Few topics generate more heated discussion than diet and weight loss, and for the past week, readers have posted hundreds of comments reacting to the latest diet research.
The latest study, published in The New England Journal of Medicine, compared three diets. Some participants cut fat, others counted carbohydrates in a version of the Atkins diet, while others adopted Mediterranean-style eating habits. Some people declared the research a vindication for Atkins, others criticized my view of the study as more evidence that diets don’t really work.
For some needed perspective, I turned to Gina Kolata, a New York Times reporter and author of the wonderful book, “Rethinking Thin: The New Science of Weight Loss — and the Myths and Realities of Dieting.” Not only is Gina well versed in the science of weight loss, but she has an unusually compassionate take on the efforts of the dieters in this recent study and all people who struggle with their weight.
“Every study that has ever been done, and this one included, shows that it’s absolutely unbelievably difficult,” she said. “When people beat themselves up and say, ‘I should be thin, it’s my own fault,’ maybe it’s not your own fault. How much harder can somebody try than people in this study and look what happened. They didn’t lose much weight.”
Unfortunately, there are no easy answers. “Rethinking Thin” shows how difficult it can be for people to lose weight and keep it off. So what advice does Gina have for people who are overweight?
“Don’t always blame yourself, and don’t beat up on yourself,” she said. “It’s obviously really, really hard. Don’t say, ‘I’m a weak person and it’s my own fault.’ ”
Instead, Gina says some people who have tried unsuccessfully to lose weight may decide to say to themselves, “I can be attractive. I can buy clothes. I can be fit. I can be healthy. I can have a good life, and I may not be skinny, but so what.”
Gina offers a powerful and compassionate message to people who are overweight and those who judge them. I hope you will click on the podcast below to listen to the rest of our conversation and post your comments.
Listen to the Podcast (mp3)
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
From 1 to 25 of 287 Comments
Even though it’s the new Weight Watchers tag line, I think the concept that “Diets Don’t Work” is dead on. Most Americans view dieting as a temporary condition, something they’ll do until they lose the 5, 10, 20 pounds and therefore the diet can be unrealistic, unenjoyable, and restrictive because hey, it’s only for a month or two. A single cookie or piece of cake never made anyone fat. There’s no reason foods should be absolutely banned. It just makes you want them more and it inevitably lead to failure (and then you eat the whole box of cookies!)
A much, much more successful approach to getting fit and healthy is to add small, realistic lifestyle changes into your day. So it’s not going to be the magic bullet that allows you to drop 10 pounds in a month, but you will be healthier, and likely thinner, in the long run.
— JLBHooray for Tara Parker-Pope and for Gina Kolata! I am about 25lbs “overweight”, but I do yoga daily, eat fairly healthfully, and dont have high cholesterol, diabetes or any other health conditions.
— Mrs. PrimmMy Dr. is reasonably supportive but clearly doesnt quite believe that it is possible to be a bit fat and still healthy.
Changing the emphasis from gross weight to overall health is long overdue. Your message is a welcome refreshment from the constant negative messages about weight that bombard American people from all angles.
Diets Don’t Work which is exactly why Weight Watchers focuses its thinking on teaching people to learn to control portions and rework habits around food.
Let’s face it — everything we do is habit-related and trained behavior. From the moment most of us put our key in the lock returning home from work, we begin to salivate (Pavlov had his act together) and generate feelings of (sometimes false) hunger, and reach for anything to satisfy that before we THINK about what we’re going to eat.
Brian Wansink, in his book, Mindless Eating, proved that so much of what we do is also based on not paying attention to not only our bodies’ natural signals to slow down, assess, and stop, but also to eating because it’s there. We’ve all done that at some point.
Weight Watchers works. why? Try it. It’s the best there is — any “diet” that sanctions foods that are typically forbidden (albeit in controlled amounts) and teaches you to Eat Wisely, Think First, Move More, (and attend meetings for the support) is one that will carry you through a lifetime of better habits.
I’m a successful member (67 pounds lost, and kept off for 9+ years) and still attend meetings.
Remember — eating is not a sport and food is not its equipment.
Ellen
— ellenThanks for the podcast, Tara. Having just returned from an international conference on nutrition, I am amazed at how little we know about helping ourselves change our eating habits.
Historically, humans do NOT pick their food based on health reasons - we eat food because of our culture, experience, local food availability, pleasure, religious beliefs, etc. Yet In American we are told to pick food that makes us healthy - YUK!
it is a difficult situation — the greatest food abundance in human history is in each of our American faces every day. It is cheap, delicious, and attractive — after all, marketing experts have made sure that we will buy it.
Most people will struggle in this type of food world. In 1900 only 5% of Americans were overweight, and today it is 60%.
I worked in a hospital weight loss program for over 20 years, and it was rare to see anyone NOT lose weight. We used a formula and it worked: men multiply their current scale weight by 12, women by 11. That is a rough estimate of how many calories needed daily to stay at your current weight. Next do the same for the weight YOU WANT TO BE. The difference between the two (calories at current weight minus calories at desired weight) is how many calories you need to cut out of your daily life to reach or to stay at your desired weight.
(Of course, a regular exercise program gives you some extra calories you can eat — but not many, usually 200-300 for the average person.)
The difference between what we eat now and what we need to remove to achieve weight loss is often surprisingly small — especially when you look at the calories in food. One level tablespoon of mayo or butter is 100 calories (and both disappear into the food). Some restaurant meals or specific foods supply me with enough calorie needs for the entire day.
Americans are not so much victims of metabolism as we are victims of our food supply. We CAN control what we eat — that is good news. HOW we achieve it is very hard.
There is no evil food. We can eat what gives us pleasure and what we are used to eating with one major change — calorie awareness. I learned that I have to add in TONS of fruits and vegetables, use nonfat dairy only, keep meat and bread servings to a reasonable portion (not the typical restaurant portions), and watch the add-ins like mayo, butter, oil.
You are right — above all, we don’t have to give up and we should be compassionate with ourselves. We are not weak, but we are forced to do something that is not natural: constantly think safety and health in a food supply that can kill us. Ellie — http://www.FeedingTheKids.com
— Ellie TaylorAMEN!
— betsyDiets don’t work, but lifestyle changes can. I’ve lost, and maintained, 100 pounds since 2003. I simply decided “I don’t eat that.” It’s not that it was a temporary status, where I will lose some weight and then start eating junk again. I just don’t eat it. I never liked tuna - never ate it. I put unhealthy, simple-carbs and sugars on that list. Like tuna, Pop Tarts became something not on my eating radar. Like tuna, french fries vanished from my list of things to eat.
I did this with low carbohydrate diets. I don’t claim that low-carb is the only way, but for me it was the way that worked, and continues to work. I can live with it.
It is a *very* difficult process. All life changes are. But you have to have perspective on that. What’s most difficult - weighing 350 pounds or giving up bread? Life as an obese person is torture. Life without ice cream is not easy, but it’s easier than being fat. People hate the fat. The world isn’t built for the fat. I was never comfortable at that size; I was always on edge, always uncomfortable whether at home or in public. Giving up potatoes is nothing compared to that.
It’s still imperfect. I am still overweight by 50 pounds and find that 50 pounds extremely difficult to attack. But I’m so much better off. Kolata, if she is saying that it’s hard, is right. If she’s saying that it’s impossible, or not worth doing, she’s wrong.
— ScottBody fat is a measure of calories consumed versus calories burned. It’s quite simple. As I age (now 47), I must eat fewer calories and exercise more to maintain the same weight. I often skip lunch, shrinking stomach size and making me feel full sooner when I do eat. Some days, I fast. None of this is difficult, but it does require commitment and willpower. Indeed, diets may not work. So instead of dieting, adopt a healthful lifestyle, forever.
— Nathan JamesEvery diet works you just have to stick to it. People who claim diets dont work have not really committed themselves to losing weight. Once the motivation is there its not really difficult to lose weight. No one wants to change their lifestyle and then claim that the diet didnt work, truth is you didnt work.
— CWI love it when science catches up to common sense. The published study - supported by Kolata’s comments - reinforce what anyone who has ever been frustrated about not losing weight despite faithful dieting already knows: that not only is difficult to lose weight, but also that there is no one single “magic diet” or “healthy” way of eating that will work for everybody.
Most nutritionists’ continued insistence that “a calorie is a calorie is a calorie” and that our metabolisms are just “fast” or “slow” is no longer helpful, and contributes to dieters’ anxieties and frustrations. Maybe food has this quality in a bunsen burner in a lab, but the release of energy by food is not that simple when it hits your digestive system! Clearly, everyone processes foods differently and at different rates according to their genetic makeup, the hormones and bacteria present in their bodies, etc. There is no one, definitively “healthy” way of eating for all.
— LDSLosing weight is harder than quitting cigarettes. At least I found that to be true. After all, the minute you stop smoking, you’re a non-smoker. The minute you start dieting, you’re still fat. It’s been twenty years without a cigarette but the struggle to lose weight goes on.
— Marc GerberWe evolved to gain weight, reproduce, and die. Not gaining weight means fighting your own DNA.
— R.No diet or gimmick can work; the only thing that will work is constant self-discipline.
If you won’t exercise this, you gain weight and pay the consequences.
We live and die in our own skin, whatever the size.
I have really mixed feelings about this. On one hand, being a little over some “ideal” weight probably won’t hurt/kill you. What a lot of people want in their weight is unrealistic. But in my case, my weight (100+ pounds over what I am now), was aging me fast. I hurt whenever I got up from a chair, I had trouble walking up a flight of stairs, and I was only in my mid 40s. Losing the weight is hard, and it doesn’t make the rest of your life magically better, but I feel a lot younger, and am in less pain. I could buy clothes, look good, etc. at the higher weight, but it did hurt my well being. I guess everybody has to come to the decision about how they will deal with their weight themselves: is it worth it?
— LindaI went on my first diet at age 12 and spent the next 35+ years on and off diets with the usual short-term success only to gain more.
Finally at 38, I admitted my problem with food was bigger than me and began working a twelve step program (Overeaters Anonymous oa.org).
I’m now 43 and have been maintaining a healty weight for 3 years. Something I was never able to do before.
— A Member of Overeaters AnonymousI can be attractive, maybe, to another fat person, but fat is very unattractive to most people. But to really lose weight and keep it off while not impossible, it is close enough that few will exceed. I think most wait to long before starting, ones that get 20 or more pounds overweight will almost never get back to correct weight & keep it there. Life is just not fair what used to allow for the survivable of the species now works against else, in that you can never lose fat cell just stink them, but you can add fat cells when you get fat.
— bradCorrection of my math. 25+ years.
— A Member of Overeaters AnonymousMaybe diets don’t work on many people who are and have been fat all their life, or at least all their adult life. But what about the persons who DO have no will power; those who can’t resist a candy bar or any kind of sweet treat…all day long? We see them walking the street and in the ice cream parlor. That’s the trouble with doing research and then generalizing to a larger circle. Was the selected group really representative of the population? I doubt it.
EB
— Eli BakerIn the podcast, a comment that caught my attention was made by the woman who had bariatric surgery. She said that it is the constant hunger that gets to her.
One thing about the Israeli study that needs more attention (only a few commentors mentioned in in your previous post) is that the low-carb diet was not calorie restricted.
Calorie restriction causes the feeling of hunger and undermines many a strong-willed dieter. Anecdotal evidence suggests that low carb non-calorie restricted diets do not induce hunger.
It is significant that all three diet groups in the Israeli study lost similar amounts of weight and that the low-carb group accomplished this without counting calories. I wish that the subjects had been debriefed as to whether they felt hungry or had food cravings.
— PangaeaI think that the key to losing weight is to keep a written record–a journal. Have a plan and write it down and what you do each day. My plan is to limit calories (eat healty food, few fats, sugars, etc., and exercise regularly) I count calories but only in a rough way (one serving of a vegetable is 50 cals, one fruit is 90, etc). I also weigh myself every week and have a goal for each week as well as a long term goal. My exercise program combines, aerobics (biking and running/walking), with some weight training and yoga. It works!
— John MartinAnyone reading these comments will likely benefit from using a wonderful new (and free) website called myfitnesspal.com
The site allows you to track your caloric intake and then breaks down your macro-nutrient ratios, fiber, salt and other figures.
It also allows you to enter your exercise & its duration to see how many extra calories you are burning.
Check it out and give it a shot for a few days.
The education you will receive from simply measuring & being aware of your portion sizes and the associated calories will be a real eye-opener.
— Lord StanleyIt never fails to amaze me that the words “hunger” and “satiety” rarely enter into this conversation. The problem with “diets” is that they’re always based on the external - either what time it is, or how many “points” one should consume, or a list of foods one should choose from. So of course it’s temporary and miserable! Diets cause people to GAIN weight, research shows!
The authors who have provided read solutions get little credit, but anyone working in the field of eating disorders is well aware of Susie Orbach and Geneen Roth who both proposed (in the 80s) the radical notion that the body is truely wise, if we only listen to it, and that heeding true physical hunger and satiety cues will free us from the shackles of dieting and compulsive eating,
I encourage anyone who wants real help to read On Eating by Susie Orbach, and Breaking Free from Compulsive Eating by Geneen Roth (I believe the latter has been republished as Breaking Free from Emotional Eating). Is this an EASY solution? of course not, because it requires finding healthier ways to cope with uncomfortable feelings than eating them away, but it’s the only long term solution that can ever work. I urge anyone who thinks that dieting is ever a good idea to read these pioneers in this field first!
Lise Osvold, Ph.D.
— Lise OsvoldLicensed Psychologist
There is a mindset of exclusion that one adopts from being chronically overweight. It is an insidious side effect of the obvious health risks to “being fat.”
I am stunned by how nice people are to the skinny me. How strange to be called “dear” instead of nothing, or “ma’am” by the pizza delivery man. Curious.
— SusanIt’s not too complicated. If you consume more energy than you expel, you gain weight.
For the last few years, I weigh myself naked every Monday morning after going to the bathroom. If I’ve put on any weight, I use a small plate for all my meals that week.
— David BlackburnDiets don’t work, but eating sensibly all the time and doing simple exercises like walking do work. That’s how I lost 15 pounds.
— GregI began “dieting” 23 years ago when I was diagnosed with type 1 diabetes. My doctor placed me on the “constant carbohydrate” plan which has a 1980s ring to it but worked well for years. Since then I’ve created my own diet plan: gluten-free, low carbohydrate, low fat. The truth for me is: carbohydrates can be an amazing source of energy, but they will slowly kill me if I eat too many, and I can die of low blood sugar if I eat too few. I’m skinny as a rail by the way.
The fact is, if you take measure of everything you put in your body and if your life depends on it, you can change your habits. People who wish to lose weight and talk about getting on a “special” diet to do that remind me of folks who long to quit smoking and never do it (me) but keep talking about how with their nicotine gum or whatever they will win the battle someday.
I can relate to doing bad things out of habit. Its easy to put off the choice to quit smoking because immediate consequences are hard to notice while enjoying a cigarette. Kinda like gaining weight from eating donuts perhaps?
Maybe it helps to think of it as life or death decision making. I need to change my thinking on tobacco from a “zero carbohydrate” pleasure substance to what it really is: poison.
Just like donuts.
— BrockI am now 84 and have been trying to lose weight for the last 4 years. Somewhat successful. But there are two things that no one above has mentioned.
One is that we tend to increase about 10 lbs. each decade. I weighed 163 in 1963. Now I weigh 190.
The second item is that it has been learned that somewhat overweight people live longer than thin people. So that should be some solace for dieters.
I work out 6 days a week at the YMCA, doing cardio activities and weight lifting machines. My health is excellent, I never get sick. I am in good shape. I will keep on controlling my diet, which is largely vegetarian, and trying to lose a half-pound a day. But given my good health, I don’t worry too much.
— James Holton