The only diet that works: Adherence

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.

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.

The results? 

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.

Source: This study which I read in this book

Conclusion

  • 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”

1916 to 1930s: “Food for Young Children” and “How to Select Food”
– Established guidance based on food groups and household measures
– Focus was on “protective foods”

1940s: A Guide to Good Eating (Basic Seven)

1940s: A Guide to Good Eating (Basic Seven)
– Foundation diet for nutrient adequacy
– Included daily number of servings needed from each of seven food groups
– Lacked specific serving sizes
– Considered complex

1956 to 1970s: Food for Fitness, A Daily Food Guide (Basic Four)

1956 to 1970s: Food for Fitness, A Daily Food Guide (Basic Four)
– Foundation diet approach—goals for nutrient adequacy
– Specified amounts from four food groups
– Did not include guidance on appropriate fats, sugars, and calorie intake

1979: Hassle-Free Daily Food Guide

1979: Hassle-Free Daily Food Guide
– Developed after the 1977 Dietary Goals for the United States were released
– Based on the Basic Four, but also included a fifth group to highlight the need to moderate intake of fats, sweets, and alcohol

1984: Food Wheel: A Pattern for Daily Food Choices

1984: Food Wheel: A Pattern for Daily Food Choices
– Total diet approach – Included goals for both nutrient adequacy and moderation
– Five food groups and amounts formed the basis for the Food Guide Pyramid
-Daily amounts of food provided at three calorie levels
– First illustrated for a Red Cross nutrition course as a food wheel

1992: Food Guide Pyramid

1992: Food Guide Pyramid
– Total diet approach—goals for both nutrient adequacy and moderation
– Developed using consumer research, to bring awareness to the new food patterns
– Illustration focused on concepts of variety, moderation, and proportion
– Included visualization of added fats and sugars throughout five food groups and in the tip
– Included range for daily amounts of food across three calorie levels

2005: MyPyramid Food Guidance System

2005: MyPyramid Food Guidance System
– Introduced along with updating of Food Guide Pyramid food patterns for the 2005 Dietary Guidelines for Americans, including daily amounts of food at 12 calorie levels
– Continued “pyramid” concept, based on consumer research, but simplified illustration. Detailed information provided on website “MyPyramid.gov”
-Added a band for oils and the concept of physical activity
-Illustration could be used to describe concepts of variety, moderation, and proportion

2011: MyPlate

2011: MyPlate
– Introduced along with updating of USDA food patterns for the2010 Dietary Guidelines for Americans
– Different shape to help grab consumers’ attention with a new visual cue
– Icon that serves as a reminder for healthy eating, not intended to provide specific messages
– Visual is linked to food and is a familiar mealtime symbol in consumers’ minds, as identified through testing
– “My” continues the personalization approach from MyPyramid

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