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The individualized approach to dieting has powerful proof at the Weight Loss Registry, a roster of successful long-term dieters started 12 years ago. To be included, members must have maintained a 30-pound weight loss for at least a year. At 4,800 members, the Registry is now the largest collection to date of long-term weight-loss data, says its cofounder James Hill, PhD, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center and co-author of The Step Diet Book. The Registry's key finding, he reports, is that "there are a lot of different ways to lose weight." The Registry entrants did "low-carb diets, low-fat diets, diets based on the food pyramid, the grapefruit diet, the beer diet ... it's amazing how many different plans worked."Even the venerable weight-loss program at the Duke Diet and Fitness Center in Durham, North Carolina, which recently had only a single low-fat, low-salt plan consistent with American Heart Association guidelines, now gives patients choices. "As of last year, we offer a wider range of options, including three different versions of low-carb diets," says Howard Eisenson, MD, the center's director. "There has been emerging research showing that some people do very well with those plans."
What Kind of Car Are You?
While all of us require regular fueling and maintenance, just like cars, we're made to different specifications. Some of us are trim, fuel-efficient Hondas; others are wide-bodied, gas-guzzling Hummers. "Eventually we will be able to identify dozens of different types of obesity, and therefore dozens of ways of treating it," says C. Wayne Callaway, MD, an endocrinologist and weight specialist at George Washington University. In his practice, he sees people who have insulin resistance (a condition in which the body becomes less sensitive to insulin and begins to overproduce it to compensate); genetic variations in the autonomic nervous system that favor storing more abdominal fat; and people whose metabolisms have temporarily slowed while dieting. While some of these patients might need one of the few FDA-approved prescription weight-loss drugs, many will benefit from a diet that works with their body and lifestyle.
The human machine also contains a computer (otherwise known as the brain) that supplies the other half of the weight-loss equation. Eating is an emotional, cultural and personal experience, not just fuel.
What type of diet should a person choose? That question hit home with Gary Foster, PhD, clinical director of the Weight and Eating Disorders Program at the University of Pennsylvania School of Medicine, who compared low-fat and low-carb regimens. Though still a firm proponent of low-fat "heart healthy" diets, Foster found, in a recent study he headed, that after one year of adherence, the two diets offered equal benefits in pounds lost -- but those on the low-carb plan had greater improvement in some heart-disease risk factors such as cholesterol levels. (Experts caution, though, that the long-term safety of low-carb, high-protein diets is unknown.)
"On a low-fat diet there's a lot of counting calories, fat grams, fiber, sodium," says Foster. "But some people like the freedom it provides to choose what to eat as long as they keep track of it. Others would prefer a simpler plan like Atkins, where you just count one thing: carbs."
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