I do not believe the Atkins diet will get much respect from the nutrition community unless improvements in heart attack rates or cholesterol plaque buildup in the heart are found in carefully designed studies. I’d like to see funding for such studies, but I’m not aware of any yet.
Individuals should obtain individualized advice whenever possible, in order to account for specific food preferences, medical conditions, and lifestyle issues. Nevertheless, as a general public health measure, I do believe that the government should provide generic guidelines based on expert consensus of scientific evidence.
Dr. Dansinger holds multiple academic positions. He is the Clinical Nutrition and Obesity Editor for WebMD's academic journal (MedGenMed), is an assistant professor at Tufts University School of Medicine in Boston, is a scientist with the USDA Nutrition Research Center, and is a member of the Division of Endocrinology at Tufts-New England Medical Center.
His research on dietary counseling in well known. He published the highly publicized research study "Comparison of the Atkins, Ornish, Weight Watchers and Zone Diets for Weight Loss and Cardiac Risk Reduction" in the prestigious Journal of the American Medical Association (JAMA) in January 2005, which was one of the most highly read and quoted scientific articles of the year. His published meta-analysis "The Effect of Dietary Counseling for Weight Loss" (July, 2007) also received media attention and scientific praise as the first study to clarify the amount and duration of weight loss resulting from diet-based lifestyle programs. He is currently conducting a clinical trial to determine the effectiveness of the USDA food pyramid and a low-starch version of the food pyramid, for weight loss and heart disease reduction in 200 overweight adults.
Sought after as a highly desirable keynote speaker, his humor, discussion of the Biggest Loser show, insights on the national obesity crisis, and prescription for accelerated weight loss, have earned high praise from audiences of over 1000.
Dr. Dansinger directs a lifestyle coaching practice for weight loss and diabetes reversal and prevention, limited to a select group of 40 adults in Boston. He is available for public speaking opportunities or for his one-on-one telephone coaching program.
Listen and learn from Dr. Dansinger today.
1. Please welcome to the "Body Talk” today Tufts University medical professor Dr. Michael Dansinger.
There's so much I want to talk with you about today, Dr. Dansinger, because yours is a voice that needs to be heard by those who can bring about changes in dietary recommendations that come from our government. And actually you had the chance to do just that with a congressional report about how providing incentives for people to begin an organized weight loss plan would actually end up saving money in healthcare costs in the long run. Share with listeners about what was in that report.
First let me thank you for interviewing me, and congratulate you for your dedication to improving public health. The report, prepared at the request of the US government, was titled “Cost Effectiveness of Behavioral Weight Loss Programs for the Elderly.” My co-authors at Tufts and I submitted this report in 2004 after researching the topic for a year.
The report concluded that lifestyle-based weight loss programs for the obese elderly population may improve health at a relatively low cost. The findings could potentially be used to support government subsidies or funding for such programs. The report also found a disturbing shortage of diet and lifestyle improvement studies in the elderly population.
2. You are a big believer, just as I am, that there are individualized plans for losing weight and improving health that are different for everyone and that finding the method that each person can "stick with" is the key to solving the obesity crisis we find ourselves in. While one person may do very well on a low-fat diet and eat that way forever, someone else may find that the low-carb lifestyle is more compatible for them. Find the diet that's right for you, I always say.
If this is true, then where is the disconnect in the line of communication between our nation's government and health leaders and the overweight public looking for guidance? How and why has the low-fat diet become the center of attention in virtually every government-endorsed nutritional recommendations while the low-carb diet is simply ignored and scorned?
I agree wholeheartedly that the low-carb approach has been wrongfully dismissed by nutrition experts, simply because it seems counterintuitive. They should have recognized 30 years ago that we had more to gain by studying this approach than by dismissing it.
My fear is that health professionals will continue to dismiss it, even in the face of the accumulating consistent data demonstrating equal or superior improvements in excess body fat and heart disease risk factors. I believe the authorities are blinded to alternative approaches by the massive inertia that sustains the standard approach.
3. In 2005, you became a household name and appeared in numerous television, radio, newspaper, and magazines as the Principal Investigator in the famous Tufts Popular Diet Trial published in the Journal of the American Medical Association (JAMA) which compared the Atkins, Zone, Weight Watchers, and Ornish diets for weight loss and heart disease prevention.
It was a monumental study because the Atkins low-carb diet was placed in a head-to-head match-up with the more traditional low-fat diets like Ornish and Weight Watchers and showed livin' la vida low-carb is the best way to lose weight over a six-month period and at the very least just as effective as low-fat for weight loss after a year.
Did you realize the magnitude of your research and the possible implications it could have on future health and obesity policy in the United States at the time? Have you seen any changes being proposed or implemented by government agencies like the FDA or USDA that happened in direct response to your study results?
Our popular diet trial confirmed what other researchers had found before us: that lower carb diets could reduce weight with favorable effects on cholesterol levels and other heart disease risk factors. More importantly, we highlighted the fact that a high dietary adherence level is the key to health benefits, regardless of diet type.
With the publication of our study, I think we saw a little more open-mindedness about popular diet diversity among nutrition policy makers. In the meantime, the old USDA food pyramid that emphasized starchy foods was undergoing substantial revision, with a de-emphasis of grains as the base of the American diet. This new pyramid was released a few months after our study was published, and I believe this represents the government’s principal response to criticism of the high carb/low fat approach.
4. We recently saw another spike in media attention to the Atkins low-carb diet when a one-year Stanford study published in JAMA in March 2007 found that the low-carb diet outperformed the more traditional low-fat diets for weight loss and improving health risk factors in yet another head-to-head matchup.
This is now the largest randomized trial of popular diets conducted to date and complements many of the findings of your study. With so much evidence beginning to mount in favor of low-carb as a sustainable dietary approach for at least one year, why haven't government health agencies like the National Institutes of Health called for even more extensive long-term studies to be conducted looking at this way of eating for weight and health management? What length of time does a legitimate study need to be in order to be an indicator of "long-term" success?
The government has recently funded a wide variety of studies of low and moderate carb diets. I believe
5. I'm personally intrigued by something you are working on regarding the much-heralded USDA-recommended food pyramid. While this has long been regarded as the "holy grail" about what should constitute a healthy diet, you are working on creating several different variations of it that would be customized for each person.
If we all respond to different nutritional plans in different ways, then why should the government or anyone else besides a professional nutritionist educated in a full spectrum of diet plans who has met one-on-one with a patient even attempt to make universal suggestions for weight loss and health? Why not recommend low-carb alongside low-fat?
The USDA food pyramid is the most widely recognized format for such advice, and therefore it is important to determine the health effects of the food pyramid, and to evaluate alternative designs intended to improve it.
If the USDA food pyramid is further modified to replace starchy foods with vegetables, fruits, and healthy proteins, would it provide more effective treatment for obesity and heart disease risk factors? I’m working with the USDA nutrition research center at Tufts to answer this question in 200 obese adults who will aim to follow either the current pyramid or a low-starch pyramid for a year.
6. The American Heart Association (AHA) changed their dietary recommendations last year to reflect some of the very principles the late great Dr. Robert C. Atkins helped bring to the forefront. But, as my fellow blogger Regina Wilshire was quick to notice and pointed out, it is impossible to create a menu with a day's worth of meals that follow the AHA recommendations of less than 7 percent saturated fat and simultaneously meet all the essential nutrient-requirements for fatty acids, amino acids, vitamins, minerals and trace elements.
In fact, they have yet to produce any sample menus to satisfy the requirements of their own diet plan. By putting out recommendations that are not based on any hard evidence or proof, isn't the AHA, USDA, and FDA, among others, simply confounding the obesity problem that people like yourself are trying to solve?
Perhaps you are being a tad too hard on the standard approach. I think the real villain is the obesogenic environment, not necessarily the moderate-fat diet promoted by the government. That dietary approach is based on scientific evidence of effectiveness when followed, and can provide all the essential nutrients.
Unfortunately, all eating strategies are difficult for most people to maintain on a long-term basis. We need to find better ways to help people stick to the plans they want to follow. Embracing a broad spectrum of eating strategies, and learning how to match up the plans according to each individual’s needs are important priorities in our efforts to improve public health.
We can’t afford to dismiss the standard moderate fat approach any more than we can afford to dismiss the low-carb, moderate carb, or low-fat approach.
7. As we look to the future of scientific research on whether low-carb diets can be used as a means for losing weight over the long-term as well as a preventative measure such ailments as heart disease and diabetes, do you see this happening anytime soon? What is standing in the way preventing this kind of much-needed research from happening and is there anything that can be done by those of us who support the low-carb lifestyle to help persuade the people funding these studies that this is a worthwhile endeavor?
Various political forces determine the amount of government money available for nutrition research. In addition, various charitable foundations (including the Atkins Foundation) provide significant amounts of money for nutrition research.
In most cases, experienced nutrition scientists submit research grant proposals, which in turn are evaluated by experienced scientists according to scientific merit and potential to improve public health. Low-carb is a hot topic within the nutrition community, and there is clearly a willingness to allocate some of the available money to well-designed studies of low-carb diets.
The total amount of money available for nutrition and obesity studies is limited, however, and that is the main factor limiting the existence of more definitive studies of low-carb diets. Charitable foundations and congressional leaders can make the biggest impact on the amount of money available for nutrition and obesity research.
Those who want to see more studies can support charitable foundations and congressional leaders with an interest in such research.
8. Speaking of a worthwhile endeavor, a lot of people may not realize that you are one of the consultants on the hit NBC television weight loss reality show "The Biggest Loser." I am a strong supporter of the work that is being done on that show to change the lives of the contestants forever.
One thing I have noticed, though, among the people who have been the most successful on that show is the fact that they seemed to lose their weight following some variation of the low-carb lifestyle. Ryan Benson, Matt Hoover, and most recently, Erik Chopin all experienced major triple-digit weight loss success because of the low-carb diet that you and the nutrition team on "The Biggest Loser" put them on.
Why can't the viewers at home be told what kind of diet plan is being used with each contestant? Wouldn't that be helpful for fans of the show looking for weight loss advice to know it was livin' la vida low-carb that produced the improvements in weight and health?
I have greatly enjoyed the opportunity to work with the show because I believe it can provide the public with a weekly reminder of the power of lifestyle change. The trainers and nutrition team members all agreed that a carb-controlled, moderate fat, high protein eating strategy would be the best starting point. Each contestant then modified this general approach to suit his or her preferences.
"The Biggest Loser" book and cookbook each discuss the eating plan in detail and provide recipes. Many of the winners have pushed the carb intake very low at times, and have focused on lean protein and low carb vegetables, but many big losers have cut calories and weight without being so restrictive with the carbs. I agree that it could benefit viewers to know more about what each contestant is eating.
9. Speaking of the contestants, how are some of the older contestants from Season 1 and 2 doing now? The long-term success of any diet program is determined by whether the person strictly adheres to the concepts of that plan in the short term or transitions their new lifestyle choices into a permanent way to eat and live. Are there any stellar examples, such as Kelly Minner (another one who lost her weight with low-carb), who have continued to keep the weight off years later?
I believe the contestants have done better than some might expect, considering how difficult it is to keep weight off in today’s world. We expected some to keep most of the weight off, and some to regain most of the lost weight, depending on each individual’s ability to stick to the principles they learned while living in an optimal environment for fitness.
Although almost every contestant has continued to lose weight for several months at home, I believe a very big predictor of long-term success is the extent to which one is able to reorganize one’s life to accommodate the time needed to exercise and prepare healthy food. One stellar example is Matt Hoover, who has maintained most of his 157-pound weight loss since November 2005 by exercising most days and livin’ la vida low-carb.
10. On behalf of my readers who so faithfully visit my blog day after day for new information about diet and health, let me say THANK YOU to you, Dr. Dansinger, for being willing to challenge the status quo in the great debate over obesity. It's a noble subject to address and we need more leaders like you willing to stand up and speak the truth rather than simply regurgitating the same failed messages over and over again.
Do you have anything positive to share with that overweight or obese person who is reading this interview right now to encourage them that they can succeed at weight loss?
Jimmy, my gratitude goes out to you and your readers for stimulating public interest and debate on nutrition issues. Despite how seriously damaging the obesity epidemic has become, I am optimistic that things can change in the future.
I would like to remind doctors and other health professionals that lifestyle change is one of our most potent treatments and preventive measures for chronic illness, and that our enthusiasm when discussing these issues with our patients is crucial.
And for the overweight person reading this, you know you’ll succeed once you decide you’ll never give up trying! I wish you all good health for many years to come!
Michael Dansinger, MD MS provides articles about health medicine.Michael Dansinger, MD, is an internationally recognized authority on dietary and lifestyle counseling for weight loss and prevention of obesity-related medical problems.
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