Dieting

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Dieting is the practice of eating food in a regulated fashion to decrease, maintain, or increase body weight. Dieting is often used in combination with physical exercise to lose weight in those who are overweight or obese. Some people, however, follow a diet to gain weight (usually in the form of muscle). Diets can also be used to maintain a stable body weight.

Diets to promote weight loss are generally divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie.[1] A meta-analysis of six randomized controlled trials found no difference between the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram weight loss in all studies.[1] At two years, all calorie-reduced diet types cause equal weight loss irrespective of the macronutrients emphasized.[2] In general, the best diet is one where you find a way to eat fewer calories in any way that you can.[3]

Some long-term studies of dieting indicate the majority of individuals who have dieted regain virtually all of the weight that was lost after dieting, regardless of whether they maintain their diet or exercise program[4] and that after two years of dieting, up to two-thirds of dieters were even heavier than they are prior to beginning their regimen. A study published in the APA's journal American Psychologist found diets 'do not lead to sustained weight loss or health benefits for the majority of people.'[5] However, other studies have found that the average individual maintains some weight loss after dieting.[6] Weight loss by dieting, while of benefit to those classified as unhealthy, may slightly increase the mortality rate for individuals who are otherwise healthy.[4][7][8]

The first popular diet was "Banting", named after William Banting. In his 1863 pamphlet, Letter on Corpulence, Addressed to the Public, he outlined the details of a particular low-carbohydrate, low-calorie diet that had led to his own dramatic weight loss.[9]

History[edit]

William Banting, popularized one of the first weight loss diets in the 19th century.

One of the first dietitians was the English doctor George Cheyne. He himself was tremendously overweight and would constantly eat large quantities of rich food and drink. He began a meatless diet, taking only milk and vegetables, and soon regained his health. He began publicly recommending his diet for everyone suffering from obesity. In 1724, he wrote An Essay of Health and Long Life, in which he advises exercise and fresh air and avoiding luxury foods.[10]

The Scottish military surgeon, John Rollo, published Notes of a Diabetic Case in 1797. It described the benefits of a meat diet for those suffering from diabetes, basing this recommendation on Matthew Dobson's discovery of glycosuria in diabetes mellitus.[11] By means of Dobson's testing procedure (for glucose in the urine) Rollo worked out a diet that had success for what is now called type 2 diabetes.[12]

The first popular diet was "Banting", named after the English undertaker William Banting. In 1863, he wrote a booklet called Letter on Corpulence, Addressed to the Public, which contained the particular plan for the diet he had successfully followed. His own diet was four meals per day, consisting of meat, greens, fruits, and dry wine. The emphasis was on avoiding sugar, sweet foods, starch, beer, milk and butter. Banting’s pamphlet was popular for years to come, and would be used as a model for modern diets.[13][14] The pamphlet's popularity was such that the question "Do you bant?" referred to his method, and eventually to dieting in general.[15] His booklet remains in print as of 2007.[9][16][17]

The first weight-loss book to promote calorie counting, and the first weight-loss book to become a bestseller, was the 1918 Diet and Health: With Key to the Calories by American physician and columnist Lulu Hunt Peters.[18]

The Atkins Diet was suggested by the American nutritionist Robert Atkins in 1958, in a research paper titled "Weight Reduction". Atkins used the study to resolve his own overweight condition and went on to popularize the method in a series of books, starting with Dr. Atkins' Diet Revolution in 1972. In his second book, Dr. Atkins' New Diet Revolution (2002), he modified parts of the diet but did not alter the original concepts.

Types of diets[edit]

Low-fat diets[edit]

Main article: Low-fat diet

Low-fat diets involve the reduction of the percentage of fat in one's diet. Calorie consumption is reduced because less fat is consumed. Diets of this type include NCEP Step I and II. A meta-analysis of 16 trials of 2–12 months' duration found that low-fat diets (without intentional restriction of caloric intake) resulted in average weight loss of 3.2 kg (7.1 lb) over habitual eating.[1]

Low-carbohydrate diets[edit]

Main article: Low-carbohydrate diet

Low carbohydrate diets such as Atkins and Protein Power are relatively high in protein and fats. Low-carbohydrate diets are sometimes ketogenic (i.e. they restrict carbohydrate intake sufficiently to cause ketosis).

Low-calorie diets[edit]

Main article: Calorie restriction

Low-calorie diets usually produce an energy deficit of 500–1,000 calories per day, which can result in a 0.5 kilogram (1.1 lb) to 1 kilogram (2.2 lb) weight loss per week. Some of the most commonly used low-calorie diets include DASH diet and Weight Watchers. The National Institutes of Health reviewed 34 randomized controlled trials to determine the effectiveness of low-calorie diets. They found that these diets lowered total body mass by 8% in the short term, over 3–12 months.[1]

Very low-calorie diets[edit]

Main article: Very low calorie diet

Very low calorie diets provide 200–800 calories per day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to starvation and produce an average weekly weight loss of 1.5–2.5 kilograms (3.3–5.5 lb). "2-4-6-8", a popular diet of this variety, follows a four-day cycle in which only 200 calories are consumed the first day, 400 the second day, 600 the third day, 800 the fourth day, and then totally fasting,[19] after which the cycle repeats. These diets are not recommended for general use as they are associated with adverse side effects such as loss of lean muscle mass, increased risks of gout, and electrolyte imbalances. People attempting these diets must be monitored closely by a physician to prevent complications.[1]

Detox diets[edit]

Main article: Detox diet

Detox diets claim to eliminate undesirable "toxins" from the human body rather than claiming to cause weight loss. Many of these use herbs, homeopathic remedies, or celery and other juicy low-calorie vegetables.

Religious diets[edit]

Religious scripture may be a factor in motivating people to adopt a specific diet.[20] For example, the Biblical Book of Daniel (1:2-20, and 10:2-3) refers to a 10 or 21 day avoidance of foods (Daniel Fast) declared unclean by God in the laws of Moses.[20][21] In modern versions of the Daniel Fast, food choices may be limited to whole grains, fruits, vegetables, pulses, nuts, seeds and oil. The Daniel Fast resembles the vegan diet in that it excludes (fasts from) the consumption of foods of animal origin.[21] The passages strongly suggest that the Daniel Fast will promote good health and mental performance.[20]

Nutrition[edit]

Weight loss diets that manipulate the proportion of macronutrients (low-fat, low-carbohydrate, etc.) have not been shown to be any more effective than diets that maintain a typical mix of foods with smaller portions and perhaps some substitutions (e.g. low-fat milk, or less salad dressing).[22] Extreme diets may, in some cases, lead to malnutrition.

Heavily processed and fried foods as well as sweets, junk foods, and alcohol should also be avoided in a healthy diet.

Nutritionists also agree on the importance of avoiding fats, especially saturated fats, to reduce weight and to be healthier. They also agree on the importance of reducing salt intake because commercial foods such as snacks, biscuits, and bread, among others, already contain salt, thus contributing to an excess of salt daily intake.[23]

MyPyramid Food Guidance System is the result of extensive research performed by the United States Department of Agriculture to revise the original Food Guide Pyramid. It offers a wide array of personalized options to help individuals make healthy food choices. It also provides advice on physical activity.[24]

How the body eliminates fat[edit]

When the body is expending more energy than it is consuming (e.g. when exercising), the body's cells rely on internally stored energy sources, such as complex carbohydrates and fats, for energy. The first source to which the body turns is glycogen (by glycogenolysis). Glycogen is a complex carbohydrate, 65% of which is stored in skeletal muscles and the remainder; in the liver (totaling about 2,000 kcal in the whole body). It is created from the excess of ingested macronutrients, mainly carbohydrates. When glycogen is nearly depleted, the body begins lipolysis, the mobilization and catabolism of fat stores for energy. In this process, fats; obtained from adipose tissue, or fat cells, are broken down into glycerol and fatty acids, which can be used to generate energy. The primary by-products of metabolism are carbon dioxide and water; carbon dioxide is expelled through the respiratory system.

Weight loss groups[edit]

Some weight loss groups aim to make money, others work as charities. The former include Weight Watchers and Peertrainer. The latter include, Overeaters Anonymous, as well as several groups run by local churches, hospitals, and like-minded individuals.

These organizations' customs and practices differ widely. Some groups are modelled on twelve-step programs, while others are quite informal. Some groups advocate certain prepared foods or special menus, while others train dieters to make healthy choices from restaurant menus and while grocery-shopping and cooking.[25]

Food diary[edit]

A 2008 study published in the American Journal of Preventive Medicine showed that dieters who kept a daily food diary (or diet journal), lost twice as much weight as those who did not keep a food log, suggesting that if you record your eating, you wouldn't eat as many calories.[26]

Medications[edit]

The most recent prescription weight loss medication released is Acomplia (generic name Rimonabant), manufactured by Sanofi Aventis. Used to treat obesity in persons with a BMI (body mass index) of 30 or above, as well as for smoking cessation treatments, Acomplia is still pending FDA approval for use in the United States. Other weight loss medications, like amphetamine, are addictive and consequently are now banned in the US for casual weight loss. Some supplements, including those containing vitamins and minerals, may not be effective for weight loss.

Diuretics[edit]

Diuretics induce weight loss through the excretion of water. Diuretics, which can be used in the forms of medications, supplements, or herbs, reduce overall body weight, but have no effect on an individual's total body fat content. Diuretics can thicken the blood, cause cramping, kidney and liver damage. In a single report, the death of Jacqueline Henson was found to be related to swelling in her brain, which was associated with excessive water consumption over a short period of time, while she was on a special water diet.[27]

Possible weight loss effects of drinking water prior to meals[edit]

A 2009 review found that existing limited evidence suggests that encouraging water consumption and substituting energy-free beverages for energy-containing beverages may facilitate weight management. A 2009 article found that drinking 500 ml of water prior to meals for a 12 week period resulted in increased long-term weight reduction. (References given in main article.)

Fasting[edit]

Main article: Fasting

Lengthy fasting can be dangerous due to the risk of malnutrition and should be carried out under medical supervision. During prolonged fasting or very low calorie diets, the reduction of blood glucose, the preferred energy source of the brain, causes the body to deplete its glycogen stores. Once glycogen is depleted the body begins to fuel the brain using ketones, while also metabolizing body protein (including but not limited to skeletal muscle) to be used to synthesize sugars for use as energy by the rest of the body. Most experts believe that a prolonged fast can lead to muscle wasting although some dispute this. The use of short-term fasting, or various forms of intermittent fasting have been used as a form of dieting to circumvent this issue.

Fasting may refer to the avoidance of specific foods. For example, the modern Daniel Fast resembles the vegan diet because it fasts from foods of animal origin. Meat, dairy, eggs, and fish are replaced by whole grains, fruits, vegetables, pulses, nuts, seeds and oil.[21]

Side effects[edit]

While there are studies that show the health and medical benefits of weight loss, a study in 2005 of around 3000 Finns over an 18-year period showed that weight loss from dieting can result in increased mortality, while those who maintained their weight fared the best.[4][8][28] Similar conclusion is drawn by other studies,[4][29] and although other studies suggest that intentional weight loss has a small benefit for individuals classified as unhealthy, it is associated with slightly increased mortality for healthy individuals and the slightly overweight but not obese.[7] This may reflect the loss of subcutaneous fat and beneficial mass from organs and muscle in addition to visceral fat when there is a sudden and dramatic weight loss.[8]

Low carbohydrate versus low fat[edit]

Many studies have focused on diets that reduce calories via a low-carbohydrate (Atkins diet, Scarsdale diet, Zone diet) diet versus a low-fat diet (LEARN diet, Ornish diet). The Nurses' Health Study, an observational cohort study, found that low carbohydrate diets based on vegetable sources of fat and protein are associated with less coronary heart disease.[30] The same study also found no correlation (with multivariate adjustment) between animal fat intake and coronary heart disease (table 4). A long term study that monitored 43,396 Swedish women however suggests that a low carbohydrate-high protein diet, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, are associated with increased risk of cardiovascular disease.[31]

A meta-analysis of randomized controlled trials by the international Cochrane Collaboration in 2002 concluded[32] that fat-restricted diets are no better than calorie restricted diets in achieving long term weight loss in overweight or obese people. A more recent meta-analysis that included randomized controlled trials published after the Cochrane review[33][34][35] found that "low-carbohydrate, non-energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to 1 year. However, potential favorable changes in triglyceride and high-density lipoprotein cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein cholesterol values when low-carbohydrate diets to induce weight loss are considered."[36]

The Women's Health Initiative Randomized Controlled Dietary Modification Trial[37] found that a diet of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily resulted in:

  • no reduction in cardiovascular disease[38]
  • no statistically significant reduction in invasive breast cancer[39]
  • no reductions in colorectal cancer[40]

Additional recent randomized controlled trials have found that:

  • A comparison of Atkins, Zone diet, Ornish diet, and LEARN diet in premenopausal women found the greatest benefit from the Atkins diet.[41]
  • The choice of diet for a specific person may be influenced by measuring the individual's insulin secretion:
In young adults "Reducing glycemic [carbohydrate] load may be especially important to achieve weight loss among individuals with high insulin secretion."[42] This is consistent with prior studies of diabetic patients in which low carbohydrate diets were more beneficial.[43][44]

The American Diabetes Association released for the first time a recommendation (in its January 2008 Clinical Practice Recommendations) for a low carbohydrate diet to reduce weight for those with or at risk of Type 2 diabetes.[45]

Low glycemic index[edit]

"The glycemic index (GI) factor is a ranking of foods based on their overall effect on blood sugar levels. The diet based around this research is called the Low GI diet. Low glycemic index foods, such as lentils, provide a slower, more consistent source of glucose to the bloodstream, thereby stimulating less insulin release than high glycemic index foods, such as white bread."[46][47]

The glycemic load is "the mathematical product of the glycemic index and the carbohydrate amount".[48]

In a randomized controlled trial that compared four diets that varied in carbohydrate amount and glycemic index found complicated results:[49]

  • Diet 1 and 2 were high carbohydrate (55% of total energy intake)
    • Diet 1 was high-glycemic index
    • Diet 2 was low-glycemic index
  • Diet 3 and 4 were high protein (25% of total energy intake)
    • Diet 3 was high-glycemic index
    • Diet 4 was low-glycemic index

Diets 2 and 3 lost the most weight and fat mass; however, low density lipoprotein fell in Diet 2 and rose in Diet 3. Thus the authors concluded that the high-carbohydrate, low-glycemic index diet was the most favorable.

A meta-analysis by the Cochrane Collaboration concluded that low glycemic index or low glycemic load diets led to more weight loss and better lipid profiles. However, the Cochrane Collaboration grouped low glycemic index and low glycemic load diets together and did not try to separate the effects of the load versus the index.[46]

See also[edit]

References[edit]

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Further reading[edit]

  • American Dietetic Association (2003). "Position Paper on Vegetarian Diets". J Am Diet Assoc 103: 748–765. doi:10.1053/jada.2003.50142. 
  • Cheraskin Emmanuel (1993). "The Breakfast/Lunch/Dinner Ritual". Journal of Orthomolecular Medicine 8 (1). 
  • Dansinger, M.L., Gleason, J. L., Griffith, J.L., et al., "One Year Effectiveness of the Atkins, Ornish, Weight Watchers, and Zone Diets in Decreasing Body Weight and Heart Disease Risk", Presented at the American Heart Association Scientific Sessions, Orlando, Florida, 12 November 2003.
  • Schwartz, Hillel. Never Satisfied: A Cultural History of Diets, Fantasies, and Fat. New York: Free Press/Macmillan, 1986.
  • Wansink, B. Mindless Eating: Why We Eat More Than We Think, New York: Bantam Dell (2006).

External links[edit]