Should crash diets be part of NHS treatment?

Should crash diets or fad diets be available on the NHS? This is always a controversial one that splits opinion. I suspect I could start full scale warfare just within my dietetic department by mentioning this topic.

Some are staunch believers crash diets are what is needed to kick start people into losing weight. Others see this as unsustainable and destined to fail long term.

I’d love to hear your thoughts on the topic. Michael Mosley of ‘trust me i’m a doctor’ fame and now BBC journalist thinks they should be.

This is off the back of the latest research demonstrating an 800kcal a day liquid diet has proven successful in putting many peoples type 2 diabetes into remission. I’ve written about this diet before so I won’t get into again. You can find my article here.

So I thought I’d give you my thoughts and see if I can offer a balanced argument.

Why crash diets should be available

We need to actually define crash diet because there are many different types. The dictionary actually defines them as:

“A weight-loss diet undertaken on an urgent, short-term basis with the aim of achieving very rapid results”.

Under this definition several spring to mind such as 5:2, Atkins, Juicing etc. No definition of short term is provided however. Also, if someone is able to stick to one of these diets it would no longer meet the definition of short term.

So the definition isn’t concrete but I think most of us can recognise a crash diet when we see one. Perhaps just using the word diet is more appropriate.

For diets

Simply put, they work, short term anyway.

An argument for crash diets and a good one in my opinion is what’s worse for the patient, a few weeks restricting calories or continuing with excessive weight and possibly type 2 diabetes?

If the diet can help resolve the underlying issue of a persons health issues it is may actually be worth a try. This is particularly true with the 800kcal type 2 remission diet.

Furthermore, psychology is a fascinating thing. Have you noticed how much more likely you are to continue with something if you start to see results quickly. How often have you started a diet only to become disheartened when the weight does not instantly begin to move. Compare that to the feeling of losing large amounts of weight at the start of a diet. I know I’ve seen patients in both circumstances and I can tell you which group is happier initially.

They also provide patients with a plan to follow. We have moved away from the prescriptive method in healthcare and now use more behaviour change and empowerment techniques to motivate patients. Although I think this is a good thing. Sometimes patients just want a plan to follow.

I wouldn’t necessary consider some diets as crash or fad diets anyway. Some are more sustainable than others. I have seen patients stick to diets with relative ease. Sure, just because that diet works for that person it doesn’t mean it can be applied to the masses. However diets like the 5:2, Paleo, high protein aren’t overly fady compared to others. If you can sustain them.

Evidence

One reason crash or fad diets aren’t recommend is because of the distinct lack of scientific evidence they work long term. Since the 800kcal calorie study this has shown to be a very effective tool in people needing to lose weight and lower glucose levels.

However, scientific evidence in nutrition is a tricky one because often studies are underfunded and underpowered. Therefore, getting significant results can be difficult. This means little evidence exists for the best diets for weight loss (if one indeed exists) but you will hear many individual stories of what worked for individual people. As far as evidence goes this doesn’t quite cut it but you will come across people who swear by their diet.

I always compare evidence to roulette at the casino. Lets say I played only once. Placed a bet on red and it came in. I then told you to place a bet on red every time you play cause it came in for me. Would you place that bet?

Probably not or not every time anyway.

Now lets say I played a million times each time betting on red and each time it came in. I then told you to place your bet on red at this casino. Would you be more inclined to place it on red? I’d assume so.

This is the same principle with medical research. So individual stories may work for one person but may not be applicable to the wider population. This is why 800kcal diet is interesting – although the numbers weren’t huge – the proportion of people achieving results was large.

Why crash diets shouldn’t be available

Against diets

Long term data actually shows crash or fad diets are no better than a more balanced approach. Yes they get better short term success but the goal with weight loss is long term success. So it’s almost neither here nor there if you manage to lose a few pounds for a couple of months. Losing it and keeping it off is where the benefit is.

Many diets can also be restrictive. They can be very difficult to follow. Take this 800kcal diet for example. It is an 800kcal/day liquid diet. I personally don’t think I could stick to that. I doubt I’d last a day.

Also, if you are going to dedicate so much effort into crash dieting why not redirect that effort into a more sustainable plan. Just by choosing a plan you can be consistent with makes a big difference. This is why plans like Slimming World and Watch Watchers work for so many people. On these diets technically nothing is off limits as long as its within their allowance. So it helps people to moderate their diet. This will hopefully be more long term.

When falling in and out of diets you become trapped in a cycle of fluctuating weight. The so called yo yo effect where you lose some weight but often put it back on with interest. People that fall into this trap generally have an upward trend with their weight over the years.

So there are clearly arguments for and against. Ultimately, you need to do what works for you because everyone is different.

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