Dieting

Dieting is the practice of eating food in a regulated fashion to decrease, maintain, or increase body weight. Dieting is often used in combination with physical exercise to lose weight in those who are overweight or obese. Some people, however, follow a diet to gain weight (usually in the form of muscle). Diets can also be used to maintain a stable body weight.

Diets to promote weight loss are generally divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie. A meta-analysis of six randomized controlled trials found no difference between the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram weight loss in all studies. At two years, all calorie-reduced diet types cause equal weight loss irrespective of the macronutrients emphasized.

Some long-term studies of dieting indicate the majority of individuals who have dieted regain virtually all of the weight that was lost after dieting, regardless of whether they maintain their diet or exercise program and that after two years of dieting, up to two-thirds of dieters were even heavier than they are prior to beginning their regimen. A study published in the APA's journal American Psychologist found diets 'do not lead to sustained weight loss or health benefits for the majority of people.' However, other studies have found that the average individual maintains some weight loss after dieting. Weight loss by dieting, while of benefit to those classified as unhealthy, may slightly increase the mortality rate for individuals who are otherwise healthy.

The first popular diet was "Banting", named after William Banting. In his 1863 pamphlet, Letter on Corpulence, Addressed to the Public, he outlined the details of a particular low-carbohydrate, low-calorie diet that had led to his own dramatic weight loss.

History
One of the first dietitians was the English doctor George Cheyne. He himself was tremendously overweight and would constantly eat large quantities of rich food and drink. He began a meatless diet, taking only milk and vegetables, and soon regained his health. He began publicly recommending his diet for everyone suffering from obesity. In 1724, he wrote An Essay of Health and Long Life, in which he advises exercise and fresh air and avoiding luxury foods.

The Scottish military surgeon, John Rollo, published Notes of a Diabetic Case in 1797. It described the benefits of a meat diet for those suffering from diabetes, basing this recommendation on Matthew Dobson's discovery of glycosuria in diabetes mellitus. By means of Dobson's testing procedure (for glucose in the urine) Rollo worked out a diet that had success for what is now called type 2 diabetes.

The first popular diet was "Banting", named after the English undertaker William Banting. In 1863, he wrote a booklet called Letter on Corpulence, Addressed to the Public, which contained the particular plan for the diet he had successfully followed. His own diet was four meals per day, consisting of meat, greens, fruits, and dry wine. The emphasis was on avoiding sugar, saccharine matter, starch, beer, milk and butter. Banting’s pamphlet was popular for years to come, and would be used as a model for modern diets. The pamphlet's popularity was such that the question "Do you bant?" referred to his method, and eventually to dieting in general. His booklet remains in print as of 2007.

The Atkins Diet was suggested by the American nutritionist Robert Atkins in 1958, in a research paper titled "Weight Reduction". Atkins used the study to resolve his own overweight condition and went on to popularize the method in a series of books, starting with Dr. Atkins' Diet Revolution in 1972. In his second book, Dr. Atkins' New Diet Revolution (2002), he modified parts of the diet but did not alter the original concepts.

Low-fat diets
Low-fat diets involve the reduction of the percentage of fat in one's diet. Calorie consumption is reduced because less fat is consumed. Diets of this type include NCEP Step I and II. A meta-analysis of 16 trials of 2–12 months' duration found that low-fat diets (without intentional restriction of caloric intake) resulted in average weight loss of 3.2 kg (7.1 lb) over habitual eating.

Low-carbohydrate diets
Low carbohydrate diets such as Atkins and Protein Power are relatively high in protein and fats. Low-carbohydrate diets are sometimes ketogenic (i.e. they restrict carbohydrate intake sufficiently to cause ketosis).

Low-calorie diets
Low-calorie diets usually produce an energy deficit of 500–1,000 calories per day, which can result in a 0.5 kilogram (1.1 lb) to 1 kilogram (2.2 lb) weight loss per week. Some of the most commonly used low-calorie diets include DASH diet and Weight Watchers. The National Institutes of Health reviewed 34 randomized controlled trials to determine the effectiveness of low-calorie diets. They found that these diets lowered total body mass by 8% in the short term, over 3–12 months.

Very low-calorie diets
Very low calorie diets provide 200–800 calories per day, maintaining protein intake but limiting calories from both fat and carbohydrates. They subject the body to starvation and produce an average weekly weight loss of 1.5–2.5 kilograms (3.3–5.5 lb). "2-4-6-8", a popular diet of this variety, follows a four-day cycle in which only 200 calories are consumed the first day, 400 the second day, 600 the third day, 800 the fourth day, and then totally fasting, after which the cycle repeats. These diets are not recommended for general use as they are associated with adverse side effects such as loss of lean muscle mass, increased risks of gout, and electrolyte imbalances. People attempting these diets must be monitored closely by a physician to prevent complications.

Detox diets
Detox diets claim to eliminate undesirable "toxins" from the human body rather than claiming to cause weight loss. Many of these use herbs, homeopathic remedies, or celery and other juicy low-calorie vegetables.

Fat loss versus muscle loss
Weight loss typically involves the loss of fat, water and muscle. Overweight people, or people suffering from obesity, typically aim to reduce the percentage of body fat. Additionally, as muscle tissue is denser than fat, fat loss results in increased loss of body volume compared with muscle loss. Reducing even 10% body fat can therefore have a dramatic effect on a person's body shape. To determine the proportion of weight loss that is due to decreased fat tissue, various methods of measuring body fat percentage have been developed.

Muscle loss during weight loss can be restricted by regularly lifting weights (or doing push-ups and other strength-oriented calisthenics) and by maintaining sufficient protein intake. Those on low-carbohydrate diets, and those doing particularly strenuous exercise, may wish to increase their protein intake. According to the National Academy of Sciences, the Dietary Reference Intake for protein is 0.8 grams per kilogram of body weight for adults. Endurance athletes, such as those who compete in distance running or cycling require many more calories in order to maintain weight. Due to the large caloric intake these athletes must consume it can be particularly tricky to ensure they obtain the nutrition required to maintain muscle mass.

Excessive protein intake, though not connected to declined kidney functioning in healthy individuals, may be harmful to those with certain kidney diseases. There is no conclusive evidence that moderately high protein diets in healthy individuals are dangerous; it has only been shown that these diets are dangerous in individuals already suffering from kidney and liver problems.

The Basal Metabolic Rate, which is the amount of calories the body expends at rest, meaning without performing any physical activity, is influenced by the person's total weight and total amount of muscle. The more muscle, the more calories a person can burn naturally. When the amount of muscle is increased, then more calories can be ingested without gaining weight. Conversely, if the amount of fat is increased, increasing the number of calories ingested will only add weight.

Normally, when people lose weight, they lose a combination of fat and muscle. If the diet plan includes a daily caloric intake greater than the basal metabolic rate (BMR), the person will most likely lose fat. In contrast, if the person follows a diet that includes a lower caloric intake than the BMR, this person will lose fat but also a higher percentage of muscle. Severe diets may make people lose 50% fat and 50% muscle weight thus affecting their metabolism because by losing muscle the BMR is affected.

Maintaining muscle mass while losing fat is therefore a key factor to reach both the ideal weight and body composition.

Energy obtained from food
The energy intake from food is limited by the efficiency of digestion and the efficiency of utilization. The efficiency of digestion is largely dependent on the type of food being eaten, while efficiency of utilization is affected by a variety of factors, including age, gender, body weight, hormone levels, and many more.

Chewing, especially in the elderly, has been shown to increase the intake of micronutrients. However, the effect of chewing on the intake of macronutrients, such as sugars, fats, and proteins has not been observed.

Proper nutrition
Food provides nutrients from six broad classes: proteins, fats, carbohydrates, vitamins, dietary minerals, and water. Carbohydrates are metabolized to provide energy. Proteins provide amino acids, which are required for cell construction, especially for the construction of muscle cells. Essential fatty acids are required for brain and cell membrane construction. Vitamins and trace minerals helps to keep good electrolyte balance and are used for metabolic processes. Dietary fiber also affects one's health, although it's not digested into the body.

The National Academy of Sciences and the World Health Organization publish guidelines for dietary intakes of all known essential nutrients.

Sometimes dieters will ingest excessive amounts of vitamin and mineral supplements. While this is usually harmless, some nutrients are dangerous. Men (and women who don't menstruate) need to be wary of iron poisoning. Retinol (oil-soluble vitamin A) is toxic in large doses. Vitamin E supplements have been found in some studies to increase mortality, congenital heart defects in offspring and an increased risk of stroke (see the corresponding article). Most people can obtain their nutritional needs from their diet. In any event, a multivitamin taken once a day will suffice for the majority of the population.

Weight loss diets that manipulate the proportion of macronutrients (low-fat, low-carbohydrate, etc.) have not been shown to be any more effective than diets that maintain a typical mix of foods with smaller portions and perhaps some substitutions (e.g. low-fat milk, or less salad dressing). Extreme diets may, in some cases, lead to malnutrition.

Besides the importance of eating a balanced diet that includes all the necessary nutrients, other factors also contribute to healthy nutrition. As well, drinking sufficient amounts of water is often claimed to help eliminate toxins and fat. Heavily processed and fried foods as well as sweets, junk foods, and alcohol should also be avoided in a healthy diet.

Also a topic of great importance discussed among nutritionists as well as psychologists is the attitude to weight-loss and the consumption of food in general. Voicing ideas such as "it's just one burger" during and after weight loss regimes is discouraged, and often is said on the part of an insecure individual who has reached the unfortunate conclusion that nothing can be done any longer and that any effort to do so is futile. The advice given is, avoid reaching such a conclusion, as not only does it change one's perception of the effect of excessive amounts of food on the body, but also encourages a 'lacklustre' lifestyle and approach to life as a whole.

Nutritionists also agree on the importance of avoiding fats, especially saturated fats, to reduce weight and to be healthier. They also agree on the importance of reducing salt intake because commercial foods such as snacks, biscuits, and bread, among others, already contain salt, thus contributing to an excess of salt daily intake.

MyPyramid Food Guidance System is the result of extensive research performed by the United States Department of Agriculture to revise the original Food Guide Pyramid. It offers a wide array of personalized options to help individuals make healthy food choices. It also provides advice on physical activity.

How the body eliminates fat
All body processes require energy in order to function properly. When the body is expending more energy than it is consuming (e.g. when exercising), the body's cells rely on internally stored energy sources, such as complex carbohydrates and fats, for energy. The first source to which the body turns is glycogen (by glycogenolysis). Glycogen is a complex carbohydrate, 65% of which is stored in skeletal muscles and the remainder; in the liver (totaling about 2,000 kcal in the whole body). It is created from the excess of ingested macronutrients, mainly carbohydrates. When glycogen is nearly depleted, the body begins lipolysis, the mobilization and catabolism of fat stores for energy. In this process, fats; obtained from adipose tissue, or fat cells, are broken down into glycerol and fatty acids, which can be used to generate energy. The primary by-products of metabolism are carbon dioxide and water; carbon dioxide is expelled through the respiratory system.

Fats are also secreted by the sebaceous glands (in the skin).

Weight loss groups
Some weight loss groups aim to make money, others work as charities. The former include Weight Watchers and Peertrainer. The latter include, Overeaters Anonymous, as well as several groups run by local churches, hospitals, and like-minded individuals.

These organizations' customs and practices differ widely. Some groups are modelled on twelve-step programs, while others are quite informal. Some groups advocate certain prepared foods or special menus, while others train dieters to make healthy choices from restaurant menus and while grocery-shopping and cooking.

Food diary
A 2008 study published in the American Journal of Preventive Medicine showed that dieters who kept a daily food diary (or diet journal), lost twice as much weight as those who did not keep a food log, suggesting that if you write your food down, you wouldn't eat as many calories. Accordingly, diet journal software and websites have gained significant popularity, and help people track calorie consumption, calorie burning, weight loss goals, and nutritional balance.

Medications
Certain medications can be prescribed to assist in weight loss. The most recent prescription weight loss medication released is Acomplia (generic name Rimonabant), manufactured by Sanofi Aventis. Used to treat obesity in persons with a BMI (body mass index) of 30 or above, as well as for smoking cessation treatments, Acomplia is still pending FDA approval for use in the United States. Other weight loss medications, like amphetamine, are addictive and consequently are now banned in the US for casual weight loss. Some supplements, including those containing vitamins and minerals, may not be effective for weight loss.

Diuretics
Diuretics induce weight loss through the excretion of water. Diuretics, which can be used in the forms of medications, supplements, or herbs, reduce overall body weight, but have no effect on an individual's total body fat content. Diuretics can thicken the blood, cause cramping, kidney and liver damage. In a single report, the death of Jacqueline Henson was found to be related to swelling in her brain, which was associated with excessive water consumption over a short period of time, while she was on a special water diet.

Stimulants
Stimulants such as ephedrine, green tea, caffeine or synephrine work to increase the basal metabolic rate.

Possible weight loss effects of drinking water prior to meals
A 2009 review found that existing limited evidence suggests that encouraging water consumption and substituting energy-free beverages for energy-containing beverages may facilitate weight management. A 2009 article found that drinking 500 ml of water prior to meals for a 12 week period resulted in increased long-term weight reduction. (References given in main article.)

Dangers of fasting
Lengthy fasting can be dangerous due to the risk of malnutrition and should be carried out under medical supervision. During prolonged fasting or very low calorie diets, the reduction of blood glucose, the preferred energy source of the brain, causes the body to deplete its glycogen stores. Once glycogen is depleted the body begins to fuel the brain using ketones, while also metabolizing body protein (including but not limited to skeletal muscle) to be used to synthesize sugars for use as energy by the rest of the body. Most experts believe that a prolonged fast can lead to muscle wasting although some dispute this. The use of short-term fasting, or various forms of intermittent fasting have been used as a form of dieting to circumvent this issue.

Side effects
Dieting, especially extreme food-intake reduction and rapid weight loss, can have the following side effects and consequences:
 * Subsequent weight re-gain
 * Lowered metabolism, causing future attempts at weight loss to become more difficult, and making weight gain easier
 * Muscle atrophy
 * Risk of developing eating disorders, especially anorexia nervosa or bulimia nervosa, even if initial intentions of dieting were health-wise
 * Prolonged hunger
 * Depression
 * Reduced sex drive
 * Fatigue
 * Irritability
 * Fainting
 * Sinus problems (especially post-nasal drip)
 * Rashes
 * Acidosis
 * Bloodshot eyes
 * Gallbladder disease
 * Seizures
 * Malnutrition, possibly leading to death
 * Constipation, due to lack of food-intake
 * Dehydration, due to lack of fluid-intake

While there are studies that showed the health and medical benefits of weight loss, a study in 2005 of around 3000 Finns over an 18-year period showed that weight loss from dieting can result in increased mortality, while those who maintained their weight fared the best. Similar conclusion is drawn by other studies, and although other studies suggest that intentional weight loss has a small benefit for individuals classified as unhealthy, it is associated with slightly increased mortality for healthy individuals and the slightly overweight but not obese. This may reflect the loss of subcutaneous fat and beneficial mass from organs and muscle in addition to visceral fat when there is a sudden and dramatic weight loss.

Low carbohydrate versus low fat
Many studies have focused on diets that reduce calories via a low-carbohydrate (Atkins diet, Scarsdale diet, Zone diet) diet versus a low-fat diet (LEARN diet, Ornish diet). The Nurses' Health Study, an observational cohort study, found that low carbohydrate diets based on vegetable sources of fat and protein are associated with less coronary heart disease. The same study also found no correlation (with multivariate adjustment) between animal fat intake and coronary heart disease (table 4). A long term study that monitored 43,396 Swedish women however suggests that a low carbohydrate-high protein diet, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, are associated with increased risk of cardiovascular disease.

A meta-analysis of randomized controlled trials by the international Cochrane Collaboration in 2002 concluded that fat-restricted diets are no better than calorie restricted diets in achieving long term weight loss in overweight or obese people. A more recent meta-analysis that included randomized controlled trials published after the Cochrane review  found that "low-carbohydrate, non-energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to 1 year. However, potential favorable changes in triglyceride and high-density lipoprotein cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein cholesterol values when low-carbohydrate diets to induce weight loss are considered."

The Women's Health Initiative Randomized Controlled Dietary Modification Trial found that a diet of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily resulted in:
 * no reduction in cardiovascular disease
 * no statistically significant reduction in invasive breast cancer
 * no reductions in colorectal cancer

Additional recent randomized controlled trials have found that:
 * A comparison of Atkins, Zone diet, Ornish diet, and LEARN diet in premenopausal women found the greatest benefit from the Atkins diet.


 * The choice of diet for a specific person may be influenced by measuring the individual's insulin secretion:
 * In young adults "Reducing glycemic [carbohydrate] load may be especially important to achieve weight loss among individuals with high insulin secretion." This is consistent with prior studies of diabetic patients in which low carbohydrate diets were more beneficial.

The American Diabetes Association released for the first time a recommendation (in its January 2008 Clinical Practice Recommendations) for a low carbohydrate diet to reduce weight for those with or at risk of Type 2 diabetes.

Low glycemic index
"The glycemic index (GI) factor is a ranking of foods based on their overall effect on blood sugar levels. The diet based around this research is called the Low GI diet. Low glycemic index foods, such as lentils, provide a slower, more consistent source of glucose to the bloodstream, thereby stimulating less insulin release than high glycemic index foods, such as white bread."

The glycemic load is "the mathematical product of the glycemic index and the carbohydrate amount".

In a randomized controlled trial that compared four diets that varied in carbohydrate amount and glycemic index found complicated results:
 * Diet 1 and 2 were high carbohydrate (55% of total energy intake)
 * Diet 1 was high-glycemic index
 * Diet 2 was low-glycemic index
 * Diet 3 and 4 were high protein (25% of total energy intake)
 * Diet 3 was high-glycemic index
 * Diet 4 was low-glycemic index

Diets 2 and 3 lost the most weight and fat mass; however, low density lipoprotein fell in Diet 2 and rose in Diet 3. Thus the authors concluded that the high-carbohydrate, low-glycemic index diet was the most favorable.

A meta-analysis by the Cochrane Collaboration concluded that low glycemic index or low glycemic load diets led to more weight loss and better lipid profiles. However, the Cochrane Collaboration grouped low glycemic index and low glycemic load diets together and did not try to separate the effects of the load versus the index.

Feminist perspectives
Numerous feminists have written and spoken about the societal pressure on women to diet. Fat feminism is a movement that began in late sixties that opposes dieting, and instead promotes the Health at Every Size (HAES) approach and encourages women to accept their bodies' basal metabolic rate. In The Beauty Myth, Naomi Wolf calls dieting "the most potent political sedative in women's history".