Frontline: Diet Wars

Frontline (washingtonpost.com)

Americans spend $40 billion a year on books, products and programs designed to do one thing: help us lose weight. From Atkins to Ornish and Weight Watchers to the Zone, today's dieters have a dizzying array of weight loss programs from which to choose -- yet the underlying principles of these diets are often contradictory. Is low fat better than low carb? Is Atkins the answer? And has the USDA Food Pyramid done more harm than good? In "Diet Wars," Frontline examines the great diet debate.

Correspondent Steve Talbot was online Friday, April 9 at 11 a.m. ET, to discuss the documentary and which diet choices are better than others.

"Diet Wars" airs Thursday, April 8 at 9 p.m. ET on PBS (check local listings).

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

________________________________________________

San Francisco, Calif.: I watched your program last night and enjoyed it but wonder why there was such a heavy emphasis on BMI. BMI is a measure of mass, not body composition, which is much more important since it matters more how much fat you have in your body, rather than simply how much you weight. By BMI standards, Arnold Schwarzenegger is obese. Why didn't you introduce the concept of body fat percentage as measured by displacement or skin-fold calipers instead of the overly simplistic and often wrong BMI?

Steve Talbot: Well, that's a very good observation and it's a totally valid point as well. The only reason we didn't do it was that the shorthand for everyone these days is the BMI as a quick fix on whether you're overweight or not. We thought that would be an easier handle for the audience and we talk more about the questioner's observation on the Web site.

And we do make the point on the Web that the BMI does not work for old people, kids or athletes or bodybuilders like my current governor.

_______________________

Calgary, Alberta, Canada: I was impressed by how your program communicated many complicated issues and information, and have recommended it to many associates for educational purposes.

However, there is an additional element which is essential for achieving lifetime weight control for many that you may want to investigate in more depth. The element I refer to is the "mental/emotional attachments" many people have with food, their lifestyle and themselves.

For more information on a program being developed to successfully manage this "emotional element" please reply to ashworthave-canada.com with more direct contact information.

Sincerely.

Steve Talbot: The psychology of food is crucial. A lot of people we interviewed discussed it. Especially Dr. Dean Ornish. Again, there's more from him in an interview on our Web site.

I know myself when I am editing a documentary, I sit for hours in a semi-dark room nervously contemplating a screen and wondering how I should structure the film. And one of my first instincts is to snack. It gives me something to do the way smokers use cigarettes. Fortunately I never smoked, but I have noticed my editor and I putting on weight. It's one of those things you have to become concious of -- when you eat and why.

_______________________

Steve Talbot: We do say in the documentary that there's no longer any food-free zone in America. It's permissible these days to eat anywhere -- your car, your office desk, walking around on the streets -- which incidentally my son tells me having just visited Japan is socially frowned upon. People are not supposed to eat walking around on the streets.

_______________________

San Bernardino, Calif.: What was the most shocking "thing" you learned about the weight lose industry?

Steve Talbot: I'll say two things. One is simply the size of it -- that its a $40 Billion a year industry is staggering.

The second point is how fierce the competition is between the diet gurus and how much is at stake for them financially. I found that the lowfat advocates are very defensive at the moment because of the popularity of Atkins.

_______________________

Davie, Fla.: With the American public learning more and more about what and how to eat, one would wonder why obesity, overeating, and inactivity are all on the rise. I believe the missing piece to this puzzle is within the brain. There is some psychological reason that, as a whole, the American public are doing the opposite of what they know is right. Why do you think this is? And, do you feel that the psychological aspect of eating, dieting, and weight gain is as important as diet and exercise?

Prof. Damian Stanziano
Florida Atlantic University

Steve Talbot: I am certainly not an expert in the human brain, though I wish I were. Again, the psychology of food -- why we eat, when we eat, how much we eat -- are absolutely essential questions. There's been some fascinating research done, but I am definitely not the person to ask about this.

_______________________

Toronto, Ontario, Canada: You mentioned you came up with your own customized plan...

What was it? It seems a healthy steady loss, which in the long term is more sustainable.

Regards from a Canadian viewer of Frontline.

Steve Talbot: Great. Hello Canada -- we love it when Canadians watch public TV.

I'm hesitant to name the diet that I actually used because I don't want to be seen -- and Frontline doesn't -- as endorsing a particular diet program.

The bottom line, I've found is that any of the major diet programs -- lowfat, low carb, all work if you actually stick to their program. That is, they work in the short-run. The really key obstacle for longterm health is how you manage to keep the weight off. Because invariably for mere mortals like myself you end up craving the one thing you have given up on any particular diet and the tendency is always to go back and start eating that again. This leads to the infamous "yo yo dieting" effect which doctors tell me can be even more damaging to your health than simply being overweight.

The diet I was on I called the "Frontline Diet" -- which involves having a camera crew monitoring your every move anxiously awaiting the moment you'll fall off the wagon into chocolate cake exposed on national television. I found that to be a powerful motivator. So, fear of humiliation was my diet.

I will say that I ended up doing a modified version of the South Beach diet, which currently seems to be the best-selling diet book.

_______________________

Kearney, Neb.: Was there ever any discussion on diet pills, such as the newly popular "Release" program?

Steve Talbot: We simply didn't have the time to cover everything, including diet pills. Everyone always seems to be hoping for the magic cure -- the pill that will solve everything and maybe scientists and doctors will one day actually discover a pill that can guarantee safe weight loss, but to my knowledge this doesn't exist yet.

_______________________

Madison, Wis.: I'm very interested in the media's role in playing up all the "hype" around certain diet fads. Your program seemed to be very balanced and objective, but I know that some (perhaps many) people will perceive some bias. Is it possible to cover this issue and truly remain objective? Did your personal involvement in the story help or hinder your efforts to remain neutral?

Steve Talbot: That's a very good question. There's no doubt at all that the media hypes diet wars. There's way too much hyperbole in especially TV coverage, talk show coverage, of these competing diet plans. We tried to be as neutral and fair-minded as possible and the idea of having me as the correspondent -- a lay person with no special expertise on this subject -- was an attempt on our part to be as objective as possible. Our producer, John Palfreman, is a very knowledgeable veteran producer of science and medical documentaries for Frontline and NOVA, so he set the parameters of the program. But I was on a genuine personal journey of trying to sort all this out for myself and the average person.

_______________________

Washington, D.C.: There's a lot of talk about how students today have fewer PE classes, I had PE everyday in school up through the beginning of high school, but it was pretty useless -- I was lousy at sports and spent a lot of time sitting around waiting for my turn at bat, standing around in the outfield, etc. I would have been a lot better off if I could have just walked during PE. Has there been any changes to PE these days that focuses more on getting students MOVING?

(By the way, I've lost 45 pounds in the past year based on good fat/good carbs eating and regular exercise.)

Steve Talbot: That's a great observation. I grew up loving sports and hating PE class for much the same reason: it was boring. I have spent a lot of time reporting about education over the last four or five years, but I haven't noticed a tremendous improvement in PE classes. Walking, any form of aerobic activity, is much better for your health than standing around in the outfield.

On the other hand, I have seen a lot of teenagers getting very active in soccer, volleyball, even sports like rowing.

_______________________

Arlington, Va.: I was disappointed in your treatment of the Pritikin program on last night's show. I'm a 54 year old woman who spent 2 weeks at Pritikin in the fall of 2002. Meal portions were not tiny, but rather realistic for someone who wants to lose weight. There was food available at all times of day at Pritikin, and I was never hungry. I also want to put in a word for Ivan ("the drill sergeant") and the other trainers at Pritikin. They are a caring and dedicated group of people who never pushed anyone beyond their limit. Did they push us to do more? Yes, but there was tremendous pride at having been able to do more. I went back to Pritikin with my teenaged daughter in the summer of 2003 for a special "family program" that Pritikin has to help kids learn how to eat and exercise properly. I wonder that you didn't mention this program, given your emphasis on the problems of the next generation.

I've lost 45 lbs. in the past year and a half, as well as lowering my cholesterol. I'd say the most important thing I learned at Pritikin was to look at eating healthy as a gift to myself, rather than a deprivation.

Steve Talbot: Good for you! Pritikin obviously has worked for you and has worked for many people over many years. I talked to a lot of happy veteran Pritikin dieters when I was in Miami and found that a lot of them return year after year, so I don't want to knock the program. But it did seem rather spartan to me.

And many people have commented that the Pritikin doctor in the film looked rather gaunt, perhaps not the best advertisement for lowfat diets -- which have helped many people lose weight and been lifesavers for people recovering from heart attacks.

_______________________

Palm Beach, Fla.: The Program was great but too short. Will there be another follow-up?

Steve Talbot: Not with me, I hope.

Seriously, I'm sure that Frontline will return to this subject. A number of years ago they did a first-rate program simply called "Fat." If you would like to see more documentaries like this, let Frontline and PBS know.

_______________________

Arlington, Mass.: Steve, I really enjoyed your program. In your reporting, did you discuss with any of the experts the detrimental effects of certain ingredients of foods, particularly partially-hydrogenated oils?

Most people I speak with have no idea about the potentially harmful effects of this ingredient and it seems that the proliferation of partially hydrogenated oils may further compound the debate on just what is "best" to eat.

Steve Talbot: Yes, Dr. Walter Willitt of the Harvard School of Public Health, spoke in the film about the bad consequences of the food industry's removing healthy fats from salad dressings, for example. And he discusses the issue you raise in more depth on our Web site.

The bottom line is to avoid the worst so-called trans fats, which are called partially hydrogenated oils or vegetable shortening. I found Willett's book very useful as well, it's called "Eat, Drink and Be Healthy: The Harvard Medical School Guide to Healthy Eating."

_______________________

Alexandria, Va.: I agree that a lot of overeating can be attributed to emotion and the brain, but one has to wonder why obesity has skyrocketed in the past decade. Has our emotional state/brain chemistry changed that much as a society that it can be considered a significant factor in the obesity epidemic? I think not.

Having lost over 45 pounds in the past 2 years, I believe that your observation of eating permissiveness is on target. We are surrounded by cheap, processed food, and LOTS of it. I think as a society we have lost our sense of proportion (be it food, houses, cars or what.) We truly believe as a society that bigger is better.

Steve Talbot: I think those are excellent points. I really agree. To recommend another book that elaborates on this, I would suggest people read "Fat Land," by Greg Critser. The subtitle is "How Americans Became the Fattest People in the World." And he, as well as many other experts we spoke with, showed that the national obesity trend really took off in the late 1970s and he explores the many reasons why that happened, including the tendency to serve huge portion sizes. He mentions, and I vividly recall growing up in southern California, McDonalds serving french fries -- the portions were small. I used to lick the salt out of the bottom of the bag as a kid. The calories in those original servings were about 200 calories. The current McDonalds french fry order is about 600 calories. So, mega-portions are a big part of the problem.

_______________________

Waldorf, Md.: Doesn't the existence of dozens of theories about diets, almost all of which have something approaching a 90 percent failure rate one year later, really just indicate that doctors, nutritionists, dieticians and other scientists really have no clue what they're talking about? Most of their theories are highly ideological (fat is bad, counting calories is the only way, etc.) I understand that many things are not an "exact science," but generally their is an informed consensus, and occasionally new data comes along and scientists readily admit it and revise their theories. But in dieting/weight loss, there is NO consensus whatsoever, and every charlatan who comes down the pike Richard Simmons? Give me a break) is allowed to weigh in. We don't have 20 theories about the solar system, or 20 theories about why airplanes fly, or 20 theories about what causes measles. Why not just admit that the diet/weight loss field is still in the mumbo-jumbo phase?
Twenty years ago 90 percent of the experts" thought (and said) that Atkins was a fruitcake; now about half seem to think there's some validity to his theories about carbs.
C'mon, this isn't how "science" and "medicine" are conducted. Why not say so?

Steve Talbot: Well, I understand your frustration. There is a plethora of information and misinformation and rival factions in these diet wars that reminds me of religious war. But, there has been some research and, not to over-tout him, but I would urge people to look at the longterm study of health professionals that Walter Willitt has worked on at Harvard. And there does seem to be an emerging concensus that there are good fats and there are good carbs and that we need to eat both for longterm weight loss and health.

But studies of dieting are particularly difficult. Again, our Web site discusses some of these complications. And, in the end for now, a lot of this comes down to common sense. And what my wife has been telling me for years, which is eat healthy food in moderate portions and exercise regularly. It's not a very exciting message, it doesn't sell a lot of diet books, but its the closest thing we have to the truth.

_______________________

Townville, Pa.: Am I the only person who sees a relationship between food tampering for profit... such as growth hormones for beef cattle, milk production stimulating chemicals, and other interventions that directly affects humans, and even their pets, who are further up on the same food chain... and the overweight epidemic?

Steve Talbot: I think that's really another topic. Frontline looked at the meat industry in America not so long ago in an excellent documentary called "Modern Meat" -- you can watch that online at the Frontline Web site.

_______________________

Fairfax, Va.: As a member of the American Dietetic Association and a Registered Dietitian for 20 years, I appreciate and applaude your effort to parse through the diet quagmire and bring some clarity to the issue -- if Americans do not learn to moderate their food intake, include a variety of foods that we know to be good for us, and move their bodies more, we will have an unmanageable health care situation in the years to come. A registered dietitian is a good resource and can provide more indepth analysis of an individual's dietary needs and concerns. One comment on the BMI -- it is a useful screening tool, however, you must remember that muscle weighs more than fat, so one could have a high BMI if they are building muscle. A more precise gauge of actual body fat may be necessary.

Steve Talbot: Thank you very much. Glad you found the documentary useful. The longterm healthcare consequences of obesity are really frightening and when my old acting friend Jerry Mathers, Beaver on "Leave it to Beaver," found out that he had become a diabetic as a consequence of being overweight, that struck very close to home for me. It's something we all need to be concerned about.

Dr. James Hill in our documentary calls the fattening of America the number one health issue of our generation.

_______________________

Bethesda, Md.: In terms of psychology of eating -- the class differences mentioned on the Web site were fascinating. I think the scientific and the advertising agencies are working at cross purposes, but also working on different people. The science needs to be simpler -- as simple as the milk ads and the beef ads. Science tends to be presented in ways geared towards the educated elite -- show me the data, Ornish says -- and that works for me. But when the less-educated see scientists, they see a bunch of mixed-up, in-fighting, inconclusive results. And then the food industry comes in with simpler ads, snackwells, etc. There's more money in it for them, more incentive to keep the less-educated people confused.

Steve Talbot: Right, all too true. And the class and even race component of America's weight problem is both a very important and a very sensitive subject. But the link between poverty and obesity is now so clear that the CDC and others are looking at low income as being a risk factor for obesity. The problem in America no longer seems to be so much about having enough to eat, but about having access to and being able to afford healthy nutritious food. Try to find fresh affordable fruit and vegetables in a poor neighborhood. It's not easy. No shortage of liquor stores or convenience stores selling tobacco and twinkies, but hard to find an apple.

_______________________

Silver Spring, Md.: Steve,
I think the most eye opening thing for me was that article in the New York Magazine in 2002 that talked about the history of the low fat campaign in food and the leap of faith researchers did equating low fat with weight gain. Also, the fact that the RDA for carbohydrates silently dropped from 300 to 150, about a year or so ago. I do not follow Atkins but the reduction of simple carbs in my diet has enabled me to get past that wall (of weight) I keep hitting with the low fat.
regiment. Also in that article the interesting info about how carbs effect your blood sugar and the affect on feeling hungry. Can you address some of these issues.
Thanks

Steve Talbot: Speaking personally, having tried South Beach -- which is a more liberal version of Atkins. I found that eating a steak, for example -- a smaller portion of steak, did in fact leave me feeling full, or as they say, "satiated." So even in the first two weeks -- the most restricted phase of South Beach -- when I was losing weight rapidly, I honestly did not feel hungry. And that is an important consideration for dieters and I know that Atkins has worked for many people, including those who just couldn't get through a barrier on low fat diets, which left them feeling deprived. The problem with Atkins, doctors told us, is that the longterm effects of eating such a high protein, high fat diet can possibly lead to problems like heart disease.

_______________________

Washington, D.C.: Steve, it is true that the bottom line (no pun intended) is calories in vs. calories out. We need to do a little more and eat a little less. I know of a book that stats this fact and it works!

Steve Talbot: Absolutely true. And that's what I'm trying to do myself right now.

It all comes down to calories and the average number they say is about 2,000 calories a day that people need -- so with a little effort you can figure out your caloric intake and if you're going to splurge, which is fine, you do know that you need to step up your activity. With the help of those step counters -- the pedometers that James Hill is recommending -- I've increased my own level of exercise. I find that I'm now walking on average over three miles a day with much more activity on the weekends.

What they say about exercise is true, that if you start slowly, work your way up, you actually begin to feel better. And the longterm value of even a simple activity like walking is pretty astounding.

One of the great regrets in my life is that I never convinced my own mother to take up walking when she began to put on a lot of weight when she reached her 50s. She ended up having very high blood pressure aggrivated by her weight and died of a stroke.

_______________________

Anchorage, Alaska: Hello "Light going on Extra Light" Steve, and I'm motivated beyond belief by your program to get back into a program to last me for life. My question is about the pedometer and walking. I was confused by the amount of steps one needs each day to sustain target weight. And it still seems impossible for me to believe that you need to walk or run 4000 steps a day! Could you expand on this a bit?

Steve Talbot: I'll try. For more information you can go to the web site for America on the Move. Their original recommendation was that people walk 10,000 steps a day on average -- that's about five miles. And they found that even in Colorado, which claims to be the leanest state in America and the most physically active, very few people met that goal. So they now have a more modest recommendation, which is to increase the average number of steps a day from 4,000 to 6,000 -- which personally I found is quite doable. The pedometer seems like a gimmick, a crutch, but Americans do like new gadgets and we like to keep score and I found that using it even for a few weeks made me much more concious of when I needed to move. And now I think its ingrained.

_______________________

Newington, Conn.: What kind of role could government (states or federal) have in addressing the obesity problem? Especially since this will become a public health issue if it's not addressed early on.

Steve Talbot: That's a fantastic question. I think the government needs to play an important role. I'm pleased to see that Tommy Thompson, HHS Secretary, has taken up the cause. It turns out that he is my same height, 5'11" and that when we both started dieting we weighed 210 pounds. I saw him on TV recently where he proudly proclaimed that he had lost 15 pounds on his own diet -- the exact same amount I lost in the course of making the documentary. He said he wanted to lose an additional 10 pounds. I too want to continue to lose more weight, because as I discovered somewhat to my disappointment, that for a person 5'11", you need to be below 180 pounds to be considered the normal weight on that pesky BMI chart.

So, in the interests of the nation and my own waistline, I challenged Tommy Thompson to keep on pushing to get to 180 and I'd be happy to have a weigh in on the mall with him at a time of his choosing.

I'm old enough to remember president Kennedy's 50-mile walks, which was part of his national health crusade to get the country to shape up. Not such a bad idea for now.

There's also a great deal that the government might do in regulation of the food industry, but that's a topic we can continue to investigate.

_______________________