Is there a Right or Wrong with Dieting?
I’ve noticed lately that there seems to be daily articles written about the negatives of dieting and how dieting does more harm than good. Some of the criticism comes from the poor success rate of dieting. Some of the criticism is about the stigma and shame felt when suffering with obesity and the mocking that occurs when someone is unsuccessful. And some of the criticism is about whether losing weight is necessary for health.
Unfortunately for many “dieters” they think they created/caused a problem that they could have prevented. This results in living with guilt, shame, deprivation and poor self-esteem. “How could I have let myself get in this shape that now I have to eat like this?”
But, what does that word “diet” mean? Below is the Merriam-Webster definition of diet:
Definition of diet
1a : food and drink regularly provided or consumed
a diet of fruits and vegetables
a vegetarian diet
b : habitual nourishment
links between diet and disease
c : the kind and amount of food prescribed for a person or animal for a special reason
was put on a low-sodium diet
d : a regimen of eating and drinking sparingly so as to reduce one’s weight
going on a diet
The first three definitions are simply, “the way we eat.” The last definition (d) is confusing to me. I don’t understand why they felt the need to use the word “sparingly” in defining reducing one’s weight.
For anyone feeling deprived, shamed, or blaming themselves for having obesity, diabetes, or any other “lifestyle” disease, I say, “Please don’t. You have a disease and although you must take an active role in managing your disease, it is not your fault.”
Lifestyle diseases, defined by Wikipedia, are diseases linked with the way people live their lives. This definition misses the point that a disease is a condition that impairs the normal functioning of the body and typically has a genetic component. Having a “lifestyle” disease (obesity, diabetes, hypertension) is not a weakness of character. Not everyone gets diabetes—even when they eat too many carbs or are overweight; not everyone has obesity, even when they overconsume food, and not everyone has hypertension, even when they consume a lot of sodium.
In helping people manage their disease, there are different approaches to motivating or supporting someone to take action. Making someone feel bad or shaming someone is not motivating/supporting. Scaring someone to diet or you will die is not motivating/supporting. But just as most parents never were formally taught the skills for best parenting, most healthcare professionals, families and peers never were formally taught the skills to say the right thing to support self-care.
How do we want our healthcare provider to talk about dieting? When talking about dieting (the way we eat), words do matter. The disease is not the person. “Mary has a disease.” Mary isn’t the disease. There is a fairly recent concept in healthcare called Shared Decision Making. Shared Decision Making is when the healthcare provider and the patient talk together about treatment options. The decision is ultimately with the patient. When a patient hears a neutral explanation of self-care options in a person-centered, respectful, and objective way, and the person decides to take action, there is an empowering rather than guilt or shame. Is there anything wrong with “dieting” (a way of eating) when the patient is in agreement with the decision and is empowered to take action?
In the family setting, families don’t need to talk about “dieting.” Parents need to provide an environment that supports the person working to manage their disease. This might mean making adjustments to family meals. It may mean removing soft drinks from the home (with the family member knowing it is okay to have them but having them in the house makes it too hard to resist drinking them too often); it may mean serving food from the stove; or it may mean eating ice cream out instead of keeping the gallon in the home (same rationale as the soft drinks). Except for those with rare dietary needs, there is no need to cook special meals for the one member separate from what the rest of the family is eating. There is also no need to tell that person that they can’t eat what others are eating. The family treats everyone with the same love, respect, and dignity.
So here is how I talk about dieting. First, I don’t talk dieting, I talk food. I ask a lot of questions and get to know the person and their needs and struggles. I talk about “the way to eat” for one’s needs. I talk about the facts; I talk about what we know about diet and the disease and I ask the person what they are willing to do given their knowledge. I may have a different nutrition recommendation when I talk to someone with obesity vs with an eating disorder, but my message is the same. “This way of eating is helpful for you to take care of yourself to manage your disease and improve your life.” And from there we talk about how I can help them with behavioral strategies that make it easier to follow their desired path. Most importantly, I help my patients enjoy every bite of food they eat hoping that I have set the stage for them to be at peace with food.