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Medical Forum / General / Nutrition / November 2004

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Study, best long term weight control strategy

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markd@toad-net.com - 16 Nov 2004 12:20 GMT
Study: Low-fat diets better long-term

  By MARILYNN MARCHIONE, AP Medical Writer

  LAS VEGAS (AP) - Regardless of how they shed pounds in the first
  place, big losers stayed that way by limiting fat rather than
  carbohydrates, according to new research that could add fuel to the
  backlash against low-carb diets.

  Dieters already have been turning away from Atkins-style plans as a
  long-term weight-control strategy, and the new study gives them more
  reason: Low-fat plans seem to work better at keeping weight off.

  "People who started eating more fat ... regained the most weight over
  time," said Suzanne Phelan, a Brown Medical School psychologist who
  presented results of the study Monday at a meeting of the North
  American Association for the Study of Obesity.

  The study used the National Weight Control Registry, a decade-old
  effort to learn the secrets of success from people who had lost at
  least 30 pounds and kept them off for at least a year. The registry
  run by doctors from the University of Colorado in Denver, the
  University of Pittsburgh and Brown University in Providence, R.I.

  They studied 2,700 people who entered the registry from 1995 through
  2003. Their average age was 47, most were women, and they had lost an
  average of 72 pounds initially. Doctors compared their diets to see
  whether one type or another made a difference in how much weight they
  had lost and how much they had regained a year later.

  All reported eating only about 1,400 calories a day, but the portion
  that came from fat rose - from 24 percent in 1995 to more than 29
  percent in 2003 - while the part from carbohydrates fell, from 56
  percent to 49 percent.

  The number who were on low-carb diets (less than 90 grams a day) rose
  from 6 percent to 17 percent during the same period.

  The type of diet - low-fat, low-carb or in between - made no
  difference in how people lost weight initially.

  But those who increased their fat intake over a year regained the most
  weight. That meant they ate less carbohydrates, because the amount of
  protein in their diets stayed the same, Phelan said.

  "Only a minority of successful weight losers consume low-carbohydrate
  diets," she and the other researchers concluded.

  Colette Heimowitz, a nutrition expert and spokeswoman for the Atkins
  diet organization, noted that the study considered 90 grams to be
  low-carb, while Atkins recommends 60 grams for weight loss and 60 to
  120 for weight maintenance.

  She said that for many of the dieters studied, "the carbs aren't low
  enough for them to be successful." They also should have replaced
  carbs with more protein rather than fat, she said.

  Dr. Thomas Wadden, a University of Pennsylvania weight loss expert who
  had no role in the study, said it is too soon to say which approach is
  better. Several longer-term studies of low-carb and low-fat dieters
  are in the works, he said.

  But he said: "I do think that people who are keeping the weight off
  are eating a low-fat, high-carb diet."

  The dietary establishment has long been skeptical of the long-term
  safety and effectiveness of low-carb diets, and consumers increasingly
  are losing their enthusiasm for the glut of low-carb products that
  overloaded grocery store shelves as the diet became a fad in the past
  few years.

  More than half of Americans who have tried a low-carb diet have given
  up, according to a recent survey by the market research firm
  InsightExpress. Other published survey information suggests that the
  number of Americans following such a diet peaked at 9 percent last
  February and fell to 6 percent by June.

  The American Institute for Cancer Research used those trends to issue
  a statement in September urging dieters to "come back to common
  sense."

  "Eat a balanced diet weighted toward vegetables and fruits, reduce
  portion sizes and increase physical activity," the institute said.

  Dr. William Dietz, director of chronic-disease prevention at the
  federal Centers for Disease Control and Prevention, said it is
  difficult to tell whether these low-carb diets really work because
  people find it hard to stick to a strict regimen for long periods.

  "My anecdotal experience is that people go on and off these diets," he
  said. "When their weight goes up, they go back on the diet to lose
  weight."

  Other research at the conference underscored the many health and
  personal problems obese people face.

  Duke University doctors said two-thirds of obese people seeking
  treatment at the Duke Diet & Fitness Center reported not enjoying or
  wanting to have sex, and having problems with sexual performance. Only
  5 percent of normal-weight people from the surrounding community who
  completed the same quality-of-life survey reported such problems.
tcomeau - 16 Nov 2004 20:47 GMT
National Weight Control Registry

http://www.uchsc.edu/nutrition/WyattJortberg/nwcr.htm

James O. Hill, PhD
Rena Wing, PhD

James O. Hill, Ph.D., Professor of Pediatrics and Director, Center for
Human Nutrition at the University of Colorado Health Sciences Center,
Denver, CO. Research support from Amgen, Hoffman-LaRoche, Procter &
Gamble, and Knoll Pharmaceuticals; has received consultant fees from
Knoll, Roche Laboratories, International Life Sciences Institute, and
Procter & Gamble and is a consultant to the Duke Diet and Fitness
Center. (Newark Star-Ledger, 2/17/97). President, North American
Association for the Study of Obesity. (USA Today, 9/1/98) Lead author
of a study on olestra supported by a grant from Procter & Gamble. (Am.
J. Clin. Nutr. 1998;67:1178-85) Co-wrote (with Barbara Rolls) a 1998
report for ILSI on "Carbohydrates and Weight Management." Participated
in a 3/25/99 panel assembled by the Sugar Association to inform New
York magazine editors about obesity, calories, and activity. (Sugar
Association's 1999 annual report,
http://www.foodingredientsonline.com; accessed 03/30/99) Research on
the effects of covert substitution of olestra for conventional fat on
spontaneous food intake supported by Procter & Gamble. (Am. J. Clin.
Nutr. 1998;67:1178-85) Research on the role of carbohydrates in weight
management was supported by the Sugar Association. (Letter from Sugar
Association to USDA; on file with CSPI; 4/16/99) Research on using
Orlistat for weight maintenance funded by Hoffmann-La Roche. (Am. J.
Clin. Nutr. 1999;69:1108-16) Member of the Foodfit.com advisory board.
(http://www.foodfit.com/about/advisoryBoard.asp; accessed 11/11/00)
Research on weight management supported in part by Abbott
Laboratories. (J. Amer. Coll. Nutr. 2001;20:26-31) Member of the
McDonald's Corporation Global Advisory Council on Healthy Lifestyles;
formed to "help guide the company on activities that address the need
for balanced, healthy lifestyles."
(http://www.mcdonalds.com/corporate/press/corporate/2003/05212003/;
accessed 6/23/03) Receives consulting fees from HealtheTech, Johnson &
Johnson, Procter & Gamble, and Coca-Cola. Receives speakers fees from
Abbott Laboratories, Roche Laboratories, and Kraft Foods. Receives
research funding from M&M Mars. (N. Engl. J. Med. 2003:348;2082-2090)
Member of the expert advisory board for the American Council for
Fitness and Nutrition. (http://www.acfn.org/about/advisory.html;
accessed 10/31/03)

Rena R. Wing, Ph.D., U. of Pittsburgh School of Medicine. Consultant
to and received research support from Lilly Pharmaceuticals, is on
Weight Watchers Advisory Board; has received research support from
Ross Laboratories and ILSI. (Newark Star-Ledger, 2/17/97 notes Eli
Lilly, WW)

*****

Do you see how these two people and the entire purpose of the weight
registry is called into question when they fail to declare their
obvious conflicts of interests. Why do they hide it? Because they
understand that their affiliations render them scientifically
questionable.

That is what brings disrepute to science in general. Had they declared
their financial interests up front we could then go on to the report
and consider its scientific value.

Where the hell is the press in all of this? Why are they not reporting
these blatant conflicts of interest?

TC

> Study: Low-fat diets better long-term
>
[quoted text clipped - 97 lines]
>    5 percent of normal-weight people from the surrounding community who
>    completed the same quality-of-life survey reported such problems.
tcomeau - 16 Nov 2004 21:57 GMT
> Study: Low-fat diets better long-term
>
[quoted text clipped - 19 lines]
>    run by doctors from the University of Colorado in Denver, the
>    University of Pittsburgh and Brown University in Providence, R.I.

more about the weight registry:

http://www.uchsc.edu/nutrition/Administration/admin.htm

Robert H. Eckel, M.D., Division of Endocrinology, Health Sciences
Center, University of Colorado. Research on the "effect of medium
chain triglycerides on glucose and lipid metabolism in type II
diabetes melitus" was supported by Procter and Gamble. Research on
"the effect of leptin on postprandial lipid metabolism" was supported
by Amgen. (Undated resume on file at CSPI; accessed 6/18/02)

Uwe Christians, Department of Biopharmaceutical Sciences, University
of California, San Francisco. Research on mitochondrial metabolism
supported in part by Novartis Pharma AG. (Br. J. Pharmacol.
2001;133:875-85)

William C. Heird, Ph.D., Baylor College of Medicine, Baylor, TX.
Research on fatty acid in breast milk partially funded by Mead-Johnson
Nutritional Group. (Am. J. Clin. Nutr. 2000;71(supp):292S-9S)

Stephen C. Woods, Ph.D., Department of Psychiatry, University of
Cincinnati College of Medicine. Received $1,000,000 in 2000-2001 and
$1,037,500 in 2001-2002 from Procter & Gamble for a study on obesity
and energy homeostasis. (University of Cincinnati, Office of Research,
Active Grants and Contracts - FY 2001,
http://www.med.research.uc.edu/grants/granttemplateshell.cfm?department_id=186;
accessed 6/24/02)

Holly R. Wyatt, M.D., Assistant Professor of Medicine, University of
Colorado Health Sciences Center, Denver. Receives consulting fees from
Ortho-McNeil, USANA, and GlaxoSmithKline. Receives speaker fees from
Roche Laboratories, Abbott Laboratories, Slim-Fast, and Ortho-McNeil.
(N. Engl. J. Med. 2003;348:2082-90)

TC
Larry Hoover - 16 Nov 2004 22:06 GMT
> Study: Low-fat diets better long-term
>
[quoted text clipped - 9 lines]
>   whether one type or another made a difference in how much weight they
>   had lost and how much they had regained a year later.

I question the validity of anything determined via this methodology. We do not know
how the subjects were recruited (were they truly random representatives of the
greater population, or were they already clients of conventional weight-loss
programs?), how reliable their self-reports are (as far as I know, all client
reports are electronically submitted), whether any uncontrolled but unreported
variables are at play, or whether the initial requirement that one must have lost 30
pounds and kept it off for a year presupposes certain characteristics in the
participants themselves. Those are just ideas off the top of my head. I wonder what
I'd find if I read a detailed article.

Lar
tcomeau - 17 Nov 2004 15:01 GMT
> > Study: Low-fat diets better long-term
> >
[quoted text clipped - 21 lines]
>
> Lar

The topic comes up on the low carb forums often. The main complaint is
how the questionaires are worded and the narrow choices of responses
to the questions. The questionaires seem to be specifically designed
to make it difficult for low carbers to indicate the methods they used
to lose weight. The questions are skewed to solicit a low-fat message
even from low-carbers. How can you answer a multiple choice question
that doesn't give you the option that best represents your desired
answer?

The questionaires out forward by the weight registry people were never
and will never be designed to reflect the truth.

TC
bj - 17 Nov 2004 18:55 GMT
> The questionaires out forward by the weight registry people were never
> and will never be designed to reflect the truth.

I'm not on any registry, but my "truth" -- which may not be your "truth" or
even THE TRUTH -- was that eating less & moving more worked quite well, and
continues to work for me in maintaining my weight. I've never been a low
carber. I don't think I'm "low fat" either. I'm just plain moderate
(although I do sometimes go a bit too far in the exercise department).
bj
tcomeau - 17 Nov 2004 15:01 GMT
> > Study: Low-fat diets better long-term
> >
[quoted text clipped - 21 lines]
>
> Lar

The topic comes up on the low carb forums often. The main complaint is
how the questionaires are worded and the narrow choices of responses
to the questions. The questionaires seem to be specifically designed
to make it difficult for low carbers to indicate the methods they used
to lose weight. The questions are skewed to solicit a low-fat message
even from low-carbers. How can you answer a multiple choice question
that doesn't give you the option that best represents your desired
answer?

The questionaires out forward by the weight registry people were never
and will never be designed to reflect the truth.

TC
tcomeau - 18 Nov 2004 14:42 GMT
> > Study: Low-fat diets better long-term
> >
[quoted text clipped - 21 lines]
>
> Lar

Anyone can register thru their website. I signed up my wife a couple
of years back because she fit the requirements. The questionaire was
simplistic and very incomplete in terms of allowing the subject to
fill in details that gives a clear picture of the methodolgy used to
lose the weight.

We haven't heard from them since.

If you know someone who qualifies, go on their site and register them
and see for yourself. It really smacks of cherry picking data and
trying to maniplulate the results and findings.

Personally, I can't believe that such a farce exists and is allowed to
exist without someone challenging tham, either someone from the media
or someone from the scientific community. I guess that leaves us to do
that.

TC
 
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