Why do we keep forgetting that diets must be personalized? Sure, many diets allow the dieter to choose between eating yogurt and cottage cheese, between ordering poached chicken breast or poached salmon for dinner or deciding to snack on an apple or a pear. This is so the dieter feels that he or she has control over what and how much is eaten. But books (mea culpa, including mine), commercial weight-loss programs, and even diet plans at a doctor’s office rarely formulate regimens to fit the gender of the person, much less the starting size or the amount of weight that has to be lost. Nor are the degrees of daily physical activity, sleep and work patterns (i.e. day time work versus shift work) and myriad other factors considered.
My own culpability in this was evident is a recent email from a male dieter wondering why he was so hungry on our Serotonin Power Diet. It turned out that he needed more to eat; he was quite tall and exercised vigorously every day so the additional calories in the male version of our diet were not enough to take away his hunger. Of course I added more calories in the form of protein and extra servings of carbohydrate, once he told me of his problem.
No one should be hungry on a diet.
But many people expect to be. Often I will hear the remark, “Well, after the first two or three days, the (whatever plan it is) was tolerable.” Sometimes the nature of the plan itself, such as a fast or cleanse, makes immediate hunger unavoidable. But diets that are going to be followed for more than five or six days should not start off causing hunger because of a gigantic decrease from the calories consumed before the plan begins. If someone has been consuming 6000 or 7000 calories a day, decreasing to 1500 is akin to semi-starvation. A personalized plan would be a step-down process in which calorie intake is decreased slowly in keeping with a reduction in weight and stomach size.
No one should expect that a diet plan for an average-size woman who has to lose 40 pounds would be tolerable for a Julia Child-size woman (she was over six feet) who is very physically active. Nor should a diet plan for a typical male (Julia Child size) who works on a construction site be given to someone six inches shorter who works as a tax accountant.
Meal size and timing should also correspond with sleep/wake/work patterns.
We assume, wrongly of course, that everyone eats three meals a day at roughly the same time, and most diet menu plans are based on this assumption. I learned very quickly how ill-fitting a daytime work-diet plan is when consulting with several people at our weight-loss clinic who worked evening or graveyard shifts. Should someone who works from 11PM to 8AM eat dinner at 7PM? What if he is just waking up? What about hospital, law enforcement or traffic control staffers who get off work at 11PM and do not go to sleep until 4AM? Should they eat breakfast or dinner before they go to bed? Does the off-repeated mantra of not eating late at night because you will gain weight apply to such people?
Customary eating patterns and reasons we overeat are rarely considered when handing out a diet. Should you tell someone to eat breakfast who cannot put anything in her stomach before noon? What about the individual who goes to sleep at 2AM? If he eats dinner at 6 or 7 o’clock at night, won’t he be hungry by the time late evening comes around? And if eating to decrease stress characterizes the eating habits of the dieter, the diet must find foods that this person can eat which decrease stress and still allow weight loss. Otherwise, once the stress becomes sufficiently severe, the diet will be abandoned. (This may be one reason why people gain weight after bariatric surgery. The operations reduce the size of the stomach, but do not take away the mind’s need to eat when upset.)
Fitting the treatment to the individual is an effective approach to treating cancer and other diseases. Perhaps it is time to use this approach for weight loss. When someone in a weight-loss program announces, “This diet is not working for ME!” it is wise to listen, figure out what is wrong and alter the program. We should not assume failure to lose weight is always the fault of the dieter.
Personalizing a diet is labor intensive and does not lend itself to prepackaged meals or packaged instructions on exercise or how to decrease stress. It doesn’t fit the use of various apps or following so-called reality weight-loss TV shows. It requires an active interaction between the dieter and the advisor; the dieter must be honest and forthcoming about his or her eating problems, exercise, work and sleep patterns as well as social and even financial issues. Then the advisor must be willing to alter, even drastically, eating, exercise and support plans to meet the dieter’s personal needs.
This is expensive and time consuming. But considering how little is working these days to reverse the increase in obesity, perhaps it is time we tried this approach.