Thread by @Whitneycatalano

Can we stop pretending like diets in 2019 are any different than old diets just because they have been repackaged for health?

Keto is Atkins
WW Freestyle is still Weight Watchers
Intermittent Fasting is just skipping meals
Low carb is the new low fat

& they all still don’t work

Quick note: I’m going to do a thread later on the evidence to support what I’m saying

Also: I have a podcast called Trust Your Body Project if ya wanna check it out. It’s about intuitive eating, body image, and mental health

WhitneyCatalano.com/podcast

OKAY RESEARCH TIME! Let's do this, people. I guarantee I'll miss things and this won't be comprehensive, but I'm gonna try my damn best to lay this out. Are you ready?!

DIETS DON'T WORK! We'll be talking about the research here, but before I get into it, I'm gonna lay some ground rules and give some context [THREAD]

1. please keep in mind that this is my job. I went to school for this and I am a registered dietitian. I am not a random nutritionist on the internet (well I kind of am), im a health care provider who follows a code of ethics.

Outlining research on twitter is NOT part of my job, this work is unpaid. So if you want to support me or my podcast (trust your body project), check out whitneycatalano.com/podcast or patreon.com/trustyourbodyp…

Next ground rule – if you’re gonna fight me on this thread, please read the entire thread first and be willing to SHOW ME research. I’m taking the time to craft this, and I WANT to learn. So if I’m missing something, please just show it to me. Anecdotes are not research

Clarifying the original tweet:
#1 - I was NOT talking about medical nutrition therapy (aka eating a certain way to prevent, reduce, or manage a disease). I’m talking about diets with the intent of weight loss.

What you do for your body to treat, manage, or prevent diseases is between you and your medical team. If your quality of life improves from dieting or eating a certain way, then it shouldn't matter what i say. IT'S YOUR LIFE!

The reason that our “wellness” culture is so confused by the use of the word diet is because our medical system is weight-centric, meaning that weight loss is seen as the ultimate goal.

Specific dietary patterns used to help people with certain conditions feel healthier and live better lives have been co-opted by internet doctors and health coaches to sell weight loss. You might be thinking, what’s wrong with that? Isn’t weight loss good? I’ll explain soon

When I say that keto or intermittent fasting are just new forms of old diets, im saying the version of keto and IF that are often being sold for weight loss are just old forms of diets with a new twist because it’s for “health” this time instead of overtly for weight loss

The goal here is still weight loss though. You should question any diet that promises you'll lose weight because no diet can actually claim that

Does that mean that IF isn’t being studied to improve biometric markers? NO. Does that mean that keto doesn’t work for children with epilepsy? NO. Someone even sent me an RCT of keto for disease management independent of weight loss. Great! We still need more long-term research

I’m saying that your uncle who is on keto is 1. Most likely not using keto the way that it is clinically researched to be used, and 2. There is NO evidence that “keto” results in LONG-TERM WEIGHT LOSS. Period. (will expand on this soon)

#2 – when I say “low carb is the new low fat” I mean that diet culture LOVES to remove entire food groups & macros for weight loss. I’m not talking about eating for insulin resistance under the guidance of an RD, I’m talking about “cutting out carbs b/c I heard they’re bad”

#3 – Im also NOT blaming you for doing these diets. Its not your fault that you think you need to (will explain this). I'm just calling a spade a spade. The people selling these diets profit off the fact that you think it’s this ground-breaking diet. It’s not.

#4 – Please also know that my motivation for challenging diet culture is 1. To challenge fatphobia, and 2. To prevent eating disorders. I work in disordered eating. I work with people who struggle with CHRONIC DIETING – meaning they have been dieting for DECADES...

...and feel completely out of control and hopeless with food. I help them regain a sense of normalcy with food & learn to listen to their bodies. I help them stop chasing impossible beauty ideals & focus on loving their bodies, eating intuitively, & practicing radical self-care

IF YOU HAVE A DISORDERED RELATIONSHIP WITH FOOD, I am currently taking new clients for my Jumpstart to Food Freedom program. You can learn more here: whitneycatalano.com/food-freedom

OKAY RESEARCH TIME!
I am a Health At Every Size (#HAES) provider, meaning I take a weight-neutral approach to health. Our current medical system practices a weight-centric approach to health, which is not only NOT supported by research, but is actually doing more harm than good.

In a weight-centric model, doctors FREQUENTLY will see fat people for MANY reasons, prescribe weight loss as a treatment (even if weight has nothing to do with the condition), and move on. People in bigger bodies receive WORSE medical care, are treated worse in society...

...are less likely to be paid fairly or have equal access to jobs, physically cannot fit in many public places, and have worse health risks. This is all because of what the research calls WEIGHT STIGMA

The "obes*ty epidemic" is RESPONSIBLE for perpetuating the harmful effects of weight stigma. “Weight stigma can trigger physiological & behavioral changes linked to poor metabolic health & increased weight gain” bmcmedicine.biomedcentral.com/articles/10.11…

Even using that word is harmful. The latin root of "obes*ty" literally means "to eat yourself fat". It places personal responsibility on you. It was also only classified as a disease in 2013 for insurance purposes by the AMA, AGAINST recommendation by their research committee

In 1 study, a sample of 2284 physicians showed strong explicit & implicit “anti-fat” bias. Anti-fat bias is assoc. with beliefs that people who are fat are “lazy”, “weak-willed” and “bad”. Physicians with anti-fat bias are more likely to report fat patients as a “waste of time”

Physicians often flat-out REFUSE the same medical exams and treatments for fat people that they offer thin people. People in bigger bodies are more likely to avoid healthcare completely in order to avoid being stigmatized

Now you’re probably wondering – but Whitney, why don’t fat people just lose weight? Then they won’t be stigmatized.

Great (and super problematic & fatphobic) question! Well for starters, fat people are not thin people trapped in fat bodies. Weight diversity is as normal as height diversity, and there are a TON of biological and physiological mechanisms keeping the body from losing weight

The main secondary citation for my follow tweets is “A clinician’s guide to acceptance-based approaches for weight concerns” by Margit Berman. This book does a very thorough lit. review, better than I could do myself right now, so id recommend any practitioner read this book

At the end of this thread, ill also list a ton of other reliable sources for you to learn more!

When I say “diets don’t work” I mean they don’t work long-term. We have plenty of evidence supporting use of diets in the short-term. Any study lasting a year or less will show you this. Long-term weight loss studies typically have “v-shaped” results

You'll see at the bottom of that pic that the study with the most significant weight loss and smallest weight regain is problematic because "19% of the sample was excluded from the analyses because they failed to lose 5% of their initial body weight in the initial trial"

This happens a LOT. Studies where weight loss isn't achieved are often not published, and many times studies will leave participants out of the final analyses who "fail" to lose weight

When we look at this V shape, it shows us that peak weight loss occurs at 1 year, and then weight begins to increase, EVEN in studies where participants maintain dieting behaviors. Some studies even add additional dieting strategies, and still see weight regain

‘“Some meta-analyses and comprehensive reviews report that obes*ty treatments, on average, cause weight GAIN over long-term follow up” (Mann et al, 2007; ayyad & Anderson, 2000)’

An article that I love is Weight Science: Evaluating the Evidence for a Paradigm Shift. It's a super easy read, it makes a great case for Health at Every Size, and it'll honestly blow your mind. Takes down the whole "being fat is a health risk" thing nutritionj.biomedcentral.com/articles/10.11…

So why is "failing" diets harmful? Dieting failure increases risk of depression, worsened cardiometabolic health, eating disorders, and weight cycling. Please note here that you are not failing the diet, the diet is failing you

Get this – there are studies showing that health behaviors like exercising and eating more fruits and vegetables actually predict weight gain when the behaviors are done with the intention of trying to lose weight. ncbi.nlm.nih.gov/pubmed/16567152

Dietary restraint also leads to food cravings, particularly for high fat, high carb, and high sugar foods, as well as “loss of self-regulation, overeating, and binge eating”.

Yall, your body rebels against dieting because it’s trying to survive

I don’t have time to get into the whole study now, but a good example of the effects on the body from dietary restriction can be seen in the Minnesota starvation experiment. In the study, 36 men were put on ~1800 calorie/day diets for 6 months. Read: academic.oup.com/jn/article/135…

The men became obsessed with food, would hoard food, experienced personality changes, emotional distress, irritability, fatigue, decreased sex drive, and difficulty focusing. Two men were excluded from the study for binge eating.

This can be explained by evolution because it doesn’t make any sense for the body to be able to drop extreme amounts of weight quickly. We wouldn’t have survived historical famines. This is a biological survival mechanism.

There is SO much more i could say on why our current weight-centric approach to health is harmful, why dieting for weight loss can actually do more harm than good, and why all of this is just institutionalized fatphobia, but I truly am running out of mental bandwidth

One of my all-time favorite resources is @FionaWiller Health, Not Diets Digest. it's a monthly digest of HAES articles and research. If you're interested in diving deeper into research, she also has a patreon podcast called Unpacking Weight Science unpackingweightscience.com

The final thing I want to say is that you do not owe anyone an explanation for your body. That includes me. You don't have to tell me why your diet worked or didn't work. You don't have to explain anything to me unless you're my client, because then I obviously care haha

Again, I'm not sharing any of this to shame you for dieting. I used to diet too. We're taught to hate our bodies by people who profit off of us hating our bodies. If diets worked, you wouldn't be a lifetime consumer, and that'd be pretty bad for business

In that same sentiment, please stop telling people that they "should" eat a certain way or "should" lose weight for health. This perpetuates weight stigma, healthism, disordered eating, food and body shame, and harmful body ideals

You are not better than someone else because of how you eat. You are not a bad person for eating sugar or carbs. You are not morally superior just because you are healthy.

TO learn more on the effectiveness (or lack thereof) of dieting & physical activity FOR weight loss and health, here are some articles. TW that all medical research uses stigmatizing language
escholarship.org/uc/item/2811g3…
nutritionj.biomedcentral.com/articles/10.11…
jandonline.org/article/S2212-…

And if you're wondering what you should do instead of trying to lose weight, start by googling these terms:

Health At Every Size
Intuitive Eating
Body Positivity

My fav resources:

Learn about health at every size: haescommunity.com/find/
Learn about @LindaBaconHAES and @Lucy_WellNow
Learn about intuitive eating: intuitiveeating.org with @Etribole and @ElyseResch
Learn about body trust: benourished.org/what-is-body-t…

Body Kindness by @ScritchfieldRD : bodykindnessbook.com
Or Health Not Diets with @FionaWiller : healthnotdiets.com/books-resources
Listen to food psych podcast with @chr1styharrison @FoodPsychPod : christyharrison.com/foodpsych
Or my Trust Your Body Project podcast: whitneycatalano.com/podcast

Or “You Can Eat With Us” podcast with @StreetSmartRD : libreconnections.com/home/podcast/
Or She’s All Fat podcast @shesallfatpod : shesallfatpod.com
Or Love Food Podcast with @foodpeacerdn juliedillonrd.com/lovefoodpodcas…
Or the @fatnutritionist fatnutritionist.com

ALSO please actually listen to fat activists when they talk about this. It's ridiculous that people listen to me over a fat person even if we're saying the exact same thing

Some notable authors & activists:

@Sonyareneepoet
@militant_baker
@ScarredNtScared
@virgietovar
@comfyfat
@yrfatfriend
@rslntfatgoddess

I'm sure i'm missing some, but that's a great place to start! Id say reply to this thread, but honestly this thread is a whole TW shit show so be careful before you read through the replies

THE FINAL THING I'LL SAY - be careful with any diet that 1. promises weight loss and 2. restricts certain foods. Disordered eating is a slippery slope. Orthorexia is literally defined as an unhealthy obsession with health. You can learn more here: nationaleatingdisorders.org/learn/by-eatin…

More favorites:

@MerQueenJude
@MarciRD
@EricaLeonRDN
@thefuckitdiet
@iamchrissyking
@fyeahmfabello
@meghantonjes
@fatgirlfreedom
@BitchMedia
@iHartEricka
@DietitianAnna
@DanaSuchow
@RachelCargle

Quick note: I totally left socioeconomic privilege out of this conversation, which is arguably one of the most important things we should be talking about. This conversation is unbelievably nuanced, but I hope this is a good starting point!

My only regret from this thread is that instead of “Keto is Atkins” I should have said Whole 30 is Paleo