Making beautiful music: less dogma, more harmonious progress.

D ogma is a catalyst for dissent and quagmire, and not much else. Call it a pet peeve. It is a problem that prevails in the areas of nutrition and weight management, forestalling progress we might otherwise make quite handily. A sensible common ground of healthful eating and effective weight control has long been at our very feet. The good to be done by eating even just reasonably well, and being even moderately active, is both a matter of public record and of stunning significance. However, here we stand, contesting the best steps, and consequently going nowhere. This is a problem among the public at large, where everyone with an opinion about diet and weight control mistakes conviction for expertise. It is a problem aided and abetted by news media that find constantly shifting controversy far more lucrative than a constant drumbeat of reliable truth. But expressions of dogma are at their most ominous and insidious when made by legitimate experts. In nutrition, that, too, prevails. Advocates of low-carb eating, for instance, cite only the evidence that supports their point of view, while steering clear of studies that show decisive benefits of low-fat diets. Paleo diet proponents tend not to cite studies that support veganism. Ardent vegans tend not to acknowledge that evidence for health benefits from an omnivorous Mediterranean diet is at least as strong. Therefore, it is in the service of a refreshing reality check that we proudly feature a clinical trial by RamonKrauel and colleagues, including senior author David Ludwig, in this issue of the journal. Dr. Ludwig, a prominent pediatric obesity expert, no doubt well known to readers of the journal, has long been a persuasive advocate for low-glycemic eating. But, in this article, he publishes the results of a pilot trial demonstrating that a low-fat diet works comparably well to induce weight loss and reverse hepatic steatosis in children. The limitations of the study are laid out by the authors with clarity and candor and need not be belabored here. The study is small, and of limited duration, but it serves, nonetheless, to enforce a very important principle: There is a well-established theme of healthful eating that does not obviate variations on that theme. What seems to matter most here is that all of the kids in the trial wound up eating better than they had before with measureable effects on health and weight ensuing. The article by Ramon-Krauel et al. is important in its own right, of course, but I am particularly enamored of what it insinuates. It insinuates the folly of competing dogmas. This, in turn, has important implications for childhood obesity and the health of children. Among the many factors that impede our urgent mission is the distraction of adults by promises of effortless weight loss allied to a panoply of dogmas—dogmas and diets in many cases defended and peddled by professionals with credentials. A seemingly endless parade of such enticements keeps adults lining up for weight loss lotions, potions, and programs that leave their kids behind. In an age of epidemic childhood obesity, that is at best irresponsible. But it is worse than that, because adults and kids live together in what constitutes the basic functional unit of society and the fundamental building block of culture—the family. Rejecting dietary dogma is one of several important means of propelling families toward better health they can share. When dietary dogma loses its power and appeal, we might all embrace our common knowledge and apply it. Doing so would lead in the direction of sensible, balanced, sustainable diets suitable for adults and children alike. Another element is the recollection that in unity there is strength. Families have the power to make a lifestyle stick that individuals do not. Yet another is the notion that while we, as responsible adults and loving parents, should safeguard the health of our children, they are people, too. They, too, have opinions and are even subject to age-particular varieties of dogma. ‘‘If it’s good for you, it tastes bad,’’ for instance. This dogma, too, must be overcome so that we may pursue health with the enthusiasm of our kids adding momentum, rather than the resistance of our kids adding drag. For us to reach the children we are trying to help, we must keep pace with the changes in our own culture and exploit the media that matter to them and the languages