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What approach to dieting is best for sustainable weight loss? This question remains under debate. Image credit: Monica Rodriguez/Getty Images.
  • Researchers compared the effects of a diet focused on food choices with those of a diet focused on calorie counting.
  • Both diets led to similar small losses on weight circumference after a year, although neither led to significant weight loss.
  • Further studies are needed to understand how these diets can be optimized for weight loss.

The prevalence of obesity increased from 30.5% to 41.9% among the population of the United States between 1999 and 2020. During the same period, cases of severe obesity increased from 4.7% to 9.2%.

Reducing obesity is a key public health target, as it can increase the risk of other chronic health conditions, such as type 2 diabetes. So far, Most behavioral interventions for obesity emphasize calorie restriction and portion size limits.

However, weight regain after weight loss is common. A meta-analysis of 29 long-term weight loss studies found that almost 80% of the participants regained weight within 5 years.

Some studies suggest that diets focusing on satiety and satiation by including higher levels of protein and fiber may be more effective than calorie counting for maintaining weight loss. Satiety refers to feeling free from hunger, while satiation is feeling satisfied with a meal.

Further study of diets that promote satiety and satiation could improve weight loss interventions.

Recently, researchers compared the weight loss effects of two diets. One diet focused on healthy food choices, and the other on reducing calorie intake.

They found that diets based on food choices may be a practical alternative to calorie counting approaches, although neither produced significant weight loss results after a year.

The study was published in The Annals of Family Medicine.

For the study, the researchers recruited 261 adult participants who were overweight and from low-income backgrounds. Participants had an average age of 42 years, around 95% were female, and 86% were Latinx.

They split the participants into two groups at random. One group engaged in a diet focused on calorie reduction, the National Diabetes Prevention Program, while the other followed the MyPlate diet, which focuses on healthy nutrient intake with an emphasis on fruits, vegetables, grains, protein foods, and dairy products.

Participants engaged in both diets for 12 months. The interventions included 11 touchpoints, among which:

  • two home education visits
  • two group education sessions
  • seven telephone coaching calls over 6 months.

Ultimately, participants in the MyPlate intervention group and the calorie counting intervention group lost an average of 3.15 centimeters (cm) and 2.72 cm of their waist circumference, respectively.

Altogether, 59.1% of people in the MyPlate group and 53.5% of those in the calorie counting group lost weight by the end of the study.

However, the researchers found that neither intervention yielded significant reductions in body weight. Those in the MyPlate group lost an average of 0.34 kilograms (kg), whereas those in the calorie counting group lost an average of 0.75 kg.

Both groups reported increased satiation and satiety over the course of the study. Those in the calorie counting group, but not the MyPlate group, also reported decreases in hunger. Participants in both groups also experienced increases in quality of life and mental health.

The researchers further noted an association between the number of sessions attended by participants and weight-related changes. Those who did not attend sessions underwent no change, whereas those exposed to between one and six sessions or between seven and 11 sessions experienced modest and significant improvements, respectively.

Neither group experienced a significant decrease in systolic or diastolic blood pressure at 12 months, although those in the MyPlate group experienced a small decrease in systolic blood pressure at six months.

Medical News Today spoke with Dr. Debbie Fetter, assistant professor of teaching nutrition at the University of California, Davis, who was not involved in the study, about when MyPlate-based interventions may be more practical than calorie-counting diets.

“Using food-based approaches can be easier for people to integrate into their everyday lives. This approach allows people to identify foods, rather than meticulously track their dietary intake using some type of application/resource,” she said.

“Plus, what may be surprising is that the nutrition data isn’t even entirely accurate. For example, the calorie amounts that you see on the food label are allowed to have a margin of error of +/- 20%. If someone is using calorie counting to adjust their body composition, they could unknowingly be using flawed data. Calorie counting can also attribute to unhealthful eating behaviors, so it’s important for consumers to be mindful about this and decide what approach is right for them,” she added.

Dr. Johanna Finkle, clinical assistant professor of OB/GYN, and obesity medicine specialist at The University of Kansas Health System, also not involved in the study, further told MNT:

“I always tell my patients that protein will keep you full longer. The type of protein also matters. The composition of our diets impacts the release of our gut hormones and impacts our gut microbiome. [This means that] healthier food — as promoted by the MyPlate intervention — may keep us healthier from a hormonal and gut microbiome standpoint which, in turn, translates to more satiety and more weight loss.”

MNT asked Dr. Deepa Iyengar, professor of family medicine and obesity expert with McGovern Medical School at UTHealth Houston, not involved in the study, which patients may be better suited for MyPlate and calorie-cutting interventions.

According to her, “MyPlate is for most people since it is just [the] introduction of a balanced diet with different food groups; calorie counting can also be used for most foods but is more often used in diabetic patients.”

MNT also spoke with Dr. Felix Spiegel, a bariatric surgeon at Memorial Hermann in Houston, TX, who was not involved in the research, abut the study.

He noted: “People who eat because they are actually hungry and crave the full feeling are more suitable for MyPlate. People who are snackers and grazers and who rarely feel actual hunger sensation in their belly, are more suitable for calorie counting. Also, if you’re a type A person, who wants control, you may benefit better from calorie counting.”

When asked about the study’s limitations, Dr. Finkle told MNT that the study did not include details such as:

  • how patients were instructed to eat
  • timing of food
  • how slow or fast they eat
  • which part of the plate they ate first.

“The study [also] did not use a digital tool like my fitness pal which can be easily used to count calories. [Furthermore, participants] had an extreme amount of support from the community which is not commonly available in a primary care setting. [Interventions may not] yield the same results without [similar] home visits, education, etc.,” she pointed out.

Dr. Fetter added that “[t]he external generalizability of the study may be limited. Participants were primarily female and Latinx.“

“However,“ she said, “it’s important to have nutrition interventions tailored to people’s communities and cultural backgrounds. To further strengthen the study, the researchers may consider tailoring the education to focus on cultural/traditional foods that are personally meaningful to their target population.”

Dr. Spiegel noted that a key limitation is that after 12 months of intervention, neither group reported significant weight loss, and that waist circumference decreased very little.

“Both techniques can work to produce weight loss. However, there needs to be much more structure and guidance in these programs. If that is done, the results could be more significant,” he told us.

Dr. Fetter said: “Working with participants to develop a dietary pattern that works well for them may lead to [a] greater likelihood of incorporating these healthy changes into their everyday life.”

“It can also be easier for participants to picture a vegetable or a whole grain, rather than XX number of calories or grams of fiber. Using a foods-based approach can bring the nutrition concepts to life and provide realistic examples. Participants can have greater confidence in implementing the dietary changes e.g., choosing brown rice in place of white rice.”

– Dr. Debbie Fetter

She noted, however, that adjusting body composition and maintaining weight loss can be difficult, and that she always recommends consulting a doctor to figure out whether changes are necessary.

“I also recommend working with a registered dietitian to develop a healthful eating plan that will help you reach your goal in a safe and effective manner. There are a lot of factors that influence our body composition, and it’s not as simple as calories in versus calories out. Everybody is different, and losing or gaining weight is complicated,” she concluded.