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

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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 The "treatment" paradigm is flawed, yet so pervasive that millions of people are trapped in outdated beliefs and behaviors, despite all of the evidence that it's not moving the majority toward healthier, happier, more vibrant lives.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.

Around the Web

The Center for Mindful Eating - The Principles of Mindful Eating

Mindful Eating as Way to Fight Bingeing - NYTimes.com

Mindful Eating | Psychology Today

Mindful Eating Strategies

How to Master the Art of Mindful Eating :zenhabits

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