ISSUE1308
A recent article in the New England Journal of Medicine confirms something that others, including The Medical Letter (Treat Guidel Med Lett 2008; 6:23), have been saying for years: no particular combination of protein, carbohydrate and fat in the diet offers any advantage in losing weight. This randomized 2-year trial followed 800 overweight and obese subjects on low fat/average protein, low fat/high protein, high fat/average protein, and high fat/high protein diets. Carbohydrate intake varied from 35% (in the high fat/high protein diet) to 65% (in the low fat/average protein diet). All patients were advised to undertake 90 minutes of moderate exercise per week and given a “caloric prescription” to produce a deficit of 750 kcal per day. Most participants lost weight in the first 6 months and regained some thereafter. There was no significant difference in weight loss between different diets and no indication that any particular diet was more pleasant or less painful than any other. Average weight loss at the end of the trial was 4 kg among the remarkably high 80% of subjects who completed the trial, and 9 kg among those who also attended two thirds of the counseling sessions offered to the participants (FM Sacks et al, N Engl J Med 2009; 360:859).