Diets don't work, flexible or not
The basis for the abundance model of nutrition is the idea of more. More movement, more training, more food. But how can we expect to eat more and lose weight when we can’t even seem to lose weight on a diet? Well, that's because diets don’t work. Haven’t you heard?
What a load of bs that is. Diets don’t work. We hear that phrase repeated ad nauseum. We know diets work. They are worth billions of dollars world wide. Yet the idea that they don’t keeps being spread. So where does it come from? Is it just that they don’t work long term? Not so fast. There seems to be evidence that they don’t work at all.
Research has consistently shown that dietary restraint results in weight gain, and not weight loss. Some of the most important metrics in nutrition research is that of qualitative, or descriptive data, rather than just quantitative what we would call “hard data”. Now, in some nutrition research we have more complete quantitative values such as studies that occur in a metabolic ward. A metabolic ward is simply a controlled environment where researchers can be sure of every calorie consumed and the exact amount of energy expended from exercise and movement. With these studies the evidence is very clear: a calorie deficit results in weight loss. Yet we don’t live in a metabolic ward.
The majority of nutrition research is done in a manner known as free living. This means that there will be some type of intervention, such as low carb. So enrollees will be instructed to not eat any carbohydrates and will weigh themselves daily as well as keep a food journal. The control group might be instructed to follow the same caloric guidelines as the experimental group but they will be instructed to eat freely in terms of macronutrient guidelines. There will be some qualitative measures taken at set points throughout the study. Usually time periods like 12 weeks, 26 weeks, and a year if the study is that long. Maybe even a follow up years later.
Clearly, metabolic ward nutrition research will be much more accurate in terms of physiological responses to food interventions than free living studies. However, are they more valuable? That is to be debated as most practitioners work with free living societies and not clients living inside of a vacuum. When applied as a large cross section, such as in meta-analysis, we can have a good overview of how humans react to different interventions, at least at a population level. The interpretation of the qualitative data, however, can lead to huge misappropriations of results. This is why the myth that diets don’t work has been so heavily propagated.
A common data point in nutrition research, particularly in the area of weight loss, is one of dietary restraint. Dietary restraint is defined as the tendency to purposefully restrict or control caloric intake with the intent of losing weight. So, basically, a diet. The issue with the literature on diets, and the one that the anti-diet movement has jumped on, is that dietary restraint is almost directly correlated to weight gain. As dietary restraint increases so does bodyweight. That’s pretty damning evidence. But there’s a piece missing here.
“Dietary restraint is typically measured through self-report measures, the most popular of which include the Restraint Scale (RS) (11), the restraint subscale of the Three-Factor Eating Questionnaire (TFEQ) (12) and the Dutch Restrained Eating Scale (DRES) (13). Example items include ‘How often are you dieting?’ (RS), ‘When I have eaten my quota of calories, I am usually good about not eating any more’ (TFEQ) and ‘When you put on weight, do you eat less than you normally do?’ (DRES). These meas- ures are not highly correlated with variables such as self- reported energy intake, disinhibition and weight trajectory (14–17). Research using the DRES, RS and TFEQ-R indi- cates that all three scales fail to predict intake across various situations (e.g. laboratory test meal, 3-month meal purchases at a university cafeteria) and populations (e.g. individuals who are eating disordered, healthy or obese) (18–20). Altogether, results from these studies indicate that dietary restraint and reduction of energy intake to effectively produce weight maintenance and/or loss are separate constructs.” Schaumburg et al 2016
Dietary restraint refers to the act of restriction. Yet without accurate monitoring of intake it becomes an amorphous discussion about the psychological aspect of restriction while still likely being in a caloric surplus. So when the literature looks to be showing that dietary restraint is tied to weight gain, it is simply the feeling of restraint rather than the physiological act of being in a calorie deficit.
So why does this matter? The most important aspect in weight management is control of calories. Without monitoring of actual intake we are unable to set our maintenance or deficit or surplus numbers. Now while this is not the long term goal of the abundance model, it is necessary at first. We must understand the difference between psychological and physiological restraint.
Yet what about those who stay in a caloric deficit until they don’t? Those who feel the psychological stress of dieting yet one or two days off throw them into a surplus? This is best described by the idea of counter-regulatory eating. Counter-regulatory eating is the act of eating more after already having eaten. In particular, when one is practicing dietary restraint. In the confines of a diet, the psychological impact is often that the diet has already been broken so therefore the excess calories “don’t matter”. What we in the industry call a case of the fuckits. As in, I already screwed up so fuckit.
When someone who is already practicing dietary restraint falls into an episode of counter-regulatory eating it often leads to guilt around the specific event that in turn leads to shame around an inability to be disciplined in practice. This can lead to further restriction and more dietary restraint which then leads to more episodes of counter-regulatory eating. It becomes a vicious cycle.
Another aspect to dieting that is widely contested is the very act of self-monitoring itself. Popular wisdom holds that daily self monitoring, of intake and output and bodyweight, is damaging to mental health. We have been hammered with a narrative that any form of monitoring is disordered and will lead us to a life of unhappiness. Much of the recent literature, however, is in conflict with this, with some notable exceptions.
Historically, the conclusion in much of the research on weight loss has been that daily self monitoring and weighing are associated with a higher likelihood of preventing weight regain after weight loss as preventing weight gain in the first place. The physiological benefits are pretty clear and within this research there are often qualitative measures for body image concern, disinhibited eating, as well as other behaviors that are seen in correlation with disordered eating patterns. There seems to be pretty conclusive evidence that self monitoring has the most potential for harm in adolescents and those with a history of disordered eating. There are mixed results in negative and positive correlations between self monitoring and mood but the negative connotations associated with daily weighing seem to lessen over time. TLDR: there may be negative associations between mood and weighing early on in a diet but as time progresses the associations dissipate to the point of there being a neutral association. This means that frequent exposure may degrade the emotional attachment that the scale holds and allow dieters to view scale weight as just another data point.
An interesting aspect in the argument over self monitoring comes in the form of outcome. It looks as if many of the negative connotations associated with self monitoring are only present when the subject sees results that are in contrast with their desired results. When subjects were attempting to lose weight yet saw no change or an increase in scale weight, they reported negative emotions associated with weighing. However, in the same study the cohort who saw scale weight trend down viewed daily self monitoring as a positive. Even in a cohort of young adults where monitoring was increased steadily over 18 months there was decreased disinhibited eating and lessened occurrence of binge like behaviors yet there was a marked increase in restrained eating showing that, perhaps, dietary restraint is just a necessity of eating in a caloric deficit and not negatively tied to an emotion.
There also may be some signals in place to better understand how to proceed based on some of the qualitative data we do have. There may be a connection between motivational forces for change and the likelihood of success long term. Anecdotally, we see this regularly in our practice. When someone can tie a value system to their desired change it becomes not only easier to adhere but they feel an increase in “willpower” or “discipline”. In contrast, when we encounter someone who decides they want only to change because of hating the person they see in the mirror, it can likely create more shame and reduce the chance of efficacy in their diet. We might see some early motivation to move along the continuum of change due to negative reinforcement but that type of motivation rarely moves beyond itself. We need to create a positive environment for change.
“Even though some degree of dissatisfaction can be a positive force for change, there is reason for caution about the potential exacerbation of body image concerns via weight monitoring.The problem is that although increased concern about body size may motivate a decision to change behavior, only vigilance over a longer period of time will lead to long-term benefits. Of concern is the evidence that poor body image can lead to a number of undesirable outcomes in weight loss attempts. For example, studies indicate that poorer body image at baseline predicts limited success in weight loss interventions as measured by the amount of weight ultimately lost or attrition from the program.14-17 Again, consistent with the view that there is an optimal amount of dissatisfaction for effective behavior change, the available research would suggest that although body image concerns may initially interest clients in signing up for programs, greater levels of concern may be a harbinger of later failure.” -Dionne, Yeudall 2005
Regardless, there will always be inter-individual responses to daily monitoring and what may be perfectly safe for one person may be disastrous for another. As a practitioner it is imperative to understand the risks associated with any form of dietary restraint and to apply tools appropriately. As a dieter, it is important to be honest with ourselves and see potential red flags on the road to abs so as not to drive ourselves into a potential minefield of disorder just to obtain an aesthetic result. Even if diets do work, who wants to spend the rest of their life in restriction? Especially in this world of abundance.
That’s why flexible dieting and If It Fits Your Macros seemed like the great saving grace. We had read the research. We understood why diets tend to fail long term. And it was quite simple: they were too strict.
So when all of this research on dietary restraint was becoming more popular in the nutrition and particularly the bodybuilding world, fitness folks took note. They began to view things less through the lens of strict food rules and meal plans and started to apply a flexible restraint model to the old paradigm of tilapia, broccoli, and brown rice. The catch phrase for whenever someone asked if a food was okay was “IIFYM” or If It Fits Your Macros. Bro.
Further, as this type of dieting strategy took hold it began to filter over from bodybuilders into more general population. Crossfitter who were confused about why they hadn’t made any progress after the initial 3 months of classes realized that maybe eating like a caveman was probably best left to a time period when life spans were 35 years and you were likely burning an entire day’s worth of energy just looking for food rather than eating 4 lbs of bacon and two 42 oz steaks a day. They started eating carbs and gained muscle and got leaner. They were able to have an ice cream cone at a birthday party. The era of macros was upon us.
This was a huge opportunity for both the industry as a whole and for coaches who had felt let down by diets in the past and saw so many people struggling to manage weight but unable to find an effective way to do so. By counting calories in a flexible manner adherents were more likely to stick with it and all of the fears of behavioral issues associated with dieting could be alleviated. I mean, the only bad thing about diets was the lack of flexibility and this new strategy had “flexible” right in the name. We were all good. Except, as with everything, there are downsides. As Dr Ben House says, all diets lead to cupcakes. And shitting your pants.
As the macro world grew we saw an uptick in macro coaches, macro based calculators, macro cookbooks, macro nutrition companies; everyone wanted in on the action. Foods were no longer demonized. People were getting jacked on Pop Tarts and pancakes. Lifestyle brands were popping up everywhere and as visual social media accounts grew we saw the evidence plastered in front of us at all times. There was no denying that this was changing people’s lives.
As adherents to the culture of flexibility grew, they removed the second half of the word culture and we saw the rise of the macro cultists. People believed that this was some new kind of diet invented last year by their favorite guru. They spread the gospel of macros to anyone who would listen, especially that asshole James in accounting who was always talking about vegan-paleo-keto-intermittent fasting and shaming them for having a cookie. They were gonna show him what an idiot he was because macros are science. They came in droves with their My Fitness Pal app loaded up, ready to take on the world one gram of protein at a time. And damn if they didn’t lose weight. Success spread like wildfire! But then, something became apparent. Flexible dieting had become really inflexible.
If the wifi was out or an emergency dinner came up, adherents were thrown into a tailspin. How can we manage our lives if we can’t track the macros for this meal? How will we ever succeed if we end up going over our macros for the day? What do I eat when I have 32 carbs, 3 fats, and 1 protein left? What if my coach is asleep and I don’t know how to manage dinner?
And this is when wholesale macro diet failure starts to appear. We start to see an obsession with exact numbers, with perfect adherence, with a rigidity to a diet under the guise of flexibility. We see people who have lost 100lbs unable to eat more than 1200 calories a day for fear that they will gain everything back. We see yo yo dieting on a scale we see with every other diet trend over the past 50 years. We have created the same problem we set out to solve. And that is that we just created another diet that doesn’t work. And unless we recognize the shortcomings we will continue down the same path those diets have gone. Unless we move away from the rigidity that leads to weight gain we will be doomed to repeat the past.
I believe in the value of cognitive oversight with food. I believe in the value of educating clients on the contents of their foods. And I think understanding the macronutrient content of foods is a phenomenal way to do so. But it must be a truly flexible plan. There is no one size fits all attack. For some, it might mean macros. For others it might mean protein and calories. For others it could just mean portion control or daily habits. Different people with different backgrounds and personalities will respond very differently to different approaches.
At its essence though, none of it matters if we have unhealthy relationships. With food, with others, with ourselves. That is what Food on the Mind is about. It is about improving these relationships through emotional regulation, improving our nutritional education and strategy, and striving for physical health and a regular movement practice. We can’t look at any of these things in isolation. Each has a resounding influence on the others. At the risk of sounding all hippie dippy, ours is a holistic practice.
If you are tired of seeing fleeting results, tired of fighting the same fight again and again, and sick of looking at the same scene replay every year, maybe it's time we try something different. Maybe it's not about another diet but rather what keeps leading us to another diet. With our work and the work of the group, you just might be able to get to a place where things finally stick.
If you are ready, click the link below or shoot me a message. Space for this first cohort is running out, We start our intro calls next week and time slots are already filling up. This will be a game changer for so many and I can’t wait to get started.