Why Choose A ‘Non-diet’ Approach?
When women come to see me for the first time, it’s often clear that they are carrying a massive burden of guilt and shame about their bodies and dieting ‘failures’. Fifteen minutes into our consultation, most clients will be in tears as they talk about what they’ve been through with weight struggles and dieting. Common sentiments are,
I can’t control myself around food.
I’m a failure.
Who’d love this? (gesturing to body)
I have no willpower.
Once the tears have abated and the sniffles settled, it’s at this point in the session that I might say, ‘Lovely lady, it’s not you that’s broken or a problem. It’s diets.”
I then explain a statistic that you’ll never read on any diet marketing campaign:
95% of people who diet will regain their weight within a five year period and a further 30-60% of people will be heavier than where they started.
Startling, isn’t it?
Dieting is not a new phenomenon. Ask your mum or grandmother and they’ll be able to rattle off a litany of weight loss fads that they tried back in the 70’s. This means that health researchers have thirty years of robust data, epidemiological studies and empirical research about the efficacy of diets. This mountain of evidence points in one clear direction; Diets do not successfully result in long-term weight loss for the vast majority of people who undertake them.
So why on earth are we still flogging the dead horse of dieting?
This lag time of integrating published health data into accepted norms is nothing new. For example, cast your mind back to the successful propaganda campaigns of tobacco companies to cover up the deadly side-effects of their product. The link between cigarette smoking and lung cancer was established in the 1940’s, yet by the 1960’s only one in three medical doctors believed that smoking was linked to this terrible disease.
In a somewhat eerie echo of this, ‘weight loss’ advice is embedded into just about every health policy, practice guideline for managing chronic disease and our nation’s entire cultural narrative around health. Worldwide, dieting is a multi-billion dollar industry and you’d have to live under a rock to avoid messages about the obesity epidemic. We’re accosted by this message on all fronts, yet not given any real solution. It’s little wonder that women end up crying their hearts out in a stranger’s office.
Why Don’t Diets Work?
It is no coincidence that 95% of people are not able to lose weight on a traditional calorie-restricted diet. The majority of the population aren’t ‘weak’ or have ‘no will-power’ (despite what my clients tell themselves). Our collective inability to sustain a low food intake over any prolonged time is due to basic biology.
Consider for a moment that human beings have been on planet Earth for 150,000 to 200,000 years. For the vast stretch of this time we lived as hunter gatherers, with no assurance of a steady food supply. Survival tests were harsh and famine was a very real threat. According to some researchers, the last major climate change (approximately 10,000 years ago) created food shortages that almost wiped out the human population, with only 1,000 and 10,000 individuals estimated to have been left on the entire planet.
Therefore, the very survival of our species has been largely dependent on our body’s ability to withstand starvation and the brain’s ability to be resourceful with finding food.
Unlike our ancestors, modern homo sapiens (i.e. us!) are faced with the unique challenge of having an environment of over-abundance and food sources which supply excess calories. In the blink of two centuries, we’ve gone from agricultural-based food supply to modern mega-industry.
Whilst technical advances in food manufacturing have been swift, our biological evolution is comparatively slow. The genetics which were fostered over 200 millenia to protect us against starvation have no hope of adapting in two centuries. Thus, we are a famine-protected species in a food-excessive environment. Talk about fish out of water!
Armed with ancient DNA, your body cannot differentiate between starvation induced by external famine or semi-starvation due to an internal agency to be thinner. Either way, your body is primed to recognise that calories in are less than calories out and acts accordingly to defend you against the threat of starvation.
What happens to your body during dieting?
Firstly, when humans are plunged into calorie restriction – whether from enforced starvation (i.e. famine) or voluntarily (i.e. dieting) – our metabolic rate drops. It’s like running on power-saving mode! The body knows how to conserve energy and to make the fuel we’ve got last as long as possible. Thus, the body burns less calories. These metabolic changes also prime the body to ‘suck up’ calories when you start eating normally again (because diets don’t last forever) and trigger weight regain.
Secondly, when we’re calorie-restricted, we also feel hungry. Sounds obvious, right? But if you’ve ever made a serious attempt at dieting, you’ll know that constant hunger is powerful and very difficult to resist over any extended period.
Many seasoned dieters battle with their appetite as though it were an enemy to conquer. But that’s like fighting against your heartbeat or hating your lungs for breathing – it’s futile. Our appetite is a normal bodily function that helps us to gauge how much food our body needs to remain fueled. During dieting (and perhaps as humans today living in a new, obesogenic environment) this natural mechanism is ignored. Many of us oscillate between two extremes; we either overeat or we overly restrict our eating. Nevertheless, the fundamental point remains that hunger is a primal urge that is difficult to ignore. Similarly, fullness is a natural mechanism that signals when our body is satiated.
Thirdly, when we’re hungry it affects our mood. ‘Hanger’ pops up on memes for a reason! Hunger can make us cranky, irritable, emotional or fuzzy-headed and yet we ‘will’ ourselves to overcome it. The problem is, willpower is a psychological apparatus reserved for short-term efforts. For example, you may use willpower to cram overnight for an exam the next day. On the other hand, hunger is something we need to deal with multiple times a day and it requires obsessive effort (which we often see in the pathological presentation of eating disorders), not willpower, to suppress this. Therefore, hunger is not something we can override with positive thinking or motivational gumption.
Fourthly, during dieting our body tends to breakdown muscle tissue preferentially to fat. Unfortunately, this exacerbates our drop in metabolic rate. You may ask yourself, ‘why does the body attack muscle instead of fat during weight loss?’ which is a very reasonable question.
The body – and brain in particular – loves to have a steady supply of glucose. Glucose is a bit like Grade A Premium fuel for the cells in our body. It is an efficient and effective substance for cells to convert into energy.
The breakdown of muscle tissue provides a lot of glucose, which our cells love to use. On the other hand, whilst fat tissue provides some glucose, the primary fuel provided by our fat stores is ketones. Ketones are like Grade B Inferior fuel for your cells; it does the job but not quite as readily. Whilst there are some dietary strategies that mitigate the loss of lean body mass, the reality is that most people will find it difficult to lose weight without losing muscle for the simple reason that our brain and body demand glucose.
Fifthly, the human body upregulates the production of monocarboxylate transporters (MCTs) within fat cells during starvation. MCTs help to police energy transfer and storage within our cells. A higher number of MCTs means that when we stop fasting (or ‘fall off’ our diets, fat cells are perfectly primed to uptake calories much more efficiently. This is one of many reasons why it is easy to regain weight after dieting.
One of the most fascinating aspects of starvation is what happens in the end stages. The body will break down organs in preferential order of least importance to derive calories. The body chooses the least essential organs to break down first, with vital organs deteriorating last. Your digestive tract is the first to go (if you’re not eating, who needs intestines?)with the spleen, liver and kidneys somewhere along the middle of the road, and your heart and brain protected until the final stages of starvation. Simply remarkable. The human body is wise beyond words.
As if that’s not enough, it’s not just our bodies that we’re up against. As any dieting woman will attest, it’s also our minds. One of the most common reactions to calorie deprivation is an increased preoccupation with food. You may find yourself overly concerned about the next time ‘you’re allowed to eat’ or ruminate excessively over food. Again, this increase in food-related thoughts is another clever mechanism to protect against starvation. This is simply another evolutionary adaption to motivate us to hunt, gather and act proactively to seek out a food supply.
This is just a short exploration into the complex physiological and psychological changes that occur during the dieting process. In actual fact, over 50 different hormones and chemicals are recruited into our dieting physiology, not to mention the profound shifts that many people experience in their moods and obsessive thinking patterns around food. Despite these very real challenges that our embedded into our DNA, we’re essentially told to ‘will’ ourselves to stick to a diet.
Can you will your heart to stop beating or your lungs to stop breathing? Of course not! Therefore, ‘willpower’ is not a sufficient tool to overcome biology. We need other tools that take into account our inherent evolutionary make up.
What about my health? Can you be fit and fat?
The health risks of a high fat/sugar/salt/calorie diet and sedentary lifestyle are undeniable. Nobody’s arguing that poor nutrition, coupled with low exercise, is a recipe for numerous metabolic diseases such as diabetes, heart disease and high blood pressure, an increased risk of certain cancers, as well as a suite of random health conditions such as reduced fertility.
However, the picture of this association may not be as linear as you once thought. Calorie-laden foods, coupled with low exercise, tends to lead to weight gain. And as we know, these food and movement patterns are also connected with increased disease risk. Yet the bulk of health research has focused on the association between body fat and disease, without taking into account the MASSIVE confounding factor of individual diet quality and movement patterns.
That’s a bit like testing whether or not a woman is at risk of falling pregnant, without checking if she is sexually active or not. It’s totally missing the forest for the trees.
When we look at broader population data through a lens that DOES account for diet and exercise, the results are very different. In 2012, the Journal of the American Board of Family Medicine published a study that looked at the long-term association of weight, diet, exercise and health outcomes. Spanning 170 months with over 11,000 subjects, the key findings were startling:
- Amongst people with poor diet and low exercise, individuals with higher body fat had significantly higher risk of developing chronic disease than people with lower body fat.
- Individuals with higher body fat had a comparable risk of developing chronic risk to those with lower body fat, if there were physically active, moderated their alcohol intake, didn’t smoke and consumed plenty of fruit and vegetables.
Check out the graph of these results from the study (and note that you can read the full article for free here: bit.ly/articleFFDgraph):
In other words, body fat only seems to significantly increase our health risk when we are inactive and eating non-nutritiously. Once healthy lifestyle habits are introduced, body fat appears to play an insignificant role in our longer term health risk. Not exactly the kind of info you’ll find on any diet advertising, it is?
This is a wonderful silver lining! If you are inactive and eat low-nutrient foods, higher body fat will increase your risk of morbidity. But – and this is a major BUT – if you exercise regularly and follow a mostly nutritious diet, body fat is not a determinant of health outcomes. It’s very possible to be healthy at a range of different body sizes.
On a final note, let’s take a look at some of the potential harms of dieting and recurrent weight cycling:
- Suppressed immune system. In a study of 114 overweight but otherwise well women, more than one weight loss episode of 10 pounds or more in the last 20 years was associated with lower natural killer cell function. Natural killer cells are an integral part of the immune system, involved in fighting cancer cells and viruses. Women who had lost significant weight more than five times in the previous twenty-year period had approximately 30% lower natural killer cells than their more weight stable peers.
- Increased risk of mental health issues, specifically eating disorders, anxiety and depression
- Declines in cognitive function,
- Higher risk of diabetes, high blood pressure and certain cancers,
- Lower bone density,
- Higher overall risk of mortality.
It is natural to feel resistance to this information as it totally flies in the face of everything we’ve been told by diet culture. Many of us keep hanging onto the false promise of the next diet that’s ‘going to work this time’. I would kindly ask you this: If it hasn’t been working for the last however many years – and could potential be causing you physiological and psychological harm – why not let go of that bond? Why not try something different?
What Is The Non-Diet Approach?
Hopefully by now, you can see that the diet model is inherently flawed – at least for most people.
In the first two years of my clinical practice, I witnessed this merry-go-round of yo-yo dieting in countless patients. People would successfully lose kilo’s in the initial weeks and months of dieting but eventually “fall of the wagon” and regain weight.
Patients would describe episodes of non-hungry eating (particularly in the evenings) and feeling like the dam walls of their willpower would burst open once the weekend arrived and temptation hit in social situations. In other words, their restrictive dieting behaviours during the start of their days and week were counterbalanced by 3pm munchies that would last until dinner, guilty late night binges and weekend social occasions that precipitated high calorie and alcohol intakes.
My heart completely went out to these people because I could completely relate. Just ten years previously, I had flirted within a razor blade edge of a full-blown eating disorder and what I was hearing sounded an awful lot like disordered eating that I had both experienced personally and studied in an academic capacity. The story I had experienced and was seeing reflected in my clients goes like this:
Step One: Body Dissatisfaction and a desire to lose weight.
Step Two: Restrictive eating (dieting) and increased exercise.
Step Three: Weight loss.
Step Four: Increasingly obsessive thoughts about food, contrasted with a sense of being out of control with eating.
Step Five: Overeating episodes, typically towards the end of the day or late at night.
Step Six: Self-imposed famine (i.e. skipping breakfast and eating minimally) throughout the day to make up for overeating the night before, made easier by the fact of waking up full and bloated.
Step Seven: Overeating in the afternoon and evenings due to high hunger from food avoidance during the start of the day.
Step Eight: Weight gain.
Step Nine: Back to the start – Body dissatisfaction and a desire to lose weight.
Seeing this in client after client after client after client….and within myself, I figured that there had to be a reason for this overwhelmingly common pattern of behaviour.
So, I put my Nutrition Geeky Hat on, and got investigating!
It turns out that there is an entirely new area of health research, often referred to as the ‘Health At Every Size’ model or ‘Non-Diet Approach’.
This model is backed by evidence, meaning that it’s not some latest diet fad that’s been slapped together by a celebrity who lost thirty kilo’s drinking lemon water. Rather, it’s backed by peer-reviewed, robust research by academics who are not fiscally invested in trying to sell you a weight loss product.
The HAES and non-diet approach says that:
- Your body is beautifully designed with internal cues, such as hunger and fullness signals that you can trust,
- All foods are allowed and there is no such thing as “good” or “bad” foods…(Therefore, neither is your self-worth dependent on being “good” or “bad” with food!)
- All body shapes are worthy of respect and everybody deserves to have positive body image,
- Choose exercise and ways of moving your body that you enjoy,
- Be balanced in the way that you nourish your body.
Initially, many clients fear that they will gain mountains of weight if they willingly let go of their control around food. However, whilst initial weight gain sometimes occur, most studies indicate that people are typically weight neutral after adopting a ‘non-diet approach. In other words, whilst they don’t lose weight, they don’t typically gain weight either.
Importantly, the non-diet approach is explicitly weight neutral and we are not trying to lose weight or control ourselves with food. Instead, the non-diet approach offers us the tools to embrace our bodies as they are, work with our body’s natural cues and cultivate health in a way that feels good for us.
Would you like to find out more about the Non-Diet Approach? Here’s how:
- Listen to my FREE seminars at the Women’s Lifestyle Expo on August 31st and September 1st,
- Subscribe to my fortnightly MFC newsletter,
- Contact me for info on my 4 week ‘Freedom From Dieting’ course on the Sunshine Coast, launching Oct 1st,
- Find out more about my professional, compassionate and effective consulting services.