Calorie Counters Have It Right, Diet Study Says
By Jennifer Levitz, Wall Street Journal
February 26, 2009
You aren't what you eat. You're how much.
That's the message from a two-year National Institutes of Health-funded study that assigned 811 overweight people to one of four reduced-calorie diets and found that all trimmed pounds just the same. It didn't matter what foods participants ate, but rather how many calories they consumed.
An intense debate has long raged over which dieting regimen is best. Low carb? High protein? Low fat? But the federal study, one of the longest of its kind, "really goes against the idea that certain foods are the key to weight loss," says Frank Sacks, principal investigator and a professor of cardiovascular-disease prevention at Harvard School of Public Health. "This is a pretty positive message. It gives people a lot of choices to find a diet they can stick with."
The study, published Thursday in the New England Journal of Medicine, put participants on one of four diets: Two were low fat and two were high fat, and each of these included either a high-protein or an average-protein component. Carbohydrate intake ranged from 35% to 65%. All the diets were low in calories and saturated fat, and high in fiber, and participants were asked to exercise a fixed 90 minutes a week.
Patients, who attended counseling sessions, lost an average of 13 pounds after six months. After two years, they had lost nine pounds on average and trimmed two inches off their waists regardless of which diet they followed. The study, which ended December 2007, was conducted in Boston at Brigham and Women's Hospital, and in Baton Rouge, La., at Pennington Biomedical Research Center.
In the study, doctors calculated each participant's energy needs, and structured a diet that had 750 fewer calories than would be necessary to fuel his or her activity. Typical diets in the study had between 1,400 and 2,000 calories a day.
Rudy Termini, a retiree in Cambridge, Mass., says that before joining the study, he downed about 2,400 calories a day. If he dined on T-bone steak, he'd make it a one-pounder. "I just didn't need all that food," says the 69-year-old and former owner of a telecommunications company.
Mr. Termini, who is 5 feet 11 inches tall, says he dropped to 175 pounds from 195 pounds and lost his "little pot belly" by limiting himself to 1,800 calories a day. He followed the study's higher-fat, average-protein diet (40% fat, 15% protein, and 45% carbohydrates). For fats, he ate avocado, nuts and other sources of unsaturated fat. Mr. Termini says he stuck with the diet because he could eat what he enjoys, but just smaller portions -- his steak choice now is a small fillet. He says he's kept the weight off since the study ended.
The message is that dieting may be "much simpler" than everyone thought, says Catherine Loria, a nutritional epidemiologist at the NIH and co-author of the study. Along with choosing healthful foods, "all you have to do is count your calories."
The findings could influence public policy through efforts to require more disclosure of calorie counts in prepared food, she says. New York City, for instance, recently required chain eateries to put calorie counts on menus. "For the first time, people are seeing that the muffin they used to have in the morning is 400-plus calories, and they're saying, 'Oh my gosh, you have got to be kidding me,'" says Mark Erickson, a dean at the Culinary Institute of America in Hyde Park, N.Y.
In the NIH study, participants used a Web-based, self-monitoring tool that tracked how their daily food intake met their calorie goals. Debbie Mayer, of Brockton, Mass., says this helped her stay disciplined. "I'd just see the numbers and say, 'I can't eat anymore today.'"
Tried Many Diets
Ms. Mayer, who is 52 and works at an elder-outreach agency, believes she had made dieting "too complicated." She'd tried the Grapefruit Diet, which claims the fruit has fat-burning properties, and the Zone Diet, which promotes a fixed ratio of food groups. One diet had her spending hours preparing zucchini.
In the NIH study, she was on a lower-fat, higher-protein diet -- 20% fat, 25% protein, 55% carbs -- and consumed 1,400 calories a day. Ms. Mayer, who is about 5 feet tall, says she dropped 50 pounds, going to 129 from 179, and has kept the weight off since the study ended.
Some promoters of specialized diets say calorie counting isn't the key to losing weight. "Measuring your food is not going to work in the long term," says Arthur Agatston, a Miami cardiologist and creator of the South Beach Diet, which focuses on food selection. The first two weeks of the diet, for instance, ban all carbohydrates except vegetables in an effort to reduce food cravings that cause people to overeat, Mr. Agatston says. Although regimens like the South Beach Diet may end up cutting calorie intake, they also aim to break people's unhealthy habits with food.
In an editorial accompanying the NEJM report, Martijn Katan, a nutrition researcher at Amsterdam's VU University, noted that participants had waning success keeping off weight toward the end of the study, suggesting their discipline began slipping. "Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices," he said.