United States Department of Agriculture
 
Popular Diets: A Scientific Review 2/2

Obesity Research 9(2001):1s
by by Marjorie R. Freedman, Janet King, and Eileen Kennedy
http://www.obesityresearch.org/cgi/reprint/9/suppl_1/33S.pdf

Janet King, Ph.D., R.D., is the Director at the U.S. Department of Agricultural Research Service, Western Human Nutrition Research Center, Presidio of San Francisco, CA and is currently the President of the American Society for Nutritional Sciences.

Insulin and Leptin in the Endocrine Regulation of Appetite and Body Weight

Insulin and leptin are hormones that act as medium- to long-term regulators of body weight through their actions to decrease food intake and increase energy expenditure (metabolic rate), ensuring that energy intake and energy expenditure is closely matched (109 –111).

People who do not produce leptin due to a genetic deficiency, or who have defects in the leptin receptor, have dramatically increased appetites and overeat to the point of becoming massively obese (112,113). The effects of leptin deficiency are ameliorated by the administration of recombinant leptin (114).

Insulin, in addition to its effects in the central nervous system to inhibit food intake, acts in the periphery to ensure the efficient storage of incoming nutrients. The role for insulin in the synthesis and storage of fat has obscured its important effects in the central nervous system, where it acts to prevent weight gain, and has led to the misconception that insulin causes obesity (115). It has recently been shown that selective genetic disruption of insulin signaling in the brain leads to increased food intake and obesity in animals (116) demonstrating that intact insulin signaling in the central nervous system is required for normal body weight regulation.

Insulin also has an indirect role in body weight regulation through the stimulation of leptin (117). Both insulin and leptin are transported into the central nervous system, where they may interact with a number of hypothalamic neuropeptides known to affect food intake and body weight (118). Insulin and leptin are released and circulate in the bloodstream at levels that are proportionate to body fat content. Secretion and circulating levels are also influenced by amount and type of foods eaten, with decreased concentrations noted during fasting or energy-restricted diets (119,120). The decrease of leptin during a prolonged energy- restricted diet has been shown to be related to increased sensations of hunger (120) suggesting a role for low leptin levels to increase appetite during dieting in humans, and therefore to the predisposition for weight regain after initially successful dieting.

Circulating concentrations of both insulin and leptin, measured over a 24-hour period, are reduced in women consuming high-fat meals (60% fat, 20% CHO) compared with when equicaloric meals high in CHO and low in fat (60% CHO, 20% fat) are consumed (36,37). Increased insulin secretion has been suggested to protect against weight gain in humans (106). Because insulin also stimulates leptin production, which acts centrally to reduce energy intake and increase energy expenditure, decreased insulin and leptin production during the consumption of high-fat diets could help contribute to the obesity promoting effects of dietary fat (42,44,121).

Recent studies show consuming a high-fat diet induces resistance to the actions of leptin to decrease food intake (122,123), and that increased energy intake and weight gain is related to an impairment of insulin transport into the brain (124). Therefore, dietary macronutrient composition affects not only production of insulin and leptin but also may influence their ability to gain access to the brain to signal target neurons. In studies investigating the efficacy and long-term consequences of weight loss diets, it is important to consider the effects of dietary macronutrient content and composition on the production of insulin and leptin, and their actions to regulate energy intake and expenditure.

5. Performance and Physical Activity

c Does the low-CHO diet affect physical performance? Although reference is made to physical activity and exercise by proponents of low-CHO diets (48, pp. 260 – 267; 49, pp. 187–206; 50, pp.143–144), only one study examined the capacity for moderate exercise in obese subjects after adaptation to a hypocaloric, ketogenic diet. This study was conducted in six slightly to moderately overweight, untrained subjects on a protein-supplemented fast for 6 weeks (e.g., 500 to 750 kcal/d, ,10 g CHO, weight loss, 10.6 kg). Results indicate that subjects adapt to prolonged ketosis and use lipid, rather than CHO, as the major metabolic fuel during prolonged exercise at 60% of maximum oxygen concentration. This shift was confirmed by an respiratory quotient of 0.66 during exercise (125).

Other studies were conducted in physically untrained, but normal weight males who were fed eucaloric low- CHO (,20 g/d), high-fat (80%) ketogenic diets, or nonketogenic, low-, medium-, or high-fat diets (15%, 30%, or 55% fat) (126,127). They report diet manipulation, per se, did not effect maximal or submaximal aerobic performance in untrained individuals. However, one cannot extrapolate results from these studies to typically untrained, sedentary, overweight individual consuming low-calorie, low-CHO diets.

Weight Maintenance

Is There an Optimal Diet for Weight Maintenance?

In light of the current obesity crisis, prevention of weight gain and weight maintenance is critical. Is there an optimal Data support the contention that those consuming lowfat, low-calorie diets are most successful in maintaining weight loss (194 –196) (Table 18). Insulin and leptin responses to dietary CHO may play a role in the effects of these diets to sustain weight loss through long-term signals promoting decreased energy intake, increased energy expenditure, or both. Increased physical activity and decreased consumption of (high-fat) fast food meals are also key variables (46,195,197). Palatability and dietary variety within food groups may predict body fatness. McCrory et al. (198) report that the direction of the association depends on which foods provide the variety (e.g., the variety of sweets, snacks, condiments, entrees, and carbohydrates consumed was positively associated with body fat, whereas the variety of vegetables was negatively associated).

Table 19 summarizes the macronutrient composition of diets reviewed in this article. The last line represents the diet consumed by individuals enrolled in the National Weight Control Registry, who have maintained a 13.6 kg (30 pound) weight loss for at least 1 year but who, on average, have lost 30 kg and have maintained the loss for 5.1 years. Data from the Registry indicate that successful weight maintainers comsume a low-calorie diet containing ;40 g of fat (24% of energy), 200 g of CHO (56% of energy), and 70 g of protein (19% of energy) (195–197). This diet most closely resembles the moderate-fat, balanced nutrient reduction diet promoted by every health organization in the United States. The high vitamin and calcium intakes of successful weight loss maintainers suggest they eat a diet high in fruits, vegetables, and calcium-rich foods (dairy). The low iron intake suggests a low intake of animal products.

The American public needs to be told (and believe) that diets are not followed for 8 days, 8 weeks, or 8 months, but rather form the basis of everyday food choices throughout their life. A diet high in vegetables, fruits, complex CHOs (whole grains and legumes), and low-fat dairy is a moderate- fat, low-calorie diet that prevents weight gain, results in weight loss and weight maintenance. It is associated with fullness and satiety. It reduces risk of chronic disease. It is fast, convenient, and inexpensive. How can we convince people it works, and to try it?

References

1. Serdula MK, Mokdad AH, Williamson DF, Galuska DA,
Mendlein JM, Heath GW. Prevalance of attempting weight
loss and strategies for controlling weight. JAMA. 1999;282:
1353–8.
2. Flegel KM, Carroll MD, Kuczmarski RJ, Johnson CL.
Overweight and obesity in the United States: prevalence and
trends, 1960–1994. Int J Obes Relat Metab Disord. 1998;
22:39–47.
3. Mokdad AH, Serdula MK, Dietz WH, Bowman BA,
Marks JS, Koplan JP. The spread of the obesity epidemic
in the United States, 1991–1998. JAMA. 1999;282:1519 –22.
4. Allison DB, Fontaine KR, Manson JE, Stevens J, Van
Itallie TB. Annual deaths attributable to obesity in the
United States. JAMA. 1999;82:1530–8.
5. Must A, Spadano J, Coakley EH, Field AE, Colditz G,
Dietz WH. The disease burden associated with overweight
and obesity. JAMA. 1999;282:1523–9.
6. National Institutes of Health, National Heart, Lung, and
Blood Institute. Obesity Education Initiative. Clinical
guidelines on the identification, evaluation, and treatment of
overweight and obesity in Adults. Obes Res. 1998;6(Suppl
2):51S–210S.
7. World Health Organization. Obesity: Preventing and Managing
the Global Epidemic. Geneva: World Health Organization;
1998.
8. French SA, Jeffery RW, Murray D. Is dieting good for
you? Prevalence, duration and associated weight and behaviour
changes for specific weight loss strategies over four
years in US adults. Int J Obes Relat Metab Disord. 1999;23:
320–7.
9. Institute of Medicine. Weighing the Options. Criteria for
Evaluating Weight-Management Programs. Washington,
DC: National Academy Press; 1995.
10. Foster GD, Wadden TA, Vogt RA, Brewer G. What is
reasonable weight loss? Patients’ expectations and evaluations
of obesity treatment outcomes. J Consul Clin Psychol.
1997;65:79–85.
11. Evans E, Stock AL, Yudkin J. The absence of undesirable
changes during consumption of the low carbohydrate diet.
Nutr Metab. 1974;17:360 –7.
12. Yudkin J, Carey M. The treatment of obesity by the “highfat”
diet: the inevitability of calories. Lancet. 1960;2:939.
13. Ornish D. Eat More, Weigh Less. New York: Harper Paperbacks;
1993.
14. Ornish D, Scherwitz LW, Bilings JH, et al. Intensive
lifestyle changes for reversal of coronary heart disease.
JAMA. 1998;280:2001–7.
15. Pritikin R. The New Pritikin Program. New York: Simon &
Schuster Inc; 1990.
16. Pritikin R. The Pritikin Weight Loss Breakthrough. New
York: Signet; 1999.
17. Pritikin R. The Pritikin Principle. Alexandria, VA: Time
Life Books; 2000.
18. Shape Up America! Guidance for Treatment of Adult Obesity.
Bethesda, MD: 1998.
19. Kinsell LW, Cunnino B, Michaels CD, Bathartalls, Cox
SE, Lemon C. Calories do count. Metabolism. 1964;13:195–
204.
Popular Diets: A Scientific Review, Freedman, King, and Kennedy
34S OBESITY RESEARCH Vol. 9 Suppl. 1 March 2001
20. Powell JJ, Tucker L, Fisher AG, Wilcox K. The effects of
different percentages of dietary fat intake, exercise, and
calorie restriction on body composition and body weight in
obese females. Am J Health Promot. 1994;8:442– 8.
21. Golay A, Allaz A-F, Morel Y, de Tonnac N, Tankova S,
Reaven G. Similar weight loss with low- or high-carbohydrate
diets. Am J Clin Nutr. 1996;63:174–8.
22. Golay A, Eigenheer C, Morel Y, Kujawski P, Lehmann T,
de Tonnac N. Weight-loss with low or high carbohydrate
diet? Int J Obes Relat Metab Disord. 1996;20:1067–72.
23. Yang M-U, Van Itallie TB. Composition of weight loss
during short-term weight reduction. Metabolic responses of
obese subjects to starvation and low-calorie ketogenic and
nonketogenic diets. J Clin Invest. 1976;58:722–30.
24. Kekwick A, Pawan GLS. Metabolic study in human obesity
with isocaloric diets high in fat, protein or carbohydrate.
Metabolism. 1957;6:447– 60.
25. Van Itallie, TB, Tang M, Hashim SA. Dietary approaches
to obesity: metabolic and appetitive considerations. In: Recent
Advances in Obesity Research. London: Newman Publishing;
1975, pp. 256–69.
26. Dattilo AM, Kris-Etherton PM. Effects of weight reduction
on blood lipids and lipoproteins: a meta-analysis. Am J Clin
Nutr. 1992;56:320–8.
27. Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda
S, Kris-Etherton PM. Effects of the National Cholesterol
Education Program’s Step I and Step II dietary
intervention programs on cardiovascular disease risk factors:
a meta-analysis. Am J Clin Nutr. 1999;69:632– 46.
28. Noakes M, Clifton PM. Changes in plasma lipids and other
cardiovascular risk factors during 3 energy-restricted diets
differing in total fat and fatty acid composition. Am J Clin
Nutr. 2000;71:706 –12.
29. Lichtenstein AH, Van Horn L. AHA Science Advisory.
Very low fat diets. Circulation. 1998;98:935–9.
30. Anderson JW, Chen W, Sieling B. Hypolipidemic effect of
high-carbohydrate, high-fiber diet. Metabolism. 1980;29:
551–8.
31. Grey N, Kipnis DM. Effect of diet composition on the
hyperinsulinemia of obesity. N Engl J Med. 1971;285:827–
31.
32. Baba NH, Sawaya S, Torbay N, Habbal Z, Azar S,
Hashim SA. High protein vs. high carbohydrate hypoenergetic
diet for the treatment of obese hyperinsulinemic subjects.
Int J Obes Relat Metab Disord. 1999;23:1202– 6.
33. Heilbronn LK, Noakes M, Clifton PM. Effect of energy
restriction, weight loss, and diet composition on plasma
lipids and glucose in patients with type 2 diabetes. Diabetes
Care. 1999;22:889 –95.
34. Havel PJ, Kasim-Karakas S, Mueller W, Johnson PR,
Gingerich RL, Stern JS. Relationship of plasma leptin to
plasma insulin and adiposity in normal weight and overweight
women: effects of dietary fat content and sustained
weight loss. J Clin Endocrinol Metab. 1996;81:4406 –13.
35. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial on
the effects of dietary patterns on blood pressure. N Engl
J Med. 1997;336:1117–24.
36. Havel PJ, Townsend R, Chaump L, Teff K. High-fat meals
reduce 24-h circulating leptin concentrations in women. Diabetes.
1999;48:334–41.
37. Romon M, Lebel P, Velly C, Marecaux N, Fruchart JC,
Dallongeville J. Leptin response to carbohydrate or fat meal
and association with subsequent satiety and energy intake.
Am J Physiol. 1999;277:E855– 61.
38. Schaefer EJ, Lichtenstein AH, Lamon-Fava S, et al. Body
weight and low-density lipoprotein cholesterol changes after
consumption of a low-fat ad libitum diet. JAMA. 1995;274:
1450–5.
39. Siggaard, R, Raben A, Astrup A. Weight loss during 12
weeks carbohydrate-rich diet in overweight and normalweight
subjects at a Danish work site. Obes Res. 1996;4:
347–56.
40. Harvey-Berino J. The efficacy of dietary fat vs. total energy
restriction for weight loss. Obes Res. 1998;6:202–7.
41. Ogden J. The correlates of long-term weight loss: a group
comparison study of obesity. Int J Obes Relat Metab Disord.
2000;24:1018 –24.
42. Bray GA, Popkin BM. Dietary fat intake does affect obesity.
Am J Clin Nutr. 1998;68:1157–73.
43. Astrup A, Grunwald GK, Melanson EL, Saris W, Hill
JO. The role of low-fat diets in body weight control: a
meta-analysis of ad libitum dietary intervention studies. Int J
Obes Relat Metab Disord. 2000;24:1– 8.
44. Hill JO, Melanson EL, Wyatt HT. Dietary fat intake and
regulation of energy balance: implications for obesity.
J Nutr. 2000;130(suppl):284S– 8S.
45. Alford BB, Blankenship AC, Hagen RD. The effects of
variations in carbohydrate, protein, and fat content of the diet
upon weight loss, blood values, and nutrient intake of adult
obese women. J Am Diet Assoc. 1990;90:534–40.
46. Kayman S, Bruvold W, Stern JS. Maintenance and relapse
after weight loss in women: behavioral aspects. Am J Clin
Nutr. 1990;52:800 –7.
47. Atkins RC. Dr. Atkins’ Diet Revolution. New York: David
McKay Inc. Publishers; 1972.
48. Atkins RC. Dr. Atkins’ New Diet Revolution. New York:
Avon Books, Inc; 1992.
49. Eades MR, Eades MD. Protein Power. New York: Bantam
Books; 1996.
50. Heller RF, Heller RF. The Carbohydrate Addict’s Diet.
New York: Penguin Books; 1991.
51. Bernstein RK. Dr. Bernstein’s Diabetes Solution. Boston:
Little, Brown and Company; 1997.
52. Allan CB, Lutz W. Life Without Bread. Los Angeles: Keats
Publishing; 2000.
53. Steward HL, Bethea MC, Andrew SS, Balart LA. Sugar
Busters! New York: Ballantine Books; 1995.
54. Hill JO, Drougas H, Peters JC. Obesity treatment: can diet
composition play a role? Ann Intern Med. 1993;119:694 –7.
55. Council on Foods and Nutrition. American Medial Association.
A critique of low-carbohydrate ketogenic weight
reduction regimens. A review of Dr. Atkins’ Diet Revolution.
JAMA. 1973;224:1415–9.
56. Rickman F, Mitchell N, Dingman J, Dalen JE. Changes in
serum cholesterol during the Stillman diet. JAMA. 1974;228:
54–8.
Popular Diets: A Scientific Review, Freedman, King, and Kennedy
OBESITY RESEARCH Vol. 9 Suppl. 1 March 2001 35S
57. Larosa JC, Gordon A, Muesing R, Rosing DR. Effects of
high-protein, low-carbohydrate dieting on plasma lipoproteins
and body weight. J Am Diet Assoc. 1980;77:264 –270.
58. Benoit FL, Martin RK, Watten RH. Changes in body
composition during weight reduction in obesity. Ann Intern
Med. 1965;63:604 –12.
59. Fletcher RF, McCririck MY, Crooke AC. Weight loss of
obese patients on diets of different composition. Br J Nutr.
1961;15:53– 8.
60. Lewis SB, Wallin JD, Kane JP, Gerich JE. Effect of diet
composition on metabolic adaptations to hypocaloric nutrition:
comparison of high carbohydrate and high fat isocaloric
diets. Am J Clin Nutr. 1977;30:160 –70.
61. Kasper H, Thiel H, Ehl M. Response of body weight to a
low carbohydrate, high fat diet in normal and obese subjects.
Am J Clin Nutr. 1973;26:197–204.
62. Bortz WM, Howat P, Holmes WL. Fat, carbohydrate, salt,
ad weight loss. Am J Clin Nutr. 1968;21:1291–1301.
63. Krehl WA, Lopez-SA, Good EI, Hodges RE. Some metabolic
changes induced by low carbohydrate diets. Am J Clin
Nutr. 1967;20:139–48.
64. Young CM, Scanlan SS, Im HS, Lutwak L. Effect on body
composition and other parameters in obese young men of
carbohydrate level of reduction diet. Am J Clin Nutr. 1971;
24:290–6.
65. Cederquist DC, Brewer WD, Beegle RM, Wagoner AN,
Dunsing D, Ohlson MA. Weight reduction on low-fat and
low-carbohydrate diets. J Am Diet Assoc. 1952;28:113– 6.
66. Worthington BS, Taylor LE. Balanced low-calorie vs.
high-protein-low carbohydrate reducing diets. I. Weight loss,
nutrient intake, and subjective evaluation. J Am Diet Assoc.
1974;64:47–51.
67. Rabast U, Schonborn J, Kasper H. Dietetic treatment of
obesity with low and high-carbohydrate diets: comparative
studies and clinical results. Int J Obes Relat Metab Disord.
1979;3:210 –11.
68. Rabast U, Kasper H, Schonborn J. Comparative studies in
obese subjects fed carbohydrate-restricted and high carbohydrate
1,000-calorie formula diets. Nutr Metab. 1978;22:269–
77.
69. Wing RR, Vazquez JA, Ryan CM. Cognitive effects of
ketogenic weight-reducing diets. Int J Obes Relat Metab
Disord. 1995;19:811– 6.
70. Baron JA, Schori A, Crow B, Carter R, Mann JI. A
randomized controlled trial of low carbohydrate and low
fat/high fiber diets for weight loss. Am J Public Health.
1986;76:1293– 6.
71. Kekwick A, Pawan GLS. Calorie intake in relation to bodyweight
changes in the obese. Lancet. 1956;ii:155– 61.
72. Werner SC. Comparison between weight reduction on a
high-calorie, high fat diet and on an isocaloric regimen high
in carbohydrate. N Engl J Med. 1985;252:661– 4.
73. Pennington AW. Treatment of obesity with calorically unrestricted
diets. Am J Clin Nutr. 1953;1:343– 8.
74. Pilkington TRE, Gainsborough HJ, Rosenoer VM, Carey
M. Diet and weight reduction in the obese. Lancet. 1960;i:
856–8.
75. Oleson ES, Quaade F. Fatty foods and obesity. Lancet.
1960:1048 –51.
76. Grande F. Energy balance and body composition changes. A
critical study of three recent publications. Ann Intern Med.
1968;68:467– 80.
77. Astrup A, Ro¨ssner S. Lessons from obesity management
programmes: greater initial weight loss improves long-term
maintenance. Obes Rev. 2000;1:17–29.
78. Bell JD, Margen S, Calloway DH. Ketosis, weight loss, uric
acid, and nitrogen balance in obese women fed single nutrients
at low calorie levels. Metabolism. 1969;18:193–208.
79. Worthington BS, Taylor LE. Balanced low-calorie vs.
high-protein-low carbohydrate reducing diets. II. Biochemical
changes. J Am Diet Assoc. 1974;64:52–5.
80. Shils ME, Olson JA, Shike M., eds. Modern Nutrition in
Health and Disease. Philadelphia: Lea & Febiger; 1994, p.
1996.
81. Vogel RA, Corretti MC, Plotnick GD. Effect of a single
high-fat meal on endothelial function in healthy subjects.
Am J Cardiol. 1997;79:350–4.
82. Gudmundsson GA, Sinkey CA, Chenard CA, Stumbo PJ,
Haynes WG. Resistance vessel endothelial function in
healthy humans during transient postprandial hypertriglyceridemia.
Am J Cardiol. 2000;85:381–5.
83. Wachman A, Bernstein DS. Diet and osteoporosis. Lancet.
1968;i:958 –9.
84. Lutz J. Calcium balance and acid-base status of women as
affected by increased protein intake and by sodium bicarbonate
ingestion. Am J Clin Nutr. 1984;39:281– 8.
85. Lemann J, Litzow JR, Lennon EJ. The effects of chronic
acid loads in normal man: further evidence for the participation
of bone mineral in the defense against chronic metabolic
acidosis. J Clin Invest. 1966;45:1608 –14.
86. Lemann J, Litzow JR, Lennon EJ. Studies on the mechanisms
by which chronic metabolic acidosis augments urinary
calcium excretion in man. J Clin Invest. 1967;46:1318 –28.
87. New SA, Bolton-Smith C, Grubb DA, Reid DM. Nutritional
influences on bone mineral density: a cross-sectional
study in premenopausal women. Am J Clin Nutr. 1997;65:
1831–9.
88. Barzel US, Massey LK. Excess dietary protein can adversely
affect bone. J Nutr. 1988;128:1051–3.
89. New SA, Robins SP, Campbell MK, et al. Dietary influences
on bone mass and bone metabolism: further evidence
of a positive link between fruit and vegetable consumption
and bone health. Am J Clin Nutr. 2000;71:142–51.
90. Skov AR, Toubro S, Bu¨low J, Krabbe K, Parving H-H,
Astrup A. Changes in renal function during weight loss
induced by high vs low-protein low-fat diets in overweight
subjects. Int J Obes Relat Metab Disord. 1999;23:1170 –7.
91. Metges CC, Barth CA. Metabolic consequences of a high
dietary-protein intake in adulthood: assessment of the available
evidence. J Nutr. 2000;130:886 –9.
92. Byers T, Guerrero N. Epidemiological evidence for vitamin
C and vitamin E in cancer prevention. Am J Clin Nutr.
1995;62(suppl):1385S–92S.
93. Tavani A, La Vecchia C. Fruit and vegetable consumption
and cancer risk in a Mediterranean population. Am J Clin
Nutr. 1995;61(suppl):1374 –7S.
94. Djuric Z, Depper JB, Uhley V, et al. Oxidative DNA
damage levels in blood from women at high risk for breast
Popular Diets: A Scientific Review, Freedman, King, and Kennedy
36S OBESITY RESEARCH Vol. 9 Suppl. 1 March 2001
cancer are associated with dietary intakes of meats, vegetables,
and fruits. J Am Diet Assoc. 1998;98:524–8.
95. Zhang SM, Hunter DJ, Rosner BA, et al. Intakes of fruits,
vegetables, and related nutrients and the risk of non-
Hodgkin’s lymphoma among women. Cancer Epidemiol Biomarkers
Prev. 2000;9:477– 85.
96. Rosen JC, Hunt DA, Sims EA, Bogardus C. Comparison
of carbohydrate-containing and carbohydrate-restricted hypocaloric
diets in the treatment of obesity: effects of appetite
and mood. Am J Clin Nutr. 1982;36:463–9.
97. Rosen JC, Gross J, Loew D, Sims EA. Mood and appetite
during minimal-carbohydrate and carbohydrate-supplemented
hypocaloric diets. Am J Clin Nutr. 1985;42:371–9.
98. Wurtman JJ. Carbohydrate cravings: a disorder of food
intake and mood. Clin Neuropharmacol. 1988;11:S139–45.
99. Wurtman JJ, Wurtman RJ. Studies on the appetite for
carbohydrates in rats and humans. Psychosomat Res. 1982;
17:213–21.
100. Wurtman JJ. The involvement of brain serotonin in excessive
carbohydrate snacking by obese carbohydrate cravers.
J Am Diet Assoc. 1984;84:1004 –7.
101. Toornvliet AC, Pijl H, Tuienburg JC, et al. Serotoninergic
drug-induced weight loss in carbohydrate craving obese patients.
Int J Obes Relat Metab Disord. 1996;20:917–20.
102. Toornvliet AC, Pijl H, Hopman E, Elte-de Wever BM,
Meinders AE. Psychological and metabolic responses of
carbohydrate craving obese patients to carbohydrate, fat and
protein rich meals. Int J Obes Relat Metab Disord. 1997;21:
860–4.
103. Drewnowski A. Changes in mood after carbohydrate consumption.
Am J Clin Nutr. 1987;46:703.
104. McLaughlin T, Abbasi F, Carantoni M, Schaaf P, Reaven
G. Differences in insulin resistance do not predict weight
loss in response to hypocaloric diets in healthy obese women.
J Clin Endocrinol Metab. 1999;84:578–81.
105. Swinburn BA, Nyomba BL, Saad MF, et al. Insulin resistance
associated with lower rates of weight gain in Pima
Indians. J Clin Invest. 1991;88:168 –73.
106. Schwartz MW, Boyko EJ, Kahn SE, Ravussin E, Bogardus
C. Reduced insulin secretion: an independent predictor
of body weight gain. J Clin Endocrinol Metab. 1995;80:
1571–6.
107. Sigal RJ, El-Hashimy M, Martin BC, Soeldner JS,
Krolewski AS, Warram JH. Acute postchallenge hyperinsulinemia
predicts weight gain. Diabetes. 1997;46:1025–9.
108. Reaven G, Strom TK, Fox B. Syndrome X. New York:
Simon & Schuster; 2000.
109. Schwartz MW, Woods SC, Porte D, Seeley RJ, Baskin
DG. Central nervous system control of food intake. Nature.
2000;404:661–71.
110. Havel PJ. Role of adipose tissue in body-weight regulation:
mechanisms regulating leptin production and energy balance.
Proc Nutr Soc. 2000;59:359 –71.
111. Woods SC, Chavez M, Park CR, et al. The evaluation of
insulin as a metabolic signal influencing behavior via the
brain. Neurosci Biobehav Rev. 1996;1996:20:139–44.
112. Montague CT, Farooqi IS, Whitehead JP, et al. Congenital
leptin deficiency is associated with severe early-onset
obesity in humans. Nature. 1997;387:903– 8.
113. Clement K, Vaisse C, Lahlou N, et al. A mutation in the
human leptin receptor gene causes obesity and pituitary
dysfunction. Nature. 1998;392:398–401.
114. Farooqi IS, Jebb SA, Langmack G, et al. Effects of recombinant
leptin therapy in a child with congenital leptin
deficiency. N Engl J Med. 1999;341:879–84.
115. Schwartz MW. Staying slim with insulin in mind. Science.
2000;289:2066 –7.
116. Bruning JC, Gautam D, Burks DJ, et al. Role of brain
insulin receptor in control of body weight and reproduction.
Science. 2000;289:2122–5.
117. Havel PJ. Mechanisms regulating leptin production: implications
for control of energy balance. Am J Clin Nutr. 1999;
70:305– 6.
118. Woods SC, Seeley RJ, Porte D, Schwartz MW. Signals
that regulate food intake and energy homeostasis. Science.
1998;280:1378–83.
119. Dubuc GR, Phinney SD, Stern JS, Havel PJ. Changes of
serum leptin and endocrine and metabolic parameters after 7
days of energy restriction in men and women. Metabolism.
1998;47:429 –34.
120. Keim NL, Stern JS, Havel PJ. Relation between circulating
leptin concentrations and appetite during a prolonged, moderate
energy deficit in women. Am J Clin Nutr. 1998;68:
794–801.
121. Astrup, A, Ryan L, Grunwald GK, et al. The role of
dietary fat in body fatness: evidence from a preliminary
meta-analysis of ad libitum low-fat dietary intervention studies.
Br J Nutr. 2000;83(Suppl 1):S25–32.
122. Widdowson PS, Upton R, Buckingham R, Arch J, Williams
G. Inhibition of food response to intracerebroventricular
injection of leptin is attenuated in rats with diet-induced
obesity. Diabetes. 1997;46:1782–5.
123. El-Haschimi K, Pierroz DD, Hileman SM, Bjorbaek C,
Flier JS. Two defects contribute to hypothalamic leptin
resistance in mice with diet-induced obesity. J Clin Invest.
2000;105:1827–32.
124. Kaiyala KJ, Prigeon RL, Kahn SE, Woods SC, Schwartz
MW. Obesity induced by a high-fat diet is associated with
reduced brain insulin transport in dogs. Diabetes. 2000;49:
1525–33.
125. Phinney SD, Horton ES, Sims EA, Hanson JS, Danforth
E, LaGrange BM. Capacity for moderate exercise in obese
subjects after adaptation to a hypocaloric ketogenic diet.
J Clin Invest. 1980;66:1152– 61.
126. Phinney SD, Bistrian BR, Wolfe RR, Blackburn GL. The
human metabolic response to chronic ketosis without caloric
restriction: physical and biochemical adaptation. Metabolism.
1983;32:757– 68.
127. Pogliaghi S, Veichsteinas A. Influence of low and high
dietary fat on physical performance in untrained males. Med
Sci Sports Exerc. 1999;31:149 –55.
128. National Institutes of Health, National Cholesterol Education
Program. Second Report of the Expert Panel on
Detection, Evaluation, and Treatment of High Blood Cholesterol
in Adults (Adult Treatment Panel II). Bethesda, MD:
National Institutes of Health; September, 1993.
129. Shape Up America! Shape Up and Drop 10! www.shapeup.
org.
Popular Diets: A Scientific Review, Freedman, King, and Kennedy
OBESITY RESEARCH Vol. 9 Suppl. 1 March 2001 37S
130. Willett WC. Dietary fat and obesity: an unconvincing relation.
Am J Clin Nutr. 1998;68:1149 –50.
131. Knopp RH, Walden CE, Retzlaff BM, et al. Long-term
cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic
and combined hyperlipidemic men. JAMA.
1997;278:1509 –15.
132. Buzzard IM, Asp EH, Chlebowski RT, et al. Diet intervention
methods to reduce fat intake: nutrient and food group
composition of self-selected low-fat diets. J Am Diet Assoc.
1990;90:42–50, 53.
133. Carmichael HE, Swinburn BA, Wilson MR. Lower fat
intake as a predictor of initial and sustained weight loss in
obese subjects consuming an otherwise ad libitum diet. J Am
Diet Assoc. 1998;98:35–9.
134. Hammer RL, Barrier CA, Roundy ES, Bradford JM,
Fisher AG. Calorie-restricted low-fat diet and exercise in
obese women. Am J Clin Nutr. 1989;49:77– 85.
135. Insull W, Henderson MM, Prentice RL, et al. Results of a
randomized feasibility study of a low-fat diet. Arch Intern
Med. 1990;150:421–7.
136. Henderson MH, Kushi LH, Thompson DJ, et al. Feasibility
of a randomized trial of a low-fat diet for the prevention
of breast cancer: dietary compliance in the Women’s Health
Trial Vanguard Study. Prev Med. 1990;19:115–33.
137. Jeffery RW, Hellerstedt EL, French SA, Baxter JE. A
randomized trial of counseling for fat restriction versus calorie
restriction in the treatment of obesity. Int J Obes Relat
Metab Disord. 1995;19:132–7.
138. Pascale, RW, Wing RR, Butler BA, Mulen M, Bononi P.
Effects of a behavioral weight loss program stressing calorie
restriction versus calorie plus fat restriction in obese individuals
with NIDDM or a family history of diabetes. Diabetes
Care. 1995;18:1241–7.
139. Prewitt TE, Schmeisser D, Bowen PE, et al. Changes in
body weight, body composition, and energy intake in women
fed high- and low-fat diets. Am J Clin Nutr. 1991;54:304 –10.
140. Puska P, Iacono, JM, Nissinen A, et al. Controlled, randomised
trial of the effect of dietary fat on blood pressure.
Lancet. 1983;1:1–5.
141. Rumpler WV, Seale JL, Miles CW, Bodwell CE. Energyintake
restriction and diet-composition effects on energy
expenditure in men. Am J Clin Nutr. 1991;53:430–6.
142. Shah M, McGovern P, French S, Baxter J. Comparison of
a low-fat, ad libitum complex-carbohydrate diet with a lowenergy
diet in moderately obese women. Am J Clin Nutr.
1994;59:980–4.
143. Skov AR, Toubro S, Ronn B, Holm L, Astrup A. Randomized
trial on protein vs carbohydrate in ad libitum fat
reduced diet for the treatment of obesity. Int J Obes Relat
Metab Disord. 1999;23:528 –36.
144. Swinburn BA, Woollard GA, Chang EC, Wilson MR.
Effects of reduced-fat diets consumed ad libitum on intake of
nutrients, particularly antioxidant vitamins. J Am Diet Assoc.
1999;99:1400 –5.
145. Schlundt DG, Hill JO, Pope-Cordle J, Arnold D, Vitrs
KL, Katahn M. Randomized evaluation of a low fat ad
libitum carbohydrate diet for weight reduction. Int J Obes
Relat Metab Disord. 1993;17:623–9.
146. United States Department of Agriculture (USDA). Nutrition
and Your Health. Dietary Guidelines for Americans. 5th
ed. Washington, DC; 2000.
147. Thuesen L, Henriksen LB, Engby B. One-year experience
with a low-fat, low-cholesterol diet in patients with coronary
heart disease. Am J Clin Nutr. 1986;44:212–9.
148. Ornish D. Dr. Dean Ornish’s Program for Reversing Heart
Disease. New York: Ballantine Books; 1990.
149. Lissner L, Levitsky DA, Strupp BJ, Kalkwarf HJ, Roe
DA. Dietary fat and the regulation of energy intake in human
subjects. Am J Clin Nutr. 1987;46:886 –92.
150. Djuric Z, Uhley VE, Depper JB, Brooks KM, Lababidi S,
Heilbrun LK. A clinical trial to selectively change dietary
fat and/or energy intake in women: the Women’s Diet Study.
Nutr Cancer. 1999:3427–35.
151. Kasim-Karakas SE, Almario RU, Mueller WM, Peerson
J. Changes in plasma lipoproteins during low-fat, highcarbohydrate
diets: effects of energy intake. Am J Clin Nutr.
2000;71:1439–47.
152. Agus MSD, Swain JF, Larson CL, Eckert EA, Ludwig
DS. Dietary composition and physiologic adaptations to energy
restriction. Am J Clin Nutr. 2000;71:901–7.
153. Surwit RS, Feinglos MN, McCaskill CC, et al. Metabolic
and behavioral effects of a high-sucrose diet during weight
loss. Am J Clin Nutr. 1997;65:908 –15.
154. Ornish D, Scherwitz LW, Doody RS, et al. Effects of stress
management training and dietary changes in treating ischemic
heart disease. JAMA. 1983;249:52–9.
155. Barnard RJ. Effects of life-style modification on serum
lipids. Arch Intern Med. 1991;151:1389 –94.
156. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle
changes reverse coronary heart disease? Lancet. 1990;336:
129–33.
157. Shintani JJ, Hughes CK, Beckham S, Kanawaliwali
O’Connor H. Obesity and cardiovascular risk intervention
through the ad libitum feeding of traditional Hawaiian diet.
Am J Clin Nutr. 1991;53:1647S–51S.
158. Barnard RJ, Guzy PM, Rosenberg JM, O’Brien LT.
Effects of an intensive exercise and nutrition program on
patients with coronary artery disease: five-year follow-up.
J Cardiac Rehab. 1983;3:183–90.
159. Barnard RJ, Massey MR, Cherny S, O’Brien LT, Pritikin
N. Long-term use of a high-complex-carbohydrate, highfiber,
low-fat diet and exercise in the treatment of NIDDM
patients. Diabetes Care. 1983;6:268 –73.
160. Barnard RJ, Zifferblatt SM, Rosenberg JM, Pritikin N.
Effects of a high-complex-carbohydate diet and daily walking
on blood pressure and medication status of hypertensive
patients. J Cardiac Rehabil. 1983;3:839–46.
161. Barnard RJ, Pritikin R, Rosenthal MB, Inkeles S. Pritikin
approach to cardiac rehabilitation. In: Goodgold J, ed. Rehabilitation
Medicine. St. Louis: CV Mosby Company; 1988,
pp. 267–284.
162. Barnard RJ, Ugianskis EJ, Martin DA, Inkeles SB. Role
of diet and exercise in the management of hyperinsulinemia
and associated atherosclerotic risk factors. Am J Cardiol.
1992;69:440–4.
163. Barnard RJ, Ugianskis EJ, Martin DA. The effects of an
intensive diet and exercise program on patients with non-
Popular Diets: A Scientific Review, Freedman, King, and Kennedy
38S OBESITY RESEARCH Vol. 9 Suppl. 1 March 2001
insulin dependent diabetes mellitus and hypertension. J Cardiopulm
Rehabil. 1992;12:194 –210.
164. Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the
treatment of NIDDM. Diabetes Care. 1994;17:1– 4.
165. Barnard RJ, DiLauro SC, Inkeles SB. Effects of intensive
diet and exercise interventions in patients taking cholesterollowering
drugs. Am J Cardiol. 1997;79:1112– 4.
166. Barnard RJ, Inkeles SB. Effects of an intensive diet and
exercise program on lipids in postmenopausal women. Women’s
Health Issues. 1999;9:155–9.
167. Ornish D. Avoiding revascularization with lifestyle changes:
the Multicenter Lifestyle Demonstration Project. Am J Cardiol.
1998;82:72T– 6T.
168. Boyar AP, Rose DP, Loughridge JR, et al. Response to a
diet low in total fat in women with postmenopausal breast
cancer: a pilot study. Nutr Cancer. 1988;11:93–9.
169. Lee-Han H, Cousins M, Beaton M, et al. Compliance in a
randomized clinical trial of dietary fat reduction in patients
with breast dysplasia. Am J Clin Nutr. 1988;48:575– 86.
170. Boyd NF, Cousins M, Beaton M, Kriukov V, Lockwood
G, Tritchler D. Quantitative changes in dietary fat intake
and serum cholesterol in women: results from a randomized,
controlled trial. Am J Clin Nutr. 1990;52:470–6.
171. Sheppard L, Kristal AB, Kushi L. Weight loss in women
participating in a randomized trial of low-fat diets. Am J Clin
Nutr. 1991;54:821– 8.
172. Singh RM, Rastogi SS, Verma R, et al. Randomized controlled
trial of cardioprotective diet in patients with recent
acute myocardial infarction: results of one year follow-up. Br
Med J. 1992;304:1015–9.
173. Hunninghake DB, Stein EA, Dujovne CA, et al. The
efficacy of intensive dietary therapy alone or combined with
lovastatin in outpatients with hypercholesterolemia. N Engl
J Med. 1992;328:1213–9.
174. Raben A, Due Jensen N, Marchmann P, Sandstro¨m B,
Astrup A. Spontaneous weight loss during 11 weeks’ ad
libitum intake of a low fat/high fiber diet in young, normal
weight subjects. Int J Obes Relat Metab Disord. 1995;19:
916–23.
175. Thompson PD. More on low-fat diets. N Engl J Med.
1998;338:1623– 4.
176. Scherwitz L, Kesten D. The German Lifestyle Change Pilot
Project. Effects of diet and other lifestyle changes on coronary
heart disease. Homeostasis. 1994;25:198 –203.
177. Beard C, Barnard RJ, Robbins DC, Ordovas JM,
Schaefer EJ. Effects of diet and exercise on qualitative and
quantitative measures of LDL and its susceptibility to oxidation.
Arterioscler Thromb Vasc Biol. 1996;16:201–7.
178. Katan MB. Beyond low fat diets. N Engl J Med. 1997;337:
563–7.
179. Kenney JJ, Barnard RJ, Inkeles S. Very-low-fat diets do
not necessarily promote small, dense LDL particles. Am J
Clin Nutr. 1999;70:423– 4.
180. Heber D, Ashley JM, Leaf DA, Barnard RJ. Reduction
of serum estradiol in postmenopausal women given free
access to low-fat high-carbohydrate diet. Nutrition. 1991;
7:137– 40.
181. Coulston AM, Liu GC, Reaven GM. Plasma glucose, insulin
and lipid responses to high-carbohydrate low-fat diets
in normal humans. Metabolism. 1983;32:52– 6.
182. Ludwig DS, Pereria MA, Kroenke CH, et al. Dietary fiber,
weight gain, and cardiovascular disease risk factors in young
adults. JAMA. 1999;282:1539–46.
183. Blundell JE, Green S, Burley V. Carbohydrates and human
appetite. Am J Clin Nutr. 1994;59(suppl):728S–34S.
184. Stubbs RJ, Harbron CG, Murgatroyd PR, Prentice AM.
Covert manipulation of dietary fat and energy density: effect
on substrate flux and food intake in men eating ad libitum.
Am J Clin Nutr. 1995;62:316 –29.
185. Stubbs RJ, Ritz P, Coward WA, Prentice AM. Covert
manipulation of the ratio of dietary fat to carbohydrate and
energy density: effect of food intake and energy balance in
free-living m en eating ad libitum. Am J Clin Nutr. 1995;62:
316–29.
186. Astrup A, Toubro S, Raben A, Skov AR. The role of
low-fat diets and fat substitutes in body weight management:
what have we learned from clinical studies? J Am Diet Assoc.
1997;97(suppl):S82–7.
187. Rolls BJ. The role of energy density in the overconsumption
of fat. J Nutr. 2000;130:268S–71S.
188. Kendall A, Levitsky DA, Strupp BJ, Lissner L. Weight loss
on a low-fat diet: consequence of the imprecision of the control
of food intake in humans. Am J Clin Nutr. 1991;53:1124–9.
189. Burton-Freeman B. Dietary fiber and energy regulation.
J Nutr. 2000;130(suppl):272–5S.
190. Goris AHC, Westerterp-Plantenga MS, Westerterp KR.
Undereating and underrecording of habitual food intake in
obese men: selective underreporting of fat intake. Am J Clin
Nutr. 2000;71:130–4.
191. Lichtman SW, Pisarska K, Berman ER, et al. Discrepancy
between self-reported and actual caloric intake and exercise
in obese subjects. N Engl J Med. 1992;327:1893– 8.
192. Lyon X-H, Di Vetta C, Milon H, Je´quier E, Schutz Y.
Compliance to dietary advice directed towards increasing the
carbohydrate to fat ratio in the everyday diet. Int J Obes
Relat Metab Disord. 1995;19:260 –9.
193. Costill DL, Hargreaves M. Carbohydrate nutrition and fatigue.
Sports Med. 1992;13:86 –92.
194. McGuire MT, Wing RR, Klem M, Lang W, Hill JO. What
predicts weight regain in a group of successful weight losers?
J Consult Clin Psychol. 1999;67:177– 85.
195. Shick SM, Wing RR, Klem M, McGuire MT, Hill JO,
Seagle H. Persons successful at long-term weight loss and
maintenance continue to consume a low-energy, low-fat diet.
J Am Diet Assoc. 1998;98:408 –13.
196. Toubro S, Astrup A. Randomized comparison of diets for
maintaining obese subjects’ weight after major weight loss:
ad lib, low fat, high carbohydrate v fixed energy intake. Br
Med J. 1997;314:29 –35.
197. Crawford D, Jeffery RW, French SA. Can anyone successfully
control their weight? Findings of a three year community-
based study of men and women. Int J Obes Relat Metab
Disord. 2000;24:1107–10.
198. McCrory MA, Fuss PJ, Saltzman E, Roberts SB. Dietary
determinants of energy intake and weight regulation in
healthy adults. J Nutr. 2000;130:276S–9S.
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Atkins Facts:
 
> What the Experts Think of Atkins
> Faulty Science
> Short-Term Side Effects
> All Long-Term Studies on Atkins a Wash
> Long-Term Side Effects
> The Safer Alternative
> References 1-1160

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