All diets work if adhered to.
Adherence, per the Oxford Dictionary, is an “attachment or commitment to a person, cause, or belief.”
In other words, it’s a fancy way to say “stick to something.”
So is it a contrarian take to say “All diets work if you stick to them?”
I don’t think this is contrarian, but I came across a graph this week which really hammered this point home for me.
A study compared the following diets for weight loss:
- Atkins: aimed for less than 20 g of carbohydrate daily, with a gradual increase toward 50 g daily.
- Ornish: aimed for a vegetarian diet containing 10% of calories from fat.
- Weight Watchers: aimed to keep total daily “points” in a range determined by current weight. Each “point” was roughly 50 calories, and most participants aimed for 24 to 32 points daily. Lists provided by the Weight Watchers Corporation determined point values of common foods.
- Zone: a 40-30-30 balance of percentage calories from carbohydrate, fat, and protein, respectively.
A variety of popular diets can reduce weight … but only for the minority of individuals who can sustain a high dietary adherence level:
Left graph: “Any single diet can help you lose weight…”
- All 4 diets resulted in modest statistically significant weight loss at 1 year… with no statistically significant differences between diets
Right graph: “… but your adherence helps you lose more weight”
- There is a strong association between self-reported dietary adherence and weight loss that was almost identical for each diet
- Below is an explanation of how adherence was measured:
How can these results be improved?
One way is by using a broad spectrum of diet options, to better match individual patient food preferences, lifestyles, and cardiovascular risk profiles.
- Participants in this study were not allowed to choose their dietary assignment.
- However, the study suspects adherence rates and clinical improvements would have been better if participants had been able to freely select from the 4 diet options.
Makes sense to me!
These findings also challenge the concept that 1 type of diet is best for everybody.
Again, I don’t think this is an extremely “hot take” take but I like the way Jeff Volek, Chief Science Officer and Co-Founder of Virta Health and Stephen D. Phinney, a Professor of Medicine Emeritus at the University of California-Davis, explain how this belief isn’t aligned with other beliefs we have:
- We readily accept the idea that people differ in appearance, intellect, physical performance, preferences for music, art, sports and of course food. Therefore the need to customize diets should come as no surprise… (source)
This is a great transition to… the food pyramid… which hasn’t always been a pyramid!
I’ve included a pictorial overview through the years of the food pyramid below (source).
For over a century the USDA (United States Department of Agriculture) has provided science-based dietary guidance to the American public. If you believe the need to customize diets should come as no surprise, then it is quite surprising that the USDA essentially recommends the same diets to … everyone!
But hold on, hold on: what is the evidence that we should have customized diets?
Some of the best proof showing how much genetics impacts weight loss comes from studies in … genetically identical twins.
Positive Energy Balance Experiment:
- Test: Twins were overfed 1000 calories for 100 days
- Result: There was a wide discrepancy in weight gain ranging from 9 to 30 lbs between the different pairs of twins BUT weight gain within each twin pair was quite similar.
- In other words, all twins gained weight but the amount of weight gained between pairs of twins differed.
Negative Energy Balance Experiment:
- Test: Twins exercised twice a day for 93 days while their dietary intake was held at their maintenance energy level, which created a daily deficit of 624 calories.
- Results: There was a surprisingly wide discrepancy in weight loss among the different pairs of twins ranging from 2 to 18 lbs BUT weight loss within twins was again very similar.
- In other words, all twins lost weight but the amount of weight loss differed between different pairs of twins.
- Any (popular) diet can help you lose weight but only if you stick to it
- There are findings that challenge the concept that 1 type of diet is best for everyone
- A diet is temporary while a lifestyle change is permanent. A change you make that becomes part of your new natural routine is the best way to adhere to any dietary plan long term [Insert plug for one of my favorite books Atomic Habits here 😄]
A Brief History: The Evolution of the Food Pyramid
1916 to 1930s: “Food for Young Children” and “How to Select Food”
1940s: A Guide to Good Eating (Basic Seven)
1956 to 1970s: Food for Fitness, A Daily Food Guide (Basic Four)
1979: Hassle-Free Daily Food Guide
1984: Food Wheel: A Pattern for Daily Food Choices
1992: Food Guide Pyramid
2005: MyPyramid Food Guidance System