Will the “Diet Debate” Ever End?

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One of the joys (and burdens) of being a dietitian is the feedback that I get about the merits and pitfalls of various types of diets. Some people ask about certain types of diets because they’re curious or because they want to lose weight/manage their diabetes/live longer, etc. Other people take a firm stance or position (often zealous in nature) that the “X” diet (fill in the blank here) is really the ONLY diet to be following if one wants to lose weight or lower his blood glucose. They’ll argue and sometimes, I admit, become rather rude and dismissive if I or others won’t jump on their particular bandwagon.

Then, there are the health-care professionals, be they doctors, nurses, pharmacists, psychologists, or, yes, even other dietitians, who fully subscribe to a particular diet, eating plan, or way of life. Some are proponents of a vegan lifestyle (think Dr. Neal Barnard). Others eschew practically all carbohydrate (think Dr. Pierre Dukan) or maybe just particular carbohydrate foods, such as grains and dairy, for example (think Paleo diet).

Some health-care professionals (including dietitians) are more mainstream, meaning that they realize and recognize that there isn’t just one approach that will work for everyone — when it comes to weight and diabetes management, that is. Which brings me to the topic of this week’s posting: Will the diet debate ever really end?

One viewpoint
This past summer, a “viewpoint” appeared in the August 21 edition of The Journal of the American Medical Association. The title of this viewpoint was “A Call for an End to the Diet Debates” and was authored by Sherry L. Pagoto, PhD, from the Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, and Bradley M. Appelhans, PhD, from the Rush University Medical Center in Chicago. Until I read this article, I had never heard of either one of the authors.

A Google search revealed that Dr. Pagoto is an associate professor of medicine and also a licensed clinical psychologist, providing weight-loss counseling. She’s authored numerous papers and has published a book, as well. Dr. Appelhans is an assistant professor of medicine and is a practicing psychologist and obesity researcher.

Their opening sentence is,

As the obesity epidemic persists, the time has come to end the pursuit of the ‘ideal’ diet for weight loss and disease prevention. The dietary debate in the scientific community and reported in the media about the optimal macronutrient-focused weight loss diet sheds little light on the treatment of obesity and may mislead the public regarding proper weight management.

The authors go on to state that despite the numerous types of “diets” out there, such as low-carb, low-fat, and Mediterranean, the differences in weight loss and metabolic risk factors are really very small, and that conducting more studies on these diets will likely not produce findings that would “significantly advance the science of obesity.”

Adherence is the key
Let’s face it — any type of diet, or, if you prefer, lifestyle approach, will work — that is, if you stick with it. Certainly, some approaches may be more effective than others, based on their macronutrient composition. For example, a higher-protein eating plan may be more satiating, or filling, so you probably would be more likely to stay with it longer. But, unless your goal is to quickly drop 20 pounds so that you’ll look good for your vacation, most people aim for keeping the weight off (and managing their diabetes) long term. The authors of this piece write that the most important question is not which diet is best, but rather, how to improve behavioral adherence. It’s not glamorous or exciting, but I have to agree with them.

And lest you be skeptical, know that lifestyle interventions (healthy eating, physical activity, and behavior modification) can be sustained. The Finnish Diabetes Prevention study, the Diabetes Prevention Program, and the China Da Qing Diabetes Prevention Study all showed that interventions can and do last a long time.

Cutting out carbohydrate or subsisting on green juice drinks will only get you so far; for any of the benefits to be long-lasting, you need to examine other areas, such as how much exercise you’re getting, along with your eating habits and patterns. Without also addressing these, your chances for long-term success dwindle. Therefore, should research dollars continue to be spent on analyzing the ideal macronutrient composition of the ideal diet? Or would they be better spent on finding ways to help people be more active, adopt healthier behaviors, and be able to stay with a plan for the long haul?

So, what IS the best diet?
That’s the million-dollar question, isn’t it? Part of the answer has to do with what you’re following the diet for — weight loss, diabetes, allergies, celiac disease, etc. However, if you have Type 2 diabetes and are overweight, a plan that helps you lose weight will also very likely help you control your blood glucose. So, back to the question. I’ll give you my standard answer: The best “diet” (I prefer the term “eating plan”) is one that you can adhere to long-term and one that provides you with the nutrients that you need to support and sustain health.

As Pagoto and Appelhans write, behavioral adherence is much more important than dietary composition. There’s no single, effective approach to weight management or diabetes management. The ADA 2013 nutrition recommendations were just issued, and they clearly take the position that there is not a “one size fits all” eating pattern (new terminology) for people with diabetes. Hopefully we can recognize that there are many eating approaches that can work for people who need to lose weight and/or who have diabetes. Many factors play a role in what approach a person will take and what approach is truly the best for him.

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