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A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity
Open accessAbstract
BACKGROUND: The effects of a carbohydrate-restricted diet on weight loss and risk factors for atherosclerosis have been incompletely assessed. METHODS: We randomly assigned 132 severely obese subjects (including 77 blacks and 23 women) with a mean body-mass index of 43 and a high prevalence of diabetes (39 percent) or the metabolic syndrome (43 percent) to a carbohydrate-restricted (low-carbohydrate) diet or a calorie- and fat-restricted (low-fat) diet. RESULTS: Seventy-nine subjects completed the six-month study. An analysis including all subjects, with the last observation carried forward for those who dropped out, showed that subjects on the low-carbohydrate diet lost more weight than those on the low-fat diet (mean [+/-SD], -5.8+/-8.6 kg vs. -1.9+/-4.2 kg; P=0.002) and had greater decreases in triglyceride levels (mean, -20+/-43 percent vs. -4+/-31 percent; P=0.001), irrespective of the use or nonuse of hypoglycemic or lipid-lowering medications. Insulin sensitivity, measured only in subjects without diabetes, also improved more among subjects on the low-carbohydrate diet (6+/-9 percent vs. -3+/-8 percent, P=0.01). The amount of weight lost (P<0.001) and assignment to the low-carbohydrate diet (P=0.01) were independent predictors of improvement in triglyceride levels and insulin sensitivity. CONCLUSIONS: Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost. This finding should be interpreted with caution, given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study. Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed.
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“We did not confirm previous findings that low-carbohydrate or high-protein diets caused increased weight loss at 6 months3–12 and that the advantage of these diets usually eroded by 12 months, with weight loss that was nearly or fully equivalent to that with low-fat diets6,11,18 or other diets.12”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [7]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Nevertheless, low-carbohydrate, high-fat diets may lead to spontaneous reduction in calorie reduction and increased weight loss, especially over the short term50–52.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [52]
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In the citing paper
“Several trials showed that low-carbohydrate, high-protein diets resulted in more weight loss over the course of 3 to 6 months than conventional high-carbohydrate, low-fat diets,4–12 but other studies did not show this effect.13–17”
From Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates (2009) · cites this paper as [7]
In the citing paper
“Significant reductions in fat mass including truncal fat, which is a marker for visceral obesity, have been demonstrated in many studies [9,11,26,29].”
From The case for low carbohydrate diets in diabetes management (2005) · cites this paper as [11]
In the citing paper
“It is interesting that despite advocating ad libitum fat and protein intake, a LoCHO diet may be hypocaloric either by design or by spontaneous reduction of intake [8-12].”
From The case for low carbohydrate diets in diabetes management (2005) · cites this paper as [11]
In the citing paper
“There are several other reports indicating metabolic advantage in low carbohydrate diets over short term (3–6 months) [8,10,11,26-28].”
From The case for low carbohydrate diets in diabetes management (2005) · cites this paper as [11]
In the citing paper
“Conversely, LoCHO diets have been consistently demonstrated to lower triglycerides and increase HDL [8-11,26-28].”
From The case for low carbohydrate diets in diabetes management (2005) · cites this paper as [11]
In the citing paper
“LoCHO diets have been reported to reduce fat mass including truncal fat over long term in many studies [11,21,26,29].”
From The case for low carbohydrate diets in diabetes management (2005) · cites this paper as [11]
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“Several studies comparing carbohydrate restriction without CR versus low-fat calorie-restricted diets have revealed a similar reduction in calories, suggesting that single macronutrient reduction may be an acceptable and tolerable approach for some individuals to successfully reduce their calories [30,31].”
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Fernandez, C., Potts, K. S., & Bazzano, L. (2021) · Obesity Science & Practice · doi:10.1002/osp4.567 · Cited by 6
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The 2012 University of Cape Town Faculty of Health Sciences centenary debate
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“Several studies have demonstrated that low-carbohydrate diets produced greater short-term (6-months) weight loss than low-fat diets [7,18,19,41,52]; nevertheless, the longer term (1–2 years) results are controversial.”
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Is there a role for low carbohydrate diets in the management of type 2 diabetes?
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“A commentary in the same issue of the New England Journal of Medicine [20] states that "In both studies, the reduction in serum triglyceride levels in subjects randomly assigned to the low-carbohydrate diet might have been anticipated as a result of their greater weight loss, although it is true that reduced carbohydr…”
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Efectos de una dieta baja en grasas frente a una dieta rica en proteínas y grasa en pacientes obesos
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“The first study([8]) was carried out over six months.”
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“Studies have suggested that low-carbohydrate ketogenic diets (LCK diets) result in significant weight loss [4-6] and appear to significantly reduce hunger [7-9].”
BackgroundFood fermentation by lactic acid bacteria for the prevention of cardiovascular disease
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Association of body fat with stress levels and dietary intakes in Indian women
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“고밀도지단백(High dense lipoprotein, HDL) 콜레스테롤의 증가 역시 일관성 있게 저탄수화물 다이어트에 서 더 효과가 큰 것으로 보이는데(4-8,10,11,14,17,18) 일부 단기간의 연구에서 는 저탄수화물 다이어트가 저지방 다이어트에 비해 HDL 콜레스테 롤의 증가 차이가 크지 않은 것으로 보고하였다.(3,9) 총 콜레스테롤과 저밀도지단백(Low dense lipoprotein, LDL) 콜레스테롤은 연구마다 다소 차이를 보인다.”
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“By the end of the year, 19% of US adults reported they were on “LoCarb” diets [14-16].”
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“14,15 With mounting evidence, the VA/DoD guidelines on T2DM management included LC diets as dietary options for treating T2DM.”
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“In addition, low-carbohydrate [32–34] or low-GL diets [35,36] result in great weight loss over periods of 3–6 months and have a favorable effect on triglyceride and HDL cholesterol [37].”
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“A 2003 meta-analysis that included randomized controlled trials found that "low-carbo‐ hydrate, non-energy-restricted diets, appear to be at least as effective as low-fat, energy-re‐ stricted diets in inducing weight loss for up to 1 year [108].”
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“Furthermore several studies showed that lowcarbohydrate diet was more effective than low-fat diet in managing obesity and insulin resistance syndrome [23-25].”
Mechanisms by Which the Ketogenic Diet Reverses Obesity and Diabetes
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“The efficacy of low-carbohydrate diets to reduce blood glucose, especially in diabetic individuals, provides a major rationale to treat patients with diabetes with such diets, in contrast to current recommendations, which advocate highcarbohydrate low-fat diets [18-21].”
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“This drug is accepted by many as first line treatment in diabetes mellitus which is not insulin dependent (Type 2) (United Kingdom Prospective Diabetes Study 1995, Holman 2007) and is resistant to dietary control (Brehm et al. 2003, Samaha et al. 2003).”
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“[17] In this context, studies have shown an extreme correlation between low‐carbohydrate diets and improvement of insulin sensitivity in type 2 diabetes.[18] Studies have also shown that low‐carbohydrate diets reduce hyperglycemia in patients with type 2 diabetes.”
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Foundations of Nutritional Medicine
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High-Density Lipoprotein Cholesterol
Toth, P. P., & Gotto, A. M. (2006) · Fundamental and clinical cardiology · doi:10.3109/9781420019667.008 · Cited by 5
Body fat distribution, inflammation and cardiovascular disease
Toss, F. (2011) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 4
Fibroblast growth factor 21, ketogenic diets, and insulin resistance
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Is a Low-Carb, Low-Fat Diet Optimal?
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Good thinking: seven powerful ideas that influence the way we think
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“…adiposity, and modulating lipid metabolism, with additional findings highlighting their potential to ameliorate inflammation-related processes such as cardiovascular risk factors and obesity-related metabolic disturbances (Samaha et al. 2003; Goldenberg et al. 2021; Minihane et al. 2015).”
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“The type of carbohydrate in the diet may also be related to body weight [16].”
BackgroundAl-Awadi, A. A., Grove, J. I., Taylor, M. A., Valdes, A. M., Vijay, A., Bawden, S., Gowland, P. A., & Aithal, G. P. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045802 · Cited by 3
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“35 Various exercise studies reported conflicting results, for example, decreased FBG, 36 no change, 37 and increased FBG. 38 The association between muscle force and reactive oxygen species (ROS) has been described by Reid et al., who suggested that increasing force production by skeletal muscles…”
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Razmpoosh, E., Abdollahi, S., Sikaroudi, M. K., Sangsefidi, Z. S., Zeraattalab-Motlagh, S., Torabinasab, K., Hejazi, M., Meshkini, F., Motallaei, M., & Soltani, S. (2025) · BMC Public Health · doi:10.1186/s12889-025-23454-0 · Cited by 4
“Some evidence suggests that low-carbohydrate, high-protein, and HF diets are more satiating and promote greater short-term weight loss than LF diets [11, 12], whereas some other investigations revealed that dietary energy and fat restriction reduce appetite due to the decreased glucagon-like…”
High rate of calories from protein is associated with higher prevalence of hypertension
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Carbohydrate-Restricted Diet and Acute Coronary Syndrome
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“Caloric restriction via low carbohydrate intake has been shown in randomized studies to reduce weight when compared with low-fat diets at 6 months.(5,7) However, these effects on weight loss were short lived.”
Background
Metadata
- Authors
- Samaha, F. F., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, T., Williams, M., Gracely, E. J., & Stern, L.
- Affiliations
- Veterans Health Administration (US)
- University of Pennsylvania (US)
- Drexel University (US)
- ORCID
- Gracely, Edward J.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2003-05-22
- Volume
- 348
- Issue
- 21
- Pages
- 2074-2081
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2154184102
- Semantic Scholar
- b42feb4332c5988f5d769f116b2b96ffdfc37bd4
- Cited by
- 1,267
- References
- 20
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 26 · 2023: 24 · 2022: 39 · 2021: 38 · 2020: 58 · 2019: 33 · 2018: 36 · 2017: 36 · 2016: 43 · 2015: 28 · 2014: 37 · 2013: 46 · 2012: 62
- FWCI
- 70.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
- Health Sciences › Medicine › Physiology (medical) › Dietary Effects on Health
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- low-carbohydrate diet, low-fat diet, morbid obesity, weight loss, triglycerides, insulin sensitivity, diabetes mellitus, metabolic syndrome, atherosclerosis risk factors, dietary intervention
- MeSH terms
- Arteriosclerosis, Blood Glucose, Diabetes Mellitus, Diet, Reducing, Dietary Carbohydrates, Female, Humans, Insulin Resistance, Lipids, Male, Middle Aged, Obesity, Risk Factors, Triglycerides, Weight Loss, Body Mass Index, Diet, Fat-Restricted, Metabolic Syndrome
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