Diet fads come and go with author upon author promoting one diet craze after the other. Bookstores promote them cafeteria fashion, with selections ranging from the Rotation Diet, Rice Diet, Beer Diet, Scarsdale Diet, Dr. Adkins Diet, Elizabeth Taylor's diet and Oprah's varieties. We buy them, hoping for success through new and enticing discoveries that will perhaps let us indulge our cravings in some new manner that our dietary sins cancel each other out.

The latest fad seems to say it's time to throw away the low-fat, carbohydrate-saturated diets and take another look at protein and insulin control. Barry Sears' The Zone and other diet books on the market such as Protein Power and Healthy for Life are capitalizing on the carbo-phobia phase. What is the truth and what is sheer theory? Let me summarize information in the Nutrition Action Letter about this fad.

Dr. Kelly Brownwell, an obesity expert in the psychology department at Yale University puts it succinctly when she says the latest fad diets are "little trick birthday candles that keep lighting up," offering a brief flurry of hope with little or no supporting scientific data. The reason health professionals condemn such fads are that they are dangerous or have no supporting data. Many diet fads, Sears' included, take some scientific truth, develop a theory and sell it as a fact.

Most experts believe the major claims in Sears' book are false. He claims that Americans are fatter because they are eating less fat. But, the average American ate 81.4 grams of fat a day in 1970 and 82 grams a day in 1980, according to the National Center for Health Statistics. We are not eating less fat!

Not only are we eating less fat, but Sears' claims we are eating more carbohydrates and that makes us fat. How? By sending hormonal messages to our body through insulin to store fat, he says. It's simple, he explains: carbohydrates increase insulin, and insulin says "store fat." But, endocrinologists, (even the endocrinologist Sears quotes in his book) disagree with this theory. High blood insulin levels, by themselves, do not "make you gain weight," says Dr. Gerald Reaven.

The truth of the matter is that any time we eat a high calorie diet and exercise less, we gain weight. When Sears says calories don't count, protein does, he gently overlooks the fact that his diet adds up to about 1,700 calories, which does cut calories for most people. Hoping to or attempting to control weight through balancing the body's eicosanoid is taking scientific knowledge too far in theory, with no evidence to support it. It is true that eicosanoids are hormones that help regulate inflammation, coagulation/clotting tendencies of the blood, and that every disease state can be viewed in terms of bad vs. good eicosanoids. But Sears' statement: "The closer you get to the center of that ideal protein to carbohydrate ratio (.75) the better your ability to control your balance of eicosanoids," is unproven in two ways:

• Eating equal amounts of carbohydrates and proteins does not lower insulin levels, and

• There is no evidence that changes in insulin have an effect on eicosanoids.

People are losing weight on Sears' diet because they reduce calories. Losing weight makes you feel better, but chances are, on this diet, like all restrictive diets, people will maintain the weight loss for about two months and then lose interest in the diet and regain the weight. The major problem with adopting the new protein power diet craze is that eating fatty meats causes clogged arteries - that is proven!

What is the answer to weight loss and weight maintenance? Here are many suggestions:

1) Go to a physician who specializes in weight loss. Select a doctor, clinic or program that offers what you need to produce results. This includes experts to provide a comprehensive program of diet, exercise, monitoring, group support and individualized attention. Make sure those taking care of you are qualified and competent. Ask for statistics and results of treatment outcomes, not just a good story of one or two patients. Request the credentials of the professional staff and investigate. Call the medical board of your professional (doctor, nurse, physician assistant) and ask if he or she has outstanding actions or suspensions. Just because a physician is a member of the American Society of Bariatric Physicians does not make him or her an expert. It only shows he has an interest in weight loss since membership is open to all licensed physicians who agree to follow their guidelines.

2) Exercise using social reinforcement - join a program, group or solicit a friend to exercise with you. Only 10% of those who design their own program maintain the commitment, 70% of those who use some form of group support or structured program continue.

3) Join a weight loss support group. The best results come from close-ended groups (those which maintain a constant group by closing membership once formed) of 8-10 people. Eighty percent of members in these groups reach their goal weight.

4) Don't spend your money and time on unproven diet books, remedies and ineffective treatments which may cost you more in the long run. Don't expect instant results or long-term benefits without commitment to exercise and healthy, proven nutrition management. Lifestyle changes take six to nine months and are best made under the supervision of professionals.

The Center for Science in the Public Interest (CSPI) recently summarized the treatment results of weight loss programs and clinics and reported the following:

• Jenny Craig advertises the cost of the program as 20 lbs for $20, but the cost is $50 per pound, plus $70-$80 per week for food.
• NutriSystem advertisements tell consumers they must buy $49 worth of food per week, which would cost $49 a pound, and signing up for the program can cost up to $299.
• Physicians Weight Loss Center implies it is supervised by physicians, when two of the programs are not.

You may request this report from CSPI at 202-332-9110.

5) Beware of diet programs or books offering short-term solutions, expensive meal plans, diets of less than 800 calories, ones that eliminate food groups, and programs that sell unproven diet aids. Especially be suspicious when diet aids are secretive about the product used. Request a reasonable explanation, and ask your family doctor for his opinion of new theories or products. Avoid shots or diuretics that can be dangerous. A training program sponsored by the American Society of Bariatric Physicians that I attended recently stated that vitamins, thyroid pills and diuretics (water pills) were not indicated except under special conditions, but patients often asked for them and doctors often complied, generally because they could charge for them. Diuretics are used effectively for high blood pressure, kidney failure, and congestive heart failure, but if you don't have these conditions, the fluid loss is regained. Vitamins are only indicated for surgical weight loss programs and very low calorie diets of less than 800 calories. Thyroid pills only work if you have hypothyroidism, not just because you have low metabolism. The only way to increase metabolism is to increase muscle mass.

6) Don't expect medications to be wonder pills. If you look at the research of Dr. Weintraub, in 50% of people the pills stop being effective after six months. Also, for those with more than 50 pounds to lose, when they stopped the medications, nutrition management and exercise, 100% regained the weight. Redux (the new "diet pill") does not work with 25% of the population at all. If you do not lose 4 pounds per month and are exercising and managing your intake, you should not continue medication.

7) Weight management is a long-term investment. Don't quit if you fail the first time! research shows that individuals are more successful on their third attempt than their first attempt to lose weight.

In summary, research shows that the following are key factors in successful weight loss:

• 80% of patients relapse in the first 90 days of obtaining their goal weight, so close supervision is needed during this period.

• 90% of patients who exercise maintain weight loss as opposed to 30% who do not exercise, and as mentioned above, success is increased when exercise is done with a friend.

• Food replacement and VLCD (liquid diet) are only 5% effective; in the long term, medications, exercise and nutrition management have a greater success rate.

• Individuals who smoke should undertake a smoking cessation program simultaneous with a weight loss program.

• 90% of the reason for not reaching a goal weight is because of stress, and the most effective way to develop stress coping skills is in small support groups, not education groups on nutrition and exercise.

Dr. Borrell is a board certified physician with graduate certification in child, adolescent and adult psychiatry. He is an Assistant Clinical Professor at Baylor College of Medicine and Consultant to the Adolescent Medicine Clinic at Baylor. He has practiced in Houston for 15 years, treating over 2000 patients.