Dieting

Dieting is the practice of eating food in a regulated way to decrease, maintain, or increase body weight, or to prevent and treat diseases such as diabetes and obesity. Dieting to lose weight is recommended for people with weight-related health problems, but not otherwise healthy people.[1][2] As weight loss depends on calorie intake, different kinds of calorie-reduced diets, such as those emphasising particular macronutrients (low-fat, low-carbohydrate, etc), have been shown to be no more effective than one another.[3][4][5][6][7] As weight regain is common, diet success is best predicted by long-term adherence.[4][7][8] Regardless, the outcome of a diet can vary widely depending on the individual.[4][9]

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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.[10]

Estimations reveal that almost half of all American adults attempt to lose their weight through dieting.[11]

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

According to Foxcroft, the word diet comes from the Greek diaita, which represents a notion of a whole way healthy lifestyle including both mental and physical health, rather than a narrow weight-loss regimen.[12][13]

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.[14]

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.[15] 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.[16]

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.[17] The pamphlet's popularity was such that the question "Do you bant?" referred to his method, and eventually to dieting in general.[18] His booklet remains in print as of 2007.[10][19][20]

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.[21]

It was estimated that over 1000 weight loss diets have been developed up to 2014.[22]

Types
Main article: List of diets

A restricted diet is more often pursued by those who want to lose weight. Some people follow a diet to gain weight (usually in the form of muscle). Diets can also be used to maintain a stable body weight and improve health.

Low-fat
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.[3]

A low-fat, plant-based diet has been found to improve control of weight, blood sugar levels, and cardiovascular health.[23]

Low-carbohydrate
Main article: Low-carbohydrate diet

Low-carbohydrate diets are relatively high in protein and fats. Low-carbohydrate diets are sometimes ketogenic (i.e., they restrict carbohydrate intake sufficiently to cause ketosis).[24]

"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."[25][26]

A randomized controlled trial comparing four diets concluded that the high-carbohydrate, low-glycemic index diet was the most favorable as it led to both high weight loss and a decline in low density lipoprotein.[27]

The "glycemic load" is the glycemic index multiplied by the amount of carbohydrate.[28] 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 but did not separate the effects of the load versus the index.[29]

Low-calorie
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 to 1 kilogram (1.1 to 2.2 pounds) weight loss per week. One of the most commonly used low-calorie diets is 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.[3] Women doing low-calorie diets should have at least 1,000 calories per day and men should have approximately 1,200 calories per day. These caloric intake values vary depending on additional factors, such as age and weight.[3]

Very low-calorie
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 loss of 1.5–2.5 kg (3.3–5.5 lb) per week. "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, after which the cycle repeats. These is some evidence that these diets results in considerable weight loss.[4] These diets are not recommended for general use and should be reserved for the management of obesity 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.[3]

The concept of crash dieting is to drastically reduce calories, using a very-low-calorie diet.[30][31][32][33] Crash dieting can be highly dangerous because it can cause various kind of issues for the human body. Crash dieting can produce weight loss but without professional supervision all along, the extreme reduction in calories and potential unbalance in the diet's composition can lead to detrimental effects, including sudden death.[34]

Fasting
Main articles: Fasting and Intermittent fasting

Fasting is when there is a long time interval between the meals. In dieting, long term (periodic) fasting is not recommended, instead, having small portions of food after small intervals is encouraged. Lengthy fasting can also be dangerous due to the risk of malnutrition and should be carried out only under medical supervision.[35] 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 the issues of long fasting.

Detox
Main article: Detox diet

Detox diets are promoted with unsubstantiated claims that they can eliminate "toxins" from the human body. Many of these diets use herbs or celery and other juicy low-calorie vegetables.

Environmentally sustainable
See also: Environmental vegetarianism

Another kind of diet focuses not on the dieter's health effects, but on its environment. The One Blue Dot plan of the BDA[36] offers recommendations towards reducing diets' environmental impacts, by:

  1. Reducing meat to 70g per person per day.
  2. Prioritising plant proteins.
  3. Promoting fish from sustainable sources.
  4. Moderate dairy consumption.
  5. Focusing on wholegrain starchy foods.
  6. Promoting seasonal locally sourced fruits and vegetables.
  7. Reducing high fat, sugar and salty foods overconsumption.
  8. Promoting tap water and unsweetened tea/coffee as the de facto choice for healthy hydration.
  9. Reducing food waste.

Effectiveness

Several diets are effective for weight loss of obese individuals,[2][4] with diet success most predicted by adherence and little effect resulting from the type or brand of diet.[4][7][22][37][38][39] As weight maintenance depends on calorie intake,[4][5] diets emphasising certain macronutrients (low-fat, low-carbohydrate, etc.) have been shown to be no more effective than one another and no 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).[40][41][42] A meta-analysis of six randomized controlled trials found no difference between low-calorie, low-carbohydrate, and low-fat diets, with a 2–4 kilogram weight loss over 12–18 months in all studies.[3] Extreme diets may, in some cases, lead to malnutrition.

A major challenge regarding weight loss and dieting relates to compliance.[4] While dieting can effectively promote weight loss in the short term, the intervention is hard to maintain over time and suppresses skeletal muscle thermogenesis. Suppressed thermogenesis accelerates weight regain once the diet stops, unless that phase is accompanied by a well-timed exercise intervention, as described by the Summermatter cycle.[43] As a result of this, some argue against using weight loss as a goal, preferring other measures of health such as improvements in cardiovascular biomarkers,[1][44] sometimes called a Health at Every Size (HAES) approach.[45]

Short-term dieting results on average in a meaningful long-term weight-loss, although more limited because of gradual 1 to 2 kg/year weight regain.[2][4][8] For each individual, the result will be different, with some even regaining more weight than they lost, while a few others achieve a tremendous loss, so that the "average weight loss" of a diet is not indicative of the results other dieters may achieve.[4][46] A 2001 meta-analysis of 29 American studies found that participants of structured weight-loss programs maintained an average of 23% (3kg) of their initial weight loss after five years, representing an sustained 3.2% reduction in body mass.[8]

Dieting appears more effective than exercise for weight loss, but combining both provides even greater long-term results.[2][4]

Adverse effects

A number of studies have found that intentional weight loss is associated with an increase in mortality in people without weight-related health problems.[45][47][48][49] A 2009 meta-analysis of 26 studies found that "intentional weight loss had a small benefit for individuals classified as unhealthy (with obesity-related risk factors), especially unhealthy obese, but appeared to be associated with slightly increased mortality for healthy individuals, and for those who were overweight but not obese."[1]

Eating disorders

In an editorial for Psychological Medicine, George Hsu concludes that dieting is likely to lead to the development of an eating disorder in the presence of certain risk factors.[50] A 2006 study found that dieting and unhealthy weight-control behaviors were predictive of obesity and eating disorders five years later, with the authors recommending a "shift away from dieting and drastic weight-control measures toward the long-term implementation of heathful eating and physical activity".[51]

Mechanism

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.[52] The primary by-products of metabolism are carbon dioxide and water; carbon dioxide is expelled through the respiratory system.

Set-Point Theory
See also: Energy homeostasis § Imbalance

The Set-Point Theory, first introduced in 1953, postulated that each body has a preprogrammed fixed weight, with regulatory mechanisms to compensate. This theory was quickly adopted and used to explain failures in developing effective and sustained weight loss procedures. A 2019 systematic review of multiple weight change procedures, including alternate day fasting and time-restricted feeding but also exercise and overeating, found systematic "energetic errors" for all these procedures. This shows that the body cannot precisely compensate for errors in energy/calorie intake, countering the Set-Point Theory and potentially explaining both weight loss and weight gain such as obesity. This review was conducted on short-term studies, therefore such a mechanism cannot be excluded in the long term, as evidence is currently lacking on this timeframe.[53]

Methods

Meals timing

Meals timing schedule is known to be an important factor of any diet. Recent evidence suggest that new scheduling strategies, such as intermittent fasting or skipping meals, and strategically placed snacks before meals, may be recommendable to reduce cardiovascular risks as part of a broader lifestyle and dietary change.[54]

Food diary

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 a person records their eating, they are more aware of what they consume and therefore eat fewer calories.[55]

Water
Main article: Weight loss effects of water

A 2009 review found limited evidence suggesting that encouraging water consumption and substituting energy-free beverages for energy-containing beverages (i.e., reducing caloric intake) 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.)

Society

It is estimated that about 1 out of 3 Americans is dieting at any given time. 85% of dieters are women. Approximately sixty billion dollars are spent every year in the USA on diet products, including "diet foods," such as light sodas, gym memberships or specific regimes.[56][57] 80% of dieters start by themselves, whereas 20% see a professional or join a paid program. The typical dieter attempts 4 tries per year.[58]

Weight loss groups

Some weight loss groups aim to make money, others work as charities. The former include Weight Watchers and Peertrainer. The latter include Overeaters Anonymous, TOPS Club and groups run by local organizations.

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.

See also

References
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Further reading
  • American Dietetic Association (2003). "Position Paper on Vegetarian Diets". J Am Diet Assoc. 103 (6): 748–765. doi:10.1053/jada.2003.50142. PMID 12778049.
  • 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.
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