Sacks et al., 2009

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The new england journal of medicineA Low-Fat, Average-Protein20B Low-Fat, High-Protein20Change in Weight from Baseline to 2 Yr (kg)100−10−20−30−40N=169Slope=−0.179Change in Weight from Baseline to 2 Yr (kg)100−10−20−30−40N=157Slope=−0.1910 10 20 30 40 50 600 10 20 30 40 50 60No. of Sessions AttendedNo. of Sessions AttendedC High-Fat, Average-Protein20D High-Fat, High-Protein20Change in Weight from Baseline to 2 Yr (kg)100−10−20−30−40N=151Slope=−0.252Change in Weight from Baseline to 2 Yr (kg)100−10−20−30−40N=168Slope=−0.2170 10 20 30 40 50 600 10 20 30 40 50 60No. of Sessions AttendedNo. of Sessions AttendedFigure 3. Change in Body Weight from Baseline to 2 Years According to Attendance at Counseling Sessions for Weight Loss,among the 645 Participants Who Completed the Study.Panel A shows data for the low-fat, average-protein AUTHOR: group; Panel Sacks B, for the low-fat, RETAKE high-protein 1st group; Panel C, for the high-fat, averageproteingroup; and Panel D, for the high-fat, high-proteinICMREG F FIGURE: group. 3 of 4There were no significant differences 2nd among the regression coefficients3rd(P>0.2 for all comparisons; R 2 = 0.2 for total cohort).CASERevisedEMailLine 4-CSIZEARTIST: tsH/T H/TEnon36p6ComboAUTHOR, PLEASE NOTE:Figure has been redrawn and type has been reset.Please check carefully.36009 ISSUE:to high-protein or low-fat goals but not to thegoals in the average-protein or high-fat groups.However, attendance had a strong association withJOB:weight loss, and the association was similar acrossdiet groups. We view attendance at counseling sessionsas a proxy for commitment to achievingweight loss and for engagement in the program.Study participants who attended two thirds of thesessions over the course of 2 years lost about 9 kgof weight. Regain after 6 to 12 months was about20% of the regain reported in earlier trials. 28 Severalrecent trials have also shown that continued02-26-09contact with participants after weight loss is associatedwith less regain. 12,24,37,38 These findingstogether point to behavioral factors rather thanmacronutrient metabolism as the main influenceson weight loss.Conformity to cultural norms, scientific nov-870n engl j med 360;9 nejm.org february 26, 2009Downloaded from www.nejm.org on March 14, 2009 . For personal use only. No other uses without permission.Copyright © 2009 Massachusetts Medical Society. All rights reserved.
Weight-Loss Diets with Different Compositions of MacronutrientsA High Fat0B Low Fat0Weight Loss (kg)−5−10Weight Loss (kg)−5−10Fat Intake (% kcal)Sessions Attended (%)24.354.531.253.135.254.939.647.345.548.7Fat Intake (% kcal)Sessions Attended (%)19.461.625.161.428.755.234.548.841.540.7C High Protein0D Average Protein0Weight Loss (kg)−5−10Weight Loss (kg)−5−10Protein Intake (% kcal)Sessions Attended (%)15.341.618.248.520.355.022.058.425.659.3Protein Intake (% kcal)Sessions Attended (%)14.554.016.847.818.456.020.357.124.148.7Figure 4. Weight Loss at 2 Years According to Adherence to Dietary Fat and Protein Goals.Intake was determined from three 24-hour diet recalls. Quintiles of fat and protein intakes are shown for the combined high-fat groups(Panel A), low-fat groups (Panel B), high-protein groups AUTHOR: (Panel Sacks C), and average-protein RETAKEgroups 1st(Panel D); there were 45 to 51 participantsper quintile. Rates of attendance at group sessionsICMREG F FIGURE: (percent 4 of 4 of total sessions attended 2nd over the 2-year period) are shown for thequintiles of fat and protein intake. I bars indicate 95% confidence intervals. P values for a trend 3rd in weight loss across quintiles are as follows:P
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