A randomized study of dietary composition during weight-loss maintenance: Rationale, study design, intervention, and assessment.
Study Goal
The researchers aimed to evaluate the effects of three test diets with varying carbohydrate-to-fat ratios on weight-loss maintenance and energy expenditure.
Results Summary
The study compared high-carbohydrate, moderate-carbohydrate, and low-carbohydrate diets during weight-loss maintenance, measuring energy expenditure and weight change during an ad libitum feeding phase as a proxy for hunger. Results focused on metabolic outcomes but did not explicitly report comparative efficacy in weight maintenance.
Population
164 participants aged 18–65 years with overweight or obesity who achieved initial weight loss of 12±2% of baseline body weight.
Effective Dosage
Diets provided 20% protein, with varying carbohydrate (20–60%) and fat (20–60%) ratios.
Duration
20-week test phase followed by a 2-week ad libitum feeding phase.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat) | neutral | body weight | 164 participants aged 18 to 65 years | - | assessed the effect | #1 |
moderate-carbohydrate diet (40% carbohydrate, 40% fat) | neutral | body weight | 164 participants aged 18 to 65 years | - | assessed the effect | #2 |
low-carbohydrate diet (20% carbohydrate, 60% fat) | neutral | body weight | 164 participants aged 18 to 65 years | - | assessed the effect | #3 |
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat) | neutral | total energy expenditure | 164 participants aged 18 to 65 years | - | evaluated | #4 |
moderate-carbohydrate diet (40% carbohydrate, 40% fat) | neutral | total energy expenditure | 164 participants aged 18 to 65 years | - | evaluated | #5 |
low-carbohydrate diet (20% carbohydrate, 60% fat) | neutral | total energy expenditure | 164 participants aged 18 to 65 years | - | evaluated | #6 |
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat) | neutral | resting energy expenditure | 164 participants aged 18 to 65 years | - | assessed | #7 |
moderate-carbohydrate diet (40% carbohydrate, 40% fat) | neutral | resting energy expenditure | 164 participants aged 18 to 65 years | - | assessed | #8 |
low-carbohydrate diet (20% carbohydrate, 60% fat) | neutral | resting energy expenditure | 164 participants aged 18 to 65 years | - | assessed | #9 |
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat) | neutral | physical activity | 164 participants aged 18 to 65 years | - | assessed | #10 |
moderate-carbohydrate diet (40% carbohydrate, 40% fat) | neutral | physical activity | 164 participants aged 18 to 65 years | - | assessed | #11 |
low-carbohydrate diet (20% carbohydrate, 60% fat) | neutral | physical activity | 164 participants aged 18 to 65 years | - | assessed | #12 |
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat) | neutral | chronic disease risk factors | 164 participants aged 18 to 65 years | - | assessed | #13 |
moderate-carbohydrate diet (40% carbohydrate, 40% fat) | neutral | chronic disease risk factors | 164 participants aged 18 to 65 years | - | assessed | #14 |
low-carbohydrate diet (20% carbohydrate, 60% fat) | neutral | chronic disease risk factors | 164 participants aged 18 to 65 years | - | assessed | #15 |
high-carbohydrate diet (60% of energy from carbohydrate, 20% fat) | neutral | metabolism | 164 participants aged 18 to 65 years | - | influence | #16 |
moderate-carbohydrate diet (40% carbohydrate, 40% fat) | neutral | metabolism | 164 participants aged 18 to 65 years | - | influence | #17 |
low-carbohydrate diet (20% carbohydrate, 60% fat) | neutral | metabolism | 164 participants aged 18 to 65 years | - | influence | #18 |
standard run-in diet | decrease | body weight | 164 participants aged 18 to 65 years | 12±2% of baseline body weight | weight loss corresponding to | #19 |
BACKGROUND: While many people with overweight or obesity can lose weight temporarily, most have difficulty maintaining weight loss over the long term. Studies of dietary composition typically focus on weight loss, rather than weight-loss maintenance, and rely on nutrition education and dietary counseling, rather than controlled feeding protocols. Variation in initial weight loss and insufficient differentiation among treatments confound interpretation of results and compromise conclusions regarding the weight-independent effects of dietary composition. The aim of the present study was to evaluate three test diets differing in carbohydrate-to-fat ratio during weight-loss maintenance. DESIGN AND DIETARY INTERVENTIONS: Following weight loss corresponding to 12±2% of baseline body weight on a standard run-in diet, 164 participants aged 18 to 65years were randomly assigned to one of three test diets for weight-loss maintenance through 20weeks (test phase). We fed them high-carbohydrate (60% of energy from carbohydrate, 20% fat), moderate-carbohydrate (40% carbohydrate, 40% fat), and low-carbohydrate (20% carbohydrate, 60% fat) diets, controlled for protein content (20% of energy). During a 2-week ad libitum feeding phase following the test phase, we assessed the effect of the test diets on body weight. OUTCOMES: The primary outcome was total energy expenditure, assessed by doubly-labeled water methodology. Secondary outcomes included resting energy expenditure and physical activity, chronic disease risk factors, and variables to inform an understanding of physiological mechanisms by which dietary carbohydrate-to-fat ratio might influence metabolism. Weight change during the ad libitum feeding phase was conceptualized as a proxy measure of hunger.