The Future of Everything covers innovation and technology that transforms the way we live, work and play, with monthly questions about transportation, health, education and more. This month is Well-being, online from January 6th and in print January 13th.
Caroline Dooner spent her teens and early 20s trying to lose weight. A doctor diagnosed her with an endocrine disorder and suggested she try to shed a few pounds. She went on the Atkins diet low in carbohydrates and high in fat.
She found that she could not stop thinking about the food she should not eat. She began a cycle of binging on her favorite foods and then losing weight again. She tried other diets. No one worked. “I was constantly thinking about my weight and what I was putting in my body,” she says.
Ms. Dooner, 34, is no longer slim. In 2019, she published a book, “The F * ck-It Diet”, about her struggle with dieting and the cultural obsession with being thin. She is happier than ever for her body and her relationship with food, she says.
More people like Ms. Doons, exhausted by the pressure of the scale, restrictions on their favorite foods and the need to try to look a certain way, question whether they should completely abandon dieting. Some of them find the budding anti-diet movement predicting a future where people are not trying to change their weight. Instead of relying on weight or body mass index, this subgroup of dietitians, nutritionists and others recommend stopping diets and placing more emphasis on health markers such as endurance, sleep and mental well-being. Changing views on what it means to be healthy – as well as scientific research on diet and health – help drive the movement.
The anti-diet movement has major obstacles to becoming mainstream, say anti-diet supporters. The medical community overwhelmingly regards weight as a crucial barometer of health. Decades of scientific research link higher weights with increased risk of heart disease, cancer, diabetes and other diseases.
Dietitians, including Christy Harrison, author of a book called “Anti-Diet,” envision a different future in which people listen to their own hunger signals, instead of trying the latest diet, and approach nutrition and exercise to emphasize self-care. , rather than self-control. In this vision, there is no stigma or bias associated with even the largest bodies, whether they suffer from weight-related diseases or not.
“Reducing weight stigma is a really big piece in all of this,” she says.
For a culture imbued with the knowledge that being overweight is unwanted and dangerous, it is a radical idea. But some research is emerging that points to both the inefficiency and dangers of dieting and suggests a more nuanced explanation for some of the health problems associated with higher weight.
Yo-yo diets have been shown to have negative health effects. A study looking at data on more than 9,500 people with heart disease showed that those who experienced the largest fluctuations in weight over nearly five years had a significantly increased risk of heart attack, stroke or death compared to those whose weight fluctuated less. Diets can also predispose people to eating disorders, especially adolescents and adolescents, studies show. And some researchers have found that weight stigmatization, or discrimination based on a person’s weight or size, may in itself be responsible for some of the negative health outcomes typically associated with higher weight. In a study looking at data for 18,000 people, researchers found that those who reported experiencing weight discrimination had a 60% increased risk of dying, independent of BMI.
Most doctors and public health experts say that staying within a certain weight range is also crucial for health. The risk of illness and death tends to increase at BMI higher than 25 or 30, experts and research say.
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“There is no doubt that obesity increases the risk of a wide range of chronic diseases,” said David Ludwig, a professor of nutrition at the Harvard TH Chan School of Public Health.
Steven Heymsfield, director of the Body Composition-Metabolism Laboratory at the Pennington Biomedical Research Center, is in favor of an approach that is not weight-centered but does not completely weigh up. The medical community should encourage people to get treatment for problems like high cholesterol and blood pressure and ask them to be more active and smoke less, he says. He still recommends some patients to lose weight. “Weight loss would do a lot of what these other things would do,” he says.
For anti-diet advocates, encouraging people to lose weight is putting them up for failure. Many people are unable to maintain the weight loss they may experience during dieting.
A recent review of 121 trials of different diets showed that participants’ weight and blood pressure measurements generally improved after six months on the diets. But after a year, most people took the weight off, they lost, and any cardiovascular improvements mostly disappeared.
Most diets also omit the psychological side of limiting certain foods. It can make people scared and also obsessed with these foods, Ms. Harrison says. This in turn can lead to disordered eating habits such as binge eating.
Many anti-diet advocates are instead in favor of intuitive eating or listening to the body’s innate signals about hunger, satiety and food preferences. Central to the process is giving up tracking weight and categorizing foods as morally good or bad.
“There’s a feminist upsurge in saying, ‘No, let me be. I’m not going to go on a diet … to make others think I’m attractive.”
It does not just mean eating chips and ice cream. The idea is that the less people restrict their access to certain foods, the less they will have an out of control urge. By removing the food rules, followers eat a varied diet – yes, chips, but also fruits and vegetables.
A review of 24 studies published in 2016 showed that intuitive eating was associated with greater body appreciation and satisfaction along with a greater motivation to exercise. Another study published in 2014 found an association between intuitive eating and blood sugar control in young people with type 1 diabetes.
Intuitive eating, which can be dated back to the 1990s, has gained more traction in recent years, partly due to social media about the message, as well as a cultural shift in how women look at themselves, says Elyse Resch, a nutritionist and co-author of “Intuitive Eating: A Revolutionary Anti-Diet Approach,” the original book on intuitive eating.
“There’s a feminist upsurge in saying, ‘No, let me not be. I’m not going to go on a diet and be traumatized by a diet to lose weight to make others think I’m attractive.” she says.
Another key component of the anti-diet movement is Health at Every Size, a trademarked principle that rejects that any weight level is necessarily ideal or pathological. HAES also recognizes that people’s life experiences, including trauma, poverty, stress, and medical issues, can contribute to a larger body size, says Jennifer Gaudiani, a Denver-based physician who treats patients with eating disorders.
“People are genetically predisposed to emerge as adults in a different set of body sizes,” she says.
While the wider medical community recognizes that a combination of factors is involved in determining a person’s size, most doctors say that there are weight classes that are harmful to health and that obesity is a public health problem that needs to be addressed.
“In my mind, there is no doubt that obesity is a medical problem, but we need to destigmatize it,” says Harvard’s Dr. Ludwig. “We have to look for approaches that will not create this invincible battle between mind and metabolism.”
A biological approach to weight management, focused on the underlying driving forces behind hunger rather than calorie restriction, could help resolve the conflict between health and stigma that often arises on conventional diets, he says.
When Mrs. Dooner embraced intuitive eating, she feared it would make her eat out of control if she gave herself the freedom to eat what she wanted. The decision had the opposite effect, she says. “I slowly but surely noticed that my obsession with food, my extreme hunger, my binging episodes – they just died,” she says.
Ms. Dooner says she also gave herself permission to gain weight to stop the cycle of binging and dieting. She started buying clothes that suited her, rather than clothes she hoped she would one day fit into. At her last doctor visit, she was given a clean health statement, and her blood pressure and blood sugar were normal, she says.
“People can improve their health – and often improve their health – by focusing on health habits, as opposed to trying to micro-control or lose weight,” she says.
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