How many times can you recall a friend losing weight and evangelizing a new diet that you should try? It worked for them so de facto it should work for you. The reality, however it more complicated. Should you Keto, Paleo, WW, Noom, or DASH? Data from randomized controlled trials suggest that all approaches work in the short term for weight loss, and the one that is best for you is the one you can stick with over the long haul.
In the 1950s, as part of the post-war boom, the advent of processed food allowed for much less time to be spent in meal prep and in the 1980s the low-fat diet garnered global attention. Since that time we have seen massive shifts in the farming-industrial complex that enabled food production at scale while profits remain high and cost relatively low. What price might we be paying in terms of health? What have all these dietary shifts resulted in? The USA spends more on healthcare than most countries with almost 18% of its GDP tied up in health care. Studies show health outcomes aren’t superior for this dollar spend and newer data points to a lowering of life expectancy which is troubling in a time when new treatments are emerging weekly. The Standard American Diet is also known as SAD shows consumption patterns are high for processed food and the most popular vegetable is the French Fry.
I would argue that debating which diet is best has trapped us in the wrong narrative. The word diet comes from the Greek word dieta- which means “way of life” – most people associate the word diet with a sustained period of deprivation that may or may not result in weight loss. Food is fuel, but it is also much more than that, it is childhood memories, it is your favorite meal, it also represents social time with friends and family. What if we were to leave the diet war mentality behind and instead pursued an overall dietary pattern for health. Small changes individually could result in significant changes at a population level. What if we celebrated progress over perfection?
What does a global dietary pattern entail, and what can differences tell us about the health of nations? A new paper in the Lancet by Christopher Murray from the University of Seattle in collaboration from colleagues from around the globe tracked the health effects of dietary intake from 1990 to 2017 in 195 countries. There is a lot to unpack in this study — one of the primary aims to understand how a suboptimal diet contributes to the global burden of disease.
Image depicts number of deaths age-standardised mortality rate (per 100 000 population) attributable to individual dietary risks at the global and SDI level in 2017 DALY=disability-adjusted life-year. SDI=Socio-demographic Index.http://dx.doi.org/10.1016/ S0140-6736(19)30041-8
The study examined the disease burden of dietary risks and included 15 major food groups and nutrients. The authors then developed pairs of diet-disease attributable risks related to the global burden of disease, for example, they examined diets high in processed meats, trans fats, sodium, sugar-sweetened beverages and low in grain, legume, nuts, and seed consumption. They also calculated the optimal and sub-optimal levels of intake to determine what levels of exposure constituted a higher or lower risk for a disease.
Their findings suggest that globally levels of healthy food consumption were suboptimal in 2017, most notably for nuts, seeds, milk, and whole grains. Sugar-sweetened beverage, processed meats, and sodium consumption was considered high and sub-optimal for health. Red meat consumption was deemed to be 18% higher than optimal healthy levels. Globally, 11 million deaths were attributable to dietary risks and contributed to a further 225 million disability-adjusted years of life (DALY- a measure of years lost due to disability). The leading cause of death was Cardiovascular disease (10 million deaths) followed by cancers. The lowest rates of diet-disease related deaths were in high-income areas of Asia, and the highest in Oceania (includes Australia, New Zealand, and Papua New Guinea).
While the authors recognize the limitations of effect sizes of dietary risk factors as they relate to disease-endpoints and dietary exposure, they do call for significant changes to be made for food systems, locally and globally to improve overall nutritional patterns to support health and reduce risk.
This paper is also important as a commentary on global farming and food production – with climate change becoming increasingly apparent as a significant disruption in modern times, addressing issues related to soil and water table degradation and the dietary patterns that currently skew toward animal-based protein seems prudent. Newer data suggest a shift toward plant-based protein is happening but is the pace fast enough to positively impact climate change and the overall burden of disease? Cost of healthy food also remains a significant barrier for many global citizens. A greater focus on social determinants of health that includes access to an affordable healthy diet is also part of the solution.
Thanks for reading – Trina
(Opinions are my own)
Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for Global Burden of Disease Study 2017. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30041-8/fulltext
USA GDP Spend on Healthcare