Fighting Fear

Confronting phobias and other fears

Diets and More Diets

Especially weight-loss diets

          Many different diets have been promoted for weight loss. Most of them seem to be based on the idea that certain foods control appetite better than others. These diets are peculiar in the sense that they deviate significantly from an ordinary diet. That is what makes them interesting commercially. They suggest that there is a previously unknown, relatively simple, way of losing weight. They are all ineffective, and some are out and out dangerous. They work, when they do work, by boring the dieter. If you can eat all the ice cream you want, but only ice cream, you end up eating less. Even someone who likes ice cream doesn’t like it all the time—the same with steak, or eggs, or whatever. Usually, people stick with these narrow diets only briefly and then go back to what they were eating previously. If a diet is narrow enough, and the dieter is stubborn enough, some of the great number of essential nutrients the body requires will inevitably be left out. I have seen a case of’ pellagra, rare in this country since the turn of the Last century, because of a self-imposed dietary restriction. People have died by sticking stringently to diets they considered healthy.

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There are other diets marginally less restrictive that have become popular only to be succeeded by another emphasizing an almost opposite approach. There are high fat diets and low fat diets, high carbohydrate diets and low carbohydrate diets. There are high protein diets and low protein diets. Each has a somewhat different rationale. Each diet has had some success. I think the reason they succeed, at least for a while, is that they are recommended by enthusiastic and sometimes charismatic proponents, usually in a group setting in which the person dieting receives a lot of attention and support.

Everyone has an emotional stake in making the diet work. And it does. For a while. Keep in mind that a diet that leads to an average weight loss of only ten pounds over the space of six months would be considered wildly successful.

Let us imagine a new diet that is going to be proposed next week by a scientist working secretly in his basement laboratory. It will be called the “Spinach Diet” because it recommends spinach morning, noon and night. And in the afternoon. It is a special spinach that he has grown in the basement with a special light. Let’s say this diet works beautifully without turning the dieter green. (Too many carrots will turn a person orange. Too many tomatoes will turn him red. No kidding. Carotonemia, and whatever condition it is you get from eating too many tomatoes, tomatonemia, perhaps, are entirely safe.)  The spinach dieter loses weight quickly before he tires of the diet and runs off to the nearest Burger King.  He reaches his proper weight.  And then what?  How does he make the transition to a normal diet without gaining all the weight back?  The problem with all unbalanced diets is that they come to an und, inevitably, without the dieter learning how to ear normal food in the company of normal people.  The trick is not to lose the weight, which can be accomplished sometimes by an effort of will, but to keep it off.

There is another diet commonly recommended by doctors and others who recognize the deficiencies of an unbalanced diet: “Eat less.” I take this to be a sign of indifference when offered up by a doctor, since the doctor knows the fat person he is talking to cannot, or will not, eat less. Besides, the implication is that the overweight person has been overeating – “pigging out” is the expression one physician used; and that may not be the case.  Some people eating exactly as much as some others will gain weight while the others will not.

Doctors tend to feel frustrated advising obese individuals.  They usually comment perfunctorily that their patient should really lose weight, and they give three or four health reasons to do so.  Once he has said that a few times, he can think of nothing else to say without seeming to nag.  He may recommend a visit to a nutritionist.  Actually, psychiatrists have more time than other professionals to talk about these matters; but a referral to a psychiatrist might be construed as insulting.  Sooner or later psychiatrists too get to a point where there is nothing else to say.  Recently, when I told a woman about some new information about weight-loss surgery, she looked at her watch and said “twenty-five minutes.  A new record,” meaning that I had gone twenty-five minutes into the session before reminding her that she was fat.

There are some people, of course, who do naturally eat less than others; and they are not fat.  But you cannot get to be that kind of person by an effort of will.  They naturally feel full, if not stuffed, while eating less.  Whatever the reason is, it is not because they control themselves better than people who are fat. The same can be said about other indulgences, for that matter Alcoholism, for example. Most people cannot become alcoholics, because they feel bad when they have more than two of three drinks. They have to fight to stay awake. Similarly, some people cannot become fat because eating too much is unpleasant. By the way, I think parents telling their kids they are too fat over and over again is a waste of time and likely to spoil their relationship with their children. Kids get fed up with their parents just as overweight people sometimes get fed up with their doctors. This is not to be construed as an endorsement of being fat.

There are other weight loss programs that skip dieting advice; they simply make all the food themselves and deliver it to your door. In such a way, the dieter avoids the pitfalls of deciding for himself what he should eat. Presumably, his judgment is deficient. He would probably be the first to agree. But what happens when the diet comes to an end? How has he learned to eat properly for the rest of his life?

There are other diet programs that have two important elements: dieting in a group context—which works for a while, but usually only for a while-- and calorie counting. Similar programs involve prescribing foods or food groups in exact and somewhat arbitrary proportions. In a way, this last group of diets represents another kind of calorie counting. And calorie counting emphasizes the wrong elements in a diet. The right element is to eat properly and to exercise.

In order for a diet to be successful, it has to lead to a permanent weight loss. It must include a life-long exercise program-- since exercise does much more for health than simply to cause loss of weight. Exercise has an effect on mood and on cognition, and on many other aspects of health.

A successful diet is measured by how well a person sticks to a proper diet and by how well that person adheres to an exercise program, and not by what the scale says from day to day, or even week to week.

The diet that is statistically associated with longer and healthier life is the Mediterranean Diet, which emphasizes olive oil over butter fat, and fish over meat. And vegetables. Especially vegetables. The particular variation I recommend in “The Stuff-Yourself Diet,” emphasizes soups, salads and cereals.  The basic principle requires that people eat when they are hungry. It is not possible to go through life hungry. Proper dieting must include eating when hungry. It is not possible to diet forever by an effort of will alone.  (c) Fredric Neuman Follow Dr. Neuman's blog at fredricneumanmd.com/blog/ or ask advice at fredricneumanmd.com/blog/ask-dr-neuman-advice-column/

 

Fredric Neuman, M.D. is the Director of the Anxiety and Phobia Center at White Plains Hospital.

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