Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

Weighty Matters

We’ve got a heavy topic this week, folks: obesity in America and our quest for the perfect, quick fix. The latest guidelines from the FDA (supported by comprehensive scientific review of fad diets) state that any diet that limits daily intake to 1500 calories or less will result in weight loss. However, there are plenty of best friends, self appointed nutrition experts, and next-door neighbors who swear by one fad diet or another. In this Insight, I’d like to feed you the facts rather than a bunch of bull. So, let’s move on to the meat of the issues.

There’s no question that obesity is a BIG health problem in the United States. Obesity with its attendant health complications kills approximately 280,000 U.S. adults each year. The prevalence of both overweight and obese Americans is steadily increasing regardless of gender, ethnicity, age or level of education. And yearly direct and indirect costs of treating obesity-related health problems have ballooned to approximately 100 billion dollars. Direct costs encompass all visits to physicians (estimated 65 million/year) and hospitals, and all treatments including medications. Indirect costs include the value of lost wages because of illness and/or disability as well as value of future earnings lost by premature death.

So it’s a growing problem. And as the percentage of overweight and obese Americans has ballooned, the number of fad diets and the amount of money spent on them have expanded proportionately. Including expenditures such as diet pills, supplements, diet books, special foods, memberships to commercial weight loss organizations, and other diet aids, it’s estimated that wishfully-lean Americans spend between $30 and $60 billion per year. Certainly more than a few bank accounts are getting fat with such revenues.

Touting special diets is not a new concept. The first known diet book, the ” Letter on Corpulence,” (catchy title, don’t you think?) was published in 1864 and advocated a low carbohydrate/high alcohol diet. However, it wasn’t until 1917 that the first calorie-counting book arrived. . .advocating 1,200 calories/day. The book sold a whopping 2 million copies. Further landmarks in the dieting timeline: Banana and skim mild diet endorsed by AMA in 1935–and a flurry of activity followed in the last 50 years. The first support group for weight loss was founded in 1948. Weight Watchers rolled out in 1963. The Stillman diet debuted in 1967 (high protein, low-carb diet), and its founder died of a heart attack in 1975. A similar concept, the First Version of the Atkins Diet (high-protein, low-carb, fat-concentrated) caused many a double-chin to quiver with anticipation when it arrived in 1972. Then, in fairly rapid succession came the High protein, minimal calorie Scarsdale Diet in 1978; Pritikin Diet in 1979 (super low fat), Jenny Craig appeared in 1983,and Fen-Phen craze and the second version of Atkins Diet in 1992 rounded out the score of options in early 1990s. . . though Fen-Phen was withdrawn from the market in 1997 because of heart related complications associated with its use.

Obviously. Fad diets are not new, but the lure of a quick fix and hopes for a sleek, stereotypically-attractive body continue to pull millions of Americans into one type or another with great regularity. We want to believe there’s an easier way than permanent changes in our food consumption patterns and activity levels to achieve healthy lean body mass and balanced metabolisms. Among the most popular current diets are Atkins, Zone, and Blood Type. Let’s examine each briefly.

Atkins maintains that cutting down on carbohydrate consumption causes the body to burn fat preferentially as an energy source. Theoretically, this is true since ketones derived from fat are used as energy when glucose from carbohydrate stores is not available. However, the diet also maintains there’s a direct link between carbohydrate and insulin production–leading to storage of body fat. In fact, foods other than carbohydrates also stimulate insulin production, and the body stores fat when we take in more calories than we burn off…no matter what the carbohydrate, fat, and protein compositions of our diets might be. Know, too, that diets which generate ketones also raise uric acid levels and lead to kidney stones and gout. Additionally, high-protein diets are often high in cholesterol and saturated fats as well. . .so risks of heart disease are increased. Dr. Atkins, himself, has just demonstrated the latter point personally.

The Zone diet maintains that our genetic biochemical responses to carbohydrates (and attendant major swings in insulin production) are what makes us fat. The diet further maintains that humans are designed to eat only two food groups: lean protein and natural carbs from fruits and fiber-rich vegetables. We humans started off without breads, grains, and pasta in our diet, and the Zone diet contends that our bodies still don’t know how to utilize these food stuffs. So, eating within the Zone diet plan should theoretically allow one to maintain body insulin levels in a ‘therapeutic zone’ where body fat melts away (and stays away), and vitality and mental acuity are perpetually enhanced. The “studies” supporting these claims lack control groups and seem to be more success story anecdotes than scientific method. Bottom line, the Zone Diet works because it’s an energy-restricted eating pattern where people eat less food than their baselines and lose weight AS LONG AS THEY CONTINUE THIS PATTERN OF EATING.

The Premise of the Blood Type diet is that we have genetically preferential eating patterns based on our blood types and that our metabolism of food is either enhanced or diminished as a result of the positive and negative interactions of food enzymes with our own blood antibodies. In this diet, foods are right for a given blood type if they do not agglutinate(that is, cause clumping of the red blood cells) of that blood type, do not lead to bowel toxicity, and protect against some disease with a known preference for that blood type. Very interesting thinking, but the research leading to the major tenants of this diet is dubious at best. The Blood Type diet contends we all evolved from O positive, mostly meat eating ancestors, but molecular research has demonstrated the existence of all blood types millions of years before homo sapiens even existed–no scientific evidence to support one blood group evolving later into several. Additionally, there is no evidence that lectin agglutination happens in the body–and if it did, it would be lethal because showers of agglutinated red cells would clog our blood vessels causing our vital organs to die from lack of oxygen. Finally, since most people really don’t even know their blood types, they’d be regularly eating the “wrong” foods and showering their innards with clumped up red blood cells. . .leading to cataclysmic tissue and organ destruction as described above. French fries and cheese burgers may be bad for our wastelines, but they’re killing us softly over time, through years of repeated ‘exposure.’

Finally, it’s nonsense to think that certain foods (such as cabbage and grapefruit) possess magical abilities to melt away our tummies and thighs. In reality, any results stem from drastically reduced calorie intake with associated loss in water weight. There is no Mayo Clinic Diet which allegedly found magical weight loss combinations in grouped consumption of “right” foods. And even the popular “Fit for Life” diet claims that inappropriately combined foods “become rotten” in our bodies leading to malabsorption and body toxification that ultimately makes us fat.

So, we’ve waddled to the bottom line. There’s no magic bullet to melt away body fat. Embracing a Fad Diet can cause a wishful lean person to analyze portions and types of food that go into their mouths. And such critical analysis often does generate more sensible food choices and smaller portions. But remember that eating patterns should be compatible with overall lifestyles and palatable over years of dietary choices. Sensible, calorie-conscious eating coupled with regular exercise will continue to be the mainstays of a healthy body weight.

Stephen L. Hines, M.D.
April 2002

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