Getting Through the Mire of Fad Diets

1. Getting Through the Mire ofFad Diets Susan Woods, MS, RD,LD Consultant Dietitian & Doctoral Student, OUHSC

2. Objectives • Understand why are Fad diets so popular • Understand the Problems with Fad Diets • Be able to quickly evaluate a diet as Fad/Bad • Guide clients in the right direction

3. Obesity Trends* Among U.S. AdultsBRFSS,1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2000 1990 2010 Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

5. Why do People Even Consider a Fad Diet? • Few people WANT to be overweight • Quick & “easy” fix • Whatever they’ve been doing isn’t working • Solutions are drastic

6. Why do People consider Fad Diets? (cont’d) • It takes 3500 kcalories to lose one pound of fat • Weight in pounds x (factor)= kcals to 2.2#/kgkg maintain weight Activity Factors: 20 – signif overweight/or sedentary 25 – average activity 30 – moderately active 35 – active

7. Vicious Cycle

8. What’s the problem with Fad Diets? • Fad diets are short-term solutions; they don’t address the long-term problems • Initial, quick loss may be only water/fluid • They are probably not nutritionally adequate; usually eliminate or limit a food group • They get expensive – you need to buy a product

9. What’s the Problem? (cont’d) • It’s hard on the body – missing nutrients, restrictive kcalories • It’s hard on the client’s motivation – short term success & then regain

10. Typical Characteristics of Fad Diets • Sounds too good to be true (“lose 25# in 1 month) • May require an expensive supplement or specialty food products • Restrict at least one food group or nutrient • Have requirements that the dieter can only tolerate following for a short period of time • May discourage exercise • Bases evidence for effectiveness only on quotes from other dieters

11. Gluten-Free • Negatives: Only works if client has gluten-sensitivity, may restrict fiber, can be expensive, may involve a significant amount of cooking from scratch • Positive: may encourage people to eat more fruits and vegetables • Example: South Beach Diet Gluten Solution, Wheat Belly Diet

12. Least Processed Foods • Negative: May be too difficult for most people to do on a regular basis -> eventual noncompliance • Positive: encourages people to eat less processed food • Examples: PaleoDiet (Caveman), Ultimate Weight Solution Diet

13. Low Carb • Negative: restricts fruit, milk/dairy, some vegetables & grains • Positive: quick results, discourages refined grain products, less kcalorie restriction • Weight loss most likely due to kcalorie restriction; greater weight loss @ 6 mo, but no greater loss by 12 months (N Engl J Med 2003) • Examples: Atkins (older version), South Beach, 4-Hour Body, The Dukan Diet, The Ultimate New York Diet • Success: < 12# @ 2 years (Atkins) (Foster et al. Ann Intern Med 153 (2010))

14. Glycemic Index • Theory – eating low glycemic index foods decreases blood sugar & hunger • Problem – how do clients know glycemic index of every food; once food is mixed with others at meal, the overall G-Index changes • Examples – Glucose Revolution, NutriSystem, The Bread for Life Diet

15. Dairy Products • Inverse relationship between dietary calcium intake (more effective from dairy products than supplement) and body weight (NHANES I) • Whey protein & casein – possibly some research supporting the benefit in weight loss • Other studies support this information: (McCarron, DA (1983) Ann. Intern Med; Pereira, MA, et al. (2002) JAMA); Davies, KM (2000) J ClinEndocrinolMetab; Zemel, MB (2004) Am J ClinNutr; Heaney, RP, et al. (2002) J Am CollNutr)

16. Severely Low Fat • Severely Decrease animal & vegetable fat in diet • Problems – may provide inadequate essential fatty acids • Examples: Ornish Diet • Success rate: 4-6# at 12 months (Dansinger et al. JAMA 293 (2005))

17. Vegetarian Diet • Positive – has been associated with decrease: obesity, cancer, heart disease & blood pressure • Negative – may not get all essential amino acids, difficult for some to adhere to • Examples: Vegan, Aggregate Nutrient Density Index (ANDI), Vegan Before 6pm • Success rate: 2-7# @ 2 years(Turner-McGrievy et al, Obesity (2007))

18. “Body Confusion” • By changing plans, your diet creates body confusion, resulting in weight loss (may be based on same theory as changing exercise) • Examples: The 17 Day Diet, The FastDiet (eat 25% for 2 days/week), The 4 Day Diet

19. Plans Perceived as Confusing • The plan is usually so intricate that most dieters will eventually give up due to the time it takes to follow • Examples: The Zone, You on a Diet, The Sonoma Diet, Ultra-Metabolism • Success rate: 3# @ 12 months (Zone) (Gardner et al. JAMA 297 (2007))

20. Pills • Alli (Orlistat) • Claim – with Alli & a healthy diet, for every 2# lost thru diet & exercise, Alli will help you increase that to 3# • can cause GI upset, diarrhea • only works if diet has moderate amount of fat, may cause malabsorption of fat-soluble vitamins • Others – usually do not use science but reported results to attract buyers

21. Supplements • Chromium – supports a healthy glucose level & carb metabolism • Raspberry Ketones – no scientific evidence to support use • HCG (human chorionic gonadatropin/ produced during pregnancy) – expensive, highly restrictive in kcalories, discourages exercise

22. Supplements - caffeine • General – is a stimulant that can support increased metabolism • Green Coffee Extract – claim: may encourage metabolism of fat; also contains caffeine; chlorgenic acids may be a source of antioxidants • Green Tea – may support healthy glucose levels & metabolism • Guarana – South American fruit containing high levels of caffeine

23. Surgery • Stomach or Bowel Resectioning • Negative: very restrictive in type of food that can be eaten at first, eventually client may find ways to intake kcalories(milkshakes, etc), risk of infection • Positive: clients enjoy rapid weight loss

24. Programs • Negative: don’t always teach LONG-TERM changes, can be expensive, high drop-out rate • Positive: pulls people out of poor eating habits, usually meets standard nutrition recommendations • Examples: Weight Watchers, NutriSystem, Biggest Loser, Jenny Craig • Success rate: 7# @ 1 year (Weight Watchers) (Dansinger et al. Jama 293. (2005))

25. Sea Salt • Sodium content is same as table salt • Minerals: may contain small amounts of some trace minerals, depending on the minerals found in the water where it comes from

26. Protein Powders • Problems: Most Americans already get enough/too much protein

27. What Makes up a Good Weight Loss Plan? • Focused on the individual’s needs – evaluate for problem areas • Makes small changes that can be continued • Focuses on slow weight loss • Includes all foods but controls portion • Encourages exercise

28. What’s Realistic?

30. What should I recommend? • Don’t feed the fad craze • Focus on positive changes for health – exercise, good food choices, small portions • Avoid deprivation • Focus on small successes that are maintained • A fit person who is overweight usually has lower health risk factors than a thin person who is not fit

31. Resources • www.eatright.org/media (Academy of Nutrition & Dietetics) a lot of write-ups on current fad diets • “High protein, low-carbohydrate diets: Do they work?”JAmer Dietetic Assoc, July 2000. (has “what you should tell your clients?”) • Clifton, P. “The science behind weight loss diets: A brief review”. Australian Family Physicians, Vol 35: 8. Aug 2008 • Table showing long-term results: MakrisA, Foster G. “Dietary approaches to the treatment of obesity”. Psychiatric Clin of North Amer, 34:4, Dec 20110.

32. Questions