Weight-Loss Diets Believed Harmful : Nutrition: The industry is unregulated and untamed, critics say. Liquid formulas, especially, are cited as culprits, but they have their defenders.
When Dr. C. Wayne Callaway, an endocrinologist speaking on behalf of the American Board of Nutrition, testified at a congressional hearing on the weight-loss industry, he told the committee that “the weight-loss business in the United States has gotten out of hand.”
Callaway was not alone. Nancy S. Wellman Ph.D., a registered dietitian and president of the American Dietetic Assn., whose 59,000 members comprise the nation’s largest group of food and nutrition professionals, also testified at the hearing. “Too often the emphasis is on the pocketbook not the paunch,” she told a subcommittee of the House Committee on Small Business.
Because the $33 billion-a-year weight-loss industry is largely unregulated, it has operated like an untamed, runaway horse for decades and accountability, the critics believe, is long overdue.
“The issue with quick weight-loss diet programs is that they are acting on response to market demand,” said Marsha Hudnall, a registered dietitian interviewed at an American Dietetic Assn. conference in Los Angeles recently.
“There is a professional responsibility to design (diet) strategies based on scientific evidence. According to the guidelines of the American Dietetic Assn., ideal weight is based on 10 calories per pound of current weight, which means that a person weighing 150 pounds should consume a total of 1,500 calories a day. Many of these programs are much lower than that with calorie levels anywhere from 1,000 to 1,500 calories and some popular liquid diets are even lower, with 400 to 800 calories a day,” Hudnall said.
Wellman thinks that very low calorie diets are not for people with medical conditions such as active cancer, insulin-dependent diabetes, renal failure, cardiac dysfunction or severe psychological disturbances. “These diets should not be used by infants, teen-agers, pregnant and breast-feeding women, or older Americans,” she added.
Nutri/Systems, a portioned meal plan, Optifast, a liquid formula diet program and Slim Fast, a partial liquid diet program (the program involves two glasses of liquid formula and one meal a day) are among those being criticized for making use of low calorie intakes during weight loss.
Dr. Stuart Shapiro, former Philadelphia commissioner of health and current national director of Nutri/Systems, insists that the program is medically safe. “We don’t consider ourselves a ‘fast’ weight loss program,” Shapiro said. “We provide a nutritionally balanced meal plan that meets safe calorie levels recommended by major health organizations.
“Medical literature is clear that weight loss programs should be tailored to individuals, and for many individuals 1,000 calories a day may be appropriate while for others 1,500 may be. Nutri/Systems is a ‘comprehensive’ weight loss and management program tailored to individual needs.
“Weight loss of 1 1/2 to 2 pounds per week (about 1% of body weight per week) until ideal weight is achieved is followed by a maintenance program using portioned meals twice a week and continual access to nutrition classes,” Shapiro said.
William Bush, senior vice president of Sandoz Nutrition/Optifast, pointed out that Optifast is a 15-year-old program originally developed for hospital treatment of the grossly obese. The program is now available primarily through hospital outpatient clinics and is intended for patients who are 30% overweight. (Obesity is categorized as being 20% above ideal weight.)
Bush contends that Optifast has been unfairly “lumped in with storefront operations that do not offer the medical supervision or the comprehensive program to teach people how to keep weight off. Our average patient loses 45 pounds in 26 weeks, and at the end of 18 months they have maintained (loss of) two-thirds of that weight.”
The data, Bush said, comes from “large multicenter trials, one involving 1,500 patients and the other 500.”
The Optifast program can cost a patient from $2,500 to $3,000. The first 12-week phase of the three-phase program begins with a 420 to 800 calorie formula diet followed by gradual introduction of “normal” foods. Behavior modification, exercise, lab tests and supervision by credentialed professionals and physicians also are provided.
Some low-calorie diets have been useful as short-term methods for reducing weight in the dangerously obese and in persons with hypertension, diabetes or high blood levels, Callaway pointed out.
The congressional hearing in late March was just the beginning. According to Callaway, the “warning has been sounded” and there are stirrings within the Federal Trade Commission and the Food and Drug Administration for further investigations.
“We must better define roles of the FTC and FDA in regulatory aspects of such diets,” said Callaway.
The hullabaloo started three months ago when 18 Florida women filed suits against Nutri/Systems, claiming that rapid weight loss affects bile in the gallbladder and contributes to the formation of gallstones.
According to Callaway, gallbladder problems occur with “extremely high frequency” when people go on low calorie diets. “A study . . . published in the Archives of Internal Medicine showed that in eight weeks of dieting on a 500 calorie diet 25% of dieters developed gallstones. In contrast, equally overweight individuals who did not diet showed no development of gallstones.”
Callaway also pointed out that many diet program promoters blame obesity and not the diet for obese persons’ gallbladder problems.
According to Shapiro of Nutri/Systems, there “is no evidence linking gallbladder disease to weight-loss programs like Nutri/Systems.”
“We will defend against (the suit) and we will prevail,” said Tim Hermeling, public affairs director for Nutri/Systems.
The comprehensive weight-loss program provides a $49 to $64 weekly food and beverage package for an initial 1,000 to 1,500 calorie intake per day, followed by a yearlong maintenance diet, adding behavior modification and education to the program. A Nutri/Systems nutrition specialist (not all of them registered dietitians or licensed practitioners) meets with the client once a week to monitor weight loss.
Some low-calorie commercial diet plans call for 500 to 1,000 calorie daily diets, which is considered lower than is safe for supplying all the nutrients needed for good health, according to the Recommended Daily Allowances, which set standards for nutrient intake.
A position paper published in the May issue of the Journal of American Dietetic Assn. states that rapid weight-loss programs are recommended only for dieters who are at least 30% to 40% overweight. Wellman stressed that rapid weight loss should be undertaken only with the supervision of a qualified health team. “The most significant drawback to an unsupervised very low calorie diet is the potential for life-threatening side effects,” she said.
“Loss of body protein may affect cardiac function and could be related to heart failure. . . . Eventually all dieters need to learn to be realistic about their food choices,” Wellman said.
Callaway, who practices internal medicine, endocrinology and metabolism in Washington, where he is also associate clinical professor of medicine at George Washington University Medical Center, expressed similar concerns to the committee: “If you are going to engage in something potentially hazardous you need to have people who know how to intervene.”
Callaway cited the case of some 60 people who had died in the mid-1970s shortly after discontinuing their liquid protein diets. Sudden deaths, he said, still occur. “The fact that we have not heard about them until recently reflects our lack of any type of tracking mechanism. We have no way of knowing how common these occurances are,” he said.
Some of the diets out there, Callaway asserts, are ineffective. “Most of the evidence suggests that the more you lose the more quickly you gain,” Callaway told The Times. Oprah Winfrey, who lost 67 pounds on a liquid diet plan and regained some of it back, is often cited as a victim of the yo-yo syndrome common to fast-loss weight programs.
The phenomenon of losing and regaining has been scientifically established since the early 20th Century, Callaway said. But little of the knowledge has been incorporated into the currently available commercial loss programs.
Low calorie diets, Callaway explained, start out with loss of water, which then is retained as the body adapts to starvation. The metabolic rate slows down (nature’s way of preserving fat in the face of starvation or famine). “Unfortunately, it is accompanied by symptoms that severely compromise one’s quality of life,” Callaway said. Symptoms include fatigue, depression, dry skin, sleeplessness, constipation, a fall in blood pressure, dizziness, bloating and even loss of consciousness. Some studies indicate that with each subsequent attempt at dieting weight loss is slower and rebound weight gain occurs more rapidly.
Starving also leads to stuffing and binge eating, as found among bulimia victims.
Callaway called for qualified supervision of weight-loss plans. At the congressional hearing Callaway said that many people successfully diet on their own if they also increase physical activity or cut back on snacks and fats.
A second alternative is to see a registered dietitian. “There are more than 50,000 registered dietitians who are qualified to provide dietary advice,” Callaway said. Furthermore, rapid weight-loss plans should be restricted to individuals who truly need to lose weight for health reasons and who have some medically justifiable indication for losing weight rapidly, he said. “In all cases it is imperative that there be medical supervision and that the medical supervision be competent to monitor the types of complications that are known to occur.
“A number of commercial programs in which physicians are not involved refer to their staff as ‘certified’ nutrition counselors, behavioral therapists or whatever. In most cases, the only certification comes from the company offering the program. . . . (Consumers) have no existing effective mechanism for tracing the incidence and severity of complications due to unsupervised and poorly supervised weight loss programs. At present, our main recourse is through the media. For the victim, the only recourse is through civil suits. Surely we can improve upon this situation,” Callaway told the subcommittee.
Among his other recommendations to the subcommittee:
--Hold weight-loss programs accountable for their diets’ outcomes by documenting dietary complications of clients and stop blaming the dieter for their failure.
--Establish a registry or clearinghouse for collecting data of adverse effects on clients of commercial diet plans and make the information available to the scientific community for evaluation.
In his recent book, “The Callaway Diet: Successful Permanent Weight Control for Starvers, Stuffers and Skippers,” (Bantam Books: $17.95) Callaway gives reasons why starving, stuffing and skipping are counterproductive methods for losing weight. He also provides a four-step personal dieting profile that determines the dieters’ specific weight loss challenge.
The book first guides the dieter through a new formula for determining healthiest weight range and body fat distribution. Secondly, it helps define which diet approach will be most effective. Diet history, current metabolic score and eating and activity patterns are determinants.
The menus developed are for diet levels of 1,400 calories, 1,600 calories, 1,800 calories and 2,000 calories per day, with exercise recommended. Callaway considers the program a sensible approach to dieting because the calories provide the necessary RDA’s for a balanced diet while allowing overweight individuals to eventually lose weight because they are eating less and exercising more.
Callaway’s rules for eating:
1--Eat three regularly scheduled meals a day and no snacks.
2--Don’t skip meals.
3--Balance meals throughout the day, allowing 25% of the calories for breakfast, 30% to 35% for lunch and the remainder for dinner.
4--Drink no alcohol during the first six weeks, as alcohol is known to trigger bingeing.
5--Up to two cups of caffeinated coffee a day are allowed. Drink tea or coffee without sugar or artificial sweeteners as they can set off bingeing. Replace diet sodas with mineral water or unsweetened seltzer.
According to Wellman, all dieters need to learn to deal with food in a balanced manner with variety and moderation as the keys.
“Changing eating habits is a gradual process that requires individualization, ongoing monitoring and reinforcement,” she said.
Dietitians can play a role in helping people make permanent adjustments. “We’re the dieters’ personal cheerleader,” she said.
In Southern California registered and licensed dietitians can be located through a dietitians’ referral hot line: (800) 297-7629.
