This week you read one of two articles discussing several diets and their impact or potential impact on weight loss. In this discussion, you should use information from the peer reviewed article as well as what you have learned in class and from your readings to identify one diet for weight loss and address the following points:
(First, identify the diet for which you are advocating)A. What evidence exists that this diet can be effective for weight lossB. What other potential health benefits (in addition to weight loss) does this diet provide?C. How realistic is it for an individual to use this diet for weight loss AND weight maintenance in the long term and what factors may impact this ability?D. What drawbacks does this potential diet have? (these could be health, social, environmental, etc).ORIGINAL CONTRIBUTION
Comparison of the Atkins, Ornish, Weight
Watchers, and Zone Diets for Weight Loss
and Heart Disease Risk Reduction
A Randomized Trial
Michael L. Dansinger, MD
Joi Augustin Gleason, MS, RD
John L. Griffith, PhD
Harry P. Selker, MD, MSPH
Ernst J. Schaefer, MD
P
OPULAR DIETS HAVE BECOME INcreasingly prevalent and controversial.1 More than 1000 diet
books are now available,2 with
many popular ones departing substantially from mainstream medical advice.3 Cover stories for major news
magazines, televised debates, and cautionary statements by prominent medical authorities4,5 have fueled public interest and concern regarding the
effectiveness and safety of such diets.6-8
Although some popular diets are
based on long-standing medical advice and recommend restriction of portion sizes and calories (eg, Weight
Watchers),9 a broad spectrum of alternatives has evolved. Some plans minimize carbohydrate intake without fat
restriction (eg, Atkins diet),10 many
modulate macronutrient balance and
glycemic load (eg, Zone diet),11 and others restrict fat (eg, Ornish diet).12 Given
the growing obesity epidemic,13 many
patients and clinicians are interested in
using popular diets as individualized
eating strategies for disease prevention.14 Unfortunately, data regarding the
relative benefits, risks, effectiveness, and
For editorial comment see p 96.
Context The scarcity of data addressing the health effects of popular diets is an important public health concern, especially since patients and physicians are interested
in using popular diets as individualized eating strategies for disease prevention.
Objective To assess adherence rates and the effectiveness of 4 popular diets (Atkins, Zone, Weight Watchers, and Ornish) for weight loss and cardiac risk factor reduction.
Design, Setting, and Participants A single-center randomized trial at an academic medical center in Boston, Mass, of overweight or obese (body mass index: mean,
35; range, 27-42) adults aged 22 to 72 years with known hypertension, dyslipidemia,
or fasting hyperglycemia. Participants were enrolled starting July 18, 2000, and randomized to 4 popular diet groups until January 24, 2002.
Intervention A total of 160 participants were randomly assigned to either Atkins
(carbohydrate restriction, n=40), Zone (macronutrient balance, n=40), Weight Watchers (calorie restriction, n=40), or Ornish (fat restriction, n=40) diet groups. After 2 months
of maximum effort, participants selected their own levels of dietary adherence.
Main Outcome Measures One-year changes in baseline weight and cardiac risk
factors, and self-selected dietary adherence rates per self-report.
Results Assuming no change from baseline for participants who discontinued the study,
mean (SD) weight loss at 1 year was 2.1 (4.8) kg for Atkins (21 [53%] of 40 participants
completed, P=.009), 3.2 (6.0) kg for Zone (26 [65%] of 40 completed, P=.002), 3.0
(4.9) kg for Weight Watchers (26 [65%] of 40 completed, P⬍.001), and 3.3 (7.3) kg for
Ornish (20 [50%] of 40 completed, P=.007). Greater effects were observed in study completers. Each diet significantly reduced the low-density lipoprotein/high-density lipoprotein (HDL) cholesterol ratio by approximately 10% (all P⬍.05), with no significant effects
on blood pressure or glucose at 1 year. Amount of weight loss was associated with selfreported dietary adherence level (r=0.60; P⬍.001) but not with diet type (r=0.07; P=.40).
For each diet, decreasing levels of total/HDL cholesterol, C-reactive protein, and insulin
were significantly associated with weight loss (mean r=0.36, 0.37, and 0.39, respectively) with no significant difference between diets (P=.48, P=.57, P=.31, respectively).
Conclusions Each popular diet modestly reduced body weight and several cardiac
risk factors at 1 year. Overall dietary adherence rates were low, although increased
adherence was associated with greater weight loss and cardiac risk factor reductions
for each diet group.
www.jama.com
JAMA. 2005;293:43-53
Author Affiliations: Division of Endocrinology, Diabetes, and Metabolism (Drs Dansinger and
Schaefer), and Institute for Clinical Research and
Health Policy Studies (Drs Griffith and Selker), TuftsNew England Medical Center; and Lipid Metabolism
Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on
©2005 American Medical Association. All rights reserved.
Downloaded From: by a University of South Carolina User on 07/19/2018
Aging, Tufts University (Dr Schaefer and Ms Gleason), Boston, Mass.
Corresponding Author: Michael L. Dansinger, MD,
Atherosclerosis Research Laboratory, Tufts-New England Medical Center, Box 216, Boston Dispensary 342,
750 Washington St, Boston, MA 02111 (mdansinger
@tufts-nemc.org).
(Reprinted) JAMA, January 5, 2005—Vol 293, No. 1 43
EFFECT OF 4 DIETS ON WEIGHT LOSS AND CARDIAC RISK FACTORS
sustainability of popular diets have been
limited.15-25
We conducted a 1-year randomized
trial of the dietary component of the Atkins, Zone, Weight Watchers, and Ornish plans, aiming to determine their
realistic clinical effectiveness and sustainability for weight loss and cardiac
risk factor reduction. Of note, this study
only evaluated the dietary components and did not include other specific components that may be unique
to each individual dietary program.
METHODS
Participants
We recruited study candidates from the
Greater Boston area using newspaper
advertisements and television publicity (local news coverage). Of 1010 telephone inquiries, 247 individuals agreed
to be screened in person and 160 indi-
viduals were enrolled at an academic
medical center in Boston, Mass, from
July 18, 2000, through January 24, 2002
(F IGURE 1). We included adults of
any age who were overweight or obese
with body mass index (calculated as
weight in kilograms divided by the
square of height in meters) between 27
and 42, and having at least 1 of the following metabolic cardiac risk factors:
fasting glucose of at least 110 mg/dL
(ⱖ6.1 mmol/L), total cholesterol of at
least 200 mg/dL (ⱖ5.2 mmol/L), lowdensity lipoprotein (LDL) cholesterol
of at least 130 mg/dL (ⱖ3.4 mmol/L),
high-density lipoprotein (HDL) cholesterol of 40 mg/dL or less (ⱕ1.0
mmol/L), triglycerides of at least 150
mg/dL (ⱖ1.7 mmol/L), systolic blood
pressure of at least 145 mm Hg, diastolic blood pressure of at least 90
mm Hg, or current use of oral medica-
Figure 1. Study Flow Diagram of Participants
1010 Telephone Inquires
763 Excluded
340 Not Interested
173 Too Busy
110 Reported BMI >42
92 Reported BMI 42
8 BMI
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