By Dennis Sale
FOR those who remember the 1970s singer Roger Whittaker, he had a hit song titled No, I Don’t Believe in If Anymore.
It provides a context for why making sense of the wellness industry is so important – one could even say it’s a matter of life or death. How often have you heard people say “if only” in relation to their life choices, ranging from the mundane (eg, if only I had not bought that item yesterday, as it’s now on sale today and I would have saved £20) to the existentially important life-changing events – and I don’t need to spell these out here.
One of my “if only” gripes is that I collected Marvel comics as a kid, especially Spiderman and X-Men, and I had the first 15 editions of both, all in pristine condition. Sadly, I sold my whole collection for “30 bob” – that’s a slang term in old currency for £1.50. For context, as of 2023, a pristine copy of Spiderman #1 sold for a record-breaking $3.36 million; I paid three pence in old money for mine – a “threepenny bit” – as it was called then. Yep, “if only”.
OK, I’ve stopped the tears for now, and I would expect you have some empathy here, and I also think you will be making connections to why we need to make sense of the wellness industry. Many people today go overseas for a range of treatments, as it’s much cheaper in some countries. Well, some come back very happy with the results, others less happy – and it’s then just another “if only”.
Framing the wellness industry
The wellness industry encompasses a wide range of practices, services and products aimed at promoting physical, mental and emotional wellbeing. It has grown significantly in recent years, driven both by increasing consumer awareness and a demand for healthier lifestyles. Some key areas and facilities include:
-
Nutrition and diet: This involves food products, dietary supplements, nutritionists and healthy eating programmes.
-
Fitness and exercise: This includes gyms, fitness studios, personal trainers, and workout equipment.
-
Mindfulness and meditation: This encompasses yoga, meditation apps, mindfulness retreats and stress management techniques.
-
Mental health and counselling: This includes therapists, psychologists and mental-health support services.
-
Wellness technology: This includes fitness trackers, health apps, oxygen chambers and ice tanks.
-
Alternative and complementary medicine: This includes acupuncture, massage therapy, herbal remedies and homeopathy.
However, going deeper into these broad areas, one notices conflicting evidence “for and against” specific practices, techniques and technology use. In the second part of this series, I offer an evidence-based analysis and evaluation on key aspects of this wide industry, unpacking how they work and on what basis. This makes ascertaining the essential questions that individuals must address in making their choices on the options available a more thoughtful exercise.
Concern over what is healthy eating is a major case for initial consideration, as this is a real “health minefield”– so let’s unpack and address this first. Most people are familiar with the traditional food pyramid, which has its origins in 1992, when the US Department of Agriculture (USDA) developed a food pyramid that reinvented the way many people think about their diet.
At the bottom of the pyramid were grains and starches, telling us that the bulk of our diet ought to consist of carbohydrates such as cereal and bread. Up at the top – in very moderate amounts – was fat. We were told that low fat would ensure a healthy life (although not one ounce of good science backed up this claim).
It was documented that even while the pyramid was being developed, dietitians knew that fat is essential to our health and can reduce the risk of cardiovascular disease. They also found little evidence that a high intake of carbohydrates is beneficial. However, the USDA pyramid was released, and the public adopted it.
However, obesity rates have tripled in 30 years, and with it, cases of type 2 diabetes and heart disease. Today, two-thirds of Americans are overweight or obese. The Health Survey for England 2021 estimates that 25.9% of adults in England are obese and a further 37.9% are overweight. Furthermore, using the most up-to-date figures, when obesity and overweight figures are taken together, 36.6% of children are an unhealthy weight.
A growing body of research indicates that the USDA pyramid was grossly flawed, with the following main criticisms:
-
Overemphasis on grains: The pyramid often placed grains at the base, suggesting they should form the foundation of a healthy diet. However, critics argue that this overemphasis on grains, particularly refined grains, can lead to excessive carbohydrate intake and contribute to health issues like obesity and diabetes.
-
Underemphasis on healthy fats: Early versions of the pyramid often demonised fats, leading to a misconception that they were unhealthy. Recent research has shown that healthy fats, such as those found in avocados, nuts and olive oil, are essential for overall health and can help manage weight.
-
Influence of industry: Some critics have suggested that the food pyramid was influenced by industry interests, particularly the grain and dairy industries. This has led to concerns about the pyramid’s recommendations being biased.
Even a quick survey of the diet literature reveals that there is still much disagreement on what constitutes the healthiest and most effective diet. A major difference centres on whether macronutrient ratios (eg, proteins, fats, carbohydrates) or calorie intake is the key to weight loss. Macronutrient-focused diets prioritise specific nutrient combinations, while calorie-counting diets emphasise overall energy balance.
However, there is no universal agreement on the ideal macronutrient ratios for weight loss or health. Some advocate for high-protein, low-carb diets, while others suggest high-fat, low-carb or high-carb, low-fat approaches. Similarly, there are significant differences within the macronutrient approach regarding the most healthful foods. Two prominent examples are paleo diets and plant-based diets.
The paleo diet is based on the idea of eating foods such as those consumed by early humans. It typically emphasises lean meats, fish, fruits, vegetables, nuts and seeds, while avoiding grains, legumes and dairy products. The focus is on whole, unprocessed foods.
In contrast the plant-based diet emphasises foods such as fruits, vegetables, whole grains, legumes, nuts and seeds. It may or may not include animal products like dairy or eggs. The focus is on minimising animal products and maximising plant-based foods for health benefits.
While the low-calorie restriction approach does initially result in weight loss for many people, it can be difficult – very difficult – to maintain long-term, and often leads to a rebound in weight gain. Furthermore, it may not provide enough essential nutrients, including fibre, to support overall health and wellbeing. This can result in fatigue, weakness and other health problems such as eating disorders.
Tim Spector, a renowned researcher in the field of genetics and health, emphasises the importance of gut health and microbiome diversity, arguing that focusing on specific macronutrients or calorie counting is less important than consuming a variety of whole, unprocessed foods. Spector suggests that a varied diet helps to feed a diverse gut microbiome which, in turn, contributes to overall health, weight management and disease prevention. Additionally, he highlights the role of personalised nutrition, emphasising that individual responses to different foods can vary based on genetics and gut microbiome composition.
For clarification, the gut microbiome is a complex ecosystem of trillions of micro-organisms living in your digestive tract. These tiny organisms, primarily bacteria, play crucial roles in digestion, nutrient absorption, immune function and even mental health. Your gut microbiome is unique to you and is influenced by factors like genetics, diet and environment.
In summary, I have highlighted certain main areas of disagreement concerning diet and its impact on health and wellbeing. In the next column, I offer what I see as an evidence-based synthesis of broad agreement on what constitutes a healthy diet for promoting wellbeing, as well as posing the big essential that needs to be addressed at the individual level.
-
Dennis Sale worked in the Singapore education system for 25 years as adviser, researcher and examiner. He coached over 15,000 teaching professionals and provided 100-plus consultancies in the Asian region. Dennis is author of the books Creative Teachers: Self-directed Learners (Springer 2020) and Creative Teaching: An Evidence-Based Approach (Springer, 2015). To contact Dennis, visit dennissale.com.
