Fad Diets: Weighing Short-term Gains Against Long-term Harms?

For Some, Regimens May Offer Springboard to Healthier Lifestyle

May 17, 2010 08:35 am Hannah DeClerk

When it comes to weight loss, there is no doubt that so-called fad diets are everywhere. From television commercials to magazines lining the racks at the local grocery store, rapid weight-loss promises are practically plastered on every corner. But according to the CDC, fad diets can limit nutritional intake, are unhealthy, and always seem to fail in the long run.

According to the CDC's Healthy Weight -- It's Not a Diet, It's a Lifestyle! Web page(www.cdc.gov), a fad diet is any diet that promises fast results and represents only a short-term dietary change.

As the obesity epidemic continues in the United States, family physicians need to become more aware of the harmful effects fad diets can have on patients.

That is the stance of family physician Jeffry Gerber, M.D., of Littleton, Colo., who specializes in patient weight loss and diabetic management. He told AAFP News Now that about two-thirds of his patients struggle with their weight.

"I believe the manufacturers are trying to sell a quick fix. I call it the 'pay per pound principal' -- that is, manufacturers make money when patients get lost in weight loss maintenance. It is all about big business, where fad diets are the majority of it."

Fad Diets and Healthier Lifestyles

However, some patients, such as Bruce Wells, 49, have had help from a "fad diet" in achieving a healthier lifestyle.

Wells told AAFP News Now that in the fall of 2007, he was driving home from work when he heard a Smart for Life (www.smartforlife.com)advertisement. It was promoting an eight-week weight-loss competition involving the Smart for Life Cookie Diet combined with a healthy living regime in a team environment. Wells decided to enter the competition.

"I asked to be considered as a contestant, and I told them how I have been overweight all my life," said Wells. "I joked that I've probably lost a 1,000 pounds, but gained back 1,500."

Wells said that a few days later, he was contacted by the organization and told that he had been selected to participate. Soon after, he started the Smart for Life Diet, which consisted of eating about six cookies or muffins a day, followed by a "sensible" dinner.

"It didn't take long for Smart for Life to make a believer out of me," said Wells. "It's medically supervised, easy to follow, and there was a professional staff to help and encourage me along the way."

Because of the diet and how it made him feel, Wells said that he was motivated to incorporate an overall healthier and more physical lifestyle by walking one to two miles, five days a week.

Wells said that in the first week, he dropped 16.5 pounds, and at the end of the eight-week period, he had lost 58 pounds.

The following year, Wells said he lost a total of 130 pounds. He said that although he still has 40 more pounds to lose, he is healthier and more active than ever, resulting in a vast improvement in the quality of his life.

Low Carbohydrate Diet Proves More Beneficial to Patients' Health

A team of researchers at Duke University Medical Center found that when comparing the effects of restricted carbohydrate diets with a diet plus medical therapy, the low carbohydrate diet proved more beneficial to a patient's overall health.

In an article titled "A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss"(archinte.ama-assn.org) in the Jan. 25, 2010, Archives of Internal Medicine, overweight or obese outpatients from primary care clinics were randomized to receive either low-carbohydrate dietary instruction or low-fat dietary instruction plus orlistat therapy delivered at group meetings for 48 weeks.

The results of the study showed that although a low-fat diet plus medication versus a low-carbohydrate diet provided similar weight loss results, the low-carbohydrate diet was more effective for lowering blood pressure.

The study's authors also noted that a low-carbohydrate diet may be an attractive alternative for patients because it is simpler and less expensive than a low-fat diet plus medication.

Physician Concern With Fad Diets

Still, some family physicians, including Gerber, believe that fad diets, in the long run, could be detrimental to a patient's health.

Gerber said that it is the FP's responsibility to speak to patients about losing weight, because an unhealthy lifestyle is a major factor behind many acute and chronic diseases. "In the long-term, it is not good for the patient's health," he said. "It makes your cholesterol worse, and, due to recurring failure, (the patient) could be at more of a cardiac risk."

The reason so many patients turn to fad diets may not be the patients themselves, but doctors who haven't embraced nutrition as a viable treatment option, said Gerber. "A lot of primary care doctors tell their patients that they need to lose weight but not how," he said. "Patients become frustrated and turn to their own solutions."

Gerber recommends that if a patient says he or she is struggling with weight and is considering a fad diet, the FP should take some specific steps. "It's not about just losing weight, but helping patients understand health risks about losing weight. It is about an FP explaining to the patient how their weight gain is related to their health by pointing out their high cholesterol or blood pressure," he said.

These specific plans integrate with a more science-based, nutritional approach, unlike that on which many fad diets are based.

"It is unfair to tell patients, 'Dietary fat is bad,' or 'Cholesterol is bad for you,'" Gerber explained. "In moderation, there are positive aspects (to these dietary components). It's a combination of certain foods that is unhealthy. It's all about redefining the balance."

The CDC agrees. According to the agency, the key to achieving and maintaining a healthy lifestyle isn't about making short-term dietary changes. Rather, it is about adopting a lifestyle that includes healthy eating and regular physical activity.