I take it this was not with ad libitum intake and that researchers controlled the calories? IMO, the best weight loss diet is one that makes you eat less calories ad libitum, as most people seem to be unable to restrict calories for long periods. High protein diets probably do that better than high carbs because of the increased satiety. This also helps keep the weight off once you get it off since energy expenditure drops as you lose weight.
Which Is The Best Weight-Loss Diet?
August 09 2010
The best weight loss diet is still intensely debated and there has been very few well conducted studies which looked at this issue. Is a high protein diet better, or high carb or a high fat diet the best weight loss diet?
A recent study looked to find out which is the best weight loss diet and received a lot of good attention.
What were the strengths of the best weight loss diet study?
- Large number of participants: There were 811 participants from diverse backgrounds irrespective of age, income, geography and included a large percentage of men. Obviously the largest RCT related to determine the best weight loss diet.
- High rate of retention: The people who dropped out of the study were low which was a serious problem in other weight loss studies.
- Long Duration: The best weight loss diet study lasted for 2 years which is the longest trial for randomized weight loss trial.
- Compliance accessed: Compliance was assessed by objective markers .For example, urinary nitrogen excretion was used to asses adherence to the protein intake.
- Intense Treatment: Treatment included individual and group instructional sessions to promote adherence.
What was the design of the best weight loss diet study?
Eight hundred and eleven participants were randomly assigned to four different diets:
- 20% fat, 15% protein, and 65% carbs; Low-fat,average-protein
- 20% fat, 25% protein, and 55% carbs; Low-fat, high-protein
- 40% fat, 15% protein, and 45% carbs; High Fat, Average Protein
- 40% fat, 25% protein, and 35% carbs.High Fat High Protein
All of the diets had an average calorie deficit of 750 calories from the patients’ aggregate baseline caloric intake. Participants followed the diets for two years, during which time they were also expected to engage in 90 minutes of moderate exercise each week, keep a daily food diary, fill out a Web-based tool that monitored how closely their intake adhered to their assigned diet, and attend group and individual sessions to promote adherence
What were the results of the best weight loss diet study?
All the diets were equally successful in promoting moderate weight loss and maintaining this loss for over 2 years. Weight loss averaged 3-4 years after 2 years.
Practical Recommendations
- Any diet which emphasizes calorie restriction will work and the specific amount of protein, fat or carbs of the diet does not matter.
- Diets should be tailored to the person based on their individual and cultural preferences than based on nutritional recommendations for long term success.
- Behavioral strategies maybe more important in weight loss diets than their composition.
Related Articles
Anoop | Tue August 10, 2010
Yes- “All of the diets had an average calorie deficit of 750 calories from the patients’ aggregate baseline caloric intake.”
Most of the diet study we have are short term, like a year the most. These studies won’t tell you much since people start gaining back weight after 6-12 months on any diet. This was a study which received a lot of accolades for the way it was done. And I think behavioral strategies is the key. Most diet books and diets emphasize too much on the diet composition and why the diet better than the rest.
Yes, protein blunts hunger. The problem with high protein diets though is that normal people cannot sustain it for long periods and fall back to their usual diets.People like us who can eat high protein day after day is the minority.
Why can’t they eat high protein diets? I’m not saying they have to go low carb, high protein isn’t that hard, just eat more meat for dinner, maybe a shake or two during the day. I’ve never seen any research on very long term compliance to long term high protein diets compared with calorie restricted, but I would think calorie restricted would have a lower compliance than high protein not calorie restricted.
This study has always indicated what I have said to people I know for years: the bottom line is a calorie deficit. While there may be some truth to the whole insulin response concept (with higher protein and fat), I really think it’s quite minimal in the grand scheme of things for weight loss.
To repeat the oft-quoted axiom, “The best diet is the one that you stick to”.
With a couple of caveats (e.g. ensuring that you get sufficient protein, sufficient EFAs, and ultimately establish a consistent energy deficit) this is what I see every day with my clients.
Individuals have different responses to foods, exercise, and meal frequencies. Even studies that show that ‘diet x’ performed better than ‘diet y’ only show the aggregated mean response (or some other statistical measure) to the respective diets. They don’t show that diet x beat diet y for all the individuals involved. People need to learn how to select the best diet for their lifestyle, goals, and personal preferences…thus implying a higher rate of dietary compliance over time.
Cheers
Mav
FullDeplex | Fri August 13, 2010
Interesting study, but wait a minute.
They kept a DAILY foodlog for two years? That’s hard to believe…and if they really did, doesn’t this study actually show the effect of counting calories for two years instead of the the effect of different diets?
I wonder if the results would be different if they had let the participants follow the diets without the daily counting.
Also: It’s not clear to me how much weight or fat they lost. (I think it’s a typo)
Still, it is a big achievement.
I also like this study:
http://jama.ama-assn.org/cgi/content/full/297/9/969
also watch youtube for more info on this study:
http://www.youtube.com/watch?v=eREuZEdMAVo&feature=player_embedded
Greetz
FullDeplex
Anoop | Sun August 15, 2010
Hi Karky,
I think for people who has been eating a low protein or high carb diet it is hard to change their habits, at least for a few. It could be cultural or it could be environmental.
There are studies which shows how people gradually move from a high protein or a low protein or a low carb to a moderate carb after a few months. And one of the criticisms of the study was that it wasn’t a big difference in protein or carbs, so the study is not a true measure of high carbs or high protein on body composition. But other studies shows how it is almost impossible to adhere to high protein atkins like diet and people gradually gravitate towards moderate carbs and protein.
Anoop | Sun August 15, 2010
Hi Dave & Mavros,
Thanks. I do agree.
Even the insulin resistance concept only affects a segment of the population. In fact, the study quoted by fulldeplex shows that a low carb diet maybe better for people who are insulin resistant if I remember it right.
Hi Fullduplex,
Thanks for commenting. I think they had a number of group and individual sessions, and daily meal plans for 2 week block were provided. So the treatment was pretty intense.
If they had a control group with no food counting, we then could have made some conclusions about calorie counting.
And the primary outcome was weight lost and not fat loss.
Thanks for the study!
I think atkins is hard to stick to because of the low carbs, not the high protein. However I think most studies show similar drop outs between low carb and calorie restriction.
Anoop | Sun August 15, 2010
Extreme macro nutrient recommendations always fail whether it is low carbs or high protein. People find it so hard to change their habits and eating habits. People who do stick with all the recommendations are people who are really motivated. These are the people you see in the magazines who lost 100 lbs and now workout everyday and eat healthy and stuff. It’s possible, but not the norm you know. How many people can make such a change? Not many.
I think this is the problem when diet gurus say this will work. He is getting his subjects because they have gone through other diets and believe in him and his diet and are highly motivated to begin with and will stick to it. This is why studies worry so much about the selection criteria, randomizing, drop outs, and blinding of the groups. They all start at the same point.
You think changing macronutrients is harder than calorie restriction? I think hunger is probably one of the biggest reasons why people don’t succeed in losing weight. If we can take care of that hunger by eating more stake or having a few shakes, then I think that would increase compliance. I also think low carb is much harder than high protein, as when you cut out something you are bound to cut out some of a persons favorite food, also, carbs are very bound into our culture.
I’m not saying it’s easy to stick to high protein, all diet change is very hard to stick to, hardly anyone actually manages to keep the weight they lose off regardless of how they did it.
FullDeplex | Sun August 15, 2010
I agree that it is hard (and probably unnecessary) to change macronutrient content of your diet AND to constantly eat less. This is why I like phase-shift diets and “fasting” (I never do total fasts, but do eat almost nothing for a day or two a week) when I want to drop fat.
The hardest part about diets is that they take so long. You could call it boredom, I call it torture.
Glad you like the study, Anoop!
PS:
“Weight loss averaged 3-4 years after 2 years.”
This just has to be a typo….
Well, my idea is that if you change macronutrient to more protein, you won’t have to restrict cals as they will restrict themselves because of increased satiety.
3-4 years of weight loss.. yeah.. probably meant kilos.
Hi Karky,
Higher protein certainly helps to lower ad libitum calorie intake (mostly due to increased satiety and reduced hunger - it also helps to mitigate against insulin resistance issues, which are pervasive in the obese sub-set of dieters).
However, the literature consistently shows, as does my own experience with clients, that macronutrient manipulation with ad libitum eating usually only works up to a point (i.e. to a certain level of lean-ness and not beyond) and even worse, weight losses begin to reverse in time as dieters start upping their calorie intake with the allowed foods (i.e. they gradually start eating more protein and fat calories).
The bottom line is that, for the vast majority of dieters, long-term weight loss success (especially when maintaining a low body fat percentage) does require some form of restricted calorie protocol (whether it be through ‘eye-balling’ portion control or more anal techniques like calculating maintenance calories based on LBM etc.). Regular physical activity is also a common feature in almost all successful long-term weight losers.
Cheers
Mav
FullDeplex | Mon August 16, 2010
“3-4 years of weight loss.. yeah.. probably meant kilos.”
or pounds…. big difference.
By the way, I don’t think 3-4 Kg (and especially pounds)after 2 years is not that much when you consider the subjects put in a lot of effort by keeping daily foodlogs and were kept on a short leash by the researchers.
In my experience, they usually report weight lost in kg so it’s the same all over. 3-4kg is pretty much nothing over 2 years.. so is 3-4 pounds. Most long term diet studies don’t really show very impressive weight loss.
Bottom line: when you’be been enjoying eating at a calorie surplus level for years (as most obese people have done) and you’re right in the middle of an increasingly obesogenic culture, it’s hard for most folks to sustain the required low calorie lifestyle day in and day out.
5 year failure rates are so very high for weight loss(depending on the sources, somewhere in the 95% vicinity) meaning that a protocol that is 300% more succesfull than the mean is still going to see 8 people out of 10 regaining the weight.
The only way I can see to dramatically change things at a population level is either: (a) pharmacological ‘solutions’ or (b) radical changes in the obesogenic environment(e.g. food supply).
Cheers
Mav
Anoop | Tue August 17, 2010
It is pretty clear now that weight loss after 2-4 years will be average around 3-4 kg. As usual, in the first 6 months they saw an average of 6 kg weight loss, and then subjects started gaining weight.
And mind you, the researchers were the top in their feild, the majority of the subjects were highly educated, the particpants were highly motivated (levels assessed by interview and questionnaire) and they had multiple number of group and individual sessions. And still they coulddn’t continue with weight loss or stick with the diet plans.
And I think Mavros hit the nail on the head. What we need is a community effort which might be a paradigm shift in obesity treatments. The individualistic approach is not working as we have seen again and again. The EPODE trial which began in France which is a community based trial to prevent childhood obesity is a good example.Everyone the teachers, mayor, shop owners, resturant owners, researchers were involved in making kids move around more and eat healthy. And now it being tried in other towns in Europe.
Definitely. Obesity is a large scale problem and it requires a large scale solution. This is why epidemiological studies (which a lot of people often knock) are actually quite useful in this field, IMO.
You can’t say that something will work for 1 person from an epidemiological standpoint, but you can say that if you implement these changes in a large population, a significant portion of those people will lose weight/not gain weight. IMO we need to focus more on preventing obesity. Once you’re there it’s very hard to get rid of it, specially if it started in childhood and resulted in fat cell hyperplasia.
FullDeplex | Wed August 18, 2010
Telling people they are unhealthy because they are fat and then combat this by peer pressure or other forces of society always gives me a bit of the creeps. It is a slippery slope.
I don’t disagree the points made above. I too think preventing that people are able to eat al lot of crap will decrease wiht a community effort will be beneficial for everyone, because I find it will help decrease the amount of decease amongst the population significantly.
I do, however, find the focus on a link between obesity and sickness unjust. People get sick from crappy foods even when they are not fat. It’s easy to see fat people as unhealthy and “pick” on them, but a lot of research does not show such a high correlation between fatness and sickness (or even any at all) and correlation is not the same as causation. I also know some fat people that might be healthier than me, but this is not a sienctific argument so I will leave it at that.
In short: We might be doing the right things (community effort) for the wrong reasons.
And: In most cases conformity has much greater negative concequence than deviance.
For sure, you can do bad things to your health by eating a ‘toxic’ diet even while in neutral or negative energy balance (thus not getting fat).
But, there is no doubt that obesity creates morbidities and comorbidities. It’s not just epidemiological correlations that support this; it’s the directly observed biological phenomena that are associated with excessive adiposity (like increased inflammation, lipotoxicity, increased blood pressure, insulin resistance etc.).
The other thing to note is that numerous individuals that have lost weight enjoy improved health and improved health markers. While it ‘may’ occasionally occur that people enjoy better health after aquiring obesity than before, I think the reverse is patently more prevalent!
Cheers
Mav
Have they check body composition, or not?
Because weight loss not always fat loss.
Could be muscle mass loss
Yeah, you usually lose some muscle mass as well. I haven’t read the full study so I dunno about body comp.
Obesity is definitely a cause in many diseases. Long ago we thought adipose tissue was just a passive storage facility, boy were we wrong!
There is such a thing that has been dubbed “healthy obesity” or “insulin sensitive obesity”. Some obese people don’t develop insulin resistance. In comparing insulin sensitive with insulin resistant obesity, a very strong correlation has been found between macrophage infiltration into adipose tissue (typical sign of low grade inflammation, circulating adiponectin levels and insulin resistance(I think the r was about 0.98.. I can check it if you want).
But some people don’t seem to get insulin resistance, and insulin sensitive obesity was in one study (same as the one above) actually associated with a higher amount of fat cells. Which is weird as this has been thought of as a bad thing. However, one theory says that low grade inflammation is cause by fat cells becomming so large that the distances oxygen has to diffuse are too big. So if you have more fat cells you can have the same level of fatness with smaller fat cells.
Anoop | Wed August 18, 2010
Hi Anatoly,
When it comes to overweight or obese individuals, it is mostly fat and less muscle. And muscle loss is somewhat accepted for these population.
Exercise plays a bigger role in maintaining weight lost it seems. And when the study means exercise, it is mostly walking and cardio stuff.
And I don’t know if anyone has really looked into if weight training helps for weight loss/weight maintenance or if it makes a difference to add to the cardio. Weight training has never been really popular with obesity researchers.
And the study only looked at weight and waist circumference for composition measures.
The reason physical activity is important in maintaining the weigh loss is probably because losing weight makes your muscles more efficient (not only because you’re moving around less weight, the muscles themselves increase their efficiency)http://ajpregu.physiology.org/cgi/content/abstract/285/1/R183, that pretty much means you have to more more in order to compensate. The effect weight loss has on non resting energy expenditure (it can’t be entirely be explained by increased efficiency) has been shown to be present even after 1 year of maintained weight loss, so it’s probably permanent. http://www.ajcn.org/cgi/reprint/88/4/906
I think the other advantage derived from physical activity in terms of maintaining weight is that the calorie burn from exercise (say, 45 mins of vigorous activity > approx 450 cals) represents a proportionally larger percentage of maintenance calories for a dieted-down person than for an obese/overweight person.
That is to say, as a percentage of the 2200 cals maintenance for your average 160lb dieter, 450 cals is significant (20%), whereas for an obese 320lb person on 4400 cals maintenance, the 450 calorie burn constitutes only approx 10%.
The other factor, even more important than the last, is that, once you’ve dieted down to a lean body composition, you’re going to of necessity be eating small amounts of food. In this context, it’s actually easier to do a bit of extra physical activity than to remove the equivalent calorie value from your food intake. While some amount of calorie restriction is necesary, it becomes too onerous under a certain threshold, and thus, will not be volitionally maintained by most dieters.
Cheers
Mav
Anoop | Fri August 20, 2010
The calorie burned depends on your body weight too. So a obese or overweight person burns a lot more than lean individuals. So the calories burned is not always fixed number. This is part of the reason women find it so hard to keep losing bcos of their small BMI.
There are couple of reasons quoted for exercise helping in weight maintenance. Couple of them are: the increase in expenditure with exercise compensates for the decrease in energy expenditure due to weight loss, physical activity adherence can also improve diet adherence.
Good discussion, guys.
I did not read this article as I only need to look at the argument which we have heard a million times which is better high fat or low fat or high carbohydrate intake or low intake at the end of the day for weight loss it is how many calories you burn then you eat and the amount of any fat, carbs and protein you eat all depends on your lifestyle, training, weight loss goal etc and I personaly believe low carb diets lead to decreased energy thus less activity leading to weight gain.
mtfitness | Thu October 07, 2010
Obtaining most of your nutrients from whole foods is always best, but of course, it can be very difficult to obtain all of the nutrients you need throughout the day; this is where supplements should come in. No products, by themselves, will change your body without any effort on your part. The framework of consistent strength training, cardiovascular exercise, and a healthy diet of complex carbohydrates, protein, and dietary fat will keep you from burning out and you will be much better off and still achive weight loss in the long run.
Anoop | Fri October 08, 2010
Thanks for the comment BJ. I do think the researchers conducted the study because we weren’t really sure about it.
And as you said according “to your personal opinion”, Usually personal opinions are more often wrong than right.
Well from personal experience with myself and others I know Low carb diets don’t work.
FullDeplex | Sun October 10, 2010
That is great to hear BJ, but from my personal experience with myself and other I know low carb DOES work, but both of our arguments are not scientific at all. They are personal experience that is all.
It would have helped if you actually read the article and viewed the research presented for you would have found out that people respond differently to different diet and methods. There are a lot of people having greater succes with low carb diets AND there are also those that have no succes with them. It is unclear why this is, but there are theories.
Let me ask you this:
How many lean people do you know that are not counting calories, are inconsistent with everything, don’t train, are lazy as hell and eat junk food all day. I know a lot of these kind of people, but I also know a lot of people that behave the same way and are as fat as a hippo.
How do you explain that? Calories? 😊
Bottom line: all diets work, insofar as they result in a net energy deficit, when under controlled conditions (e.g metabolic ward studies).
However, under free-living conditions, the “best diet” is the diet that the subject has the greatest chance of complying with for the long-term. And that’s going to vary from gender to gender, culture to culture, and ultimately, from individual to individual.
In today’s obesogenic environment, people need to actively design an effective eating stratgey that suits them…mindless eating or ‘once-size-fits-all’ diets are equally ineffective.
Cheers
Mav
mtfitness | Mon October 11, 2010
I agree. There are no 1 size fits all diets. Another thing to note is there is no such thing as a( 30 - 60 - 90 ) day diet. Fitness and proper eating habits are a life time effort.
I aggree it is what suits you some people can do it where as others can’t same with fitness the train of thought is high intense exercise burns weight fast which it does but it might not suit yourself.
Anoop | Mon August 08, 2011
Hi Toni,
I usually have the references at the end of the article. It is at the bottom of the article in blue.
Dane McGuckian | Thu January 26, 2012
Hi Anoop,
If you get a chance, I’d love to hear your thoughts on this review of research:
Low-Carbohydrate Diets Promote a More Favorable Body Composition Than Low-Fat Diets
Volek, Jeff S PhD, RD; Quann, Erin E PhD, RD; Forsythe, Cassandra E PhD, RD
Author Information
Department of Kinesiology, University of Connecticut, Storrs, Connecticut
Here is a bit of the Abstract: “A PRIMARY CONCERN WITH CONVENTIONAL WEIGHT LOSS APPROACHES IS THE LOSS OF LEAN BODY MASS THAT OCCURS WHEN FAT MASS IS DECREASED. CONSUMING MODERATE PROTEIN, WHILE RESTRICTING CARBOHYDRATE,ALLOWS FOR GREATER PRESERVATION OF LEAN BODY MASS. A LOW-CARBOHYDRATE DIET IN CONJUNCTION WITH PERIODIZED RESISTANCE TRAINING PROMOTES GREATER FAT LOSS WHILE PRESERVING LEAN BODY MASS AND
PROMOTING ROBUST IMPROVEMENTS IN METABOLIC HEALTH.”
Sincerely,
Dane
