“Doctor, I don’t get it. I am eating healthy and I don’t eat a lot. Yet, I am gaining weight.”
As a board-certified Obesity Medicine Specialist and physician, I see patients in my office who report they intend to lose weight to improve their health and feel better. But they make statements like this and are discouraged. That is because what it is healthy food for one, is not fit for all.
Physiologic diversity rules that food that is most beneficial for each person varies. That is evident as despite following guidelines limiting fats and eating more whole grains, the majority of Americans are affected by overweight and obesity
A patient can stop a recent eating pattern that is effectively reducing weight and improving chronic medical conditions such as diabetes, high blood pressure and osteoarthritis, when some well-meaning healthcare provider may suggest a single rigid diet plan as the only healthy option.
This dogmatic approach interferes with a patient’s progress.
The Federal Drug Administration’s new and revised nutrition labels introduced recently are a step toward informing consumers on making smarter choices. But this is not an improvement unless the new 2020-2025 Dietary Guidelines for Americans acknowledge that physiologic diversity allows a variety of eating patterns to be health-promoting for different people, and across different ages.
As people age, dietary needs change. For example, protein is essential throughout a person’s life for building and maintaining muscle. By default, everyone loses 3-8 percent of muscle every decade after 30 years old and higher after 60 years old.
This age-related muscle loss, or sarcopenia, increases with age and in response to insufficient protein. Sarcopenia increases the risk for falls, fractures, loss of independence, poor quality of life and mortality.
The recommended daily allowance (RDA) for adults is 0.8 grams of protein per kilogram of body weight. However, optimal protein requirements vary among individuals based on age and health status.
A 2018 update on protein in the prevention and treatment of sarcopenia, suggests protein recommendations varying from 1.0-1.2g kilograms a day for healthy older individuals, to 1.2-1.5g kilograms a day for those with non-renal acute and chronic diseases.
In the same way, advising everyone to eat whole grains or to avoid certain foods is not universally helpful for all.
For example, carbohydrates have variable effects on people’s weight. Although most people gain weight with a high carbohydrate diet, some can tolerate it without weight gain or adverse health outcomes. A 2018 study provides evidence of success from a variety of diets for long term weight loss.
When I was a medical student, I learned that prediabetes and diabetes are progressive diseases and cannot be reversed. However, research now shows that prediabetes and diabetes can indeed be reversed. Overweight and obesity may lead to prediabetes or diabetes in some individuals, so managing weight is critical.
Recent studies show that many people can effectively manage or reverse diseases like prediabetes and type 2 diabetes by eating a low carbohydrate diet under medical supervision. For those who are on medications to treat diabetes, this advice goes directly against the general recommendations to limit fats and eat more whole grains.
In my practice, many patients seek weight management treatment due to their “high” body mass index. A BMI of 18.5 to 24.9 percent in adults is considered “normal.” A 25-29.9 percent BMI is a diagnosis of being overweight; patients with 30 percent or more are diagnosed as obese.
Yet, while BMI can be used as a screening tool, these number cutoffs are not absolute.
For instance, East Asian and older individuals, especially postmenopausal women, may appear to be at a “normal” BMI and yet, they manifest chronic diseases expected at higher BMI’s.
Similarly, bodybuilders and some athletes are penalized for an overweight BMI identified on a work health screen, even though a high BMI many be healthy due to the increased muscle mass.
Even though there are multiple paths to being healthy and they may be different for each individual, to be sure, some healthy behaviors are more universal. This includes cutting back on sugar and processed foods and increasing daily physical activity and social connectedness contribute to everyone’s well-being.
Understanding individual healthy choices requires paying attention to what works for the individual, rather than just following other people’s recommendations.
Better nutrition labeling is not the panacea for a healthy America. It’s only a start.
Dr. Naomi Parrella is an assistant professor in the Department of Family Medicine and the Department of Surgery and the medical director for Rush University Center for Weight Loss and Lifestyle Medicine, and she is board-certified in family medicine and obesity medicine.