"Lose 40 pounds in two weeks!" "Burn fat fast with our new protein shake!" "Lose weight fast!" These are the enticing promises that bombard us daily, fueling a multi-billion dollar weight loss industry. The weight loss market was worth an estimated $72 billion, including best selling books, meal plans, powders and pills, all claiming to hold the secret to weight loss. But are these claims true and, more importantly, are they sustainable? The reality is often far more complex. Research has shown that on average dieters lose only a small amount of weight and most gain the weight back in the future. This is because fad diets are difficult to maintain in the long term and do not often result in weight loss or other promised benefits.
What is a Fad Diet?
A fad diet, as defined by the Centers for Disease Control and Prevention (CDC), is any weight loss plan that promises quick results with temporary nutritional changes, the promise of fast weight loss, no need for regularly scheduled exercise, and the intake of limited calories and healthy foods. These diets gain popularity quickly, similar to fads in fashion, without being a standard scientific dietary recommendation. Fad diets are often nutritionally imbalanced or highly restrictive, forbidding entire food groups or allowing unlimited quantities of a single food.
Recognizing a Fad Diet
It can be challenging to distinguish a legitimate weight loss approach from a fad. Here are four ways to recognize a fad diet:
- Restricting or avoiding entire food groups: Eliminating certain foods from the diet may result in weight loss due to calorie restriction. However, it may also come at the cost of overall health and well being. Eliminating foods that have demonstrated to have positive health benefits, such as grains, dairy, and oils, can result in nutritional deficiencies followed by short- and long-term consequences. Additionally, starting a new elimination diet induces a “last supper mentality” in which dieters binge certain foods when there is a looming threat of deprivation. Our diets should include a variety of foods from all food groups in order to provide our bodies with the nutrients essential for life and growth. It’s important to remember that all foods fit into the diet in moderation - yes, that includes desserts!
- Requires you to purchase specific pills, supplements, shakes, bars, or meals: Although shakes, bars, and pre-packaged meals may make your life easier initially, it is a difficult lifestyle to maintain in the long term. With any new diet, you should always ask yourself, “Can I eat this for the rest of my life?” Additionally, supplements are not closely regulated and have not necessarily been proven to be safe and effective. annually are attributed to adverse events related to dietary supplements. Keep in mind a food first approach before ingesting possibly unregulated substances.
- Based on testimonials and exaggerated promises rather than evidence-based research: As the saying goes, if it sounds too good to be true, it probably is. Most fad diets fail to live up to their promises. Initial weight loss usually comes from water, muscle and bone, not fat. Research has shown that individuals who lose weight quickly are more likely to regain the weight in the future. Gradual weight loss of 1 to 2 pounds per week is generally recommended for more sustainable results. Additionally, anecdotes and before-and-after photos often portray the exceptional cases. The diet should rely on multiple, peer reviewed scientific studies rather than anecdotal claims.
- Ignores the importance of exercise to maintain a healthy lifestyle: Regular physical activity is just as important as a healthy diet in maintaining good health. The Physical Activity guidelines recommend at least 150 minutes of moderate intensity physical activity per week for adults. Achieving and maintain weight loss often requires more than 150 minutes per week. Look for activities that you enjoy doing, such as dancing, biking, and gardening.
The Allure of Initial Weight Loss
Many fad diets promise rapid weight loss, and this initial success can be very appealing. High-protein diets are also called low-carbohydrate diets. Most high-protein diets are also high in fat. Many of these diets become popular because of sizable initial weight loss. Because high-protein diets are low in carbohydrates, they tend to promote urine output, which causes the loss of water weight. This diuretic effect may create a false sense of weight loss.
During the first two weeks on a high-protein diet, the carbohydrate intake is lower than normal, and some body fat is burned. However, carbohydrates are necessary for proper body functions like energy production, energy storage, proper glucose usage, and muscle tissue health. Without carbohydrates, the body does not burn fat completely, and substances called ketones are formed and released into your bloodstream. This condition called ketosis may make restricting calories easier because it often depresses your appetite and may even cause nausea. Ketosis is the body's way of adapting to a shortage of carbohydrates. It can be hard to sustain and is unhealthy long term.
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Common Fad Diets and Their Implications
Let's examine some popular fad diets and their potential impact on initial weight loss and overall health:
Ketogenic Diet
The Ketogenic diet has grown in popularity over the years. Despite its origin as a treatment for epilepsy, it has now become a more common diet for weight loss. The hallmark of this diet is the high amount of fat and low intake of carbohydrates. Carbohydrates are the body's main source of fuel but when this is severely restricted, as it is on a true keto diet, the body is forced to be fueled by another source (fat). The breakdown of the standard ketogenic diet is 70% of daily calories come from fat, only 20% for protein, and 10% carbohydrates. The severe decrease in carbohydrates can cause the body to hold less water, leading to quick weight loss. Carbs are your body's primary energy source, limiting your intake of these may cause brain fog, irritability, fatigue, and constipation. Weight loss on the diet may not lead to long-term weight loss or maintenance. It eliminates healthy food from your diet, such as whole grains, fruits, and some vegetables. These foods are high in vitamins and minerals that your body needs. The diet does not differentiate between healthy and unhealthy types of fat. Higher protein needs after surgery may be hard to achieve with a standard keto diet which is predominately fat. High amounts of fat are not well tolerated by people after weight loss surgery, and fat sources tend to be rich in calories. Fat malabsorption may occur, leading to loose and frequent bowel movements, excessive gas production, and vitamin deficiencies.
Although the ketogenic diet has been called a fad diet, it can be effective for weight loss and may have benefits for people with prediabetes and diabetes. The ketogenic diet is a very low carb diet that works by lowering insulin levels and shifting your primary fuel source from sugar to ketones. Ketones are compounds made from fatty acids, and your brain and other organs can burn them for energy. When your body doesn’t have carbs to burn and switches to ketones, you’re in a state called ketosis. However, unlike other low carb diets, ketogenic diets don’t gradually increase their carbs. Instead, they keep carb intake very low so people following the diet stay in ketosis. The macronutrient distribution typically ranges from approximately: 55% to 60% fat, 30% to 35% protein, 5% to 10% carbohydrates. That means, in a 2000 kcal per day diet, the carbohydrate allowance would amount to approximately 20 to 50 grams daily.
Researchers note that though some research suggests it may benefit weight loss in people who are overweight or have obesity, the evidence isn’t strong enough to draw conclusions. More research is also needed to determine its long-term safety. Another review of research notes that while the ketogenic diet may be associated with certain benefits in the first 6 to 12 months, it did not result in additional benefits beyond that, suggesting these benefits may be temporary. Negative health effects include lower bone mineral density and increased risk of fractures, increased risk of kidney stones hypercalcemia (too much calcium in the blood) low parathyroid hormone, vitamin D, and alkaline phosphate (ALP) levels risk of impaired renal function.
Atkins Diet
The Atkins Diet, similar to the keto diet, is a low carbohydrate diet to aid in weight loss and disease prevention. Limiting carbohydrates may help reduce the amount of non-nutritive foods you are consuming. Fewer simple carbohydrates may help control your blood sugar, this is especially important for people with diabetes. This diet excludes many healthy foods, including fruits and vegetables, that provide essential vitamins/minerals and fiber in the diet. This diet also allows processed meats, which can raise your risk for heart problems and certain cancers. A low-carb diet may cause constipation, low blood sugar, kidney issues, and electrolyte imbalances. It is recommended that post-op bariatric patients avoid high sugar and high-fat foods as their bodies cannot break down or absorb these foods as well. *Certain vitamins/minerals may not be adequately absorbed by the body after bariatric surgery, it is important to take the vitamins and supplements recommended by a registered dietitian.
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The Atkins diet consists of four stages during which you can consume unlimited amounts of protein and fat: Phase 1 (Induction): During the initial phase, proponents recommend you consume 20 to 25 grams (g) of net carbs per day until you are 15 pounds (lb) or 7 kilograms (kg) from your goal weight. During this phase, your body begins converting fat into ketones and uses them as its main source of energy. Phase 2: You can eat 25 to 50 g of net carbs daily until you are 10 lb (5 kg) from your goal weight. Phase 3: This phase raises your net carb allowance to 50 to 80 g per day until you have met your goal weight and maintained it for 1 month. Phase 4: During the final phase, you can consume 80 to 100 g of net carbs daily to maintain your weight.
For stages 2 through 4, the Atkins diet asks followers to gradually add back their carbs in 5-gram increments to determine their “critical carbohydrate levels” for losing weight and maintaining it. Negative health effects The Atkins diet is associated with multiple negative health effects, including: risk of metabolic acidosis (when your body contains too much acid) risk of other metabolic side effects potential for urinary stone formation due to decreased urine pH and calcium balance risk of chronic kidney disease
Paleo Diet
The Paleo diet is designed to resemble the diet of human ancestors who relied on hunting and gathering thousands of years ago. This diet includes meat, fish, eggs, vegetables, fruits, nuts, seeds, herbs, spices, and healthy fats and oils. Foods excluded from this diet include processed foods, sugar, soft drinks, grains, most dairy products, legumes, artificial sweeteners, vegetable oils, margarine and translate fats. This diet was designed with a focus on improving overall health, including improving insulin sensitivity, lowering blood pressure, weight management, improving cholesterol balance, better satiety, healthy blood glucose levels, and overall lower risks of early mortality. This diet eliminates many processed foods that negatively impact our health. One study indicated a reduction of salt intake in patients with insulin resistance and metabolic syndrome and a lower intake of high-glycemic-index products. High consumption of plant products provides many anti-inflammatory benefits. This diet reduces carbohydrate intake, which is essential for several body systems, including brain function. May be expensive and difficult to sustain long-term. If you are an athlete or exercise frequently, you may not be consuming a sufficient amount of carbohydrates to optimize your performance. Overconsumption of red meat may increase your risk of cancer and heart disease (WHO) due to its saturated fat content. The paleo diet emphasizes vegetables and fruits, many of which are low in calories but may be large in volume. Choose lean protein options to avoid eating high-fat meats and dairy products, which may not be absorbed properly.
Vegetarian and Vegan Diets
A vegetarian diet eliminates meat from the diet. A vegan diet removes all animal products and by-products from the diet, including meat, dairy, eggs, and honey. These diets are adapted for a variety of reasons, including moral convictions, environmental consciousness, or improving overall health. Heart-protective benefits of vegetarianism include intake of legumes, high fiber whole grains, nuts, fruits and vegetables, and other low-glycemic foods. Plant foods tend to be lower in fat, sodium, and cholesterol, resulting in a positive effect on blood pressure. It can be difficult for some people to reach their protein goals, especially after surgery without consuming meat. Vitamin deficiencies can be common in both vegans/vegetarians and those with a history of weight loss surgery.
Research suggests that whole plant-based vegan diets may support weight loss. They may also have additional benefits, including helping prevent and manage chronic diseases, such as type 2 diabetes and hypertension, supporting the gut microbiome (the healthy bacteria that live in the digestive tract), and improving blood glucose levels. Following a vegan diet may potentially lead to nutrient deficiencies in: vitamin B12, vitamin D, calcium, zinc, iron, vitamin E, essential fatty acids.
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Weight Watchers (WW)
Weight Watchers (WW) is a weight loss program featuring a point-based system that gives a numerical value for foods, drinks, and WW recipes. There is an allotment of points per day based on your weight loss goals. They offer in-person meetings or online programs. It does not eliminate an entire food group. It can help people develop healthy habits and provide a community through their meetings. Some people find it difficult or frustrating to track your points, workouts, and weight as much as is required with this program. The program is facilitated by coaches, not physicians or other medical professionals. Some participants may not learn or truly understand the fundamentals of a healthy diet since they depend on the program to determine "points" for each food. Lifestyle modifications greatly benefit the maintenance of weight loss and weight maintenance after bariatric surgery. Lifestyle changes are a foundational part of the Weight Watchers program, which can be a benefit post-surgery.
Intermittent Fasting
Intermittent fasting is an eating pattern that includes periods without food or very little food that our glycogen stores are depleted. There are variations of intermittent fasting; 16/8 is one of the most popular. 16/8 intermittent fasting limits intake of food and drinks containing calories to 8 hours of the day, while fasting for the other 16 hours. You are allowed to drink water, zero-calorie beverages (black coffee and plain tea) during the 16-hour fast. Regardless of its label, most people experience a form of intermittent fasting during their sleep cycle. This diet does not outline nutrient-dense foods, it only limits the time frame for meals and snacks. For some, this may encourage overeating/ overindulging before or after fasting. This diet may be helpful for weight loss or weight control by limiting the time frame in which you eat.
On this diet, you eat as you usually would for five days a week and restrict your calorie intake to 500 to 600 calories for two days each week, resulting in an overall calorie deficit that leads to weight loss. The extremely low calorie allotment on the two “fast” days has led some to classify the 5:2 diet as a fad diet. Some of the possible negative health effects can include: fluctuations in free fatty acid levels, which can affect insulin levels, reductions in insulin sensitivity, increased risk of disordered eating.
South Beach Diet
Like Dr. Atkins, Dr. Arthur Agatston was a cardiologist interested in helping his patients lose weight sustainably without feeling hungry. He liked certain aspects of the Atkins diet, but was concerned that unrestricted use of saturated fat might increase the risk of heart disease. Therefore, in the mid-1990s, he created a lower-carb, lower-fat, high protein diet called the South Beach Diet, named for the area in South Florida where he practiced medicine. Although Stage 1 of the diet is low in carbs and very low in fat, the diet becomes less restrictive in Phases 2 and 3, which allow limited quantities of all types of unprocessed foods while keeping protein intake high. The diet encourages a high protein intake, because protein may burn more calories during digestion than carbs or fat. Protein stimulates the release of hormones that suppress hunger and help you feel full longer. While more research on the South Beach diet is needed, potential negative health effects can include: increased risk of ketoacidosis, hypocalcemia (calcium deficiency), fiber deficiency.
The Importance of Sustainable Lifestyle Changes
Overall, there is no one size fits all diet for weight loss. Fad diets do not take into consideration health history or individual lifestyle habits, such as exercise, sleep, and stress. What works for one individual may not work for another. There is no shame in wanting to achieve a healthier lifestyle. However, it must be achieved through lifestyle habits that can be sustained throughout the life cycle. In order to achieve a healthy lifestyle, you should follow a dietary pattern that meets your nutritional needs, includes a variety of foods, and fits your lifestyle and dietary preferences.
Diet success in weight loss and health benefits is most predicted by adherence and negative energy balance, regardless of the diet type. Fad diets, with their popularity and variety, may be useful to introduce obese individuals via a dietary plan tailored to their food preferences and lifestyle into long-term dietary and lifestyle changes under supervision by nutrition professionals. Indeed, a wide variety of diets aiming at gentle caloric restriction under supervision, including commercial, fad, and standard care diets, have shown considerable and comparable success and safety, both in the short-term and long-term. Comprehensive diet programs are more effective than dieting without guidance.
Building a Healthy and Sustainable Lifestyle
Here are some tips for building a healthy and sustainable lifestyle:
- Focus on whole, unprocessed foods: Prioritize fruits, vegetables, lean proteins, and whole grains. MyPlate is an easy-to-follow diagram that is used for creating healthy and nutritious meals. MyPlate consists of 4 sections - Fruits and Vegetables, Grains, Protein, and Dairy that represent the five food groups. Using MyPlate will make it easier to control portions and ensure you are eating a nutrient dense meal that is low in fats, salt, and sugar to maintain a healthy weight. My Plate encourages Americans to make half of the grains consumed every day whole grains. It recommends half your plate be fruits, and vegetables and encourages Americans to eat a variety of fruits and vegetables each day to ensure a nutrient dense diet. My Plate also recommends low fat (1%) or fat free dairy at each meal, low fat and fat free dairy has the same amount of calcium but much less fat. Daily protein portions are encouraged at each meal and should include lean and plant-based protein like beans and legumes. Fruits and vegetables should be eaten at every meal.
- Limit added sugars and saturated fats: Choose healthier food and beverage choices, such as nutrient-dense foods.
- Eat regularly: Waiting too long to eat can cause you to be so hungry that you overeat or binge on high sugar, fatty or salty foods. Eat several healthy, low-fat snacks if more than 5 hours pass before your next meal. As a general rule, try to minimize any long gaps during the day without fuel, keeping in mind that 5-6 hours between meals is the absolute max to keep blood sugar stable. Some people may even need to eat every 3-4 hours for optimal blood sugar management.
- Manage stress: Overeating for many is caused by stress and overscheduling. Take a deep breath and count to 10 before grabbing that cookie or other high calorie food.
- Track your progress: Keep track of your food intake and daily exercise on a calendar or smart phone to determine what is happening with your weight and energy levels.
- Stay informed: Know about the latest research so that you don't rely on fad diets, celebrities, TV infomercials, advertisements for quick weight loss products, or questionable web sites.
Exercise
150-300 minutes of moderate cardiovascular exercise each week is recommended for adults with an additional two days that include muscle strengthening activities. If you are not currently exercising walking is a good place to start, it's free and can be done anywhere. Weightlifting or resistance bands are examples of strength training exercises. Moving more and sitting less burns calories, improves mental health, aids sleeping, and assists with weight loss. Always consult a healthcare professional before starting a new exercise routine. Make exercise and mealtimes a MUST each day.