offer my support if you would like to try starting a group in your area.  Email me and I'll help as much as I can. 

Form a group.  Define your culture.  Meet your neighbors.  An island can be a pretty beautiful place to live, as long as you are not alone.

 

The Paula Deen Flap: Sugar, Lies, and the Bitter Truth.

by Barbara Berkeley, MD

I think I generally try to be non-judgemental, but I'm afraid I'm about to depart from that behavior temporarily.  The reason?  Paula Deen, her diabetes, and her response.

Here's a nauseating little morsel:  CBS News report on Deen's big reveal.  

Turns out, Deen has been diabetic for three years during which time she has continued to encourage Americans to eat some of the worst food on the planet.  Of course, she intended her viewers to eat this food "in moderation" (these two words make me see red dear readers)....as SHE herself does!

OK, so Deen may have been among the misguided.  Perhaps she really didn't realize that eating a crispy creme burger would contribute to obesity and it's deadly handmaidens. Maybe she really believed that her message was a moderate one:  just have a little.  (A little fried stuffing on a stick, anyone???)

But that explanation is, shall we say, a bit hard to swallow.

I am perfectly content for individuals to decide what they want to eat, as long as they understand what's at risk if they develop conditions like diabetes, hypertension, high cholesterol, and heart disease. If they understand fully, this remains their right and their choice.  But most people don't understand, and I feel badly for those who think that a glass of water and a handful of lipitor, diuretics and metformin will reverse the damage caused by eating without thinking.

 Deen's choices are a different story.  She is not an individual.  She's a public spokesman for food.  Now that her food choices have made her ill, she should be honest about the cause.  I'm particularly angered by Deen's new role as "Diabetes Ambassador".   She has made a deal with a diabetes drug manufacturer and is already speaking for diabetes as if she knew something about it.  Let's see.  What would a drug company want a desginated celebrity to say about diabetes?  Oh...I know!  "Don't you worry.  Our drugs can take care of everything.  Just make sure to buy the particular drug we make, and make sure you order often."

Here's Deen on diabetes:

“I’m here today to let the world know that it is not a death sentence,” said the Food Network star, who is now being paid as a spokesperson for Novo Nordisk, the pharmaceutical company that supplies her diabetes medication. Coinciding with her announcement, Deen and her family are appearing in a new ad campaign for the company this month.

The announcement that diabetes is not a death sentence would be news to the families of the tens of thousands of people who have died as a result of this disease.  It would also be news to the Centers for Disease Control, whose diabetes web page describes diabetes as follows:

Diabetes Is Common, Disabling, and Deadly

• 25.8 million people in the United States (8.3% of the population) have diabetes. Of these, 7.0 million have undiagnosed diabetes.

• In 2010, about 1.9 million new cases of diabetes were diagnosed in people aged 20 years or older.

• If current trends continue, 1 of 3 U.S. adults will have diabetes by 2050.

• Among adults, diabetes is the leading cause of new cases of blindness, kidney failure, and amputations of feet and legs not related to accidents or injury.

• Diabetes was the seventh leading cause of death listed on U.S. death certificates in 2007.

• A person with diabetes has a shorter life expectancy and about twice the risk of dying on any given day as a person of similar age without diabetes.

Does Ms. Deen know that type two diabetics frequently progress to needing insulin?  Does she know that studies have unequivocally shown the importance of dietary change and life habits in controlling this disease?  Is she appropriately concerned about her own health and, perhaps more importantly, the health of the vast audience she commands?  If not, does she have any business offering herself as a spokesperson? Time will tell, but right now, things don't look good.

According to the Today Show, on which she made her announcement:

When asked about whether she will make a change in how she cooks on her show, “Paula’s Best Dishes,” Deen didn't give a direct answer, instead encouraging viewers to practice moderation.

“Here’s the thing, you know, I’ve always encouraged moderation,” she said. “On my show, you know, I share with you all these yummy, fattening recipes, but I tell people 'in moderation... You can have that little piece of pie ...'"

This does not give me much hope for Ms. Deen as an advocate for the real behaviors and tough lifestyle changes that can truly change the life of a diabetic.  But someone will benefit.  She'll probably make alot of money for the sponsoring drug company who will be more than happy to perpetuate the lie that pills and shots conquer all, even a deadly and toxic diet.

 

 

 

Is Your Irisin A'Risin?

by Barbara Berkeley, MD

The latest chemical substance to get scientists into raptures is irisin, a hormone that is produced in muscle cells but exerts its effect on fat.  We've all figured out that exercise and weight are somehow tied together and that this means that muscle and fat must communicate. Unfortunately, we've showed a woeful lack of imagination in tryng to come up with the mechanism. For decades, we've persisted in trying to jam the same puzzle piece into a space that doesn't fit.  We are determined to prove that the connection is calories.  It seems so logical.  If we burn calories through working out we must lose weight, right?  And yet the evidence that this is so remains annoyingly equivocal.  

While readers will occasionally write to me about great weight loss successes from becoming physically active, it is rare to observe this in clinical practice. The more common experience is to see people who have added exercise, but have not achieved anything more than a minor result.  As I've mentioned in the past, I have taken care of many very athletic people, even marathoners, who were clinically obese.  Could they have just been eating enormous amounts of food?  Of course it's possible.  But most of them were trying to lose weight by modulating their diet.  One would think that these prodigious amounts of exercise would force weight loss, but in their cases it did not.

On the other hand, it is observationally obvious that maintainers who exercise have a higher rate of success at keeping weight off.  This observation has been confirmed by data from the National Weight Control Registry, a large study which monitors those in maintenance.  While the NWCR subject pool is limited to maintainers who volunteered themselves (and thus are probably highly motivated), the data shows that successful study maintainers are exercising a lot (on average, about 1 hour daily). 

Irisin is a hormone that is produced from the breakdown of a protein that is produced when muscles are exercised.  In rodents, it's injection appears to turn white fat into the more metabolically active brown type.  Humans do not have very much brown fat, so it is difficult to speculate whether this finding is meaningful for us.  Even rats who made more brown fat did not lose weight when injected with irisin.  So why the flurry of interest?  Because high levels of irisin appear to improve the way the body metabolizes food, making it less insulin resistant and more weight stable.  The following is from a recent NY Times article on irisin:

But while irisin appears to have a critical impact on metabolism, it does not appear to play any discernible role in the effects that exercise has on the heart or the brain. And various issues remain unresolved. Why, for instance, if exercise increases levels of irisin and irisin increases the body’s stores of energy-burning brown fat, does exercise so rarely produce significant weight loss? The mice injected with irisin lost little weight. On the other hand, Dr. Spiegelman notes, they resisted weight gain, even on a high-fat diet, and their blood sugar levels remained stable. So it would seem that exercise, through the actions of irisin, can render you healthy, if not svelte.

As I have repeatedly said in this blog, research results only become important when they are repeatedly reproduced.  The irisin story is obviously in its very earliest chapters.  But the existence of such a hormone may well help to explain why exercise is so important during maintenance, and relatively ineffectual during weight loss.  For those who are currently losing weight, I don't discourage exercise, but I ask you not to rely on it.  Weight loss is about forcing the body to burn itself (which it would prefer not to do) through caloric restriction.  Think of your exercise as a way of rebuilding and retuning your muscles for later use.  Once you reach maintenance, these irisin producing factories will be fired up and ready to go--giving you a much improved shot at maintaining the body you've earned. 

Sir: I Detect an Excess of Avoirdupois

by Barbara Berkeley, MD

A few days ago, I wrote about the excessively blunt language and targeting of obese kids in an anti-fat campaign in Georgia.  On the other end of the spectrum, doctors are being cautioned about using straightforward words like "obesity" when counseling patients about weight loss.  

A survey from the University of Pennsylvania asked overweight people to rate words that described their condition and to assign them negative, neutral or positive values.  Words like "obese" and "fat" were given low marks, while words like "weight" were considered acceptable.  Based on these responses, doctors in Canada are being cautioned about turning off patients with words that offend them. But in reality, it's not the words themselves that are the problem.  It's the sentences that surround the words and their perceived subtext. Changing individual words is silly in my opinion.  Often attempts at political correctness lead us even further astray from our objective, as our beliefs remain the same while the words that describe those belefs simple become euphemisms.

Some time ago, I wrote about the lack of effective words in English to describe exercise.  Prior to becoming a doc, I was an aspiring writer and English major (gee, can you tell?) and someone who respected the power of words to create reality.  Here's an example:  if we had lots of better words for types of exercise, these descriptive words might entice many more people to try it.  The single word that we DO have--exercise-- is so devoid of depth and so connected to negative perceptions that it limits our ability to motivate.

Similarly, we have very few words to describe the state of having too much fat.  Here are the main choices:  "overweight", "fat", "heavy" and "obese".  If we start eliminating these, we get into some pretty labor-intensive options:  "scale-istically challenged"?, ""metabolically weight-accumulative"?, "lipidophilic"? Or we might move even further into safe territory by developing acronyms like "PAL" (prone to accumulating lipids) or "FAD" (fat accumulation disorder).  Feel free to make some up, perhaps one of yours will enter the lexicon.

As many as 78% of physicians currrently give no counsel to overweight patients about losing weight.  In some odd jump of logic, the U of P survey leads some to conclude that asking doctors to limit their ability to level with patients will make it easier for them to provide this guidance.  I would submit that the reason that doctors don't counsel patients is exactly because they don't want to risk riling them up or offending them.  Will politically correct language solve this problem?

I have a novel idea.  Suppose we learn how to sympathize with obese patients and speak to them in a way that shows that we not only support them, but understand them and aim to help?  Here's the approach that I take:

"Mrs. Jones, according to our BMI charts you are considered medically obese.  That's a term that doctor's use and it just means that you are more than about 30 pounds overweight.  So I want to tell you a couple of things.  First of all, if you're strugging with weight loss, I don't think that's your fault.  What I believe is that most people haven't gotten good guidance about how to lose weight and keep it off.  What you think you may know about eating healthy may actually not be correct for you, so I hope you will listen to what I propose and consider it.  Second, It's very, very worthwhile to lose weight.  Extra fat is simply not good for you.  With every pound you lose, you'll take a strain off your heart and your joints.  You'll also correct your diabetes, high blood pressure, reflux and cholesterol to a large degree.  You'll be amazed that once you start eating a diet that is harmonious with your body instead of oppositional to it, that you'll also feel much more energetic and less anxious.  You'll probably be interested in doing some physical activity for the first time in a very long while. I've done this with lots of people and I'll be here to help you the whole way.  But here's the most important part:  many people can't make these changes on their first try.  Getting closer to eating well can be a life's work.  Lots of people who've done it permanently have had missed attempts.  So don't blame yourself if it doesn't "take" right away.  Just keep tryng. So, here's the plan.  If you agree, let's get to work and give this a try."

No fancy words, no acronyms.  On the other hand, a doctor might say this:

"Mrs Jones, your BMI shows that you are obese.  (subtext:  that's your fault).  You really need to lose about 50 pounds (subtext:  I don't know how to tell you to do it, that's your problem).  This is important, you're going to have lots of problems down the road unless you take care of this.  (Subtext: I'll be annoyed if you haven't lost anything by the next time you come in)."  

It's not about the single words, is it?

 

 

 

 

 

On Dietary Purism and Pragmatism

by Barbara Berkeley, MD

Human beings are curious characters who seem to enjoy nothing more than dividing into factions, the better to denigrate those on the other side.  Sometimes this unavoidable tendency turns life into a series of tiresome tug-of-wars.  Are Cleveland Cavs fans really so different than Celtics fans?  Clearly not, and yet even sports rivalries can engender strong beliefs that one side is physically, geographically, perhaps even morally, superior.  

When we divide into groups, we seem often to inflate the "truthiness" of our cause.  Part of the action is to believe that we have found the one true path.  So it is with religion, politics, and nationalism.  Yet we can't all be right and there are an awful lot of factions claiming to have the one right answer to an awful lot of problems.   If this line of thinking sounds familiar, it's because I've blogged in the past about our need to form dietary factions that look alot like the other tug-of-wars described above.(Dietary Tribalism: Factionalism Goeth Before the Fall).  

In my post on dietary tribes, I wrote this:

....At least as I see it,  the truth about optimal diet remains the furthest thing from being settled.  It is as complex and elusive as a shadow that recedes into our endless human past. Does any group, whether it be the vegans, the vegetarians, the Primalists, the Mediterranean Diet followers...ad infinitum.... truly have the hubris to believe that they have completely solved the equation?   There is no diet on earth that does not eventually lead to death.  And if there is ever to be one it will have to come with the assist of modern science, since no living species has yet negotiated immortality.

I believe it unlikely that there is one, true diet. ( See: Previous post on The Perfect Diet). However, I do believe that there are diets that work exceedingly well for individuals. It's interesting and important work for each of us to find the one that best fits ourself. Based on clinical observation, I feel strongly that a mostly Primal diet with elimination of the bulk of sugars and starches is an excellent diet to choose.  But there are people who may do very nicely as vegetarians, Ornish followers, Mediterranean devotees, etc.. 

 I remain a dietary pragmatist. I don't like to criticize the dietary choices of others (unless they are making no choice other than to default to the SAD).  I also realize that purism within dietary philosophies is not necessarily practical.  For example,  I often receive questions from readers about perceived contradictions in my book and blog.  How can I suggest that maintainers use artificial sweeteners, use Lean Cuisine occasionally, or buy meal replacement shakes?  I make these suggestions because they work, are practical, and don't seem to cause harm.  I do not expect people to be perfect in the adoption of any new way of eating.  Imperfection is the reality for the vast majority of us.  So my goal is to try to give readers practical ways to maintain lower weights, that allow them to remain "primarily Primarian".   Luckily, the body--particularly when at good weight and in good physical shape--is a wonderfully flexible instrument.  A continued commitment to eating well is required, but utter perfection is not.

So I'd like to start the New Year with a confession and an observation.  My confession?  I don't have the answer about perfect diet.  My observation:  No one else does either.  When you look for guidance from the gurus who are out there on the internet and whose words seem so much weightier because they appear in books, remember that YOU are the most important part of any dietary experiment.  Here is the list of guidelines I've posted in the past for deciding if your diet is a good one:

1. Your diet  is good if it is helping you achieve normal blood sugar, decent cholesterol readings, low triglycerides and a good blood pressure.  If you already have some of these problems, your diet is a good one if it is lessening these markers or allowing you to decrease your medications.

2. Your diet is good if it is allowing you to stay a a good weight.  That weight doesn't have to correspond to a perfect BMI, but it should be as low as you can comfortably maintain and should stay relatively stable.

3. Your diet is good if your energy is good.  If you are sluggish or have no energy to get out and move around, look at making a dietary change.

4. Your diet is good if it exposes you to the fewest carcinogens.  We get enough exposure to cancer causing chemicals in our air, plastics, x-rays, and modern products.  Avoidance of processing and additives is the basis for every healthy diet whether it be Primarian, Pritikin, Vegetarian or an Atkins variant.

5. Your diet is good if you can believe in it and stick to it.  If you are simply eating reflexively, without any specific thought, it's unlikely that your diet is healthy.  The reason is simple: we are presented with few good choices.  In order to eat well, we have to eat mindfully.  

6. Your diet is good if you wake up without guilt. 

7.  Your diet is good if eating it makes you not only healthy...but happy.

Feel free to let me know about the dietary discoveries you have made as you've proceeded on your own journey.

 

 

 

 

 

 

 

 

 

Big Kids on Billboards

by Barbara Berkeley, MD

Just a quick post about a recent article on the anti-obesity campaign that is running in the state of Georgia.  The bottom line is that someone has decided that a tough way to tackle childhood obesity is to put up posters that feature fat kids and harsh rhetoric (example: "Big bones didn't make me this way.  Big meals did.") 

I believe I can predict your response to this, although some may say that we need more blunt and honest approaches to the problem.  Speaking for myself, I have always been particularly infuriated by those who blame parents for the obesity epidemic.  It is increasingly difficult to control the lives of children when an entire society opposes the message you give at home.  And for many parents, especially in low income areas, the options for eating well may be few.  We can't ask parents to do this on their own and we certainly shouldn't be giving the greater society more ammunition for shunning those who are obese.

Here's my posted response to the article above:

It makes us feel good to blame the problem on someone (in this case, the parents). We think that the fix is an easy one: simply cut out the chips, turn off the TV, and take a walk. It simply isn't so.

There is no fair shot for kids until the fight against obesity permeates our national consciousness. Schools MUST teach children about their bodies and the real consequences of bad eating. We can't shrink from the graphic understanding of how a clogged artery kills the heart or what diabetes does to destroy kidneys, eyes and limbs. Second, we need a public campaign to demand that food manufacturers be prevented from marketing junk foods to kids. Third, public outrage must demand better food from food makers. Fourth, we must reward good health and healthy behaviors with incentives in our insurance premiums and at work. Fifth, we must work in our own communities to bring in healthier food and to tamp down the proliferation of fast food and chain restaurants. I'd personally love to see supermarkets divide their stores into processed and minimally processed sections so that anything bought in one area would contain no more than one to three ingredients, none of which was an additive. 

The list could go on endlessly. Parents are a vital part of the equation, but will be unable to control the problem without much broader public strategies. The problem is in the larger culture, of which each home is simply a greater or lesser reflection.

 

Care to weigh in on this one?

 

Got Eudaimonia? Beyond Diet and Lifestyle Change

by Barbara Berkeley, MD

" The ancient Greeks called it eudaimonia, and positive psychologists have adopted the term to refer to the kind of profound satisfaction and meaning one derives from raising children, training for an Olympic event, completing a college degree or helping your neighbors rebuild after a disaster. " ( NY Times, "Get A MidLife", 1/8/12)

 

It's a gift from the ancients!  Today's New York Times introduced me to a word I've needed and searched for; a word to take the place of the weak and poorly descriptive phrase:  "lifestyle change".  One of my early blogs on this site complained about the fact that dieters dutifully repeat a rote phrase when asked why many diets ultimately fail, "It can't just be a diet," they say, "it has to be a lifestyle change."  

Whatever that means.

 While every successful maintainer I've every met has definitely altered his/her lifestyle, the phrase "lifestyle change" is not sufficient to describe the accomplishment, nor does it provide any specifics about what that change included. Some time ago, I asked readers to come up with words that better described the experience of maintenance and that included the profound sense of transformation and accomplishment that seems to go with it.  But no words seemed strong or specific enough.

Today's NY Times has an article about modern middle age, it's drawbacks and it's benefits.  Among the good things middle-agers experience is more frequent EUDAMONIA: a sense of having accomplished something truly profound.   Bingo!  I believe that eudamonia is what separates those who just diet from those who become different people at the end.

Look at the Silly  Season ads that currently fill our airwaves and magazines.  What's the message?  That diet is about fitting into smaller clothes.  That dieting is painless and can be accomplished by eating the very same foods that the SAD equates with pleasure. (Nutrisystem: Features "butternut squash ravioli", "double chocolate almond cookie").  Who are the spokepeople?  Often, they are celebrities who have long histories of gaining and losing weight.  Chances are you wouldn't believe that Oprah or Kirstie Alley had found the secret to weight loss unless they had managed to stay at lower weights for a very significant amount of time.  What are the attractions?  Women in tiny jeans and lots of makeup.  It's pretty superficial when compared to the significant tasks that anchor weight maintenance. 

What creates eudaimonia?  Achieving something big, meaningful, and real.  To do this, we need to go several steps past the usual suggestions.  Here's an example:  a weight loss tip from US magazine: "When baking, replace oil with applesauce".  The same tip for those in pursuit of eudaimonia:  "Stop baking.  Guess what? You'll live."

You can find the comments of eudaimonic maintainers scattered throughout the responses to most online articles on diet.  They generally will describe how they lost the weight and their long term regimen for keeping it off.  There is always a simplicity to it and a pride.  They worked it out!  This has created a deep satisfaction.  

As I always like to say,  losing weight is no more nor less than throwing out the trash at home.  It's great to get rid of it, but it's not a cause for intense, deeply-felt pride.  But if you can turn that nice, clean home into a showplace, a thing of beauty, a place that anchors the neighborhood...now you've got eudaimonia.   

 

 

 

 

 

And More Silly Season....

US News and World Report is now ranking diets.  At the top of their list, diets that promote lots of whole grains, which immediately turn into blood sugar further taxing the damaged insulin axis of those who are overweight.  Remember when good diet sense meant cutting out the bread and pasta?  There was a reason for that:  it worked!  According to the article, the diet NOT to be recommended is the Primal diet.  Better to do Jenny Craig, according to these experts.  Have any of these guys actually tried cutting out starch and sugar and had the experience of decreased appetite, weight loss, and well being?  On what are these rankings based?  January 6th and Silly Season in full swing.  

See the info here, as reported by Medscape:

Report Looks at Best Diets, Easiest to Follow

Experts Examine 25 Diet Plans, Rate Them Seven Different Ways

Kathleen Doheny

 

January 4, 2012 — Who isn't looking for a diet this month? Whether you're resolving to lose weight, eat healthier, or manage or prevent health problems, here's help.

Just out today: the U.S. News & World Report's Best Diets 2012, a rating of 25 different diet plans.

And the winner is?

The DASH Diet (Dietary Approaches to Stop Hypertension), a plan to prevent high blood pressure, took the top spot in the best diets overall category.

Next were:

• Therapeutic Lifestyle Changes (TLC), a diet that's high in fiber and low in fat, developed by the National Institutes of Health, took second place.
• Mayo Clinic Diet, the Mediterranean, and Weight Watchers all tied for third place overall.
  • Mayo Clinic Diet includes foods with low energy density, such as fruits and vegetables, and allows dieters to eat more while eating fewer calories.
  • The Mediterranean plan includes whole grains, fresh fruits and vegetables, healthy fats such as olive oil, and red wine in moderation.
  • Weight Watchers focuses on portion control and encourages plenty of fruits, vegetables, whole grains, and low-fat dairy. 

A panel of 22 experts also rated the plans six other ways, such as best diabetes diet, best commercial plan, and easiest diets to follow.

The entire list is here.

Best Diets: How to Use the Lists

"The diets near the top of the lists are sensible," says David Katz, MD, MPH, founding director of the Yale University Prevention Research Center, and a panel member.

Those on the bottom? "Frankly, we are saying we wouldn't recommend you choose one of those," Katz says.

Diets on the bottom of the overall list include the Dukan Diet, a high-protein, low-fat, low-carbohydrate plan, and the Paleo Diet, which encourages eating like ancient hunter-gatherers, with fruits, vegetables, and animal proteins. Those diets tied for last place.

Still, if a patient asked him how to pick from the lists, Katz would say: "You're the boss. You're in the driver's seat. You can go shopping. I like the idea of empowerment."

Before choosing, think of your priority, says panel member Andrea Giancoli, RD, a spokeswoman for the Academy of Nutrition and Dietetics. Do you want most to eat better? Lose weight? Prevent or manage diabetes?

"We're so fixated on that New Year's resolution of losing weight, we lose sight of the big picture -- to be at a healthy weight and maintain the healthy weight and get the nutrition your body needs," says Giancoli, a Los Angeles dietitian.

The experts rated the diets in six other ways.

Easiest to follow:

• Weight Watchers
• Jenny Craig
• Mediterranean

For best weight-loss diets:

• Weight Watchers
• Tied for second place were Biggest Loser, Jenny Craig, and raw food.
  • Biggest Loser focuses on weight loss and includes fruits, vegetables, lean proteins, and whole grains.
  • Jenny Craig is a commercial program that uses consultants and portion control, among other measures, to help people lose weight and eat better.
  • Raw-food diets focus on eating plant foods in unprocessed or uncooked states.

For best diets, commercial plans:

• Weight Watchers
• Jenny Craig
• Biggest Loser

For best diabetes diets:

• Biggest Loser and DASH tied for first place.
• Mayo Clinic, Ornish, and vegan were next, all tied.
  • The Ornish plan is a very low-fat diet for weight loss and prevention and reversal of health problems such as heart disease.
  • Vegan diets exclude meat, fish, poultry, eggs, and dairy products.

For best diets that are heart-healthy:

• Ornish
• TLC
• DASH

Best diets for healthy eating:

• DASH
• TLC
• Mediterranean

Best Diets? More Advice

Before picking a plan, think about whether it will fit your lifestyle, Giancoli says. If the diet calls for you to prepare food, think about whether you like or hate spending time in the kitchen. If you don't like it, or don't have the time, a plan that doesn't require extensive food preparation may be better.

Get more information on the diet before plunging into it, says Marion Franz, MS, RD, a Minneapolis dietitian and another panel member. A couple of key questions: How successful were people who followed the diet? And, if it's a weight loss plan, how long did they keep off the weight?

"Most people will be successful for the first six months [on a diet]," she says. "The real question is what happens after six months."

If a plan can show you long-term results past that time, that's ideal, Franz tells WebMD.

Think very long term, says panel member Sachiko St. Jeor, PhD, RD, professor of clinical medicine at the University of Nevada. The long haul, she says, often means making permanent diet changes, not changing your eating just for a few months.

No diet is perfect, she says: "All have good, bad, and limitations."

SOURCES:

U.S. News & World Report's Best Diets Rankings, 2012.

Marion Franz, MS, RD, nutrition consultant, Minneapolis, Minn.

Andrea Giancoli, MPH, RD, Los Angeles registered dietitian and spokeswoman, Academy of Nutrition and Dietetics.

Sachiko St. Jeor, PhD, RD, professor of clinical medicine, University of Nevada School of Medicine, Reno.

David Katz, MD, MPH, founding director, Yale University Prevention Research Center.

 

 

More Silly Season....

Here's a great example of Silly Season media coverage.  This article in USA Today is utterly confusing.  The headline shouts that LOW protein promotes weight gain, while the body of the article says that those who ate MORE protein while overfeeding themselves gained more weight.  The recommendations at the end make no sense whatsoever and the whole article is based on a single small study.  Dieters are so overwhelmed with this kind of pseudo info that they don't know what to do next.  Best advice:  ignore this stuff. 

Silly Season

by Barbara Berkeley, MD

In January, the attention of Americans turns to weight loss.  Retailers exploit this interest, displaying towers of shiny new diet books.  The media pumps out stories, offers tips and guidance (the same tips as every other year) and earnestly discusses the ways to make our New Year's resolutions work.  Gyms fill will newbies.  Thankfully, it will all be over in a couple of weeks and those with the serious intent of changing their lives will be able to go back to work undistracted. 

January is an odd time for self renewal.  Yes, the calendar turns a page and we move into a new year.  The business cycle starts anew.  But for a good part of the United States, January is a cold, unfriendly month.  It's hot soup and mashed potato time, the very month when a little extra fat feels good.  In Cleveland, the prospect of heading out for a run through slushy streets covered by slate gray skies is a tough sell even for career exercisers.  

Of course January is weight loss month because it is preceded by the season called, "I Have to Eat It, It's the Holidays".  We have developed an unfortunate cycle of gorging and disgorging on a yearly basis.  This mirrors the shorter cycle we run more frequently throughout the year:  eat things we know we shouldn't, gain weight, then diet to get them off.   The problem, as we are all well aware, is that we eventually reach a point when we can't get the weight off anymore.  We burn out, allow the higher weight to become our new reality and start adding extra pounds to that new base.

I know that I am preaching to the choir, but the reason that weight resolutions and periodic diets don't work is that they have nothing to do with the real work of making oneself healthy.  That little chore requires commiting oneself to a new way of viewing food and to new personal and permanent rules about how to eat.  These rules include guidelines for such things as exceptions.  Over the holidays, some maintainers may allow themselves a certain amount of indulgence for example, where others may stick strictly to their daily plan. But it's programmed.  Flying by the seat of one's pants is a rarity among maintainers, who are well aware that the food winds blow with gale force.  Crashing is likely unless someone has a close eye on the rudder.

January, then, is the silly season for weight loss.   This month's People leads with the popular "Half Their Size" feature.  Here are the amazing before and after photos, the airbrushed picutres of beautiful women in their skinny jeans, and the tantalizing promise that anyone can lose a mere 100 pounds or so.  The guidance for wannabes?  One woman hung a bikini in her garage and looked at it while she worked out on the elliptical.  Another ate a lot of spinach; she suggests you take weight loss 5 pounds at a time. To People's credit, they do provide a section that features subjects of the Half Their Size issue in years past. These successful maintainers look inspiring, but the amount of useful information that accompanies their stories is miniscule.  How are they doing it and what made them able to do what they couldn't before?  That's the information that might help a curious reader, but it's not included.  These features are strictly about the photos.  There's no room for content.  

Us Weekly has a cover that touts "Diets that Work" and suggests that each of us can have legs like JLo and Rihanna's abs.  The diet guidance below each photo of skinny women in shorts and bathing suits is mostly useless. One woman did 2 1/2 hurs a day of karate and boxing while training for a movie (try that after getting home from a day at the office!), another does sessions that "shorten the muscle fibers", a third practices "portion control".  In addition to sparse information, the women in these photos are mostly in their mid 20s, a time when dieting tends to work. What does any of this mean for the 50 year old empty nester who has been struggling with slow and steady weight gain for ten years?  Here's my favorite quote from Us Weekly. It comes from Mariah Carey, who has been up and down the scale more frequently than Kirstie Alley.  Once again she is at a  smaller size and is now a spokesperson for Jenny Craig. Carey says of herself, "I'm extremely disciplined."  Hmmmm.  

Silly season tips abound.  The sillier the better.  Here are a couple of great ones:  Eat with large forks.  Spice soup with pepper.  Put coconut oil in your coffee to "increase metabolism".  Oh my.

If silly season has your head spinning, here's what I suggest:

1. Cover your ears and close your eyes.  There's too much information out there, most of which is ineffectual or just plain wrong.

2. Make a resolution, but not a weight loss resolution.  Instead, resolve to begin the process of making yourself an all around healthier person, someone who will feel good and live well over an extended lifespan.

3. Pick a time of year when you will begin.  It doesn't have to be tomorrow.  It does have to be a time when you won't have immediate challenges from food....challenges like weddings, cruises, or birthdays.  Give yourself a month when you aren't forced into situations when food is likely to win.  Start with some breathing room in front of you.

4. Resolve to try eating a diet of real food, pretty much as it comes from the earth or its animals.  Unless the food in a can or package is original and not adulterated with "stuff", don't eat it.  If you are looking for weight loss as a part of this renewal, stop eating sugars, potatoes, and starchy foods like grains and the things made from grains (cereal, bread, pasta, flour based baked goods).  

5.  Read books, articles and blogs that further your knowledge of eating style.

6. Start looking around for a kind of sustained physical activity that you think you would enjoy once you mastered it.  Start doing that thing at a beginner level and without significant challenge.  Work up.  If you do it for three months and don't like it, start over with something else.  

7.  Observe yourself and take note (either mentally or in written form) of your progress along the way.  Does your skin look better?  Do you feel happier?  Do you have more energy?  Are you less anxious?  These are all results that have been observed after changes in the way people eat and live.  

Silly season can be fun if you don't take it too seriously.  Within a week or two, most of America will be back to its predictable cycle of weight gain and periodic dieting.  Be bold, and head off in a different direction.  Happy New Year!