Sunday, December 16, 2012

Extreme Weight Loss Solutions: The Failure of Fad Diets in Achieving Long-term Weight Loss and Maintenance- Jeremy Greco

                  In 2012, the United States is in a state of war. This war is not for peace, land, power, or profit. Rather, it is for our basic survival as a nation. The war I am speaking of is the war on obesity. According to the Mayo Clinic, obesity is defined as “an excessive amount of body fat.” Obesity is also defined by the use of the Body Mass Index (BMI) measure. Using this measure, obesity is defined as “a BMI at or above the 95th percentile for adults of the same age and sex” (3). Health officials differentiate between obese and “overweight”. Overweight is defined as “a BMI at or above the 85th percentile, and lower than the 95th percentile, for adults of the same age and sex” (3).  The Center for Disease Control and Prevention estimates that, as of 2010, 35.9% of U.S. adults are obese, with another 32.3% considered overweight. Individuals who are overweight/obese have been found to have increased risks of developing heart disease, stroke, type 2 diabetes, and certain types of cancer (3). These diseases represent some of the leading causes of preventable death, here in the United States. The health costs associated with obesity are immense. According to the CDC, in 2008 medical costs associated with obesity were estimated at $147 billion. Today, in the United States, we have an entire weight loss industry profiting from the weight of the nation. According to this industry, the best way to lose weight is to go on a “diet”, or as some call a “fad diet”. A fad diet is defined as “a weight loss diet that becomes very popular (often quickly) and then may fall out of favor” (9). Despite this definition “some nutritionists define a fad diet by a series of questions rather than assessing popularity” (9). Here are some questions/characteristics that distinguish a fad diet from a quality nutritional program: recommendations promise a quick fix; lists of "good" and "bad" foods ; warnings of dangers from a regimen; claims that sound too good to be true; simplistic conclusions drawn from a complex study; recommendations based on a single study; dramatic statements that are refuted by reputable scientific organizations; recommendations from studies that ignore differences among individuals or groups; and elimination of one or more of the five food groups (9). A few examples of fad diets are the Atkins diet, South Beach diet, blood type diet, and paleolithic diet.  Using diets to achieve weight loss has become common practice in the U.S. In 2009 “over half of the American public went on a diet at one point or another” (32). Recently, health experts have begun to question the safety, efficacy, and overall nutritional quality or fad diets. This paper will address the shortcomings of the use of fad diets to achieve weight loss and provide an alternative public health intervention for weight loss, and maintenance.
Critique One: Dieting Practices Elicits Psychological Reactance
            The first critique of the use of fad diets, to achieve weight loss, is that this practice takes away the individuals control of what foods they can eat. Due to their restrictive nature, fad diets usually provide a list of “good” and “bad” foods, which is the equivalent of telling people what and what not to eat. Because of their restrictive nature, individuals are more likely to develop psychological reactance. Psychological reactance is defined as “the motivational state that is hypothesized to occur when a freedom is eliminated or threatened with elimination” (as cited in, 5). Once an individual perceives a specific freedom, “any force on the individual that makes it more difficult for him or her to exercise that freedom constitutes a threat” (5). The theory of psychological reactance states that when a perceived freedom is eliminated/threatened, the individual will be motivated to re-establish that freedom. In dieting, when an individual is told that they have to consume specific foods, their freedom to eat those other “forbidden foods” is threatened. Based on the theory of psychological reactance, individuals should attempt to re-establish their freedom to eat what they want, or how much they want. There is a general consensus in the research literature that “dieting contributes to binge eating” (as cited in, 27). One experimental study found that “restrained eaters are likely to overeat following the (perceived) ingestion of any “forbidden foods” (as cited in, 27).  Urbszat et al. (27) states that binge eating is a common experience among dieters, and may be considered a part of the dieting process. This study confirmed that not being “allowed” to consume forbidden foods, can override restrained eating patterns, seen in diets (27). When an individual experiences psychological reactance, he/she may respond by a “boomerang effect”.  This phenomenon is described as “a condition producing the opposite effect of that desired- in response to certain persuasive messages” (as cited in, 20). This reaction results in a restoration of the individual’s need for control (20). The boomerang effect may accompany the initiation of a fad diet, but most likely does not occur immediately; most likely because of the voluntary nature of fad diets. Sadly, little to no research exists on this topic, which limits my previous statement to a hypothetical one. In my opinion, due to the restrictive nature of fad diets, individuals begin with high compliance, but as time elapses individuals seek to control their food choices, once again, leading to a period of binging.
The concept of perceived scarcity may be related to the initiation of food binging, in dieters. Perceived scarcity is simply a restriction on obtaining a particular item/commodity. Cialdini (1987) asserts that “scarcity affects availability of a product, and people assume that what is less common is more valuable” (as cited in, 25). When individuals perceive food as being “scarce” or unobtainable, it’s value increases. By increasing the value of these “forbidden foods”, individuals become motivated to “cheat” on their diet, which restores individual autonomy. This type of back and forth, “yo-yo”, dieting may result in minimal weight loss, or even weight gain. Psychological reactance has been found to occur across a variety of other health related behaviors. For example, Miller et al. (20) demonstrated that “psychological reactance may play a prominent role in defining the risks associated with adolescent tobacco use, uptake and maintenance.” These researchers found that psychological reactance increased adolescent risk of tobacco use. The investigators concluded that adolescents use tobacco as a way to assert their own independence and prove that they are mature (20).
While the initiation of a diet regimen is usually voluntary, there are some circumstances in which the initiation of a dietary regimen is non-voluntary. One example of a non-voluntary diet initiation is one prescribed by a medical practitioner, or even more likely a personal trainer. According to psychological reactance theory, because an individual’s behavior is being controlled by another person (e.g. personal trainer), the individual will seek to regain their control. While minimal research has been conducted on this specific topic, studies have examined the relationship between reactance and adherence to prescribed health interventions. Overall, a negative association exists between reactance and adherence (as cited in, 6). In one study, health care providers administered a set of health rules for African Americans to follow, for a hypertension treatment program. Study results illustrated that African Americans preferred to maintain their personal freedom rather than to follow the hypertension pharmacological regimen (1). Additionally, Bensley and Wu found that “high threat messages recommending either abstinence or controlled drinking created a reactance effect as demonstrated by negative ratings and higher consumption” (as cited in, 6). It appears that, overall, there are significant negative effects of psychological reactance on prescribed health interventions. The use of fad diets to achieve weight loss is subject to psychological reactance, due to their restrictive nature. Individuals on these diets will eventually seek to restore their control of food choice, and when they do, research suggests that they will binge eat.
Critique Two: Fad Diets Fail to Account for Socio-environmental Disparities
            The second critique of fad diets is that they assume that all individuals are able to put into practice these dietary modifications easily and without resistance. In other words, they assume that people are able to exert “free choice”, and the only thing holding them back from achieving weight loss is a lack of discipline. This idea of free choice asserts that “individuals can select from a variety of different options and perform the acts they desire” (1). In order for an individual to properly exercise his or her free choice, they must have ample knowledge and/or resources (as cited in, 1).
With regards to food choice, a variety of environmental and social factors have been found to impede healthy eating, in certain groups (17). Fad diets do not consider these social and environmental disparities, and as a result, only allow for specific audiences to successfully follow these dietary regimens. Cross-sectional research has found that “socio-economically disadvantaged individuals have less healthy dietary habits, which may contribute to a higher prevalence of obesity and consequently diet-related chronic diseases” (17). U.S. national survey data shows that socioeconomic status (SES) explains a considerable proportion of racial/ethnic differences in diet (28). Kontinnen et al. (17) conducted research which examined the various motives behind unhealthy eating practices. They found that individuals with a low income and/or education place more importance on food price and less importance on health, compared with more educated individuals (17). This prioritization of food choice can be seen by examining the vegetable consumption patterns of the study participants. Vegetable consumption was negatively associated with both level of education and household income (17). These results align with the finding that food price is an important motivator in decision-making. Kontinnen et al. (17) demonstrated that “the relationship between income and price was the strongest of all the associations between motives and the SES indicators” (17). According to Forbes (12), “assuming that purchasing habits remain relatively steady, a weekly household grocery bill likely averages about $111, though this may be significantly higher or lower given income and family size”. Individuals who are on fad diets spend considerably more money than the average American household. Below is a table that estimates the fad diet food bill (first week of diet), for a single individual (12). After examining the expenses associated with fad diets, it is easy to see why low SES individuals lack the financial resources to follow them.
Fad Diet
First Week Individual Expense
Other Items to Buy
Abs Diet
Diet Book
Zone Diet
Book & Protein Powder
South Beach Diet
Diet Book
Book & Protein Powder

                  While food price is a strong motivator for food choice, other socioeconomic variables have also been found to influence what people eat. Research has shown that the built-in environmental context plays a major role in the accessibility, and as a result, consumption patterns of individuals. Positive associations have been found between proximity to supermarkets/health food stores and dietary patterns (as cited in, 23). There are large socioeconomic disparities in access to quality food sources (as cited in, 23). Studies have shown that wealthier neighborhoods tend to have greater access to supermarkets and a wider variety of foods (as cited in, 23). These disparities are significant because “availability and the perception of availability may influence consumption, suggesting that less wealthy minority neighborhoods are at a distinct disadvantage regarding food choice” (as cited in, 23). Research also suggests that education level is positively associated with food choice. Miura et al. (21) found that, compared to more educated groups, lower educated groups consumed greater levels of fast food, and were more likely to choose less healthy options. Specifically, “less educated groups were significantly more likely to consume potato chips, non-diet soft drinks and fried chicken compared with the highly educated group” (21).It is evident that food choice is a complex behavior, which is likely influenced by many variables. Fad diets assume that individuals have full control over this choice, when in reality many do not. Socioeconomic status, and other social/environmental factors, can serve as barriers to food choice, and as a result, may present a challenge for diet adherence, among disadvantaged individuals.

Critique Three: Diets are Ineffective for weight loss maintenance
            The framework of the fad diet falls under a social and behavioral model called the Transtheoretical Model (TTM). The TTM asserts that change takes place over a series of stages (13). As a result, the type of behavior modification required, for an individual, varies depending on which stage he/she is currently at, in the model.  The stages depicted in the transtheoretical model are seen below:
1)     Pre-contemplation
Person does not intend to take action
2)     Contemplation
Person is thinking about change in future
3)     Preparation
Person is ready to do something; intend to act soon
4)     Action
Person has taken action towards behavior change
5)     Maintenance
Focused on maintaining achieved behavior change
6)     Termination
Behavior change/maintenance no longer part of  behavior
Although these stages describe overall behavioral change as linear, an individual can enter this continuum at any stage (13). While fad diets fall under this model, they do not adequately address all stages, thereby minimizing their capability to initiate long-term behavior change. Most importantly, fad diets do not utilize the transtheoretical model correctly because they neglect the maintenance phase. In terms of weight, successful weight loss maintenance can be defined as “intentionally losing at least 10% of initial body weight and keeping it off for at least 1 year” (30). According to the Center for Disease Control and Prevention only 5% of all dieters will be successful at both losing unwanted weight and then keeping it off. (as cited in, 32). Once a person achieves short-term weight loss, fad diets do nothing to help individuals maintain this weight. It is assumed that in order to achieve weight maintenance, the individual must remain on the diet. This is problematic because these restrictive dietary guidelines are associated with low adherence rates and high attrition rates. In one randomized control trial, high dropout and low adherence rates occurred among the four diets under study (Atkins, Ornish, Weight Watchers, Zone), especially the Atkins and Ornish diets (8). These findings were replicated in another study examining the Weight Watchers diet program. An observational study found that “50% of participants stopped attending weight watchers meetings in the first 6 weeks and 70% stopped within the first 12 weeks” (as cited in, 26). Moroshko et al. (22) found that weight loss intervention attrition is associated with “lower nutrition values, not eating breakfast, lower levels of fruits, carbohydrates, fibre, and total daily energy intakes and higher levels of protein and cholesterol intake.” These nutritional characteristics are common among fad diets. Ironically, the number of times an individual has engaged in previous dieting attempts has been shown to increase subsequent weight loss intervention attrition rates (22). It is evident that fad diets lack the capacity to produce weight maintenance, following weight loss. Once again, this is mainly due to the fact that fad diets expect individuals to maintain adherence to these restrictive nutrition regimens, after weight loss is achieved. Weight regain occurs when individuals cannot engage in healthy eating and exercise behaviors, over time (31).
Despite the widespread use of fad diets to achieve weight loss, weight maintenance continues to be a problem.  In general, “many individuals who lose weight eventually regain most of the weight that was lost” (18). In order to help develop successful weight loss maintenance interventions, we must study the behaviors of individuals who have lost weight and kept it off. Research on this population illustrates that there are several common behavioral tendencies that are associated with successful weight loss maintenance. These behavioral tendencies are as follows: self-monitoring, frequent physical activity, regular meals, and control over eating behavior (18, 30). The two most common behavioral characteristics of weight maintainers were self-monitoring and physical activity. Self-monitoring included behaviors such as monitoring types of food, quantity of food, and forms of self-monitoring (e.g. weekly weighing’s) (15, 30-31).
The second most common behavioral tendency, in weight loss maintainers, was frequent physical activity. According to Kruger et al. (18), “successful weight losers and maintainers were more likely to engage in physical activity for at least 30 minutes per day, or to add physical activity in their daily routine than those unsuccessful at weight loss and maintenance.” Frequent physical activity was also a behavioral tendency among maintainers in other studies examining the specific characteristics of this population (15, 30-31). Specifically, weight lifting was twice as common among those who lost weight successfully (18).
            The examination of successful weight maintainers reveals that none of the fad diet principles are common among these individuals. In contrast, “individuals who were successful at weight loss and maintenance had lower odds of using over-the-counter diet products than those who were unsuccessful at weight loss” (18). Additionally, research has shown that the use of a variety of strategies is common among successful weight maintainers; however, none of these strategies are extreme ones (e.g. eating only one of two types of food) (15). Regarding the dietary plans of successful maintainers, a “low-fat, high carbohydrate, low-calorie-eating pattern” was most associated among weight maintainers (30). In sum, fad diets fail to address weight loss maintenance. They believe that weight loss can be maintained by following their restrictive nutrition principles for long periods of time. However, due to their restrictive nature, fad diets have high attrition and low adherence rates, thereby limiting their ability to produce sustainable weight loss. 

Articulation of New Intervention: The “Freedom of Our Diet (FOOD)” Campaign
            In response to the major flaws surrounding the use of fad diets to elicit weight loss and maintenance, I propose an alternative intervention. This intervention utilizes group-level theories in order to elicit larger scale behavior modification; unlike fad diets which use the transtheoretical model, which is individually focused. This group level intervention is called the “Freedom of our diet” or “FOOD” campaign. Because of their great potential for change, I decided to focus my intervention on the adolescent population. The Food campaign is based off of two successful public health campaigns, the “Truth” campaign and the “84 Movement”. Both of these programs targeted youth smoking, in an effort to reduce its prevalence. The “Truth” campaign is a counter-marketing effort aimed at reducing the prevalence of youth smoking through the use of marketing strategy (10). On the other hand, the 84 Movement is a “statewide youth tobacco prevention movement in Massachusetts. It is made up of the 84% of youth in MA who live tobacco-free lifestyles” (11). The major objective of the Food campaign is to increase the adoption of healthy eating behaviors, in youth, resulting in better health and a reduction in the prevalence of youth overweight and obesity. The program is broken down into several components which include: group organization/youth involvement, marketing efforts and branding, and anti-manipulation. 
Group Organization/Youth Involvement
            The Food campaign seeks to organize a coalition of public high school students who are interested in changing the current food system, on a small scale (e.g. individual schools) and a national scale (e.g. the U.S. food system). Each school will have its own smaller group, but will be a part of a larger group which is comprised of all participating public schools. The groups will examine issues such as why certain foods are easily accessible and others are not, and the differences in food prices based on type of food. The main function of this group is to challenge the way individuals perceive the current food environment, and begin to demand access to cheaper, healthier foods.  For this to occur, members will conduct student interviews inquiring about current food perceptions, the difficulties in eating healthy at school and outside of school, and how much other students know about their food (e.g. where it comes from, nutrition information). Youth involvement in this process is a necessity in order to obtain accurate information.  It also provides students with a niche of others who are concerned about what food they eat, thus reinforcing healthy eating practices.
The group will also provide access to resources about the current food system, both at school and on a national level. These resources will include detailed information on the differences in pricing between healthy and non-healthy foods, a summary of government subsidies on corn (which is responsible for price differences), issues involving “mass produced” foods (e.g. e-coli, salmonella), benefits of healthy food, and finally a list of personal resources to aid in healthy eating (e.g. locations of farmer’s markets, which foods are in season, companies who sell organic products). The main vector of information dissemination is the “Food” Campaign magazine, which would include all of the previous resources, information about the group and its goals, the contact information of participating student leaders, and finally, access to the group Facebook page.  The use of a youth-based group is optimal because it will provide participants with a sense of control and authority. In order to stay organized, and to aid in multi-school initiatives, groups will be assigned a faculty advisor, who will aid students when needed.
Marketing Efforts and Branding
One of the major reasons the “Truth” campaign was so successful was because it utilized social media and created a brand for their “product” (2). Because social media plays such an influential role in young people, it is important for this campaign to include it. Representatives from each school will come together to create a media advertisement that adequately represents the goals and main objectives of the campaign. The main focus on the media advertisement will be to highlight the problems with the current food environment, and the manipulation of the local school and national food system, with regards to controlling youth food related behavior (more of this discussed in the next section). The media advertisement will consist of only students, in order to increase viewer similarity. The commercial will frame the issue of food choice in terms of the removal of autonomy, which will stimulate the adolescent core value of rebellion. In order to minimize reactance, the message of how to change food policy, both locally and nationally, will be done implicitly. To further ensure that reactance does not occur, the group will conduct as pre-screening and assess if reactance occurred through the use of open ended self-report measures. Because brands play an important role in the lives of youth (4), the Food campaign will attach its unique brand to the campaign’s magazine, advertisements, and Facebook page. This brand will be illustrated through the use of the campaign logo (see below). Students will also gather funds through school fundraising activities, in order to purchase group t-shirts and accessories, which will also contain the Food Campaign logo.
FOOD – Freedom of Our Diet

Youth Anti-manipulation
            As stated in the previous section, one of the main goals of this campaign is to highlight how local schools and the national food system manipulate youth, by controlling what they can and cannot eat. Based on the current food system, healthier options are less accessible because of price and availability. In the United States, fruits and vegetables tend to be more expensive than unhealthy food options. This price discrepancy makes it difficult for young people, and people in general, to purchase healthy foods. The reason for this difference in price is due to government subsidies on corn. Since the government has control over which ingredients and products are subsidized, it is important for the national Food system to be targeted. The food campaign targets the national food system by advocating for subsidies on fruits and vegetables, and greater access to these foods. This campaign asserts that the current food system fosters unhealthy eating by reducing individual autonomy in food choice. In other words, the government takes away adolescent’s control with regard to food choices, due to pricing and availability, making it difficult to eat healthy.  The school environment also controls youth food choice by providing a greater proportion of unhealthy options compared to healthy ones, in the cafeteria and vending machines, and by allowing soda companies to target adolescents to consume sugar sweetened beverages.  Finally, teen’s food choices are manipulated by another source, the mass media. On a daily basis, teens are exposed to commercials telling them to consume unhealthy snack foods and beverages. The food campaign seeks to end manipulation by local/national food environment, and the mass media. This is accomplished by group organized advocacy focused on changing the school food environment, policy changes aimed at the national food system and advertising regulations, and finally by gathering support by increasing youth awareness of this food choice manipulation. The food campaign strives for youth to retake their rights to choose what they eat, instead of being coerced into eating unhealthy foods. This objective stimulates the core value of rebellion, which is highly valued in adolescents. Furthermore, the campaign frames the importance of food control as follows:  the ability to choose to eat healthy foods allows one to gain control of their life and assert their independence; being a healthy eater shows that you are committed to being the best you can be and only fuel your body with quality foods. The focus of this program is on long-term lifestyle choices rather than short-term eating behaviors.
Defense of Intervention Section One: Psychological Reactance
            Unlike fad diets, the food campaign is designed to minimize psychological reactance. One way which this intervention accomplishes this, is through the organization of campaign groups. Each school’s campaign group is made up entirely of students, which increases the similarity between individuals. Because individuals are similar to each other, communication is not likely to be viewed as threatening (33). When communication is not viewed as threatening individuals are more likely to agree with each other, which allows for a more efficient group (33). The presence of an academic advisor is not likely to induce psychological reactance, because they are not directly involved in the group process. More importantly than the group structure is the actual program itself. The goal of the program is not to impose a set of dietary guidelines on people, but rather highlight the idea that schools, the media and the national food system are attempting to control food choice. By doing this, the food campaign actually induces individual psychological reactance which stems from these targeted institutions. This reverse-psychological reactance has been shown to be effective in the truth campaign (10).  The food campaign tries to emphasize an informative tone, which then assumes a persuasive one, after reverse-psychological reactance occurs. Research shows that when advice/messages are presented in a more informative tone, rather than persuasive, psychological reactance is minimized (5).
The food campaign uses commercial advertising as its main tool for health promotion. The advertising campaign is framed around the core values that resonate most highly with youth.  These core values include: self-reliance, activism, authenticity, and identity ( The use of framing theory has been shown to produce positive behavior change (14). The advertising component of the food campaign had to be designed very carefully, in order to not induce psychological reactance. To ensure that this reactance does not occur, the advertisement was designed to use implicit language, and maximize similarity between actors and viewers. Also, the advertisement highlights the dominant attitudes of the institutions we are attempting to modify, thereby initiating reverse-reactance in viewers. Dillard and Shen (5) state that psychological reactance can be controlled by minimizing explicitness and dominance, which is taken into account for our advertisements. With all of these mechanisms in place, it is unlikely than the food campaign will induce psychological reactance in its participants.

Defense of Intervention Section 2: Socio-environmental Disparities
            While most weight loss interventions assume that behavior change occurs in a vacuum, the food campaign does not fall victim to this fallacy. In fact, one of the major strengths of this campaign is that is aims to change these social and environmental disparities at the school level, and also at the national level. Research demonstrates that price, availability, and marketing are predictors of unhealthy food consumption (24).  According to the Yale Rudd Center, “if efforts to reduce obesity are to succeed, economic change is essential, as is attention to the price, accessibility, and marketing practices associated with both healthy and unhealthy foods.” The food campaign seeks to highlight the effect of social and environmental determinants of food choice, and actively seeks to change these underlying mechanisms, through grassroots activism focused on policy change, both locally and nationally. Additionally, by highlighting these underlying mechanisms, the food campaign seeks to reduce the prevalence of “blaming the victim”, with regards to food choice related to obesity (as cited in, 16). It is the goal of this program to make people realize that it is not the failure to assert control that is responsible for unhealthy eating, but rather a lack of control entirely.

Defense of Intervention Section 3: Weight Loss Maintenance
            Another reason that the food campaign improves on fad diets is that the campaign contains components which address weight loss maintenance. The first component of the food campaign that addresses weight loss maintenance is its implicit tone. In contrast to fad diets, the food campaign does not tell individuals what to eat or what not to eat. Because of this, I predict that program adherence will be high and dropout will be low. According to Urbszat et al. (27), diets can be broken by eating forbidden foods and by “the prospect of not being able to eat forbidden food”. Unlike fad diets, the food campaign has no “forbidden foods”. Instead, the program focuses on gaining control over food choice, and implicitly attempts to increase healthy eating behaviors. The difference between the two programs lies in the restrictiveness of each. It is hypothesized that a non-restrictive program will enhance participation rates, and decrease attrition, thereby leading to long-term behavior change. As stated earlier, the focus in the food campaign is on lifestyle choice modification, rather than restrictive short-term eating habits.  According to the Mayo Clinic (19), “successful weight loss depends on permanent lifestyle changes, such as eating healthy foods and exercising more.” The food campaign does not seek to control an individual’s eating behavior; rather, it empowers individuals to better themselves through expressing their dietary autonomy. This is an important distinction, especially since weight-loss success depends in large part on one’s readiness to seek it out (19).
Finally, the food campaign addresses weight loss maintenance by working towards reducing environmental barriers to healthy food choice (e.g. in schools). According to Kruger et al. (18), the “odds of being a successful weight loser were lower for those who reported being influenced by dietary weight control barriers… this suggests that issues of taste, cost and convenience may need to be included in initiatives aimed at helping individuals lose or maintain weight”. One of the main goals of this initiative is to promote awareness and advocate for changes in pricing and convenience.  The use of the media to accomplish the goals of this program further lends to its effectiveness. Research has demonstrated a strong effect of media on socialization; these results are especially applicable to the adolescent population (4).
In summary, the three main critiques of fad diets to achieve weight loss are as follows:  1) they invoke psychological reactance by restricting food choice, 2) they fail to account for social and environmental disparities and 3) they neglect weight loss maintenance completely. In this paper I propose an alternative, group-level intervention called the “Freedom of Our Diet (FOOD)” campaign. This campaign is vastly superior to fad diets, because it operates on a group level and it addresses all of the critiques associated with the use of fad diets. In sum, I strongly support the use of the Food campaign, in the adolescent population, and am optimistic about its capability to promote long-term weight loss, and healthy eating behaviors among adolescents. 

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