William S. Yancy Jr., MD; Stephanie B. Mayer, MD; Cynthia J. Coffman, PhD; Valerie A. Smith, DrPH; Ronette L. Kolotkin, PhD; Paula J. Geiselman, PhD; Megan A. McVay, PhD; Eugene Z. Oddone, MD; Corrine I. Voils, PhD
Note: Drs. Coffman and Smith conducted the data analysis. Drs. Yancy and Coffman, who are affiliated with the Durham VAMC and Duke University Medical Center, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Disclaimer: This article is the result of work done with resources and the use of facilities at the Durham VAMC. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the U.S. government, Duke University, Pennington Biomedical Research Center, Louisiana State University, or Virginia Commonwealth University.
Acknowledgment: The authors thank Marsha Turner, Leslie Gaillard, Terry Ervin, and Jahdai Dawes for their assistance in delivering the intervention and collecting data.
Grant Support: By the Department of Veterans Affairs (IIR 09-381).
Disclosures: Dr. Yancy reports grants from the Department of Veterans Affairs during the conduct of the study and personal fees from Nutrisystem and the University of Pennsylvania outside the submitted work. Dr. Smith reports a grant from the Department of Veterans Affairs during the conduct of the study. Dr. Kolotkin reports personal fees from the Department of Veterans Affairs Health Services Research & Development during the conduct of the study and a patent with royalties paid for the Impact of Weight on Quality of Life-Lite questionnaire. Dr. Geiselman reports an honorarium from the Department of Veterans Affairs during the conduct of the study and royalties from the Pennington Biomedical Research Center of Louisiana State University for intellectual property. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2358.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Study protocol and statistical code: The authors are willing to share the study's protocol and statistical code to approved persons through written agreements with the authors (e-mail, firstname.lastname@example.org) and as approved by the Durham VAMC Institutional Review Board. Data set: Not available.
Requests for Single Reprints: William S. Yancy Jr., MD, Durham VA Medical Center (152), 508 Fulton Street, Durham, NC 27705; e-mail, email@example.com.
Current Author Addresses: Drs. Yancy, Coffman, Smith, McVay, Oddone, and Voils: Durham VA Medical Center (152), 508 Fulton Street, Durham, NC 27705.
Dr. Mayer: Virginia Commonwealth University, MCV Campus, PO Box 980111, Richmond, VA 23298-0111.
Dr. Kolotkin: Duke University Medical Center, 932 Ninth Street, Durham, NC 27705.
Dr. Geiselman: Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808.
Author Contributions: Conception and design: W.S. Yancy, C.J. Coffman, P.J. Geiselman, E.Z. Oddone, C.I. Voils.
Analysis and interpretation of the data: W.S. Yancy, S.B. Mayer, C.J. Coffman, V.A. Smith, R.L. Kolotkin, P.J. Geiselman, M.A. McVay, E.Z. Oddone, C.I. Voils.
Drafting of the article: W.S. Yancy, C.J. Coffman, R.L. Kolotkin.
Critical revision of the article for important intellectual content: W.S. Yancy, S.B. Mayer, C.J. Coffman, V.A. Smith, R.L. Kolotkin, P.J. Geiselman, M.A. McVay, E.Z. Oddone, C.I. Voils.
Final approval of the article: W.S. Yancy, S.B. Mayer, C.J. Coffman, V.A. Smith, R.L. Kolotkin, P.J. Geiselman, M.A. McVay, E.Z. Oddone, C.I. Voils.
Provision of study materials or patients: W.S. Yancy, C.I. Voils.
Statistical expertise: C.J. Coffman, V.A. Smith.
Obtaining of funding: W.S. Yancy, C.J. Coffman, P.J. Geiselman, C.I. Voils.
Administrative, technical, or logistic support: W.S. Yancy, C.J. Coffman, E.Z. Oddone.
Collection and assembly of data: W.S. Yancy, S.B. Mayer, C.J. Coffman.
Choosing a diet rather than being prescribed one could improve weight loss.
To examine whether offering choice of diet improves weight loss.
Double-randomized preference trial of choice between 2 diets (choice) versus random assignment to a diet (comparator) over 48 weeks. (ClinicalTrials.gov: NCT01152359)
Outpatient clinic at a Veterans Affairs medical center.
Outpatients with a body mass index of at least 30 kg/m2.
Choice participants received information about their food preferences and 2 diet options (low-carbohydrate diet [LCD] or low-fat diet [LFD]) before choosing and were allowed to switch diets at 12 weeks. Comparator participants were randomly assigned to 1 diet for 48 weeks. Both groups received group and telephone counseling for 48 weeks.
The primary outcome was weight at 48 weeks.
Of 105 choice participants, 61 (58%) chose the LCD and 44 (42%) chose the LFD; 5 (3 on the LCD and 2 on the LFD) switched diets at 12 weeks, and 87 (83%) completed measurements at 48 weeks. Of 102 comparator participants, 53 (52%) were randomly assigned to the LCD and 49 (48%) were assigned to the LFD; 88 (86%) completed measurements. At 48 weeks, estimated mean weight loss was 5.7 kg (95% CI, 4.3 to 7.0 kg) in the choice group and 6.7 kg (CI, 5.4 to 8.0 kg) in the comparator group (mean difference, −1.1 kg [CI, −2.9 to 0.8 kg]; P = 0.26). Secondary outcomes of dietary adherence, physical activity, and weight-related quality of life were similar between groups at 48 weeks.
Only 2 diet options were provided. Results from this sample of older veterans might not be generalizable to other populations.
Contrary to expectations, the opportunity to choose a diet did not improve weight loss.
Department of Veterans Affairs.
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Yancy WS, Mayer SB, Coffman CJ, Smith VA, Kolotkin RL, Geiselman PJ, et al. Effect of Allowing Choice of Diet on Weight Loss: A Randomized Trial. Ann Intern Med. 2015;162:805–814. doi: 10.7326/M14-2358
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Published: Ann Intern Med. 2015;162(12):805-814.
Cardiology, Coronary Risk Factors, Diabetes, Dyslipidemia, Endocrine and Metabolism.
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