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Beware of DietWhat if counting calories makes you fatter in the long run?

By Sydney Spiesel
Posted Wednesday, July 4, 2007, at 8:25 AM ET

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It showed that adolescents who diet are more likely to engage in future binge eating. But this doesn't rule out the worrisome possibility that dieting also alters the body's metabolism so that calories later cling more tenaciously.

Does dieting have other health benefits? In the short-term, yes. Many brief trials have shown the benefit of diets for people at risk for type 2 diabetes and osteoarthritis, and for lowering high blood pressure. For the limited time that they reduced their caloric intake, patients with these conditions realized real gains.

The problem is that the benefits are erased by the typical return of those stubborn pounds. And as with the higher-than-ever weight gains, the aftereffects of dieting may cause additional basic health problems. Weight cycling—the common up-and-down yo-yoing of the scale—seems to have especially pernicious effects and is associated with higher blood pressure and heightened risk for heart attack, stroke, and diabetes.

What to make of all this? Mann's analysis casts serious doubt on the value of dieting for weight control. In my pediatric practice, I've become increasingly reluctant to push dieting on children, even very heavy ones. Though it's contrary to my own years-long cultivation of sloth, I am coming to believe ever more strongly in the value of pleasurable exercise for weight control and for independent health benefits, as demonstrated in innumerable medical studies. The problem, of course, is persuading the noninclined of the "pleasurable" part.

Ultimately, I think we need to start at the other end: by preventing kids from putting on excess weight in the first place. There's no easy fix, but in addition to increasing exercise, we need to somehow encourage families to shop and live differently. Perhaps we need to devise new kinds of calorie-limiting diets that don't make people feel deprived, because the hard fact is that they should never stop dieting. And, of course, we all hope for a magic pill to come out of the huge body of research now devoted to understanding how hormones regulate appetite and how the body's weight thermostat is controlled.

One other possibility. For a few people, dieting is effective. In one recent study, although more than 90 percent of the participants were no thinner after a year (and may gain more weight as time passes), about 7.5 percent continued to lose weight. Maybe we need to figure out just what contributed to these unusual success stories—and then find a way to apply it to the rest of us.

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Sydney Spiesel is a pediatrician in Woodbridge, Conn., and clinical professor of pediatrics at Yale University's School of Medicine.
Photograph of a woman on a scale by Digital Vision.
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Remarks from the Fray:

Its a flawed belief to think that everyone can be physically fit, we don't all have the same motivations, lifestyles, nor do our bodies work the same way. Some people are more adept at burning calories naturally, some just can't seem to shed weight no matter what they do. I think its important that people recognize that fat people aren't necessarily gluttons. But I believe fat people need therapy - the same kind of therapy given to bulemics, anorexics, and other people suffering from eating disorders. More importantly, I think they need simple understanding from the people around them - not bigotry, condescension, or quick fixes - like diets.

--Eigenvector

(To reply, click here.)

Though I've read about the high failure rates of dieters, my anecdotal observations refute this. I know more people who have lost weight and kept it off, then who have yo-yoed or failed to lose weight. Though those who lost weight tended to be closer to a normal weight to begin with, and had at some time put on extra weight; while those who were heavier from the onset, seemed never to be able lose weight.

I simply don't believe that our increasingly heavier population is incapable of slimming down. There are more variables than just diet. If the person is heavy and rarely exercises, then exercise should be added to the equation. I'd also wonder if there are other factors, such as stress, that make it difficult to lose weight.

--pfire

(To reply, click here.)

If dieting doesn't work then the solution must be more dieting starting earlier in life and including every member of the family. If only someone authorized every meal eaten in a lifetime, people would weigh less. Or not.

But the important part is, someone has the authority to control what other people do. That has to produce improvement, right?! Even if some people die sooner because of yo-yoing weight. Okay, if dieting doesn't work because there are factors beyond diet, then exercise or diet and exercise have to work, right?

True, most people are not interested in exercising, as the article notes. And non-athletes who exercise are likely to suffer injuries, which sometimes allows them to stop before the increased risk of a heart attack can have an impact.

But some people can stick to a diet and undergo exercise without apparent harm. And that does produce a small but noticeable decrease in blood pressure. Approximately 1/10th of the amount needed to make them healthier.

The real antagonist for the controllers is that people have a natural weight and a natural amount of activity. Trying to change them is rarely advantageous.

I appreciate the honesty which has led to the current level of general understanding about "preventive medicine", also known as making statements that control what other people do. When the facts are recognized, I am optimistic that behavior will be more sensible. Not ordinary human behavior, but the actions of those who want to control them.

--Philidor

(To reply, click here.)

How many people who eat 3-4 satiating meals a day featuring whole grains, legumes, veggies, and olive oil with fruit snacks in between, and drink lots of water and tea; how many of these people are fat?

The diet study that I would like to see is to survey a large, random population on their current diet. How much do they eat in various food categories? What is their weight and health? Would it surprise anyone if eating more in the bad categories correlated to more weight and poor health?

There is absolutely nothing mysterious about dieting and health. Don't diet. Change your diet, permanently, and enjoy the benefits for the rest of your life. While we continue to feature refined flour, corn syrup, sugar and saturated fats in our restaurants and supermarkets, we will be a fat nation.

--ClavisRa

(To reply, click here.)

A diet isn't supposed to be a long-term fix. Examined objectively, the claim that something you did at age 20 will keep you thin at age 40 is pretty ridiculous. We don't expect our brains to retain material for twenty years - why would we expect it of our bodies?

The other reason that diets don't work is that many people don't know how to diet. The big benefit that participants in scientific studies (and famous pop stars) have over the average dieter is the advice and careful monitoring of industry professionals. Many people have a poor understanding of nutrition, or even what their body needs to function. I know that for many years I tried to diet without knowing exactly what a "diet" was. The result: even when I was slim, I was incredibly unhealthy.

Psychologically, I think diets are difficult because you start thinking you're holding back from something you truly deserve. For example, you're laying off brownies, but you wouldn't have to, if it weren't for your diet. The truth is, brownies are unnatural to begin with. In order to lose weight, people have to permanently change the way they think about food. And that's a tall order.

--AnikaG

(To reply, click here.)

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