Yes, According to a Study By Finnish Scientists. But Not All Nutritionists and Dieticians Agree With the Controversial Findings.

IN THE midst of an obesity crisis which costs the NHS an estimated pounds-500m a year, antidiet campaigners are barely heard. Adult obesity has nearly quadrupled in Britain in the past 25 years and nobody is hailing it as an improvement in quality of life. So, those who are anti-diet have a rough time when it comes to fighting for fat acceptance on aesthetic grounds.

After all, nobody would ever argue a case for other potentially fatal conditions being beautiful.

A new study, however, adds to mounting evidence that the antidieters may have some valid points.

The health of just fewer than 3000 people, who were screened to ensure they had no underlying illnesses, was studied over 25 years to see what physiological damage could be caused by weight loss. The study, which was carried out in Finland and led by Thorkild Sorensen of the Institute of Preventive Medicine at Copenhagen University Hospital in Denmark, concluded that overweight people who dieted to reach a healthier weight were more likely to die young than those who remained fat.

It follows a large-scale US study reported in the New England Journal of Medicine in 1998, which highlighted the risks of fluctuating weight. It said that men and women whose weight see- sawed often or greatly over a period of many years had a significantly higher risk of death than those with stable, although very high, weight. At the time the National Centre for Eating Disorders questioned whether it was dieting associated with obesity rather than the obesity itself which contributes to the risk of ill health.

Where does all this leave the diet industry? At present it can use government guidelines on healthy target weights and information about the physical and psychological benefits of weight loss in order to sell its products.

Companies can even push nocarb, quick-fix diets that contradict government guidelines about eating a balanced diet and the quantities of food we should eat from each food group. The industry rakes in an estimated pounds-2bn in the UK alone and not just from the 21-per cent of the population who are obese. If public health messages change as a result of these new findings, the health claims of, for example, slimming clubs, may have to change with them.

WeightWatchers gives short shrift to the new study. Having spoken to the company’s scientific advisers, a spokeswoman says that there is nothing they can learn from it.

“[Our registered dieticians] have been very honest and have considered the findings of this recent study and believe it to be of insufficient size and scale compared with the huge wealth of data showing the health benefits associated with even modest weight loss, ” she says. “In view of this we won’t be making any further comment.”

WeightWatchers also declined to comment on whether its counsellors talk through the benefits of stable weight with dieters or whether they discussed with them the wellresearched pitfalls of losing weight in the wrong way.

Hopefully, the counsellors do. Far from being a shock to professors of nutrition and registered dieticians, the Finnish study added to what they already knew about the potential risks of weight loss.

Sorensen’s research showed that the loss of lean body mass (such as muscle tissue) caused a general weakening of the body in the long term. Dr Frankie Phillips, a registered dietician with the British Dietetic Association, has been highlighting the perils of losing muscle mass as a result of diets for years.

“That dieting can be very detrimental to health is nothing new, ” she says. “We know very well the risks of losing weight quickly, for example. Crash dieting means losing glycogen and water in the muscles and liver. For every gramme of glycogen you use, you lose 4g of water. You’ll lose weight for a while but then you’ll put it straight back on as glycogen and water when you eat properly again.” Depriving the body of food has also been linked with loss of calcium in the bones, as many diets restrict dairy products.

Since it is not just the obese who diet in this way, the implications of the new Finnish study are further reaching than they first seem.

According to the National Centre for Eating Disorders, at least one in every two women who are not overweight has tried dieting.

“Extreme or crash dieting puts the body in starvation mode and makes it use its reserve stores of energy, which produces more of a problem, ” says Phillips. “Extreme weight loss means starting to break down protein mass, so you’re effectively breaking down your body. More moderate caloriecutting with exercise would actually mean losing fat.”

She adds that low-calorie diets leading to fluctuating weight can be particularly bad for the self-esteem, creating a highly-damaging Bridget Jones-style preoccupation with food, and making the dieter tie their esteem to their weight. The dieter is caught in a cycle of fear of fatness, food avoidance and inability to control normal food intake.

Peter Mackreth is a senior lecturer in physical activity and obesity management at Leeds Metropolitan University. He hopes that we do not throw the baby out with the bath water in writing off the enormous benefits of “careful and scientific” weight loss. While it may be a good excuse to bin the dubious faddy diets, it is not an excuse to avoid intelligent and balanced debate, or, indeed, to combat obesity.

“Of course we already know it is quite possible to lose weight in a very unsafe manner, ” he says, “but there is still much research to say that losing weight per se on a good weight management programme that is sustainable and includes exercise can improve general health. There are not really many risks of losing weight when it is done in a safe way and, in those cases where body fat decreases, mortality decreases.”

Mackreth helps to run a holistic weight-loss scheme attached to the university. The staff are conscious of making sure children are losing the pounds and ounces in a way that does not damage their bodies in the long term. “Losing weight in a programme such as ours and not a fad diet is safe and effective, and we have scientific, peerreviewed data to back that up. We make sure children lose fat mass, and not muscle, which then allows them to continue with physical activity and be more active. If someone is on a strict low- calorie regime without someone overseeing what they are doing, then of course it can be risky.”

The emphasis at the camp is on all-round, long-term health, rather than on desperate and rushed attempts to reach a target weight.

There is much evidence to suggest that fatness, in any case, is not always an indication of bad health in the same way that thinness is no signifier of good health. Two years ago, Jennifer Portnick, a 17-stone US fitness fanatic, forced Jazzercise, the world’s largest dance exercise company, to drop its requirement that its instructors look fit and to accept that fitness and fatness may not be mutually exclusive.

A study carried out at the University of California (UCLA) says that those who are fat and get plenty of exercise enjoy better health and longevity than the thin and unfit.

Dove, the cosmetics brand owned by Unilever, is currently trying to challenge the idea that fatness means unfitness. While its webbased “fat or fit?” debate is also a sales drive, the company looked at reams of research with conclusions that fall in line with the UCLA findings.

In seeking out scientific data before encouraging discussion, Dove has shown itself to be more responsible than those in the diet industry who pick out one strand of an argument that suits their agenda.

Since the Finnish study was published, many nutritionists, including the study’s own authors, have begged for the findings not to be sensationalised or twisted.

The British Nutrition Foundation says that, far from being a cue to drop the diet, the Finnish study merely shows that more research is needed. “Severe obesity is associated with a 12-fold increase in mortality in 25 to 35-year-olds when compared to lean individuals, ” says a spokeswoman. “Findings from studies investigating weight loss in obese and overweight individuals have not been consistent as although some studies show similar trends, other studies have shown a reduction in mortality.”

Professor Mike Lean, head of the department of human nutrition at Glasgow University, is by no means a fan of diets based on quasiscience, but hopes Sorensen’s results will not be taken as licence to be complacent. “Our own research in Scotland produced very clear results that modest weight loss for diabetic people led to longer life-expectancy.

With 10kg weight loss at the hands of the dieticians, patients lived about four years longer, ” he says.

“We all agree that the totality of the evidence says that people who are overweight have multiple health problems as a consequence, that prevention is the preferred public health approach, but that modest weight-loss brings multiple health benefits - for blood pressure, cholesterol, diabetes, blood clotting, back pain, arthritis, breathlessness, tiredness, depression. The list goes on. It is not all about dying.”

Source: Herald, The; Glasgow (UK)