Dr. Lona Sandon

Nutritionists stress healthy eating for weight loss rather than dieting

 It fits all the criteria for a “four-letter” word. The very name conjures up unpleasant feelings, and it’s not something you typically talk about in polite society. Yet the “d-bomb” will be dropped countless times over the next few weeks as individuals resolve to undo the damage of their recent holiday eating binge by going on a diet. (See related story below.)

Actually, if dropping five pounds gained over the holidays was all that needed to be done, then a diet might be the appropriate answer. Unfortunately, the majority of Americans need to shed much more than a few unwanted pounds. In fact, according to the latest statistics from the Centers for Disease Control and Prevention, 33.8 percent of American adults are obese, and a similar percentage is overweight. Additionally, 12.5 million children and adolescents … approximately 17 percent … are also clinically obese.

How We Got in This Mess

Lona Sandon, RD, MEd, an assistant professor in the Department of Clinical Nutrition at the University of Texas Southwestern, said in comparison to 30 years ago, “People are consuming about 300 calories per day more than we did back then. We’re eating more and burning less … it’s a perfect recipe for weight gain.”

She added that plentiful food sources are another issue. A generation ago, food was consumed at the table. Today, it can be consumed on the go and at any hour. “Food was reserved for a meal. Now, some people eat all day long. We’ve gone snacking mad. There’s not a good physiological reason why we’re eating all day long,” stated Sandon, who is a national spokesperson for the Academy of Nutrition and Dietetics (formerly the American Dietetic Association).

Nixing the Quick Fix

With two-thirds of the American population battling their weight, most nutritionists and registered dietitians are calling for a different approach to eating other than restrictive diets and weight loss gimmicks.

Gluten-free food is the latest craze. South Beach and Atkins have their own disciples, and a host of other options promise fat will simply melt away when you take a specific pill, eat a certain berry, or drink a specially-formulated metabolic potion. But nutritionists argue these approaches ultimately fail even if there is short-term success. 

“If it’s a fad diet, the promise is quick fixes where you don’t have to exercise or where you cut out certain food groups. People should avoid those,” said Sandon. “These are ones that are not going to be sustainable for the long run. They’re seen as temporary … not as a lifestyle change.”

In fact, Sandon generally discourages meal plans that eliminate entire food groups, call for exotic foods or require supplements unless there is a medically sound reason behind the decision. Gluten-free makes perfect sense for someone with Celiac disease … not so much for someone who is trying to lose weight. The mystic, magical Chinese goji berry is another quick fix that makes Sandon laugh. “When was the last time you saw goji berries anywhere?” she questioned. “Things like that should trigger people to think, ‘hmmm … maybe I should find something more reasonable.’”

Supplements, Sandon noted, should be approached with caution. While B-12 does work in the body to help break down carbohydrates and fats to convert them to energy, the effectiveness of a pill or shots has not been proven in weight loss. “You should not be getting B-12 shots unless your doctor has documented a B-12 deficiency,” she said. If that’s not the case, she added, “I’d say get your B-12 from real food like a lean steak or low-fat milk.”

Sandon continued, “Certainly in cases of chronic diseases — diabetes, rheumatoid arthritis, heart disease — there’s probably some benefit to having nutritional supplements.” However, in the general population, she noted, “When you look at supplement research, it’s not all that promising, and some recent research has been fairly negative, actually.” The unregulated nature of the business, she said, means that consumers have no real way of knowing which products are good, which are bad, and which ones are actually harmful.

Breaking Down Barriers

So what is a better solution to achieving sustained weight loss? The first order of business is to listen to patients and to address the barriers that have caused them to get off track in the past.

“Motivational interviewing helps resolve ambivalence,” said Melissa Joy Dobbins, RD, MS, CDE.

Dobbins, a dietitian and diabetes educator at NorthShore University HealthSystem in Evanston, Ill. and a national spokesperson for the Academy of Nutrition and Dietetics, added, “The premise behind it is the patient has the answer … you just have to draw it out of them. You can’t just hand somebody a standard diet. It’s not going to help solve their ambivalence.”

Neither, she continued, is dismissing the reasons behind past failures as mere excuses. “Look at excuses as barriers,” Dobbins said. When a patient says they know they should exercise more but can’t afford a gym, she likes to look at this as an opportunity to help empower patients to address their individual challenges. “What could you do that would increase your activity but not cost anything?” she said she might ask. Perhaps the patient used to walk with a neighbor or owns an old exercise video that was fun. “You get them to think about realistic solutions instead of beating themself up with their own excuses.”

Time is another huge barrier. Sandon noted that many people don’t have time to do a lot of meal prep or to even plan healthy menus or go to the grocery store. Convenience, after all, is one of the huge lures of fast food.

Dobbins agreed that being tired and not having time are two issues that come up again and again. “I think it’s really important to acknowledge that and validate it. What is it they say? People don’t care how much you know until they know how much you care.” She added that sharing personal experiences could be a good way to make that connection. In her case, she’ll let patients know, “I have a three-year-old and a 12-year-old and a husband who travels. I know there’s no time for breakfast so that’s why I always have a bowl of hard-boiled eggs in my refrigerator.”

Sometimes, she continued, it’s just a matter of giving people simple solutions and letting them know little things add up. “You’ve got to move people past thinking about it to acting on it.”

Probably the biggest barrier to sustainability, however, is the cardboard taste of many diet food products. “Taste is the number one driver,” said Sandon. “If it doesn’t taste good, people won’t stick with it.” She added that meals are often associated with family and social events so naturally people want them to be enjoyable. “Somewhere along the line, we got this perception that if it’s good for you, it doesn’t taste good; and that’s simply not true.”

What Does Work

Sandon favors food options that have some flexibility and sound science behind them. She likes the support system and social connection that comes with Weight Watchers, which doesn’t limit any specific food. She also favors DASH (Dietary Approaches to Stop Hypertension). “It’s actually aimed at preventing hypertension, but it’s a diet that is high in fruits and vegetables, low in saturated fat and total fat but does include things like nuts and seeds that bring in the heart-healthy fats,” she explained. Sandon added, “They are all nutrient-rich foods you would find right there in the regular grocery store.”

Dobbins said it’s important for people to know they can start small and build on their success. She tells patients a healthy breakfast really is the most important way to start the day. “I would say 95 percent of my overweight clients were skipping breakfast, eating a piddly lunch, a huge dinner and then snacks. You’ve got to stimulate that metabolism first thing in the morning and spread those calories throughout the day,” she counseled.

She added that most people eat too many carbohydrates and don’t balance out with protein. “A traditional high carb breakfast like cereal and milk won’t hold you,” Dobbins explained. “If you’ll spread your protein better throughout the day, you’ll have more hunger control.” Easy breakfast options, she continued, include hard-boiled eggs, half a peanut butter sandwich, reduced fat cheese and whole grain crackers, or eggs with a whole grain English muffin.

Like Dobbins, Sandon said small steps make a big difference. “It’s not getting up for a second helping … or if you do, take half of what you normally would.” She added that portion sizes are out of control. “We have no idea what we’re eating. We’re terrible judges, and we always underestimate.” To help put portions in perspective, she will have people take out measuring cups in the beginning so they see what a half-cup of vegetables actually looks like.

Sandon said she also suggests patients make little changes like eliminating 100 or 200 calories a day. “When you cut out too many calories, you actually stimulate hormones that tell you, you are hungry.” Often, a few days of hunger leads to either giving up, eating to make up for lost time, or both. Ultimately, Sandon said it’s critical to get people away from the roller coaster dieting mentality. “That really weighs on somebody’s psyche after a time, and they lose motivation.”

Dobbins also said people need to cut themselves some slack. “Everybody knows we’re supposed to get more fruits and vegetables. They think it needs to be fresh, and they’re feeling pressure that it needs to be organic. Even I find it difficult to put fresh fruits and vegetables on my family’s plate every night. Stop the insanity. Have some fresh, but it’s okay to have dried fruit. It’s okay to have frozen and canned vegetables.”

Refer, Refer, Refer

Dobbins and Sandon recognize the time limitations most physicians have during a routine appointment. For that reason, they strongly suggest referring overweight and obese patients to a registered dietitian who can help the individual customize a plan.

“The more personalized you can make a meal plan to fit someone’s lifestyle, the more likely they are going to be able to follow it,” Sandon pointed out. “That’s where physicians typically don’t have time.”

Dobbins added, “We have the time, and we are very cost effective. The 30-60 minutes we can spend with a patient can take them so much further. I think getting the patient empowered and motivated right off the bat is key.”

She added that physicians can not only find registered dietitians in their vicinity but can also find those who specialize in various food issues by going online to the Academy of Nutrition and Dietetics website at www.eatright.org.

Related Story

 Resources to Help Patients Establish Better Habits

Registered Dietitian and Certified Diabetes Educator Melissa Joy Dobbins said there are a number of good resources to help individuals get off to a good start. A few of her favorites are:

• ChooseMyPlate.gov: The plate has replaced the traditional food pyramid in the hopes that it will visually make more sense to individuals. The site also has a number of interactive tools. “What I really like is the ‘Ten Tips’ nutrition education series. It’s 10 simple suggestions for each topic,” Dobbins said.
• EatRight.org: This is the website for the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). The section for the general public includes statistics, healthy alternatives for snacking, reviews of various diet plans, meal plan options, time-saving tips and recipes.
• NutritionBlogNetwork.com: “This lists all the different blogs by registered dietitians. You can look up by name or category. A lot of these blogs are very food oriented and recipe oriented.”

There are also a number of sites that provide calorie and nutritional information for popular chain restaurants that are helpful when making choices while dining out.

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