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Why do some people lose 100 pounds on a diet that other people follow faithfullywith the result of weight gain? The answer is simpler than you might think.

Since the 1990's, a variety of diets have promoted restriction of certain macronutrients (carbohydrate, protein, or fat) as a tool for quick weight loss. The famous Dr. Barry Sears of Zone Diet fame copied a diet used for feeding race horses to propose weight loss by getting 30 percent of calories from protein foods, 30 percent of calories from fat, and 40 percent of calories from carbohydrates. Dr. Dean Ornish, an ethical vegan, recommended eliminating all foods of animal origin and getting no more than 10 percent of calories from fat. The late Dr. Robert Atkins took the exact opposite approach, lauding fat and protein but insisting that no more than 10 percent of calories should come from carbs.

The truth is, none of these diets works reliably well. Dr. Frank Sacks, a professor of nutrition at Harvard, recruited 811 adults to follow one of four different diet plans, and gave them access to coaches who would help stick to their diet plan. The four diets ranged over the span of what has become popular. Two diets were low in fat. One low-fat diet, however, was high in protein and the other had average amounts of protein. Two others were high in fat. One of those high-fat diets was high-protein while the other was average in protein. Dieters were instructed to record everything they ate and drank, and to exercise at least 90 minutes a week. The diets lasted two years.

How much weight do you suppose dieters, on average, lost by dieting for two whole years? The average weight loss in the each of the four diet groups was just three to four kilograms, or seven to nine pounds. Even though dieters were given plans that reduced their calories by 750 per day, which should have resulted in a loss of a pound (450 grams) every four days, the average weight loss was closer to a pound every four months. The problem wasn't just that dieters were cheating. Every plan had a few participants who lost 20 kilograms (44 pounds) or more, and every plan had at least a few dieters who gained weight.

The truth is, some people will lose weight on a low glycemic-load diet (a diet that not only restrict foods by their glycemic index but also restricts how much of those foods are allowed), and others will gain. Some people will get nearly miraculous results by taking the stimulant phentermine for a year or two, and then start gaining weight even though they are still taking the drug. Some people need to count each and every calorie each and every day. Others lose weight when they vary their intake day by day. Some people lose weight by working out hard, but gain it back when they resume a more moderate exercise program.

The simple fact is, you are very lucky if the first weight loss plan you try works for you. But don't give up. There are countless variations of diet plans. There are at least 15 diet drugs. In extreme cases (and for anyone who has uncontrolled diabetes) there is weight loss surgery. It can take several years to find the program that works for you, but persist in your efforts. Just as no diet works for everyone, some diet will work for you if you keep trying to find it.

  • Frank M. Sacks, M.D., George A. Bray, M.D., Vincent J. Carey, Ph.D., Steven R. Smith, M.D., Donna H. Ryan, M.D., Stephen D. Anton, Ph.D., Katherine McManus, M.S., R.D., Catherine M. Champagne, Ph.D., Louise M. Bishop, M.S., R.D., Nancy Laranjo, B.A., Meryl S. Leboff, M.D., Jennifer C. Rood, Ph.D., Lilian de Jonge, Ph.D., Frank L. Greenway, M.D., Catherine M. Loria, Ph.D., Eva Obarzanek, Ph.D., and Donald A. Williamson, Ph.D. Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. N Engl J Med 2009. 360:859-873February 26, 2009DOI: 10.1056/NEJMoa0804748.
  • Photo courtesy of freepik.com
  • Photo courtesy of freepik.com
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