Point of Contention: Can Dietary Debate Ever End?

— Clinicians weigh in on the latest round of sugar versus fat

MedpageToday

The sugar versus fat, exercise versus diet debates not only continue but rise in intensity with the publication of each new study.

We contacted some diet and obesity experts via email to ask:

What can be done to simplify the message for patients in order to reduce the obesity epidemic and slow obesity related diseases?

Discuss the best ways clinicians should respond to patients who say, "I'm so confused by all the different studies I hear about and I don't know what is right anymore when it comes to diet."

The participants are:

Lee Kaplan, MD, PhD, director, MGH Weight Center at Massachusetts General Hospital in Boston

Barbara Moore, PhD, president and CEO, Shape Up America! in Clyde Park, Mont.

Daniel W. Jones, MD, professor and interim chair, department of medicine at University of Mississippi Medical Center in Jackson

No One-Size-Fits-All Approach

Kaplan: The reason that the message is not simple is that the disease of obesity is not simple. There are multiple different subtypes that have different causes, each with different strategies for effective prevention and treatment. We don't currently know how to determine which subgroup of obesity each person is in, so we have to try different approaches (diets, exercise programs, sleep, stress reduction, etc.) and see which one works for a given individual. This sounds complicated, and it is: trying to simplify it to a single approach for everyone leads to inadequate clinical benefit for many people, leading over time to widespread frustration, and ultimately, someone who will tout a "new" dietary panacea (e.g., low-fat, low-glycemic index, low-calorie, etc.), starting the process all over again. What we need is a more vigorous research effort to define the different subtypes of obesity which will lead to better predictors of which approach will work best for each one of us.

Jones: There certainly are many confusing messages about obesity. The American Heart Association has simplified the messaging about a healthy lifestyle through their "Life's Simple 7" [program]. There is advice and information to get active, eat better, and lose weight. The advice is simple, straight-forward, and easy to understand. You can count on scientists at the AHA to keep up with the latest research results and to interpret that for the American public.

Moore: Any weight loss strategy that works is effective because, through one mechanism or another, people eat less -- that means they are eating fewer calories. For lasting success, my own evaluation of the literature suggests that not only do overweight people have to eat less, they also need to learn how to make healthier food choices. That means choosing fewer calorie-dense foods, especially choosing fewer fatty-sugary foods, and more (much more) vegetables and fruits. All of this boils down to an "eat less" message. I know that "eat less and move more" is somewhat of an oversimplification, because I encourage learning what foods to avoid and what foods to consume more. But at least "eat less and move more" is the simple message you are seeking. As a formerly fat person myself, I know it works. But more importantly, as an obesity professional with more than 30 years of experience, I know it works.

Importance of Diet

Jones: One of the best strategies for clinicians is to guide the conversation toward what should be eaten, rather than what should be avoided. If one eats five servings of FRESH fruits and vegetables a day, the rest of the nutrition choices become much easier -- and less important.

Moore: I would encourage clinicians to work with dietitians, whenever possible. I think diets that avoid entire food groups such as dairy or carbs are -- over the long run -- hard to sustain, are nutritionally unbalanced, and should be avoided. People who are trying to lose weight will encounter many barriers and will have many questions. They have to find and sustain the motivation to change their diet and lifestyle. This is difficult. They will need ongoing support. Of all the healthcare professionals, I would say that the training of dietitians is best suited to provided the necessary support and guidance. So local weight loss support groups can be formed by laypersons through the nonprofit TOPS program or commercial programs such as Weight Watchers. In the absence of those resources, some people work with a friend or another member of their own family. This can make a daily exercise routine more fun.