DIETING LESSONS LEARNED SINCE PRESIDENT TAFT’S DAY

That President Taft (1909-1913) struggled with his body weight was no secret.  Details of his struggle were revealed when medical historian Dr. Deborah Levine located the correspondence he maintained with British diet doctor Nathaniel E. Yorke-Davies.  As Levine describes in the October 15, 2013 issue of Annals of Internal Medicine, Yorke-Davies prescribed a regimen which began with hot water and lemon at 8 am and continued at specified times for each meal which included modest portions of grilled lean meat or fish, fruit, vegetables and gluten biscuits (as opposed to the gluten-free products so often encouraged today).  All food was to be prepared without fat, snacking was not allowed, and a serving of wine was permitted at lunch only.  He was also to weigh himself daily, keep a log of all food consumed, and increase his level of physical activity.

Taft lost weight – about 60# in the first 6 months – but was unable to keep it off.  In “In Struggle with Weight a Century Ago, a Diet From Today” (New York Times 10-15-13) journalist Gina Kolata finds similarities between the experiences of President Taft and many dieters today.  She states that this demonstrates “…how little progress has been made in finding a combination of foods that lead to permanent weight loss.”

Actually, progress has been made.  A plethora of studies have found that calories are key.  Regardless of the proportions of protein, fat and carbohydrates, those who limit their calories will lose weight.  Extreme dieting, though, is likely to result in too great a loss of lean tissue to be effective in the long term.  From the information provided, it appears that President Taft’s diet prescription provided about 1700 calories a day, quite a bit less than the estimated 3500 calories he needed.  This most likely explains his consistent complaints of hunger.

Behavioral change strategies are now acknowledged to be key for long term success.  Some of these were included in Dr. Yorke-Davies’ prescription:  keeping food logs, regular weigh-ins, and increasing physical activity.  However, equally important strategies were absent.  Dr. Levine notes that in a letter to his brother Taft spoke of how difficult compliance became once he became a prominent politician which required frequent attendance at formal dinners.  Changing eating behaviors means learning how to solve problems (how do I excel in my career as a politician while continuing to eat healthfully), addressing emotional eating, and learning how to work through dichotomous desires (I want to breath more easily but I also want to eat my favorite foods) through motivational interviewing.

Dr. Yorke-Davies’ program required strict adherence to a highly restrictive regimen and was very low in calories.  Behavior modification and nutrition education were not included.  Today we know that a more successful approach would avoid hunger, include behavior modification, and include flexibility and problem-solving.  Rather than telling Taft he must adhere to this plan at formal dinners, he would be counseled on how he could achieve both of his goals, professional and health, without compromising either.
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It is heartening to find that Taft sought out a medical professional rather than a faddist to assist him.  His doctor impressed upon him the need for accountability and self-monitoring.  However, the excessively low calorie content of this program which resulted in persistent hunger, along with the failure to address other factors involved in food choices made long-term success unlikely.  While Ms. Kolata’s interpretation focuses on the similarities of dieting 100 years ago and today, there is much we have learned to do differently since that day.  Of concern is that so many still believe that rigid unrealistic plans and the willpower to resist environmental cues is needed for success.  In fact, these approaches are more likely to lead to recidivism than more flexible programs.

 

 

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