14
The Duel
Should we give up dieting?
YES
Susie Orbach
We both agree that there is a crisis
YES around food and bodies. I know
your motives arent cynical. I dont
dispute the sugar and refined carbs argu-
ment, but what worries me is the seductive
thrust of your latest book: that you can lose
weight fast by reprogramming your body.
You are appealing to the same people
who bought your first book. But did they
learn? Did they change their life?
If only. If only the perfectly reasona-
ble advice you proffer were of use to more
than a few. It all sounds sane and welcom-
ing. Indeed, the stories of blood sugar levels
slashed, energy returned, illness replaced
by health and vigour, depression banished,
would enthuse anyone troubled by their
weight. But this victorious narrative in which
the beast of appetite is slain by the judicious
reduction in food and in type of food eaten
is not, as experience shows, borne out. Diets
dont work. You know that. I know that. The
researchers know that. The publishers know
it. You didnt sell 250,000 copies of The 8-
Week Blood Sugar Diet and a million copies of
The Fast Diet because diets were successful.
You sold them because diets fail. There
is panic where food, fat and fitness are con-
cerned. The miracle first story of Jon who
lost 8.5kg in the first week is irresistible to a
reader seeking salvation from troubled eat-
ing and a troubled body. Its that hope which
sells your book, despite the shocking evi-
dence that diets are only effective in a maxi-
mum of 5 per cent of people.
From my vantage point, I see the anguish
and self-hatred that arises from weight
cycling and the 95 per cent of people who
experience themselves as dieting failures. I
fear you are soliciting return customers who
will crash in the wake of a shocking recidi-
vism rate which has anguishing mental and
physical health consequences.
I understand your cynicism about
NO diets and their very high failure rate.
There are thousands of diet books
out there and new ones being added all the
time. Many are awful. But that doesnt mean
all are awful. And I do think it is important
to do something, at an individual level, about
the current diabesity epidemic.
Clearly it would be better if we didnt live
in such an obesogenic environment, where
fattening foods are all around and where
children are bombarded with adverts for
high-sugar foods. It would be great if our
built environment encouraged us to walk
rather than take the car. I would like to see
fewer escalators and more people walking
on the ones that are there, rather than just
standing. Unfortunately a lot of the things
that could and should be done depend on
policy decisions made by government,
PROSPECT FEBRUARY 2017
SUSIE ORBACH PORTRAIT ANDREW CRAWLEY. BENREIS/WIKIMEDIA COMMONS
NO
Michael Mosley
which you and I can do little about, other
than agitate.
You say that diets are only effective in
5 per cent of people. Its a statistic that
appears to be an urban myth. I have tried
to track its origins and failed. But even if
there were some basis to it, it wouldnt tell us
much beyond the fact that lots of people fol-
low some very bad diets.
What I have done, based on my own expe-
rience and scientific studies, is offer a differ-
ent way to approach weight loss, through
intermittent fasting (the real goal being to
reduce high levels of abdominal fat, which
are linked to a wide range of poor health
outcomes) and then aim for weight main-
tenance via a Mediterranean-style diet and
more activity.
Generations are now growing up
YES exposed to non-food foods. You
abhor this as much as I do and I
wish you would challenge the rubbish con-
coctions saturated with bliss points sold to
parents as wholesome foods which are then
given to children in good faith.
Where we disagree is that government
and the food industry cant be taken on.
I think that is where a major part of our
efforts must be directed, not just at the indi-
vidual level. I know thats an odd remark
from a psychoanalyst but its precisely
PROSPECT FEBRUARY 2017
because I see the extraordinary anguish
visited on the individual by food indus-
try shenanigans and the so-called well-
ness industries. And this relates to the diet
industry too, which is often owned by and
thus part of the food industry. Inciden-
tally Im surprised that you dont know (a)
the studies which show that dieting causes
eating disorders and (b) Professor Traci
Manns study on the appallingly low levels
of success from dieting.
Success for me would constitute being
able to identify hunger and responding to
that appetite with real food. Then, being
able to taste every mouthful, knowing how
foods sit with the person and how to stop
when they are full and to understand what
they are reaching for emotionally when
they eat when they arent physically hun-
gry. These essential categories of hunger
and satisfaction, which we need to restore,
are not solved by a diet, however wholesome
or good.
Ive had plenty of patients on the Medi-
terranean diet who are compulsive eaters.
We need to reduce the hysteria about size,
about diet and intake and encourage the
enjoyment of delicious real food so one is not
deprived and can notice the signal of satis-
faction. Going up and down the scale in the
name of the fight against obesity is detri-
mental to health and to mental well-being.
There is much that we agree on, so I
NO might as well focus on where we
dont: the question of whether diet-
ing ever works. I didnt know Traci Manns
work so I looked up her latest paper, Pro-
moting public health in the context of the
obesity epidemic. It is a good read and
offered compelling alternatives to simply
dieting. Above all I completely agree with
her conclusion that we must make use of
environmental changes to reduce the
amount of willpower necessary to achieve
healthy behaviour.
I was also interested that the first refer-
ence in her paper was to a systemic review
and meta-analysis of weight loss clinical tri-
als, published in 2007. Strangely enough its
authors concluded that the diets they looked
at did work, with an average weight loss of
3-6kgs with none of the groups experienc-
ing weight regain to baseline.
A more recent study, published in the
New England Journal of Medicine, which fol-
lowed 322 people, again found that dieting
worked. Yes, there was some weight regain
after the initial falls, but after two years
most people had stabilised at a new, lower,
weight. Those allocated to a low-fat diet
had kept off an average of 2.9kgs, while the
low carb and Mediterranean diet groups
enjoyed more impressive weight losses of
4.7kg and 4.4kg respectively.
This scale of weight loss would be suffi-
cient to prevent many overweight people
THE DUEL
progressing to type 2 diabetes, avoiding a sit-
uation where they would be offered medica-
tion that in the long term might simply make
them fatter and sicker.
Researching this area has convinced me
that there are dietary approaches worth
talking about, writing about and maybe
even embracing. Yes, we must agitate for
policy change, but at the same time we
neednt accept the nihilistic belief that
diets always fail.
I think we read the research differ-
YES ently and as Weight Watchers said
in their submission to the All-Party
Parliamentary Group a few years back, we
are only successful at the level of a 5kg
weight loss, and then for not that many peo-
ple. Yet government moneyour funds from
the NHSgoes to Weight Watchers, to pro-
mote a course of action that it admits does
not work.
My hope is that people could learn to eat
well without a sense of having to be wary and
watchful of their food all the time. What sad-
dened me about your book was the sense of
hidden dangers. You portray your own strug-
gle as frightening, even though you had
already advocated certain dietary regimes,
lost weight and sold a million books on the
back of it.
You present it like a plague we cant see,
yet the real plague is troubled eating and
self loathing towards ones body. A vicious
food industry aided by the style industries
the fashion, beauty, cosmetic surgery and
wellness industries lead people to feel Her first book, Fat is a Feminist Issue, was
that their bodieshowever small and lithe
they areare somehow not quite right and
need changing. This is playing havoc with
the nations eating habits. The diet industry
feeds off it, and unfortunately your hid-
den invaders argument inadvertently plays
into the idea that we must be ever watchful.
You encourage people not to view their bod-
ies as something to live from and do things
with, but as something to be feared and
constantly remade.
If the government were truly serious
about diabetes and obesity, they would ban
certain food practices by manufacturers.
They would implement measures to chal-
lenge the disturbed eating that lives in all
size bodiesthin, medium, fat. We both
know that. Lets try to do something valua-
ble about it together.
I havent seen that particular submis-
NO sion by Weight Watchers but Im not
surprised. Weight Watchers have, at
least until recently, followed the failed low
fat paradigm. Give me a Mediterranean diet,
rich in olive oil and nuts, any day.
I dont obsess about weight because it is
clearly possible to have a body mass index
(BMI) which puts you into the overweight
category and still be perfectly healthy. I
15
do bang on about visceral fat, the fat that
collects around your stomach and inter-
nal organs, because it is the enemy within.
Once it infiltrates your liver and your pan-
creas you are well on the road to hyperten-
sion, type 2 diabetes and heart disease. It
has recently overtaken alcohol as the num-
ber one cause of liver failure. I wrote my lat-
est book because rising blood sugar levels
are a global disaster and if you know you are
at risk then you can do something about it,
preferably before you tip over into diabetes
and other metabolic disorders.
In fact the importance of knowing your
blood sugar levels, rather than simply your
BMI, is one of the many good points that
Traci Mann makes in her paper. As she elo-
quently puts it, Lets retire weight and BMI
as measures of health and replace them with
more valid indicators, such as blood pressure
and heart rate, as well as levels of cholesterol
and blood glucose.
Other things she suggests, with which I
completely agree, include limiting the size
and availability of sugary drinks, making
healthy foods more visible in school can-
teens, reducing the stigma around being
overweight and finding creative ways to
reduce elevator use. I particularly enjoyed
the study which showed that delaying lift
door closure by six seconds cut lift use by
a half.
So yes, do lets try and do something valu-
able together. I would enjoy that.
Susie Orbach is a psychotherapist,
psychoanalyst, author and social critic.
published in 1978. Bodies is her latest.
Michael Mosley qualified as a doctor and now
works for the BBC as a producer and presenter.
He is the author of The Fast Diet and The
8-Week Blood Sugar Diet.
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