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MUDGE’s Musings
Summertime. People are vacationing. The weather, here in the Northern Hemisphere, at least (reportedly quite chilly in Oz, sorry guys!) is excessively hot and humid. The beach beckons.
News is sparse, but the need to sell the advertisers’ wares means that the 24-hour news cycle keeps on spinning.
Thus a story in the New England Journal of Medicine received undue prominence this week: a report on a clinical study of a comparison of two popular diet programs, the Atkins diet (once a tool of yr (justifiably) humble svt) vs. the Mediterranean diet (a favored tool of an official brother of y[j]hs). So it was all over the headlines for a day or so, midweek, filling those column inches and 30-second sound bites during the summer doldrums and of more than a little personal interest.
This was a 2-year study, and the weight loss reported was depressingly small. What was going on?
I turned, as often I do when trying to dig beneath the headlines on medical issues, to Left-Handed Complement‘s favorite authority on such medical studies, especially as regards weight loss, Sandy Szwarc, writing in her amazingly wise blog, Junkfood Science. Here are some previous occasions when she cut through the jargon and the statistical distortions for us.
Sure enough, yesterday’s Junkfood Science post provided a thorough analysis, detailed but not excessively technical, of the study. Were you aware, for example, that it was partially funded by the Atkins people?
Round eleventy-seven in the diet wars
Junkfood Science | Sandy Szwarc | July 19, 2008
Here we go again in the battle of the diets. Another weight loss study was published this week. This one, partly funded by Atkins Research Foundation, pitted a low-fat diet against a Mediterranean diet against an Atkins-like diet. The news has either declared Atkins the winner, or that they all worked, or that they all failed.
This study, published in the New England Journal of Medicine, actually confirmed everything already known about weight loss diets. The quickest post would be to simply refer you here, here and here and say “step and repeat.” But new readers might not like that. 🙂
So, at the risk of boring regular readers with a rehash of diet study fallacies, here’s a quick rundown.
Overview
This trial was conducted in 2005-2007 in Dimona, Israel. It was registered as a phase 1 trial (ClinicalTrials.gov registration #NCT00160108), explained here. Given its size and duration, though, it appears more a combined phase 1 and 2, designed to evaluate the safety and note the effects of the dietary interventions on weight loss.
The objectives of this 2-year randomized trial were to evaluate not just the safety and weight loss effectiveness of the three diet plans, but also to test the effectiveness of a workplace weight loss program.
For most people, diets just don’t work on any long-term basis. Weight lost by reducing calories, carbohydrates, fats, whatever, eventually comes back. And this two-year study, despite some chartmanship that Szwarc clarifies for us, proves this disappointing law of nature yet again.
Since the first low-calorie diet book was published nearly a century ago, diet doctors have come up with every imaginable gimmick for reducing calories, manipulating macronutrients in every conceivable way. If anything was truly effective, after nearly a century, there would be no diet industry and everyone would be slim. Any contrivance to cut calories works to enable most everyone to lose some weight… but only temporarily… and only to a point. Then, those homeostatic metabolic adjustments work to return body weights to their genetically-determined setpoint range, in both naturally obese and nonobese bodies. These biological adjustments are so powerful, as much as a four-fold increase in metabolic efficiency, that to keep weight off below one’s natural range, or to try to lose more, requires increasing severe caloric restrictions, not optimal for nutritional health or wellbeing.
Diets. Just. Don’t. Work.
Junkfood Science: Round eleventy-seven in the diet wars
One of her most intriguing points is that there was no attention given in the analysis of the data to any medical outcomes: was heart disease risk lessened? Did any pre-diabetic conditions fail to become diabetes as a result of the diets?
This was dieting for the sake of dieting (okay, to lose some weight), but the clinicians were apparently disinterested in whether the weight loss experienced by the study participants had any positive therapeutic value.
Looking better (at least for a few months) in their Speedos at the beach (this was an Israeli study after all) doesn’t seem sufficient, does it?
5-1/2 years ago, I bravely embarked on the Atkins program, with some excellent early results. Of the ultimately nearly 50 pounds lost, in the past year about 15-20 have returned, but I’m “guilty with an excuse.” My level of exercise was slashed due to the pesky Achilles tendinosis issue that, nearly a year along, still bedevils and restricts activity. And of course, as the weight started coming back, the rigidity about the virtual carb-free daily choices disappeared; four years of denial needed to rebound, and did. Sigh.
Am I better off 30-35 pounds down? Yes. Have I any confidence in my ability to get that pesky 15-20 back off, not to speak of the further 40 or 50 beyond that my BMI says I need to lose. None whatsoever.
Diets. Just. Don’t. Work.
But, as always, I appreciate Sandy Szwarc’s careful reading and literate daylighting of what most of us take at face value, because we are all too willing to let the MSM do our chewing and digesting for us, with the expected results.
Mainstream media is the medical reporting equivalent of a Hostess Twinkie, absolutely empty calories.
Sandy Szwarc’s Junkfood Science is the high fibre, whole grain, naturally sweetened, real deal.
It’s it for now. Thanks,
–MUDGE
Left-handed Complement 