Why Diets Don’t Work and What to Do Instead

You might be thinking, why is a dietitian telling me not to diet? Don’t they put people on diets?

Well, it’s complicated. Let’s first define ‘diet’ in the context of this post. When I say diet, I am referring to an eating plan with rules focused on restricting foods, food groups, calories, etc. The diet’s primary measure of success is the manipulation of body size or maintenance of an ideal weight. Often these goals are set forth by a societal standard and not the individual person.

Diets also tend to moralize foods as good or bad, healthy or not healthy, clean or—for lack of a better word—dirty. The foods you eat on a diet and how much you eat are usually determined by external rules set forth by an individual or the diet itself, and not internal cues like hunger, fullness, and cravings.

Popular examples include the paleo diet, which heavily restricts highly processed foods along with grains, legumes, and dairy products; the ketogenic diet, a low-carbohydrate and high-fat diet that virtually eliminates fruit and root vegetables; or structured eating plans where you are counting points or calories throughout the day.

Nearly everyone has tried to diet and most have ended up feeling like a failure in one way or another. But it is not the individual who has failed; it’s the diet, because diets don’t work.

In the long term, diets are not sustainable. There is not a single randomized-controlled trial that can show sustained weight loss after two years on any diet. Within five years, 95 percent of dieters will regain all weight lost. Often, the regain will leave folks heavier than they were before the diet, because dieting can adversely affect your hormones and slow your metabolism.

It is absolutely possible to feel good and live a healthy lifestyle without dieting. Instead of the latest fad diet or obsessing over a food tracking app, try the following:

Forget the black and white thinking.

Labeling foods as good or bad makes it really difficult to listen to hunger, fullness cues, and cravings.  Think of all foods as one big, neutral shade of gray. There is a place for every food in a balanced, varied diet. Remove the stigma placed on certain foods and the pedestal we put on other foods. That’s right, have your cake and eat your kale too.

Instead of focusing on weight or body size, focus on how you feel.

What health-promoting behaviors will help you feel good? Make a list of these items: things like eating more vegetables, going for evening walks, taking an exercise class that you enjoy, or cooking dinner for your family. Identify the behaviors that make you feel good but that you may not be doing enough of, and vice versa. These behaviors and the frequency with which we practice them make a difference in long term health, not micromanaging our diets or weight.

Seek out help from a registered dietitian with non-diet, weight neutral philosophies.

Our relationships with food are complicated. It can be extremely hard to break up with dieting and the diet mindset. These specialized dietitians can help guide you on a path of diet freedom and a more positive relationship with food, and help you identify the health-promoting behaviors that can fit within your lifestyle.

Kelly Hogan, MS, RD, CDNKelly Hogan, MS, RD, CDN, is a registered dietitian who focuses on breast cancer nutrition for the Dubin Breast Center of The Tisch Cancer Institute. Ms. Hogan creates patient education and wellness programs and provides individual counseling in the areas of wellness, weight management, and symptom/side effect management.

While diets do not promote prolonged weight loss, they often lead to the following:

Increased cravings

Restricting certain foods and food groups often makes us want them more than ever.

Higher risk of bingeing

The restrictive nature of diets can also cause an increase in bingeing, the body’s physiological response to energy deficiency and starvation.

Nutrient deficiencies

Over long periods of time, eliminating certain foods or food groups can lead to deficiencies in fiber, calcium, and other vitamins and minerals.

A negative relationship with food

In some cases, the hyper-focus on food can lead to disordered eating, which profoundly impacts quality of life.

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How to Dine Out and Still Eat Healthy

Dining out can be a great way to spend quality time with friends and family. Health-conscious individuals, however, may find dining out to be a challenge due to the overabundance of unhealthy options and the lack of transparency on restaurant menus. Fortunately, by following these simple steps, you can painlessly make healthy eating choices while out on the town.

Before heading out, be sure to check the menu and have a snack.

Most establishments have their menu available online. Plan a nutritious meal in advance. Selecting your meal beforehand prevents you from being tempted by less healthy options once at the restaurant. To avoid overdoing it, have a small, healthy snack that includes fiber and protein before the meal, so that when the bread basket arrives, you won’t overindulge.

Start your meal smart by avoiding liquid calories and ordering a healthy appetizer.

Try to avoid sodas and alcoholic beverages, as these can quickly add excess calories and sugar. Go for healthier options like seltzer, water with lemon, or unsweetened iced tea. If you’d like an alcoholic drink, avoid one of the pre-made, sugary ones like margaritas or daquaris.  Consider a light beer, a glass of red wine, or a seltzer paired with the alcohol of your choice and a lemon wedge.

Healthy starters can keep you full so you are less likely to overeat when the entrées arrive. Some smart options include a vegetable appetizer, a tossed salad, or a broth-based soup rather than lobster bisque.

Eat your vegetables and steer clear of fried foods. 

Vegetables are high in fiber, which will help you feel full without adding extra calories, so add non-starchy ones (i.e., not potatoes or corn) as side dishes. If your meal normally comes with French fries or onion rings, swap them for a side salad or a vegetable. Avoid anything fried, as well as entrees described as breaded, pan-fried, creamy, or crispy, since these are often higher in calories and fat. Instead, look for menu terms that are broiled, steamed, roasted, and baked – all healthier options.

Making smart eating choices while dining out is possible. By preparing before the meal, you can dine out without the guilt. Remember, indulging is okay occasionally; just try to get back on track for the next meal.

Melissa Mann, RD, is an inpatient dietitian in the Clinical Nutrition Department at The Mount Sinai Hospital where she specializes in oncology and general medicine. Ms. Mann is enthusiastic about the field of nutrition and is eager to help patients best optimize their nutrition status, whether in or out of the hospital.

Healthy Pre-Dining Snacks

To avoid overindulgence, try a fiber- and protein-rich snack before dinner:

  • Greek yogurt with fresh fruit
  • An apple with 2 tablespoons of peanut butter
  • Hummus with vegetables

Salad Do’s and Don’ts

If you order a salad as your entrée, limit these high-calorie, high-fat add-ons and salty or creamy salad dressings:

  • croutons
  • fried noodles
  • candied nuts
  • blue cheese dressing
  • ranch dressing
  • Caesar dressing

Instead, substitute lighter options like olive oil and vinegar or lemon juice. Ask for salad dressings on the side, so that you control the amount.

Tips on Portion Control

Restaurants often provide very generous portions. Try ordering an appetizer instead of an entrée and add a small salad to complement the meal. Share an entrée with a friend and add a vegetable side to keep you full. If you do order a full-size entrée, ask to box up half of it before the meal starts to avoid the temptation of finishing the whole portion.

Intermittent Fasting: Feast or Famine

Reclaiming the health of western society may require matching our diet and lifestyle to those that our bodies and minds evolved for, notes Julie Devinsky, RD, an inpatient dietitian of the Department of Clinical Nutrition at The Mount Sinai Hospital.

Julie Devinsky, RD

Before the modern age, we ate to survive. Our bodies and metabolism were more opportunistic and adaptive to what was intermittently available. There was no such thing as breakfast, lunch, or dinner. For most of human history, it was a mix of scavenging, gathering plants, and hunting. Diets varied by season, differing enormously across climates. At times, it was feast or famine.

Intermittent fasting—a term for prolonged cycles between eating and fasting—aims to mimic what early humans experienced by interrupting the regular flow of calories into our bodies.

Because intermittent fasts can be considered more of an eating pattern, rather than a diet, they may be more beneficial and can be used to complement a low-fat, low-carbohydrate, plant-based, or high-fat animal-based diet. However, this pattern works best for a very disciplined person and may not be realistic for many American lifestyles.

There are three types of intermittent fasting: the 5:2 method, alternate-day fasting, and time-restricted fasting.

  • The 5:2 method involves eating normally for five days and fasting for two. On fasting days, roughly 500 calories are consumed. Based on an archetypal “hunter-gatherer” diet, the proposed benefits of the 5:2 diet are based on the premise that fasting increases insulin sensitivity and decreases leptin levels. A hallmark of the fasting phase of this diet is mobilizing fatty acids and ketosis, a process in which the body uses fat rather than glucose for energy. Glucose is stored in the liver as glycogen, which runs out after about 10-12 hours (without exercise), forcing the body to burn fat.
  • Alternate-day fasting (ADF) requires eating no more than 500 calories every other day. In an October 2010 study published in the International Journal of Obesity, approximately 100 obese women on a ADF diet lost an average of 13 pounds over six months with reductions in cholesterol, blood pressure, triglycerides, and insulin. The mechanism of high-fat alternate-day fasting is inducing ketosis similar to the 5:2 regimen. Even lower-fat ADF diets were shown to be effective for weight loss. Further, the dropout rate in the ADF study was only 10-20 percent, which is considerably lower than other diet trials. Interestingly, researchers found that on the non-fasting days, participants ate less than expected. Instead of “feasting” to make up for the fasting days, participants only ate 10-15 percent more than baseline.
  • The time-restricted feeding diet requires that the entire day’s worth of calories be consumed over six to eight hours and the remaining 16-18 hours are to be spent fasting. Research is limited, but preliminary studies suggest this diet may lower cancer risk and help with weight maintenance.

The jury is still out on fasting diets. Initially, many experience a two- to three-week adjustment period where symptoms often include fatigue and nausea. The long-term effects remain to be seen. Fasting may slow metabolism and cause persistent fatigue while some studies show marked changes in weight, blood glucose, insulin sensitivity, and lipid profiles.

These regimens are not for everyone, especially those with diabetes, pregnant and breastfeeding women, people taking certain medications, or those with serious medical conditions. However, in this age of escalating obesity and when the failure of “dieting” is commonplace, intermittent fasting may be useful as part of a weight loss regimen.

The Big Fat Myth: Can Fat Be ‘Good?’

A low-fat diet was once touted as the best for weight loss and optimal health. Groceries stocked low-fat foods on the shelves and everyone avoided fat like the plague. Unfortunately, the low-fat diet trend did America a great disservice. In fact, obesity rates in the United States have consistently climbed. Adena Neglia, MS, RDN, CDN, Senior Dietitian at The Mount Sinai Hospital, explains why fat is not the enemy and how to incorporate ‘good fat’ into your diet.

Do fatty foods make you fat?

Let’s clear up a common misconception: Fat does not make you fat. We gain weight when we eat in excess of our needs, whether the excess comes from protein, carbohydrates, or fats. From a weight management standpoint, fat makes food taste good. When we eat it, we feel more satiated and wind up craving and eating less food later on. In fact, getting adequate amounts of healthy fats in your diet may make managing your weight easier.  From a health and wellness standpoint, fat is needed to help our bodies absorb certain fat-soluble vitamins, including vitamins A, D, E, and K. In the brain, fat stimulates the creation of new brain cells and improves our memory. Fat is critical for reproductive health in men and women because it is used to both produce and balance our hormones.

What is a ‘good’ fat?

As with any macronutrient, quality matters. Healthy sources of fat include avocados, olive oil, nuts, seeds, grass-fed beef, and fatty fish. Incorporate healthy fat into your diet by mashing avocado on toast or pureeing it into a sauce for zucchini noodles. Drizzle olive oil on vegetables to roast them or use as a dressing with lemon on a salad. Add chopped nuts to yogurt and oatmeal or eat them as a snack by themselves.

So, what fat do I need to limit or avoid?

Trans fat. Found in most processed and packaged foods—such as cake, cookies, chips, and crackers—it can be hidden on the nutrition label as “partially hydrogenated oils.” This kind of fat is terrible for our hearts. Not only does it raise your LDL (“bad”) cholesterol, but it also lowers your HDL (“good”) cholesterol. In 2013, the U.S. Food and Drug Administration (FDA) specifically designated partially hydrogenated oils as no longer “generally recognized as safe.”

How can I avoid trans fat?

Choose whole food sources and check your labels for lurking trans fat. Here’s a list from the FDA of foods that contain trans fat.

Adena Neglia, MS, RDN, CDN, graduated from Long Island University with a Bachelor of Science in Nutrition and received her Master’s degree in Nutrition Education from Columbia University. She is the senior dietitian at The Mount Sinai Hospital’s outpatient nutrition program where she provides counseling for both pediatric and adult patients. She covers several clinics including nephrology, hematology, oncology, cardiovascular disease, and general medicine.

What’s so bad about low-fat food?

When companies start to take fat out of their products, they often replace it with sugar to compensate for the taste. We now know that increased sugar intake contributes to obesity, heart disease, diabetes, and cancer. Food additives, emulsifiers, and stabilizers are also added to mimic the texture and mouthfeel of fat. Many people are under the impression that they can eat more of these foods because the low-fat label makes it “healthy.”  As it turns out, these low-fat products often do more harm to our health than good.

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Is Red Meat Bad for You?

 

“Red meat is a source of protein, and it’s recommended to get two to three servings of protein daily for a 2,000 calorie diet. There’re different sources of protein – meat is one of them. You can also get protein from eggs, seafood, nuts, peas, beans. If meat is your main source of protein consumption, I would recommend leaner meat, as opposed to red meat, because red meat, if you look at the data, has been associated with an increased risk of all-cause cardiovascular, as well as cancer related mortality. Whereas lean meat, has a lower mortality with cardiovascular events, as well as cancer associated. So, you can have your occasional steak. But red meat, being your main source of protein, I wouldn’t recommend that.”

Monaa Zafar, MD, is a board certified primary care doctor at Mount Sinai Doctors, seeing patients Monday-Friday. She has a particular interest in disease prevention, health promotion, and chronic illnesses. Dr. Zafar is fluent in Urdu and Spanish. Mount Sinai Doctors is an organization of clinical relationships and multi-specialty services that expand the Mount Sinai Health System’s footprint beyond the seven main hospital campuses into the greater New York City area.

Are Detox Diets Safe?

“Are detox diets safe? The short answer is probably sure, they’re safe. The long answer is that we actually really don’t know. The problem with many of these kinds of fad diets, or juicing, or so-called detox diets, is that there’s not a lot of science behind all of them. There’s a lot of pseudoscience behind them. If you’re going to google this kind of thing, you’ll see lots of claims and benefits with so-called detox diets and juice diets.The science, however, frequently is not there. My biggest concern as a primary care physician about these so-called detox diets, or any other fad diet, is what do you plan on doing as a patient once that diet is over? When we talk about having a healthy diet and healthy nutritional status, it’s not about what you’re doing for the next  2-3 weeks or a month. It’s how you’re going to live for the rest of your life. So if you’re going to make changes to your diet, these changes need to be sensible and need to be sustainable. Those are the big questions you should be asking yourself and asking your physician. Feel free to come talk to me or any of my colleagues at Mount Sinai Doctors in Brooklyn Heights.”

David Coun, MD, is a board-certified primary care doctor and Chief of Internal Medicine at Mount Sinai Doctors Brooklyn Heights. He has lectured regularly on various topics, including smoking cessation, prostatic conditions, EKG review, and physician communication skills. Dr. Coun is fluent in Spanish and has a particular interest in prevention, as well as, the intersection between mental health and chronic medical conditions. Mount Sinai Doctors Brooklyn Heights is a two-floor practice with a walk-in urgent care center and more than 35 specialties. Located at 300 Cadman Plaza West, the practice is situated on the 17th and 18th floors.

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