How Not to Diet

by Michael Greger

But it doesn’t have to be frank obesity. Of the four million deaths every year attributed to excess body fat, nearly 40 percent of the victims are just overweight, not obese.461 According to two famous Harvard studies, as little as eleven pounds of weight gain from early adulthood through middle age increases the risk of major chronic disease.462

The good news is the riskiest fat is the easiest to lose. Our bodies appear to preferentially shed the villainous visceral fat first.463

At 3 percent weight loss (only six pounds for someone weighing two hundred), your blood sugar control and triglycerides start to get better.465 At 5 percent weight loss, blood pressure and cholesterol improve. Furthermore, a 5 percent weight loss—just ten pounds for someone starting at two hundred—may cut the risk of developing diabetes in half.466

All fat is not the same, though. There is the pinchable, superficial flab you may see jiggling about your body, and then there’s the riskier, visceral fat that coils around and infiltrates your internal organs, bulging out your belly.

Measuring BMI is simple, cheap, and effective, but it doesn’t take into account the distribution of fat on the body—whereas waist circumference can provide a measure of the deep underlying abdominal fat.

This is why the World Health Organization,495 National Institutes of Health,496 and American Heart Association497 recommend measuring both BMI and waist circumference.

This may be especially important for older women, who lose approximately 13 pounds of bone and muscle as they age from twenty-five to sixty-five, while quadrupling their visceral fat stores.

While the belly button may be the most intuitive and easiest to measure (and the preferred location for a one-time visceral fat assessment),504 the halfway point between the top of the hip bones and bottom of the rib cage appears to be the most effective at tracking changes in visceral fat over time.505

Shedding the pounds may not shed the stigma of even prior obesity. Studies suggest that, in the eyes of others, knowing someone was fat in the past leads them to always be treated more like a fat person.

real food costs money to grow. Shareholders don’t want dirt—they want dirt-cheap commodities such as corn syrup, preferably discounted by taxpayer subsidies, that they can then mix with carbonated water and sell for a few bucks a bottle. Burgers on the Dollar Menu are there thanks in part to hundreds of billions of dollars of federal subsidies for cheap animal feed.

Those who resist calls for “heavy-handed” government regulation may not realize those heavy hands are already pressing down the scale on the side of Big Business.

All too often in the choice between the physical health of consumers and the financial well-being of business, concealment is chosen over disclosure, sales over safety, and money over morality. Who are these persons who knowingly and secretly decide to put the buying public at risk solely for the purpose of making profits, and who believe that illness and death of consumers is an apparent cost of their own prosperity?

Tobacco is one of our great public health victories. The share of adults who smoke declined from 42 percent in 1965754 down to just 15 percent today.755 That’s about five out of twelve down to fewer than two out of twelve. Thanks to the decline, cigarettes now only kill about a half million Americans a year, whereas our diets kill many thousands more.

Currently, the leading cause of death in America is the American diet.756

A systematic review of the available evidence suggests that dietary financial incentives and disincentives do work. The cheaper we make fruits and vegetables, the more people said they’d buy, and the more we tax unhealthy foods, the lower their consumption drops.766 Based on this kind of modeling, a tax on saturated fat (found mostly in fatty meat, dairy, and junk) could potentially save thousands of lives a year.767

From Coke to Coors: Unintended Consequences

A tried-and-true method used by alcohol, tobacco, and food-related corporate interests to deflect attention away from health is to reframe something like a fat tax or soda tax as an issue of freedom, railing against the “nanny state” for restricting consumers’ rights.793 However, those complaining about the governmental manipulation of people’s choices hypocritically tend to be fine with corporations doing the very same thing.794 Case in point: former New York City mayor Michael Bloomberg’s attempt to cap soft drink sizes. How dare he try to manipulate consumer choice! But isn’t that just what the industry’s done? In 1950, a twelve-ounce soda was the “king-sized” option.795 Today, it’s marketed as a child’s portion. “King-sized” became “kid-sized.”

effects. If someone understands the hazards, shouldn’t they be able to do as they please? This assumes consumers have access to accurate and balanced information. How could smoking be a fully informed choice when tobacco companies spent decades deliberately suppressing, manipulating, and undermining the scientific evidence?

People love hearing good news about their bad habits, so clickbait headlines like “Butter Is Back” may sell a lot of magazines, but they sell the public short.

“It is not just Big Tobacco anymore,” declared the director-general of the World Health Organization.801 “Public health must also contend with Big Food, Big Soda, and Big Alcohol. All of these industries fear regulation, and protect themselves by using the same tactics … front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt.”

It’s like that infamous tobacco industry memo that read: “Doubt is our product since it’s the best means of competing with the body of fact that exists in the mind of the general public.”802 The tobacco industry didn’t have to convince the public that smoking was healthy to get people to keep consuming its products. It just nee...

Conflicting messages in nutrition cause people to become so frustrated and confused they may just throw their hands up in the air and eat whatever’s put in front of t...

In the Mad Men age before the consumer movement was in bloom, advertising company executives were more willing to talk frankly about the purpose of their ads and how they felt about aiming them at the “child market.”825 For example, consider this 1965 quote from an ad executive for Kellogg’s and Oscar Mayer: Our primary goal is to sell products to children, not educate them. When you sell a woman a product and she goes in to the store and finds your brand isn’t in stock, she will probably forget about it. But when you sell a kid on your product, if he can’t get it, he will throw himself on the floor, stamp his feet and cry. You can’t get a reaction like that out of an adult.826

The cereal companies got to decide for themselves their own definitions of “healthier dietary choices,” and what they chose should give a sense of how serious they are about protecting children: They classified Froot Loops and Reese’s Peanut Butter Puffs, which consist of up to 44 percent sugar by weight, as “healthier dietary choices.”

In that case, what are their unhealthy choices?! Rather than base it on what might be best for children, they basically set the limit based more on the sugar content of everything they were already selling.830

The industry has since revised the “healthier dietary choices” criteria to allow only cereals that are below 38 percent sugar by weight.831 Even if they’re “only” one-third sugar, that means kids effectively are eating at least one spoonful of sugar in every three spoonfuls of cereal.832 I wouldn’t call that a healthy dietary choice.

In 2012, a prize-winning845 exposé on corporate lobbyists found that the food and beverage industries had never lost a significant political battle in the United States, winning fight after fight at every level of government.

That all changed in 2018 with the successful ban on added trans fat in the American food supply.

Trans fat, found largely in vegetable oils partially hydrogenated to mimic the qualities of animal fats in snack foods, was implicated in the deaths of tens of thousands of Americans every year.847 So how did the public health movement finally triumph?

We learned about the dangers of trans fat in 1993, when the Harvard Nurses’ Health Study reported that high intake of trans fat may increase the risk of heart disease by 50 percent.852 That’s where the trans fat story started in Denmark—a story that ended a decade later with a ban on added trans fat in 2003.853

It took another ten years before the United States even started considering a ban.854 All the while, trans fat continued to kill the estimated tens of thousands of Americans every year,855 resulting in as many years of healthy life lost as conditions like meningitis, cervical cancer, and multiple sclerosis.

If so many people were suffering and dying, why did it take so long for the United States to even suggest taking action?

Comparing stroke and heart attack rates before and after the rollout of the trans fat ban in different New York counties, researchers estimate the ban successfully reduced cardiovascular death rates by about 5 percent.868 This then became the model for the nationwide ban in 2018.

How was public health able to triumph when past attempts to regulate the food industry failed? If you would have asked me back then about the odds of a trans fat ban, I would have answered: Fat chance.

In Denmark, as a leading Danish cardiologist put it, “Instead of warning consumers about trans fats and telling them what they are, we’ve simply removed them.” The cardiologist continued, “As they say in North Americ...

Weight Watchers, for example, featured a testimonial of a woman who lost more than two hundred pounds after two years on the program908—but when Weight Watchers was actually put to the test, the average weight loss after two years was more like six pounds.909 The Weight Watchers watched a lot more weight stay on than come off.

ANTI-INFLAMMATORY

One of the most important medical discoveries in recent years was the realization that inflammation appears to play a role in many of our chronic diseases, including at least eight of our top ten leading causes of death.

chronic inflammation, also called metabolic inflammation, or meta-inflammation for short, is persistent, systemic, and nonspecific, and it appears to perpetuate disease.

Simple blood tests, however, can detect abnormally high levels of inflammatory markers like C-reactive protein so that we can gauge our level of chronic inflammation.

This widespread meta-inflammation appears to be our immune systems’ reaction to many unhealthy aspects of our lives—from the broader environment like traffic pollution and toxic chemicals to our day-to-day lifestyle choices, such as cigarettes, chronic stress, and too little physical activity and sleep.

The primary driver of meta-inflammatory chronic disease, however, may be the portions of the outside world we introduce into our bodies multiple times a day: what we eat.936

constituents of whole plant foods, such as fiber and phytonutrients, were strongly anti-inflammatory.938

Those eating diets rated as more inflammatory also experienced faster cellular aging.

Overall, eating a more inflammatory diet was associated with 75 percent increased odds of having cancer and 67 percent increased risk of dying from cancer.

Not surprisingly, those eating more anti-inflammatory diets appear to live longer lives.

We used to think fatty tissue was just a passive depot for the storage of excess fat,971 but we now know it actively secretes inflammatory chemicals.

an anti-inflammatory diet is not just a move toward a more plant-based diet in general but specifically one centered around whole, unprocessed plant foods.

In the Dietary Inflammatory Index, the single most anti-inflammatory food is the spice turmeric, followed by ginger and garlic, and the most anti-inflammatory beverage is green or black tea.

The two most anti-inflammatory food components are fiber and flavones.1021 Dietary fiber is found in all whole plant foods, but it is most concentrated in legumes, such as beans, split peas, chickpeas, and lentils.