As we embark on another new year and establish our resolutions, it’s no secret that our country focuses more on diet and exercise than on nutrition. While diet constitutes what a human habitually consumes, nutrition is defined as the quality of components in our food and beverages. As a nation dedicated to weight loss goals, we resort to fad diets and gym memberships. Despite such efforts, we’re not achieving our weight loss goals; in fact, from 1999 to 2018, the prevalence of nationwide obesity increased from 30.5% to 42.4% and that of severe obesity increased from 4.7% to 9.2%.1
In the current COVID-19 era, restricting travel and limiting access to gyms has certainly helped flatten the viral transmission curve but introduced the veritable disadvantage of decreased physical activity. Furthermore, the combination of working from home, online education, and social media use have all caused a sharp surge in sedentary screen time and comfort eating.2 The food industry quickly acknowledged this profitable market opportunity by intensifying online advertising. Food shopping has increased by 124%, take-out food purchasing has soared,3 and alcohol sales have spiked by more than 24%.4 This trend may fuel a flare in the ongoing epidemic of American obesity to uncontrollable proportions, a phenomenon aptly christened “Covibesity” by Khan and Moverly Smith.5 As the effects of lockdown perpetuate, the global burden of obesity continues to increase.
We’ve been aware of the plethora of obesity-related morbidities for decades. These include hypertension, coronary heart disease, stroke, type 2 diabetes, high low-density lipoprotein (LDL) cholesterol, low high-density lipoprotein (HDL) cholesterol, high triglycerides (dyslipidemia), gallbladder disease, osteoarthritis, sleep apnea and breathing problems, low quality of life, and body pain.6,7 A 2016 study indicated that US had the highest fractions attributable to obesity for colorectal and pancreatic cancer and postmenopausal breast cancer.8 The association of obesity with arthritis and depression is also well established.9,10 In the US, 72% of adults are overweight. The estimated annual medical cost of American obesity has increased from $78.5 billion in 1998 to $147 billion in 2008 and was $1,429 higher in obese Americans than that in people of normal weight.11
The interesting paradox: Many obese Americans are also malnourished. This “double burden of malnutrition” is a direct consequence of replacing a diet full of fruits, vegetables, whole grains, and beans with ultraprocessed and snack foods not only full of refined carbohydrates/sugars but also low in specific essential vitamins and minerals.12 The importance of these micronutrients as cofactors in glucose metabolic pathways, pancreatic β-cell function, and the insulin signaling cascade suggests that their deficiencies may play a role in the development of type 2 diabetes.13
Since the craze of thin, boyish figures among flapper girls in the 1920s to the cabbage soup diet of the 1950s, fad diets have urged the consumption of certain types of food over others while counting calories. The first real breakthrough came in the late 1960s with the Atkins® Diet,14 which gained popularity largely based on celebrity endorsements. Since then, trends such as the Paleo Diet®, the South Beach Diet®, veganism, the Blood Type Diet, cleansing and juicing, and others have made headlines, yet the national obesity statistics clearly prove that we haven’t moved the needle in the right direction.
Several myths surround our diet concerns, a common one being that grain-based products such as bread, pasta, and rice should be avoided when trying to lose weight. The Dietary Guidelines for Americans 2015-2020 recommend consuming grains as part of a healthy eating plan,15 although at least half of the grains consumed should be whole grains such as brown rice and whole-wheat bread, cereal, and pasta. Whole grains provide iron, fiber, and other important nutrients.
Similarly, many believe that choosing gluten-free foods will help one eat a healthier diet. Gluten is a protein found in wheat, barley, and rye. The fact is that healthcare professionals prescribe a gluten-free diet to only people who have celiac disease or gluten sensitivity. A gluten-free diet was found to be poor in alimentary fiber and essential micronutrients such as vitamins D and B12 and folate, as well as minerals such as iron, zinc, magnesium, and calcium.16 Nor should one avoid all fats and dairy to lose weight, as milk provides protein and calcium, and fats pack essential fatty acids and vitamins.
While some fad diets are backed by scientific evidence and therapeutic applications (such as the Ketogenic Diet and modified Atkins Diet for epilepsy17 or caloric restriction and the Mediterranean Diet for obesity and diabetes18), most take known nutritional concepts and apply them in excess and in isolation from the bigger health picture. For example, in the 1990s the focus was on low-fat/no-fat diets,19 with the tagline Fat causes fat making rounds. So in answer to this newfound revelation, the drive was to get skinny with high-carb diets. A plate of pasta was considered a healthy food choice. Low-fat/no-fat food options became available, and manufacturers added more sugar to compensate for the missing flavor. We concentrated on what not to eat, not recognizing that we might be depleting our bodies of essential nutrients. And yes, some people saw results—often short lived—but the average American got fatter.
As we neared the new millennium, we recognized our flawed approach and changed to low-carb/no-carb diets. After all, carbs, not fat, make us fat. Carbs, especially sugars, trigger hormones and metabolic consequences. So we turned to bacon instead of pasta. And again, some saw results, although often short lived. However, now we were depriving our brain of glucose, its primary energy source, while adding fat.
As our scientific understanding of human physiology and nutrition advanced, we started to understand that fats and carbs are not all created equal; some are worse than others. As individualized medicine emerged, so did individualized dieting and new fads based on our body shape. Foods travel different metabolic pathways and can have vastly different effects on hunger and the hormones that regulate body weight; we ignored this fact while deciding what to deplete from the body and how to make up for it.
Dieting primarily focuses on what not to eat, thereby presenting an unbalanced platter that can eventually deplete the body of necessary nutrients or add harmful components. This pattern of restrained eating, often characterized by failed efforts to control caloric intake, leads to elevated cortisol levels.20 The resulting stress from deprivation forces the metabolic and endocrine reactions to produce cravings and therefore binge eating.21 Nutrition, on the other hand, focuses on what nutrients our body needs and in what quantities. It’s about minimizing depletion such that the body can effectively function and burn energy. As a general guide, balanced nutrition for the day should comprise 30% protein, 40% complex carbs, 30% essential healthy fats (ideally omega-3 fatty acids), 2-4 L of water, vitamins, minerals, phytonutrients, and antioxidants, all eaten in the right proportions.22 Cravings and overeating are less likely when our nutritional needs are met.21,23 Focus on nutrition is especially important for people with chronic illness. While obesity might be the outcome of poor nutrition, years of experience have taught us that dieting may, in fact, make it worse instead of better.
As we enter a new decade in a time of global pandemics and ever-increasing rates of obesity and diabetes in the Western world, our attention should be on holistic wellness and not just physical weight loss. While weight is one part of wellness, it‘s not isolated, and focus on this single outcome has led us astray. It’s been stated many times, but we need to optimize nutrition first, and healthy weight will follow.
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