Losers, Finders, Keepers: New Year, Same Old Game?

David L. Katz

It's 2013, and you know what that means! The 2012 Best Diets results are yesterday's--well, last year's actually--news. It's time for an update.

I defer that update to my U.S. News & World Report colleagues, who will provide it soon, and with appropriate fanfare I'm sure. I know that game is afoot, because I was privileged once again to participate in the judging, along with a very illustrious panel of colleagues.

As I have previously conveyed, no single judge can know how the rankings will turn out--so we await the results along with everyone else. Each of us contributes our scores to the editors, who aggregate the data. The final verdict in each case derives from the pooling of expert opinion. The criteria are, of course, topic specific, but the process is similar to what U.S. News & World Report uses to generate all of its go-to ranking lists, including Best Hospitals and Best Colleges.

So the Best Diets results are not my beans to spill. I am simply here to offer some ancillary commentary.

[See Recipe for Health]

As we await the 2013 results, I dare to hope that this might be the year we establish some new rules for what is becoming an old and fairly predictable game. Whichever diets are considered best in any given year, they are, inescapably, only as good as the use to which we put them.

Traditionally, we have done a very questionable job. We have made use of short-term diets as temporary solutions to the permanent challenges of eating well, losing weight, and finding health. Traditionally, diets of every description have been things we go on, and fall off.

Traditionally--at this time of year in particular--diets have been the stuff of resolution and inspiration, a leap born more of faith than preparation, and predicated almost entirely on willpower.

Willpower is important. In the absence of will, nothing intentional happens.

But willpower isn't enough. Our culture encourages us to believe that where there's a will, there's a way. But an experience as homely as a highway closed due to a car crash or fallen tree is all the proof any of us needs to know that just isn't so: You may have the will, but lack the way. The way may be closed. Or elusive. Or just very challenging.

[See This Year, Make a New Year's Resolution Resolution]

In the case of eating well, the way is challenging at best for all of us. This should come as no surprise. We are the descendants of generation upon generation of ancestors for whom calories were relatively scarce and physical exertion an inevitable, daily fact of survival. They adapted to that world, or perished without passing on any genes.

The genes the survivors did pass along to us are suited to their world--not ours. Ours is a world awash in calories and labor-saving technologies. A world in which eating well and being active lie along the road less traveled, while we would all prefer to find them on a path of lesser resistance.

This could change, of course; health could be found along a path of lesser resistance. But it will take the concerted effort of the body politic to pave the way, and make it so. I'm not inclined to put the health of my body on hold while waiting on the world to change, and recommend you don't, either. Which leaves us where we started: needing to get there from here, in spite of it all.

[See We're Not Fat Because We're Lazy]

So as we acknowledge that the game is, indeed, afoot--that weight loss once again tops the list of resolutions, and diets will again be ranked--perhaps we might consider changing the game altogether. What might the rules for a new and consistently winnable game be? Here are some of mine:

1. Don't start what you can't sustain.

You don't want to be thinner--or healthier--for a little while. If you want these things, you want them permanently. That means the approach you use to get there has to be permanent as well. If you are contemplating a strategy to lose weight or find health, ask yourself: Is this something I can do forever? If not, keep looking.

You should be looking for skills you can learn and master--like riding a bike. If you learn new skills for healthy living, you can't unlearn them. Willpower can get you launched--skill power can get you over the finish line. For example, knowing how to distinguish between more and less nutritious foods is a skill. Knowing how to cook (at least a little!) is a skill. Knowing all the different ways to fit some activity into your daily routine is a skill. And so on. Skill power changes the game!

2. Don't lose if you don't stand to gain.

Losing weight fast is not all that hard, really. And certainly, not every way of doing it is a good idea. Need convincing? Well, a cocaine binge would work. The prosecution rests! Don't mortgage your health to pay for weight loss.

If what you are doing to lose weight is not equally appropriate for finding health, you are playing the wrong--and a potentially dangerous--game. Move on.

3) Don't go it alone.

We all know that "in unity, there is strength." But all too often, we abandon our families when we go on a diet. However, involving our family in an attempt to be healthy makes us more likely to succeed--and if it really is about health, why on earth would we leave out the people we love most? Family is the basic building block of culture, and we can change the culture of our family to prioritize health. But only if we remember that no one is an island.

[See Finding Support For Your Health Goals]

4) Don't rely on willpower without skill power.

This is a corollary to rule No. 1. Skill power enables us to troubleshoot, and to keep going when the going gets tough. Our culture has lots to say about willpower, but tends to neglect the critical role of skill power in completing any challenging task.

If you wanted to build something out of wood, you would need more than will; you would need carpentry skills, and the right tools. If you wanted to climb Mt. Everest, you would need mountaineering skills, and the right gear. Healthy living in the modern world takes skill. Skills can be acquired!

5) Get clinical support instead of clinical care.

I believe that clinicians can and should be part of the solution to the prevailing problems of obesity and chronic disease. But let's face it: Making better use of your feet and fork is something YOU control, not a doctor. There is no pill or surgery to substitute for these actions, which leave you in charge.

We want good coaching and guidance from clinicians we can trust. The alternative, of course, is to neglect our health--as is more the norm than the exception in our culture--and wind up needing clinical care for bona fide illness. But let's not forget: Good use of feet and forks can prevent entirely the bad health outcomes that pharmacotherapy can only partly fix. Easy choice!

So my wish for 2013 is that the losers (of weight) become finders (of health), and finders become keepers! My wish is that you--and your family--win this time, because you apply better rules, and make it a whole new game!

Hungry for more? Write to eatandrun@usnews.com with your questions, concerns, and feedback.

David L. Katz, MD, MPH, FACPM, FACP, is a specialist in internal medicine and preventive medicine, with particular expertise in nutrition, weight management, and chronic-disease prevention. He is the founding director of Yale University's Prevention Research Center, and principal inventor of the NuVal nutrition guidance system. Katz was named editor-in-chief of Childhood Obesity in 2011, and is president-elect of the American College of Lifestyle Medicine.