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14. Pairs of reviewers independently, and in duplicate, extracted the following data items: study setting, type of trial (parallel or factorial), demographic information, experimental interventions, control interventions, exercise information, degree of calorie restriction, degree of behavioral support, and each of the outcomes of interest. The search strategy is available from the authors upon request. To determine weight loss outcomes for popular diets based on diet class (macronutrient composition) and named diet. For example, dietary programs that did not refer to Atkins but consisted of less than 40% of kilocalories from carbohydrates per day for the duration of study or were funded by Atkins were considered Atkins-like. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning. Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women. Network diagrams for randomized controlled trials investigating change in BMI among diets, categorized by diet class eFigure 6. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada. Our analyses adjusted for behavioral support and exercise. Combining behavioral weight loss treatment and a commercial program: a randomized clinical trial. A detailed description of the statistical analysis appears in the eMethods in the Supplement. We reviewed bibliographies of review articles and eligible trials, and searched the registries of ClinicalTrials. 9, 10, 17, 18, 22 -. US Preventive Services Task Force. 71 kg greater weight loss than the Zone diet at 6-month follow-up. Comparison of the effects of four commercially available weight-loss programmes on lipid-based cardiovascular risk factors. Quiz Ref ID Network meta-analysis facilitates comparison of different diets using all available randomized clinical trial (RCT) data. Because it is impossible to provide a placebo diet in a clinical trial, eligible control diets included wait-listed controls, no specific assigned diet, or competing dietary programs. Eligible programs included meal replacement products but had to consist primarily of whole foods and could not include pharmacological agents. Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: lighten up randomised controlled trial. Effects of dietary carbohydrate restriction versus low-fat diet on flow-mediated dilation. GRADE guidelines: 3, rating the quality of evidence. Reviewers, in pairs, independently screened titles and abstracts of articles and reviewed the full text of any title or abstract deemed potentially eligible by either reviewer. The diet was labeled as brand-like when the diet met the definition of a branded diet, but failed to name or reference the brand in the article. We categorized dietary treatment groups in 2 ways: using diet classes (moderate macronutrient distribution, low carbohydrate, and low fat) 15 and according to diet brands. 9, 10. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Using a network meta-analytic approach, we assessed the relative effectiveness of different popular diets in improving weight loss. Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects. Influence of reported study design characteristics on intervention effect estimates from randomized, controlled trials. Supplement. Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses. We searched 6 electronic databases: AMED, CDSR, CENTRAL, CINAHL, EMBASE, and MEDLINE from inception of each database to April 2014. A low-carbohydrate as compared with a low-fat diet in severe obesity. Effects of a low-intensity intervention that prescribed a low-carbohydrate vs a low-fat diet in obese, diabetic participants. View Large Download Diet Classes Based on Macronutrient Composition Table 2. 9, Author Audio Interview. Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these are effective at improving weight loss. Improved psychological well-being, quality of life, and health practices in moderately overweight women participating in a 12-week structured weight loss program. A Bayesian framework was used to perform a series of random-effects network meta-analyses with meta-regression to estimate the relative effectiveness of diet classes and programs for change in weight and body mass index from baseline. 12. Dieting and the development of eating disorders in obese women: results of a randomized controlled trial. The 48 RCTs included 7286 individuals with a median age of 45. Diet classes were established by macronutrient content ( Table 1 ). The effects of an intensive lifestyle modification program on carotid artery intima-media thickness: a randomized trial. Effects of two weight-loss diets on health-related quality of life. Difference in mean decrease in BMI at 6 and 12 months across diet brands with 95% credible intervals eTable 15. Difference in mean weight loss at 6 and 12 months across all diet classes with 95% credible intervals when adjusting for baseline weight (overweight to obese vs morbidly obese) eTable 7. These programs represent a multibillion dollar industry. 2, 3 Low-carbohydrate diets may drive weight loss due to a higher intake of protein, which may induce a stronger satiating effect than fats and carbohydrates. Lifestyle Behaviors Nutrition Obesity Shared Decision Making and Communication Treatment Adherence Diet. Moderate carbohydrate, moderate protein weight loss diet reduces cardiovascular disease risk compared to high carbohydrate, low protein diet in obese adults: a randomized clinical trial. Network diagrams for randomized controlled trials investigating weight loss among branded diets eFigure 4. Establishing which of the major named diets is most effective is important because overweight and obese patients often want to know which diet results in the most effective weight loss. In the latter cases, transformations were used to express weight loss and BMI as mean change. Accessibility verified August 4, 2014. Exercise was defined as having explicit instructions for weekly physical activities and simply dichotomized when differences between varying degrees of exercise frequencies appeared to have negligible effects. Of the total, 889 proved potentially relevant for full-text review and 59 articles that reported 48 RCTs of 11 branded diets proved eligible (eFigure 1 in the Supplement ). Weight loss with self-help compared with a structured commercial program: a randomized trial. Quiz Ref ID Despite potential biological mechanisms explaining why some popular diets should be better than others, recent reviews suggest that most diets are equally effective, 2, 5, 6 a message very different from what the public hears in advertisements or expert pronouncements. Search terms included extensive controlled vocabulary and keyword searches for (RCTs) AND (diets) AND (adults) AND (weight loss). A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. Branded diets and weight loss in overweight or obese adults: a network meta-analysis. Effects of energy-restricted diets containing increased protein on weight loss, resting energy expenditure, and the thermic effect of feeding in type 2 diabetes. A randomized trial of a low-carbohydrate diet for obesity. Significant weight loss was observed with any low-carbohydrate or low-fat diet. Difference in mean weight loss at 6 and 12 months across all diet classes with 95% credible intervals when restricted to low risk of bias studies eTable 5. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. GRADE confidence in direct estimates: 12-month weight loss eTable 11. Long-term effects of a high-protein, low-carbohydrate diet on weight control and cardiovascular risk markers in obese hyperinsulinemic subjects. We included RCTs that reported weight loss or BMI reduction at 3-month follow-up or longer. Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults A Meta-analysis. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. The characteristics of eligible branded dietary programs are reported in eTable 1 in the Supplement. Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomised trial. Analyses were conducted using 6- and 12-month data, with a 3-month window (eg, if a study reported weight loss at 5 months, it was used in the 6-month analysis). For example, the Atkins diet resulted in a 1. To test the hypothesis that, compared with a standard behavioral weight loss intervention (standard intervention), a technology-enhanced weight loss intervention (enhanced intervention) would result in greater weight loss. Network diagrams for randomized controlled trials investigating change in BMI among branded and common diets. This supports the practice of recommending any diet that a patient will adhere to in order to lose weight. The connectivity of each network meta-analysis was described using density, which was calculated as the ratio of the number of treatment pairs with head-to-head evidence over the total number of treatment pairs. 1 Debate regarding the relative merit of the diets is accompanied by advertising claiming which macronutrient composition is superior, such as a low-carbohydrate diet being better than a low-fat diet, and the benefits of accompanying lifestyle interventions. Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, Ball GDC, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ. When available, we used P values for group differences to derive the standard deviation of change from baseline. Systematic review: an evaluation of major commercial weight loss programs in the United States. Some physiological explanations regarding the merits of different macronutrient compositions, including variable genetic response to diets with different recommended dietary fat intake, make intuitive sense. Randomized trial of a multifaceted commercial weight loss program.
Long-term effects of 2 energy-restricted diets differing in glycemic load on dietary adherence, body composition, and metabolism in CALERIE: a 1-y randomized controlled trial. Self-help weight loss versus a structured commercial program after 26 weeks: a randomized controlled study. Effect of a high-protein, energy-restricted diet on weight loss and energy expenditure after weight stabilization in hyperinsulinemic subjects. The effect of a low-carbohydrate, high-protein diet on post laparoscopic gastric bypass weight loss: a prospective randomized trial. Difference in mean decrease in BMI at 6 and 12 months across diet classes with 95% credible intervals eTable 14. At 6 months, participants randomized to the standard intervention group initiated self-monitoring of diet and physical activity using a website, and those randomized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity. 9. Accessed July 30, 2014. Effects of hypocaloric diet, low-intensity resistance exercise with slow movement, or both on aortic hemodynamics and muscle mass in obese postmenopausal women. Many claims have been made regarding the superiority of one diet or another for inducing weight loss. Search of 6 electronic databases: AMED, CDSR, CENTRAL, CINAHL, EMBASE, and MEDLINE from inception of each database to April 2014. 12. Two reviewers independently extracted data on populations, interventions, outcomes, risk of bias, and quality of evidence. Participants were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions. Effective long-term treatments are needed to address the obesity epidemic. The role of energy expenditure in the differential weight loss in obese women on low-fat and low-carbohydrate diets. Difference in mean weight loss at 6 and 12 months across all diet classes with 95% credible intervals when adjusting for percentage loss to follow-up (continuous measure) eTable 6. Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial. eMethods. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. A moderate-protein diet produces sustained weight loss and long-term changes in body composition and blood lipids in obese adults. By not exploring the full range of potential comparisons in a statistically and methodologically rigorous fashion, these reviews could have missed important benefits of specific diets or their compositions. Random-effects pairwise meta-analyses (using the method by DerSimonian and Laird 19 ) were used to determine direct and indirect associated treatment effects for all network meta-analyses. Nondieting versus dieting treatment for overweight binge-eating women. Effects of a low carbohydrate weight loss diet on exercise capacity and tolerance in obese subjects. How to use an article reporting a multiple treatment comparison meta-analysis. Combining weight-loss counseling with the Weight Watchers plan for obese breast cancer survivors. They also relied on aggregating studies comparing one diet with another and did not have the ability to determine the relative performance of diets when they were not directly compared with one another in clinical trials. For our branded diet analysis, we made a visual assessment of funnel plots for publication bias for direct comparisons that included 10 or more studies. eTable 1. Publication bias assessed via funnel plots—Atkins versus moderate micronutrient diets: 6-month weight loss eFigure 5. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss The IDEA Randomized Clinical Trial. GRADE confidence in indirect estimates: 12-month weight loss eTable 12. Weight-loss diets modify glucose-dependent insulinotropic polypeptide receptor rs2287019 genotype effects on changes in body weight, fasting glucose, and insulin resistance: the Preventing Overweight Using Novel Dietary Strategies trial. Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. 7 years (median SD, 9 years), median weight of 94. Dietary guidelines for Americans: 2010. Summary of risk of bias by diet class and brand eTable 3. A self-regulation program for maintenance of weight loss. 4. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Dietary energy density in the treatment of obesity: a year-long trial comparing 2 weight-loss diets. We considered 3 weight loss effect modifiers that were modeled as present or absent if they were included in an overall dietary program: calorie restriction, exercise, and behavioral support. Short-term effects of severe dietary carbohydrate-restriction advice in type 2 diabetes—a randomized controlled trial. 312, No. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. gov and the metaRegister of Controlled Trials. A randomized controlled trial of a commercial Internet weight loss program. Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women: a randomized controlled trial. Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial. 9, Author Audio Interview. A 12-week commercial web-based weight-loss program for overweight and obese adults: randomized controlled trial comparing basic versus enhanced features. 13 We assigned 1 of 2 summary assessments for each included study: low risk of bias for key domains, allocation concealment, and missing participant data or high risk of bias for key domains. Risk of bias versus quality assessment of randomised controlled trials: cross sectional study. GRADE overall confidence in estimates: 12-month weight loss eTable 13. Weight loss differences between individual named diets were small. Continuous outcomes were most often reported as mean change, but sometimes were reported as preintervention and postintervention measures or percentage change. We contacted the named diet companies and individuals working in the field of obesity and weight management to identify additional or unpublished trials. JAMA 2014-09-02, Vol. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. The hazards of scoring the quality of clinical trials for meta-analysis. Stern. Weight, protein, fat, and timing of preloads affect food intake. Otherwise, we used the pre- and postintervention standard deviations along with a correlation estimated from studies that reported both change and pre- and postintervention results. Screening for obesity in adults: recommendations and rationale. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. In the case of percentage change, we assumed independence. The effects of a commercially available weight loss program among obese patients with type 2 diabetes: a randomized study. Lifestyle intervention in overweight individuals with a family history of diabetes. Long-term weight loss after diet and exercise: a systematic review. Diets with at least 2 group or individual sessions per month for the first 3 months were considered as providing behavioral support. Weight loss differences between individual diets were minimal. GRADE guidelines: 4, rating the quality of evidence—study limitations (risk of bias). 7 In the absence of published head-to-head clinical trials of each diet against each other diet, network meta-analysis uses both direct and indirect clinical trial evidence to estimate their relative effects. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs reduced carbohydrate diets. Named diets were identified through the explicit naming of the brand, the referencing of branded literature, or the naming of a brand as funders of an article reporting weight loss outcomes from the diet. Key differences between this analysis and recent joint guidelines from the American Heart Association (AHA), American College of Cardiology (ACC), and The Obesity Society (TOS) eFigure 1. Only a few of the reviews of named diets have used rigorous meta-analytic techniques to provide quantitative estimates of how much better one diet is compared with another. Randomized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012, with data collection completed by December 2014. Pairs of reviewers independently assessed the risk of bias associated with individual trials using the Cochrane Collaboration instrument. Difference in mean weight loss at 6 and 12 months across all diet brands with 95% credible intervals when restricted to low risk of bias studies eTable 10. Named or branded (trade-marked) weight loss programs are broadly available to the general public, providing structured dietary and lifestyle recommendations via popular books and in-person or online behavioral support. Difference in mean weight loss at 6 and 12 months across all diet classes with 95% credible intervals when adjusting for proportion female (continuous measure) eTable 8. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A to Z Weight Loss Study: a randomized trial. Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome—a pilot study. Description of dietary programs eTable 2. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. The gray literature search identified 213 additional articles. JAMA 2014-09-02, Vol. Network diagrams for randomized controlled trials investigating weight loss among diets, categorized by diet class eFigure 3. 312, No.
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