Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets

doi:10.1016/j.nut.2019.07.001

Nutrition

Volume 69, January 2020, 110549

https://doi.org/10.1016/j.nut.2019.07.001 Get rights and content

Highlights

•
Several popular diets for weight loss are not supported by scientific evidence.
•
To date, no optimally effective weight loss diet exists for all individuals.
•
Food quality matters in a weight loss diet aiming to promote health.
•
To lose weight, it is fundamental to adopt a diet that creates negative energy balance.
•
Adherence is an important predictor of success.

Abstract

New dietary strategies have been created to treat overweight and obesity and have become popular and widely adopted. Nonetheless, they are mainly based on personal impressions and reports published in books and magazines, rather than on scientific evidence. Animal models and human clinical trials have been employed to study changes in body composition and metabolic outcomes to determine the most effective diet. However, the studies present many limitations and should be carefully analyzed. The aim of this review was to discuss the scientific evidence of three categories of diets for weight loss. There is no one most effective diet to promote weight loss. In the short term, high-protein, low-carbohydrate diets and intermittent fasting are suggested to promote greater weight loss and could be adopted as a jumpstart. However, owing to adverse effects, caution is required. In the long term, current evidence indicates that different diets promoted similar weight loss and adherence to diets will predict their success. Finally, it is fundamental to adopt a diet that creates a negative energy balance and focuses on good food quality to promote health.

Introduction

Obesity is a worldwide, multifactorial disease defined as abnormal or excessive fat accumulation that presents a risk to health. The disease is associated with several chronic morbidities, such as cardiovascular diseases (CVDs), diabetes, and cancer. Prevalence of overweight and obesity has tripled since 1975, reaching 39% and 13% of the world's population, respectively [1]. Because of its significant effects on health, medical costs, and mortality, obesity has become a public health concern.

The fundamental cause of obesity is an energy imbalance between calories consumed and calories expended; however, this involves a complex interplay of biological, genetic, and psychosocial factors [2]. Evidence has shown that a weight loss of ≥5% to 10% within 6 mo is necessary to reduce risk factors of comorbidities and to produce clinically relevant health improvements such as reductions in blood glucose, triacylglycerols, and blood pressure [3].

To achieve successful weight loss and sustain it over time, the Academy of Nutrition [4] recommends changes in lifestyle behavior; a diet that reduces excessive energy intake and enhances dietary quality; and an increase in energy expenditure. Furthermore, the successful treatment of overweight and obesity could require adjuvant therapeutics such as cognitive-behavioral therapy [4], pharmacotherapy [5], and even bariatric surgery [6]. These therapies are indicated for specific conditions and should be individually analyzed, which is a topic that goes beyond the scope of this review.

Regarding dietary interventions for weight loss, an individualized diet that achieves a state of negative energy balance should be prescribed [4]. Many dietary approaches can generate this desired reduction in caloric intake. Diets are usually based on the inclusion or exclusion of different foods or food groups (Fig. 1). Historically, several diets have become popular and then faded owing to a lack of reliable scientific support. In this context, this review aimed to provide scientific evidence to support the adoption of dietary strategies to promote weight loss. We classified these strategies into three main categories:

1.
diets based on the manipulation of macronutrient content (i.e., low-fat [LF], high-protein [HP], and low-carbohydrate diets [LCDs]).
2.
diets based on the restriction of specific foods or food groups (i.e., gluten-free, Paleo, vegetarian/vegan, and Mediterranean diets).
3.
diets based on the manipulation of timing (i.e., fasting).

Section snippets

Diets based on the manipulation of macronutrient content

The manipulation of macronutrient content in isocaloric diets has been studied to determine which composition best promotes weight loss while including other metabolic benefits. Increased protein and decreased carbohydrates are the most common modifications and have resulted in several popular diets created over time (Table 1; Fig. 2). Changes in the macronutrient composition affect hormones, metabolic pathways, gene expression, and the composition and function of the gut microbiome that might

Diets based on the restriction of specific foods or food groups

Different foods and food groups have emerged as villains and have been removed from specific diets to promote weight loss. The long list includes a vegetarian diet, which excludes all animal products; the Paleo diet, which restricts many food groups including grains, dairy, and legumes; and the popular gluten-free diet (GFD). The Mediterranean diet is not based on the complete restriction of a specific food group, but instead is characterized by a richness of plant-based food and moderation of

Diets based on the manipulation of timing (fasting)

To achieve the negative energy balance required for weight loss [4], most weight control programs use a 20% to 40% continuous (daily) calorie restriction. However, more recently the manipulation of timing, namely intermittent calorie restriction or intermittent fasting (IF), has received considerable interest as an alternative strategy. IF consists of abstaining from food and caloric beverages for a certain period of time alternated with normal eating. Several variations of IF differ in length

Alternative dietary approaches

There are several alternative dietary approaches with promising favorable outcomes in patients with overweight and obesity. For instance, the replacement of two to three meals a day with “meal replacements” that contain all recommended nutrients has been described as an approach that promotes significant weight loss [146], [147], [148]. Studies also reported reductions in cardiovascular risk factors [147] and improvement in metabolic parameters [149] associated with meal replacements. However,

Adherence

Adherence to a diet is defined as the degree to which participants meet diet requirements [151]. Many factors influence adherence to a dietary program including food preferences, cultural or regional traditions, food availability, food intolerances, and motivation. Furthermore, diet cannot be addressed only as a biochemical process, since it is strongly influenced by human behavior and environmental factors.

Advancing the search for an optimal dietary weight loss approach suggests that a higher

Final remarks and conclusion

The creation of new diets will continue to follow popular trends. However, the belief that these diets promote weight loss has emerged more from personal impressions and reports published in books, rather than from rigorously controlled research.

Over the past several decades, efforts have been concentrated on clinical trials to determine the best diet for the treatment of obesity. Unfortunately, the evidence remains inconclusive and contested, and the trials present important limitations (Table

Acknowledgments

The authors acknowledge Susie Flaherty and Diogo Castilho for editing the manuscript.

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ReviewScientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets

Highlights

Abstract

Introduction

Section snippets

Diets based on the manipulation of macronutrient content

Diets based on the restriction of specific foods or food groups

Diets based on the manipulation of timing (fasting)

Alternative dietary approaches

Adherence

Final remarks and conclusion

Acknowledgments

Am J Med Sci

J Am Coll Cardiol

J Acad Nutr Diet

Med Clin North Am

Am J Clin Nutr

Cell Metab

Nutr Res

Am J Clin Nutr

Nutr Res

Lancet Public Health

Atherosclerosis

J Acad Nutr Diet

J Am Diet Assoc

Eat Behav

Am J Clin Nutr

J Acad Nutr Diet

Appetite

Nutrients

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Nutr Res

J Nutr Biochem

Endocrinol Metab Clin North Am

Updates on obesity pharmacotherapy

Ann N Y Acad Sci

The carbohydrate-insulin model of obesity: beyond “calories in, calories out”

JAMA Intern Med

Dietary fat: from foe to friend?

Science

Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial

Ann Intern Med

Change in food cravings, food preferences, and appetite during a low-carbohydrate and low-fat diet

Obesity

Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial

JAMA

Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial

BMJ

Obesity energetics: body weight regulation and the effects of diet composition

Gastroenterology

Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women

Obes Res

Effects of a low-glycemic load vs low-fat diet in obese young adults: a randomized trial

JAMA

Ketogenic diet and epilepsy: what we know so far

Front Neurosci

Do ketogenic diets really suppress appetite? A systematic review and meta-analysis

Obes Rev

Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus

Nutr Diabetes

Timeline of changes in appetite during weight loss with a ketogenic diet

Int J Obes

Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: a randomised clinical trial

PeerJ

Effect of a very low-calorie ketogenic diet on food and alcohol cravings, physical and sexual activity, sleep disturbances, and quality of life in obese patients

Nutrients

A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial

Ann Intern Med

Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies

Nutrients

Long term effects of ketogenic diet in obese subjects with high cholesterol level

Mol Cell Biochem

A very low-carbohydrate, low-saturated fat diet for type 2 diabetes management: a randomized trial

Diabetes Care

Acute and long-term impact of high-protein diets on endocrine and metabolic function, body composition, and exercise-induced adaptations

J Am Coll Nutr

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

JAMA

Review
Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets