Dietary Treatment for Overweight and Obesity - Selected Milestones In The History Of Dieting
The early 1900s marked the beginning of diets that restricted calories. The 1918 bestseller Diet and Health by Dr. Lulu Hunt Peters advised readers to think in terms of consuming calories rather than food items and remained in print for twenty years. Peters wrote "You should know and also use the word calorie as frequently, or more frequently, than you use the foot, yard, quart, gallon and so forth … hereafter you are going to eat calories of food. Instead of saying one slice of bread, or a piece of pie, you will say 100 calories of bread, 350 calories of pie." The 1920s also saw the rise of very-low-calorie diets to promote weight loss. For example, the Hollywood eighteen-day diet advised just 585 calories per day largely derived from citrus fruits.
Throughout the 1920s and 1930s the low-calorie diet remained a popular weight-loss strategy; however, other approaches, such as food-limiting plans that restricted dieters to just one or two foods such as lamb chops, pineapples, grapefruits, or cabbage, were introduced, as were diets that prescribed combinations of certain foods and forbid others. For example, some diets prohibited eating protein and carbohydrates together; others were more specific, advising which vegetables could be served together. The 1930s also saw the first condemnations of carbohydrates as causes of overweight. A high-fat, low-fiber diet consisting primarily of milk and meat was thought to be protective against disease. The Italian poet Filippo Tomaso Marinetti exhorted Italians to forgo their pasta because he claimed it made them sluggish, pessimistic, and fat.
In 1943 the U.S. Department of Agriculture (USDA) released the Basic Seven Food Guide in the National Wartime Nutrition Guide. It emphasized a patriotic wartime austerity diet that included between two to four servings of protein-rich meat and milk products, three servings of fruits or vegetables, and the rather vague recommendations of "bread, flour, and cereals every day and butter, fortified margarine—some daily."
In 1948 Esther Manz, a 5—foot, 2-inch, 208 pound homemaker established TOPS (Take Off Pounds Sensibly; http://www.tops.org/), the first support-group program for weight loss. Manz was inspired to start the program after she attended childbirth preparation classes where women benefited from mutual support and encouragement. Annual membership dues of $24 currently support the international nonprofit organization, based in Milwaukee. Along with weekly meetings and private weigh-ins, TOPS participants are encouraged to adhere to a calorie-counting meal plan based on a program developed by the American Dietetics Association. In 2006 TOPS boasted more then 200,000 members in 10,300 chapters worldwide. Members who achieve their weight goals become KOPS (Keep Off Pounds Sensibly), and often keep attending meetings to maintain their weight and serve as role models for others.
In 1950 the American physician and biophysicist John Gofman of the University of California at Berkeley hypothesized that blood cholesterol was involved in the rise in coronary heart disease. Gofman found not only that heart attacks correlated with elevated levels of cholesterol but also that the cholesterol was contained in one lipoprotein particle, low density lipoprotein (LDL). Early reports of the connection between overweight and elevated blood cholesterol intensified interest in weight loss, which was now promoted as a strategy for preventing heart disease. During the late 1950s injections of human chorionic gonadotropin (hCG), derived from urine of pregnant women or animals, enjoyed fleeting popularity as a weight-loss agent; however, it was quickly proven entirely ineffective. Fad diets, such as a diet advocating consumption of many bananas to satisfy sugar cravings, and another that involved ingesting a blend of oils to boost metabolism continued to lure Americans seeking quick weight loss. In 1959 the American Medical Association termed dieting a "national neurosis."
By 1960 Metrecal, the first high-protein beverage, was widely advertised by the fifty-nine-year-old Mead Johnson Company as a weight-reducing aid. It was originally sold as a powder, which when mixed with a quart of water yielded four, eight-ounce glasses intended to serve as four meals a day, totaling 900 calories. The powder was made from milk, soy flour, starch, corn oil, yeast, vitamins, coconut oil, and vanilla, chocolate, or butterscotch flavoring. The low-calorie regimen enabled a dieter to lose ten pounds in a few weeks, without the trouble of meal preparation or counting calories. Later, Metrecal was sold in a pre-mixed, liquid form that could be consumed right from the can. Mead Johnson made more $10 million selling Metrecal in the first two years. It was the forerunner of such liquid diet products as SlimFast.
The 1960s also witnessed the birth of Overeaters Anonymous and Weight Watchers. Overeaters Anonymous began as a support group modeled on the twelve-step physical, emotional, and spiritual recovery program used by Alcoholics Anonymous. Today about 6,500 Overeaters Anonymous groups meet each week in sixty-six countries (http://www.oa.org/about_oa.html). In 1961 Jean Nidetch, an overweight housewife in New York City, invited a few friends to her home to gain support for her efforts to diet and overcome an "obsession for cookies." From this first meeting, the friends gathered on a weekly basis, offering one another encouragement and sharing advice and ideas. The weekly support meetings proved successful, providing motivation and encouragement for long-term weight loss. In 1963 Nidetch incorporated Weight Watchers, and hundreds of people turned out for this first meeting. Weight Watchers grew in both size and popularity, developing nutritious and convenient eating plans, promoting exercise, cookbooks, healthy prepared food, and a magazine. The com-pany became so successful that in 1978 it was acquired by the Heinz company. In 2006 more than a million "weight watchers" meet weekly (http://www.weightwatchers.com/).
Two best-selling diet books also debuted during the 1960s. Herman Taller, an obstetrician-gynecologist, wrote Calories Don't Count (New York: Simon & Schuster, 1961), which told dieters to avoid carbohydrates and refined sugars and eat a high-protein diet that included large quantities of unsaturated fat. While they were not the first to tout low-carbohydrate diets, Taller and another physician, Irwin Stillman, author of The Doctor's Quick Weight Loss Diet (New York: Prentice Hall, 1967), which restricted carbohydrates completely, permitting dieters to consume just meat, poultry, fish, cheese, eggs, and water, introduced the first modern high-protein weight-loss diets. Taller's career as a diet guru ended abruptly in 1967, when he was convicted of mail fraud for the sale of safflower capsules as weight-loss aids. Stillman, however, followed up his wildly successful first book with six additional weight-loss titles, including The Doctor's Quick Teenage Diet (New York: David McKay Co., 1971), one of the first diet books to address the needs of overweight adolescents. High-protein, low-carbohydrate diets washed down by liberal amounts of alcohol were also advocated by other titles from the 1960s, including The Drinking Man's Diet (San Francisco: Cameron & Co., 1964) by Gardener Jameson and Elliot Williams, and Martinis and Whipped Cream and The Lazy Lady's Easy Diet: A Fast-Action Plan to Lose Weight Quickly for Sustained Slenderness and Youthful Attractiveness (West Nyack, NY: Parker Publishing Co., 1968) by Sidney Petrie.
During the same decade, chemically processed, non-nutritive sweeteners were marketed as calorie- and guilt-free substitutes that enabled dieters to enjoy many of their favorite sweet treats. Saccharin, which is 300 times sweeter than sugar, was the first artificial sweetener to be widely used in diet foods and beverages. Other chemically processed, artificial, nonnutritive sweeteners followed, although cyclamates were withdrawn from the U.S. market in 1969 because research findings in animals suggested that cyclamate might increase the risk of bladder cancer in humans. According to the National Cancer Institute, more recent animal studies have failed to demonstrate that cyclamate is a carcinogen (a substance known to cause cancer) or a co-carcinogen (a substance that enhances the effect of a cancer-causing substance). To date, cyclamate is not approved for commercial use as a food additive in the United States. Acesulfame K and aspartame were approved by the U.S. Food and Drug Administration (FDA) in 1988 and 1981 respectively. (The FDA recommended safe daily consumption of aspartame is eighteen packets of Equal or three 12-ounce diet sodas per day for a 130-pound person.) In July 2002 the FDA approved another nonnutritive sweetener, neo-tame, for use as a general-purpose sweetener. Neotame is from 7,000 to 13,000 times sweeter than sugar and has been approved for use in food products including baked goods, nonalcoholic beverages (including soft drinks), chewing gum, confections and frostings, frozen desserts, gelatins and puddings, jams and jellies, processed fruits and fruit juices, toppings, and syrups. Another noncaloric sweetener, sucralose, was approved by the FDA for general use in 1999 and is marketed under the brand name Splenda. Sucralose has gained popularity because it is derived from and tastes like sugar, has no aftertaste, does not promote tooth decay, and is deemed safe for use by pregnant women and diabetics, as well as those in the general population who are trying to cut down on their sugar intake.
In 1972 cardiologist Robert Atkins published Dr. Atkins' Diet Revolution (New York: Avon, rev. ed., 2001), with a new explanation about how an extremely low-carbohydrate diet targets insulin to promote weight loss. Atkins termed insulin, the hormone that regulates blood sugar levels, a "fat-producing hormone." He asserted that most overeaters are continually in a state of "hyperinsulinism" primed and ever-ready to convert excess carbohydrates to fat. As a result they have excess circulating insulin, which primes the body to store fat. Atkins contended that when people with hyperinsulinism dieted to lose weight—especially when they reduced their fat intake and increased carbohydrate consumption—their efforts were doomed to fail. He claimed that dieters could alter their metabolisms and burn fat by inducing a state of "ketosis" (the accumulation of ketones from partly digested fats because of inadequate carbohydrate intake) that they monitored by testing their urine for the presence of ketones. Dieters who were tired of limiting portion size, weighing and measuring their foods, counting calories, and assiduously avoiding fatty foods like steak, bacon, butter, cheese, and heavy cream embraced the low-carbohydrate diet with religious fervor.
The high-protein, low-carbohydrate diet not only was satisfying but also produced the immediate benefit of weight loss through water loss because the body flushes the waste products of protein digestion in the form of urine. Especially during the early weeks of dieting this additional weight loss delivered a psychological boost to dieters and the motivation to continue. Today, many researchers and health professionals agree with Atkins's premise that sharply limiting carbohydrate intake can help to curb the appetite by maintaining even levels of insulin and preventing the insulin surges and blood sugar drops that may trigger hunger.
While Atkins and his devotees were celebrating weight loss, good health, and even improved mood as a result of the low-carbohydrate diet, nutritionists and health professionals were countering by trumpeting the benefits of low-fat diets, high in complex carbohydrates and fiber. Fat was demonized, and nutritionists pointed dieters to the USDA Food Guide Pyramid that advises using fats sparingly. (The updated 2005 USDA Food Guide Pyramid continues to promote a low-fat diet and minimal use of fats and oils.) Critics of the low-carbohydrate regimen were concerned about the long-term health consequences of the high-fat diet and wondered if it might elevate cholesterol and triglyceride levels in people who by virtue of being overweight were already at increased risk for heart disease. There also were concerns that high-protein diets might cause kidney damage or bone loss over time. Rigorous research to compare the effectiveness and assess the health outcomes of low-carbohydrate and low-fat diets was not conducted until the end of the twentieth century. Although Atkins enjoyed tremendous celebrity, publishing a series of weight-loss books, and overseeing manufacture and sale of food products bearing his name, his significant contributions to the scientific understanding of nutrition and weight loss were not fully appreciated until the year preceding his death in 2003.
The 1970s also had its share of fad diets. Robert Linn's The Last Chance Diet (New York: Lyle Stuart, 1977) advised a protein-sparing fast, so dangerously deficient in essential nutrients that several deaths were attributed to it. In The Complete Scarsdale Diet (New York: Bantam, rev. ed., 1982), physician Herman Tarnower advocated a fat-free, high-protein diet that allowed 700 calories per day, but he became better known posthumously, after he was murdered in 1980 by his lover, Jean Harris.
At the close of the decade, physician Nathan Priti-kin's The Pritikin Program for Diet and Exercise (New York: Grosset & Dunlap, 1980) championed a nearly fat-free diet that consisted of fresh and cooked fruits and vegetables, whole grains, breads and pasta, and small amounts of lean meat, fish, and poultry, in concert with daily aerobic exercise. Advocating heart health and fitness, in 1976 he opened Pritikin Longevity Centers where people could learn to modify not only their diets but also their lifestyles. Although Pritikin's plan, which essentially eliminated fat from the diet, was considered by many health professionals too extreme to gain long-term adherents, Pritikin enjoyed as loyal a following as did Atkins.
During the 1980s author Judy Mazel resurrected the notion of specific food combinations as central to weight loss in The Beverly Hills Diet (New York: Berkley Publishing Group, 1984). Mazel asserted that eating foods together, such as protein and carbohydrates, destroyed digestive enzymes and caused weight gain and poor digestion. Her diet featured an abundance of fruit, and some observers speculated that weight loss attributable to the diet resulted from the combined effects of caloric restriction and fluid loss resulting from diarrhea. Celebrity endorsements and the glamorous author's frequent media interviews served to stimulate interest in the diet.
In 1983 Jenny Craig launched a weight-loss program that would become one of the world's two largest classroom diet companies (along with Weight Watchers). At more than 650 centers in North America, Australia, Guam, New Zealand, and Puerto Rico, the company that bears her name sells prepared foods, along with other weight-loss materials. The company also offers telephone consultations and home delivery of food and support materials. In 2002 company founders Jenny and Sid Craig sold their majority stake in the company to ACI Capital Co. and MidOcean Capital Partners, Inc., but retain 20% interest in the company.
Yet another nutritionally deficient, protein-sparing liquid diet program, The Cambridge Diet, debuted during the 1980s and met with a fate similar to its successors—it was denounced following the deaths of dieters. Although the reformulated diet remains in use today, most health professionals caution against it and comparable regimens unless dieters are under medical supervision.
The 1990s served up "new" and revised versions of high-protein, high-fat, and low-carbohydrate diets and the low-fat diet as well as an update of Mazel's Beverly Hills Diet. Atkins's 1992 and 1999 updates of Dr. Atkins' New Diet Revolution offered advice about how to achieve total wellness as well as weight loss, spent more than four years on the New York Times bestseller list, and won over a new generation of dieters. Cardiologist Dean Ornish rekindled enthusiasm for low-fat eating with his Eat More, Weigh Less: Dr. Dean Ornish's Life Choice Diet for Losing Weight Safely While Eating Abundantly (New York: HarperCollins, 1993). Ornish's approach was directly opposed to Atkins's—he espoused the health benefits of vegetarianism and limiting dietary fat to just 10% of the total daily calories. However, both physicians took a holistic approach to health and weight loss, encouraging readers to engage in moderate exercise, foster social support, and reconnect with themselves to support their physical and emotional well being.
Still, the diet that generated the most fanfare during the late 1990s was biochemist Barry Sears's The Zone: Revolutionary Life Plan to Put Your Body in Total Balance for Permanent Weight Loss (New York: Regan Books, 1995). Sears's high-protein, low-carbohydrate plan promised that by eating the correct ratio of protein, fat, and carbohydrates, dieters would lose weight permanently, avoid disease, enhance mental productivity, achieve maximum physical performance, balance and control insulin levels, and enter "that mysterious but very real state in which the body and mind work together at their ultimate best."
At the dawn of the twenty-first century the fiery debate about the merits of low-carbohydrate and low-fat diets intensified, with both sides citing scientific evidence to support the supremacy of one diet as the healthier and more effective weight-loss strategy. Cardiologist Arthur Agatston offered a kind of compromise between the two regimens in The South Beach Diet (New York: Rodale Press, 2003). Agatston condemned simple carbohydrates, such as white flour and white sugar, citing them as the source of the continuous cravings that sabotage dieters, but did not eliminate complex carbohydrates from the diet. (Carbohydrates are classified as simple or complex. The classification depends on the chemical structure of the particular food source and reflects how quickly the sugar is digested and absorbed. Simple carbohydrates have one or two sugars while complex carbohydrates have three or more.) Agatston's plan was a modified carbohydrate plan, recommending plenty of high-fiber foods, lean proteins, and healthy fats, while cutting back on, but not entirely banishing, bread, rice, pastas, and fruits.
In 2004 the Atkins organization that had previously advised dieters to satisfy their appetites with ample quantities of steak, bacon, eggs, heavy cream, and other saturated fats modified its position. Colette Heimowitz, the director of research and education for Atkins Nutri-tionals, advised health professionals and dieters that just 20% of a dieter's calories should come from saturated fat. She and other Atkins representatives asserted, however, that this did not represent a change in the diet itself, simply a revision in communicating how the diet should be followed. Diet industry observers maintained that the warning to reduce consumption of saturated fat was in direct response to the debut of the South Beach Diet and other low-carbohydrate regimens that called for less saturated fat. In an interview in the New York Times (January 18, 2004), Heimowitz asserted that the change was made because "we want physicians to feel comfortable with this diet, and we want people who are going to their physicians with this diet to feel comfortable."
Americans' enthusiasm for low-carbohydrate diets cooled during 2004, and Atkins Nutritionals Inc., the company that catapulted low-carbohydrate diets into a national obsession, filed for bankruptcy court protection in August 2005. Many dieters abandoned low-carbohydrate diets in favor of regimens based of the glycemic-index (GI)—a ranking system for carbohydrates based on their immediate effect on blood glucose levels, in which a numerical value is assigned to a carbohydrate-rich food based on its average increase in blood glucose. The GI measures how fast and how much a food raises blood glucose levels. Weight-loss diets based on the index emphasize sharply restricting high-index foods and consuming primarily low-index foods.
Examples of foods with glycemic index scores of seventy or above are cake, cookies, doughnuts, honey, French fries, rice, baked potato, and white bread. In contrast, a serving of lentils has a GI of twenty-nine, while servings of broccoli, peanuts, and spinach have GIs of less than fifteen. Carbohydrates that break down slowly, such as whole grain breads and cereals, beans, leafy greens or cruciferous vegetables, generate slower glucose release into the blood stream and lower glycemic index scores—fifty or less. Eating low glycemic index foods supports weight loss by enhancing satiety—the feeling of fullness or satisfaction after eating, and decreases in total food consumption.
In 2004 diet books that extolled the virtues of the low GI diet—including The New Sugar Busters (H. Leighton Steward et al., New York: Ballantine, 2003), Eat Yourself Slim (Michel Montignac, New York: Erica House, 1999), and The GI Diet: The Easy, Healthy Way to Permanent Weight Loss (Rick Gallop, New York: Workman, 2003)—flew off the shelves. Proponents of low GI diets observed that the regimen not only produced weight-loss but also improved overall health by reducing risk for both Type 2 diabetes and cardiovascular disease.
Although diet industry observers could not predict the next "craze," they were certain that a replacement for the low-carbohydrate diet would emerge. Contenders among the diets and diet books that debuted in between 2004 and 2006 include:
- The Three-Hour Diet: How Low-Carb Diets Make You Fat and Timing Makes You Thin (New York: Collins, 2005) by fitness guru Jorge Cruise, which recommended eating frequently and timing meals and snacks to "stoke the metabolism"
- French Women Don't Get Fat (New York: Reed Business Information, 2004), in which author Mireille Guiliano contends that the French are able to eat croissants and chocolate without becoming overweight because they take time to savor flavors and eat thoughtfully
- The CSIRO Total Wellbeing Diet (New York: Penguin Books, 2005), a low-carbohydrate, high-protein diet developed by scientists at the Commonwealth Scientific and Industrial Research Organisation (CSIRO) to help Australians lose weight
- The Perricone Weight Loss Diet (New York: Ballantine Books, 2005), written by dermatologist Nicholas Perricone, the book recommends a diet composed of high- as opposed to low-glycemic index foods, and healthy (Omega-3-rich) versus unhealthy fats
- The Diet Code: Revolutionary Weight-Loss Secrets From Da Vinci and The Golden Ratio (New York: Warner Books, 2006). Author Stephen Lanzalotta, a baker who lost half his business to the low-carbohydrate enthusiasm developed a diet based on the mathematical principles of the Golden Ratio, a formula used by Leonardo Da Vinci and popularized in the best seller The Da Vinci Code. The diet promotes Mediterranean-style eating, and emphasizes bread, fish, cheese, vegetables, meat, nuts, and wine
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