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Michelle May, M.D.

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Diets Are Like Antacids: It's Time for a Paradigm Shift

Posted: 04/10/2012 8:00 pm

Diets are like antacids. Let me explain...

When I was in medical school just a few decades ago, peptic ulcer disease (PUD) was believed to be caused by stress and excess stomach acid. The treatment was a bland diet and antacids, which didn't work very well. Later powerful acid blockers were developed. These treatments worked better, but the ulcers frequently relapsed and required repeated or chronic treatment.

Despite these ultimately ineffective therapies, the discovery by Barry Marshall and Robin Warren that most cases of PUD were caused by a bacterial infection was initially met with great skepticism, defensiveness and criticism. They continued to challenge the dogma, even going so far as to intentionally infect themselves with H. pylori. It was well over a decade before it was widely accepted that PUD could be cured with a single round of triple therapy.

Aha! No wonder the old PUD treatment didn't work: We were treating the symptoms, not the cause. Marshall and Warren won a Nobel Prize in 2005 for their persistence, and millions of PUD sufferers have finally been cured.

We're at a similar crossroads with dieting, the antacids of our day. Diets temporarily treat symptoms, not causes; diets temporarily change behaviors, not the source of those behaviors. The "treatment" paradigm is flawed, yet so pervasive that millions of people are trapped in outdated beliefs and behaviors, despite all of the evidence that it's not moving the majority toward healthier, happier, more vibrant lives.

There's endless, tiresome debate about which diet works better, but none have shown a permanent cure. Some even resort to blaming or subtly shaming dieters (or themselves) when they quit the diet or regain weight, even though that is the known outcome for the vast majority of people.

I've been speaking and writing about a non-restrictive, "non-diet" approach since 1999 when I founded the Am I Hungry® mindful eating workshops. In the book based on this program, Eat What You Love, Love What You Eat and my latest book, Eat What You Love, Love What You Eat with Diabetes, I guide readers through this paradigm shift one step at a time. I'll be the first to admit that although the concepts are simple, it's not always easy. Paradigms are notoriously difficult to see through, much less break through. Yet countless workshop participants and readers have changed the way they think about eating -- even after decades of recurrent or chronic yo-yo dieting.

I've seen many other hopeful signs that the shift is finally taking place. Many of my colleagues are now helping their patients and clients learn mindful eating skills rather than teaching restrictive rule-following and preaching willpower and motivation.

In fact, the mantra, "diets don't work," is growing louder. However, in an effort to catch the rising tide, many diets now claim they are "not a diet." But to the trained eye, they clearly are. Just saying so doesn't make it so, and therefore the results will be the same.

It's understandably difficult to see the need for a radical shift, particularly if your reputation, life's work and, in some cases, financial security depend on keeping people trapped in the eat-repent-repeat cycle. I don't think that most who promote various forms of dieting are malicious or ignorant; it's just that restrictive eating is so deeply embedded in our cultural norms that they can't see the difference.

Below are some of the telltale signs that a plan, program, or "lifestyle change" is actually a diet, even if it says it's not. If you feel skeptical, defensive or critical as you read this list, take note; your paradigm is showing.

  • The focus is on weight loss rather than health
  • You're supposed to write down everything you eat
  • There is weighing, measuring or counting involved: calories, exchanges, points, grams, pounds, etc.
  • You have to plan your meals days in advance or follow a predetermined meal plan
  • Foods are labeled as good/bad, or allowed/not allowed
  • "They" say you can "eat what you love," but then they tell you what, when or how much
  • Food is provided for you
  • You eat substitutes for real food (shakes, bars, supplements)
  • Some are based on an addiction model and require restriction or avoidance
  • Alternatively, you're "allowed" to "eat whatever you want," but the diet or expert determines the limits for you
  • Certain foods are considered indulgences, treats or splurges, and therefore are made special and even more desirable
  • There are "cheat" days
  • There are arbitrary rules, like "don't eat after seven" or "eat every three hours"
  • Minutes of exercise are converted to calorie or food equivalents
  • Exercise becomes punishment for eating; it is used to earn food or pay penance for eating something "bad"
  • There is a weight loss phase and a maintenance phase (in other words, you'll be on this diet for the rest of your life)
  • Rules, willpower, incentives, tricks and motivation help temporarily, but repeated "treatment" is necessary to maintain the results
  • While you are "on" it, you find yourself thinking about food frequently
  • You feel guilty for certain choices
  • You crave or miss certain foods
  • You have to avoid certain places, people or events because of the "temptations"
  • When you eventually "give in" and eat the foods you miss or crave, you find yourself overeating those foods
  • You resort to eating differently in private than you do in public to avoid comments, judgment and criticism
  • You overdiet the way you overeat: thinking and talking about food all the time
  • There are subtle implications that you can't be trusted with food so you need these externally-imposed limits

In short, diets fail because they exert external control on what was once a natural, internal process. (Think of the way a baby eats.) Diets focus on what people should eat without addressing why they eat in the first place. Dieters often don't learn to recognize their non-hunger eating triggers or effectively meet their true physical, emotional and social needs. As a result, the overeating cycle is never really broken.

This outdated and ineffective diet paradigm is a result of dichotomous thinking that presumes that if we don't control behavior, it will be out of control.

But there is a third radical option: People can relearn to be in charge instead.

When nutrition, fitness, and self-care are approached with a non-diet, mindful eating paradigm, people are able to relearn to balance eating for enjoyment with eating for health, rediscover joy in physical activity and meet their true needs in more fulfilling, satisfying ways. Mindful eating requires awareness, intention, trust, new skills, practice -- and revolutionary thinking.

What's the alternative? Argue for an outdated paradigm that obviously doesn't work? Just continue to treat the symptoms? I've moved on. How about you?

For more by Michelle May, M.D., click here.

For more on diet and nutrition, click here.

 
 
 
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01:00 PM on 04/16/2012
As a recovering food addict, I respectfully disagree with these commwnts. the key for me is to give my body the high quality nutrition it craves. then the desire to overeat disapoeared for me so i can be mindful and make good choices. Thanks Dr Michelle!
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05:25 PM on 04/14/2012
Loved your article. I would add, though, that eating mindfully isn't enough. If you're mindfully eating Twinkies and colas and chips and cheeseburgers, your body is STILL starving for the nutrients it is missing. When it doesn't get what it needs, it sets up cravings in a frantic attempt to find nutrients somewhere, anywhere.

I fought weight for forty years. It wasn't until I got off the diet/fitness industry insanity and started eating REAL food -- fruits, vegetables, nuts, seeds, legumes and grains I mill myself -- that my weight "problem" was resolved. Quickly, effortlessly and with no sagging skin.

Our bodies need fresh, living food. They will do whatever it takes to try and get the nutrients it needs, even if it means overfeeding it on crap.

Just because something tastes good and just because we put it in the same pie hole as real food doesn't mean it's food. I don't care how mindfully you eat a two pounder bag of m&m's, those calories are crowding out the real nutrients that we need to be healthy -- and sane.
05:09 AM on 04/14/2012
You are spot on Michelle. For 15 years I tried every diet known to mankind and I was frustrated and devastated every time I failed. It wasn't until I turned away from rigid rules and restrictions and learned to eat by listening to my body cues that I was finally able to lose over 25lbs and keep it off for over ten years. In hindsight, I clearly see that dieting as a solution was actually part of my problem, because it kept me struggling and distrustful of my body and it's inner wisdom. So many more could liberated from the shackles of dieting if only they knew the way. I wish I had known about mindful eating as an alternative to dieting in my teens! Now I eat a little bit of everything without guilt and couldn't be happier. Thanks for spreading the word.
05:13 PM on 04/12/2012
There is a great deal of research to suggest that mindfulness training for binge eating disorder (BED) is effective. There is a growing movement among the bariatric professional community to focus on health at every size/intuitive eating/mindfulness based interventions as these solutions are much more likely to improve health In The Long Run. Dr. May is absolutely spot on with this article.
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ginadeoliveira2008
Seen a shooting star tonight and I thought of you
02:33 PM on 04/11/2012
Nice marketing, but you came up with nothing much to guide the reader out of a diet into mindful eating. The revolution ends up looking like a way of speaking--spelling d i e t in a new form. Don't tell us what not to do in 25 alerts, tell us the right way to do it!
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William Anderson LMHC
Licensed Psychotherapist, Weight Control Expert
08:45 AM on 04/11/2012
While I thoroughly agree that diets are a part of the problem rather than a solution, I don't think you understand the problem that most overeaters have. The solution is a behavioral approach, but your mindful eating approach misses the mark with many overeaters.

Consider that some people experience feelings and drives related to food that you have never had. If you have never had a compulsive gambling problem or a sex addiction problem, it's hard to understand what is going on there, but I guarantee you that "mindfulness" is not going to help. These behavioral problems require a very definite treatment plan to resolve, and these treatment plans work.

Compulsive gambling and sex addiction are rare compared to the problems that many overweight people have with their eating and food experience, and I don't think you are taking into account that something is going on with them that you just have not experienced and don't know how to treat.

I have been helping people solve their chronic weight problem with a solution I discovered as a behavior therapist and addictions counselor. It helped me to lose 140 pounds after 25 years of obesity and weight loss failure, and I have maintained my ideal body weight since. I have been training others in it, and now other therapists. Please check my work at my website and contact me if you would like.

William Anderson, LMHC
Author of 'The Anderson Method - Secrets of Permanent Weight Loss'
www.TheAndersonMethod.com
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urkiddinme
Former fatty turned fitness freak
09:36 AM on 04/11/2012
For once, I like your post and will let your spamming slide. The author TOTALLY doesn't get food addiction and why, for MANY people who have overcome it and successfully lost significant weight and maintained a healthy weight, ELIMINATING trigger foods, being vigilant about portion sizes, nutrient content and, to some degree, calories IS ESSENTIAL to this success and does NOT result in some miserable life. I identified my issues with emotional eating and trigger foods and lost 70 pounds through eating a VERY strict diet of clean, whole foods about 95% of the time, and exercising vigorously EVERY day. Is my quality of life somehow lessened because I don't drink soda, eat baked goods or processed meats and snack foods? Oh, sure, it's miserable being me, sleeping like a log every night, jumping out of bed full of energy every morning and running circles around people half my age at the gym every day. I DO love what I eat: lean protein, fresh fruits and vegetables, green tea and water. And I were to "eat what I love," or, USED to love, as the author preaches and went back to a stack of pancakes with syrup every morning for breakfast and let my "urges" lead my eating choices and habits, I'd be FAT again within three months. This article is so off the mark it's not even funny.
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William Anderson LMHC
Licensed Psychotherapist, Weight Control Expert
03:38 PM on 04/11/2012
You have done an absolutely great job! Congratulations to you are in order as well as thanks for such a friendly and informative message. Many people will benefit from it.

With the blogger's teachings, people who find her advice impossible to follow would feel like failures and freaks unless they heard from us, people like them, with our message. Regarding the "spamming", I know that some resent it, but I care more about reaching those who benefit from what I teach. They write and email and thank me for informing them about my work. As long as I am helping people, I know reaching them this way is the right thing to do. Thanks again for your message.
08:24 AM on 04/12/2012
Hi, like William, I just wanted to compliment you on your message. XLNT Post
08:23 AM on 04/12/2012
Are you familiar with any Apple Cider Vinegar Benefits within your treatment platform?
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William Anderson LMHC
Licensed Psychotherapist, Weight Control Expert
10:25 PM on 04/12/2012
I am familiar with science,