Today’s survey is a followup to the one we sent out a few months ago. Since then we tweaked it on the advice of both those of you who responded, and some expert input. Even if you filled this out last time, we’d love for you to do so again as we’re trying to iron out the kinks and I think (hope) we’re pretty much there.
Back in 2012 I first posted my wish for there to be a questionnaire that would serve to help individuals and researchers determine how easy or difficult a particular diet would be to follow.
I called it the Diet Index Enjoyability Total or DIET score, and my hope was that by using a series of simple Likert scales (descriptive scales from 1-10), researchers could set out to evaluate a particular weight loss approach’s DIET score where high scores would identify diets that could actually be enjoyed, and where low scores would identify under-eating, highly restrictive, quality of life degrading, dieting misery. This would be useful both to individuals who could use the DIET score to evaluate whatever approach they were considering, but might also serve as a surrogate for shorter term diet studies to give a sense as to whether or not there’s a low or high likelihood of long term adherence to a particular study’s strategy.
I’m happy to report that the first work on using the DIET score has been conducted by Michelle Jospe at the University of Otago in New Zealand as part of the SWIFT trial, and her and Jill Haszard‘s early look at the data is promising.
Part of the process required to validate a questionnaire involves a qualitative review to see whether or not it’s easy to use, comprehensive, and unbiased, and this here is our second kick at that can.
To fill out the survey, and again, it’ll take less than 2 minutes, just click here and thank you very much in advance!
There was a lot of buzz last week about a new study that purportedly found that “fast initial weight loss may be key to diabetes prevention“.
I say purportedly because the reporting wasn’t about a published study, but rather a presentation given to the European Association for the Study of Diabetes (EASD) 2018 Annual Meeting on the to be published one day PREVIEW study.
The presentation reported that 3 years after an initial rapid, induced by meal replacement, weight loss, by way of 4 different dietary strategies, 96% had not developed type 2 diabetes.
This was contrasted apparently with the results of the Finnish Diabetes Prevention Study (DPS) and US-based Diabetes Prevention Program (DPP), neither of which included that initial rapid 2 month meal replacement loss, and where participants without diabetes at 3 years in the DPS and DPP were 91% and 86%, respectively.
So yes, the PREVIEW results were a touch better.
Or were they?
Whereas the DPS and DPP studies had tremendous retention of participants (92% and 92.5% respectively), PREVIEW’s results come from just 41% of initial participants with 59% being lost to follow up at 3 years.
Which leads me to wonder whether PREVIEW’s results are worthy of much publicity, as that’s a tremendous loss to follow up, and it’s quite plausible that the people most likely to follow up 3 years later, are the ones who did the best in sustaining their losses. I suspect therefore, that even here, success is dependent simply on adherence, and not on weight loss modality.
Finally, as always, I’ll point out, that there is no one best way, and reporting like this, whether on a study with incredibly poor retention or otherwise, suggests to the public and to health care professionals that there may be one right or best way, despite the fact that different strategies will work differently for different people, which I would argue in turn, undermines patient care.
Oh they’re out there.
Tunnel vision physicians who believe that everyone should be vegan, or be intermittently fasting, or in ketosis, or on an incredibly low-fat diet, or vegetarian, or low carb high fat, – and I’m sure the list goes on.
It’s a head scratcher for me because a physician’s training ought to have them know better.
Because for virtually every medical problem, multiple therapies and therapeutic modalities exist. And because physicians know that some drugs work better than others with different patients – sometimes predictably, and sometimes unpredictably, and that sometimes people have adverse reactions to certain drugs that require them to try alternatives.
Diets are the same.
Whether for weight management, general health, or the treatment of particular medical conditions, certain patients, sometimes explicably and sometimes not, will do better with different diets, both in terms of the impact that diet has on whatever they’re trying to treat, but also on their ability to enjoy that diet enough to sustain it long term.
And so even if there were a scientifically proven best diet for a particular issue (and for weight, plainly at this point, there isn’t), there’ll still be some people for whom it fails, and some people for whom its adverse effects on their lives leads to its discontinuation, and if they happen to be on that diet because they’re following or seeing one of those MDs who is so stuck on there being only one diet to rule them all, I guess they’re just out of luck.
So what drives those MDs? I think the answer varies. For some it’s likely the extension of their own personal experience and success with a particular dietary approach. For others, it may be the consequence of literal or intellectually sunk costs. And finally some may not have sufficient background to evaluate much on their own and instead simply parrot an eloquently delivered diet zealot’s talking points (perhaps especially in the cases of MDs converted by other MDs). But regardless of why one thing’s for sure, the promotion of one right or best diet isn’t good medicine, it compromises patient care, provides oxygen to the fire of fads, serves as catnip for publishers, the media, and the public, and solidifies the notion that there are dietary demons and deities, all of which in turn torches the hope of improved nutrition related scientific literacy in society.
Nutritional populism is a bad look irrespective of which diet it happens to be promoting.