• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (7)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Primary Care/ Family Medicine  • Public Health  • Obesity  • Public Health, Other  • Randomized Controlled Trial  • Diet  • Health Care Reform  • Drug Therapy  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

William S. Yancy Jr, MD, MHS; Eric C. Westman, MD, MHS; Jennifer R. McDuffie, PhD, RD, MPH; Steven C. Grambow, PhD; Amy S. Jeffreys, MStat; Jamiyla Bolton, MS; Allison Chalecki, RD; Eugene Z. Oddone, MD, MHS

Arch Intern Med. 2010;170(2):136-145.

Background  Two potent weight loss therapies, a low-carbohydrate, ketogenic diet (LCKD) and orlistat therapy combined with a low-fat diet (O + LFD), are available to the public but, to our knowledge, have never been compared.

Methods  Overweight or obese outpatients (n = 146) from the Department of Veterans Affairs primary care clinics in Durham, North Carolina, were randomized to either LCKD instruction (initially, <20 g of carbohydrate daily) or orlistat therapy, 120 mg orally 3 times daily, plus low-fat diet instruction (<30% energy from fat, 500-1000 kcal/d deficit) delivered at group meetings over 48 weeks. Main outcome measures were body weight, blood pressure, fasting serum lipid, and glycemic parameters.

Results  The mean age was 52 years and mean body mass index was 39.3 (calculated as weight in kilograms divided by height in meters squared); 72% were men, 55% were black, and 32% had type 2 diabetes mellitus. Of the study participants, 57 of the LCKD group (79%) and 65 of the O + LFD group (88%) completed measurements at 48 weeks. Weight loss was similar for the LCKD (expected mean change, –9.5%) and the O + LFD (–8.5%) (P = .60 for comparison) groups. The LCKD had a more beneficial impact than O + LFD on systolic (–5.9 vs 1.5 mm Hg) and diastolic (–4.5 vs 0.4 mm Hg) blood pressures (P < .001 for both comparisons). High-density lipoprotein cholesterol and triglyceride levels improved similarly within both groups. Low-density lipoprotein cholesterol levels improved within the O + LFD group only, whereas glucose, insulin, and hemoglobin A_1c levels improved within the LCKD group only; comparisons between groups, however, were not statistically significant.

Conclusion  In a sample of medical outpatients, an LCKD led to similar improvements as O + LFD for weight, serum lipid, and glycemic parameters and was more effective for lowering blood pressure.

Trial Registration  clinicaltrials.gov Identifier: NCT00108524

Author Affiliations: Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center, Durham, North Carolina (Drs Yancy, McDuffie, Grambow, and Oddone and Mss Jeffreys, Bolton, and Chalecki); and Departments of Medicine (Drs Yancy, Westman, and Oddone) and Biostatistics and Bioinformatics (Dr Grambow), Duke University Medical Center, Durham, North Carolina.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Low-Carbohydrate Diet Review: Shifting the Paradigm
Hite et al.
Nutr Clin Pract 2011;26:300-308.
ABSTRACT | FULL TEXT  

Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate Versus Low-Fat Diet: A Randomized Trial
Foster et al.
ANN INTERN MED 2010;153:147-157.
ABSTRACT | FULL TEXT  

Low-carbohydrate ketogenic diet and the combination of orlistat with a low-fat diet lead to comparable improvements in weight and blood lipids, but LCKD more beneficial for blood pressure
Gardner
Evid. Based Med. 2010;15:91-92.
FULL TEXT  

Tackling Obesity: Is Primary Care Up to the Challenge?
Kushner
Arch Intern Med 2010;170:121-123.
FULL TEXT