The Dangers of Dieting Range From Dry Skin to Death: What to Do

Environmental Nutrition, January 1, 1991

ROBYN FLIPSE, MS, RD

Dieting has become so acceptable that even the real men who didn't eat quiche 10 years ago now drink light beer.

Yet for all the dieting, Americans are not getting any thinner. In fact, it appears that the more Americans practice this national obsession, the fatter we get.

This third segment in our four-part series on weight control takes a look at some of the physical and psychological dangers of dieting and raises the question, "Are the benefits of losing weight worth the risk of failing at another diet?"

Coronary Heart Disease. Experts believe that extreme fluctuations in body weight may increase the risk for coronary heart disease. These weight changes don't have to be the result of chronic yo-yo dieting to be dangerous. A serious illness, personal crisis or other traumatic event that triggers sudden weight loss followed by rapid weight gain can have the same detrimental effects. That is what Kelly Brownell, Ph.D., of the University of Pennsylvania, found from analyzing several large population studies of the incidence of heart disease. "There is enough evidence to be concerned and to require more research on the issue," Dr. Brownell said.

Some experts suggest that those who have been gaining and losing the same 30 to 50 pounds for years, should stop. They say that unless a person is prepared to overhaul his lifestyle and change his eating and exercise habits permanently, it may do more harm than good to lose and regain those pounds over and over again.

Accelerated Fat Storage. A small but significant study designed to measure changes in an enzyme that induces fat storage in the body, found that the fatter a person is before dieting, and the more weight that is lost, the more `likely the enzyme lipoprotein lipase is to sabotage the effort. Lipoprotein lipase is an enzyme found in fat cells and is necessary for those cells to produce and store fat. Based on this study, conducted by Philip Kern, M.D. and his colleagues of Cedars Sinai Medical Center in Los Angeles, it is believed that the activity of this enzyme is increased after weight loss in very obese subjects - making fat storage easy and continued weight loss difficult. There is, to date, no known way to control lipoprotein lipase levels.

Slowed Metabolic Rate. Recent studies do not support the notion that dieting reduces metabolic rate beyond what can be expected for a lowered body weight - at least not permanently.

A report in the Journal of the American Medical Association by Thomas Wadden, Ph.D., associate professor of psychology at the University of Pennsylvania School of Medicine, indicates that although resting metabolic rates are initially lowered by dieting, they do rise again. Wadden admits however, that, "Rebound weight gain is more rapid for these individuals, but the cause is still unclear."

Loss of Muscle Mass. The answer to the above dilemma may be found in the muscle, not the metabolism, of frequent dieters. Low-calorie diets have been shown to cause a 3% to 6% loss of muscle tissue in obese subjects. And regained weight does not replace the muscle lost, pound for pound, resulting in a net loss of body protein. Over time, this protein depletion can contribute to lowered caloric requirements and easy weight gain.

Muscle tissue is best conserved by avoiding very-low-calorie diets (less than 800 calories per day) which produce weight losses of more than 3 or 4 pound per week. A reduction in caloric intake of 200 to 300 calorie per day, combined with gradual increases in the frequency and duration of exercise helps dieters shed the most fat with the least loss of muscle.

Death. Death is the ultimate danger of dieting. Though rare, it happened to 58 people between 1976 and 1977 who were trying to lose weight on unsupervised liquid protein diets. Another six people were reported to have died while on the Cambridge Diet in the early 1980's. And the death of at least one person has been linked to the use of Cal-Ban 3000, a mail order diet product. Weight loss of more than 50 pounds should be preceded by a medical checkup from your doctor.

Psychological Dangers

Dieting Plateaus. "The gradual cessation of weight loss is the real danger for dieters," explained John Foreyt, Ph.D., director of the Nutrition Research Clinic at Baylor College of Medicine in Houston. The problem is, plateaus come sooner for chronic dieters and inevitably lead to a renewed sense of failure. This, said Dr. Foreyt, produces "Feelings of hopelessness and despair, which lead to more abusive dietary habits. One's self-esteem is just destroyed in the process."

At these most difficult times, patience is not only a virtue, it is a necessity. Dieters must learn to focus on other benefits of their newly established eating and exercise habits, and forget the scale for a while. In most cases, it is only a matter of time before weight loss begins to register again.

Moral Judgments. Because this culture still regards obesity as a moral problem rather than a medical one, people who are overweight, are made to feel weak-willed. Yet, there is no cure for obesity and the success rates of the best treatments available are still tragically low, only serving to further demoralize those who are serious about losing weight.

Sometimes the only reprieve in this desperate situation is to seek support from groups like the National Association to Advance Fat Acceptance, P.O. Box 188620, Sacramento, California, 95818 (916) 443-0303. The group's purpose is to help overweight people feel good about themselves and get on with their lives rather than waste time waiting for weight loss that may never happen. Both Drs. Wadden and Foreyt voiced support for such groups for overweight individuals provided a person has no medical complications from extra weight.

Failed Expectations. Most diets fail not because of their programs or lack of motivation from the dieters, but because dieters define success unrealistically. So-called "ideal weights" are simply not for everyone. Recent findings on the role of genetics in determining body weight and fat distribution may finally signal the beginning of the end for using standardized height and weight tables to define dieting success or failure.

More practical and successful is the use of other clinical measurements, such as a drop in blood pressure, cholesterol or glucose levels, to evaluate the benefits of a person's dietary changes. By shifting the emphasis from dieting for cosmetic reasons to eating to reduce health risks, people are able to see more immediate results and start to believe their efforts are paying off. Dr. Wadden has told clients, "You can forget about your weight, but not about your health." A 10% to 15% drop in weight is sometimes all that is needed to normalize blood pressure or blood glucose levels.

The Answer. Are the benefits of weight loss worth the risk of failure? Not for the vast majority of dieters who are 20 to 30 pounds overweight and motivated by vanity, not medical problems. For those who have complicating medical factors, modest weight reductions of no more than 10% to 15% for any single course of treatment lasting from 6 to 12 months is recommended. Only after this initial goal has been achieved and maintained and the risk factors reassessed by a doctor should dieters attempt another course of weight reduction.

COPYRIGHT 1991 Environmental Nutrition, Inc .This material is published under license from the publisher through the Gale Group, Farmington Hills, Michigan. All inquiries regarding rights should be directed to the Gale Group.HighBeam™ Research, Inc. © Copyright 2006. All rights reserved.