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LifestyleTranscript
00:01Hi, I'm Dr. Mike Evans, and today I'm talking about healthy eating.
00:05It's a huge topic. Eating seems simple, but it's actually pretty complex, so I thought I would just focus on
00:11what I'd say if you and I sat down in the clinic.
00:14I might start by wondering what we're shooting for. Weight loss, less overeating, healthy eating, a longer, better life.
00:20Then sticking with the big picture, I'd point out that eating is just one behavior in a healthy cascade.
00:26Exercising regularly leads to better stress management and sleep, which leads to better food decisions, to more energy, less chronic
00:32disease, and so on.
00:35If it's weight loss you're after, that's easy conceptually. Don't eat as much and move more.
00:40The problem is it's not so easy keeping up this energy balance in the real world.
00:44In industrialized countries, we are surrounded by a limitless supply of inexpensive, tasty, supersized, high-calorie food.
00:50The other side of the energy balance equation, i.e. activity, has also changed as our generation has a severe
00:56case of sitting disease.
00:58Nightly TV, commutes, spectacular video games, moving sidewalks, and most of us now are sitting knowledge workers.
01:05Our culture pushes us towards the easy button instead of making our days harder.
01:10On the other, other side of the equation, I think it's important to remember that eating is grand.
01:16Food brings together families, builds communities, and gives us health.
01:20Okay, so let's start with the question I most often get about eating.
01:23What's the best diet for losing weight?
01:25I'm not surprised people are confused.
01:27While you're watching this video, there's probably a pop-up window from the diet industry telling you about a diet,
01:32a detox, or a superfood.
01:35Not to mention the Hollywood star that just started that diet.
01:38No research has shown convincingly that one commercial diet trumps all the rest.
01:43The only thing that predicted success in head-to-head trials was how well you stuck to whichever diet you
01:48picked.
01:48So to reframe this, our society lurches from diet to diet looking for some magic formula, but it's not the
01:55formula as much as the pattern.
01:57Instead of obsessing about the exact composition of a diet, the science tells us to choose the one you like
02:03the best and can actually stick to.
02:05A Cochran meta-analysis in 2015 looking at what bumped the success of commercial weight loss diets showed it wasn't
02:11less carbs or fat, it was more structure and more in-person social support.
02:17Really, diets are just food rules that influence our pattern of eating, or what the economists call a commitment device,
02:23what self-aware people do to improve their chances of controlling future irrational or impulsive behaviors.
02:29So instead of autopilot, you follow a food rule that nudges you towards certain eating decisions, mostly less overeating.
02:35Each commercial diet has their own magic formula of what we call macronutrients.
02:39So low-carb, high-protein, low-fat, sugar, and so on.
02:44And they typically have a story to go with it.
02:46So you can eat like a caveman, or use a scoring system, or it's prepackaged, or a famous doctor's take,
02:52or whatever.
02:53And I suppose my two messages with macronutrients are,
02:57one, I think we spent too much time and energy focusing on them,
03:00and two, it's really more about quality than quantity.
03:04Low-carb?
03:05Well, carbs can be healthy in their complex form, fruits, veggies, legumes, whole grains,
03:10and not so healthy in their simple form, like free sugars and refined starches.
03:15You know, let's face it, carbs taste awesome, and our society tends to overeat them.
03:20So people who restrict their intake tend to lose weight.
03:24However, when we study relative weight loss outcomes,
03:26a 2014 systematic review by Dr. Celeste Naud and colleagues looked at weight and cardiovascular markers
03:32of at-risk people on low-carb diets that were followed for up to two years.
03:37And they found no difference compared to balanced weight loss diets.
03:41So how about lowering sugar?
03:42Well, if I had to pick one word to describe sugar in industrialized societies, it would be sneaky.
03:48So, so much sugar has worked its way into our diets.
03:52I mean, many drinks have eight or more teaspoons of sugar.
03:55The average American intake is approximately 20 teaspoons of sugar a day.
03:59More in teenagers, and less in Canada.
04:02It's the obvious sweets, but it's also foods we think of as healthy,
04:06so cereals and granola bars and fruit juices.
04:09When high sugar contributes to excess calories, that is when we seem to get into trouble.
04:15One interesting caveat is that when I diagnose patients with pre-diabetes,
04:20the first thing they do is drop sugar from their diet.
04:23However, when we look at the diabetes prevention trials,
04:25it was less about sugar restriction and more about the healthy cascade of being active half hour a day,
04:315-7% weight loss, eating less saturated fats, and eating more fiber
04:35that reduced risk of progression to diabetes by 58%.
04:38How about low fat?
04:39Well, I think our story has changed on fat, from all bad to, again, more of a continuum.
04:46You have your trans fats, so fried fast food, mini-packaged baked goods, not so good,
04:51and we're reducing these.
04:53We have saturated fats, mostly in dairy and red meat and plant oils like coconut or palm.
04:59These seem not so good in excess, but okay in moderation.
05:02Then we have your monounsaturated fats, or MUFA.
05:05The Mediterranean diet, which I'll discuss in a second, is pretty high in MUFA,
05:09so avocados, nuts, seeds, olive oil, dark chocolate, and shows health benefits.
05:14Finally, we have PUFAs, so these are the longer-chain fats found in oily fishes.
05:19Early trials showed some reduction in cardiac events.
05:22More recent trials, not so enthusiastic.
05:25Meta-analysis still showing some small benefit and no harm,
05:28so the suggestion is at least two servings a week.
05:30People seem to do better when they replace saturated fats with MUFA and PUFA fats.
05:35What about high-protein diets?
05:37Again, it's more quality than quantity.
05:40Protein can come in different packages with different health effects.
05:43So, say comparing a high-salt ham steak versus a salmon steak or lentils or a handful of almonds.
05:50Most data points that if you eat healthy protein, white meat, nuts, beans, fish, you do better.
05:56Especially if it is spread throughout the day, perhaps most importantly at breakfast.
06:00There are also some diets showing good results in people with disease.
06:04So, the DASH diet dropping high blood pressure by 5 to 11 millimeters of mercury
06:07or low-glycemic index diet dropping A1C, the measurement for blood sugar over time,
06:13in people with diabetes by 0.5 percentage points.
06:16Many of our patients have high cholesterol and Dr. David Jenkins and his colleagues here at the University of Toronto
06:21have shown they can reduce cholesterol by 35% with the portfolio diet.
06:26The data for vegetarianism has largely come from cohort studies
06:29and now some randomized trials showing that people do better.
06:32It's hard not to conclude that a diet rich in plant-based, unprocessed foods is a smart diet.
06:38And of course, many people make the excellent point that the burden on our planet
06:41is less with a vegetarian or vegan or local diets.
06:45One way to think about all this is to reflect on Brazil's new dietary guidelines.
06:49Here they shifted from focusing on the perfect macronutrient mix towards more appreciation of food.
06:55Stepping back a bit to see, you know, we're buying more ultra-processed foods
06:59and packaged foods that can be eaten anywhere.
07:01And that maybe there's an opportunity for healthier eating and better relationships
07:04by encouraging creating meals with your family and friends.
07:08Okay, if there's no magic formula, is there a diet that actually does work?
07:11I think the answer is yes.
07:13The diet is more about culture and small behaviors.
07:16A diet not focused on weight loss but on healthy outcomes like less cancer, heart disease, dementia, and a longer
07:22life.
07:23The diet with the most robust evidence is a Mediterranean diet.
07:27Instead of food rules or absolutes, this is more about moderation.
07:31Less meat, more veggies, fruit for dessert.
07:34Think shopping at the market or at least at the outer aisles of a grocery store.
07:38Not the processed foods for sale in the inner aisles.
07:41It's called the Mediterranean diet but really it's more of a lifestyle.
07:45A region that traditionally includes lots of physical activity, regular meals, and good social support.
07:51So let's continue this shift from diets to healthy behaviors that affect our eating
07:55by looking at the National Weight Control Registry.
07:56The NWCR administers annual questionnaires to more than 10,000 people, more women than men,
08:03who have lost quite a bit of weight and kept it off for more than a year.
08:06Not surprisingly, 98% said they modified their food intake in some way
08:10and 94% increased their activity levels.
08:13But there wasn't one formula.
08:15Most restricted some foods, some counted calories.
08:18Others ate all foods, just limited their quantities.
08:2178% ate breakfast every day.
08:24The majority watched less than 10 hours of TV and ate out just three times a week.
08:28And these people generally exceeded the prescribed half-hour day of activity,
08:32averaging an hour a day, mostly walking.
08:35Nearly all registry members indicated that weight loss led to improvements in their level of energy,
08:39physical mobility, general mood, self-confidence, and physical health.
08:45Feedback loops seem important.
08:46Losing weight is one thing, but it seems like the trickier part,
08:50at least for about 80% of us, is keeping it off.
08:53Weighing yourself, and using this as a small nudge in your daily food decisions, is an example.
08:5975% of NWCR subjects weighed themselves weekly, 36% daily.
09:04And they looked at this more closely at the Stop Regain trial,
09:07where daily self-weighing was associated with a decreased risk of regaining 2.3 kilograms,
09:12or 5 pounds on average.
09:14Another feedback nudge is a food diary.
09:16Even just for a week.
09:17And easier now with apps.
09:19Patients find this so simple, they don't do it.
09:21But seeing what you've eaten can actually double your weight loss.
09:25So, I think awareness is undersold.
09:27It may be what you're eating or weighing,
09:30but it's also about knowing that life is messy,
09:32and to enjoy it we need some flexibility.
09:35Or that you simply feel better when you eat better.
09:38That's why I like the idea of starting with small changes, or as I call them, tweaks.
09:41Maybe switch something you do a lot.
09:43So, for example, eating breakfast, snacking, drinking.
09:46You can switch your average cereal for some oatmeal or shredded wheat.
09:50A handful of almonds instead of a bag of chips.
09:52Maybe switch three of your colored drinks a day to water.
09:55I know this doesn't sound too sexy,
09:57but the Dr. Mike's Wichiru diet might actually chip away at a pound a week,
10:01or better yet, might make you feel better.
10:04Another angle is adding instead of subtracting.
10:07So, Dr. Sherry Pagotto and colleagues randomized metabolically at-risk individuals
10:11to either a multifaceted American Heart Association diet,
10:14versus a simpler advice of just increasing fiber to 30 grams throughout the day.
10:19So, getting on the brand wagon, a trip to beantown, berry picking.
10:23Both groups lost weight, the H-A group slightly more,
10:26and both improved cardiovascular markers.
10:29Now, I like this idea of pushing healthier food
10:31rather than just restricting or fencing off other food.
10:35Other data showing satiety, our feeling of being full,
10:39is not just about calories.
10:41Calories that come from proteins and fibers
10:43actually can make us feel more full.
10:46Another angle is social support,
10:48which can actually help our eating behaviors.
10:50Another study where people were either going it alone
10:53versus having three or more friends or family members supporting them.
10:56Maintaining weight loss at 10 months jumped from 24% to 66%.
11:01On the subject of support,
11:03having a dietician, even if just online, helps.
11:06They're like a genius bar for your eating.
11:09Activity is interesting in the context of eating.
11:11Research shows us that people who are active,
11:13even when they have obesity,
11:14live longer than skinny sedentaries.
11:17So, when my patients tell me they are active,
11:19but have been unsuccessful at weight loss,
11:21I shrug my shoulders and say,
11:23actually, you have been successful.
11:25You're active.
11:26It's easier to drop calories through diet,
11:28but I think it's important to know that the research shows
11:31that people who exercise have more success at maintaining their weight.
11:34My final two points about healthy eating
11:36focus on this long-term play and attitude.
11:38As restrictive diets have proven hard to sustain,
11:41many are now turning from the individual
11:43to what surrounds the individual,
11:45changing our eating environment
11:46to make it easier to make the right choice day after day.
11:49We call this redesigned choice architecture
11:51and involves two types of what I call, quote,
11:54nudge awareness.
11:56First is knowing that our world is full of triggers
11:59towards unhealthy or overeating.
12:01Convenient, shiny foods at the counter,
12:04supersizing, marketing.
12:05As Dr. Brian Wansink points out,
12:07most of us don't overeat because we're hungry.
12:11Secondly is an awareness of what nudges you personally.
12:14We are creatures of habit.
12:15We do the same thing every week.
12:17Each of us has cues.
12:18Certain foods, pastries at the coffee counter,
12:21a time, 11, 3, or 10, a predictable stressor.
12:26As Wansink says, the opportunity here
12:28is to re-engineer small behaviors
12:30that move you from mindless overeating
12:32to mindless better eating.
12:34Maybe it's redesigning your kitchen.
12:36When you leave cookies on the counter,
12:38they are much more likely to be eaten.
12:39But the same is true for fruits and veggies.
12:42Smaller plates, glasses, less supersized containers,
12:46and not eating from the bag
12:47are simple nudges to reduce mindless eating.
12:50Redesign takes some self-knowledge.
12:52Are you a nighttime nibbler or an emotional eater?
12:55I'm a grazer.
12:56I'll eat whatever is there.
12:57So my change is at the grocery store.
12:59I know it's pathetic.
13:00I should cut fruits myself.
13:01But mindless healthy eating happens for me
13:04when I buy pre-cut fruit.
13:05And just like I might tell a smoker
13:07not to have cigarettes in the house,
13:08I also don't buy super sour juice
13:10because I can't stop eating those things.
13:13My final behavior is more of an attitude, 80-20.
13:16So if you're making the healthier choice 80% of the time
13:19and your 20% is not too high cal,
13:22I and you should be thrilled.
13:24I'm having a piece of dark chocolate,
13:26a good meal out, some pie.
13:27We're into this for the long term.
13:29So I'm not looking for perfection.
13:31I'm looking for consistency.
13:33So in the end,
13:34I hope I've got you to think a bit differently
13:35about how you eat.
13:36Instead of investing in a single diet,
13:38a portfolio of behaviors,
13:40small tweaks over big changes,
13:43single ingredient foods
13:45over multi-ingredient and processed foods,
13:48dinner at home, self-awareness,
13:50depending less on constant willpower
13:52and more on tweaking your week
13:54to make mindless healthy eating more likely.
13:57My final point is more about health at every size.
13:59You know, I get that people want weight loss
14:01and obesity is a risk factor for disease.
14:04But honestly, if my patients can work
14:06with their factory settings
14:07to be more mindful of their eating,
14:09move more, a bit more self-love
14:11and start thinking more about what's healthy to eat
14:14rather than what not to eat,
14:15I'd be happy.
14:17So maybe now is the time to start
14:18your very own better life experiment.
14:20Thanks for listening.
15:12You
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