Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: The A to Z weight loss study: A randomized trial

Christopher D. Gardner, Alexandre Kiazand, Sofiya Alhassan, Soowon Kim, Randall S. Stafford, Raymond Balise, Helena C. Kraemer, Abby C. King

Research output: Contribution to journalArticle

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Abstract

Context: Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately. Objective: To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. Design, Setting, and Participants: Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women. Intervention: Participants were randomly assigned to follow the Atkins (n=77), Zone (n=79), LEARN (n=79), or Ornish (n=76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. Main Outcome Measures: Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing. Results: Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95% confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95% CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. Conclusions: In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss. Trial Registration: clinicaltrials.gov Identifier: NCT00079573.

Original languageEnglish (US)
Pages (from-to)969-977
Number of pages9
JournalJournal of the American Medical Association
Volume297
Issue number9
DOIs
StatePublished - Mar 7 2007
Externally publishedYes

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Weight Loss
Diet
Weights and Measures
Carbohydrate-Restricted Diet
Carbohydrates
High Fat Diet
Confidence Intervals
Reducing Diet
Waist-Hip Ratio
HDL Lipoproteins
LDL Lipoproteins
Adipose Tissue
Fasting
Body Mass Index
Outcome Assessment (Health Care)
Insulin
Blood Pressure
Lipids
Glucose
Proteins

ASJC Scopus subject areas

  • Medicine(all)

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Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women : The A to Z weight loss study: A randomized trial. / Gardner, Christopher D.; Kiazand, Alexandre; Alhassan, Sofiya; Kim, Soowon; Stafford, Randall S.; Balise, Raymond; Kraemer, Helena C.; King, Abby C.

In: Journal of the American Medical Association, Vol. 297, No. 9, 07.03.2007, p. 969-977.

Research output: Contribution to journalArticle

Gardner, Christopher D. ; Kiazand, Alexandre ; Alhassan, Sofiya ; Kim, Soowon ; Stafford, Randall S. ; Balise, Raymond ; Kraemer, Helena C. ; King, Abby C. / Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women : The A to Z weight loss study: A randomized trial. In: Journal of the American Medical Association. 2007 ; Vol. 297, No. 9. pp. 969-977.
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abstract = "Context: Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately. Objective: To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. Design, Setting, and Participants: Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women. Intervention: Participants were randomly assigned to follow the Atkins (n=77), Zone (n=79), LEARN (n=79), or Ornish (n=76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. Main Outcome Measures: Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing. Results: Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95{\%} confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95{\%} CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. Conclusions: In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss. Trial Registration: clinicaltrials.gov Identifier: NCT00079573.",
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T2 - The A to Z weight loss study: A randomized trial

AU - Gardner, Christopher D.

AU - Kiazand, Alexandre

AU - Alhassan, Sofiya

AU - Kim, Soowon

AU - Stafford, Randall S.

AU - Balise, Raymond

AU - Kraemer, Helena C.

AU - King, Abby C.

PY - 2007/3/7

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N2 - Context: Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately. Objective: To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables. Design, Setting, and Participants: Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women. Intervention: Participants were randomly assigned to follow the Atkins (n=77), Zone (n=79), LEARN (n=79), or Ornish (n=76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up. Main Outcome Measures: Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing. Results: Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95% confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95% CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups. Conclusions: In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight and experienced more favorable overall metabolic effects at 12 months than women assigned to follow the Zone, Ornish, or LEARN diets. While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss. Trial Registration: clinicaltrials.gov Identifier: NCT00079573.

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