Tuesday, July 17, 2012

What Every Diet Study Needs - The DIET Score

Yesterday I lamented about the regular publication of short term and medium term diet studies and how ultimately they add little to no true value to society in that short term losses in no way, shape, or form guarantee their long term maintenance. Given that people seem capable of putting up with the most god-awful and inane diets around, being able to put up with a study protocol for a few months seems a given. It's what happens once the study's over that would truly add clinical value.

Now I realize that dollars don't materialize out of thin air, and that the likelihood is that good idea or not, we're still not going to see an automatic shift from short term, to long term data reporting. To that end, I'd like to offer a work around.

Before I get to it, some non-evidence based experiential theory,
If you don't like your life when you're losing weight you're going to gain it back!
The ability of a body to gain weight isn't something that's "curable", and therefore if weight's the outcome being measured, treatment must be continued forevermore if results are to be maintained. If treatment's too much of a misery, if the diet's too strict, too sparse, too confusing, too anything, well I'm betting it's not going to be too lasting.

Even more simply put,
Weight lost through suffering will almost certainly be regained.
So if my purported truisms are in fact true, why is it the that I have never seen any consideration of dietary quality of life in a weight loss study's methodology and evaluation?

The way I see it, if there were a measure with which dietary satisfaction could be evaluated, even if it's a short term study, you might get a sense as the liveability of the diet and the lastability of its affects. If everyone in the study felt the intervention was a misery you might gather there'd be a damn good chance the intervention won't be long lasting. On the other hand, if the majority reported an intervention as being enjoyable, you might think more folks will continue with it long term.

So I'd like to propose the Diet Index Enjoyability Total (DIET) score whereby 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 represented lives that could actually be enjoyed and low scores represented the usual under-eating, over-exercising, highly restrictive, quality of life degrading, misery that are most modern day diets.

What sorts of "enjoyability" items could be scored?
  • Hunger
  • Cravings
  • Feelings of fullness/satisfaction
  • Need to cook special meals for other family members
  • Ability to still eat out with friends and family
  • Energy levels and feelings of general well-being
  • Complexity of dietary requirements
  • Dietary flexibility vs. monotony
  • Rigidity of dietary requirements (ie forbidden foods/food groups and impact on quality of life)
  • Expense/cost of dietary requirements (ie expensive foods, supplements, etc.)
10 items yielding a score of 100. Now scores wouldn't necessarily correlate with degree of loss, but I'd be willing to bet, the higher the score, the greater the long term utility of the diet which ultimately matters far more than the amount of initial loss.

Any of my obesity researcher readers willing to take this on?  I'll happily help!

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  1. I'm not sure about the idea that you'll gain it back if you don't like the method of losing. My reasoning is: people swap diets! If you lose on diet #1 (say, unlimited veges and meat - my current method) and reach a "goal weight" then swap over to say eating anything and daily weighing with an emergency red line weight then as time goes on, your method of losing becomes less important. You're maintaining.

    Nice theory though. I think that 80% of weight loss is in the mind, people are not machines that act as they are told all of the time.

  2. This will force all diets into one mould, provide research, with no hope of a solution.

    What about those of us who think sugar, flour, wheat, msg, Omega 6 seed oils (chemicals, lubricants, paint thinner), and edible ( or eatable) manufactured products are not real human food? No desire to eat, no deprivation. You people can eat what you want. I will eat real meat and vegetables. Perhaps the odd potato. Real food rebellion.

  3. I think this is a fantastic measure for the current mind set of the average dieter out there. !! The lazy-that's-no-fun-I'm-hungry overweighties out here want to know they won't be too "uncomfortable" while dieting. This kind of indicator may help some people rise to the occasion and start something that reverses their thinking that the newest "cookie diet" or 'just drink this shake diet" or "sprinkle this" is gonna enhance their overall health in the long run.

  4. I think Volumetrics honors many of the things you listed including hunger, fullness/satisfaction, flexibility, cost, etc.

  5. Monisha1:36 pm

    I think this is important - as a psychological researcher, i'd add one caveat - people's ratings of satisfaction with various things they have done tend to be inflated and somewhat overly positive (teaching evaluations in my department range from 5 to 6 on 6 point scales - we're good at what we do, but not that good). so development of this type of instrument would need to involve some careful considerations about when the assessment is taken. Assessing during the diet, rather than at the 'end' when people are 'through losing weight' would be important, methodologically, as it will at least separate the joy of achieving a weight-loss goal in pounds from the experience of living in one way or another.

  6. As a natural nutritionist, AND as a person with a history of obesity (successfully conquered!), I have to say that I don't always agree 100% with what Dr. Freedhoff says, but I do agree totally with this concept.

    People will simply NOT stay on a diet that they are not happy on. Because we are all special little snowflakes, each person will have to find the diet that scores the highest for them, personally. For that reason, I don't think that this will "force all diets into one mould", as FredT thinks. Some people prefer a more vegetable based diet. Some prefer a diet heavier in animal protein. As long as a diet is scoring high for you, that is all that matters.

    I think the only thing that I might add is that a person would have to follow a certain way of eateng for a sufficient time before rating it. Changing habits ingrained by a lifetime of bad habits and advice is not easy, and is a HUGE step out of the comfort zone for most people. For example, most people used to consuming a diet rich in refined, starchy carbs and sugar are NOT going to like the first stages of learning to replace those foods with other options and would score it very low. However, once the fog lifts and the cravings subside and the body begins to really function as it should, these people will likely feel differently and will likely score the diet higher. Vice versa... a silly starvation or fad diet will score higher at first, but after a week or two of starving and becoming very bored with limited food choices (can anyone say, "cabbage soup diet") the dieter will score the diet lower.

    I think this could be applied to any diet. I recommend a primal/paleo diet to my clients, modified for their particular needs. If you are agreeable, I would love to test drive this with my clients here in Edmonton, AB. I can be reached by e-mail at enlightenedsolutions@shaw.ca


    1. Barb, You lost me when you said, "Changing habits ingrained by a lifetime of bad habits and advice is not easy...".

      Like many (if not most) people, this statement implies the underlying perception that those of us who are overweight eat poorly, eat to excess and exercise insufficiently. If we only changed our "bad habits" we would all magically lose weight.

      I beg to differ.

      I realize that the plural of anecdote is not data, but I know far too many people (myself included) who eat balanced diets that include very little in the way of refined sugars and simple carbohydrates, don't drink soda (diet or sweetened), engage in moderate, regular exercise and are still fat. Of course, I am a "good" fatty: I don't wear plus size clothing and when people meet me, they are struck by my short stature rather than by my dress size. Most people would not think of me in relation to the "obesity epidemic". I wouldn't be chosen to appear in a "headless fattie" photo. But I'm fat.

      And I can cut down on my non-existent bad habits until the cows come home and I will still be fat. I was a plump child and have been overweight throughout my life, aside from a week or two here or there of being "normal" weight as a result of some fad diet or another. (Yes, Yoni, I agree that fad diets are for the birds and if you hate it now, you won't continue and you'll regain.)

      Maybe I'm actually in the minority and most fat people are lazy, bonbon eating slobs, but actually, I don't think so.

  7. Interesting take on the subject. I lost 110 pounds by counting calories and swimming. In the beginning it was definitely hard but then it got easier. I was NOT on a diet, however, I was changing my lifestyle. I don't think diets are sustainable and that's why people gain the weight back. But changing bad habits and developing a regular exercise program is sustainable!