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1st appeared
15 November
1999 Weighed Down with Obesity, Nation Grows Nostalgic over Diets Nostalgia, always a dubious indulgence, has in recent years been focused on the seventies, spawning an eponymous TV show, a resurgence of discos (which never really went away,) an already passé (again) revival of bellbottoms among the adolescent and--to the dismay of concerned physicians--a return of that era’s low-carbohydrate diet fad. Robert Atkins, the most influential purveyor of carbohydrate-free diets from the disco era, is back, dominating the paperback bestseller lists along with others of his ilk. In its November 1 cover story, Time magazine examined this low-carb craze. The rationale that these diet advocates use to justify eschewing not only sugar, but also more complex carbohydrates—fruits, vegetables and grains, for instance—has never been proved. Compared to eating protein or fat itself, they say, eating carbohydrates causes cells to store more food energy as fat, a result of the insulin release triggered by carbohydrates. The evergreen popularity of "new" diet books, including low-carbohydrate diet books, may be further strengthened by survey findings reported in the Journal of the American Medical Association. In the October 27 issue, researchers from the national Centers for Disease Prevention and Control concluded that most Americans now are overweight, and that one in five is obese—roughly thirty pounds or more overweight. Children and adolescents are getting fatter, too, putting them on a fast track for heart disease and type II diabetes. The news is especially sobering considering that a separate epidemiological study reported in the same issue of JAMA presented some of the most convincing evidence to date that being overweight or obese increases one’s chances of dying. Obesity is the second-leading cause of preventable death, after smoking. Challenging the standard wisdom that most people do not change behavior to lose weight is Dean Ornish, physician with UCSF’s Osher Center for Integrative Medicine, himself a health advisor to President Clinton and the author of another popular weight-loss book. Ornish, who also is considered outside the fold by some for his advocacy of a diet containing only 10 percent fat, shares mainstream physicians’ and dietitians’ advocacy of complex carbohydrates and their disdain for the currently reigning diet fat. Ornish has reported success with highly motivated patients who embrace his dietary and lifestyle changes. "Whole foods [complex carbohydrates]—whole wheat, brown rice, and fruits, vegetables, grains, and beans in their natural form—are rich in fiber, which slows their absorption," Ornish says. "Because they are absorbed slowly, your blood sugar does not spike and so your body does not need to produce elevated levels of insulin. Instead of the rapid swings in blood sugar, you get a more constant source of energy throughout the day." Like Ornish, Judith Levine, nutritionist for the American Heart Association in San Francisco and an associate clinical professor at UCSF, believes the low- or no-carbohydrate diets are potentially harmful. "The brain wants carbohydrates as a source of fuel. When they’re not present in the diet, it knows how to obtain glucose elsewhere in the body, first from the glycogen in the liver, and then from protein in muscle," she says. "The body will primarily convert protein from muscle into glucose before it starts burning fat," she adds. "That is why some people initially lose large amounts of weight quickly on these diets. Muscle has a lot of water, and they are losing water weight in addition to muscle." Eating too much protein is extra work for the kidneys, and can also cause us to lose calcium from our bones, adds Levine. She sticks to the mainstream in recommending a diet with about 50 to 55 percent of calories from carbohydrates, about 30 percent from fat, and from 15 to 20 percent from protein. The medical line on weight loss—cut calories and fat and exercise regularly—works when followed, but, in general, it is not, despite the reported success of practitioners such as Ornish and Laurel Mellin, the originator of the Shapedown Program at UCSF. As any family physician and many study authors can tell you, more than 90 percent of dieters regain all the weight they lose within a few years. Apparently exercise is joyless tedium or wasted time to so many overweight Americans that they would rather forget about it and instead spend $30 billion or so on diet programs. UCSF pediatric endocrinologist Steve Gitelman notes that the number of referrals he receives for obesity from general practitioners has been climbing steadily in recent years. Yet there is no magic hormone injection he can offer. While basic researchers have made rapid progress in understanding the biological mechanisms of weight control in recent years, safe and effective drugs—especially for children—are not likely to be available for many years, Gitelman says, and the clinical situation is desperate now. The typical American lifestyle promotes weight gain, and it may take a society-wide consciousness-raising to change it, according to Gitelman. Institutions ranging from families, to schools, to employers to the federal government can play a role in preventing obesity and in supporting individuals who may wish to lose weight for health reasons, Gitelman says. "This is a huge problem, and we’ve got a long way to go," he says. "We’re not even at square one." Links: Time - The Low-Carb Diet Craze Source: Jeffrey Norris
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