Licenciado para - Cleiciane Silva teixeira - 02821926200 - Protegido por Eduzz.
com
CHILDHOOD OBESITY
December 2014 j Volume 10, Number 6
ª Mary Ann Liebert, Inc.
DOI: 10.1089/chi.2014.1063
Why Dieting Should Die
David L. Katz, MD, MPH, FACPM, FACP
n November 11, 2014, Circulation: Cardiovas-
O cular Quality and Outcomes published a system-
atic review of diets for weight loss and improving
cardiac risk measures.1 My editorial counterpart there and
Yale colleague, Dr. Harlan Krumholz, kindly invited me to
opine on the study in a commentary, which I did.2
There were important limitations to the study, but those
were already grist for another mill. For our purposes here,
the punch line will suffice: Despite grandiose claims of
superiority, no particular diet was demonstrably better than
another, and none appeared to be very sustainable. At the
12-month mark, recidivism was common. By 24 months, it
was the rule and lasting success, very much the exception.
Other studies on the topic3,4 have also questioned the
contended superiority of any given diet over others. Re-
search, and, for that matter, conventional wisdom, gener-
ally inveigh against dieting for this rather fundamental
reason: It tends not to work. Dieting, often described as
‘‘going on’’ a diet, with the clear implication of plans to go
back ‘‘off,’’ is, by its very nature, a short-term fix to the
permanent challenge of eating well and establishing energy
balance. Short fixes are ill advised for long problems.
One might make the case on the basis of probable fail-
ure, then, that dieting—as it has historically been done—
should die.
But with this Journal, I think we can make a stronger
case still—one not dependent on the latest study, nor even
the weight of damning evidence from intervention trials.
Dieting is not only a quick fix, it is generally a go-it-alone
fix as well. Few parents go ‘‘on’’ diets and take children
with them. Is leaving children out of the formula for get-
ting to a healthy weight anything other than a cultural
anachronism, and an abdication, in an age of hyperendemic
childhood obesity?5
Presuming the expected answers to those rhetorical
questions, we might make a case against dieting on the
basis of such fundamentals as epidemiology and demo-
graphy. We might even invoke philosophy, courtesy of
John Donne,6 and note that no one is an island. We might,
finally, invoke the basic responsibility of caring adults for
the welfare of children.
People generally diet alone. But parents and children
live it together. Food—its role in sustenance, pleasure,
Editor-in-Chief, Childhood Obesity; Director, Yale University Prevention Research Center, Griffin Hospital, Derby, CT.
443
EDITORIAL
health, and weight control—should accommodate that
reality.
Dieting often represents, for individuals and the popu-
lation, the perennial triumph of misguided hope over the
genuine illumination of experience. If every quick-fix diet
to come down the pike before now left the multitudes in
need of the new one, what is the probability that the new
one won’t just take its place on the same long, lamentable
list? No formal training in statistics is needed to know that
it is just about zero. Diets represent a willful suspension of
common sense, in fact. The very same, sensible souls
among us who know to step away from our credit cards
when confronted with pitches for get-rich-quick schemes7
reach for them instead when the equally specious ‘‘get-
thin-quick’’ pitch comes along.
Dieting has been tried rather generously by our culture,
and the verdict is not flattering. Perpetuating a method
proven so robustly to be a massive failure is, at best,
foolish.
It is fatalistic as well. Dieting shifts control from us to
someone else offering to direct the destiny of our health
and weight with their particular contention or theory.8
Given the cacophony of such competing theories, the
likelihood that any one of them is the ‘‘right’’ one for any
one of us, let alone for all of us, is rather remote. Surren-
dering a thoughtful, proven approach to the promotion of
health9 and control of weight10 to the vagaries of this pop
culture proselytism is a dubious leap of faith. We are
jumping into the din, hoping the particular peddler of our
specific salvation du jour will catch us this time. Alas, we
will just fall—because they are on their way to the bank to
cash our check.
And, finally, what is the likelihood that a sound nutrition
education program for children11 will have any meaningful
impact on family behavior when mom or dad (or both) is, at
any given moment, on a diet? Just about none, of course,
and so it is that hope—for families to find health together—
dies.
The distraction of quick-fix diets kills the opportunity to
leverage effective programming—in schools, at the work-
site, or elsewhere—to influence a family, which is the fun-
damental unit of culture. When individuals try to change
and their families don’t come along, change is generally
Licenciado para - Cleiciane Silva teixeira - 02821926200 - Protegido por Eduzz.com
444
unsustainable. When families change, it is the entry-level
expression of culture change—and that lasts. In unity, there
is strength. Dieting kills unity—because we tend to diet
alone. As noted, few dieters bring along their spouses, let
alone their children.
The failure to adopt and apply what is clearly true about
eating and living well for lasting health and weight control
siphons years from life, and life from years. We generally
refer to things that take years from our lives as.fatal.
Some are immediately so, others a bit slower, and others
slower still. A lifestyle at odds with health is generally a
slow killer, but that is cold comfort—because long before
it kills us prematurely, such a lifestyle encumbers us with
chronic maladies that take life out of our years.12
Dieting, as we have traditionally done it, is fatal to a
better hope for the future of our children. It is fatal to the
promise of lifestyle as universal medicine13; to the eradi-
cation of chronic disease eight times in ten; to the addition
of years to life and life to years. It is fatal to the better
medical destiny we might bequeath to our children if
weight control and health were approached with a blend of
science and sense, rather than fatalism and folly; if we
pursued health by living it together, not dieting alone. They
do not ‘‘diet’’ in the Blue Zones14; they live well.
The fundamentals of healthful living and weight control
are far less mysterious and far more accessible than we
allow ourselves to think; there is just a mountain of mar-
keting and malarkey between here and there. There is the
suspension of sense, the denial of science, and profit-driven
predation. There is fatalism, and there is folly.
But the power to say ‘‘enough!’’ resides with each of us.
We could move on, and dieting could die. Our efforts to
engage our children in eating well and being active, to-
gether and permanently, rather than losing weight alone
and fast, would increase our own chances of meaningful
success and satisfy a basic parental responsibility. Dieting
must die so that families may rediscover the strength of
unity and live better.
References
1. Atallah R, Filion KB, Wakil SM, et al. Long-term effects of 4
popular diets on weight loss and cardiovascular risk factors: A
systematic review of randomized controlled trials. Circ Cardiovasc
EDITORIAL
Qual Outcomes 2014 Nov 11. pii: CIRCOUTCOMES.113.000723.
[Epub ahead of print]
2. Katz DL. Diets, diatribes, and a dearth of data. Circ Cardiovasc
Qual Outcomes 2014 Nov 11. pii: CIRCOUTCOMES.114.001458.
[Epub ahead of print]
3. Dansinger ML, Gleason JA, Griffith JL, et al. Comparison of the
Atkins, Ornish, Weight Watchers, and Zone diets for weight loss
and heart disease risk reduction: A randomized trial. JAMA 2005;
293:43–53.
4. Gardner CD, Kiazand A, Alhassan S, et al. Comparison of the
Atkins, Zone, Ornish, and LEARN diets for change in weight and
related risk factors among overweight premenopausal women: The
A TO Z Weight Loss Study: A randomized trial. JAMA 2007;297:
969–977.
5. Katz DL. Childhood obesity trends: Time for champagne? Child
Obes 2014;10:189–191.
6. Donne J. No man is an island. 2003. Available at www.poemhunter
.com/poem/no-man-is-an-island Last accessed November 17, 2014.
7. Katz DL. Health sucks. Huffington Post. 2013 ( June 7). Available
at www.huffingtonpost.com/david-katz-md/personal-health_b_
3405078.html Last accessed November 17, 2014.
8. Katz DL. Competing dietary claims for weight loss: Finding the forest
through truculent trees. Annu Rev Public Health 2005;26:61–88.
9. Katz DL, Meller S. Can we say what diet is best for health? Annu
Rev Public Health 2014;35:83–103.
10. The National Weight Control Registry. Home page. 2014. Avail-
able at www.nwcr.ws Last accessed November 17, 2014.
11. Katz DL, Katz CS, Treu JA, et al. Teaching healthful food choices
to elementary school students and their parents: The Nutrition
Detectives program. J Sch Health 2011;81:21–28.
12. The Lancet. The Lancet Global Burden of Disease Study 2010.
2012. Available at www.thelancet.com/themed/global-burden-of-
disease Last accessed November 17, 2014.
13. Sagner M, Katz D, Egger G, et al. Lifestyle medicine potential for
reversing a world of chronic disease epidemics: From cell to
community. Int J Clin Pract 2014;68:1289–1292.
14. The Blue Zones. Available at www.bluezones.com Last accessed
November 17, 2014.
Address correspondence to:
David L. Katz, MD, MPH, FACPM, FACP
Editor-in-Chief, Childhood Obesity
Director, Yale University Prevention Research Center
Griffin Hospital, 2nd Floor
130 Division Street
Derby, CT 06418
E-mail: david.katz@yale.edu