Diets fail. Not just often, but almost always—90% of the time. If diets worked we wouldn’t have a worldwide obesity problem. And obesity is a problem that needs to be solved. The prevalence of obesity has doubled since 1980. As a public health issue, there are few determinants of illness that are more destructive, as obesity contributes to the growing rates of diabetes, heart disease, and even cancer. There’s no “one true cause” of all illness, but obesity comes pretty close. When people ask me for the single most important thing they can do for their health, my advice (after quitting smoking) is to (1) ensure you keep your weight under control and (2) exercise in any way possible.
Despite its tremendous impact on health, I’ve only blogged about obesity in an indirect way—by pointing out what doesn’t work. Dr. Oz is my perpetual source of bad health information with his regular promotion of bogus “weight loss” supplements like the green coffee bean “miracle”. I’ve also criticized eating programs like the fads of “Eating Clean”, gluten “intolerance”, or harmful diet delusions like “detox”. It’s the typical skeptical science blogger approach—spot pseudoscience, debunk it, and hope you did something good. But none of my posts have focused on what one should do—just what you shouldn’t. Over at Science-Based Medicine (where I also blog) Dr. Mark Crislip recently commented that what science-based medicine advocates support manifests in what we oppose. He’s right, because that’s the easy approach. Using the principles of science-based medicine, there’s an awful lot to oppose in the current writing and popular opinion on how to treat obesity. And my professional advice in the role of a pharmacist has been limited to steering people away from supplements, and then giving some basic advice about dietary planning. Anecdotes and platitudes. I admit that I’ve told patients to “eat less and exercise more”. I haven’t seen pharmacists do much more, though I like to think that pharmacists can and should be playing a much larger part in obesity management and treatment.
I surmised several years ago that if I could be a more effective advocate and coach on obesity, I could deliver some meaningful health benefits to my patients—likely far greater than any medication. I started following obesity and nutrition experts who blog and tweet, and began to read the literature they cited. What I learned left me a bit chastened. My basic advice about eating less and exercising wasn’t wrong—but it was simplistic, incomplete, and almost certainly ineffective. I didn’t recognize the drivers of obesity in the population—and how people can identify and change them. Sure, “Eat food, not too much, mostly plants” has a kernel of truth. But alone, that type of recommendation isn’t helpful for weight loss. It isn’t a lack of willpower that has almost tripled childhood and adolescent obesity rates since 1980, and made one third of adults obese. Exercise as the sole strategy for weight loss is actually a terrible strategy. And while I knew most of the popular diet plans rarely succeed in the long run, I didn’t know what the evidence actually said about effective interventions. Other than recommending blogs and articles, I didn’t have any resource I could recommend without reservation, especially for those that prefer books over blogs. Until I read The Diet Fix [Amazon]—the first “diet” book I’ve read that is science-based and pseudoscience-free.
I’ve been a fan of Dr. Yoni Freedhoff’s blog Weighty Matters for years—it’s deservedly one of the most popular blogs about obesity. Freedhoff is a fierce critic of obesity pseudoscience and also an outspoken critic of the products and policies that contribute to today’s obesogenic environment. As a family physician with his own obesity practice, Freedhoff brings to the blog a knowledge of the medical literature, combined with extensive experience working directly with obese patients.
The healthiest life you can enjoy
This is an unconventional diet book because it doesn’t recommend what many will think of as a “diet” at all. If you’re looking for a strict meal plan with foods that are either celebrated or demonized, you’ll be disappointed. There are no traumatic sacrifices required. No starvation, no cleanses, and no miracle supplements.
Freedhoff opens the book describing “Dieting’s Seven Deadly Sins”, which are commonly held, but dangerous, beliefs about dieting. Hunger is the first myth to go. Freedhoff argues that any diet plan that leaves you hungry won’t be sustainable. Sacrifice is next—perpetual sacrifice of anything you enjoy will make any diet fail. Willpower is important, but permanent resistance is almost certainly futile. Blind food restrictions are the next to go, and Freedhoff is adamant we need to manage, but not banish, certain food groups. Sweating is the next myth, with The Biggest Loser epitomizing the belief that exercise can contribute to significant weight loss. You can’t outrun your fork—not in the long run. Anticipating perfection is also a myth, so real diets must be flexible enough to accommodate setbacks. Denial is the last myth. “The diet was great—I just couldn’t stick with it” is a common refrain. As weight loss progresses, any suffering gets harder to sustain, and harder to deny.
Given almost all typical “diets” don’t deliver long-term results, few who read The Diet Fix will be dieting newbies. Negative emotions and expectations from dieting are to be expected and Freedhoff reviews the most common traumas, and how to address them. These include guilt, shame, failure, depression, despair, binge eating, and weight cycling/metabolic slowdown.
The core of the book is focused on what Freedhoff calls the “Ten Day Reset” that is designed to “reset” behaviors and recalibrate expectation about what a “diet” really should be. Each day describes how to develop a new set of skills to support permanent behavior change. One of the points that Freedhoff repeatedly emphasizes is in order to make permanent changes in your weight, you must be prepared to make permanent changes in your life. And the more weight you want to lose, the more of your life you must be prepared to permanently change. Any intervention that is too difficult to sustain will eventually be abandoned, so Freedhoff emphasizes that one’s target weight must be based on a “best weight”. The “best weight” is the point at which you’ve found a balance between your weight and your own satisfaction and willingness to stick to a plan. There are no promises of magical (and unsustainable) weight loss. This is an approach for a lifetime.
The ten days of the reset are as follows:
- Gearing up: Scales, for you and for your kitchen, to measure and weigh food (and yourself) accurately. A journal (for a food diary) is essential. And buy food. Freedhoff emphasizes healthier choices and thoughtful selections, and recommends minimizing refined carbs (including juice) while promoting whole foods. He doesn’t demonize any food group, except (justifiably) artificially-created trans fats.
- The food diary: All food has a metabolic cost, and it’s measured in calories. It’s promoted as a tool to guide eating, and make eating more conscientious. Freedhoff not only encourages logging what was eaten, but also the calories, when it was eaten, and any hunger cravings. There are a number of online sites and phone apps that make logging take only minutes per day.
- Banishing hunger: Keep hunger pains at bay by eating regularly: Don’t skip breakfast, eat every 2-3 hours (set reminders if necessary), and include adequate protein (for satiety) every time you eat. Your daily calorie “budget” needs to be allocated across your meals.
- Cook: Regularly eating purchased and prepared meals make it more difficult to control portions and calories. Cook real foods focusing on healthy ingredients. Minimize using refined and processed foods as much as possible, but not so much that you’ll give up.
- Think: Describe your best weight—one in which you’re living the healthiest life you can honestly enjoy.
- Exercise: here’s no question that exercise is beneficial to health, but it alone is ineffective for generating weight loss. Why? You can’t out-exercise a bad diet, but regular exercise helps keep weight off, and changes your attitude for the better. And exercise has enormous health benefits beyond any impact on weight. What exercise? Something. Anything. “Some is good, more is better, everything counts” Freedhoff suggests.
- Indulge: There are no forbidden foods. Real life includes indulgences, and permanently denying yourself pleasurable foods (whatever they may be) makes any diet plan unsustainable. So one must learn to manage indulges in a calorically-responsible way. Freedhoff suggests asking yourself two questions: “Is it worth the calories?” and “How much of it do I need to be happy?”
- Eat out: Cooking is crucial, but eating out is part of life for many—so navigating a restaurant successfully is an essential weight management skill. Freedhoff suggests knowing your calories, pre-eating, moderating alcohol, and making thoughtful choices between calories and food you’ll actually enjoy.
- Goal setting: Behavior change is accelerated when goals are achieved. The two most important goals are (1) to eat the smallest number of calories possible (while still liking your life) and (2) to exercise as much as you can enjoy.
- Troubleshoot: Making permanent change can inevitably lead to roadblocks, and Freedhoff looks at the commonly encountered roadblocks to sustainability.
Freedhoff is adamant that there is no one perfect “diet” for everyone, so The Diet Fix doesn’t prescribe one beyond his general guidelines. The behaviors and skills are relevant to any approach to weight loss—as long as you’re enjoying the approach and see it as sustainable for the long-term, then it will work. Freedhoff repeatedly emphasizes that healthy living is a lifelong approach—not something you can repair with a “quick fix” diet or detox.
In this book we obey the laws of thermodynamics
Freedhoff tackles a number of diet and obesity issues throughout the book, blowing up cherished myths throughout:
- Calories do matter (Yes, Gary Taubes, who believes otherwise, is wrong). Calories are the fundamental unit of energy and counting calories is the intervention that Freedhoff ranks more important than anything else in the book.
- Low carb/Low fat/Paleo/Vegan are all acceptable—if you can sustain it, and as long as you watch caloric balance. Freedhoff argues against demonizing any food (even chocolate has its place, he says) and cautions that your diet must be sustainable.
- The enemy isn’t carbs/fat/glucose/gluten. Cutting out food groups can sometimes deliver short term results (like low-carb) but they’re difficult to maintain over the long term.
- Dietary fats are not the enemy. Saturated fat is not the health risk it was once believed to be. Unsaturated fats may offer health benefits, so ensuring these are part of your diet is probably a good idea.
- There are no magical supplements. There is no persuasive evidence to support the long-term effectiveness of any supplement.
- Artificial sweeteners are safe, and can be beneficial as part of a weight loss strategy. The same cannot be said for sugar.
The Diet Fix is an oddity among the diet books you’ll find in bookstores. There are no outlandish promises, no strict dietary rules, no excessive exercise, and no recommendations for supplements and potions. I doubt we’ll see Dr. Freedhoff’s book profiled on Dr. Oz. And that’s a shame, because this book deserves a wide audience, especially to those that have struggled and failed on the types of weight loss strategies that Dr. Oz loves to tout. Community pharmacists that feel challenged to help their obese patients should read The Diet Fix carefully, and consider recommending it to their patients. I wouldn’t hesitate to recommend The Diet Fix as a science-based guide for anyone that seeking credible and sustainable advice on permanent weight loss.
Full disclosure: I received a free copy of The Diet Fix from the publisher, but I was not asked (nor did I offer) to write a review of the book.