Dietary adherence and weight loss success among overweight women: results from the A TO Z weight loss study

Abstract

Background: Dietary adherence has been implicated as an important factor in the success of dieting strategies; however, studies assessing and investigating its association with weight loss success are scarce. Objective: We aimed to document the level of dietary adherence using measured diet data and to examine its association with weight loss success. Design: Secondary analysis was performed using data from 181 free-living overweight/obese women (mean ± s.d. age ¼ 43 ± 5 years, body mass index ¼ 31 ± 4 kg m À2 ) participating in a 1-year randomized clinical trial (the A TO Z study) comparing popular weight loss diets (Atkins, Zone and Ornish). Participants' dietary adherence was assessed as the difference between their respective assigned diet's recommended macronutrient goals and their self-reported intake. Association between dietary adherence and 12-month weight change was computed using Spearman's correlations. Differences in baseline characteristics and macronutrient intake between the most and least adherent tertiles for diet groups were compared using t-tests. Results: Within each diet group, adherence score was significantly correlated with 12-month weight change (Atkins, r s ¼ 0.42, P ¼ 0.0003; Zone, r s ¼ 0.34, P ¼ 0.009 and Ornish, r s ¼ 0.38, P ¼ 0.004). Twelve-month weight change in the most vs least adherent tertiles, respectively, was À8.3±5.6 vs À1.9±5.8 kg, P ¼ 0.0006 (Atkins); À3.7±6.3 vs À0.4±6.8 kg, P ¼ 0.12 (Zone) and À6.5 ± 6.8 vs À1.7 ± 7.9 kg, P ¼ 0.06 (Ornish). Conclusions: Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.

High body fat percentage among adult women in Malaysia: the role of lifestyle

“…According to [22], common failure in following traditional weight loss strategies among overweight and obese people has prompted a surge in alternative diet approaches like carbohydrate restriction (Atkins), fat restriction (Ornish) or replacing carbohydrate with protein (Zone). However, without proper weight loss strategy, losing weight is rather difficult to achieve.…”

Managing obesity in adults in primary care

“…16,32,33 These trials suggest that dietary adherence and caloric restriction are more important than macronutrient composition in determining weight loss (level I evidence). Canadian guidelines on obesity recommend a highprotein or low-fat diet as a reasonable short-term (6-12 mo) treatment option for adults with obesity (level III evidence).…”

Medical Therapy for Obesity

“…At the end of 6 months, 12 months, and 2 years, the weight loss was similar for all 4 diets. The principal determinant of success was adherence to the diet, a finding made by Dansinger et al 13 and Alhassan et al 18 …”

“…In this study, too, a post-hoc analysis showed that adherence was the best predictor for weight loss and that the level of adherence to any diet was not very good. 18 Two reasons are proposed for the differences. First, the study by Gardner and colleagues 14 had a more homogeneous population, including only premenopausal women.…”