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Diets and Weight Cycling

 

DIET – that four-letter, inescapable word in our society – is defined as “a regimen of eating and drinking sparingly so as to reduce one's weight.” Dieting is commonly (and sometimes arbitrarily) recommended by medical professionals to patients with BMI levels above a certain number or with health concerns such as high blood pressure, high cholesterol or diabetes. It has also become an increasingly prevalent practice among leaner individuals over the years; those with (medically identified) "normal” and even “underweight” BMIs often diet due to body dissatisfaction influenced by sociocultural pressures around appearance and at times, perceptions around athletic performance.  Dieting is also becoming more common in younger individuals.  Shockingly, children as young as age 9 report dieting and up to 40% of pre-adolescent school-aged girls report attempts to lose weight.

Weight cycling goes hand-in-hand with “yo-yo dieting” whereby weight - some, all, or more of what was lost - is regained after the diet. This weight gain often leads one to diet again, and again and again...repeating this pattern of loss and gain throughout life.

Why is weight loss from dieting unsustainable? 

-The diet, itself is unsustainable

-Restrictive eating increases reward value of food leading to preoccupation with food and often bingeing

-Energy expenditure decreases with weight loss and remains low even as body regains weight 

-Appetite increases as body fat mass begins to restore post-diet

-The body favors fat restoration versus lean body mass restoration following a period of restrictive eating and weight loss.

Believe it or not, dieting is actually a predictor of future weight gain.  This is especially true for repeat dieters that begin when young and in leaner bodies.  Dieting and weight cycling are related to increased risk of eating disorders and other psychological disorders (anxiety, depression), increased risk for bone fractures and decreased bone density and certain cognitive deficits. They have also been linked to increased risk for type 2 diabetes, and cardiovascular and renal diseases - the very things diets are often recommended to improve!  It's been reported that risk factors such as higher than normal values of heart rate, blood pressure, cholesterol, triglycerides, insulin, blood glucose, and glomerular filtration rate can occur during periods of rapid weight gain following a period of food restriction. Additionally, these implications are more commonly seen in leaner individuals who begin dieting in the “normal” BMI ranges.

Unfortunately, the diet industry is not held accountable for these aforementioned risks. In fact, weight cycling is likely a key sustaining factor to this billion dollar industry.  Some well-intentioned medical professionals still hold a weight-centric approach to care, strongly believing (despite evidence to the contrary) that higher weight is the cause of most health issues.  The reality is, we can't separate weight from behaviors.  And we know that dieting does harm.  The first rule of thumb in medicine is "do no harm".  So, why are some clinicians still recommending diets?  Well, for one, it takes time to unlearn something; longer than it takes to learn it in the first place.  While there is ample research to support a weight neutral, health at every size (HAES) approach, it will take some time for the medical field to shift.  And, as a result, there's still a lot of weight bias in the medical literature.

What do you do instead of dieting to encourage health?  Focus instead on sustainable lifestyle practices that support or improve overall health and well-being (aka make you feel good!).  The weight you end up at when you're taking good care of your body is the weight you're meant to be at!

 

Montani JP, Schutz Y, Dulloo AG. Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk? Obes Rev 2015; 16 (Suppl. 1): 7–18
Montani JP, Dulloo AG. Pathways from dieting to weight regain, to obesity and to the metabolic syndrome: an overview. Obes Rev 2015; 16; 1-6

 

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