Monday, March 28, 2016

Why Diet Books and Doctors Lie

By Sam Yang - Get similar updates here

A lot of what I talk to clients about is covered in this fantastic article by Julia Belluz of Vox. Being healthy is really complicated. We want neat little answers that are the equivalent to a magic pill, but that is not reality. Not now and not in the foreseeable future. What I try to do is guide people through the complexities and remove a lot of uncertainties. It's all about irrational behaviors. Irrational does not mean "stupid," it means a belief you hold or a behavior you have, that is not based on reason, but more a default automatic response. More motivation will not make you more rational. To become healthy, you must become a more rational actor. No diet book or bootcamp trainer can help you with this. There is a reason we have no definitive diet or exercise program for Americans. Even with people volunteering for the experiment, we have never gotten enough volunteers to stick with anything long enough for us to know anything. So we look at preexisting data from other countries or from our past. Food isn't the only thing that has changed, so has our social and work environments, so has our psychologies, so has society. All these things factor into our inability to change as adults.

People want to know it will be easy. When they ask about nutrition, they want to know about what foods to eat that will burn away all their fat. They want to know what workout will wash away every other damage they do to themselves. What I am going to say is, none of these wants or beliefs are rational. They are convenient but not aligned with truth, evidence or even critical thinking. Shallow-thinking comes to these conclusions. Your body isn't what needs improving, it is our minds, it is our brains, for our brain will be what facilitates any change. This involves lot of education, perception changes, thinking, and behavior change methods.

Here are excerpts from the Vox article:

No doctor has ever uncovered the solution to weight loss. If someone had found the fix for this immensely vexing and complex problem, we wouldn't be facing an obesity crisis.

But unfortunately, more and more respected doctors, despite their good intentions, are complicit with the publishing industry in confusing science and obscuring hard truths about obesity to sell diet books.


[E]very obesity researcher knows that many people following a new diet lose weight initially; the big question is what happens afterward. The data we have on this is sobering. Only a tiny percentage (estimates suggest about 5 percent) of people who try to lose weight on a diet succeed, and many more actually gain weight in the dieting process.

[Doctors] publish a diet book filled with big promises, and used their credentials to back them up.

Diet books have a formula, and doctors use it all the time

When you read a lot of diet books, said Louise Foxcroft, author of Calories and Corsets: A History of Dieting Over 2,000 Years, a clear pattern emerges: "You need to be a doctor. You need to be patronizing. You want a four-phase plan."

The typical book promise to reveal a secret about fat busting that no one has been telling you. It then guarantees that with an easy-to-follow and painless plan, the fat will finally melt right off.


Celebrity endorsements are prominent, as are anecdotes from average people who have allegedly had success following this great new program.

In evidence-based medicine, though, anecdotes are considered the lowest form of evidence, since they may be cherry-picked or otherwise unrepresentative of a broader experience. In the world of diet books, they are presented as definitive proof.

"Wrap that all up in punitive, quasi-religious language," Foxcroft said, "and you'd be rich very quickly."

Indeed, if you can come up with a diet that's appealing enough, these books seem like viable get-rich-quick-schemes. According to Nielsen BookScan, about 5 million diet books are sold in the US alone every year — around half of the entire total health and fitness category in 2015. Gardening books, by contrast, sold about a million units in 2015.

It's just one segment of the dieting industry, which is valued at $60 billion in the US, equal to the pet and cosmetics industries.


The formula remains largely the same too. "Nobody ever comes up with anything new," Foxcroft adds. "They just redress what’s gone on before and package it slightly differently."


Some doctor diet books are more sensible than others, like Yoni Freedhoff's The Diet Fix. He doesn't prescribe a specific regimen but argues that the only diet that's likely to work is actually more of a lifestyle change that's sustainable over many, many years. (That's what nearly every weight loss and obesity expert I've ever talked to has told me.)

[Doctors] contend that if people would just forget calories and follow a wholesome, low-carbohydrate, higher-fat diet, they could eventually shed weight. (Even critics agree this plan would eventually lead to slimming.)

But here's the thing: Most people know they shouldn't eat a lot of doughnuts and cookies. They know they should eat more fruits and veggies instead. But many can't stick to that pattern of eating for a host of social and environmental reasons that most diet books can't and don't address.

"All these books are always marketed as, 'Here is the answer. We have now discovered the answer for obesity, and it’s this thing,'" said health policy researcher Tim Caulfield, who has studied celebrity diets for his books, including The Cure for Everything. "But that’s problematic given what we know about how complex the obesity problem is. There are so many factors involved, and I don't think any researcher would deny obesity is a biological and social phenomenon."

Simply giving people a prescription for eating that they know they probably should be following anyway, no matter how sensible, isn't likely to change that.

Yet it's clear unscientific diet books aren't going away; they are a hugely lucrative enterprise. Nonfiction is a bigger book category than fiction, and lifestyle makes up about 80 percent of the nonfiction market.


Only a doctor's patient-physician interactions, and not his media speech, are governed by professional boards, which is why Dr. Oz has gotten away with his many outlandish claims over the past 10 years.

We humans are particularly vulnerable to diet books. As Matt Fitzgerald, author of the book Diet Cults, explained to me, our beliefs about food are highly irrational, and when we struggle with weight, we long for neat solutions. "What people want is a pill," he said, "But if you can’t have that, you want a diet that’s a functional equivalent of a pill: simple, tidy, neat, certain."


"It’s remarkable people aren’t more skeptical, because these diets never pan out," said Caulfield. "Can you point to one that over the long term has panned out? The answer is no."

Let's not repeat history. Let's do things differently. Down with diet books.

My name is Sam Yang. I'm a martial artist, entrepreneur, fitness nerd, information geek, and productivity nut. For more useful information, join my newsletter. You can also connect to All Out Effort on Facebook and Twitter. For more philosophical posts, check out Must Triumph

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