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From Snake Pit to Snake Oil: Diet Regimens

Are we still "beating the insane to keep them quiet?"

Wikimedia Commons, Public Domain, screenshot from trailer, 20th Century Fox
The film "The Snake Pit"
Source: Wikimedia Commons, Public Domain, screenshot from trailer, 20th Century Fox

Back in the late 1970s, obesity researcher, Jules Hirsch of Rockefeller University, suggested that the dietary regimens to which the obese were then subjected were "the modern day equivalent of beating the insane to keep them quiet." In other words, those regimens, analogous to "snake pit" asylum treatments, did not work very well and were perhaps even overtly cruel, and if they did work, the results were short-lived and hardly curative. Today, all these years later, many people still, looking for a quick fix, subject themselves to the cruel and unusual punishments found in nutritionally unbalanced crash diets, often with severe caloric restriction (e.g. 800 to 1000 calories/day), that promise substantial weight loss in a relatively short time. What these misinformed people end up losing is lean muscle and water rather than fat. There is no quick fix to dieting. For those who want to maintain weight loss over time, a diet must become a way of life, a "regimen," not a short-term endeavor.

More recently, Dr. David Katz, Director of the Prevention Research Center at Yale, and author of one of the most comprehensive books on nutrition, called Nutrition in Clinical Practice, conducted an extensive survey of the "seemingly limitless" possibilities for weight loss. Katz found a "prevailing gullibility" among the public who seemed "beguiled" and generally willing to suspend disbelief when it comes to promises of weight loss. In other words, many people, believing in the equivalent of snake oil, will accept any weight loss claim at face value, no matter how seemingly preposterous. In his review, Katz, incidentally, found no evidence that any diet approach, other than sensible calorie restriction, is superior to any other when we are talking about "sustainable weight loss." But, as most dieters appreciate, dieting by extreme calorie restriction is not only "intrinsically unsustainable" over time, but also downright dangerous. Incidentally, a recent long-term study by Sacks and his colleagues reported in The New England Journal of Medicine confirmed that calorie counting, rather than any specific percentage of protein, fat, or carbohydrates, is essential for weight loss. With that said, I do believe it is also likely that we will eventually isolate genetic factors that will determine what percentages of protein, fat, and carbohydrates work best for a particular individual. with permission
Source: with permission

Some general principles to maintain a healthy diet regimen and avoid either snake pit tactics or snake oil salesmen:

--Maintain a consistent caloric range (depends on weight goals, activity level, height, weight, frame, gender) on all days (weekends and holidays included)
--In general, avoid fasting and very low calorie (800 cal/day) diets unless under medical supervision; (for some, the faster the weight loss, the more likely weight regain)
--Eat foods high in fiber (about 25 grams/day)
--Maintain low fat intake (25 to 35% of daily calories) with particular restriction of saturated fats (e.g. red meat) and avoidance of trans fats that are particularly heart unhealthy (often found in processed foods to prolong shelf life). Some diets suggest very low fat intake (about 10% of daily calories), but if a diet is too low in fat, it is hard to maintain over time
--Eat low glycemic foods: that is, carbohydrates that release insulin slowly (e.g. brown rice, steel-cut, slow-cooked oatmeal rather than white rice or instant oatmeal) (note also the actual percentage of carbohydrates in a food, the so-called glycemic load) and avoid processed carbohydrates that come in packages
--Avoid foods sweetened with high fructose corn syrup (unnatural glucose-fructose combination)
--Avoid foods with chemicals, even if labeled "natural"--read all labels
--Eat lean protein (certain proteins more satiating than others and digestion of protein uses more calories than either carbohydrates or fats)
--No more than 2 glasses of wine/day (red wine has antioxidant resveratrol), but alcohol can increase appetite, as well as make someone lose track of how much eating (and alcohol is preferentially oxidized so fat is stored rather than burned)--Avoid foods that trigger you to eat more

--Eat breakfast daily and aim for three meals/day (preferably at same time each day); dinner should be smallest meal and avoid eating later in the evening

--Eat slowly (to increase sense of fullness)
--Always remember portion control (avoid "portion distortion" (Wansink))
--Monitor food intake daily (keep food diary)
--Weigh self daily or at least weekly-importance of accountability
--Exercise regularly (to maintain substantial weight loss, more than one hour/day of moderate aerobic exercise for cardiovascular fitness; in addition, flexibility for balance; and resistance, strengthening for preservation of lean muscle
--Remember all physical activity burns calories, including maintaining posture, fidgeting, even chewing gum
--Know your own zones of vulnerability: multi-task eating (eating while working or driving); overeating in particular situations (e.g. restaurants or parties); bingeing at certain times of day
--Sleep more than 6.5 hours/night but less than 9 hours

For more specific details, please see my book, The Gravity of Weight. (American Psychiatric Publishing, Inc. 2010)