Diets

Diets are a relatively new thing. For much of history, most people simply did not have enough food at their disposal to have to worry about their weight; the need to limit what you eat is a relatively modern problem. Previously, only the wealthy had the problem of needing to lose weight. Being overweight became wider spread as sugar and refined flour became cheaper. Lord Byron was a yo-yo dieter who popularised bizarre habits like drinking vinegar and eating flattened potatoes. Young people followed suit and doctors blamed his influence for ill health among young people. The first famous dieter was William Banting in the late 1800s, who was enormously overweight and lost lots of weight by eating quite a lot meat and vegetables, an early Atkins if you will. He was the first person to turn a diet into a business idea.

In the early 1900s, Fletcher’s diet advocated chewing every mouthful of food hundreds of times. People ate very little as a result on this diet and the US government unsuccessfully tried to impose it on the armed forces, in an attempt to reduce rations. An academic named Ancel Keys, who viewed butter with great suspicion, ‘discovered’ the Mediterranean diet, which is still around today. Keys is also known for conducting a ground breaking experiment shortly after WW2 which involved starving a group of soldiers.  The study aimed to find out more about supporting the recovery of starving people who had been liberated from concentration camps. (Tragic cases were reported of people dying as a result of being given orange juice and marzipan by American GIs who liberated concentration camps.) The study is however remembered for the understanding it provided of people’s psychological relationship with food and what happens when they are deprived of food. It perhaps comes as no surprise that when deprived of food, people develop all-consuming and often long-lasting obsessions with it.

Diets appeared that took the form of a therapy or support group. Weight Watchers is perhaps the one that is best known to us, appearing in the early 1960s. (I’m horrified by the idea of a public weigh-in.) There have since been endless diets. The weird foodless ones, like the cabbage soup diet from the 1950s, Slimfast shakes or the cayenne pepper & maple syrup diet, popularised by Beyoncé. Other diets assign magical properties to certain foods, like the grapefruit diet, which claimed they melted fat away if eaten with a meal. Atkins and Dukan (both devised by doctors) were very fashionable for some time as they permitted food normally not associated with diets, like cheese, cream and lots of meat.

In 1979 Susie Orbach wrote a book called Fat is a Feminist Issue. She asserted that women eat to soothe themselves, to combat the empty feeling of being sex objects with a duty to facilitate the desires of other people, always giving and giving. She also highlighted how many young women hate their bodies and see them as something in need of being fixed, regardless of what they look like. A mismatch between external appearance and internal experience.

Young women grow up seeing images of bodies that do not match their own. Was it even possible, I wondered, to be so neatly proportioned, so lean with no localised fatty deposits? Being beautiful seemed to require starving yourself and getting a boob job. We watched Jennifer Aniston and Courtney Cox in Friends become thinner and thinner and thinner. Hollywood celebrities got thinner and thinner until they were Size Zero. Everyone was weirdly fascinated by this phenomenon even though it was agreed that it was neither healthy nor attractive.

Our television screens were filled with very slim celebrities. And overweight people who seemed to be there for our entertainment and shock value. One programme made people strip down to their underwear to be weighed, before showing them everything they ate in a week, which bizarrely came plummeting down into a big clear plastic tube. Programmes often showed people getting bariatric or ‘stomach stapling’ surgery as it was sometimes referred to. It was viewed as a last resort by the NHS; for people whose weight posed a serious risk to their health but had been unsuccessful in their attempts to lose weight. We saw images of people blending tiny amounts of food to fit in their reduced stomachs. A whole new set of programmes appeared about people left with excess skin after extreme weight loss as the NHS does not pay for excess skin removal.

Then Instagram took off and clean eating boomed. It looked great on the surface as it encouraged people to eat more veg and whole grains but it surfaced a new eating disorder (orthorexia). Some zealots proclaimed that sweet potatoes could do more for you than modern medicine ever could, with detox diets leading people to follow dangerously restrictive diets.  

The tone around diet seemed to have shifted; a diet now needed to be a healthy lifestyle choice with lots of proper food. Social media promoted ideas of strong, healthy, fit and valuing your body and what it could do. M&S launched a ‘fuller for longer’ range, women were told to nourish themselves with good wholesome food, not starve themselves.

I can’t help but wonder if Kim Kardashian had something to do with shifting the obsession with being very thin. While her shape is wholly unattainable for most, she does at least look like she eats. It now seems that rather than being very thin, what is important to teenagers is spending four hours on their make-up every day and having an enormous bottom.

The body positivity movement exploded thanks to plus-sized bloggers. Larger women announced that they were done with dieting because it didn’t work and it only made them feel rubbish about themselves. They were tired of feeling bad about their bodies, of people saying cruel things, of being told again and again of the dreadful risks to their health, of spending their lives on failing diets which only served to increase feelings of self-loathing. Being routinely humiliated was not going to make them thin. They asserted their right to be treated with respect and love their bodies as they were. Companies woke up to the amount of money that could be made from plus-sized fashion and the influence of the bloggers. Milk Models signed Tess Holliday who at size 24 describes herself as fat and has a real larger body. (A plus-sized model is usually size 14-16, a neatly proportioned hourglass shape with a flat stomach.)

Voices objected to the body positivity movement saying it was irresponsible to ‘promote’ being overweight. These polarised views were showcased in a BBC programme where nine people who described themselves as fat shared a house. A young woman who was vociferous in her body positive attitude argued with older people who’d experienced serious health issues and had been given warnings by doctors. They were not convinced by her convictions. (Body positivity advocates object to the idea that being overweight means you are unhealthy.  Being fit and active is not the preserve of the thin and neither is Type 2 diabetes exclusive to larger bodies.)

Bizarrely against this new backdrop, Michael Mosley’s 5:2 or intermittent fasting diet became very popular. It involved eating normally for five days a week with two days of significantly reduced calories – 500 for women, 600 for men. M&S and Pizza Express started doing 5:2 compatible meals. It certainly wasn’t the first time that a doctor had peddled an unusual diet on the basis that it was founded on new science that would work where diets had previously failed. This diet however was accompanied by a BBC Horizon documentary. Research had found that it was good for us to eat less and that a low calorie but nutrient rich diet could extend lifespan. The diet’s success was attributed to reducing levels of a growth hormone. In high quantities, it led to ageing and age-related diseases but protected against them in low quantities, leading to weight loss. The NHS however dismisses the 5:2 diet as a fad diet. I remember feeling concerned that it seemed like a convenient disguise for an eating disorder. (I also thought that my life would fall apart and I would probably be arrested for homicide if I followed the 5:2 plan, so severe is my hanger if I don’t eat regularly.)

Exercise became bigger than ever due to social media. While providing us with a way to get fit in our kitchens for free, it also gave us a whole new way to feel bad about ourselves. Intimidatingly attractive fitness types invited us to exercise with them. These were seemingly just normal people in their homes yet they were much thinner and more attractive. Social media also created a new body tyranny for men. It wasn’t enough to be thin, you had to have a six-pack, look really good in a white t-shirt and eat low-fat chicken at six prescribed intervals a day to maintain it. The Times suggested that for a generation who discovered that working hard at school and getting a good degree did not guarantee a stable career or home ownership, getting ripped was one of the few things left for young people that actually rewarded working hard.

The fat vs. sugar debate reared its head and it was suggested that sugar was society’s new tobacco. Multiple scientists told the NHS that its diet advice and the Eatwell guide were wrong, asserting that there was nothing wrong with eating lots of fat but that telling people to build their diets around carbohydrates was a disaster. Others took the attitude that the Eatwell plate had been misinterpreted based on what people were used to eating or what was available to them. Where low fat diets had been touted as the solution to cholesterol, heart disease and weight gain, it seemed that sugar had simply replaced fat in the new low-fat foods people ate. We ate processed, simple carbohydrates rather than wholegrains and so few fruit and veg that the government had to us ask to eat more (the five a day campaign had launched in 2003). Artificial sweeteners should not be seen a good replacement for sugar as they were said to increase appetite and lead to weight gain. Fizzy drinks became enemy number one and we brought in a controversial sugar tax in an attempt to reduce consumption of fizzy drinks.

In the wake of this, giving up sugar became a thing and some of your friends no doubt became sugar-free evangelists. The craze for Atkins left us feeling cautious around carbs, which was added to by the war on sugar. The only safe remaining food was protein. Filling up on protein seemed like a good thing to do, making us feel as if we were fuelling ourselves for work, for exercise, for life.

Do people still diet? Dieting became unfeminist somewhere along the way and body neutrality became available for those women who didn’t succeed in feeling unremittingly positive about their bodies. Weight Watchers (endorsed and partially owned by Oprah) was rebranded as WW. Slimming World seems to be the current plan of choice. Follower have a budget of points, with unlimited fruit and veg allowed.

Let’s go back to the idea that diets don’t work. To some extent the NHs website says this, warning against unsustainable fad diets, including Atkins and the 5:2, emphasising the importance of making healthy choices and sticking them, such as swapping processed carbs for wholemeal ones, choosing lower fat options and drinks containing less sugar. One of the few things scientists agree on with regards to diet seems to be the Mediterranean diet, which includes lots of fruit and veg, olive oil, pulses, nuts, fish and relatively little dairy or meat. The NHS claims this is very similar to the Eatwell plate but looking at it, it seems very easy to interpret the Eatwell plate as a message to eat lots of processed carbohydrates.

How much support can you get from your GP if you do want to lose weight? I don’t really know beyond my friend being subscribed Slimming World vouchers. Rotherham Institute for Obesity offered a specialist service open to anyone with a BMI of over 25. The service offered a gym adapted for people with serious weight issues along with counsellors who specialised in food issues and others who focused on emotional trauma. Despite winning awards and getting good results, their funding was cut and it ceased to operate. From what I can tell, services like this to are few and far between. As it is, talking therapies are hard to come by on the NHS due to funding and the demand. To me, it makes sense that you would talk to someone about your relationship with food, especially in a society where we are intermittently bombarded with images of calorie dense foods and images of very thin people.

Media doctors give the impression that GPs don’t have the time to support people to make positive life changes and that’s why people may be prescribed medication instead, for example, taking statins instead of changing diet. Interestingly, medical students don’t study much nutrition as part of their training. In 2016 a number of doctors called for medical students to be trained in what they referred to as ‘evidence-based lifestyle interventions’; 80% of the issues GPs deal with are related to diet and lifestyle. Dr Rupy Aujla started teaching the first course in culinary medicine at Bristol Medical School in 2018. Furthermore, the student-led Nutritank has piqued sufficient interest among students that in 2018 it had branches at fifteen other medical schools across the UK

Dr Giles Yeo, an obesity geneticist asserts that diets don’t work and that it is very hard to keep weight off as you need to continue eating less to avoid regaining weight. He challenges the idea that losing weight is simply a matter of will power, contesting that obesity is a disease of choice. He talks about the subtle variations caused by our genes in the fat sensing pathways in our brains. Being more or less sensitive to ghrelin (the hunger hormone) and leptin (the satiety hormone) can affect how hungry we are, how attracted we are to food and how rewarding we find it. (I find myself wondering if I should get my ghrelin levels tested. A 10am breakfast of porridge with a banana barely gets me to lunch at 1 o’clock.)

Genes also play a large part in how we respond to food. Professor Tim Spectre, a genetic epidemiologist at King’s College London founded the UK Twin Registry in 1993. He noted the impacts of feeding sets of twins different diets. If the Smith twins and the Jones twins are fed the same diet, the Smith twins will both gain or lose the same amount of weight. However the Jones twins may respond entirely differently to the Smith twins, but in the same way as their sibling. Professor Spectre asserts that you have no idea how your body will respond to an ‘off-the-shelf’ diet. This perhaps highlights what Giles Yeo calls the kernel of truth that is often used to sell diets. Diets are often marketed because they worked for one person, usually the person selling the diet, which however doesn’t guarantee that it will work for you.

Both Spectre and Yeo talk about gut biomes or microbiota, describing them as another bodily organ, something to be aware of and look after. With regards to weight and a healthy microbiome, Spectre endorses the Mediterranean diet. The more diverse your microbiome, the better and it seems that eating a range of unprocessed foods high in fibre results in a diverse microbiota. Spectre states that refined carbs and fats don’t reach the microbiome, unlike starchy veg or other complex foods. More veg it is then.

Gut bacteria were found to have a huge impact on weight gain; this was discovered when a woman with colostridium difficile infection (perhaps best known as a hospital superbug) did not respond to antibiotics and was given a faecal transplant. Receiving a sample from her overweight daughter resulted in curing the infection but led to extensive unexplained weight gain. This led many to believe that the answers to weight gain or loss could be in our microbiome. (I once spoke to a man who got very excited about microbiomes. I think he liked the idea of being able to monetise his own waste.) People have asked if those who are overweight could simply be given a faecal transplant from a thinner person. The answer is no, as insufficient research has been carried out to make it a safe option, other than in high risk cases of antibiotic resistance.

New Scientist points out that the science of nutrition is complex, messy and constantly changing. It seems highly likely that this will continue to be the case; further research is needed as they say. We don’t know where research on genes and microbiomes will get us, but it seems promising. On one hand I feel a sense of despair. We live in a society where we are sold endless processed food by the food industry, while our health service bears the enormous cost of obesity and diabetes, combined with the false economy of lacking provision for those who want to lose weight. But another part of me feels hopeful, medical training is being updated to train doctors in nutrition and research may provide the answers we are looking for; whatever it is, I suspect it will involve a more personalised and hopefully holistic approach, perhaps looking at genes, gut bacteria and emotions, moving beyond the idea of food in, exercise done.

References

Alang, A. & Kelly, C. R. (2015) Weight Gain After Fecal Microbiota Transplantation, Open Forum Infect Dis. 2015;2(1):ofv004 Available at: https://pubmed.ncbi.nlm.nih.gov/26034755/

Brody, J. E. (2004) Dr. Ancel Keys, 100, Promoter of Mediterranean Diet, Dies. New York Times article available at: https://www.nytimes.com/2004/11/23/obituaries/dr-ancel-keys-100-promoter-of-mediterranean-diet-dies.html#:~:text=Dr.,Promoter%20of%20Mediterranean%20Diet%2C%20Dies&text=Ancel%20Keys%2C%20the%20Minnesota%20physiologist,died%20on%20Saturday%20in%20Minneapolis.

Dillon, S. (2018) We learn nothing about nutrition, claim medical students – BBC article available at https://www.bbc.co.uk/news/health-43504125

Leslie, I. (2016) The sugar conspiracy, Guardian article available at: https://www.theguardian.com/society/2016/apr/07/the-sugar-conspiracy-robert-lustig-john-yudkin

NHS website – How to diet – https://www.nhs.uk/live-well/healthy-weight/how-to-diet/

NHS website – The Eatwell guide – https://www.nhs.uk/live-well/eat-well/the-eatwell-guide/

Mosley, M. (2012) The power of intermittent fasting. BBC article available at:https://www.bbc.co.uk/news/health-19112549

Orbach, S. (2018) Forty years since Fat Is A Feminist Issue – Observer article – https://www.theguardian.com/society/2018/jun/24/forty-years-since-fat-is-a-feminist-issue

Saladino, D. That Gut Feeling, Part 1 – BBC Radio 4 documentary available at: https://www.bbc.co.uk/programmes/b07ff0hl

Saladino D. That Gut Feeling, Part 2 – BBC Radio 4 documentary available at: https://www.bbc.co.uk/programmes/b07h60lv

Saner, M. (2103) A History of Diets – from Byron to 5:2 Guardian article available at: https://www.theguardian.com/lifeandstyle/2013/feb/20/a-history-of-diets-byron-52

Twilley, N. & Graber, C. (2018) The ancient origins of dieting – Atlantic article available at: https://www.theatlantic.com/health/archive/2018/01/the-ancient-origins-of-dieting/551828/

Twins UK website – https://twinsuk.ac.uk/staff/prof-tim-spector/

Unger J. (2019) BBC Radio 4 – What’s Eating Rotherham https://www.bbc.co.uk/sounds/play/m0007rt6

Wilson, C. (2019) Why everything you know about nutrition is wrong. New Scientist article available at: https://www.newscientist.com/article/mg24332380-000-why-everything-you-know-about-nutrition-is-wrong/

https://www.theguardian.com/society/2018/jun/24/forty-years-since-fat-is-a-feminist-issue