The results of the Dietary Intervention Randomized Controlled Trial (DIRECT) Group have been published in The New England Journal of Medicine.

First, the details.

  • 322 moderately obese adults (average body-mass index [BMI] 31) were randomly assigned to 1 of 3 diets.
    • Low-fat, restricted-calorie
    • Mediterranean, restricted-calorie
    • Low-carbohydrate, non–restricted-calorie.
  • 86% of participants were men.

And, the results.

  • 95% of the original group continued to follow their diet at 1 year and 85% at 2 years.
  • The Mediterranean-diet provided the largest amounts of dietary fiber and the highest ratio of monounsaturated to saturated fat.
  • The low-carbohydrate diet had the smallest amount of carbs and largest amounts of fat, protein, and cholesterol, as well as the highest percentage of participants with detectable urinary ketones, significant among the groups.
  • Average weight loss for all who began the study.
    • 2.9 kg (6.4 lb) for the low-fat group
    • 4.4 kg (9.9 lb) for the Mediterranean-diet group
    • 4.7 kg (10.3 lb) for the low-carbohydrate group
  • Average weight loss for those who remained on their diet for the entire study.
    • 3.3 kg (7.3 lb) for the low-fat group
    • 4.6 kg (10.1 lb) for the Mediterranean-diet group
    • 5.5 kg (12.1) for the low-carbohydrate group
  • The differences were statistically significant.
  • The relative reduction in the total cholesterol to HDL (good) cholesterol ratio was 20% in the low-carbohydrate group and 12% in the low-fat group, also a significant difference.
  • Among 36 dieters with diabetes, changes in fasting blood sugar and insulin levels were significantly more favorable with the Mediterranean diet than the low-fat diet.

The bottom line?
The authors favor the Mediterranean and low-carbohydrate diets over the low-fat diet.

They concluded, “The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic [blood sugar] control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions.”

In other words, there’s more than one way to shed fat. The secret is to know the benefits, select a diet based on your needs, and, of course, stick with it.

Read the article to learn the specifics of each diet.

7/18/08 16:31 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.