Sherry Pagoto, a clinical psychologist and professor at UMass Med School, has an editorial in the most recent JAMA calling for an End to the Diet Debates, specifically wrt diet composition. Here’s part of the abstract:
Numerous randomized trials comparing diets differing in macronutrient compositions (eg, low-carbohydrate, low-fat, Mediterranean) have demonstrated differences in weight loss and metabolic risk factors that are small (ie, a mean difference of <1 kg) and inconsistent. …
The only consistent finding among the trials is that adherence—the degree to which participants continued in the program or met program goals for diet and physical activity—was most strongly associated with weight loss and improvement in disease-related outcomes. The long history of trials showing very modest differences suggests that additional trials comparing diets varying in macronutrient content most likely will not produce findings that would significantly advance the science of obesity.
And in other news, Gary Taubes is in Scientific American’s special issue on food suggesting that “rigorously controlled studies may soon give us a definitive answer about what causes obesity—excessive calories or the wrong carbohydrate.”
Umm, okay.
Since long-time readers know I’m not really a fan of Taubes’ carbs-insulin hypothesis, I must admit to thinking that Dr. Pagoto has a point. Here she is talking about why we need to look elsewhere:
Now I get why Dr. Pagoto, as a behavioral scientist, wants to shift the conversation. For one, in an interview with WBUR, she makes an important point that diet proponents tend to gloss over:
Stress is a huge factor in undermining adherence in any diet, undermining adherence to an exercise program. … The most common thing a patient will say is, ‘I want to lose weight, but life is getting in the way.’ And what they mean is, “I am struggling with figuring out how to make these changes last and stick given everything else I’ve got to do.’ And that’s what they need help with. That’s a behavioral science question. It’s not a nutrition question per se.
Interestingly, there may be other reasons why this focus on macronutrients may be perpetually inconclusive. Writer David Freedman suggests that one of these is that, like the drunk man looking for his keys in the light, researchers are often just looking where the looking is good:
Many, and possibly most, scientists spend their careers looking for answers where the light is better rather than where the truth is more likely to lie. They don’t always have much choice. It is often extremely difficult or even impossible to cleanly measure what is really important, so scientists instead cleanly measure what they can, hoping it turns out to be relevant.
I’m not holding my breath that we’ll see an end to the diet debates any time soon, but I will certainly welcome more conversations that aren’t about macronutrients. I don’t think that’s where the answer lies.
Weight Maven is written by Beth Mazur. Beth believes that obesity is more symptom than cause and that the real problem is our Western diet -- especially sugar, refined grains, and industrial oils. Beth writes about nutrition, ancestral health, & food policy. And cats! 
Great post! Speaking for myself, almost every semi-reasonable plan has worked for me for exactly as long as I followed it. Of course, my goals and expectations for my body are realistic and don’t involve magazine bodies. I agree that the problem is a behavioral and emotional one that is exacerbated (but not totally created) by the food industry’s engineering of processed and craving-promoting products.
Thanks for the comment. And yes, I don’t think it’s totally created by the food industry. I think it’s unfortunate that hyperpalatable crap is pervasive, but that alone doesn’t explain it. I find the parallels with industrial food and our culture and what Nick Reding talks about in Methland (here’s Bruce Alexander’s discussion of it) compelling. And I think that’s what interests me about ancestral health. There’s a lot about our lives that we’re probably not well suited for … too bad that it’s so easy to paint everyone with a failure of personal responsibility!
BTW, very much looking forward to reading your blog!
Thanks so much for sharing this. I appreciate this perspective tremendously, but what if both Taubes and Pagoto both have something to add to the conversation? Some people might find a way of eating that helps them find their way to health to be less of a matter of stress and willpower if some attention were paid to nutritional value of food (rather than the false dichotomy of carbs vs. calories) and the fact that different macronutrients do have different metabolic effects, which is true whether or not you think Taubes hypothesis is correct.
Well, I’m skeptical about Taubes, but I’m with you wrt nutrition being an assist re stress and willpower (see this post for example).
Thanks for the link. Great post there as well (I just need to sit down one day & go through your archives). I’m skeptical about Taubes’ hypothesis as well, but maybe for different reasons than you are? There are just too many other facets to the dietary change that happened between 1970 and now to blame all the changes in health on sugars and starches.
I think we can all agree that the diet industry is almost as big and harmful a parasite as the food industry, and getting bigger and more forceful all the time; and that food quality can trump macronutrient effects enough to impossibly confound simple 3-way divisions of food.
But there’s the other question, of health, diabetes, immunity and so on, which can be divorced from the question of weight, and where results do seem to be more conclusive and macronutrients seem to have more impact.
For example, http://caloriesproper.com/?p=2941
Or, less clinically, and with more attention to food quality, The Perfect Health Diet.
I agree that there’s no question that there are therapeutic uses of diets with restricted macronutrients.
Yes, I’ve found that even the best dietary (“healthy eating”) plans, which orient as much as possible towards each individual’s unique needs and preferences, might inevitably run up against unforeseen sources of acute or ongoing STRESS…stress that challenges a person’s coping abilities and resources beyond his or her access to adequate levels of NEEDED forms of support (emotional, economic, social, spiritual, etc). Then, even the healthiest and most helpful dietary approaches (which had served one’s needs so well over significant periods of time) may become much less satisfying—and, indeed, increasingly difficult to practice.
My own example: during a period of less than 3 months, I experienced 2 burglaries (break-ins); 3 scary trips to the ER for a loved-one’s injuries and health crises (plus the resulting-shockingly high-bills for 2 days in hospital, various MD consults, and 3 separate ER services); repeated incidents of surveillance of me and my home by the aforementioned burglar (with minimal to no support/reassurance from local law enforcement); the refusal by my medical insurance company to continue its partial reimbursement for prescribed (and costly) medications on which I had relied for years…etc, etc, etc.
Well. It was no surprise to me when my insomnia symptoms increased exponentially, chronic back and shoulder pains from old injuries returned as if with a vengeance, severe symptoms of PTSD reemerged—and I could find little satisfaction or comfort from having achieved a non-stigmatized body size when that same body became once again so painful to live with…then I understood once again and remembered exactly why “fast foods” (meals that are cheap and require almost no effort or forethought) hold such great appeal during times of overwhelming stress. I could acquire and eat them even while enduring states of physical and mental exhaustion, as well as physical and emotional pain. When I felt buried by fears, fatigue, and uncertainty, day after day, I was grateful to have at least one small part of my life that felt simple, required no mental or physical effort, and offered me a few welcome moments of uncomplicated pleasure and sustenance.
For some of us, the extreme sources of stress eventually diminish to manageable levels and we return to our more mindful and less desperately-needy approach to caring for ourselves. We feel compassion towards our selves for having survived this period of struggles and strife, as best we could, given the resources and sources of support that we lacked. We gradually move forward and feel grateful for easier times and for expanded options from which to choose. Some of us also recognize the privileges and lucky circumstances that restore us to conditions of living that make our “healthier eating” choices feel satisfying and rewarding once again.
Personally, I’m also grateful for this recent stark reminder to me that food (eating) plays a much greater role in my efforts to self nurture—and in my human need to enhance my tenuous sense of security—whenever my day to day (ongoing) conditions of living become so very precarious and dire.
Wow … so sorry to hear about your challenges :(. I hope things are returning to manageable levels!!
Yes, thank you, Beth, for your expression of hope! Some things are slowly returning to conditions that are less terrifying and overwhelming, while other issues remain scary and nerve wracking for me, namely the failure of our local law enforcement to apprehend the perpetrator in spite of clear evidence to indicate his identity. It seems he is hiding out and avoiding the warrant for his arrest for as long as possible—not exactly a shocking development. But this criminal case makes me feel particularly vulnerable—for reasons I best not describe here. On the other hand, my loved one’s most worrisome health issues have been resolved in a positive direction, for now, regarding his access to competent medical treatments with promising long-term outcomes. I appreciate your kind words, which offer far more comfort to me than any pepperoni pizza delivery to my door! :)
Hugs and smiles, hopefulandfree