Weight-Loss Programs

Commercial weight-loss programs and fad diets are abundant; they appear to be everywhere you look (Figure 10-1). Not uncommonly, people become desperate to lose weight and they explore commercial and fad diets to aid in losing weight. Unfortunately, finding reliable information about diets and their purported health benefits is a challenge. Few of these weight-loss programs are ever examined using the scientific rigor normally expended on health interventions involving the public (i.e., double-blind placebo-controlled studies for medicines or surgical interventions seeking US Food and Drug Administration [FDA] approval). Diet websites are often difficult to navigate and often demand that you sign up (and pay) for their programs before you can learn more about them. Ultimately, the goal of this module is more about understanding the importance of eating a balanced meal across food groups, learning about portion control, and becoming flexible than it is to impart knowledge about specific diets. Diets that promise quick weight loss might be eye-catching, but they often overlook the principles of long-term, sustainable, healthy eating.

Acid Alkaline Diet 

Background

The Acid Alkaline Diet focuses on controlling your pH through your diet to achieve health, weight loss, disease prevention, and overall health. The diet explains that foods (such as meat, wheat, refined sugar, and processed foods) produce acids that lead to poor health. Therefore, the dieter should eat alkaline foods to protect against disease and weight gain. One measure of acidity and alkalinity throughout the body is the pH (calculated on a 0 to 14 scale). Acidic substances are scored from 0 to 7. Alkaline substances are scored from 7 to 14. The diet encourages at least a 60/40 alkaline to acidic mix to maintain and promote a healthy balance. The dieter will need to understand where foods fall on the acid/alkaline scale and refer to the “Acid Alkaline Diet for Dummies” for guidance. The diet encourages you to build meals and snacks around fruits and vegetables instead of meats and starches for an alkaline balance. Examples of alkaline foods include fruits and vegetables (https://www.webmd.com/food- recipes/ss/slideshow-exotic-fruits), soybeans and tofu, as well as some nuts, seeds, and legumes. The dieter should aim for foods higher in alkaline content. Acid-forming foods include dairy, eggs, meat, yeast, wheat products, alcohol, caffeine, and processed foods.

Professional Review

The Acid Alkaline Diet is a non-scientific approach. The foods we eat will not affect our blood pH. Many dieters will benefit from increasing their fruit and vegetable intake but they also need to consume adequate amounts of protein and whole grains. This diet is restrictive and puts the dieter at risk for nutritional deficiencies.

The Atkins Diet Background

The Atkins Diet is a classic low-carbohydrate diet promoted by Dr. Robert Atkins. The diet states that it can “flip the body’s metabolic switch” from burning carbohydrates to burning fat. There are four phases with increased carbohydrates as the phases progress. The Atkins diet has an extensive website that you can visit at (https://www.atkins.com/how-it-works).

The first phase (or Introduction Phase) states that it will “jump start your metabolism.” Phase 1 lasts for at least 2 weeks and the dieter decreases “net carbs” to 20 grams daily.

During Phase 2 (or the Balancing Phase) the dieter “finds their personal carb balance.” New foods (such as nuts, seeds, strawberries, blueberries, melon, cottage cheese, and yogurt) are added. “Net carbs” are started at 25 grams and increased to between 30 and 80 grams.

Phase 3 begins as the dieter is 10 pounds away from their goal weight. This stage is designed for fine-tuning the diet and allows the dieter to focus on maintaining their weight loss. In Phase 3, the daily Net Carb intake increases gradually. After weight loss is maintained for a month, the dieter moves into Phase 4.

Phase 4 (or Lifetime Maintenance) advertises itself as a permanent lifestyle.

Professional Review

Many dieters who follow the Atkins diet find that they are able to lose weight quickly. As with many fad diets, people have a difficult time continuing with this plan over the long term. Dieters might lack an understanding on how to move throughout the phases. However, the plan does not allow the dieter to enjoy a variety of foods and the recommended portion sizes in the foods throughout the four phases are small. It is difficult to achieve adequate nutrition while following this diet. The Institute of Medicine report “Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids” (IOM, 2002) established a Recommended Dietary Allowance (RDA) for carbohydrate of 130 grams per day for adults and children. Both Phase 1 and 2 of the Atkins Diet encouraged as little as 20 grams of carbohydrates per day and as much as 80 grams of carbohydrates (or 15%–62%) of the recommended intake of carbohydrates. Carbohydrates are essential for your central nervous system (CNS) and they provide your body with quick energy. Inadequate intake of carbohydrates will affect your brain health. It is recommended that at least half of your calories come from carbohydrates. As you restrict carbohydrates you are also restricting fiber intake, which is necessary for blood sugar control and satiety; carbohydrates also assist with decreasing cholesterol and aid in regular bowel functions. Nutritionally, your body would be at risk if you decided to follow the Atkins diet.

Weight Watchers 

Background

Weight Watchers focuses on balance; it uses a group setting for a support system. The newest program, Beyond the Scale, encourages the dieter to make better food choices, to move their body more, and to shift their diet mindset. The program is designed to assist in weight loss but also to focus on benefits other than weight by balancing nutrition and fitness. Members are assigned a certain number of points daily (based on their age, gender, height, weight, and whether they desire weight loss or to maintain their weight). There are extra weekly points that range from 14 to 42 depending on the individual and their specific plan. The method of calculating points has changed throughout the years; currently, it uses SmartPoints. Each food and beverage is allocated SmartPoints based on calories and on the content of saturated fat, sugar, and protein. The point system does not encourage you to avoid any food, but it calculates points based on portion sizes. A higher calorie and fat food item would accrue more points and leave the dieter with fewer points to use during the rest of the day.

Weight Watchers has different types of programs. You have the option of going to meetings, participating only on-line, or to have a personal coach. Memberships costs vary based on their location. A 3-month subscription for On- line Plus can cost $3.07/week, meetings can cost $6.92/week, and Coaching can cost $8.46/week. Lifetime membership is earned by members who reach and maintain a weight goal that falls within the parameters of the Healthy Weight Ranges; it is free for meetings members.

Professional Review

The Weight Watchers program encourages balance and teaches members that all foods can fit into your diet. The program comes at a cost, and members might find it too costly to continue over the long term. The program allows the member to eat as many fruits and non-starchy vegetables as desired, and the member must keep in mind that these foods are a great source of fiber and nutrients, but they are not calorie free. The calorie content of the fruits and vegetables can add up throughout the day. Calculating points for each food item you eat can be difficult and time consuming. The program can serve as an educational tool for a person who wants to understand how to balance their nutrition and their exercise.

For example, I had a client, Lucy, who tried Weight Watchers to help her lose weight after she delivered her son. She used the program religiously and began to understand portion size. She learned how to enjoy a cupcake and to balance her points for the rest of the day. The problem arose when she did not have a label for a food item and could not calculate how many points she was eating.

She had a weekly meeting at work at which she and her co-workers frequently brought in snacks. Prior to the meetings she felt anxious about not knowing what would be in the meeting and how many points to allot for what was available. She would find herself distracted in the meeting and would either avoid the snacks altogether or eat past her fullness. Her frustration with her inability to eat unplanned or unknown foods eventually led her to stop the program.

The Jenny Craig Diet 

Background

The Jenny Craig Diet is a calorie-controlled diet program with pre-packed meals. The dieter has the choice of two programs: in-center (in which you have personal meetings and regular visits with a consultant) or at-home (with on-line resources with phone or video chat). There are three levels within the program. The first level involves adjusting to the program by eating the foods in small portions. The second level adds physical activity, and during the third level, dieters work on weight-loss maintenance. The dieters’ plans vary from 1,200 to 2,300 calories per day based on the participants current weight, fitness habits, and motivation. A personal consultant guides the dieter weekly with regard to nutrition and exercise. The meals are pre-packaged for portion control, and the dieter provides their own fruits, vegetables, and dairy items. After the dieter is halfway to their goal weight, they will transition back to preparing their own meals using Jenny’s recipes. The price of the program and meals vary, but it can cost $525 to $705 per month; $14.99 per month with $25 enrollment fee with no access to a health consultant, $19.99 plus an $99 for an enrollment fee with up to three consultations a week, or $39.99 with no enrollment fee for a weekly consultation. The average cost daily is $15 to $23.

Professional Review

The program is easy to follow with the pre-portioned meals, but it can be difficult for the dieter when they adjust to eating out or to cooking on their own. The cost of the plan can be significant for the dieter. Dieters might find it difficult to eat with family or loved ones due to having individual meals while following the pre-packaged meals.

The Cabbage Soup Diet 

Background

The Cabbage Soup Diet claims to help you lose 10 pounds or more in a week. There are several recipes available on-line for the Cabbage Soup Diet. The website states that it is not suitable for long-term weight loss but is designed for kick-starting dieting. It is not recommended for more than 7 days and you should not start the diet again for at least 2 weeks after completion. It cautions against high-intensity workouts. You are permitted to eat fat-free cabbage soup two to three times a day with other permitted foods as follows:

Day 1—Consume all of the fruits (except bananas) you desire. You can also eat the soup. You can drink unsweetened teas, cranberry juice, and water.

Day 2—Consume non-starchy vegetables during the day, and you can “reward” yourself with a plain baked potato for dinner. Although you can’t eat fruit on this day, you can have the soup as desired.

Day 3—You may mix the foods used on days one and two with fruits and vegetables, but not eat a baked potato. You can eat the soup as desired.

Day 4—Consume bananas (up to eight) and as many glasses of skim milk as desired. This day is designed to help decrease your desire for sweets. You can eat the soup as desired.

Day 5—Consume up to 20 ounces of beef or skinless baked chicken and up to eight tomatoes. Eat your soup at least once on this day.

Day 6—You can eat all the beef and vegetables desired. You should not have a baked potato today, but you can have at least one portion of soup.

Day 7—Consume all the brown rice, unsweetened fruit juices, vegetables, and soup you desire.

Day 8—Begin a moderate long-term eating plan.

Professional Review

The Cabbage Soup diet does not provide adequate nutrients for the dieter. The dieter might have low energy levels and find it difficult to concentrate and to think. It can be dangerous if a dieter participates in exercise due to the inadequate nutrient intake, and the participant is at risk of fainting or experiencing other medical issues. The diet does not teach the participant about balanced eating, and quick weight loss might be related to fluid loss more than fat loss. The inadequate protein might aid in more muscle loss than desired. We do not recommend that you follow this fad diet. The recommended schedule of the diet does not align with any nutritional guidelines.

On a personal note, while I was growing up, my best friend’s father followed the Cabbage Soup Diet a few times each year. I remember walking into my friend’s kitchen and smelling the strong, pungent smell of cabbage soup. Their refrigerator would be filled with soup containers. I can still picture him, a large man who had played college football, eating a bowl of cabbage soup for dinner. After a few days of following the diet he would become short-tempered. Looking back, I imagine that his blood sugar must have been low and his tolerance for teenage girls was at a minimum. At the end of the diet, which invariably did not last the full seven days, we would join him in a meal with large fried pork chops, mashed potatoes with gravy, rolls, and corn. Then, we would have the chore of throwing out the containers of uneaten cabbage soup!

The Paleo Diet 

Background

The Paleo Diet states that it is based upon every day, modern foods that mimic the food groups of our pre-agricultural, hunter-gatherer, ancestors. The diet explains that there are seven fundamental characteristics of hunter-gatherer diets that will help to optimize your health, minimize your risk of chronic disease, and lose weight:

  • Higher protein intake
  • Lower carbohydrate intake and lower glycemic index
  • Higher fiber intake
  • Moderate to higher fat intake dominated by monounsaturated and polyunsaturated fats with balanced omega-3 and omega-6 fats
  • Higher potassium and lower sodium intake
  • Net dietary alkaline load that balances dietary acid
  • Higher intake of vitamins, minerals, anti-oxidants, and plant phytochemicals

The diet does not allow cereal grains, legumes, dairy, refined sugar, potatoes, processed foods, refined vegetable oil, or salt.

The diet does allow grass-produced meat, fish and seafood, fresh fruits and vegetables, eggs, nuts and seeds, and healthful oil.

Professional Review

The Paleo Diet advertises loose scientific claims. People would benefit from increased fiber but the diet encourages the dieter to avoid whole grains. Whole grains are proven to provide the body with key nutrients, such as fiber and carbohydrates, which are needed for brain health. The diet is restrictive and encourages the dieter to avoid dairy which provides a person with calcium, vitamin D, protein, and B-vitamins. Dairy is prohibited but the diet offers potassium, calcium, vitamin D, B-vitamins, and protein. Our pre-agricultural, hunter-gatherer ancestors ate what was available to them, and their intake was dependent on what they could hunt and gather at any particular moment. They might have eaten more protein when they were able to hunt wildlife, and more fruits when they were in areas with fruit trees.

Whole30 Program 

Background

The Whole30 Program states that certain foods (such as sugar, grains, dairy, and legumes) have a negative impact on your health. It encourages a dieter to avoid these food items to allow the body to heal and to recover from damage. The program states that it is not a diet but that it is designed to “change your life,” by eliminating cravings, rebalancing hormones, curing digestive issues, improving medical conditions, and boosting energy and immune function. The diet allows moderate portions of meat, seafood, and eggs; lots of vegetables; some fruit; plenty of natural fats; and herbs, spices, and seasonings. The diet does not permit added sugar or artificial sugar, alcohol, grains, legumes, dairy, carrageenan, monosodium glutamate (MSG), sulfites, baked goods, or junk foods. Participants are encouraged not to weigh themselves for 30 days.

Professional Review

The Whole30 Program is a restrictive method of eating. The plan states that food is the cause of many medical conditions, but a variety of foods is essential to provide our bodies with adequate and varied nutrients. Unless there is a medical reason or allergy, it is not prudent to avoid an entire food group, much less multiple food groups.

I had a client, George, an athlete who learned about Whole30 from his workout buddies and he decided to try it. He wanted to maximize his health and felt that this method of eating would be a great addition. During the first few days of the diet he felt great and was proud of himself for avoiding processed foods and increasing his vegetable intake. As time progressed, he noticed increased hunger at night and started snacking on cubes of chicken. He enjoyed eating out with friends a few times a week but he began to meet with friends after meals because cooking at home was easier and he knew all the ingredients he was eating. He had lunch meetings at work at which he would ask the waiter for double protein portions and to replace the starch with a non-starchy vegetable. These requests often made his colleagues take a second look at him. After a couple of months, he recognized that he had rearranged his work and social calendar to better accommodate his new manner of eating. He decided his relationships were more important than a method of eating and he reincorporated dairy, and grains, and he no longer had to read labels on all of the foods he ate. He could be more flexible with his evening snack and switch from cubes of chicken to cheese and crackers. He learned from the Whole30 program that he was not eating enough vegetables before and he continued this new habit, but he no longer had to meet friends after dinner to watch sporting events.

The Nutrisystem Diet 

Background

The Nutrisystem Diet is a home-delivered pre-packaged meal program. The Lean 13 Plan claims that women will lose up to 13 pounds and 7 inches off their waist in the first month, whereas men can expect to lose 15 pounds and 7 inches off their waist. There is a “Turbo Take Off Week” during which the dieter eats 1,000 calories to enhance weight loss. The program prepares and delivers meals and outlines what to eat and when to eat it. The dieter is encouraged to avoid high glycemic index foods and alcohol. The plan has the dieter eat three meals with two snacks and a dessert snack from pre-packaged options. The dieter adds their personal selections of fruits and vegetables, protein, and dairy. There are three choices with a 4-week plan.

Basic—Start the first month with the Turbo10 plan and then receive portion-controlled meals as well as access to on-line tools and trackers.

Core—Start the first month with the Turbo10 plan and then receive portion-controlled meals, access to on-line tools, trackers, and diet counselors on call.

Uniquely Yours—Start the first month with the Turbo10 plan and then receive portion-controlled meals, including Nutrisystem’s new premium frozen cuisine. The dieter has access to on-line tools, trackers, and diet counselors on call.

Basic starts at $9.82/day or $274.99 for 4 weeks with free shipping, whereas the Core plan is the most popular at $10.54/day or $294.99 for 4 weeks with free shipping, and the Uniquely Yours plan starts at $11.96/day or $334.99 for 4 weeks.

Professional Review

The diet is pre-packaged and helps the dieter with portion-control for weight loss. The Turbo 10 plan provides inadequate calories to support a healthy brain and body functions. The dieter has a limited ability to eat with friends and family due to the pre-packaged meals. The cost can be a hindrance, and the dieter might become tired of eating packaged foods. The diet does not provide the dieter with education, and when the dieter stops eating the pre-packed meals, they have not gained knowledge on how to continue or to maintain their weight loss with every-day foods.

I have worked with clients who tried Nutrisystem, and they felt that they were able to lose weight only if they followed the program with pre-portioned meals. Each time they stopped the program they gained back the weight and felt hopeless with weight loss. The program would be more beneficial to a dieter if it provided the dieter with education to support balanced eating and weight loss. Education is the equivalent of gold for lifestyle changes.

The Slim-Fast Diet 

Background

The Slim-Fast Diet is a 1,200-calorie plan. The dieter prepares one 500 calorie meal a day, consumes two slim-fast meal replacements via a bar or shake, and three snacks. The diet claims to facilitate 1 to 2 pounds of weight loss per week. The Slim-Fast products’ prices vary but are available via a 30-day supply of six boxes of meal bars, five boxes of snack bars, and 32 shake mixes; it costs $75, plus shipping. A five-pack of meal bars runs about $4.88; a six-pack of snack bars is $3.25; an eight-pack of pre-made shakes is $9.88; and a carton of protein powder shake mix is $8.

Professional Review

Dieters have unique calorie needs for weight loss. A man weighing 350 pounds requires more calories to support basic bodily functions than does a woman weighing 250 pounds. An equal amount of food is not necessarily appropriate for two different people. Weight loss is achieved due to the low calorie content of shakes and snacks. The dieter can become tired of eating pre-packaged snacks, shakes, and bars.

The Glycemic Index Diet 

Background

The glycemic index categorizes carbohydrates as “good” or “bad.” Carbohydrates are a ranked on a scale from 0 to 100 based on how much they increase blood sugar levels after eating. Bad carbohydrates are said to increase blood sugar more quickly, to leave the person hungrier sooner, and to have a higher glycemic index. Good carbohydrates are lower on the glycemic index scale and are said to aid the dieter into feeling fuller longer. The dieter is encouraged to eat low-glycemic index carbohydrates (with a glycemic index of 55 or lower), to eat less medium-glycemic index carbohydrates (56 to 69), and to limit high-glycemic index carbohydrates (70 and higher).

Professional Review

The glycemic index encourages ingestion of higher-fiber foods that provide the body with many benefits, such as blood sugar stability, satiety, heart health, and regular bowel movements. However, the portions of foods tested for their glycemic index are not typical portion sizes. Most people eat several different types of food (such as a turkey and cheese sandwich with a side of carrot sticks) at once, which changes the glycemic index of the food items entirely. The glycemic index varies based on where the food is grown and how ripe the food is when it is consumed. The glycemic index is also difficult to understand. The dieter must look up each food individually. The glycemic index is completely independent of the nutrition value of the food item and it focuses on how quickly blood sugar rises when the food is eaten alone.

I had a client, Maria, who had diabetes; her doctor encouraged her to follow the glycemic index. During an appointment, we discussed various non-starchy vegetable options that she could add to her meals. I suggested carrots and she adamantly told me, “No, carrots were not good for a person with diabetes.” A cup of carrots provides around 6 grams of carbohydrate and a cup of broccoli has around 5 grams of carbohydrate. For comparison, a half cup of rice or potatoes has around 20 grams of carbohydrates. The glycemic index of carrots is 92 categorizing it as a high-glycemic-index food. The glycemic index of broccoli is 0 categorizing it has as a low glycemic index food. Carbohydrates are a main driver of blood sugar, and 5 to 6 grams of carbohydrates are considered a non- starchy vegetable and do not increase blood sugar rapidly or even much at all. It saddens me to think people who follow the glycemic index are missing out on foods they enjoy based on loose science.

The Macrobiotic Diet 

Background

The Macrobiotic Diet is an approach to help the dieter identify what foods are right for them to achieve balance and overall health and happiness. The diet follows the Chinese principle of balance, known as yin and yang. The macrobiotic diet claims to assist in warding off and curing diseases. The diet encourages organic, locally grown foods, and limits processed and chemical- containing foods. Dieters are encouraged to eat regularly, chew their food well, listen to their bodies, and stay active. The diet recommends that 40% to 60% of a daily diet include organic whole grains, 20% to 30% locally grown vegetables, and 5% to 10% beans and bean products (such as tofu, miso, and tempeh), and sea vegetables (like seaweed, nori, and agar). The dieter can consume fresh fish and seafood, locally grown fruit, pickles, and nuts, several times a week. The dieter is discouraged from eating dairy, eggs, poultry, processed foods, refined sugars and meats, tropical fruits, fruit juice, and certain vegetables (such as asparagus, eggplant, spinach, tomatoes, and zucchini). The dieter must drink only when thirsty and should avoid spicy foods, strong alcoholic beverages 

(https://www.webmd.com/mental-health/addiction/understanding-alcohol-abuse- basics), soda, coffee, and foods that are refined, processed, or chemically preserved. The macrobiotic approach encourages the dieter to chew at least 50 times, pause and give gratitude for your food before eating, eat two to three times a day, and stop eating before you are full. The Kushi Institute is a resource for coaching from macrobiotic counselors.

Professional Review

The diet encourages use of whole foods with a focus on whole grains, fruits, and vegetables. These are foods that many people could eat more. The diet is restrictive and avoids food groups that provide the body with key nutrients. This dieter is at risk for B12 and vitamin D deficiencies. The diet is difficult to follow and requires research and commitment.

Okinawa diet

Background

The Okinawa diet is a traditional eating pattern of the people living on the Japanese island of Okinawa in its purest form. They are credited with having some of the longest lifespans on the planet due to a unique diet and lifestyle.

Okinawa’s traditional diet is low in calories and fat, but high in carbohydrates. There are occasional – and small – amounts of noodles, rice, pork, and fish along with vegetables and soy products.

Dietary changes and modernization of food production have led to a change in the macronutrient content of Okinawa diets in recent years. It still contains low calories and is primarily carb-based, but now has a greater amount of protein and fat.

Additionally, a significant part of Okinawan culture utilizes traditional Chinese medicine practices and treats food as medicine. In this way, spices and herbs with health benefits are included in the diet, such as turmeric (1).

As part of the Okinawan lifestyle, exercise and mindful eating are important practices.

Traditional Okinawan diets are associated with health benefits, leading to mainstream versions intended to promote weight loss. The Western diet heavily influences the Western offshoot, which encourages nutrient-dense foods.

The popular weight loss supplement Okinawa Flat Belly Tonic is inspired by the Okinawa diet. According to the manufacturer, the Okinawa Flat Belly Tonic formula uses a rare combination of foods and berries that, when consumed, sets off a chain reaction within the body. It might lower your body’s CRP level, which, in turn, boosts metabolism and promotes fat burning. You might want to read some Okinawa Flat Belly Tonic reviews before making any purchase.

Foods to eat

It is believed that the Okinawa diet provides many of its benefits because it provides whole, nutrient-dense, high-antioxidant foods.

Nutrients are important for the proper functioning of your body, while antioxidants help prevent damage to your cells.

Okinawans consume much less rice than other Japanese. It is the sweet potato, followed by whole grains, legumes, and fibre-rich vegetables that provide them with the most calories.

Traditional Okinawan foods include:

  • Vegetables (58–60%): sweet potatoes (orange and purple), seaweed, kelp, bamboo shoots, daikon radish, bitter melon, cabbage, carrots, Chinese okra, pumpkin, and green papaya
  • Grains (33%): millet, wheat, rice, and noodles
  • Soy foods (5%): tofu, miso, natto, and edamame
  • Meat and seafood (1–2%): mostly white fish, seafood, and occasional pork — all cuts, including organs
  • Other (1%): alcohol, tea, spices, and dashi (broth)

Jasmine tea and turmeric, which are rich in antioxidants, are common ingredients of this diet.

The Ornish Diet 

Background

With the Ornish Diet, as noted in his book, The Spectrum, Dr. Dean Ornish encourages nutrition, exercise, stress management, and emotional support options to aid in weight loss or curing chronic diseases. Foods are categorized into five groups (from group one which is the healthiest to group five with the least healthy foods). It recommends that more foods from group one be eaten for increased health benefits. The diet encourages decreasing high-fat animal proteins while increasing fruits, vegetables, whole grains, legumes, non-fat dairy, soy products, and egg whites. Moderate amounts of fish, skinless chicken, avocados, nuts, and seeds should be eaten. No more than 10% of calories should be consumed from fat and only eaten in foods that naturally contain fats. Nuts should be limited to very small portions because of their high fat content. Cholesterol should be limited to 10 milligrams or less per day. This is achieved when dairy is limited to two non-fat dairy products daily; dairy alternatives such as soy milk are encouraged. The diet encourages plant-based proteins (such as egg whites, tofu, tempeh, beans, legumes, non-fat cheese, and non-fat yogurt). Foods should be flavored with spices, herbs, and other natural flavor enhancers (such as citrus and vinegars). Stimulants, such as caffeine, should be limited to promote balance, calmness, and a peaceful way of living. Green tea may be consumed (up to two cups daily), whereas caffeinated coffee is limited to one cup or less, and up to two cups of decaffeinated or up to two cups of black tea per day are permitted. Dr. Ornish states that food is not all-or-nothing; he focuses on eating the right foods. The dieter is encouraged to focus on foods found in nature while limiting processed foods. Calories are limited only if the dieter is trying to lose weight. If weight loss is desired, the dieter should eat small, frequent meals throughout the day with portion control. “Bad carbs” (such as refined carbohydrates, sugar, concentrated sweeteners, white flour, and white rice) should be limited in the dieter’s intake.

Sugar is not recommended, but it can be eaten in moderation, whereas added sugar (via maple syrup, agave, honey, white or brown sugar along with non-fat sweets, and refined carbohydrates) are limited to no more than two servings per day. Alcohol is not encouraged, but one serving daily is allowed.

Dr. Ornish recommends aerobic activities, resistance training, and flexibility. He also encourages deep breathing, yoga, and meditation to manage stress, and encourages dieters to spend time with loved ones. He explains how to lose weight, improve cholesterol and blood pressure, prevent and reverse type 2 diabetes, heart disease, prostate cancer, and breast cancer.

Professional Review

The diet encourages use of fiber-rich foods, and many people can benefit from increasing their fiber. The Ornish Diet is difficult to follow due to the recommendation of 10% of calories from fat. The USDA recommends 20% to 35% of calories from fat. Fat is necessary to aid in absorption of fat soluble vitamins A, D, E and K, it assists in satiety, insulates organs, promotes brain health, and adds flavor to foods. As a person decreases fat intake, they typically increase their carbohydrate intake.

The Pritikin Principle 

Background

The Pritikin Program is a low-fat, high-fiber plan that encourages exercise to prevent or cure heart disease. Fat intake is limited to 10% of daily calories. The diet encourages fruits, vegetables, low-fat dairy, legumes, lean protein, and fish. The dieter aims to limit oils, refined sugars, salt, and refined grains. The plan recommends avoiding processed meats, foods high in saturated fat (https://www.webmd.com/cholesterol-management/features/truth-about- saturated-fats), and those made with trans fat (https://www.webmd.com/food- recipes/understanding-trans-fats), organ meats, processed meats, and high- cholesterol foods (https://www.webmd.com/cholesterol-management/default.htm) like eggs.

There are 10 steps to The Pritikin Edge.

  1. Start each meal with soup, salad, fruit, or whole grains.It is said to promote fullness.
  2. Avoid high-calorie drinks, especially soda. A glass of wine each day can be good for the heart, but you should skip most alcoholic beverages.
  3. Avoid high-calorie foods.
  4. Snack at set times and only on healthy foods.
  5. Choose whole, unprocessed foods as often as possible, and always avoid fast food.
  6. Exercise regularly, combining lots of walking with strength training.
  7. Goeasyoneatingmeat, especially red meat. Instead, opt for fatty fish, like salmon.
  8. Skip extra salt.
  9. Don’tsmoke.
  10. Ease stress.

For support, the dieter can sign up for a free newsletter and seek online support. A starter kit is available at $459.95 and includes the “One-Week Pritikin Frozen Food Plan,” a One-Year Online Pritikin Membership, and the book The Pritikin Edge: 10 Essential Ingredients for a Long and Delicious Life. After the introduction, meal plans are $225 a week. Dieters are strongly encouraged to visit the Florida-based Pritikin Longevity Center and Spa, where prices range from $4,000 a week in the summer to $6,000 a week during the winter.

Professional Review

The diet is restrictive and difficult to comply with over the long term. As with the Ornish diet the recommended fat intake is very low. Fat is necessary for health. The diet has some balanced recommendations including aiming for whole foods and limiting processed foods, but it leaves the dieter with limited flexibility.

The South Beach Diet 

Background

The South Beach Diet is a low-carbohydrate, high-protein, and healthy-fat diet. The diet claims that the dieter can lose 8 to 13 pounds during the first two weeks, and then 1 to 2 pounds each week thereafter. The diet uses the glycemic index to determine good and bad carbohydrates. The diet states that foods with a high glycemic index increase your blood sugar faster than foods with a lower glycemic index. The diet explains that the increase in blood sugar can increase your appetite and cause weight gain and can even lead to diabetes or heart disease. The diet encourages use of mono-unsaturated fats and focuses on the benefits of fiber consumed via whole grains, fruits, and vegetables. The dieter does not need to count calories, fat grams, or carbohydrates. The plan encourages eating three meals a day with two snacks. The diet consists of three phases.

Phase 1 is designed to “jump start” weight loss and decrease cravings for sugar and refined starches. This phase lasts two weeks. The dieter is encouraged to avoid all foods with a high glycemic index. The dieter is permitted to eat non- starchy vegetables, lean protein, and foods with unsaturated fats. The dieter cannot eat starches, fruit, juice, or consume alcohol. The dieter eats 4.5 cups of vegetables and 2 cups of milk or dairy each day. The dieter may start with 2 ounces of protein at breakfast and 3 ounces for lunch and dinner and is encouraged to eat slowly and return for seconds if hunger persists.

Phase 2 is the long-term weight-loss phase. The dieter can slowly reintroduce “healthy” carbohydrates (such as whole grains, fruit, and more starchy vegetables). The dieter consumes three servings of fruit and three servings of starches per day. Two daily snacks are optional and a glass of wine at dinner is permitted. Weight loss is advertised at 1 to 2 pounds a week, and this phase will continue until the dieter reaches their goal weight.

Phase 3 is a maintenance phase. All foods are permitted, but if the dieter develops cravings or gains weight they are advised to return to Phase 1 or 2. The South Beach Diet On-line offers tools to track weight, recipes, an option for a customized meal plan, dining-out guides, and community support. Membership is $4 per week, but the first 7 days are free. An optional on-line membership is $5 per week. The diet has evolved over time and now recommends exercise as an important part of your lifestyle. The South Beach Diet says that regular exercise will boost your metabolism and help prevent weight-loss plateaus.

Professional Review

Phase 1 encourages an inadequate carbohydrate intake. Carbohydrates are necessary for health and they provide your brain with energy for optimal thinking. The diet contains many rules and does not teach the dieter about balance; instead, it applies all or nothing principles.

The Zone Diet 

Background

The Zone Diet states that the key to weight loss is achieving proper hormonal balance and keeping your blood sugar stable. The creator, Barry Sears, believes that to ensure that your insulin and other inflammation-promoting hormone levels stay “in the zone,” you should eat foods in the correct proportions at every meal: 40% carbohydrates, 30% protein, and 30% fat. The diet advertises that when the dieter follows the guidelines, they will lose 1 to 2 pounds weekly. The Zone Diet typically provides 1,200 calories daily for women and 1,500 calories daily for men. The dieter will eat five times a day with three meals and two snacks. Breakfast needs to be eaten within one hour of waking up followed by snacks and meals every five hours. The dinner plate should be divided into three equal sections of a lean protein (about the size of the person’s hand) and the other two sections should have colorful carbohydrates (such a fruit and a vegetable). A healthy fat (such as olive oil, almonds, or an avocado) will round out the meal. The diet does not prohibit foods but encourages certain types. Lean proteins (such as skinless chicken, turkey, fish, egg whites, low-fat dairy, tofu, and soy meat substitutes) are encouraged. Carbohydrates are categorized as “good” or “bad,” and the dieter should aim for low-glycemic carbohydrates. Low-glycemic carbohydrates are said to keep blood sugar and metabolism stable and to promote satiety while higher-glycemic carbohydrates increase hunger and promote unstable blood sugar levels. The diet encourages vegetables other than corn and carrots, and fruits other than bananas and raisins. The dieter should avoid pasta, bread, bagels, cereals, and potatoes. Small amounts of healthy fats are added to each meal; the dieter should avoid fatty red meat, egg yolks, liver and other organ meats, and processed foods. The dieter can seek resources via on-line membership at zonediet.com. Sears states that exercise is more important for weight maintenance than it is for weight loss.

Professional Review

The Zone Diet is a restrictive and complicated diet. The recommended calorie levels are inadequate for many men and women. Dieters must ensure that they consume adequate energy to fuel their bodies. Even though a dieter will want to decrease their calorie intake, they do not want to starve their bodies. This diet does not provide a dieter with valuable nutrition education and is not likely to build a long-term method of eating.

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