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Successful weight loss involves dietary change, behavior modification and increased physical activity. A common belief is that an energy deficit of 500-1,000 calories per day leads to weight loss of 1 to 2

Fig. 9.1. Obesity treatment algorithm.

pounds per week. This reduction typically results in a 1,000-1,200 calorie/day diet for most women and a 1,200-1,600 calorie/day diet for most men [12]. As obesity rates continue to escalate, low carbohydrate diets have become attractive as they allow for rapid weight loss and unlimited quantities of high protein foods and in some cases, unlimited dietary fat. These diets include, but are not limited to, Dr. Atkins' Diet Revolution [13], the Zone [14] and the South Beach Diet [15]. As research and public opinion continue to change regarding the safety and efficacy of these low carbohydrate diets, other diet approaches have gained popularity such as Weight Watchers, the New Glucose Revolution, Volumetrics and Slim Fast.

Americans are bombarded with changing professional and popular approaches to altering dietary intake. This next section will review the approach, safety and efficacy of some popular diets with particular emphasis on low-carbohydrate diets. It will also offer recommendations from the United States Department of Agriculture (USDA) and the National Institutes of Medicine (IOM) regarding dietary modification. Table 9.3 compares the key aspects of each of these popular approaches.

Table 9.3

Comparison of Popular Diet Approaches

Atkins Diet

The Zone Diet

The South Beach Diet

The Glucose Revolution

Volumetrics

Weight Watchers

Slim-Fast

Source

Dr. Robert

Dr. Barry Sears,

Dr. Aurther

Jennie

Dr. Barbara

Weight

The Slim

Atkins MD:

MD: Enter the

Agaston, MD:

Brand-Miller

Rolls: The

Watchers

Fast Plan:

Dr. Atkins'

Zone

The South

and Thomas

Volumetrics

Corporation:

www.slimfast.

New Diet

Beach Diet

Wolever: The

Weight-Control

www.weight-

com

Revolution

New Glucose Revolution

Plan

watchers.com

Rationale

carbohydrates

Excess CHO and

Chosing the

Chosing foods

Eating high

Portion control

Calorie

trigger insulin

portions lead to

right CHO and

with a low

volume, low-

is key to

reduction

release which

increased

the right fats

glycemic index

energy-dense

permanent

using meal

leads to

ecosanoid

will help lose

(GI) will help

foods allows

weight loss. All

replacement

excessive

production

belly fat first

regulate blood

for increased

foods are

shakes and bars

hunger and fat

which causes

and decrease

sugars, hunger.

satisfaction

monitored on

for 1-2

storage;

inflammation and

cravings

improve

which helps

daily points

meals/day.

restricting

fat promotion. The

exercise

dieters stick

system vs. lists

carbohydrates

right combination

endurance and

with low-

of allowed or

(CHO) will

of foods (40%

manage

calorie diet

avoid foods

prevent this

CHO, 30%

diabetes and

effect

protein, 30% fat) will allow for a weight loss zone.

heart disease

(Continued)

Table 9.3 (Continued)

4 phases:

Splits

3-phase plan

Glycemic index

Calorie

2 variations:

Replace 1 to 2

induction.

macronutrients

that introduces

(GI) provides a

restriction is

Flex and Core.

meals/day with

weight loss.

into "blocks" that

varying

ranking of

bottom line for

Flex assigns a

Slim-Fast meal

pre-maintence

can be measured

amounts and

individual

weight loss.

point level to

replacement

and

for CHO, fat and

types of CHO

CHO and their

Compliance of

each food

products

maintenance.

protein content

depending on

effects on

low-calorie diet

depending on

which are

Goal of

allowing the dieter

the stage.

blood glucose

can be

calories, fat

approximately

induction phase

to calculate

Phase I

after a meal.

enhanced with

and fiber

65% CHO,

to induce

40-30-30

eliminates all

Low GI

increased

content. Each

20% protein

ketosis by

breakdown at each

fruit and whole

considered

satiety. High

member

and 15% fat

consuming

meal and snack. A

grains for 2

<55, medium

volume.

receives daily

and allow for

20 gm CHO

typical meal for a

weeks. Phase 2

=56-69,

low-energy

point level for

long-term

daily. The

woman might

and 3 promote

High > 70.

dense foods

tracking. The

calorie

weight loss and

include 27 gm

the addition of

Generally, high

help increase

Core plan

restriction.

pre-maintence

CHO, 21 gm

limited

fiber, less

satiety and

encourages

phase allow for

protein and 9gm

amounts of

refined foods

allow for

food selection

incremental

fat.

allowed fruits.

have a lower

reduction in

from a healthy

additions of

nuts and whole

GI than more

eating. Overall,

"core list" that

carbs until final

grains.

refined CHO.

high fiber.

does not

CHO level is

The GI of

low-fat diet.

require

25-90 gm/day

various foods

tracking points.

for

are listed in the

maintenance.

book as well as on-line at

www.glycemicindex.com

Diet is low in

Low-calorie diet

Positively

calories

plan providing

emphasizes

ranging

roughly 1200

healthier

1200-1500

calories/day. After

choices of

calories/day

one year. Zone

proteins, fats

and does not

dieters are no

and whole

appear to be

more effective

grains but

more effective

than other

un-necessarily

at one year

approaches [16]

restricts healthy

vs.other

CHO. Also

low-calorie

low-calorie and

diets

there is no

long-term data to support its safety or efficacy.

Low GI foods

Diet

Appears to be

Long-term data

do translate

recommends

most successful

on meal

to better

healthy, high

of popular diet

replacements

post-prandial

fiber, high

programs in

endorse their

glucose levels

volume foods

terms of

safety and

in controlled

which do

client's results

efficacy for

metabolic

positively

and attrition

weight loss and

studies that

impact total

rates. Widely

maintance up

are not

calories and

considered a

to 10 years.

reproducable

weight loss in

healthy eating

Not feasible or

under normal

the short term.

program[16].

palatable to all

conditions [17].

Long term

clients.

Diet may not

studies in

be low calorie

over-weight

since no

and obese are

emphasis on

needed.

portion size.

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