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Lifestyle Interventions for Cardiovascular Disease Risk Reduction: A Systematic Review of the Effects of Diet Composition, Food Provision, and Treatment Modality on Weight Loss

  • Nutrition (JP Foreyt, Section Editor)
  • Published:
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Abstract

The purpose of this systematic review was to evaluate, synthesize, and interpret findings from recent randomized controlled trials (RCTs) of dietary and lifestyle weight loss interventions examining the effects of (1) diet composition, (2) use of food provision, and (3) modality of treatment delivery on weight loss. Trials comparing different dietary approaches indicated that reducing carbohydrate intake promoted greater initial weight loss than other approaches but did not appear to significantly improve long-term outcomes. Food provision appears to enhance adherence to reduction in energy intake and produce greater initial weight losses. The long-term benefits of food provision are less clear. Trials comparing alternative treatment modalities suggest that phone-based treatment produce short- and long-term weight reductions equivalent to face-to-face interventions. The use of Internet and mobile technologies are associated with smaller reductions in body weight than face-to-face interventions. Based on this review, clinical implications and future research directions are provided.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Toobert DJ, Glasglow RE, Strycker LA, Barrera Jr M, Radcliffe JL, Wander RC. Biologic and quality-of-life outcomes from the Mediterranean lifestyle program. Diabetes Care. 2003;26(8):2288–93.

    Article  PubMed  Google Scholar 

  2. Yancy WS, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Ann Intern Med. 2004;140(10):769–77.

    Article  PubMed  Google Scholar 

  3. Luscombe-Marsh ND, Noakes M, Wittert GA, Keogh JB, Foster PR, Clifton PM. Carbohydrate-restricted diets high in either monounsaturated fat or protein are equally effective at promoting fat loss and improving blood lipids. Am J Clin Nutr. 2005;81:762–72.

    CAS  PubMed  Google Scholar 

  4. McLaughlin T, Carter S, Lamendola C, Abbasi F, Yee G, Schaaf P, et al. Effects of moderate variations in macronutrient composition on weight loss and reduction in cardiovascular disease risk in obese, insulin-resistant adults. Am J Clin Nutrition. 2006;84, 1–813–8219.

  5. McMillan-Price J, Petocz P, Atkinson F, O’Neill K, Samman S, Steinbeck K, et al. Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults. Arch Intern Med. 2006;166:1466–75.

    Article  PubMed  Google Scholar 

  6. Noakes M, Keogh JB, Foster PR, Clifton PM. Effect of an energy-restricted, high-protein, low-fat diet relative to a conventional high-carbohydrate, low-fat diet on weight loss, body composition, nutritional status, and markers of cardiovascular health in obese women. Am J Clin Nutr. 2005;81:1298–306.

    CAS  PubMed  Google Scholar 

  7. Vincent-Baudry S, Defoort C, Gerber M, Bernard M, Verger P, Helal O, et al. The Medi-RIVAGE study: reduction of cardiovascular disease risk factors after a 3-month intervention with a Mediterranean-type diet or a low-fat diet. Am J Clin Nutr. 2005;82:964–71.

    CAS  PubMed  Google Scholar 

  8. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors. Ann Intern Med. 2006;145(1):1–11.

    Article  PubMed  Google Scholar 

  9. Esposito K, Pontillo A, Di Palo C, Giugliano G, Masella M, Marfella R, et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women. J Am Med Assoc. 2003;289(14):1799–804.

    Article  CAS  Google Scholar 

  10. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. J Am Med Assoc. 2004;292(12):1440–6.

    Article  CAS  Google Scholar 

  11. Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obesity Metab. 2010;12(3):204–9. doi:10.1111/j.1463-1326.2009.01151.x.

    Article  CAS  Google Scholar 

  12. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction. J Am Med Assoc. 2004;293(1):43–53.

    Article  Google Scholar 

  13. Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS. Effects of a low-glycemic load versus low-fat diet in obese young adults. J Am Med Assoc. 2007;297(19):2092–102.

    Article  CAS  Google Scholar 

  14. Iqbal N, Vetter ML, Moore RH, Chittams JL, Dalton-Bakes CV, Dowd M, et al. Effects of a low-intensity intervention that prescribed a low-carbohydrate versus a low-fat diet in obese, diabetic participants. Obesity. 2010;18(9):1733–8. doi:10.1038/oby.2009.460.

    Article  CAS  PubMed  Google Scholar 

  15. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360(9):859–73.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Esposito K, Maiorino MI, Cioltola M, Di Palo C, Scognamiglio P, Gicchino, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes. Ann Intern Med. 2009;151(5):306–14.

    Article  PubMed  Google Scholar 

  17. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Mohammed BS, Szapary PO, et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med. 2003;348(21):2082–90.

    Article  CAS  PubMed  Google Scholar 

  18. Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med. 2010;153(3):147–57. doi:10.7326/0003-4819-153-3-201008030-00005.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140(10):778–85.

    Article  PubMed  Google Scholar 

  20. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women. J Am Med Assoc. 2007;297(9):969–77.

    Article  CAS  Google Scholar 

  21. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229–41. doi:10.1056/NEJMoa0708681.

    Article  CAS  PubMed  Google Scholar 

  22. Turner-McGrievy GM, Barnard ND, Scialli AR. A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. Obesity. 2007;15(9):2276–81.

    Article  PubMed  Google Scholar 

  23. Li Z, Hong K, Saltsman P, DeShields S, Bellman M, Thames G, et al. Long-term efficacy of soy-based meal replacements versus an individualized diet plan in obese type II DM patients: relative effects on weight loss, metabolic parameters, and C-reactive protein. Eur J Clin Nutr. 2004;59(3):411–8. doi:10.1038/sj.ejcn.1602089.

    Article  Google Scholar 

  24. Rock CL, Flatt SW, Sherwood NE, Karanja N, Pakiz B, Thomson CA. Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women. J Am Med Assoc. 2010;304(16):1803–11.

    Article  CAS  Google Scholar 

  25. Tsai AG, Felton S, Hill JO, Atherly AJ. A randomized pilot trial of a full subsidy versus a partial subsidy for obesity treatment. Obesity. 2009;20(9):1838–43. doi:10.1038/oby.2011.193.

    Article  Google Scholar 

  26. Webber KH, Rose SA. A pilot internet-based behavioral weight loss intervention with or without commercially available portion-controlled foods. Obesity. 2013;21(9):E354–9. doi:10.1002/oby.20331. Data from this trial indicate that the use of food provision in conjunction with an internet behavioral weight loss program may help to improve short term weight loss, blood glucose, and LDL cholesterol levels.

    PubMed  Google Scholar 

  27. Hannum SM, Carson LA, Evans EM, Canene KA, Petr EL, Bui L, et al. Use of portion-controlled entrees enhances weight loss in women. Obes Res. 2004;12(3):538–46.

    Article  PubMed  Google Scholar 

  28. Hannum SM, Carson LA, Evans EM, Petr EL, Wharton CM, Bui L, et al. Use of packaged entrees as part of a weight-loss diet in overweight men: an 8-week randomized clinical trial. Diabetes Obesity Metab. 2006;8(2):146–55. doi:10.1111/j.1463-1326.2005.00493.x.

    Article  CAS  Google Scholar 

  29. Hunter CM, Peterson AL, Alvarez LM, Poston WC, Brundige AR, Haddock CK, et al. Weight management using the internet: a randomized controlled trial. Am J Prev Med. 2008;34(2):119–26. doi:10.1016/j.amepre.2007.09.026.

    Article  PubMed  Google Scholar 

  30. Patrick K, Raab F, Adams MA, Dillon L, Zabinski M, Rock CL, et al. A text message-based intervention for weight loss: randomized controlled trial. J Med Internet Res. 2009;11(1):e1. doi:10.2196/jmir.1100.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Appel LJ, Clark JM, Yeh H, Wang N, Couglin JW, Daumit D, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959–68.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Donnelly JE, Smith BK, Dunn L, Mayo MM, Jacobsen DJ, Stewart EE, et al. Comparison of a phone versus clinic approach to achieve 10 % weight loss. Int J Obes. 2007;31(8):1270–6. doi:10.1038/sj.ijo.0803568.

    Article  CAS  Google Scholar 

  33. Donnelly JE, Goetz J, Gibson C, Sullivan DK, Lee R, Smith BK, et al. Equivalent weight loss for weight management programs delivered by phone and clinic. Obesity. 2013;21(10):1951–9. doi:10.1002/oby.20334. Results of phone-based and in-person behavioral treatment for obesity suggest that both modalities produce equivalent amounts of immediate and long-term weight loss and indicate that phone-based weight treatment significantly improves the cost-effectiveness of treatment.

    Article  PubMed  Google Scholar 

  34. Harvey-Berino J, West D, Krukowski R, Prewitt E, VanBiervliet A, Ashikaga T, et al. Internet delivered behavioral obesity treatment. Prev Med. 2010;51(2):123–8. doi:10.1016/j.ypmed.2010.04.018.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Perri MG, Limacher MC, Durning PE, Janicke DM, Lute LD, Bobroff LB, et al. Extended-care programs for weight management in rural communities. Arch Intern Med. 2008;168(21):2347–54.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Tate DF, Jackvony EH, Wing RR. Effects of internet behavioral counseling on weight loss in adults at risk for type 2 diabetes. J Am Med Assoc. 2003;289(14):1833–6.

    Article  Google Scholar 

  37. Micco N, Gold B, Buzzell P, Leonard H, Pintauro S, Harvey-Berino J. Minimal in-person support as an adjunct to internet obesity treatment. Ann Behav Med. 2007;33(1):49–56.

    Article  PubMed  Google Scholar 

  38. Gold BC, Burke S, Pintauro S, Buzzell P, Harvey-Berino J. Weight loss on the web: a pilot study comparing a structured behavioral intervention to a commercial program. Obesity. 2007;15(1):155–64.

    Article  PubMed  Google Scholar 

  39. Befort CA, Donnelly JE, Sullivan DK, Ellerbeck EF, Perri MG. Group versus individual phone-based obesity treatment for rural women. Eat Behav. 2010;11(1):11–7. doi:10.1016/j.eatbeh.2009.08.002.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Sherwood NE, Jeffery RW, Pronk NP, Boucher JL, Hanson A, Boyle R, et al. Mail and phone interventions for weight loss in a managed-care setting: weigh-to-be 2-year outcomes. Int J Obes. 2006;30(10):1565–73. doi:10.1038/sj.ijo.0803295.

    Article  CAS  Google Scholar 

  41. Webber KH, Tate DF, Michael Bowling J. A randomized comparison of two motivationally enhanced internet behavioral weight loss programs. Behav Res Ther. 2008;46(9):1090–5. doi:10.1016/j.brat.2008.06.008.

    Article  PubMed  Google Scholar 

  42. Collins CE, Morgan PJ, Hutchesson MJ, Callister R. Efficacy of standard versus enhanced features in a web-based commercial weight-loss program for obese adults, part 2: randomized controlled trial. J Med Internet Res. 2013;15(7):e140. doi:10.2196/jmir.2626. Results of this randomized controlled trial suggest that the addition of personalized feedback to a basic internet weight management program provides limited additional benefits; however, personalized feedback did increase usage of the program and retention across the course of the study.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Carter MC, Burley VJ, Nykjaer C, Cade JE. Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial. J Med Internet Res. 2013;15(4):e32. doi:10.2196/jmir.2283.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Chambliss HO, Huber RC, Finley CE, McDoniel SO, Kitzman-Ulrich H, Wilkinson WJ. Computerized self-monitoring and technology-assisted feedback for weight loss with and without an enhanced behavioral component. Patient Educ Couns. 2011;85(3):375–82. doi:10.1016/j.pec.2010.12.024.

    Article  PubMed  Google Scholar 

  45. Turner-McGrievy GM, Campbell MK, Tate DF, Truesdale KP, Bowling JM, Crosby L. Pounds Off Digitally study: a randomized podcasting weight-loss intervention. Am J Prev Med. 2009;37(4):263–9. doi:10.1016/j.amepre.2009.06.010.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Turner-McGrievy G, Tate D. Tweets, apps, and pods: results of the 6-month Mobile Pounds Off Digitally (Mobile POD) randomized weight-loss intervention among adults. J Med Internet Res. 2011;13(4):e120. doi:10.2196/jmir.1841.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Khaylis A, Yiaslas T, Bergstrom J, Gore-Felton C. A review of efficacious technology-based weight-loss interventions: five key components. Telemed e-Health. 2010;16(9):931–8. doi:10.1089/tmj.2010.0065.

    Article  Google Scholar 

  48. Jensen MD, Ryan DH, Donato KA, Apovian CM, Ard JD, Comuzzie AG, et al. AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Obesity. 2013;21(Suppl 3). The most recent guidelines from the American College of Cardiology and the American Heart Association that review risk factors and consequences of obesity as well as recommendations for the assessment and treatment of overweight/obese participants by clinical providers.

  49. Esposito K, Maiorino MI, Petrizzo M, Bellastella G, Giugliano D. The effects of a Mediterranean diet on need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care. 2014. doi:10.2337/dc13-2899.

    Google Scholar 

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Conflict of Interest

Gareth R. Dutton, Melissa H. Laitner, and Michael G. Perri declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35216, USA

    Gareth R. Dutton

  2. Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL, 32610, USA

    Melissa H. Laitner & Michael G. Perri

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  1. Gareth R. Dutton
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  2. Melissa H. Laitner
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Correspondence to Gareth R. Dutton.

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Dutton, G.R., Laitner, M.H. & Perri, M.G. Lifestyle Interventions for Cardiovascular Disease Risk Reduction: A Systematic Review of the Effects of Diet Composition, Food Provision, and Treatment Modality on Weight Loss. Curr Atheroscler Rep 16, 442 (2014). https://doi.org/10.1007/s11883-014-0442-0

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