International organizations and governments are now more or less agreed we have an epidemic of obesity so, for the research community, the big question is which diet to recommend. Note the “recommend”. There’s no willingness in any government to try forcing a change in what we eat. The best first step is to recommend the most effective diet based on the best available evidence. There are a number to choose from under the general headings of low-carb, high-protein, high-fat diets. The problem with much of the current evidence is the small number of people enrolled in short-term trials. To be able to make general statements, there should be a statistically significant number of participants and the trials should last a reasonable period of time for the full effects to be measured. With dieting there’s also the problem that up to half the participants drop out of most trials. Just published is a new trial that lasted for two years. Called DIRECT (Dietary Intervention Randomized Controlled Test), it compared a Mediterranean, calorie-restricted diet based on the Harvard Medical School guide to healthy eating; a low-fat, calorie-restricted diet based on the American Heart Association’s guidelines; and a low-carb, non-restricted-calorie diet based on Atkins. The participants were aged between 40 and 65 and had a BMI of at least 27, or an existing diagnosis of diabetes or heart disease. The average was people with a BMI of 31 with 86% men. Over two years, 90% stayed with the low-fat diet, 85% with the Mediterranean diet, and 78% with the low-carb diet. Weight was lost consistently in the first six months, with the new weight then stabilizing. Those in the low-fat group lost the least weight with the loss by the Mediterranean and low-carb groups broadly similar with participants dropping two BMI levels. Everyone lost about 2 inches in waist circumference. But the Mediterranean and low-carb diets showed good reductions in blood pressure and improvements in metabolic effects making them the preferred approaches, i.e. there were real, measurable health benefits and not just weight loss. The recommendation is therefore for doctors or nutritionists to discuss dieting preferences with you, aiming to agree a strategy suited to your tastes. If selecting the diet, it may be that an Atkins approach is best for those who find it difficult to restrict their calorie intake. No one should approach this decision with closed minds. It’s a case of starting with one program and then varying it to find the combination of foods you find easiest to accept for the long-term where the greatest health benefits are earned. Acomplia is a useful addition to the program. In clinical trials, it also performed well, helping participants lose an average 10% of their body weight. With the right diet, a little additional exercise, and Acomplia in support, there’s no reason why you should not break the two-year barrier and go on to an increasingly healthy future life. All it needs is your own willpower and the support of your family and friends.

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