Confession Good for the Soul?

I confess!! I confess!! That’s what the poor data must have said when the authors of a recent study reported yesterday in the Journal of the American Medical Association finally figured out a way to spin their pitiful results. Just as Mike predicted about this in his blog on January 3, 2006 (Brace yourself for more low fat buncombe) the bit got picked up quickly by the press. Our local paper picked up an AP article by Carla K. Johnson and set the headline large and bold with this title: Low-fat, high-carb diet leads to moderate weight loss. Study discouraging but refutes claims by Atkins promoters.

A quick look at the data made me wonder how they came to that conclusion. Here’s what Ms. Johnson reported:

The low-fat group lost, on average, 4.8 pounds in the first year, then regained most of that weight. The non-diet group stayed at about the same weight over the seven years.

Let me get this straight. A large group of borderline obese women loses an average of 4.8 pounds in a year and regains most of that meager loss over the next 7 years, winding up losing just over a pound and the research shows “moderate weight loss” and the study “refutes the claims by Atkins promoters” that a high carb diet causes weight gain?? I guess a pound of loss in 7 years is moderate in some camp.

Yep, they found the smoking gun all right.

It seems to me that a more truthful headline would have been “Even with intense behavioral and nutritional coaching, low fat high carb diet proven effective to keep overweight middle aged women overweight.”

It beggars belief that the authors would have the chutzpah to trumpet as a positive result the “fact” that their study proved at last that all of us low carb gurus were wrong, that the low fat high carb diet didn’t cause weight gain! It’s no surprise that replacing cupcakes and candy bars with fruits, veggies, and whole grains would result in a little improvement–albeit, short lived. Heck, all of their participants (average BMI of just under 30) were already pretty fat at the outset and stayed just about the same despite regular professional contact, behavior mod counselling, and explicit dietary instruction to follow a whole grain, fruit and vegetable filled, low fat high carb diet on which they not only gained back most of their early skimpy loss, but according to the study data, actually increased their abdominal girth almost as much as the control group.

It’s a sorry state of affairs when that much effort garners no better result than just leaving people alone and letting them eat whatever they wanted. What kind of message can this possibly send to overweight Americans trying to lose? Work really hard trying to follow this “healthy diet” for seven years and if you’re lucky you will at least not gain more weight than if you did nothing at all!!??

I can only wish that we (or anyone without a carbs-are-us bias) had had access to the huge amount of research money that it took to run this study and could have used it to instruct a similar number of middle aged overweight women on following a healthy low carb diet. Then we’d have seen a major change. I know; we’ve seen it first hand in a head to head match up.

Back when we had our clinic in Little Rock, Arkansas, we were involved in the clinical trial of one of the major weight loss prescription drugs currently on the market. Our arm of the study was to test whether this drug would be of use as a weight maintenance tool, i.e., after people had lost weight, would taking this drug every day help them keep it off? Toward that end, the participants in this study had to undertake a 6-month long period of weight loss on a low fat, high carb, calorie restricted “healthy” food pyramid based diet. (The study design dictated the structure of the weight-loss lead-in diet; obviously that structure isn’t one we would have chosen to help people lose weight.)

The participants received regular and intense behavior mod and dietary instruction, similar, I would imagine, to that received by the women in this most recent study. Over the course of the 6 months, to be eligible for the drug trial, the participants had to lose at least 4% of their body weight. For a 200 pound person, that amounts to a loss of 8 pounds in 6 months. Not a lot by my standards, but, amazingly, many patients couldn’t manage that small degree of loss on the low-fat, high-carb, low-cal diet and had to be dropped from the study group.

But there was another slight complicaton that caused us to lose a few more patients from the study group.

We ran this trial in our weight loss clinic and these study patients sat in the same waiting room with our weight loss patients and of course they chit-chatted. When the study patients, struggling to lose slightly over a pound a month, found out that patients following our Protein Power regimen were losing 2 to 4 pounds a week… Well, you can imagine how eager they were to remain in the study.

But I digress. Back to the low-fat-high-carb-no-weight-loss-but-no- weight-gain miracle study.

Having entered this nutritional debate two decades ago at a time when low-carb dieting was a four letter word, it’s an interesting turn of events to see proponents of the low fat, high carb diet puffed up with pride that their diet (at least when carefully monitored and with lots of on-going patient education) didn’t make people fatter after all.