Two panelists battle it outby Susie Orbach , Michael Mosley / January 17, 2017 / Leave a comment
Published in February 2017 issue of Prospect Magazine
Should we give up dieting? Yes No We both agree that there is a crisis around food and bodies. I know your motives aren’t cynical. I don’t dispute the sugar and refined carbs argument, but what worries me is the seductive thrust of your latest book: that you can lose weight fast by reprogramming your body. You are appealing to the same people who bought your first book. But did they learn? Did they change their life? If only. If only the perfectly reasonable advice you proffer were of use to more than a few. It all sounds sane and welcoming. Indeed, the stories of blood sugar levels slashed, energy returned, illness replaced by health and vigour, depression banished, would enthuse anyone troubled by their weight. But this victorious narrative in which the beast of appetite is slain by the judicious reduction in food and in type of food eaten is not, as experience shows, borne out. Diets don’t work. You know that. I know that. The researchers know that. The publishers know it. You didn’t sell 250,000 copies of The 8- Week Blood Sugar Diet and a million copies of The Fast Diet because diets were successful. You sold them because diets fail. There is panic where food, fat and fitness are concerned. The miracle first story of Jon who lost 8.5kg in the first week is irresistible to a reader seeking salvation from troubled eating and a troubled body. It’s that hope which sells your book, despite the shocking evidence that diets are only effective in a maximum of 5 per cent of people. From my vantage point, I see the anguish and self-hatred that arises from weight cycling and the 95 per cent of people who experience themselves as dieting failures. I fear you are soliciting return customers who will crash in the wake of a shocking recidivism rate which has anguishing mental and physical health consequences. I understand your cynicism about diets and their very high failure rate. There are thousands of diet books out there and new ones being added all the time. Many are awful. But that doesn’t mean all are awful. And I do think it is important to do something, at an individual level, about the current “diabesity” epidemic. Clearly it would be better if we didn’t live in such an obesogenic environment, where fattening foods are all around and where children are bombarded with adverts for high-sugar foods. It would be great if our built environment encouraged us to walk rather than take the car. I would like to see fewer escalators and more people walking on the ones that are there, rather than just standing. Unfortunately a lot of the things that could and should be done depend on policy decisions made by government, which you and I can do little about, other than agitate. You say that “diets are only effective in 5 per cent of people.” It’s a statistic that appears to be an urban myth. I have tried to track its origins and failed. But even if there were some basis to it, it wouldn’t tell us much beyond the fact that lots of people follow some very bad diets. What I have done, based on my own experience and scientific studies, is offer a different way to approach weight loss, through intermittent fasting (the real goal being to reduce high levels of abdominal fat, which are linked to a wide range of poor health outcomes) and then aim for weight maintenance via a Mediterranean-style diet and more activity. Generations are now growing up exposed to non-food foods. You abhor this as much as I do and I wish you would challenge the rubbish concoctions saturated with bliss points sold to parents as wholesome foods which are then given to children in good faith. Where we disagree is that government and the food industry can’t be taken on. I think that is where a major part of our efforts must be directed, not just at the individual level. I know that’s an odd remark from a psychoanalyst but it’s precisely because I see the extraordinary anguish visited on the individual by food industry shenanigans and the so-called wellness industries. And this relates to the diet industry too, which is often owned by and thus part of the food industry. Incidentally I’m surprised that you don’t know (a) the studies which show that dieting causes eating disorders and (b) Professor Traci Mann’s study on the appallingly low levels of success from dieting. Success for me would constitute being able to identify hunger and responding to that appetite with real food. Then, being able to taste every mouthful, knowing how foods sit with the person and how to stop when they are full and to understand what they are reaching for emotionally when they eat when they aren’t physically hungry. These essential categories of hunger and satisfaction, which we need to restore, are not solved by a diet, however wholesome or “good.” I’ve had plenty of patients on the Mediterranean diet who are compulsive eaters. We need to reduce the hysteria about size, about diet and intake and encourage the enjoyment of delicious real food so one is not deprived and can notice the signal of satisfaction. Going up and down the scale in the name of the fight against obesity is detrimental to health and to mental well-being. There is much that we agree on, so I might as well focus on where we don’t: the question of whether dieting ever works. I didn’t know Traci Mann’s work so I looked up her latest paper, “Promoting public health in the context of the obesity epidemic.” It is a good read and offered compelling alternatives to simply dieting. Above all I completely agree with her conclusion that we must “make use of environmental changes to reduce the amount of willpower necessary to achieve healthy behaviour.” I was also interested that the first reference in her paper was to “a systemic review and meta-analysis of weight loss clinical trials,” published in 2007. Strangely enough its authors concluded that the diets they looked at did work, with an average weight loss of 3-6kgs “with none of the groups experiencing weight regain to baseline.” A more recent study, published in the New England Journal of Medicine, which followed 322 people, again found that dieting worked. Yes, there was some weight regain after the initial falls, but after two years most people had stabilised at a new, lower, weight. Those allocated to a low-fat diet had kept off an average of 2.9kgs, while the low carb and Mediterranean diet groups enjoyed more impressive weight losses of 4.7kg and 4.4kg respectively. This scale of weight loss would be sufficient to prevent many overweight people progressing to type 2 diabetes, avoiding a situation where they would be offered medication that in the long term might simply make them fatter and sicker. Researching this area has convinced me that there are dietary approaches worth talking about, writing about and maybe even embracing. Yes, we must agitate for policy change, but at the same time we needn’t accept the nihilistic belief that “diets always fail.” I think we read the research differently and as Weight Watchers said in their submission to the All-Party Parliamentary Group a few years back, we are only successful at the level of a 5kg weight loss, and then for not that many people. Yet government money—our funds from the NHS—goes to Weight Watchers, to promote a course of action that it admits does not work. My hope is that people could learn to eat well without a sense of having to be wary and watchful of their food all the time. What saddened me about your book was the sense of hidden dangers. You portray your own struggle as frightening, even though you had already advocated certain dietary regimes, lost weight and sold a million books on the back of it. You present it like a plague we can’t see, yet the real plague is troubled eating and self loathing towards one’s body. A vicious food industry aided by the style industries—the fashion, beauty, cosmetic surgery and “wellness” industries lead people to feel that their bodies—however small and lithe they are—are somehow not quite right and need changing. This is playing havoc with the nation’s eating habits. The diet industry feeds off it, and unfortunately your “hidden invaders” argument inadvertently plays into the idea that we must be ever watchful. You encourage people not to view their bodies as something to live from and do things with, but as something to be feared and constantly remade. If the government were truly serious about diabetes and obesity, they would ban certain food practices by manufacturers. They would implement measures to challenge the disturbed eating that lives in all size bodies—thin, medium, fat. We both know that. Let’s try to do something valuable about it together. I haven’t seen that particular submission by Weight Watchers but I’m not surprised. Weight Watchers have, at least until recently, followed the failed “low fat” paradigm. Give me a Mediterranean diet, rich in olive oil and nuts, any day. I don’t obsess about weight because it is clearly possible to have a body mass index (BMI) which puts you into the “overweight category” and still be perfectly healthy. I do bang on about visceral fat, the fat that collects around your stomach and internal organs, because it is the enemy within. Once it infiltrates your liver and your pancreas you are well on the road to hypertension, type 2 diabetes and heart disease. It has recently overtaken alcohol as the number one cause of liver failure. I wrote my latest book because rising blood sugar levels are a global disaster and if you know you are at risk then you can do something about it, preferably before you tip over into diabetes and other metabolic disorders. In fact the importance of knowing your blood sugar levels, rather than simply your BMI, is one of the many good points that Traci Mann makes in her paper. As she eloquently puts it, “Let’s retire weight and BMI as measures of health and replace them with more valid indicators, such as blood pressure and heart rate, as well as levels of cholesterol and blood glucose.” Other things she suggests, with which I completely agree, include limiting the size and availability of sugary drinks, making healthy foods more visible in school canteens, reducing the stigma around being overweight and finding creative ways to reduce elevator use. I particularly enjoyed the study which showed that delaying lift door closure by six seconds cut lift use by a half. So yes, do let’s try and do something valuable together. I would enjoy that.