Abstract
It is a problem that prevails in the areas of nutrition and weight management, forestalling progress we might otherwise make quite handily.1,2 A sensible common ground of healthful eating and effective weight control has long been at our very feet.3,4 The good to be done by eating even just reasonably well, and being even moderately active, is both a matter of public record and of stunning significance.5,6 However, here we stand, contesting the best steps, and consequently going nowhere.
This is a problem among the public at large, where everyone with an opinion about diet and weight control mistakes conviction for expertise. It is a problem aided and abetted by news media that find constantly shifting controversy far more lucrative than a constant drumbeat of reliable truth. 7 But expressions of dogma are at their most ominous and insidious when made by legitimate experts. In nutrition, that, too, prevails. Advocates of low-carb eating, for instance, cite only the evidence that supports their point of view, while steering clear of studies that show decisive benefits of low-fat diets. Paleo diet proponents tend not to cite studies that support veganism. Ardent vegans tend not to acknowledge that evidence for health benefits from an omnivorous Mediterranean diet is at least as strong.
Therefore, it is in the service of a refreshing reality check that we proudly feature a clinical trial by Ramon-Krauel and colleagues, 8 including senior author David Ludwig, in this issue of the journal. Dr. Ludwig, a prominent pediatric obesity expert, no doubt well known to readers of the journal, has long been a persuasive advocate for low-glycemic eating. But, in this article, he publishes the results of a pilot trial demonstrating that a low-fat diet works comparably well to induce weight loss and reverse hepatic steatosis in children.
The limitations of the study are laid out by the authors with clarity and candor and need not be belabored here. The study is small, and of limited duration, but it serves, nonetheless, to enforce a very important principle: There is a well-established theme of healthful eating that does not obviate variations on that theme. What seems to matter most here is that all of the kids in the trial wound up eating better than they had before with measureable effects on health and weight ensuing.
The article by Ramon-Krauel et al. is important in its own right, of course, but I am particularly enamored of what it insinuates. It insinuates the folly of competing dogmas. This, in turn, has important implications for childhood obesity and the health of children. Among the many factors that impede our urgent mission is the distraction of adults by promises of effortless weight loss allied to a panoply of dogmas—dogmas and diets in many cases defended and peddled by professionals with credentials.
A seemingly endless parade of such enticements keeps adults lining up for weight loss lotions, potions, and programs that leave their kids behind. In an age of epidemic childhood obesity, that is at best irresponsible. 9 But it is worse than that, because adults and kids live together in what constitutes the basic functional unit of society and the fundamental building block of culture—the family.
Rejecting dietary dogma is one of several important means of propelling families toward better health they can share. When dietary dogma loses its power and appeal, we might all embrace our common knowledge and apply it. Doing so would lead in the direction of sensible, balanced, sustainable diets suitable for adults and children alike.
Another element is the recollection that in unity there is strength. Families have the power to make a lifestyle stick that individuals do not. Yet another is the notion that while we, as responsible adults and loving parents, should safeguard the health of our children, they are people, too. They, too, have opinions and are even subject to age-particular varieties of dogma. “If it's good for you, it tastes bad,” for instance. This dogma, too, must be overcome so that we may pursue health with the enthusiasm of our kids adding momentum, rather than the resistance of our kids adding drag. 10
For us to reach the children we are trying to help, we must keep pace with the changes in our own culture and exploit the media that matter to them and the languages they speak. My own shop (lab and nonprofit foundation) has long placed an emphasis on the development of programs to engage kids in the pursuit of health and empower those efforts. We noticed that our portfolio had a gap in the middle, with nothing much to offer middle and early high-school kids—the “tweens and teens.” This group is hard to reach, but they sure seem to like YouTube, so we have launched a health education program built around music videos. 11 The second in that series, called “The Process,” 12 makes the case that more than food is being processed. Marketing distortions that have resulted in “junk” earning the status of a major food group are, in essence, processing people. We make this case to the kids, themselves, in a medium where West Side Story meets The Matrix. As in The Matrix, we want to help people free themselves from a virtual reality, woven of deception into a prison of sorts.
Our plans for the “Unjunk Yourself” program include the development of a full library of music videos, each conveying a simple and distinct message about diet, physical activity, and health in a blend of education and entertainment. These music videos will be linked to readings for the kids and an instructors' guide for teachers. The videos and readings can be assigned, with discussions in class to follow, as part of curricula in health, science, home economics, marketing, and more. Using charitable support to develop the program through my 501(c)(3), we will offer it to all for free.
Adults and kids will get to health together, or probably not at all. Eating better and being more active in a culture that conspires mightily against both is tough enough, without fighting our children to make it happen. If we are also fighting one another's competing opinions, it becomes virtually impossible. While arguing over competing dogmas about the best way up a hill, we remain stuck at the bottom and fail to climb. The cure is to embrace the science and knowledge we have, including the limits to that knowledge, which lay out a middle ground of common opportunity. Ramon-Krauel et al.'s article illuminates that very patch of ground. There is space there for each family to choose a route to health that works best for them. But first we must perceive the persistent chorus of reliable truths above the din of competing dogmas. Our kids must be wooed away from tired refrains about why health is unappealing or unworthy of their attention and families must work together in harmony to make health a fixture in the lifestyle and culture they share.
We could catalyze progress in public health efforts to reverse trends in obesity and chronic disease by renouncing the impediment of competing dogmas. We could best advance the goals of losing weight (when warranted) and finding health, for adults and kids alike, with efforts that consistently conjoin the practices of parents and their children and honor the primacy of family. With a focus on using the most reliable science, consistently invoking sense, and inviting the strength borne of unity to minimize delay and dissent we could make beautiful music, or at least meaningful progress, together.