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Wednesday, August 21, 2013

Is It Time To End The ‘Diet Debates’?

Shoppers peruse the produce section at The Fresh Grocer supermarket in West Philadelphia. (Coke Whitworth/AP)

Shoppers peruse the produce section at The Fresh Grocer supermarket in West Philadelphia. (Coke Whitworth/AP)

Comparing diets is something of a national pastime in America: pitting the Atkins Diet against the Paleo Diet against the South Beach Diet. It also extends into medical research.

But a provocative new paper in the Journal of the American Medical Association says researchers should stop comparing diets altogether.

Instead, it suggests researchers shift their focus to how to change behavior — forever.

Carey Goldberg, health reporter at WBUR and co-host of its Commonhealth blog, spoke to the lead author of the paper, Sherry Pagoto.

“We need to understand the key to adherence — and it does not appear to be the content of the diet,” Pagoto said. “It’s more of the context of the dieter.”

Guest

Transcript

JEREMY HOBSON, HOST:

It's HERE AND NOW.

If you're trying to lose weight, there is no shortage of diet programs to choose from. The airwaves are filled with plans that offer the promise of a thinner you.

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JILLIAN REYNOLDS: I'm 46 now. I'm a working mom of two. I don't want to be stuck in mom jeans. So I came back to Nutrisystem, and I lost 30 pounds, just like that.

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UNIDENTIFIED WOMAN: For a limited time, we'll send you the complete Sensa Starter Kit to try for 30 days, with no obligation to buy.

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JENNIFER HUDSON: I'm Jennifer Hudson. I hate getting up in the morning. I love bread. I love cheese. Did I say I love chocolate? I'm human. And the new Weight Watchers 360 program lets me be.

HOBSON: They all sound like they're going to work, don't they? Well, people often bounce from one diet to the next. Researchers spend a lot of time and money trying to figure out which ones work best. But a provocative paper out in a leading medical journal says we should stop doing research comparing various diets altogether. Carey Goldberg, health reporter at WBUR and co-host of the CommonHealth blog, joins us with more. Carey, welcome back.

CAREY GOLDBERG, BYLINE: Thank you, Jeremy.

HOBSON: So this is a national pastime of ours, pitting the Atkins diet against the Paleo diet, against the South Beach diet. Is this a serious call to stop doing that?

GOLDBERG: Well, yes. I hate to ruin the fun, but I'm afraid it is, and with a very good reason. This paper, just out in the journal of the American Medical Association, argues that there's already been plenty of research on the question of which sort of diet helps people lose weight best. There have been dozens of studies, and now even studies of studies, which are called meta-analyses.

And all these millions of dollars of research basically come down to a big, fat draw. In other words, all of the reasonable different diets help people lose weight. I mean, the good news is they work pretty well. They help people lose weight pretty much equally well, with maybe a difference of a couple, 2, 3, 4 pounds in one direction or another. But meanwhile, the obesity epidemic continues.

HOBSON: So if it doesn't matter which diet you're using, then what does matter? What are they trying to get us to do?

GOLDBERG: Well, the point is this keyword of adherence - in other words, sticking to healthier eating for a long, long time. So the paper's lead author is Sherry Pagoto, who's an obesity researcher at the University of Massachusetts Medical School. And she says that what we really need to study now is behavioral change. In other words, what makes people stick to healthier behavior, and what makes one diet easier to stick with for one person than for another? Here's Sherry Pagoto.

SHERRY PAGOTO: Some people say, oh, it's very easy for me to follow low carb. Other people will say, oh, I could never do that. I need to go low fat or Mediterranean. And it may have to do with what they're used to eating, their food preferences, their family traditions. So there are a lot of factors that go into a diet, whether you can stick to a diet.

And so that's what we're really saying. We need to kind of understand those factors. We need to understand the key to adherence. And it does not appear to be the content of the diet. It's more of the context of the dieter.

GOLDBERG: So, basically, Pagoto's talking about a shift of focus. She's saying the idea is that the most important aspect of dieting is not nutrition. It's not how many carbs, how many fats, how much protein. It's behavioral change and how to make it last, like, forever.

HOBSON: So how do we do research on that?

GOLDBERG: Well, Pagoto says this is behavioral science. So we need to understand, for example, the neurobiological differences that make you crave something different from what I do. We need to understand environmental factors like your family, your neighborhood.

We really need to understand - and you might be able to relate to this - stress, and how stress can undermine the best of intentions on diet and exercise. Personally, I'd love to know why I find it so easy to eat healthy in the morning, and by evening, all my good intentions are out the window.

(LAUGHTER)

HOBSON: Me, too.

GOLDBERG: You know that phenomenon? So Pagoto says what she most often hears from weight loss patients is I want to lose weight, but life is getting in the way. And she says that's what people need help with, and that's behavior, not nutrition.

HOBSON: And Robin is perking up here on the other side of the table.

ROBIN YOUNG, HOST:

Well, I just - we did a story on this. The reason is you have something called a will muscle, and you wear it down by the end of the day, and that's why we're all pigging out at four o'clock. Carry on.

(LAUGHTER)

HOBSON: And we should mention, by the way, Carey, that, you know, people often gain all the weight back when they do these short-term diets.

GOLDBERG: Exactly. And what Pagoto argues is that this is a chronic condition, and you can't just think that you can treat it with a diet and stop, the same way you wouldn't treat diabetes or high cholesterol with a drug and then stop.

HOBSON: Carey Goldberg, health reporter here at WBUR, co-host of the CommonHealth blog. Thanks as always.

GOLDBERG: My pleasure. Transcript provided by NPR, Copyright NPR.


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