JACN
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Greenberg, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Greenberg, I.
Journal of the American College of Nutrition, Vol. 28, No. 2, 159-168 (2009)
Published by the American College of Nutrition

Adherence and Success in Long-Term Weight Loss Diets: The Dietary Intervention Randomized Controlled Trial (DIRECT)

Ilana Greenberg, RD, MPH, Meir J. Stampfer, MD, DrPH, Dan Schwarzfuchs, MD, Iris Shai, RD, PhD for the DIRECT Group

The S. Daniel Abraham Center for Health and Nutrition, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva (I.G., I.S.)
3Nuclear Research Center Negev, Dimona (D.S.), ISRAEL, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School
Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts (M.J.S.)

Address reprint requests to: Iris Shai, RD, PhD. The S. Daniel Abraham International Center for Health and Nutrition, Department of Epidemiology and Health Systems Evaluation, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, ISRAEL. E-mail: irish{at}bgu.ac.il

Background: Data are limited as to whether participants in diet trials truly adhere to their assigned diet and the factors that affect their adherence.

Methods: We evaluated success and adherence in a two-year dietary intervention randomized controlled trial (DIRECT) in which 322 moderately obese participants (mean age 52 yrs, mean body-mass-index (BMI) 31 kg/m2, 86% men) were randomized to one of three groups: low-fat, Mediterranean, or low-carbohydrate diets.

Results: Overall compliance at month-24 was 85%, with 90% in low-fat, 85% in Mediterranean, and 78% in low-carbohydrate diet (p = .042 between groups). Attrition was higher in women (29% vs. 14% men, p = .001) and current smokers (25% vs. 14% among maintainers, p = 0.04). In a multivariate model, independent predictors of dropping-out were: higher baseline BMI (OR = 1.11; CI: 1.03–1.21) and less weight loss at month-6 (OR = 1.20; CI: 1.1–1.3). In a multivariate model, greater weight loss achieved at month-6 was the main predictor associated with success in weight loss (> 5%) over 2 years (OR = 1.5; CI: 1.35–1.67). Self-reported complete adherence score to diet was greater on low-carbohydrate diet (p < .05 compared to low-fat) until month-6, but dropped overall from 81% at month-1 to 57% at month-24. Holidays were a trigger to a significant decrease in adherence followed by a partial rebound. Changes in diet composition from month-1 to month-12 were more pronounced in the multi-stage low-carbohydrate diet-group (p < .05). Generally, the most irresistible restricted food items were cookies (45% of dieters) and fruits (30%). Among the physically active (n = 107), 44% reported a tendency to eat less after exercising compared to 10% who tended to eat more.

Conclusion: Initial 6-month reduction in weight is the main predictor of both long-term retention and success in weight loss. Special attention is needed for women, current smokers, and during holidays. Physical activity is associated with subsequent reduction in energy intake.

Key words: adherence, weight loss, long-term, attrition






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2009 by the American College of Nutrition.