“… I am drawn to conclude that any plan to reform eating habits must not lose sight of the fact that people want to enjoy their food. Any sort of cooking or diet is doomed to failure if it fails to give people pleasure.” — Michel Guérard, Eat Well and Stay Slim: The Essential Cuisine Minceur

By Thomas Goldsmith

People will stick with a healthier diet in the long term if it offers food that they like and find satisfying.

That’s one of the tenets behind a five-year study at UNC-Chapel Hill that recently earned a $3.8 million grant from the federal National Heart, Lung, and Blood Institute. With a modified Mediterranean diet at its core, the study aims for protracted weight loss among its clients — people with obesity cared for by general practitioners in the central North Carolina “stroke belt.” 

The Mediterranean cuisine variation for North Carolinians has been labeled the Med-South diet by UNC research principals Carmen Samuel-Hodge, assistant professor of nutrition at the Gillings School of Global Public Health, and Thomas Keyserling, a physician and professor of medicine.

The approach by Samuel-Hodge, Keyserling and associates starts with the widely studied Mediterranean diet, with its key elements including extra virgin olive, whole grains, nuts, fruits, vegetables, lean meats and fish. Then diners can add elements as varied as additional protein, limited servings of full-fat dairy products, cocoa-laden chocolate and even hushpuppies. If adding some bacon to leafy collard greens tastes good enough to keep participants on track, that’s all right, too.

“It’s easier for them to not feel as if they have to give up the palatability that comes with a higher fat content,” Samuel-Hodge said during a recent phone interview with both principals.

“I think that piece will allow them to feel as if, ‘Oh, I’m not going to be deprived with this dietary pattern.’ And if the feelings of deprivation are lower they’re likely to maintain the pattern for a longer period of time.” 

fresh nc seafood
Researchers at UNC-CH recently won a $3.8 million grant to test the value of a modified Mediterranean diet on 350 North Carolinians with obesity. The diet incorporates seafood as well as lots of fruits and vegetables, leafy greens, beans and nuts. Staff photo: Thomas Goldsmith

Doctors and nutritionists have tried for decades to induce Americans to eat more healthily, given the knowledge that most don’t get enough fruits, vegetables and fiber, Samuel-Hodge said.  But, she said, changing many Southeasterners’ eating habits must rely on elements that are already familiar to diners, such as vegetables, peanuts and peanut butter. Some former no-nos like whole milk are back on the table.

“Foods that were highly restricted 20 or 30 years ago, when we were trying to follow the old guideline of not having much fat in the diet, are the actual foundation of a healthful diet, plus people like to eat them,” Keyserling said. “People like to eat nuts, and they like to eat peanut butter. They like full-fat salad dressing and they like tartar sauce. And so those are all foundation foods for regular consumption.” 

Fresh produce is part of the modified Mediterranean diet designed to be more appealing to Southeastern tastes. An upcoming test will assess its value for Tar Heels with obesity. Photo credit: Thomas Goldsmith

The topic of carbohydrates gets complicated because the name covers everything from “good” foods such as fruits, vegetables, grains, beans and other unrefined carbs, to highly processed foods such as sugary soft drinks and refined grain products.

‘More weight loss’

“Our focus in the carbohydrate realm was to try to decrease consumption of sugar-sweetened beverages and to encourage the consumption of mostly familiar fruits and vegetables that people are already used to eating,” Keyserling said. “Then we’d recommend some substitution away from refined grain products to whole grain products. So maybe a common example would be brown rice instead of white rice and whole wheat bread instead of white bread.”

Samuel-Hodge and Keyserling led a previous study of the Mediterranean diet involving participants in Lenoir County. The enrollees showed significantly improved diet quality and blood pressure results, as well as weight loss even among those who did not choose a specific diet option to take off pounds. 

“In our Heart Healthy Lenoir project, the participants who did not elect to be in a weight loss weight program had lost 3.8 kilograms at the end of two years,” Keyserling said. “That’s more weight loss than is seen in many weight loss studies.” 

Weight results in the Lenoir study were observational, as opposed to a randomized trial involving a control group as in the new study, which will survey 350 people at five general practices in the central part of the state.

“The first phase of this intervention will prepare participants for the weight loss phase by teaching them a set of ‘stability skills,’ which include learning to eat a healthful diet without feeling deprived, becoming comfortable with frequent self-weighing and navigating inevitable disruptions,” Samuel-Hodge said in a news release. 

Cooking healthy OBX-style

Sharon Peele Kennedy, a Hatteras-based chef and cookbook author, said that some North Carolinians might be put off by, say, the omission of salt pork from the traditional local recipe for clam chowder. However, she’s able to satisfy many with a “meatless” version, serving corn cakes on the side to vary the offering.

Sharon Peele Kennedy, a chef and cookbook author from Hatteras Island, comes up with healthy recipes for traditional Outer Banks fare such as clam chowder. A new study at UNC-CH will encourage people in North Carolina to skip some high-fat foods and sugary drinks to be healthier and lose weight. Photo courtesy Sharon Peele Kennedy

“A lot of Southerners, if you tell them they can’t have salt pork or bacon fat, they’re like, ‘Ohhh, I don’t want that,’” she said in a phone interview.

Kennedy has been using both old-school and new techniques to prepare food that’s tasty and healthy, just as the UNC researchers suggest.

“We all love our fried fish, but we grew up with stews and chowders,” she said. “You cooked with what you had, onions, potatoes, peppers. Most of the recipes are basically braising, baking, sautéing.”

In a fusion approach, Kennedy suggests heating a jar of kimchi, the Korean staple of pickled cabbage, in a skillet as poaching liquid for fish. As in the Med-South approach, she draws the line at the excessive use of high-fat items and processed carbohydrates.

“So many people use cheese and butter and sauces on their fish,” Kennedy said. “I say, ‘You paid a premium for that seafood, why would you cover it up?’”

One size doesn’t work

The Med-South study will examine specific markers such as inflammation and skin carotenoid levels as well as typical weight, heart and lung indicators. Results of the research will be used to design further study in the concluding years of the effort.

First, there’s a four-month introductory period, eight months of the weight-loss program and a year-long followup to see whether people stick with a version of the plan that they’ve helped develop.

Poached fish, Mediterranean style, this time with tomatoes
Fresh-caught Outer Banks fish don’t have to be fried to be tasty. Hatteras Island chef Sharon Peele Kennedy recommends the no-fat method of poaching, seen here as a flounder filet cooks in black beans and salsa. It’s easy! Photo credit: Thomas Goldsmith

“You can have a healthful dietary pattern that actually is Mediterranean style that might have a little bit more protein for some people who want that,” Samuel-Hodge said. “And there are others who might want a different combination.”

Current weight-loss research has shown that no one diet pattern fits everyone who wants to lose weight. 

“One of the things we find is that you can vary dietary composition quite widely,” Samuel-Hodge said. “That’s what determines weight loss, because when you start comparing the high protein, the low fat, the medium-range fat, it really comes down to what that person can actually adhere to over a long period of time.” 

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Thomas Goldsmith

Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...

2 replies on “UNC’s southern twist on Mediterranean diet keeps diners on track, earns $3.8M grant”

  1. I would so like to work on this closer. I was part of the group at UNC Family Medicine in Chapel Hill. I have been consistently loosing adddince Sept 2016, my doctor left UNC and I was not placed with a new one. To date I have lost 154 pounds and have kept the 100 pounds off for a year, I am looking to lose 220 pounds total. Thank you for any added help on my journey to optimum health.
    PvP Dr Kane

  2. There are TREMENDOUS gains for mental health in eating a Mediterranean style diet! Research shows a significant drop of symptoms and reduced recurrance in studies of people with depression eating a mainly plant-based diet with seafood. And since so many also have inflammation related chronic physical illness, this diet is low-inflammatory and should be recommended to people by physicians, nurses, and others.

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