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By Candy Sagon The Washington Post 1/7/2003 Did you hear that sound? It's the diet pendulum, slowly but surely swinging back the other way. For 20 years, it's been hovering over the low-fat end of the spectrum, where the rules were simple: Fat makes you fat. Fat gives you heart attacks. Eat it at your peril. To reinforce the message, our stores were filled with reduced-fat this and fat-free that and low-fat everything else. Yet two decades later, you have only to look in the mirror (or people-watch at the mall) to face the ugly truth: Our derrieres are bigger than ever. Sixty percent of American adults are overweight or obese, increasing their risk for a number of health problems, from diabetes to some types of cancer. Even more alarming, the number of overweight children has doubled since 1980, while the proportion of overweight adolescents has tripled. Type 2 diabetes, which used to occur only in adults and is linked to obesity, has skyrocketed among heavy teens. So as we face another new year and make yet another resolution to lose those 20 or 30 or 50 pounds, we can only wonder: Is there a better way to diet? Yes, says a growing group of scientists and nutrition experts. The old advice obviously isn't working. Fat isn't the only culprit. Filling up on pasta and bread isn't a solution. Giving everyone the same diet isn't the answer. They argue that, among other things: Sugar and white food, like bread, pasta and potatoes, are diet derailers. A high-protein diet that stresses meat and eggs but cuts out sugar and simple carbohydrates (Dr. Atkins' New Diet Revolution for example) is more successful at helping people lose weight because they feel satisfied longer and aren't tempted to fill up on high-calorie snack food. Fat isn't all bad. The overly simplistic message to lower dietary fat ignores some important facts: Fat is essential for the body to function correctly. There are good fats and bad fats, and we've jettisoned some of the good ones and replaced them with bad ones. If not eaten to excess, fat can actually help you diet because it makes food tastes better and helps you feel full longer. "It's the calories, stupid," as Alice Lichtenstein, professor of nutrition at Tufts University, puts it. If you eat more calories than you work off in exercise and activity, you will get fat. Period. The experts can argue about which diet to follow to limit those calories — high-protein, low-fat, low-carb, a mixture — but the bottom line is still the same: Cut the calories or up the exercise. Preferably both. The simple solution to losing weight, most experts agree, is that there isn't a simple solution. "It's like treating depression," explains Madelyn Fernstrom, director of University of Pittsburgh Health System's Weight Management Center. "There is no one answer. Different things work for different people." Fran McCullough figures she's lost about 500 pounds. The New York cookbook editor says that's about how much she has lost and regained and lost again over the years. She's been on a liquid diet ("fine until my hair fell out"), low-fat diets, low-carb regimens, Dr. Atkins ("a big success for a while"), and most recently on the Protein Power diet, which allows her to eat more fruit than on Dr. Atkins. Do the diets work? Yes and no. Part of her problem is her job: She has to test and taste about 700 recipes each year for her annual "Best American Recipes" cookbook. "I think I'll only take a bite, but if it's delicious, I eat more," she admits. Her biggest diet success has come from cutting back on carbohydrates and not worrying excessively about fat. When cholesterol tests showed her blood fat levels to be better than they were when she was on a low-fat diet, she began to wonder why. The result of her research is her newest book, The Good Fat Cookbook (Scribner, 2003). It contends that in our single-minded zeal to cut down on fat, Americans have replaced perfectly good fats with highly processed, hydrogenated or partially hydrogenated oils that contain harmful transfatty acids and free radicals. These increase cholesterol in the body's tissues even more than do the saturated fats in foods like butter and bacon. McCullough devotes half of the book to summarizing some of the most recent research on fat, including that of biochemist Mary Enig, formerly of the University of Maryland and now with her own research company, Enig Associates, in Silver Spring. Enig has argued for two decades that transfatty acids in partially hydrogenated vegetable oils — not saturated fat from food — have increased our risk for heart disease and certain cancers. Enig and other researchers say Americans would be better off including pure, unprocessed fats like olive oil, butter, even coconut oil and lard in their diet instead of the hydrogenated or polyunsaturated oils that are commonly used in processed or packaged foods, especially the ones marked "low-fat," "lite" or "light." The best way to avoid eating foods that contain these kinds of processed oils, as well as "lots of hidden sugar and corn sweeteners," says McCullough, is simple. "People are just going to have to cook." (Her book, not surprisingly, includes more than 100 recipes using "good" fats like olive oil and nuts.) Cooking is fine, but Americans also just need to stop eating so much, says Greg Critser, author of Fat Land (Houghton Mifflin, 2003). Critser calls us "the fattest people in the world," thanks to our consuming passion for consuming. Super-size, high-calorie meals, lots of snack foods filled with cheap sweeteners and a medical establishment obsessed with cholesterol instead of obesity are some of the reasons for our plus-size problems, he says. Critser, who used to be 40 pounds overweight, had his own diet epiphany when a stranger called him "fatso." He started by taking the diet drug Meridia, changed his eating habits ("cut my portions by a third, stopped snacking") and began a daily 45-minute walk. A freelance journalist, he also began investigating the political and cultural reasons behind what he calls the epidemic of obesity in this country. Critser's and McCullough's books couldn't have been better timed. In the past six months, fat has become the diet buzzword, thanks in large part to vocal researchers like Walter Willett, chairman of the department of nutrition at Harvard School of Public Health, whose long-running, comprehensive diet and health studies have challenged many of the low-fat-is-good-for-you assumptions. Adding to the diet debate has been the publicity over a Duke University Medical School study in which 120 overweight volunteers followed either the Atkins diet or an American Heart Association low-fat plan for six months. Not only did the Atkins volunteers lose more weight (31 pounds compared with the low-fat group's 20), but their "good" cholesterol, or HDL, increased and their blood fat level, or triglycerides, dropped by more than twice as much as the low-fatters. The accepted diet dogma also has been challenged in splashy stories critical of low-fat diets, first by Science journal correspondent Gary Taubes in the New York Times magazine this past summer and then in a Time magazine cover story this fall. The new research seems to reinforce what low-carb diet doctors like Robert Atkins and the Zone's Barry Sears have been saying for a while. It's not the fat that has made Americans fat, it's the sugar and carbohydrates — bread, pasta, cereal and particularly the corn syrup and sweeteners hidden in most processed foods. We're gorging ourselves with that stuff. Consumption of high-fructose corn syrup — the sweetener of choice in most processed foods — quadrupled from 1980 to 1999, according to data from the Economic Research Service of the U.S. Department of Agriculture. Of the carbohydrates that Americans consume, says the USDA, sugar and sweeteners make up a whopping 40 percent. Since these kinds of carbohydrates can raise the level of fat in the blood, researchers are beginning to question whether it's really the fat we eat that's contributing to our heart disease. Overloading on carbohydrates may be just as dangerous, if not more so. Indeed, observers such as Taubes suggest that we go back to what previously had been considered an old-fashioned way of thinking — that fat and protein protect you against feeling hungry and that bread and pasta put on the pounds. A preliminary study at the University of Cincinnati College of Nursing seems to bear this out. Half of a small group of obese women were put on the Atkins diet and half were assigned to follow the American Heart Association low-fat diet. The study was funded by the heart association, and the researchers fully expected to see better results with the low-fat group. After six months, not only had the Atkins group lost twice as much weight as the low-fat group, but both groups equally improved their levels of blood fat, insulin and glucose, even though the Atkins group had eaten high-fat foods like bacon, sausage, eggs and beef. "It's not what we expected," admits lead researcher and assistant professor Bonnie Brehm. Even more unexpected was the amount of calories both groups ate. The members of the Atkins group were allowed to eat as many calories as they wanted as long as none of those calories came from forbidden foods like sweets, bread, pasta and some fruits; the members of the low-fat group were restricted to no more than about 1,200 calories a day. Yet both groups ended up eating the same amount of calories a day. The difference was the Atkins group never felt hungry on 1,200 calories a day, while the low-fat group did. Says Brehm, "I could always tells which women were on which diet. The Atkins group members always looked so happy." Further studies are planned, but Brehm admits the results have made her rethink the whole low-fat campaign. "Consumers jumped on the low-fat bandwagon because the impression was that this would make them healthy. Manufacturers responded with low-fat foods, and it just cascaded out of control from what the government and scientists intended." But blaming our obesity problem on the health experts for recommending low-fat diets or the food industry for selling low-fat food annoys Lichtenstein at Tufts. To put it bluntly, she thinks people just need to get up off their duffs and eat less food. "People are obese because they eat more calories than they expend," she says with exasperation. "No one forces us to eat that way. You can't bash the food industry — they'll give us anything we're willing to purchase." In fact, the industry already may be moving to catch the low-carb bandwagon. In an echo of the Miller Lite "tastes great, less filling" beer commercial in the 1980s, ads for the new Michelob Ultra beer show a fit male jogger in his 40s pounding down a road and the words, "Lose the carbs. Keep the taste." Demands for the beer, according to Anheuser-Busch, have exceeded expectations. Bonnie Liebman, director of nutrition for the Center for Science in the Public Interest, has another theory about Americans and fat. "The number one misconception is that this country's been on a low-fat diet. Look at serving sizes, for goodness sake," she says. "People are eating giant burgers, blowing 500 calories on a mocha Frappuccino at Starbucks. You're telling me weight gain is due to low-fat cookies? Give me a break. It's not SnackWell's that has made this country fat." Still, the renewed debate over low-fat diets has had an effect on her. She admits that while she used to steam vegetables, she now sautes them in a little oil (olive, of course), and she tries to avoid fat-free salad dressings. She points out, however, that even Harvard's Willett believes in cutting back on saturated fat. When he was interviewed on National Public Radio earlier this year, Willett described his "good" fat, "good" carbohydrate lunch for the day: tofu topped with peanuts, brown rice and an apple. The diet pendulum may have needed a push, but Lichtenstein fears that we're just replacing the low-fat dogma with some other simplistic diet debate, such as good fat vs. bad fat. "The argument shouldn't be reduced to stick margarine vs. butter," she says. "That's just trying to find another simple answer." Her answer to losing weight: Restrict your calories in whatever way works for you. If it's by eating more protein to stay full, fine. If it's by cutting back on fat, that's fine, too. Better yet, take a walk every day. Pittsburgh's Fernstrom agrees. "There are no bad foods, only bad portions." Get some exercise! Search Active and register online for an event in your area!