title: Factors associated with choice of a low-fat or low-carbohydrate diet during a behavioral weight loss intervention.
abstract: Individuals undertaking a weight loss effort have a choice among proven dietary approaches. Factors contributing to choice of either a low-fat/low-calorie diet or a low-carbohydrate diet, two of the most studied and popular dietary approaches, are unknown. The current study used data from participants randomized to the 'choice' arm of a trial examining whether being able to choose a diet regimen yields higher weight loss than being randomly assigned to a diet. At study entry, participants attended a group session during which they were provided tailored feedback indicating which diet was most consistent with their food preferences using the Geiselman Food Preference Questionnaire (FPQ), information about both diets, and example meals for each diet. One week later, they indicated which diet they chose to follow during the 48-week study, with the option of switching diets after 12 weeks. Of 105 choice arm participants, 44 (42%) chose the low-fat/low-calorie diet and 61 (58%) chose the low-carbohydrate diet. In bivariate analyses, diet choice was not associated with age, race, sex, education, BMI, or diabetes (all p > 0.05). Low-carbohydrate diet choice was associated with baseline higher percent fat intake (p = 0.007), lower percent carbohydrate intake (p = 0.02), and food preferences consistent with a low-carbohydrate diet according to FPQ (p < 0.0001). In a multivariable logistic regression model, only FPQ diet preference was associated with diet choice (p = 0.001). Reported reasons for diet choice were generally similar for those choosing either diet; however, concerns about negative health effects of the unselected diet was rated as more influential among participants selecting the low-fat diet. Only three low-carbohydrate and two low-fat diet participants switched diets at 12 weeks. Results suggest that when provided a choice between two popular weight loss dietary approaches, an individual's selection is likely influenced by baseline dietary intake pattern, and especially by his or her dietary preferences. Research is needed to determine if congruency between food preferences and dietary approach is associated with weight loss.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27701 USA.. Electronic address: megan.mcvay@duke.edu.
authors.forename: Megan A
authors.initials: MA
authors.lastname: McVay
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27701 USA.
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27701 USA.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA; Department of Psychology, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA, USA.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Geiselman
authors.affiliation: Quality of Life Consulting, Durham, NC, USA; Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA; Department of Health Studies, Sogn og Fjordane University College, Førde, Norway; Department of Surgery, Førde Central Hospital, Førde, Norway; Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.
authors.forename: Ronette L
authors.initials: RL
authors.lastname: Kolotkin
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Virginia Commonwealth University, Richmond, VA 23284, USA.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Mayer
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Smith
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Gaillard
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Marsha J
authors.initials: MJ
authors.lastname: Turner
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics & Bioinformatics, Duke University, Durham, NC 27701 USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy; D015992:Body Mass Index; D031204:Caloric Restriction; D002755:Choice Behavior; D050528:Diet, Carbohydrate-Restricted; D018752:Diet, Fat-Restricted; D004038:Diet, Reducing; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D005518:Food Preferences; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy*; D011795:Surveys and Questionnaires; D015431:Weight Loss; D061217:Weight Reduction Programs
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats
keywords: Carbohydrate-restricted; Choice behavior; Diet; Fat-restricted