Is ZOE an 'Anti-Diet' Or Just a Diet?

A personalized nutrition program dubbed as an "anti-diet" by the media has even been compared to Ozempic in terms of its effectiveness. Experts, however, say the program has much in common with regular diets.

A clinical trial published in Nature compared the effects of the ZOE personalized nutrition program and general nutrition advice on cardiometabolic health.

ZOE's personalized nutrition program involves at-home blood and stool tests that measure blood fat, blood sugar, and gut microbiome health. Samples are then sent to the lab for analysis.

Using the results, ZOE's researchers score every food from zero to 100 based on how users' bodies respond to them, claiming it helps make better food choices. Users can track their progress by repeating the tests, a kit of which costs nearly $300.

The new study, which was funded by ZOE, included 347 participants with obesity aged 41–70 years who were randomized either to follow the 18-week ZOE app-based program or the standard dietary advice based on the Dietary Guidelines for Americans.

Participants in the personalized nutrition program slimmed their waists by an average of 6.3cm (2.48 in), compared to a 5.35cm (2.1 in) reduction among those following the Dietary Guidelines for Americans.

Moreover, participants in the ZOE group saw more significant improvements in the LDL or "bad" cholesterol levels, diet quality, and gut microbiome.

One of the creators, Tim Spector, a professor of genetic epidemiology at King's College London, told the Daily Mail that current population advice is clearly out of date and overly focused on calories and low-fat foods.

What is an 'anti-diet'?

Maeve Hanan, a registered dietitian, called the ZOE's program "absolutely a diet" and a perfect example of diet culture co-opting the anti-diet movement.

"Altering the diet in order to reduce hunger and lose weight — that's basically the definition of a diet. It advises people to avoid certain foods, to eat certain foods, and the overall aim is to lose weight, so it is absolutely a diet," Hanan said in an Instagram video.

She explained that anti-diet means opposing diet culture and the pursuit of weight loss, calling the personalized nutrition program an example of sneaky marketing to take advantage of the popularity of the anti-diet movement.

The benefits of personalized nutrition

Jacob Juel Christensen, a Ph.D. candidate at the University of Oslo, says personalized nutrition is an interesting research topic, but the evidence is insufficient to implement it in the real world.

In that sense, none of the commercially available tools like ZOE are evidence-based, and you'd probably be better off just following the general food-based dietary guidelines that apply to basically all of us.

Christensen

He points out that in the Nature study, the group using the ZOE program received much more follow-up than the standard dietary control group. Research shows that the more intense the dietary intervention, the more effective the result, compared to a standard diet.

Christensen says, "To truly test if the personalization had any effect on the outcome, you would need to subject the control arm to the same intense intervention, but with a dietary regimen that was less personalized."

James Gill, M.D., an honorary associate professor at Warwick Medical School, emphasizes the study did not suggest a personalized diet plan is a miracle intervention, as several health markers, such as blood pressure, glucose, insulin, and other proteins, did not change.

However, given that no adverse events occurred and no medications were prescribed, these successes from guided diet changes can be considered a success.

Gill said in a press release, "Frankly, I view this study outcome as a strong indicator that the NHS should look towards a more personalized approach to dietary advice rather than the current generic one size fits all with regard to dealing with the health emergency which is obesity."

Eating for better health

In the United States, over 40% of the adult population has obesity, increasing their risk of type 2 diabetes, multiple cancers, coronary heart disease, and early death. This leaves millions of people wondering what they should eat to boost their health and shed extra pounds.

Christensen says everyone can improve their health by following the Nordic Nutrition Recommendations, which promote a predominantly plant-based diet rich in vegetables, fruits, berries, pulses, potatoes, whole grains, and ample amounts of fish and nuts.

The guidelines emphasize moderate intake of low-fat dairy products and limited consumption of red meat and poultry. Meanwhile, processed meat, alcohol, and processed foods containing high amounts of added fats, salt, and sugar should be kept at a minimum.

The Nordic Nutrition Recommendations are based on the same principles as the Dietary Guidelines for Americans, used as general nutrition advice in the Nature study.

Christensen tells Healthnews, "Some will have more to gain by focusing on fish and pulses intake, while others will have more to gain from limiting their red meat intake. Personal preferences and motivation also play into this, and close follow-up by healthcare professionals like registered dietitians can increase people's adherence to their dietary goals."