Diet, Lifestyle and Diabetes: The SmartBrief headline that was really dumb

 As most of you know, misleading headlines about food and nutrition are a huge concern of mine, thus the brand of my business and blog, “Eating Beyond the Headlines.” A recent set of headlines drew my ire even though they weren’t related to my usual stock-in-trade of refuting fear and misinformation about foods, ingredients and modern agriculture. Instead it was an article about a study that evaluated the effect of diet and lifestyle changes in people at risk for type 2 diabetes.
 
I first came across the headline in my Academy of Nutrition and Dietetics SmartBrief email that arrives daily in my email box filled with headlines and brief summaries of food and nutrition stories in the popular press. Imagine my surprise when I read “Diabetes risk reduction not tied to lifestyle advice, study shows.” Hmmm. I learned and have always promoted diet, exercise and lifestyle as key components in preventing and managing type 2 diabetes. 
 
Clicking the link to navigate to the news story, I find a different headline, “Lifestyle advice alone fails to reduce type 2 diabetes risk.” The key word here is "alone." That's not reflected in the SmartBrief email headline. Reading the article, it states, "Participants attended four 2.5-hour group education sessions at 2, 6, 12 and 24 months after baseline. Sessions covered general information about diabetes and diabetes risk/prevention, nutrition and dietary recommendations, advice on moderate physical activity, and information on physical activity opportunities." And just 50% attended at least 3 of the sessions. So we might conclude that it wasn't the lifestyle interventions that failed, but the subjects’ failure to use them.
 
Next I downloaded the original journal article, “Basic lifestyle advice to individuals at high risk of type 2 diabetes: a 2-year population-based diabetes prevention study,” published in BMJ Open Diabetes Research & Care. Note that this title is not at all negative about the role of diet and lifestyle in type 2 diabetes as the previous ones. In the conclusions the authors state, "In summary, the substantial 2-year diabetes incidence, the consistent increases in glycemia and BMI, the relatively low participation, and the low proportion achieving substantial weight reduction indicate that our low-grade intervention with basic lifestyle advice did not have clinically meaningful effect on diabetes prevention overall or in subgroups by age, sex, education level, depressive symptoms, BMI, physical activity, or family history of diabetes." Key terms to note are "low participation," "low proportion achieving weight loss" and “low-grade intervention with basic lifestyle advice.”
 
I haven’t worked in clinical dietetics or medical nutrition therapy for years but even I know that a “low-grade intervention with basic lifestyle advice” is not the ideal way to treat patients with or at risk for type 2 diabetes. So I went to the Academy of Nutrition and Dietetics position paper, “The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists (RDNs) in the Prevention and Treatment of Prediabetes and Type 2 Diabetes.” This paper documents the effectiveness of medical nutrition therapy (MNT) provided by RDNs for the management of diabetes, advising that individuals with prediabetes or type 2 diabetes should be referred to an RDN for individualized MNT upon diagnosis and at regular intervals throughout life as part of their treatment regimen. 
 
Specific evidence cited includes:

• MNT provided by RDNs is effective for managing prediabetes through positive changes in body weight, calorie balance and healthy lifestyle changes. 
• Greater improvements were found with increased frequency of MNT visits. 
• A majority of studies evaluating MNT provided by an RDN found significant improvements in weight, blood glucose levels, waist circumference and blood pressure.
• A report from the Community Preventive Services Task Force concluded that combined healthy diet and physical activity promotion programs are effective at decreasing diabetes incidence. More intensive programs were the most effective, and RDNs were the primary counselors in these programs.

 
According to registered dietitian nutritionist, Melissa Joy Dobbins, also a certified diabetes educator and spokesperson for the American Association of Diabetes Educators, “Nutrition counseling for diabetes is more than just giving someone information or 'lifestyle advice.' It takes time. While group classes can provide an overview, meeting with a registered dietitian nutritionist is more likely to be effective because of the individualized plan that is created together between the patient and dietitian. And research shows that more than 10 hours of diabetes self-management education and support is necessary to achieve benefits that have major impact.”
 
The bottom line: when you read a headline in the popular press that tells you nutrition therapy is not effective or a food or ingredient is bad for you, don’t accept it as fact without further investigation. Contact a registered dietitian nutritionist or check the website of the Academy of Nutrition and Dietetics for more information. And please, please do not tweet or post the story to social media without getting the facts. 
 
Sources cited:

• SmartBrief: “Diabetes risk reduction not tied to lifestyle advice, study shows”
• News Story “Lifestyle advice alone fails to reduce type 2 diabetes risk”

• Journal study: “Basic lifestyle advice to individuals at high risk of type 2 diabetes: a 2-year population-based diabetes prevention study”  
• Position paper: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes

 
 
 

---