COMMENTARY

'Veganuary': 3 Diet Lessons for Patients

Yoni Freedhoff, MD

Disclosures

January 03, 2020

Could your patient be going vegan this month? Veganuary is a nonprofit organization that encourages people to take a pledge to live a vegan lifestyle for the month of January—and this pledge is gaining popularity. As a consequence of environmental concerns, health concerns, social media champions, or the hugely popular Netflix documentaries, quite a few of your patients' New Year's resolutions may involve adopting vegan or vegetarian lifestyles.

For those resolving to make the move to a plant-based diet, the bad news is that just as dietary changes motivated by weight loss are regularly reported as only temporary, so too are vegetarian diet shifts, with the majority of people who attempt vegetarian diets not able to sustain them. In fact, despite years of advocacy from environmental and animal rights groups, and the rise of vegetarian social media influencers and celebrities, just 5% of Americans report themselves as being vegetarian—a number that hasn't changed much in the past decade.

The good news is that lasting dietary changes are far from impossible. I've seen hundreds if not thousands of patients change their eating habits in the name of weight management, and I believe that there are lessons learned from weight management that can help with the adoption of any new diet, including vegan, vegetarian, and otherwise plant-based ones.

Lesson 1: Enjoy Life

Every weight loss diet has its own success stories. The National Weight Control Registry collects the stories of thousands of registrants who have maintained an average loss of 66 lb over 5.5 years. Though there are more registrants following low-fat diets (probably because they were the most popular diets when the registry was established), others are successfully following low-carb diets, ketogenic diets, intermittent-fasting diets, and more. And they have a common denominator: The dieters enjoy the lives they are living.

Anne Fletcher, MS, RD, author of Thin for Life: 10 Keys to Success from People Who Have Lost Weight and Kept It Off, interviewed 208 registrants whom she dubbed "weight loss masters" and noted that "the vast majority told me they do not feel like they're dieting."

Ali Zentner, MD, medical director of Revolution Medical Clinic in Vancouver, who has personally maintained a nonsurgical weight loss of 170 lb for more than a decade, echoes these sentiments. "The one thing I've learned above all is that no matter what I do, it has to be comfortable. My treatment has to fit into my life or it will never work. The same holds for my patients. Whatever treatment we choose—diet, exercise, medications, surgery—it has to be comfortable and sustainable or it will never work."

It is also important to remember that for most, perfection is not a sustainable treatment goal. Food is not just fuel; it serves as the basis of the world's oldest social network and at times can bring pleasure and comfort. It is featured in all of our lives' events, no matter how small.

My office sees its share of patients who have sustained long-term weight loss. None of them are strict to the point of perfection, nor in fact do most of them have a formally definable eating strategy. Instead, their aim is to do their best, striving to maintain what we call their "best weight": the weight they reach when they're living the healthiest life they can honestly enjoy, and where the healthiest diet they can enjoy is dynamic and changes by day and circumstance.

The same can be true for vegetarian diets. Just as there isn't only one weight loss diet, there are many vegetarian diets to choose from. From the ill-informed plan that allows drinking sodas and eating ultra-processed foods such as french fries, Impossible Burgers, and Oreos, to whole-foods plant-based munching, to plant-based keto living (with a diet rich in foods like avocados, nuts, seeds, tofu, olive oil, lupini beans, nonstarchy vegetables, and berries) and everything in between, vegetarianism offers a surprisingly large variety of approaches.

Indeed, for many people, the best vegetarian approaches may not be strictly vegetarian at all. Instead, their own best efforts could include such strategies as meatless Mondays, a reduction in or elimination of one type of meat, vegetarian-only breakfasts, or vegetarian with the inclusion of fish, dairy, and/or eggs, and more.

Lesson 2: Keep a Diary

It's beneficial for patients to have a system in place to remind them of the changes they're trying to make. With weight management, it's keeping track of something: calories, carbohydrates, macronutrient percentages, Weight Watchers' points, etc. In the days before smartphone apps, pen-and-paper food diaries were found to double a person's long-term weight loss outcomes. Recent studies of people using newer technology suggest as good or better results.

I believe that these benefits come primarily from the food diary's role in cultivating and sustaining behavior change, not so much from what is actually being counted. When used wisely, food diaries aren't meant to police a person's dietary choices; instead, they serve as regular reminders of the changes a person is trying to make, which can help cement the permanent adoption of dietary changes.

With the rise of smartphones, food diaries are more accessible than ever. Some include voice transcription, wristwatch-based record keeping, or two-way contact with coaches or healthcare professionals. One even provides an objective measure of dietary adherence with a breath sensor that will let dieters know if they are actively in a state of nutritional ketosis—and it also offers a plant-based keto program.

Lesson 3: Start Slow and Think Simple

The adoption and maintenance of a new dietary strategy is a skill-building endeavor, and flying leaps of change may not get patients very far. A person interested in learning a new martial art is not likely to start as a black belt; instead, that person begins as a white belt, learns the basics, and falls down a lot.

Both managing weight and adopting a vegetarian lifestyle are going to mean gaining cooking skills and learning new recipes, changing meal preparation and potentially meal frequency, and learning how to incorporate friends, family, and a social life into an evolving lifestyle. For special populations in particular, including children and people with chronic medical conditions, changes should be bolstered with consultations with physicians and other regulated health professionals, such as dietitians with expertise in how to avoid the potential and easily manageable nutritional risks of various vegetarian or vegan diets.

I turned to two friends living long-term with very different vegetarian diets: Carrie Diulus, MD, an orthopedic spine surgeon with type 1 diabetes who enjoys a plant-based keto diet, and Danielle Belardo, MD, a sixth-year cardiology fellow who enjoys a whole-foods plant-based diet. I asked for their thoughts on the most common misconceptions held by those considering vegetarian diets.

Dr Diulus focused on perceived difficulty as a stumbling block. "Foods can be simple and delicious with minimal prep time," she said. Dr Belardo mentioned the perceived cost, saying, "Some of the most affordable foods in the grocery store are whole-food plant based, including brown rice, beans, legumes, whole wheat pasta, and various fruits and vegetables."

These are echoes of lessons learned from weight management. Among the most common misconceptions is the notion that success requires complicated, expensive meals that take forever to prepare. The truth is, a homemade sandwich and a piece of fruit instead of a food court meal; water instead of liquid calories; and losing a box or two of ultra-processed meals a week in place of simple, whole foods–based fare would go a long way for many.

At the end of the day, success depends largely on where goal posts are placed. Rather than attempting vegetarian perfection, perhaps patients who want to pursue plant-based lifestyles should be guided toward aiming for the smallest amount of meat they can honestly enjoy and encouraged to reevaluate as they go along, which will lead them much farther down the road than any flying leap ever could.

Medscape and Dr Freedhoff do not endorse or receive financial compensation from any products mentioned in this article.

Yoni Freedhoff is an associate professor of family medicine at the University of Ottawa and medical director of the Bariatric Medical Institute, a nonsurgical weight management center. He is one of Canada's most outspoken obesity experts and the author of The Diet Fix: Why Diets Fail and How to Make Yours Work.

Follow Yoni Freedhoff on Twitter: @YoniFreedhoff

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