This content is taken from the IAPAM’s Medically Supervised Weight Loss training program. The program is designed to help physicians incorporate a medical weight loss program into their medical practice.
The Atkins Diet
The Atkins Diet represents a departure from prevailing theories. Atkins claimed there are two main unrecognized factors about Western eating habits, arguing firstly that the main cause of obesity is eating refined carbohydrates, particularly sugar, flour, and high-fructose corn syrups; and secondly, that saturated fat is overrated as a nutritional problem, and that only trans fats from sources such as hydrogenated oils need to be avoided. Consequently, Dr. Atkins rejected the advice of the food pyramid, instead asserting that the tremendous increase in refined carbohydrates is responsible for the rise in metabolic disorders of the 20th century, and that the focus on the detrimental effects of dietary fat has actually contributed to the obesity problem by increasing the proportion of insulin-inducing foods in the diet. While most of the emphasis in Atkins is on the diet, nutritional supplements and exercise are considered equally important elements.
Atkins involves the restriction of carbohydrates in order to switch the body’s metabolism from burning glucose to burning stored body fat. This process (called lipolysis) begins when the body enters the state of ketosis as a consequence of running out of excess carbohydrates to burn. Dr. Atkins in his book New Diet Revolution claimed that the low-carbohydrate diet produces a “metabolic advantage” where the body burns more calories, overall, than on normal diets, and also expels some unused calories. He cited one study where he estimated this advantage to be 950 calories (4.0 MJ) a day.
The Atkins diet restricts “net carbs”, or carbohydrates that have an effect on blood sugar. The effect is to decrease the onset of hunger from low blood sugar. Dr. Atkins says in Dr. Atkins’ New Diet Revolution (2002) that hunger is the number one reason why low-fat diets fail. Though studies show the efficacy of the Atkins approach after one year is the same as a low-fat diet, Dr. Atkins claimed that it was easier to stay on the Atkins diet because dieters did not feel hungry or “deprived”.
Net carbohydrates can be calculated from a food source by subtracting sugar alcohols and fiber (which are shown to have a negligible effect on blood sugar levels) from total carbohydrates. Sugar alcohols need to be treated with caution because while they may be slower to convert to glucose, they can be a significant source of glycemic load and can stall weight loss. Fructose (e.g., as found in many industrial sweeteners) also contributes to caloric intake, though outside of the glucose-insulin control loop.
Preferred foods in all categories are whole, unprocessed foods with a low glycemic load. Atkins Nutritionals, the company responsible for marketing the Atkins Diet, recommends that no more than 20% of calories eaten while on the diet come from saturated fat.
According to his book, Atkins Diabetes Revolution, for people whose blood sugar is abnormally high or who have type-2 diabetes, this diet decreases or eliminates the need for drugs to treat these conditions. The Atkins Blood Sugar Control Program (ABSCP) is an individualized approach to weight control and permanent management of the risk factors for diabetes and cardiovascular disease.
South Beach Diet
The South Beach diet is a diet plan started by Miami, Florida area cardiologist Arthur Agatston, which emphasizes the consumption of “good carbohydrates” and “good fats”. Dr. Agatston developed this diet for his cardiac patients based upon his study of scientific dieting research.
Dr. Agatston believes that excess consumption of so-called “bad carbohydrates“, such as the rapidly-absorbed carbohydrates found in foods with a high glycemic index, creates an insulin resistance syndrome—an impairment of the hormone insulin’s ability to properly process fat or sugar. In addition, he believes, along with many physicians, that excess consumption of “bad fats”, such as saturated fat and trans fat, contributes to an increase in cardiovascular disease. To prevent these two conditions, Agatston’s diet minimizes consumption of bad fats and bad carbohydrates and encourages increased consumption of good fats and good carbohydrates.
The diet has three phases. In all phases of the diet, Dr. Agatston recommends minimizing consumption of bad fats.
The Master Cleanse detox diet, also known as the Lemonade Diet, was created by Stanley Burroughs in 1941 and made popular by Peter Glickman through his book Lose Weight, Have More Energy and Be Happier in 10 Days, which promotes Burroughs’ regimen to a modern audience.
Although the recipe varies from source to source, the ingredients are generally the same. The Master Cleanse involves eating no solid food. Instead, you drink a mixture of lemon juice, Grade B/Medium maple syrup, water and Cayenne pepper.
“Dr. Siegal’s Cookie Diet” is the brand name of Dr. Sanford Siegal’s diet cookies, shakes, soup, and nutritional supplements, which he created in 1975. Dr. Siegal’s Cookie Diet products are made in Dr. Siegal’s South Florida bakery and are available online and through physicians to whom he supplies them. This is now a franchise.
The Ornish Diet: Eat more, Weigh Less
The Ornish diet was developed by Dean Ornish, MD. Ornish was the first physician to demonstrate that heart disease can be reversed by natural methods, including specific dietary and lifestyle changes. Ornish counsels that we will find success not by restricting calories, but by watching the ones we eat. He breaks this down into foods that should be eaten all of the time, some of the time, and none of the time.
The following foods can be eaten whenever you are hungry, until you are full:
• Beans and legumes
• Fruits — anything from apples to watermelon, from raspberries to pineapples
These foods should be eaten in moderation:
• Nonfat dairy products — skim milk, nonfat yogurt, nonfat cheeses, nonfat sour cream, and egg whites
• Nonfat or very low-fat commercially available products –from Life Choice frozen dinners to Haagen-Dazs frozen yogurt bars and Entenmann’s fat-free desserts (but if sugar is among the first few ingredients listed, put it back on the shelf)
These foods should be avoided:
• Meat of all kinds — red and white, fish and fowl (if we can’t give up meat, we should at least eat as little as possible)
• Oils and oil-containing products, such as margarine and most salad dressings
• Nuts and seeds
• Dairy products (other than the nonfat ones above)
• Sugar and simple sugar derivatives — honey, molasses, corn syrup, and high-fructose syrup
• Anything commercially prepared that has more than two grams of fat per serving
If one sticks to this plan, then one will meet Ornish’s recommendation of less than 10% of calories from fat, without the need to count fat grams or calories.
Weight Watchers (WW) was founded by Jean Nidetch, a Brooklyn homemaker, in 1963. Today Weight Watchers is an international company which operates in over 30 different countries; most of them under the local language equivalent phrase to weight watchers.
The thrust of the Weight Watcher´s program is on regular meetings, monitoring and encouragement, through self-help group type sessions. The dieter aims for a target weight or BMI (body mass index) of between 20 and 25. If one’s body mass index is below 20, then the subject is considered too thin, if it is over 25, the subject is overweight, if it is between 20 and 25, the subject is within the ideal weight range. People can aim for a BMI outside the 20 to 25 parameters as long as they have a doctor’s permission.
Weight Watchers Inc. says that establishing a support network at the start of any weight-loss attempt is crucial for both short and long term success. Success in the WW program hinges on the dieter attending regularly and receiving positive reinforcement.
Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss
Source: JAMA, 2005 Jan 5; 293(1): 43-53
160 overweight people were randomly assigned to one of the four diets. They followed a supervised program for two months and were left to continue the diets on their own.
After only two months, 22 percent quit the study. After a year, 35 percent dropped out of Weight Watchers and the Zone diets, and 50 percent quit the Atkins and Ornish plans.
People who stayed on their diet for a full year did experience weight loss.
• 6 percent weight loss for the Ornish program (low fat).
• 5 percent weight loss for those on both Weight Watchers and the Zone diets.
• 4 percent weight loss for Atkins dieters (low carb).