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Fad Diets: Lifestyle Promises and Health Challenges

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p class="jfr-body"> Chronic excess of dietary intake combined with reduced energy expenditure increase the positive energy balance. This transition in behaviour contributes significantly to prevalence of obesity, impairment of health, reduction in quality of life and increases health-care costs. While obesity has turned into a public health threat, with the government failing to reverse this growing trend, good number of people is undertaking fad diets with the hope to lose weight fast and easy. Furthermore, media and peers contribute to the popularity of fad diets as they put pressure to individuals who desire a certain body image, which leads to low self-esteem and perhaps eating disorders. Despite the fact that fad diets may appeal as simple way to lose weight, recent studies have shown that such diets in the long term are unsustainable and can bring adverse side effects to health. Consideration of the reviewed literature suggests that long-life changes in diet and lifestyle might be the best approaches to maintain a healthy weight in the long term. Overweight individuals should consult nutrition professions before adopting any fad diets to minimise the health risks and psychological impacts. </p
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Journal of Food Research; Vol. 5, No. 6; 2016
ISSN 1927-0887 E-ISSN 1927-0895
Published by Canadian Center of Science and Education
80
Fad Diets: Lifestyle Promises and Health Challenges
Jomana Khawandanah1 & Ihab Tewfik1
1Department of Life Sciences, Faculty of Science and Technology, University of Westminster, London, UK
Correspondence: Jomana Khawandanah, Department of Life Sciences, Faculty of Science and Technology,
University of Westminster, 115 New Cavendish Street, London W1W 6UW, United Kingdom. E-mail:
j_khawandanah@hotmail.com
Received: September 12, 2016 Accepted: October 12, 2016 Online Published: November 16, 2016
doi:10.5539/jfr.v5n6p80 URL: http://dx.doi.org/10.5539/jfr.v5n6p80
Abstract
Chronic excess of dietary intake combined with reduced energy expenditure increase the positive energy balance.
This transition in behaviour contributes significantly to prevalence of obesity, impairment of health, reduction in
quality of life and increases health-care costs. While obesity has turned into a public health threat, with the
government failing to reverse this growing trend, good number of people is undertaking fad diets with the hope
to lose weight fast and easy. Furthermore, media and peers contribute to the popularity of fad diets as they put
pressure to individuals who desire a certain body image, which leads to low self-esteem and perhaps eating
disorders. Despite the fact that fad diets may appeal as simple way to lose weight, recent studies have shown that
such diets in the long term are unsustainable and can bring adverse side effects to health. Consideration of the
reviewed literature suggests that long-life changes in diet and lifestyle might be the best approaches to maintain a
healthy weight in the long term. Overweight individuals should consult nutrition professions before adopting any
fad diets to minimise the health risks and psychological impacts.
Keywords: Atkins diet, dieting, eating disorder, fad diets, obesity, overweight, public health, weight loss, yo-yo
dieting
1. Introduction
1.1 The Epidemic of Obesity
Since 1980 the number of people suffering from obesity has doubled on a worldwide level. According to the
latest figures published by World Health Organisation (WHO) (2015) almost 2 billion adults (39%) were
overweight (Body Mass Index, BMI≥25kg/m2), with 600 million of these (13%) being obese (BMI≥30kg/m2).
Both being overweight and obese is characterised by excess fat mass in the body (WHO, 2015). The main factors
causing obesity involve excessive calorie intake, unhealthy eating habits like consuming processed food,
sedentary lifestyle, but also medical conditions (hypothyroidism) or genetics such as the Prader-Willi syndrome
(National Health Services [NHS], 2014a).
There is plenty of evidence showing that obesity is one of the major public health threats also to the UK;
according to NHS statistics in 2011, 65% of men and 58% of women over 16 years old are overweight or obese
(Health and Social Care Information Centre [HSCIC], 2013). These figures pose a threat to the society, which
can be translated into non-communicable diseases, morbidity and mortality if not treated, with a high economic
burden to NHS.
There is no doubt that obesity can lead to various health problems. Common public health consequences
associated with abnormal fat deposits include cardiovascular diseases, especially heart attack and stroke, diabetes,
cancer as well as musculoskeletal disorders, mainly osteoarthritis (Weight-control Information Network [WIN],
2014; WHO, 2015). On the other hand, the mechanical stress induced by obesity can result in disabilities caused
by several conditions such as shortness of breath, sleep apnoea, osteoarthritis and low back pain (Visscher &
Seidell, 2001).
Given the current trend it seems like government actions to tackle obesity are failing. No country has managed to
show any supporting evidence for improvements. Policymakers do not seem to be working quickly to identify
those reasons and yet they expect fast outcomes. Intervention plans based on a broader approach that deals with
agriculture, product manufacture and education might be a starting point to reverse those trends. Table 1 below
shows the complexity of factors that contribute to obesity interventions failure.
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1.2 Health Practices: Healthy Eating and Physical Activity
There is no doubt that adjusting the daily nutritional intake and eating habits can have a major impact on weight
management. In order to lose weight, the daily energy expenditure has to be greater than the consumed energy
intake; therefore reducing the daily calories can help towards this goal. Healthy eating together with being
physically active should be the right choice for obese individuals if they want to achieve long-term weight loss
(NHS, 2014b). However, current lifestyles and easy access to cheap junk food has resulted in unhealthy eating
behaviours and a routine with minimal physical activity (NHS, 2013).
Table 1. Failure and factors shaping obesity in developed countries (Source: Lang & Rayner, 2007)
Focus of
failure
Factors shaping obesity
Domains
Transitions
Body
Mind
Diet
Physical activity
Markets
Highlight and over- supply
particular taste receptors
(sweet and fat)
Invest in technical fixes
and single-factor solutions
Appeal to pleasure
Build brand value ove r nutritional
value
Exploit vulnerable groups (e.g.
children and low income)
Produce an excess of
inappropriate, energy- dense
foods cheaply
Offer only limited
investments in workforce
training
Promote fossil-based fuels
Glamorise private motor transport
rather than expenditure of
food-as-energy
Governments
Adopt inconsistent modes
of protection (interventions
on sexual protection but not
nutrition)
Are unwilling to
modernise public health
scope and capacity
Limit health edu cation to become a
minor partner of market information,
generating asymmetry of information
flow and education
Subsidise overproduction of
fat and sugar compared with
micronutrient-rich foods
Emphasize food safety while
semi-abandoning nutrition
De-emphasize nutrition and
food education
Oversee decline of physical activity
(transport, public spaces, sports
facilities)
Prioritise car use in retail and
transport planning
Consumers
Disconnect appetite from
need and satiety
Adopt distorted images of body
acceptability
Accept temporality (short-termism)
of choice
Eat a price-led rather than
nutrition-led diet
Respond individually rather
than en masse to identity crises
about meaning and values
Bow to the ubiquity of the
non-energy-expending material
world (e.g. in travel to
work/shop/school)
Are disinclined to build exercise
into daily life
Individuals tend to ignore that the way we approach or manage the process of change, and potentially weight loss,
plays an important role. As discussed by Strecher et al. (1995), setting goals can have beneficial effects in health
behaviour change and maintenance interventions. Cognitive behavioural therapy (CBT) strategies include
specific goal setting, self-monitoring, feedback and reinforcement from outside sources, boosting the confidence
in succeeding as well as the use of incentives.
2. Fad Diets
As a consequence, people are more susceptible to adopt various fad diets that claim to aid in losing weight very
fast. As stated in CDC's “Healthy Weight It's not a diet, It's a lifestyle!” a fad diet is any weight loss plan that
promises quick results and is usually a temporary nutritional change (Centers for Disease Control and Prevention
[CDC], 2014). These diets are considered unhealthy as they provide individuals with less calories and nutrients.
2.1 History of Fad Diets
Fad diets are known for centuries. Since ancient times, it was reported that Greeks and Romans had used them;
however, at that time it was more about a healthy and active lifestyle. It was Victorians later who actually
adopted fad diets. According to Foxcroft (2011) in her book „Calories & Corsets: A History of Dieting Over 2
000 Years‟, the word diet originates from the Greek word diaita, which represents a way of life including mental
and physical health. It was in the 19th century that people started dieting for aesthetic purposes.
One of the most famous dieter of all time was Lord Byron, who in 1820 made the Vinegar and Water Diet very
popular (Foxcroft, 2011). A century later, the Grapefruit Diet was created, where eating grapefruit with each
meal was suggested as part of a low calorie diet plan. Interestingly, the Lucky Strike cigarette company launched
the known Cigarette Diet based on the appetite suppressing effects of nicotine. Later in 1963, Jean Nidetch
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founded Weight Watchers and in 1970 the „sedative‟ Sleeping Beauty Diet became famous (Rotchford, 2013).
The last few decades, fad diets, such as The Atkins and Dukan Diets, became well known, based on high-protein
and low-carbohydrate intake (Hughes, 2012). Other examples include the Zone Diet, suggesting a certain ratio of
fat protein and carbohydrates, the South Beach Diet, which is a lighter version of Atkins Diet and the Master
Cleanse, a diet based mostly in liquid food (Rotchford, 2013). Figure 1 demonstrates the most important diets
throughout history.
2.2 How to Identify a Fad Diet
A fad diet is usually described as a weight loss plan that guarantees quick weight loss and dramatic results with
no much effort. There are various types of fad diets that can be recognized; however, all of them share some
common characteristics (Bastin, 2004). All fad diets promise fast weight loss (more than 1 kg a week) without
giving away fatty, rich-in-calories food and without the need to regularly exercise. Most fad diets limit the range
of food types included in the meal plan and do not reassure a balanced and healthy diet. They usually propose
„miracle‟ foods that need to be consumed in abnormal quantities and help fat burning with a minimal effort.
Some focus on consuming large quantities of one food type that could result in intestinal disturbance, bloating,
bad breath and nutritional imbalances (Bastin, 2004).
Fad diets are usually promoted by „before and after‟ images of successful examples of people that have followed
the particular diet or by „experts‟ in the field of nutrition. However, no health warnings about possible
consequences of adopting these fad diets on individuals with chronic diseases are included in the advertisements.
Most fad diets are usually based in no or limited research and can lead to serious health impacts (Bastin, 2004).
2.3 Popular Fad Diets
As mentioned before, there is a wide range of proposed fad diets over the last centuries, which are summarised in
Tables 2 and 3. They can be categorised into several main groups including low-/no- carbohydrate,
high-carbohydrate/high-fibre as well as the liquid formula diets (Bastin, 2004; British Dietetic Association
[BDA], 2014).
Figure 1. History of dieting over time including the most popular fad diets (adjusted from Rotchford, 2013)
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When following a low- or no-carbohydrate diet, a high intake of protein and/or fat is recommended. Example fad
diets of this type include the Atkins diet, the Dukan diet, the South Beach diet and the Grapefruit diet. These
diets are particularly popular as due to the low intake of energy through carbohydrates, a rapid weight loss
mainly due to water loss occurs immediately. The success of such a „ketogenic‟ diet together with high protein
consumption promotes great weight loss by increasing satiety, which makes it easier to adhere (Geissler &
Powers, 2005). However, it is common that the weight is gained back once the diet is discontinued as the body
tries to „correct‟ the water imbalance (Bastin, 2004) (Figure 2). Although the diet‟s claimed weight loss
compared to conventional energy-restricted diets has been demonstrated in controlled trials (Foster et al., 2003),
its long-term effects are still being investigated by the scientific community.
These diets can be quite dangerous due to the ketone formation in excess amounts as a result of incomplete fat
breakdown and dehydration. Ketones are stored in blood and can even lead to death if the diet is continued
long-term. The Recommended Dietary Allowance (RDA) for carbohydrates is 130 grams per day for both adults
and children as an average minimum intake of glucose used by the brain for normal function (Food and Nutrition
Board, Institute of Medicine, 2005).
Table 2. Types of fad diets (adjusted from Bastin, 2004; BDA, 2014)
Diet type
Known examples
Low carbohydrates (<100g/day)
Atkins Diet Revolution
South Beach Diet
Extremely low fat (<20% kcal from fat/day)
Pritikin Diet
Pasta Diet
Combination
Fit for Life
Zone Diet
Very low kcalorie (<800 kcal/day)
Cambridge Diet
Rotation Diet
Novelty (certain nutrients or foods)
Beverly Hills Diet
Junk Food Diet
Formula
Slim Fast
Last Chance Diet
Pre-measured
Jenny Craig
Nutri-System
Detox
The Master Cleanse
High fat
Ketogenic Diet
High protein
Dukan Diet
Bodybuilder Diet
Table 3. Main categories of fad diets as suggested by the BDA
High-protein
Low-Carbohydrate
Moderate-fat
Low-carbohydrate
Low-fat
Very-high-carbohydrate
Very-low-calorie
Atkins
Jenny Craig
Ornish
Bernstein
Dukan
Nutri-System
The New Pritikin program
Lighter Life
South Beach
Weight Watchers
LEARN
Slim Fast
Zone
On the other hand, high-carbohydrate/high-fibre-diets are also popular, including the Pritikin diet plan and
Save-Your-Life diet. This type of diets provide with low levels of both proteins and fats, which can lead to
reduced immunity and problematic wound healing (Bastin, 2004). Furthermore, the liquid formula diets contain
very limited calorie intake (often 400-500 calories) and promise to supply with the necessary nutrients. An
example of a very low-calorie diet is the Cambridge diet. These diets should be adopted with caution as the
self-prescribed starvation be linked with health risks and serious illnesses such as anaemia, reduction of vitamins
and minerals supply, fatigue as well as weakness and dizziness. Lastly, diets suggesting the consumption of only
one food group like the Cider Vinegar and Vitamin B6 Diet are also popular but can cause malnutrition and
reduced renal function (Bastin, 2004).
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3. Causes Leading to Fad Dieting
3.1 The Effect of Peer Pressure
Following a fad diet is often a result of peer pressure. Peer pressure occurs when people of the same age
influence an individual‟s behaviours and decisions by making the person feeling uncomfortable, including the
way of thinking of themselves, dressing and eating. Peer pressure originates not only from family and friends but
also from the outside environment (Berry, 1999). Criticism of weight and diet by peer members is associated
particularly with dieting in teenagers (Cattarin & Thompson, 1994). The ideal body image introduced by peers
can lead to feelings of inferiority, low self-esteem and depression. Emotions of guilt and unattractiveness are
strongly developed causing individuals to adopt fad diets to make themselves more likable. These individuals
appear to be obsessed with their appearance, weight and popularity within their peers that results in inefficient
dieting (Berg, 1996).
Figure 2. Average weight changes amongst subjects on a low-carbohydrate diet and a
low-calorie/high-carbohydrate conventional diet (adapted from Foster et al., 2003)
Furthermore, possible failed attempts to quickly lose weight can lead to depression and „yo-yo‟ dieting. Extreme
weight loss followed by quick weight gain is associated with many health risk factors such as heart disease,
cancer, diabetes, increased in LDL cholesterol as well as reduced muscle and energy. It is believed that these
negative health impacts are linked with the stress hormone called cortisol (McNight, 2013). These feelings and
continuous dieting can result in unhealthy eating habits, which can continue over someone‟s lifetime (Berry,
1999). The fear of being fat can also lead to eating disorders from a young age, such as anorexia nervosa and
bulimia. In both disorders, sufferers show body image distortions and feelings of anxiety and shame about eating
(Human Diseases and Conditions [HDC], 2014).
3.2 The Effect of Media on Body Image and Self-Esteem
Over the last decade, statistics have shown an increase in people suffering from eating disorders in many
societies due to the continuous value that they put on being thin. In every aspects of someone‟s life, such as
going for shopping, watching television, reading fashion magazines and following favourite celebrities, the very
thin figure is linked with a happy and successful life. Therefore, thousands of teenagers are exposed to the „ideal‟,
unrealistic image of models, who according to medical standards, try to maintain a 15% below normal weight
and meet the criteria for anorexia (Mirror Mirror Eating Disorders [MMED], 2014). Television, movies and
social media are full of diet advertisements about food supplements, diet programs and in general chemically
based ways to lose weight. Every month new novel diets promise to cause dramatic changes to the appearance of
overweight people; probably due to the fact that all previous diets did not work and are rather unhealthy (MMED,
2014). The inevitable effects of food advertising on eating behaviours was studied in elementary-school-aged
children which received a snack after watching a cartoon with either a food advertisement or one about other
products (Harris, Bargh, & Brownell, 2009). The results showed that children consumed 45% more snacks (28.5
gr) when exposed to the food advertisements than their controls (19.7 gr) (Harris et al., 2009).
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Apart from advertisements, television and fashion magazines also include articles or reports about appearance
meaning how to look perfect, how to be in shape, how to apply makeup or suggestions about clothing.
Magazines are also full of photos that have previously been photo-shopped containing wrinkle-free faces and
fat-free bodies which are idealistic and far from reality (Education.com, 2014). A study has found that 69% of
teenage girls agreed that the photos in magazines affected their idea of the „ideal‟ body image, while 47% said
that as a result they desired to lose weight (Field, 2000). The frequency of reading magazine‟s articles about
weight loss and diets increases the possibilities of adopting unhealthy eating and weight control behaviours like
skipping meals and fasting, especially among teenagers (Van den Berg, Neumark-Sztainer, Hannan, & Haines,
2007).
4. Weighing Short-Term Pros against Long-Term Cons
Table 4 summarises the advantages and drawbacks of the main categories of fad diets, which are discussed in
more detail below.
Table 4. Advantages and disadvantages of fad diets as suggested by the BDA (2014)
4.1 Benefits of Fad Diets
Fad diets are usually known for showing drastic results and some of them can actually offer some benefits. There
are plenty of benefits when following a low-carbohydrate diet. Atkins diet is known for the suppression of
appetite and its anorectic properties, mainly due to the high protein intake (McClernon, Yancy, Eberstein, Atkins,
& Westman, 2007). It results in a rapid weight loss, especially during the first few weeks. In a controlled study of
63 obese patients, Atkins diet resulted in a weight loss of 6.8% body weight after three months compared to 2.7%
accomplished by an energy-restricted diet (Foster et al., 2003). Low-carbohydrate diets have also a great
potential in eliminating a larger proportion of abdominal fat (Volek et al., 2004). In addition, carbohydrate
restriction can be efficient in significantly lowering both the plasma LDL cholesterol and triglyceride following a
twelve-week weight loss intervention (Wood et al., 2006). At the same time, HDL levels can be dramatically
increased because of the high-fat consumption included in Atkins diet (Brinkworth, Noakes, Buckley, Keogh, &
Clifton, 2009). Furthermore, in a study testing the effect of a low-carbohydrate diet in type 2 diabetes, it was
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reported that most patients improved their glycemic index and reduced or eliminated medication control within
six months (Westman et al., 2007). Lastly, Atkins diet has shown to reduce blood pressure short-term, therefore
leading to a decreased risk of developing cardiovascular diseases (Gardner et al., 2007).
The proposed meal plans such as in many Detox diets or the Grapefruit diet often consist of lots of fruits and
vegetables. These food types are popular for being healthy and beneficial but of low calories at the same time.
Fad diet users will therefore supply with many vitamins, minerals and antioxidants. Following these eating habits
also helps in promoting physical and psychological health. A person that loses weight firstly reduces the risks
linked with obesity and secondly feels lighter, healthier and with increased self-confidence (Health Research
Funding [HRF], 2014). Moreover, adopting a fad diet can help someone recognise which characteristics of
his/her current diet are responsible for the excess weight. Fad diet programs like the French Woman‟s diet can
also help establish the right portion sizes and avoid unwanted snaking (Cespedes, 2014).
4.2. Health consequences of fad dieting
On the other hand, fad diets do not come without disadvantages. Weight loss occurs too fast, most of the lost
weight being water and muscle, not fat tissue. Rapid weight loss can further lead to various health risks such as
constipation, low nutrients and energy intake and tiredness, all caused by eating less calories (HRF, 2014).
Fad diets, especially the low-carbohydrate/high-protein diets such as The Dukan diet, involve physiological
aspects; they limit the amount of carbohydrate and sugar intake and at the same time promote the consumption
of animal protein. As a result, there is a shift from using glucose to using fatty acids and ketones as the main fuel
sources; therefore, the glycogen availability increases (Westman et al., 2007). Ketosis could then result in a
decrease of appetite but also cause hyperuricemia since ketones compete with urine acid for renal tubular
excretion (Denke, 2001). Despite the reputation of the ketogenic diets there is little scientific support of their
long-term side effects and sustainability. In order to suggest the adaptation of such diets as a „life nutritional
philosophy‟, possible adverse effects on health and disease prevention need to be studied.
Studies have shown that high-fat/high-protein diets like The Atkins diet also result in higher risk of heart disease
(WHO/Food & Agriculture Organisation Expert Consultation, 2013), colon cancer (Giovannucci et al., 1994),
bad breath (Mahon & Escott-Stump, 1996) and sleeping disorders (Fitness, 2014). Anderson, Konz, and Jenkins
(2000) showed that the Atkins diet increase the cholesterol levels in the serum, increasing the risk of
atherosclerosis and coronary heart disease by greater than 50% if used in long term. Various adverse effects of
following a very-low-carbohydrate short-term diet have previously been reported including constipation due to
low fibre intake (68% of participants), bad breath (63%), headache (51%), hair loss (10%) and increased
menstrual bleeding (3%) (Westman, Yancy, Edman, Tomlin, & Perkins, 2002).
High-protein diets have been linked with a greater production of nitrogen waste products, which add a pressure
on the kidneys, especially in dehydration state (Denke, 2001). Another study has shown that after six weeks of
such a diet there is an increased acid load to the kidney maximising the possibility of stone formation and a
decrease of calcium balance leading to bone loss and osteoporosis (Reddy, Wang, Sakhaee, Brinkley, & Pack,
2002). Consuming two or three times more protein than the recommended daily allowance has been associated
with loss of calcium through the urinary tract, which could predispose to bone loss long-term (Eisenstein,
Roberts, Dallal, & Saltzman, 2002). Although significant reduction in insulin responses has been observed after a
low-carbohydrate diet (Westman et al., 2007), it is believed that insulin sensitivity and resistance may be
negatively influenced in the long-term (Riccardi, Giacco & Rivellese, 2004; Shulman, 2000). Moreover,
following such a diet for several months can cause an increase in plasma homocysteine (Clifton, Noakes, Foster,
& Keogh, 2004), the effect of which has been linked with higher cardiovascular risk (Refsum, Ueland, Nygard,
& Vollset, 1998).
On the other hand, low-protein/low-fat diets might increase the risk of inadequate intake of minerals such as
calcium and zinc as well as high-quality protein. For example when following the Pritikin diet the recommended
fat intake should be less than 10% of the daily energy intake which is close to the lowest limit of the daily
requirement for essential fatty acids (Pritikin, 1981). Other nutritional deficiencies, such as iron deficiency, can
be associated with growth decrease and anaemia in adolescents (Dietz & Hartung, 1985). Additionally, adopting
unbalanced eating habits has been connected with menstrual irregularity or amenorrhea (Kreipe, Strauss,
Hodgman, & Ryan, 1989). Table 5 summarises the most popular fad diets, their main components and their
physiological implications, the main of which are explained below.
4.3 Psychological Implications
Studies in adults have suggested that constant dieting (yo-yo dieting) is associated with a range of symptoms
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such as food obsession, constant calorie counting, distractibility, increased emotional responsiveness and fatigue
(Polivy, 1996). Chronic dieters also tend to overeat, have low self-esteem as well as suffer from some eating
disorders and depression (Polivy, 1996). It is known that these effects are particularly true in children and
teenagers, causing complicated consequences in their social and psychological development (Canadian
Paediatric Society [CPS], 2004). From previous studies it has been shown that following a structured,
multidisciplinary weight loss regime might have a negative effect on the self-esteem of both children (Cameron,
1999) and adolescents (Stice, Cameron, Killen, Hayward, & Taylor, 1999). Current research has linked dieting
with higher risk of developing disordered eating as well as a trend to overeat; however, the causes are still
unclear or controversial (Polivy, 1996). Lastly, self-directed dieting early in life (9-14 years old) has been
associated with weight gain overtime in large-scale, 3-year-long study involving more than 15 000 subjects
(Field et al., 2003).
4.4 Safety of Fad Diets
Fad diets promise quick weight loss but are generally thought to be unhealthy and temporary. Weighing the
advantages over the drawbacks of fad dieting can be hard but necessary since there is no scientific evidence
proving their safety. According to NHS (2013) in 2011 the BDA had warned against many fad diets since they
were not based on clinical trials and reportedly did not give rise to long-term results. Also, most of these diets
overemphasise one particular food type (for example the Banana or the Rice diet) and are considered dangerous
and nutritionally unbalanced. Furthermore, there is not always supplementary scientific evidence to support the
proposed claims (Fisher, 2011).
5. Sustainability of Weight Loss by Fad Diets
Furthermore, the strict regime of fad diets makes it very difficult to commit as eating low-calorie foods requires
both preparation and lifestyle change (HRF, 2014). It is common that most of dieters regain the weight they have
lost - or even more within a few months - a situation that leads to yo-yo dieting. It is believed that it is very hard
to maintain a fad diet long-term as the dieters revert back to their previous eating habits at some point. Thomas,
Hyde, Karunaratne, Kausman, and Komesaroff (2008) conducted a study on obese subjects and found that they
were unable to commit to these diets for various reasons such as unsuitable or costly diet, concordance with their
lifestyle and monotony in food choices.
Foster et al. (2003) showed that although following a low-carbohydrate diet produced a larger weight loss
compared to the conventional diet at six months period, the difference was not statistically significant after a year.
Moreover, these findings are supported by a study published in 2006 from the BBC ”diet trials”. This
randomized controlled study compared the effectiveness of four popular fad diets in the UK over six months
including the Dr Atkins‟ new diet revolution, the Slim-Fast plan, the Weight Watchers pure points plan, and the
Rosemary Conley‟s eat yourself slim diet and fitness plan (Truby et al., 2006). The trial was based in 293 healthy
overweight or obese adults, who all succeed a significant loss of both weight and body fat regardless of the fad
diet followed. Although the Dr Atkins‟ new diet revolution resulted in higher weight loss during the first month,
there were no statistically significant differences among the diet plans after 6 months. The study also showed that
the initial sustainability was not feasible over a long period of time as demonstrated in Figure 3. These findings
are also supported by the review conducted by Jebb and Goldberg (1998); however, it was also shown that there
was a small portion of participants (3-4% based on 381 subjects) that were still 30% or more below baseline after
5 years and actually managed to maintain their weight loss. Nevertheless, it should be noted that these
individuals had incorporated physical activity and meal replacement into their lifestyle (Jebb & Goldberg, 1998).
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Table 5. Popular fad diets and their health consequences
Type of diet
Example
Summary/Main
components
Health consequences
References
Low-carbohydrate/
High-protein
Atkins diet
Less than 50g CHO per
day, high consumption of
animal protein
Water imbalance,
ketosis, appetite
suppression, renal
dysfunction, nausea, low
performance capacity,
dehydration,
osteoporosis
Atkins (1992)
Dukan diet
Carb-free, high in protein
diet structured in four
different phases
Diabetes.co.uk
(2011)
High-carbohydrate/
Low-fat
Pritikin
diet
Low-fat, low-calorie,
plant-based foods, mainly
fruits and vegetables, fats
not exceeding 10% of
total daily calories
Inadequate intake of
good quality protein,
vitamin and mineral
deficiencies, coronary
heart disease
Pritikin (1981)
Low carbohydrate/
High-fat
Ketogenic
diet
High-fat,
adequate-protein,
low-carbohydrate diet
changing the way energy
is used in the body
Acidosis, hypoglycemia,
gastrointestinal distress,
dehydration, lethargy,
kidney stones,
dyslipidemia, decreased
bone density
Freeman,
Kossoff, &
Hartman (2007)
Combination
Zone diet
Hormonal control
(insulin, glucagon and
eicosanoids) via a specific
ratio of protein, CHO and
fat intake
Vitamin and mineral
deficiencies
Sears & Lawren
(1995)
One-food
Grapefruit
diet
Certain combinations of
food with grapefruit and
grapefruit juice, no
sugary/starchy food
allowed
Unbalanced nutrition,
interfere with certain
medication, risk for
increase intake of
saturated fat, sodium and
cholesterol.
Ipatenco (2014)
Formula
Slim Fast
diet
Dietary supplement based
on a drinkable meal
replacement once or twice
a day, each containing
around 240 kcal
Low nutritional intake,
low energy, weakness,
risk for eating disorders
Stern (2015)
Figure 3. Weight loss over six months after following four commercial weight loss programs in UK (Source:
Truby et al., 2006)
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6. Fibre-Enriched Diets and Weight Management
As shown above, although following a fad diet could result in rapid weight loss within the first few weeks, the
sustainability of the achieved results is very low. It should be mentioned that adjusting daily dietary habits and
physical activity is the key to weight management including weight loss and maintenance. To gain the required
knowledge and positively progress towards long-term weight loss, one has to go through various stages of
adaptation such as commitment to change and self-efficacy. Temporary changes of eating habits only leads to
temporary weight loss results and to overcome fad dieting drawbacks, a high-in-fruits-and-vegetables (50%) but
low-in-fat-and-sugars (<30%) diet has been recommended by various researchers (National Institutes of Health
[NIH], 1998).
It is commonly believed that a high-fruit diet is ideal for weight loss since fruits are known to have unique
properties and play an important part of a healthy and balanced diet (He et al., 2004). Fruits are high-in-water,
high-in-sugar, low-in-fat and high-in-fibre, have only a few calories as well as essential minerals, vitamins and
antioxidants (Martin, Cherubini, Andres-Lacueva, Paniagua, & Joseph, 2002; Swinburn, Caterson, Seidell, &
James, 2004). Both soluble and insoluble fibres are found in considerable amounts in fruits (especially in fruits‟
skins) and have been reported to help with weight management (Pereira, & Ludwig, 2001). Researchers have
shown that dietary fibre increases post-consumption satiety and also decreases following hunger (Howarth,
Saltzman, & Roberts, 2001). Therefore, by eating fruits with low energy density rather than foods with high
energy density, one can eat greater amounts but the same calorie content (CDC, 2015). Howarth et al. (2001)
have shown that by increasing the daily fibre intake to an extra 14 gr per day for two days decreased the energy
intake by 10% and resulted in ~2 kg weight loss over 4 months. Furthermore, soluble fibre has a beneficial
impact in controlling post-meal glycaemic and insulin responses as it affects gastric emptying and how
macronutrients are absorbed by the gut (Babio, Balanza, Basulto, Bulló, & Salas-Salvadó, 2010).
Given all the benefits of increased fruit intake mentioned above, researchers have introduced and tested various
interventions to prevent or tackle obesity. As an example, Tohill (2005) summarised a large number of
epidemiological studies on the relationship of fruit intake and BMI on both children and adults. It has been
proven that a high fruit and vegetable intake (two servings of fruits and three servings of vegetables a day) is
associated with a decrease in high fat and sugar intake (less than 10 servings of high-fat/high-sugar foods per
week), potentially helpful in families with obesity history (Epstein et al., 2001). Moreover, in contrast with fad
diets, as illustrated after a 4-year-long intervention, individuals can sustain drastic dietary changes that mainly
include high-fibre, low-fat food provided the appropriate support (Lanza et al., 2001).
6.1 Health Benefits of Dietary Fibre
Various observational and experimental studies have shown that there is a positive link between higher fibre
intake and lower risk of many health risk factors. Increasing dietary soluble fibre results in the reduction of
various biochemical parameters such as total and LDL cholesterol and can be introduced as a small contributor
to dietary therapy to lower blood cholesterol (Brown, Rosner, Willett, & Sacks, 1999). Similarly, greater dietary
fibre intake has been associated with a lower risk of both cardiovascular disease and coronary heart disease in a
total of 22 cohort studies (Threapleton et al., 2013).
Also, better kidney function as well as reduced inflammation is considered one of the health benefits of soluble
fibre (Xu et al., 2014). It is known that rich-in-fibre food types contain large amounts of essential minerals such
as calcium, potassium and magnesium that can lead in a higher total bone mass providing evidence of a positive
association between fruit and vegetable consumption and bone health (New et al., 2000). Lastly, initial controlled
trial recently conducted by our research group introducing soluble fibre in the form of a fruit salad in the daily
nutritional intake has also highlighted the positive effects of increased dietary fibre in both weight management
and better health.
7. Government Public Health Initiatives
In the UK, the National Health Service is trying to combat fad diets and obesity by informing the public on
health and nutrition as well as promoting healthier eating habits for weight loss (NHS Choices, 2014). Together
with the British Dietetics Association, NHS emphasises the pros and cons of popular fad diets. Also, the
Medicines and Healthcare products Regulatory Agency (Medicines and Healthcare products Regulatory Agency
[MHRA], 2014) is trying to prevent people from using diet drugs like the homeopathic human chorionic
gonadotropin (hCG) by not authorizing it for use in the UK.
Furthermore, within the UK, the National Health Service has initiated the Change4life campaign that promotes
the „5-a-day‟ which includes consuming at least five portions of fruit and vegetables per day as part of a balanced
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90
diet (Change4life, 2015). Additionally, in an attempt to tackle obesity, especially in children, the non-profit
organization Mind, Exercise, Nutrition… Do it! (MEND) offers weight management programs and family
support all over the UK (MEND, 2015). This program provides help designed by health professionals including
nutritionists, dietitians, physical activity experts as well as behaviour change specialists through one-to-one
sessions with parents and children. However, this type of initiative can last for up to 10 weeks meaning that
results can only be effective and sustainable if the families take the recommendations on board.
Due to its nutritional composition, fad diets remain a subject of much controversy since the recommended daily
allowance for total energy is 35% of fat, 50% of carbohydrates and 15% of proteins (Scientific Advisory
Committee on Nutrition, 2015). Possibly one way forward would be to educate people on healthy practices and
enable lifestyle changes. This requires realistic goals and slow weight loss followed by a balanced diet,
engagement in physical activity and small portion sizes. Following the eatwell plate where 1/3 of foods should
be composed of fruits and vegetables, 1/3 of starch, moderate amounts of dairy and meat products and
occasionally small amounts of food high in fat and sugar would be a good start (Food Standards Agency [FSA],
2010) (Figure 4).
8. Conclusion
Fad diets have been popular for decades due to societal and peer pressure to have certain body shape. Most of
them limit the range of food types included in the meal plan and do not reassure a balanced and healthy diet.
They promise fast weight loss; nevertheless they suffer from many drawbacks such as introducing health risks
and low sustainability. Nowadays, there are various types of fad diets available; however, individuals should be
aware that there is no scientific evidence proving their safety. Fad diets have been linked with many
physiological conditions such as cardiovascular disease, renal dysfunction and osteoporosis as well as
psychological implications like eating disorders and depression. A long-term, high-fibre diet will overcome these
complications, as the weight loss results are more likely to be sustainable. Increased dietary soluble fibre also
provides with various health benefits such as better bone health in elderly populations commonly suffering from
osteoporosis.
Figure 4. The eatwell plate (Source: FSA, 2010)
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... Fad diets are defined as any popular weight loss plan promising fast results but often limit nutritional intake, can be unhealthy, and mostly produce short-term fixes (CDC, n.d.). Previous research has outlined common criteria used in fad diets including fast weight loss, "miracle" fat-burning foods, unusual quantities of only one type of food, ridged menus, no health warnings, and no recommendations for increased physical activity (Bastin, 2004;Khawandanah and Tewfik, 2016). Popular named diets include the Atkins diet, Weight Watchers (WW), the ketogenic diet, and the paleo diet (see Table 1; Khawandanah and Tewfik, 2016). ...
... Previous research has outlined common criteria used in fad diets including fast weight loss, "miracle" fat-burning foods, unusual quantities of only one type of food, ridged menus, no health warnings, and no recommendations for increased physical activity (Bastin, 2004;Khawandanah and Tewfik, 2016). Popular named diets include the Atkins diet, Weight Watchers (WW), the ketogenic diet, and the paleo diet (see Table 1; Khawandanah and Tewfik, 2016). Additional components of fad diets may include meal replacements and diet pills (Mayo Clinic Health System, 2019). ...
... Additional components of fad diets may include meal replacements and diet pills (Mayo Clinic Health System, 2019). Although these diets have occasionally been used for clinical purposes in certain populations (e.g. to improve glucose metabolism for those at risk for or diagnosed with type 2 diabetes mellitus; D' Souza et al., 2020;Pujol-Busquets et al., 2020), people often utilize fad diets for weight loss (Johnston et al., 2014), stemming from societal and/or peer pressure (Khawandanah and Tewfik, 2016). ...
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Background: A fad diet is a broad term used to describe dieting methods that recommend altering the intake of macronutrients to specific proportions or instruct people to intake or avoid particular foods, often with the goal of rapid weight loss. Previous literature reviews report social influence impacts general diet behaviour, but have yet to examine fad diets, specifically. Therefore, the purpose of this systematic review was to synthesize literature related to social influence on an individual's fad diet use and understand the sociocultural factors related to diet use. Methods: Using PRISMA guidelines, Medline, PsycInfo, Embase, CINAHL, and CENTRAL databases were searched to identify articles investigating the impact of social on fad diet use. Covidence was used to manage the review process and Garrard's Matrix Method was used to extract data from reviewed articles (n = 13). Results: A majority of reviewed studies examined interpersonal influence (62%) and reported social influence impacting a variety of fad diet behaviours (92%). Interpersonal and media influence were highlighted as motivating factors for adopting unhealthy dieting methods (54%), and studies showed interpersonal support impacted adoption and maintenance of fad diet use (23%). Also, social norms were reported to influence unhealthy weight control behaviours (15%). Discussion: This review revealed social influence is associated with the adoption, adherence, and termination of fad diets. The prevalence of fad diets in society and the lack of research on this topic warrants further examination of factors related to fad diets use and the spread among interpersonal networks.
... Throughout a person's life, course, specific-consciously or subconsciously taken-food choices may vary according to the social network, social norms, and expectations (Feunekes et al., 1998;Wethington, 2005;Zahra et al., 2022). Additionally, food choices and eating habits may even be influenced by phenomena such as eating disorders like anorexia or bulimia nervosa, obesity, or "fads" and "trends" in dietary choices (Rozin, 2006;Khawandanah and Tewfik, 2016). While obesity, which has turned into a public health threat, and anorexia pose relevant topics above all in developed Western Countries, food shortage remains an unsolved issue in many other parts of the world including for instance the African and parts of the Asian continent. ...
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Sustainability is not only a moral compass for organizations of all kinds and shapes; increasingly it can be identified as social representation influencing social practices and behavior. Conceptually inspired by the idea of preferences, conventions, and moral convictions influencing individual behavior and an innovative concept of moral harmonization strategies, this paper introduces a theoretical framework for the conceptualization of moralization effects in sustainability communication in general and food choices in particular. The framework is linked to empirical data from an exploratory qualitative pilot study, in which we conducted guideline-based interviews with 25 international students to gather information on individual perceptions of food choices and eating behaviors. Interview data were analyzed using inductive category formation to explore what role sustainability plays on an individual level in terms of coming in as a value or norm and how much sustainability as a normative principle influences individual decision-making processes and behavior. Based on the results of the pilot study, we hypothesize that food is less "morally overloaded" than expected and sustainability is not a moral imperative related to specific eating behavior. In line with previous findings, our results confirmed that food choices and changes in meat consumption involve a multi-faceted and complex decision-making process, which among others may be heavily influenced by inherent social norms within a person's social network, including family, friends as well as important other peers. Thus, with this preliminary study, we critically challenge existing literature on the influence of sustainability as moral imperative guiding and influencing individual behavior, at least in the domain of food and eating behavior. To elaborate on our proposed framework, additional empirical research is needed from a cultural, sustainability, language, and communication perspective.
... Similar to reducing energy intake, reducing protein consumption could be challenging as it relates to the nutrition environment and food literacy, and is currently being driven by fad diets, such as Paleo and Keto diets [55,56]. The current ratio of animal-to-plant protein is around 70:30, compared to the ratio of 60:40 observed in European countries [57]. ...
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Many studies have evaluated the life cycle environmental impacts of diets based on a single period, but few studies have considered how environmental impacts of diets change over time, even though dietary patterns (DPs) change due to policy and socio-demographic factors. This study evaluated changes in the global warming potential (GWP) of DPs in the province of Ontario, Canada, using a life cycle assessment. We quantified the farm-to-fork GWP of six DPs (Omnivorous, No Pork, No Beef, No Red Meat, Pescatarian, and Vegetarian), using dietary intake data from a 2014 and 2015 survey. Throughout this period, the biggest decrease in GWP was for DPs containing beef, even though these DPs still have the highest GWP (3203 and 2308 kg CO2e, respectively, based on the annual energy intake of one individual). Across all DPs, plant-based proteins contributed less than 5% to GWP, while meat and fish contributed up to 62% of the total GWP. Ten-year GWP reductions are insufficient to meet climate change and other sustainability goals, and major dietary shifts are needed, particularly substituting animal-based proteins with plant-based proteins. To design effective interventions for shifting towards sustainable diets, research is needed to understand how socio-demographic and regional differences influence individuals’ food choices.
... Misinformation in the form of trending dietary messages such as dieting by blood type (Cusack et al., 2013) and celebrity or media-influenced nutritional fads (Lee et al., 2018;Myrick & Erlichman, 2020) lack substantiated scientific support yet continue to gain in popularity. Fad diets are routinely associated with poor health outcomes and ill-placed health behavior change (Khawandanah & Tewfik, 2016). Unrealistic media representation of body image also contributes to misinformation about healthy diet and exercise behaviors (Maine et al., 2015). ...
Article
Given the prevalence of health misinformation (i.e., inaccurate health messaging that lacks scientific evidence), there is a need for successful communication strategies to combat this detrimental health issue (Krishna & Thompson, 2021). Guided by goals-plans-action theory (Dillard, 1990), which explains the communicative process of creating and implementing influence messages, the purpose of this dissertation was to: (a) uncover primary care physician goals, plans, and action when correcting patient-held health misinformation and (b) experimentally test corrective influence messages for their effectiveness from the patient’s perspective. Two studies addressed these two purposes. In Study One, results of surveys of primary care physicians (N = 105) discovered significant, positive relationships between their primary goal (i.e., correction of health misinformation) and the secondary goals of identity and conversation management. Additionally, Study One results revealed five types of primary care physician strategic message plans during these conversations (i.e., vocalics, clarity, body positioning, listening behavior, relationship-building tone), and five themes for communicative action strategies that primary care physicians use when correcting patient-held health misinformation (i.e., scientific evidence-based explication, recommendations for evaluating health-related information and sources, emotional and/or relationship-building appeal, simple correction, disregard/judgment). Scenario-based corrective influence messaging was created based on communicative action themes from Study One (i.e., scientific evidence, evaluation recommendation, emotional appeal), checked for validity, and pilot tested. In Study Two, U.S. IX adults ages 18 years and older (N = 371) were asked to imagine they have found information online saying vaccines contain toxic ingredients and decide to bring this information up to their primary care physician, were randomly assigned to read a scenario from one of these three corrective influence messaging themes, and then reported their perceptions of the primary care physician. Results revealed no significant differences between scientific evidence and emotional appeal messages on key patient outcomes including perceived source credibility, patient satisfaction, intent to communicate with and share online health information to a primary care physician. Results of the two studies provide evidence for the applicability of goals-plans-action theory to the context of health misinformation and corrective influence messages, and yield recommendations for primary care physicians to implement when correcting health misinformation.
... Populations consuming or moving towards typical 'western' diets (with high fat/sugar/ salt and insufficient fruits and vegetable intakes) are more likely to have higher obesity rates (33) , which then stimulate the drive for weight loss programmes within these societies. As a consequence, popular, restrictive fad diets have emerged (34,35) , promoted to achieve quick weight loss, which reduce food diversity, as well as quantity. Unlike health care professionally led weight loss programmes, they inevitably can result in micronutrients intakes below daily recommended amounts which could therefore result in long-term clinically relevant nutritional inadequacies (34,36,37) . ...
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Pistachio nuts are a nutrient-dense source of good quality plant protein, commonly consumed as a minimally processed snack food or ingredient. The present paper is based on a symposium held during the 13th FENS (Federation of European Nutrition Societies) 2019 conference in Dublin that explored recent research and practical applications of pistachios as a plant-based snack, in particular, for appetite control and healthy weight management; and for glycaemic control during pregnancy. Individual nut types, whilst similar in nutritional composition, have unique characteristics which may have a significant impact on potential health effects. Recognising this, the further purpose here is to explore future research needs for pistachios, based on work completed to date and the discussion that ensued among researchers at this event, in order to advance the full scope of health benefits from pistachios, in particular, taking into account of both sustainability and nutritional health.
... Based on Table 1, it can be seen that more than half (69.0%) of respondents currently (and ever) make efforts to lose weight by the fad diet method. e fad diet method is considered unhealthy because this diet directs a person to consume low calories and nutrients [10]. ...
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Female model has a variety of body image and experiences social pressure to have low weight. Thus, there is a desire to lose weight with a variety of efforts, such as fad diets. This type of diet can lead to insufficient intake of nutrients in the body and increase the risk of health problems in the long run. The research aimed to analyze fad diets, nutritional status, and nutritional adequacy of female models in Malang. The research design was cross-sectional in 52 female models aged 18–25 years who were selected by simple random sampling. The data of fad diets used in the questionnaire, nutritional status data using the calculation of the last body weight and height, and nutritional adequacy were measured using 2 × 24 hour food recall. Data analysis used the chi-square test. The results of this research showed that most respondents implement fad diets (69%), had negative body image (62%), had a skinny at high level (22%), skinny at mild level (44%), and normal (33%) of nutritional status, and had inadequate nutritional adequacy (77%). There was a significant (p=0.023) correlation between fad diets and nutritional adequacy (r = 0.369), and in addition, there was a significant correlation (p=0.041) between nutritional status and nutritional adequacy (r = 0.35). It is concluded that the female models who implemented fad diets and nutritional status below normal tended to not have adequate levels of nutritional adequacy because of improper food selection and psychological factors. Female models are expected to be able to conduct weight loss with the assistance of a nutritionist or in accordance with balanced nutrition guidelines.
Article
The ‘Lifestyle Medicine’ approach may offer an effective strategy for improving the outcomes of psychiatric care when used alongside conventional biological and psychotherapeutic treatments. Lifestyle interventions may also be useful in inpatient psychiatric settings, as this context provides a unique setting for adopting lifestyle changes that can be translated following discharge. While the data revealed by the small-scale feasibility studies reporting on the design and implementation of these interventions within psychiatric settings are compelling and indicative of improved patient outcomes, the strength and nature of the relationship between lifestyle factors and psychiatric care provision and outcomes remain unclear. It is strongly suggested that future research should focus on identifying any relevant organisational and programmatic challenges in psychiatric care settings, hence provide clear guidelines to enhance health-promoting behaviours and develop relevant public healthcare standards.
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The prevalence of obesity is increasing day by day and is becoming a serious issue worldwide. Obesity leads to different chronic diseases such as diabetes, CVD, hypertension etc. In attempts to lose weight faster people try different diets and Fad diets are a part of these diets. Keto genic diet, Atkins diet, vegan diet, liquid diet are some examples of these diets. Objective: To assess the emergence of fad diets and obesity related perceptions and practices among university students. Methods: A cross sectional study design with a sample size of 100 students were randomly selected from 4 different universities; University of Lahore, LUMS, Forman Christian College and Superior University. Data was collected from the participants through a questionnaire. Results: Questions regarding knowledge and perceptions about obesity and fad diets were asked to which majority of the participants answered that they knew about BMI and it being a major indicator of obesity (73%). When they were asked about knowledge of obesity related to diet and sleep 88% agreed to it being interlinked while 19% disagreed. Upon asking what the respondents thought was the main cause of weight gain 14% replied junk food, 22% replied to lack of exercise, 27% said unhealthy eating practices but majority 35% outlined lack of exercise combined with unhealthy eating practices as the foremost cause of increasing rates of obesity. When asked if the participants followed any fad diets they answered with different diets; 12 respondents followed Atkins, 20 followed keto, 7 followed vegans, 4 followed liquid diet, and 32 followed other fad diets while 32 participants didn’t follow any fad diet. The correlation between fad diets and their effectiveness was determined and the results showed a significant correlation (p<0.05). Most of the participants were females (57 females and 43 males) and through the present study it was evaluated that mostly females followed such fad diets as compared to males. Conclusion: Fad diets have been in trend from a long time and people mainly follow it to lose weight quickly and to get into a certain body shape. However, restricting specific food groups leads to drawback that cause health issues. Following a fad diet is short-term solution to obesity that can be reversed easily by slipping back into old eating patterns. The long-term solution to obesity is to eat a healthy balanced diet and to be physically active.
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Introducción: La aparición de dietas milagro podría deberse a la dificultad de la población para modificar sus estilos de vida y conseguir la adherencia a intervenciones terapéuticas. El objetivo de este trabajo fue evaluar los conocimientos, actitudes y prácticas sobre dietas milagro en un panel de consumidores de características socio demográficas similares a la población española. Material y métodos: Estudio transversal con encuesta online de conocimientos, actitudes y prácticas no validada y elaborada según guías de FAO, en muestra de ambos sexos de 18 a 65 años. Resultados: Hubo 2.604 encuestas válidas (50% mujeres). La mayoría (57,9%) declaró conocer alguna característica de las dietas milagro y supo identificarlas (65,8%). El 90% cree que no funcionan y que sus efectos son principalmente negativos (82,6%). 487 personas (18,7%) declararon haber seguido una o varias dietas milagro, durante 15 días y más de 6 meses, tomado algún producto asociado (56%) que adquirieron en herboristerías (52%) y farmacias (30%), y creyeron percibir (57%, n=277) alguno de los efectos prometidos, aunque sólo a corto plazo, y el 33% creyó percibir algún efecto adverso de carácter leve. El 73,7% del total de la muestra declaró que las dietas milagro son un problema y el 78,6% que son peligrosas. El 82,1% no indicó sentirse vulnerable por la adopción de una dieta milagro. Conclusiones: El nivel de conocimiento sobre las dietas milagro en la población del estudio es medio, la mayoría las percibe como un problema, pero no se siente vulnerable ni con intención de seguir una dieta milagro. Sin embargo, el 22% de la muestra siguió algún tipo de dieta milagro, aunque solo el 18,7% lo reconoce. Es necesario nuevas investigaciones que exploren, en mayor profundidad, cómo el nivel conocimiento y actitud de la población frente a las dietas milagro se relaciona con la práctica.
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Sara Patience examines how good intentions around nutrition and exercise can lead to health issues
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Background: The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial designed to determine the effects of a high-fiber (4.30 g/MJ), high-fruit-and-vegetable (0.84 servings/MJ), low-fat (20% of energy from fat) diet on the recurrence of adenomatous polyps in the large bowel. Objective: Our goal was to determine whether the PPT intervention plan could effect change in 3 dietary goals and to examine the intervention's effect on the intake of other food groups and nutrients. Design: Participants with large-bowel adenomatous polyps diagnosed in the past 6 mo were randomly assigned to either the intervention (n = 1037) or the control (n = 1042) group and remained in the trial for 4 y. Three dietary assessment instruments were used to measure dietary change: food-frequency questionnaires (in 100% of the sample), 4-d food records (in a 20% random cohort), and 24-h dietary recalls (in a 10% random sample). Results: Intervention participants made and sustained significant changes in all PPT goals as measured by the dietary assessment instruments; the control participants' intakes remained essentially the same throughout the trial. The absolute differences between the intervention and control groups over the 4-y period were 9.7% of energy from fat (95% CI: 9.0%, 10.3%), 1.65 g dietary fiber/MJ (95% CI: 1.53, 1.74), and 0.27 servings of fruit and vegetables/MJ (95% CI: 0.25, 0.29). Intervention participants also reported significant changes in the intake of other nutrients and food groups. The intervention group also had significantly higher serum carotenoid concentrations and lower body weights than did the control group. Conclusion: Motivated, free-living individuals, given appropriate support, can make and sustain major dietary changes over a 4-y period.
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Background and objectives: In the United States population, high dietary fiber intake has been associated with a lower risk of inflammation and mortality in individuals with kidney dysfunction. This study aimed to expand such findings to a Northern European population. Design, setting, participants, & measurements: Dietary fiber intake was calculated from 7-day dietary records in 1110 participants aged 70-71 years from the Uppsala Longitudinal Study of Adult Men (examinations performed during 1991-1995). Dietary fiber was adjusted for total energy intake by the residual method. Renal function was estimated from the concentration of serum cystatin C, and deaths were registered prospectively during a median follow-up of 10.0 years. Results: Dietary fiber independently and directly associated with eGFR (adjusted difference, 2.6 ml/min per 1.73 m(2) per 10 g/d higher; 95% confidence interval [95% CI], 0.3 to 4.9). The odds of C-reactive protein >3 mg/L were lower (linear trend, P=0.002) with higher fiber quartiles. During follow-up, 300 participants died (incidence rate of 2.87 per 100 person-years at risk). Multiplicative interactions were observed between dietary fiber intake and kidney dysfunction in the prediction of mortality. Higher dietary fiber was associated with lower mortality in unadjusted analysis. These associations were stronger in participants with kidney dysfunction (eGFR<60 ml/min per 1.73 m(2)) (hazard ratio [HR], 0.58; 95% CI, 0.35 to 0.98) than in those without (HR, 1.30; 95% CI, 0.76 to 2.22; P value for interaction, P=0.04), and were mainly explained by a lower incidence of cancer-related deaths (0.25; 95% CI, 0.10 to 0.65) in individuals with kidney dysfunction versus individuals with an eGFR≥60 ml/min per 1.73 m(2) (1.61; 95% CI, 0.69 to 3.74; P value for interaction, P=0.01). Conclusions: High dietary fiber was associated with better kidney function and lower inflammation in community-dwelling elderly men from Sweden. High dietary fiber was also associated with lower (cancer) mortality risk, especially in individuals with kidney dysfunction.
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To investigate dietary fibre intake and any potential dose-response association with coronary heart disease and cardiovascular disease. Systematic review of available literature and dose-response meta-analysis of cohort studies using random effects models. The Cochrane Library, Medline, Medline in-process, Embase, CAB Abstracts, ISI Web of Science, BIOSIS, and hand searching. Prospective studies reporting associations between fibre intake and coronary heart disease or cardiovascular disease, with a minimum follow-up of three years and published in English between 1 January 1990 and 6 August 2013. 22 cohort study publications met inclusion criteria and reported total dietary fibre intake, fibre subtypes, or fibre from food sources and primary events of cardiovascular disease or coronary heart disease. Total dietary fibre intake was inversely associated with risk of cardiovascular disease (risk ratio 0.91 per 7 g/day (95% confidence intervals 0.88 to 0.94)) and coronary heart disease (0.91 (0.87 to 0.94)). There was evidence of some heterogeneity between pooled studies for cardiovascular disease (I(2)=45% (0% to 74%)) and coronary heart disease (I(2)=33% (0% to 66%)). Insoluble fibre and fibre from cereal and vegetable sources were inversely associated with risk of coronary heart disease and cardiovascular disease. Fruit fibre intake was inversely associated with risk of cardiovascular disease. Greater dietary fibre intake is associated with a lower risk of both cardiovascular disease and coronary heart disease. Findings are aligned with general recommendations to increase fibre intake. The differing strengths of association by fibre type or source highlight the need for a better understanding of the mode of action of fibre components.
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Objective: To examine the changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women. Design: Prospective cohort study with 12 y of follow-up conducted in the Nurses' Health Study. Subjects: A total of 74,063 female nurses aged 38-63 y, who were free of cardiovascular disease, cancer, and diabetes at baseline in 1984. Measurements: Dietary information was collected using a validated food frequency questionnaire, and body weight and height were self-reported. Results: During the 12-y follow-up, participants tended to gain weight with aging, but those with the largest increase in fruit and vegetable intake had a 24% of lower risk of becoming obese (BMI> or =30 kg/m2) compared with those who had the largest decrease in intake after adjustment for age, physical activity, smoking, total energy intake, and other lifestyle variables (relative risk (RR), 0.76; 95% confidence interval (CI), 0.69-0.86; P for trend <0.0001). For major weight gain (> or =25 kg), women with the largest increase in intake of fruits and vegetables had a 28% lower risk compared to those in the other extreme group (RR, 0.72; 95% CI, 0.55-0.93; P=0.01). Similar results were observed for changes in intake of fruits and vegetables when analyzed separately. Conclusions: Our findings suggest that increasing intake of fruits and vegetables may reduce long-term risk of obesity and weight gain among middle-aged women.
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There have been several studies on the effects of dietary fibre on the metabolism. Epidemiologic studies have consistently reported an inverse relationship between dietary fibre and type 2 diabetes mellitus or cardiovascular mortality. This review focuses on observational and experimental studies that examine the effect of different types and sources of dietary fibre on body weight, glucose metabolism and lipid profile. From the available evidence, we conclude that clinical studies consistently show that the intake of viscous dietary fibre decreases the low density lipoprotein cholesterol and postprandial glucose levels, and induces short term satiety. However, few clinical trials have demonstrated that the intake of dietary fibre has a positive effect on the control of diabetes and body weight.
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Using a longitudinal design, adolescent females were initially evaluated then retested after a three-year period for levels of body image disturbance, eating dysfunction, psychological functioning, and multiple developmental variables (maturational status, level of obesity, history of being teased about appearance). Multiple regression analyses revealed that (a) level of obesity predicted teasing, (b) teasing led to overall appearance dissatisfaction, (c) body dissatisfaction predicted restrictive eating practices, and (d) bulimic symptoms predicted global psychological function. These findings are limited by a small sample size; however, the results are consistent with past research. Indications for future investigations are offered.
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Background: Low-energy diets, ideally in combination with increased energy expenditure through physical activity, are the mainstay of obesity treatment. Very low-energy liquid diets (VLEDs) were developed to provide a safe alternative to starvation, with only a modest attenuation in the rate of weight loss. Aim: This paper considers the evidence concerning the efficacy of both commercial and milk-based total liquid diets, which provide a maximum of 800 kcal/day. Results: Long-term users of low-energy formula diets are a self-selected group who find these preparations acceptable. In these subjects early compliance is often good and weight losses of 8–10 kg in approximately 4–8 weeks are regularly reported. This compares favourably with acute weight losses using other treatment methods. However, there are concerns regarding the composition of tissue lost and the long-term maintenance of weight loss. Conclusion: VLEDs are a proven success in achieving significant short-term reductions in body weight. A subset of patients achieve long-term weight loss. There is evidence to suggest that meal replacements may make a contribution to the maintenance of weight loss in some individuals. Evaluation of integrated programmes using these methods for weight loss and long-term weight control is required.
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The role of nutritional influences on bone health remains largely undefined because most studies have focused attention on calcium intake. We reported previously that intakes of nutrients found in abundance in fruit and vegetables are positively associated with bone health. We examined this finding further by considering axial and peripheral bone mass and markers of bone metabolism. This was a cross-sectional study of 62 healthy women aged 45-55 y. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the lumbar spine and femoral neck and by peripheral quantitative computed tomography at the ultradistal radial total, trabecular, and cortical sites. Bone resorption was calculated by measuring urinary excretion of pyridinoline and deoxypyridinoline and bone formation by measuring serum osteocalcin. Nutrient intakes were assessed by using a validated food-frequency questionnaire; other lifestyle factors were assessed by additional questions. After present energy intake was controlled for, higher intakes of magnesium, potassium, and alcohol were associated with higher total bone mass by Pearson correlation (P < 0.05 to P < 0.005). Femoral neck BMD was higher in women who had consumed high amounts of fruit in their childhood than in women who had consumed medium or low amounts (P < 0.01). In a regression analysis with age, weight, height, menstrual status, and dietary intake entered into the model, magnesium intake accounted for 12.3% of the variation in pyridinoline excretion and 12% of the variation in deoxypyridinoline excretion. Alcohol and potassium intakes accounted for 18.1% of the variation in total forearm bone mass. The BMD results confirm our previous work (but at peripheral bone mass sites), and our findings associating bone resorption with dietary factors provide further evidence of a positive link between fruit and vegetable consumption and bone health.