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Year Long 5:2 Intermittent Fasting Study Reports It’s No Better Or Worse Than A Horribly Restrictive Diet

Posted February 4, 2020 by Yoni Freedhoff

I started out planning to write about a different paper – a one year post intervention followup of people who had completed a prior year of being randomly assigned to 5:2 style intermittent fasting (IF) (2 days a week consuming 400-600 calories) vs. continuous energy restriction (typical of eating less daily) which showed that there was no difference between the two, but when I read it I realized the story was in the initial intervention, not the follow up.

The initial intervention involved randomly assigning 332 people to one of 3 dietary interventions:  Continuous (daily) energy restriction (CER), week-on, week-off energy restriction, and a 5:2 intermittent fasting pattern involving 5 days of habitual intake and 2 very low energy diet days each week.

Of the only 146 completers, no differences were found between the different diets in terms of weight loss, adherence, change in lipids, or fasting glucose.

And most of that is consistent with other studies of 5:2 IF which have found that it’s no better or worse than any other approach when it comes to weight loss and biochemical changes. But what’s not consistent is adherence being the same, wherein other studies tend to see more people quitting IF.

Digging the tiniest bit deeper into this two things stand out. Adherence was abysmal for both CER (49% drop out rate) and IF (58% drop out rate). But what was different here was what was involved in the CER arm. Women randomized to the CER arm were aimed at consuming only 1,000 calories daily for a year, while men were aimed at only 1,200 calories daily. That’s a life-suckingly low number of calories for anyone to be aimed at and honestly it surprises me that researchers (and peer reviewers) would think that degree of continuous restriction would be worthy of study.

All this to say, that people were just as likely to report adherence to a misery inducing 1,000-1,200 calorie per day diet as they were to a 5:2 IF approach does not reflect well on the enjoyability (and consequently the broad applicability) of 5:2 style diets.

And for the inevitable trolls, I’m not knocking 5:2 IF. If you love it, terrific! Don’t stop! But don’t anyone expect it’s a panacea for all comers.

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How Much Do You Like Your Diet? Given Adherence Likely Dependent On Enjoyment, Our Recent Paper Set Out To Quantify That

Posted January 6, 2020 by Yoni Freedhoff

Back in 2012, I wondered aloud about creating a scoring system for dietary enjoyment. I blogged about it a few times here and there, and happily, a wonderful team of researchers in New Zealand took notice. Now, thanks to the hard work of Michelle Jospé, along with Jillian Haszsard, and Rachel Taylor, the first step towards its formal use has been taken.

Our paper, A tool for assessing the satisfaction of a diet: Development and preliminary validation of the Diet Satisfaction Score, was published late last year and it details our Diet Satisfaction Score’s preliminary reliability and validity.

With the help of the 1,604 people (spanning 24 different countries!) who answered our survey questions, as well as 6 diverse experts (thanks to Melanie Dubyk, Kevin Hall, Scott Kahan, Silke Morrison, Marion Nestle, Sherry Pagoto, Arya Sharma and Ethan Weiss), we arrived on the following questions geared to address various aspects of dietary adherence and satisfaction

The simplest way to think of the Diet Satisfaction Score’s use is the higher the overall score (each question is answered on a 5 point Likert scale and the final DSS score is calculated by way of taking the mean of all available items yielding a total score between 1 and 5), the greater an individual’s satisfaction/enjoyment of that diet is. The hypothesis then would be higher scores correlating with better adherence and consequently better/sustained weight loss.

And that’s what our preliminary findings suggest whereby each 1-point higher Diet Satisfaction Score correlated with a 1.7 week longer diet duration. It was also found that compared with those who had abandoned their diets, those maintaining them reported larger losses.

The value of a simple and quick score like this to individuals would be as a means to assess how much (or how little) they were enjoying their diets taking into account more than just whether they like the foods they’re eating, but also the impact their chosen diet might be having on related aspects of life (socializing, time, cost, etc.). Those evaluating their new diets and finding their scores low, might explore means to tweak their diets, or to try new ones.

The DSS score’s value to clinicians would be as a quick means to screen their patients’ efforts and perhaps to use the tool to help trouble shoot, or to triage referrals to professional resources such as registered dietitians.

The value of the DSS score to researchers would be using this tool with shorter term studies as a means to predict whether or not their studied diets are likely to be sustainable (as who really cares how much weight a person might lose on a particular short term diet if few people would actually sustain it).

Of course now what’s required is the repeated use of the Diet Satisfaction score in a long-term prospective trial. The good news is that because the tool, like me, is diet agnostic, it can be administered with any and all dietary strategies. Should you be interested in using the Diet Satisfaction Score in your trial Dr. Jospe is the person to contact and her contact information is just this one click away.

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