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What is the best diet to help you lose weight and improve heart health in the short-term?

  • a) a low-carbohydrate (carb), high-protein diet
  • b) a moderate-carb, high-protein diet
  • c) a moderate-fat diet

If you chose "A," "B," or "C" you are right—sort of. The best answer is not there. It is "D"—the reduced-calorie diet that you will stick with. Why? Because according to a study presented at the American Heart Association (AHA) Scientific Session that compared four different diets, ranging from low-fat to high-protein, all the diets resulted in the same amount of weight loss after one year. A 2009 study by researchers at Harvard School of Public Health found similar results. The important factor is not the nutrients, but the caloric intake. According to these studies, if you reduce the number of calories that you consume, then you will lose weight, no matter what form those calories take.

Returning to the multiple-choice question, it says “short-term” because the AHA study also found that heart risk scores improved with all the diets. For long-term health, in addition to an eating plan that you can realistically follow on a daily basis, there are several factors that will help keep your weight within your ideal range and keep all your body systems healthy. These factors include regular exercise, relaxation techniques, not drinking too much, and above all, not smoking.

The truth is, most diet plans are built on the thought that reducing calorie intake leads to weight loss. That means that the diet that is right for you is the one that limits the foods you are most likely to overeat, but still allows you to eat foods you enjoy.

To help you choose the eating plan that is right for you, here is a brief explanation of four popular diet plans.

The Atkins’ Nutritional Approach

Atkins’ Nutritional Approach stresses dramatically reducing your intake of carbohydrates and replacing them with foods rich in protein and fat. The theory goes like this: “Your body burns carbohydrates and fat for energy. With Atkins’ unique approach, you limit carbs so your body burns fat.”

What’s Involved

The Atkins’diet has four phases. During the induction phase, you eat no more than 20 grams of carbohydrates per day, mostly from salad greens and other acceptable vegetables. This means no bread, pasta, rice, fruit, milk, yogurt, cereal, juice, cookies, sweets, or potatoes, among other foods. However, you can eat as much as you like from foods that are pure protein and fat, such as meats, eggs, oils, and butter. The induction phase lasts at least two weeks, and usually results in rapid weight loss.

The next three phases are ongoing weight loss, pre-maintenance, and lifetime maintenance. During these phases, you will slowly reintroduce carbs until your weight loss slows and, when you reach your goal, stops. Then, you will monitor your weight, and if you gain, you take away carbs again until you lose the weight again. This means that your calorie intake and your weight is moderated by adjusting your carbohydrate intake. Protein and fat are not restricted. You are also advised to take a multivitamin and drink eight 8-ounce (236 milliliter) glasses of water each day.

The Research

In 2003, a study in the New England Journal of Medicine reported that people following the Atkins’ diet lost more weight than a control group after three and six months, but that both groups had lost approximately the same amount of weight after one year. Since then, studies have continued to show that compared to other diets, a low-carbohydrate diet leads to greater weight loss at six months, but similar amounts of weight loss at one year. A 2009 study looked at 13 different studies and concluded that after one year on a low-carbohydrate diet, dieters tend to lose as much weight—if not more—as dieters on a traditional high-carbohydrate diet.

The Concerns

The Atkins’ diet is rich in high-protein and high-fat foods, such as bacon, steak, and cheese. While this eating pattern has not been shown to be harmful when followed for one year, many nutrition experts worry that the high levels of saturated and trans fats in these foods will increase your risk for heart disease if you follow the diet for an extended period of time. Information about the long-term effects of low-carbohydrate diets is still being collected. A 2009 study published in the American Journal of Clinical Nutrition found that after one year, an Atkins-type diet increased both good and bad cholesterol. However, a 2010 study published in the Annals of Internal Medicine found that after two years, a low-carbohydrate diet improved cardiovascular disease risk factors more than a low-fat diet. There is concern that the high levels of protein can overload and damage the kidneys, which is especially dangerous for people with diabetes or kidney disease.

Weight Watchers PointsPlus

Weight Watchers PointsPlus program stresses better food choices and portion control for long-term weight loss.

What’s Involved

On the PointsPlus program, you are allotted a daily PointsPlus target, which is based on a number of factors including your age and body weight. Every food has a PointsPlus value. You can eat whatever foods you want as long as you stay within your daily range. Weight Watchers encourages eating what it calls Power Foods—foods that are particularly nutritious and satisfying, such as lean protein, whole grains, and low-fat or fat-free dairy products. PointsPlus values are based on the amount of fat, carbohydrates, protein, and fiber in a food. The way your body processes these major nutrients are also taken into consideration. Fruits and most vegetables have zero PointsPlus values to encourage consumption of these nutrient-dense and satisfying foods.

The PointsPlus program also emphasizes exercise. When you exercise, you earn activity PointsPlus values, which may be swapped for food.

Weight Watchers recommends an average loss of 0.5-2 pounds (0.2-0.9 kilograms) a week for safe and sustained weight loss.

The Research

A 2003 study in the Journal of the American Medical Association found that people following the Weight Watchers program lost significantly more than those on a self-help weight-loss program. At the end of one year, the people on the Weight Watchers program lost an average of 9.5 pounds (4.3 kilograms), while the people in the self-help program lost an average of 2.9 pounds (1.3 kilograms). After two years, the Weight Watchers group lost an average of 6.4 pounds (2.9 kilograms) and the self-help group lost an average of 0.4 pounds (0.2 kilograms). Again, losing weight, followed by some weight gain, is typical. However, a net weight loss after two years—no matter how much—is desirable.

The Concerns

Overall, the Weight Watchers PointsPlus program is a healthy one. In addition to cutting the amount of calories you consume and encouraging you to exercise, the diet encourages taking a daily multivitamin, drinking lots of water, and eating plenty of fruits, vegetables, and low-fat dairy products. It also takes effort to log all the food you eat and exercise that you do. Fortunately, computer- and smart phone-based programs make it easier to calculate the PointsPlus value of foods and log activities. While the traditional version of the Weight Watchers program requires attendance at a weekly meeting, these days you can also choose an online-based program.

The South Beach Diet

The South Beach Diet, developed by cardiologist Arthur Agatston, MD, attempts to find a happy medium between low-carb and low-fat diets.

What’s Involved

The South Beach Diet has three phases. During the two weeks of Phase 1, breads, rice, potatoes, pasta, baked goods, and even fruit are restricted. You can eat enough meat, chicken, turkey, fish, vegetables, eggs, cheese, nuts, and salads with olive oil dressing to make you feel full. The goal of phase one is to eliminate cravings and kick-start weight loss.

Phase 2, which you will stay on until you reach your weight-loss goal, is less restrictive. You can add carbs back into your diet, but in moderation. The focus is on whole-grain carbs, but you can now splurge on refined carbs every once in a while.

After you have reached your weight-loss goal, you will enter into Phase 3, which is the maintenance stage. In this phase, you are encouraged to focus on monounsaturated and polyunsaturated fats instead of saturated and trans fats, and whole-grain carbs instead of refined ones.

Although exercise is not a main focus of this diet, Dr. Agatston recommends that you take a brisk, 20-minute walk each day. Dr. Agatston claims that you will lose 8-13 pounds (3.6-5.9 kilograms) in Phase 1, and 1-2 pounds per week in Phase 2.

The Research

The South Beach Diet relies on Dr. Agatston’s own research. A randomized, clinical trial published in a 2004 issue of the Archives of Internal Medicine compared the South Beach Diet with the National Cholesterol Education Program diet. Sixty participants were randomized and the study lasted for 12 weeks. Participants in the South Beach Diet had significantly greater weight loss over 12 weeks. However, since the study was small and, more importantly, since Dr. Agatston himself conducted the study, more research is needed to determine whether the South Beach Diet is effective.

A 2010 study published in the New England Journal of Medicine compared the effectiveness of different types of diets and found that a diet similar in make-up to the South Beach Diet led to an improved diet adherence and weight-loss maintenance compared to other diets.

The Concerns

While the strengths of this diet focuses on healthful fats and whole grains, Phase 1 is extremely restrictive and may cause many enthusiastic dieters to give up. Also, the promise that you will lose 8-13 pounds (3.6-5.9 kilograms) during the first two weeks is questionable. Even if it were true, most health professionals recommend no more than a couple of pounds a week for safe, long-term weight loss.

Bottom Line

So it seems that while there are many effective diets out there, the one that is best for you is the one that you will stick with. That means looking at the components of all these diets and finding the diet that best meets your needs. For example, if you are a bread lover, the Atkins diet probably is not going to work for you, and if you do not like to be bothered with logging your food intake, than the Weight Watchers program probably is not your best fit. If you are feeling overwhelmed or confused by all the options out there, consider working with a registered dietitian to develop a customized plan that is your best fit.

RESOURCES:

Academy of Nutrition and Dietetics
http://www.eatright.org

Choose My Plate
http://www.choosemyplate.gov

CANADIAN RESOURCES:

Dietitians of Canada
http://www.dietitians.ca

Health Canada
http://www.hc-sc.gc.ca

References:

About the diet. South Beach Diet website. Available at: http://www.southbeachdiet.com/diet/about. Accessed August 30, 2013.

Abstracts from the 2003 scientific sessions of the American Heart Association. Circulation. 2003 Oct 28;108(17 Suppl):IV1-787.

The Atkins nutritional approach: getting started, staying focused. Atkins website. Available at: http://www.atkins.com/Science/Articles---Library/Activity---Exercise/The-Atkins-Nutritional-Approach--Getting-Started,-.aspx. Accessed August 30, 2013.

Aude YW, Agatston AS, Lopez-Jimenez F, et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial. Arch Intern Med. 2004;164:2141-2146.

Brinkworth GD, Noakes M, Buckley JD, Keogh JB, Clifton PM. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 mo. Am J Clin Nutr. 2009 Jul;90(1):23-32.

Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43-53.

Duggirala MK, Mundell WC, Mikkilineni P, et al. Low-carbohydrate diets as compared with low-fat diets [letter]. N Engl J Med. 2003;349:1000-1002.

Foster GD, Wyatt HR, Hill JO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348:2082-2090.

Foster GD, Wyatt HR, Hill JO, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010 Aug 3;153(3):147-57.

Heshka S, Anderson JW, Atkinson RL, et al. Weight loss with self-help compared with a structured commercial program: a randomized trial. JAMA. 2003;289:1792-1798.

Hession M, Rolland C, Kulkarni U, Wise A, Broom J. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev. 2009;10(1):36-50.

Is carb-cutting a safe way to diet? Harvard Women’s Health Watch. 2003;11:1-2.

Larsen TM, Dalskov SM, van Baak M, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010 Nov 25;363(22):2102-13.

Sacks F, Bray G, Carey V, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009 Feb 26;360(9):859-873. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763382/. Accessed August 30, 2013.

Sizing up South Beach. Harvard Health Letter. 2003;11:5.

Weight Watchers isn’t a diet. Weight Watchers website. Available at: http://www.weightwatchers.com/plan/apr/unique.aspx. Accessed April 1, 2011.

What you'll eat. Weight Watchers website. Available at: http://www.weightwatchers.com/plan/eat/plan.aspx. Accessed August 30, 2013.

4/14/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360:859-873.



Last reviewed August 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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