Originally published in The Ottawa Citizen February 6, 2002

“The Hurst may have changed, but it’s the same old fanny.” – Franklin Delano Roosevelt commenting to novelist Fannie Hurst’s change in appearance after dieting.

We learn from experience that men never learn from experience. – George Bernard Shaw

Most diets do not work. Despite logic and nutritional science, the voices of dieticians and other health professionals specializing in healthy weight care are not heard. Rational approaches to weight loss which usually require discipline and a permanent change in lifestyle are incongruous with fad diets which promise easy and rapid results. Diet plans, books and weight loss centres are big business: in the United States, 40 to 60 billion dollars per year.

Images abound of what the ideal woman’s body should be. Although the media and advertisers are major contributors to this abnormal perception they are not alone. Peruse the women’s clothing stores in the malls. The average size of the clothes is six to eight or eight to ten depending on the store. Half of all women in the US measure size 16 or over. Imagine how this affects their self image when shopping for clothes. Would they think differently if the average clothes size was 14 to 16? Instead, the message is to lose weight regardless of necessity. Even store mannequins have become thinner over 40 years!

All this is not lost on adolescents. A recent visit to a Canterbury High School class of 15 year-old girls exposed this maddening and frustrating problem. Most of the girls expressed dissatisfaction which some part of their body. They felt they were overweight when it was obvious that they were normal or even underweight. Many were dieting or skipping meals. They reported how even a casual negative hallway comment about their appearance from a complete stranger devastated their self image. Counterarguments to encourage a more balanced body image perspective did little to change their attitude.

The science behind weight loss is straightforward. Weight loss occurs when the body consistently uses more energy per day than it takes in. It is the application of this principle that is difficult for many people due to physiological, behavioural, and geographical factors.

There is evidence that a fat regulatory center exists in the brain called an “adipostat”. Its main purpose is to keep the body within a predetermined weight range. When the body loses fat, it slows metabolism to increase fat stores; gain weight and metabolism increases to burn off the fat. It can be overwhelmed by extremes at either end of the food intake spectrum.

Geography and genetics play a central role in body type and weight. Witness what is happening to our Native People. Their culture, lifestyle and diet were interwoven with their environment. Obesity and diabetes were rare until Western dietary influences and a disruption of their way of life upset this balance. Their genetic predisposition to diabetes is triggered in part by the reduction of physical activity and the change in the type, quantity and quality of food now available to them.

How many fruits and vegetables do you eat daily? How many slices of bread? Do you eat cereal in the morning? How much pasta and rice per week? What about red meat, chicken and fish? Are they fried baked, broiled or barbequed? Is the chicken skinless? How many eggs per week? How much milk per day and what is its fat content? Do you eat cheese, use butter or margarine? How many times per week do you go out for fast food? How many chocolate bars, cookies, ice cream, nuts, sugared soft drinks and potato chips are consumed each week?

When reviewing patients’ dietary habits, look for unnecessary calorie sources. Many people consume foods high in fat. Chips, cheese, fast food and chocolate top the list. Instead of dramatic changes in one’s diet, a reduction in these calorie dense foods can to lead to similar results. One pound of fat’s energy equivalent is 3500 calories. If your weight is stable, a minimal change in intake coupled with exercise can produce long-term benefits. A reduction of 100 to 200 calories per day (about 3 slices of processed meat or half a chocolate bar or 20 potato chips) combined with exercise three times per week can lead to a pound or two of weight loss per month. Within a year 20 pounds can be shed. Using smaller plates or removing 25 percent of what’s on it before sitting down to eat can reduce food intake. Wait 20 minutes after a meal before considering seconds.

This approach is sustainable because it can lead to long-term lifestyle change that is acceptable to many people. Fad diets by their very nature imply a radical change in a person’s eating habits. Despite the promises of fast results and indeed many fad diets produce rapid weight loss; their long-term success is poor. A review of fad diets over the past 30 years show people regained their weight and more because they reverted to old habits.

There is no one solution for all people. Consult a registered dietician for a well thought out approach to healthy eating not some fast talking salesperson peddling the latest “scientifically proven” fad diet or food supplement store clerk.

The guilt, anguish and obsession that accompany diets make no sense. Give yourself a treat day every 10th day. The goal is to be happy and healthy, not to feel miserable getting there.

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© Dr. Barry Dworkin 2002