The Controversy over Dieting
G. TERENCE WILSON
For decades, dieting was the thing to do. The assumption that dieting would lead to the twin advantages of better health and improved looks was held as a self-evident truth. More recently, however, the effects of dieting have been called into question. Critics have charged that dieting is ineffective at best, and damaging to health at worst. These criticisms have been the rationale for such extreme recommendations as the call for a moratorium on weight loss programs. In a related fashion, dieting has been indicted as an element of societal oppression in some feminist critiques of the development of eating disorders and problems in weight regulation.
Too often lost in the controversy over dieting is the understanding of what precisely is said to be good or bad. From a scientific perspective, it is unhelpful to ask whether dieting helps or harms people. The more useful question is what are the effects of the various forms of dieting (namely, self-imposed restriction in food energy intake), in whom, and when undertaken for what purpose? (Further discussion of dieting and its significance is included in Chapters 15 and 16.)
Scientifically based weight control programs have long eschewed “fad diets” as quick and easy solutions to losing weight. Often these diets are of dubious nutritional value, if not downright hazardous to health. Modern behavioral weight control treatments emphasize change in nutrition as one of several components of a comprehensive program aimed at lifestyle modification, including increased physical activity (see Chapter 94). The goal is a balanced but flexible diet that emphasizes reduced saturated fat and increased complex carbohydrates. Overall caloric intake is intentionally restricted to one degree or another to produce a negative energy balance. Some programs include a very-low-calorie diet (VLCD) as an interim stage in the overall program (see Chapter 96).
Comprehensive weight control programs that combine dietary modification with in-