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    There are various fad diets that are widely marketed. However, most fad diets are short in duration and not sustainable for long term use.

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    In general, it is widely understood that excess intake of calories from any source, associated with a sedentary lifestyle, causes unintended weight gain and obesity. The goal of dietary therapy, therefore, is to reduce the total number of calories consumed. A principal determinant of weight loss appears to be the degree of adherence and compliance with the dietary recommendations, irrespective of the particular macronutrient composition [1-4]. There are 4 major categories of diets to include but not limited to: Balanced low-calorie diets/portion-controlled diets, Low-fat diets, Low-carbohydrate diets and the Mediterranean diet. These are all considered to be conventional diets which are defined as those with energy requirements above 800 kcal/day [5].

    Balanced low-calorie diets involve selection of foods that contain the adequate nutrients in addition to protein, carbohydrate, and essential fatty acids that support healthy weight loss. Intuitively, these diets often times involve eliminating alcohol, sugar-containing beverages, and most highly concentrated sweets as they are considered "empty calories", or otherwise caloric intake without nutritional value other than energy. What must be considered in these diets is that there will be breakdown of protein to some degree as there is some breakdown of lean muscle tissue during weight loss. When weight increases as a result of overeating, approximately 75 percent of the extra energy is stored as fat and the remaining 25 percent as lean tissue. If the lean tissue contains 20 percent protein, then 5 percent of the extra weight gain would be protein. Thus, it should be anticipated that during weight loss, at least 5 percent of weight loss will be protein [6].

    Portion-controlled diets are attractive as they can be associated with less effort and accuracy of intake. Individually packaged foods, such as formula diet drinks using powdered or liquid formula diets, nutrition bars, frozen food, and pre-packaged meals that can be stored at room temperature as the main source of nutrients [7].

    Low-fat diets are also well known in efforts to facilitate weight loss with respect to the fact that almost all dietary guidelines recommend a reduction in the daily intake of fat to 30 percent of energy intake or less [8]. In a meta-analysis of trials comparing low-fat diets (typically 20 to 25 percent of energy from fats) with a control group consuming a usual diet or a medium fat diet (usually 35 to 40 percent of energy), there was greater weight loss (approximately 3 kg) with low-fat compared with moderate fat diets [9]. Decrease in fat content can also have an added benefit in decreasing cardiovascular risk facts such as a decrease in total cholesterol and increase in high density lipoprotein.

    Additionally, low-fat diets can be associated with health weight maintenance with appropriate caloric intake and consumption of healthy carbohydrates. This was well demonstrated by the Women's Health Initiative Dietary Modification Trial of 48,835 postmenopausal women over age 50 years who were randomly assigned to a dietary intervention that included group and individual sessions to promote a decrease in fat intake and increases in fruit, vegetable, and grain consumption (healthy carbohydrates), but did not include weight loss or caloric restriction goals, or a control group which received only dietary educational materials [26]. After an average of 7.5 years of follow-up, the following results were seen:1) Women in the intervention group lost weight in the first year (mean of 2.2 kg) and maintained lower weight than the control women at 7.5 years (difference of 1.9 kg at one year, and 0.4 kg at 7.5 years). 2) There was no propensity to weight gain demonstrated in the intervention group overall, or when stratified by age, ethnicity, or body mass index. 3) Weight loss was related to the level of fat intake and was greatest in women who decreased their percentage of energy from fat the most [10].

    Low-carbohydrate diets are advocated by many people who deduce that the obesity epidemic in the United States may be in part secondary to low-fat, high-carbohydrate diets. The carbohydrate content of the diet is an important determinant of short-term (less than two weeks) weight loss. Low- (60 to 130 grams of carbohydrates) and very-low-carbohydrate diets (0 to <60 grams) have been popular for many years [11]. Restriction of carbohydrates leads to glycogen mobilization and, if carbohydrate intake is less than 50 g/day, ketosis will develop. Rapid weight loss develops, primarily as a result of glycogen breakdown and fluid loss as opposed to fat loss. As a result, low-carbohydrate diets are more efficacious in short term weight loss when compared to long term benefits associated with Low-fat diets.

    The central focus of the Mediterranean is consistent with a dietary pattern that is common in olive-growing areas of the Mediterranean. There may be variation in Mediterranean diets, but the common components include a high level of monounsaturated fat relative to saturated; moderate consumption of alcohol (predominately wine); a high consumption of vegetables, fruits, legumes, and grains; a moderate consumption of milk and dairy products (namely in the form of cheese); and a relatively low intake of meat. Furthermore, the Mediterranean diet appears to be associated with several health benefits, including cardiovascular risk reduction and diabetes prevention [12,13].

    In addition to the most common types of aforementioned diets, some people purport the idea of high-protein diets. However, in meta-analyses comparing the long-term effects of low-fat diets with either high or low protein content, there were no significant statistical differences in weight loss, waist circumference, lipids, and blood pressure [14,15]. If dietary fat is held constant, energy from carbohydrate sources increases as energy from dietary protein decreases. As a result, patients randomly assigned to the low-fat, high-protein diet had lower carbohydrate intake than those assigned to the low-fat, low-protein diet (typically 40 versus 55 to 65 percent of daily caloric intake). Lastly, diets with energy levels between 200 and 800 kcal/day are called "very-low-calorie diets," while those below 200 kcal/day can be termed starvation diets. Theidea surrounding these diets is that the lower the calorie intake the more rapid the weight loss, because the energy withdrawn from body fat stores is a function of the energy deficit. Starvation is the ultimate very-low-calorie diet and results in the most rapid weight loss. Surprisingly, once popular, starvation diets are now rarely used for treatment of obesity and are not considered superior to conventional diets. This is supported by a meta-analysis of six trials comparing very-low-calorie diets with conventional low-calorie diets, short-term weight loss was greater with very-low-calorie diets (16.1 versus 9.7 versus percent of initial weight), but there was no difference in long-term weight loss (6.3 versus 5.0 percent) [16].

    If adhered to, any diet that reduces caloric intake below expenditure will result in weight loss that is related to the energy deficit. This was demonstrated by the findings of a meta-analysis of 48 randomized trials (7286 individuals) comparing different dietary programs (predominantly low carbohydrate, moderate macronutrient, or low fat) with a comparator (no diet or competing dietary program) [41]. Compared with no diet, all diet programs resulted in significant weight loss (approximately 6 to 8 kg at six months). Therefore, balance and a diet that is palatable is the recommended course of action.

    Lastly, maintaining weight loss must be a multimodal approach. Many individuals have success losing weight with diet. However, people most subsequently regain much or all of the lost weight. Maintaining weight loss is made difficult by the reduction in energy expenditure that is induced by weight loss. In addition, long-term adherence to restrictive diets is difficult. Exercise and behavioral interventions may help individuals maintain weight loss [6].

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    2. Wadden TA, Neiberg RH, Wing RR, et al. Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity (Silver Spring) 2011; 19:1987.

    3. Del Corral P, Chandler-Laney PC, Casazza K, et al. Effect of dietary adherence with or without exercise on weight loss: a mechanistic approach to a global problem. J Clin Endocrinol Metab 2009; 94:1602.

    4. Pagoto SL, Appelhans BM. A call for an end to the diet debates. JAMA 2013; 310:687.

    5. Freedman MR, King J, Kennedy E. Popular diets: a scientific review. Obes Res 2001; 9 Suppl 1:1S.

    6. https://www.uptodate.com/contents/obesity-in-adults-dietary-therapy source=search_result&search=weight%20management&selectedTitle=3~150 (Accessed on April 9, 2017).

    7. Flechtner-Mors M, Ditschuneit HH, Johnson TD, et al. Metabolic and weight loss effects of long-term dietary intervention in obese patients: four-year results. Obes Res 2000; 8:399.

    8. Medline Plus: Diets http://www.nlm.nih.gov/medlineplus/diets.html#cat1 (Accessed on April 9, 2017).

    9. Phelan S, Liu T, Gorin A, et al. What distinguishes weight-loss maintainers from the treatment-seeking obese? Analysis of environmental, behavioral, and psychosocial variables in diverse populations. Ann Behav Med 2009; 38:94.

    10. Howard BV, Manson JE, Stefanick ML, et al. Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial. JAMA 2006; 295:39.

    11. Freedman MR, King J, Kennedy E. Popular diets: a scientific review. Obes Res 2001; 9 Suppl 1:1S.

    12. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368:1279.

    13. Salas-Salvadó J, Bulló M, Babio N, et al. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care 2011; 34:14.

    14. Schwingshackl L, Hoffmann G. Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis. Nutr J 2013; 12:48.

    15. Wycherley TP, Moran LJ, Clifton PM, et al. Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. Am J Clin Nutr 2012; 96:1281.

    16. Tsai AG, Wadden TA. The evolution of very-low-calorie diets: an update and meta-analysis. Obesity (Silver Spring) 2006; 14:1283.


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