How effective are diets?

Over a decade ago, I wrote a book titled, “Diets Don’t Work”. Diets don’t work because you go on a diet like you go on a holiday. You almost always come back from a holiday and you typically stop the diet after a few months.

In the first month of your diet, you may lose up to 5 kg but then, despite ongoing dieting, your weight stays stable. The typical explanation for this is that in the first month you are mainly losing water and muscle and the more ingrained fat stores take months and months to shift.

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Unfortunately, the vast majority of human beings do not have the willpower and motivation to stick at something for months and tend to drift back to their old habits, thus regaining the original weight and often adding on even more kilos.

A study published in the American Journal of Public Health from the Kings College in London showed that the chance of an obese person being able to get back to normal weight is one in 210 for a man and one in 124 for a woman. If the person is morbidly obese this increases to 1 in 1294 men and one in 677 for women.

A recent study published in the Journal of General Internal Medicine from the US, studied 134 patients with excess weight, mean age 51, 70% of whom were female and 55% African-American. A number of these patients were also diabetic and hypertensive and were followed for 12 months. They divided the groups into those given an intensive program with strict supervision and coaching and the other group given generic advice to eat less food and do more exercise. The generic advice from either a doctor or a nurse had no benefit with the specific advice group losing on average 3 kg compared with minimal weight loss in the generic group. Interestingly, it was not only the specific advice that was important but also the perception by the participants of the care and empathy from the health professionals involved.

Patients often say to me, “he or she is a very good doctor but I cannot speak to them and they cut me short when I asked them questions”. My response to this is that if the patient does not feel comfortable discussing any issues with their doctor then that person is not a good doctor regardless of their scientific knowledge.

Health professionals involved in the care of overweight or obese patients need to have an empathetic attitude along with the scientific knowledge and important specifics involved in losing weight.

But, it is not just the fault of the medical profession. It is my experience that a significant proportion of patients do not have the willpower or discipline to follow important lifestyle principles on a lifelong basis. Let’s face it, it is much easier to swallow a pill in a few seconds than it is to perform 3–5 hours of exercise on a weekly basis or not ingest too much food.

We live in an obesogenic society and until we can change attitudes and behaviours I cannot see this stopping too soon. Hippocrates once said, “Let food be thy medicine”. I would certainly add, let us not let food be our downfall which it certainly appears to be doing in our modern society.