The Same Old Diet and Exercise Advice?

My cover story on obesity is out in the February issue of Scientific American. You can see part of the article on the Scientific American website, but most of it is behind a pay wall. I’d love to find some way to make some of it available freely in some form online here, without undercutting Scientific American‘s interests. I’ll see what I can work out. (Meanwhile, I see that a university has posted the full article here.)

The reader comments on the article (about 50 so far) are right there for all to see, though. They reflect a cacophony of opinions, most of them sounding rigidly held, about what has caused the obesity problem and what will make it go away. Needless to say, the Atkinites are out in force among the comments (and in blog posts about the article), lecturing everyone on how diet and exercise don’t work, how everyone except them misunderstands physics and biology, how it’s all carbs, carbs, carbs. They read one book by Gary Taubes (available in very long and very short versions), and they think they know more than most scientists do about metabolism and thermodynamics. Whatever the merits of the Atkins diet (and I don’t think there are many for most people, nor do most scientists and physicians), the kind of disdainful, pompous, simplistic certainty mixed with gullibility and obliviousness that many Atkins fanatics endlessly spout about this highly complex subject has come to feel very tedious to me. They’re welcome to their diet and their opinion, but I can only hope few would-be dieters are actually swayed by it. If you want to understand the Atkins claims, read Taubes, he’s a smart guy. But before you buy the conclusions, go out and ask everyone you know how long they stuck with the Atkins diet and kept the weight off. Or just go ahead and try it (I did), but if it doesn’t work for you long term, as it does not for the great majority of people (or me), please don’t give up on diets. And I urge you not to give up on exercise as useless in fighting excess weight, as Atkinites suggest.

Some commenters try to dismiss the message of the article as the same old advice we’ve all been hearing forever about how we have to diet and exercise. That’s an unfortunate point of view from several perspectives. First of all, the idea that advice should be dismissed because it’s been consistently given for a long time is a troubling one. Not smoking, wearing seatbelts, drinking in moderation–this is the same old advice, too. You could argue, of course, that an article that focuses on the same old advice isn’t very thrilling. What’s much more entertaining is the latest and greatest breakthrough scientific finding about losing weight, or the latest diet guru’s special claim on how to shed pounds with a simple change in diet. But it’s the endless stream of claims for new approaches and insights that has pulled people away from what those experts who have achieved good results with the overweight have long known: you’ve got to focus on diet and exercise habits, and try to find ways to get people to take them up and stick to them forever. Part of the point of the article was to survey the scene and show how the same old basic advice, and not the endless stream of latest and greatest, is still what works, and what this means for the obesity crisis. What’s more, the article points out prominently and at some length that there are indeed significant recent and ongoing improvements in our ability to help people stick to reasonable diets and exercise.

Yes, everyone has tried, and most have failed with, diet and exercise. But in spite of what many people believe (and some of the commenters imply) all diet and exercise approaches are not alike–far from it. A smart behavioral approach based on gradual, modest, livable changes that are strongly prompted and reinforced by others and by the environment is much, much more likely to succeed than the standard slash-calories-and-burn-up-the-treadmill plans most people subject themselves to, with predictable results. Very few people have embarked on a good behavioral program designed to bring on modest life-long lifestyle changes, rather than self-torturing in order to vaporize ten pounds in two weeks just so you can put them back on in the two weeks after.

Some people complain that I have some encouraging things to say about Weight Watchers. But the point I make in the article is that Weight Watchers is as close as most people ever get to a behavioral program, and that while it’s better than most other mass-market programs and is based on sound principles, it doesn’t come close in practice to being a full, state-of-the-art behavioral program that always stays true to those principles  And of course the great majority of overweight people and dieters haven’t even tried Weight Watchers, never mind a genuine, full behavioral program.

Well, I hardly expected the article to instantly strip everyone of their misguided obsessions with  breakthrough findings and fad diets, and their distorted views of what behaviorism is about. My goal, as usual, was to try to promote discussion, and hopefully a slightly more informed, reasoned and open-minded one than one normally encounters, at least with regard to obesity and weight loss.

4 thoughts on “The Same Old Diet and Exercise Advice?

  1. Since you seem so convinced there is no one who has lost weight on Atkins and been able to keep it off, my husband and I beg to differ. He eats many fewer carbs than I and has no difficulty keeping to the diet. Beyond mere weight loss, his health and physique is greatly improved as well. My weight tracks pretty well with the amount of carbs I eat. We have no trouble exercising lots while eating few carbs too. Adaptation does take a while, or try gradually dropping carbs. I really can't understand why you would have difficulty unless you are one of those people genetically deficient in carnitine palmitoyl transferase (which you need to burn fats) or possibly other deficiencies. Endurance training will increase fat burning and numbers of mitochondria too, and may help with adaptation. The other difficulty comes when you're surrounded by tempting carby foods.Anyway, will take a look at your article and see what you have to say.Cynthia

  2. Interesting article. How does television consumption correlate to food consumption, quantity and quality? Food advertisements probably lead to more food consumption. Otherwise the manufacturers wouldn't spend money on the ads. I could speculate a lot more here, but I would love to see some real research instead.

  3. Dukan Diet says:

    Well first of all i think the picture on the home page will make everyone lose their appetite, which is a good move;)And as for the diet … for each individual suits different diet, as we all have different habits and different foods without which we can not live!

  4. Anonymous says:

    I just read your article and find the behavior modification to be a major factor in assisting me in losing weight. As a woman trying to lose baby weight, I joined Weight Watchers with the new Points Plus program. It is working for me albeit ever so slowly. Even though it is a slow process, I believe the weight I lose will stay off, give or take a few pounds, because I am working hard at modifying my behavior. I also am dealing head on with the underlying emotions that come up when I overeat or make unhealthy choices. I have realized that behavior modification takes time. Growth and change take time. Parenting two toddlers serves to reinforce the idea that changing one's behavior takes positive reinforcement and clear and consistent expectations.Thank you for the article.

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