A feasibility study to test a novel approach to dietary weight loss with a focus on assisting informed decision making in food selection

Abstract

Obesity is a significant contributor to the development of chronic diseases, some of which can be prevented or reversed by weight loss. However, dietary weight loss programs have shortcomings in the success rate, magnitude, or sustainability of weight loss. The Individualized Diet Improvement Program’s (iDip) objective was to test the feasibility of a novel approach that helps individuals self-select a sustainable diet for weight loss and maintenance instead of providing weight loss products or rigid diet instructions to follow. The iDip study consisted of 22 dietary improvement sessions over 12 months with six months of follow-up. Daily weights were collected, and a chart summarizing progress was provided weekly. Six 24-hour dietary records were collected, and dietary feedback was provided in the form of a protein-fiber plot, in which protein/energy and fiber/energy of foods were plotted two-dimensionally together with a target box specific to weight loss or maintenance. An exit survey was conducted at 12 months. Twelve (nine female, 46.3±3.1 years (mean±SE)) of the initial 14 participants (BMI>28 kg/m2) completed all sessions. Mean percent weight loss (n = 12) at six and 12 months was -4.9%±1.1 (p = 0.001) and -5.4%±1.7 (p = 0.007), respectively. Weight loss varied among individuals at 12 months; top and bottom halves (n = 6 each) achieved -9.7%±1.7 (p = 0.0008) and -1.0%±1.4 weight loss, respectively. The 24-hour records showed a significant increase in protein density from baseline to final (4.1g/100kcal±0.3 vs. 5.7g/100kcal±0.5; p = 0.008). Although mean fiber density showed no significant change from the first month (1.3g/100kcal±0.1), the top half had significantly higher fiber/energy intake than the bottom half group. The survey suggested that all participants valued the program and its self-guided diet approach. In conclusion, half of the participants successfully lost >5% and maintained the lost weight for 12 months without strict diet instructions, showing the feasibility of the informed decision-making approach.

Successful dietary changes correlate with weight‐loss outcomes in a new dietary weight‐loss program

“…The primary objective of this study was to determine correlations between weight‐loss outcomes and dietary changes. The previous feasibility study 15 showed that the correlation R 2 between weight loss and protein/calorie by food frequency questionnaire (FFQ) and 24‐h record were 0.32 and 0.17, respectively. Based on the R 2 , the sample size for 95% confidence was 24.5.…”

“…As the first step toward this goal, the iDip group created a prototype of a novel weight‐management program and tested its feasibility. 15 The premise of iDip's approach is that a sustainable dietary change, which varies among individuals, must be achieved to maintain a healthy weight for a lifetime. The main innovative approaches employed in iDip were twofold.…”

“… 17 Using the PF plot, iDip participants created an individualized weight‐loss diet starting from foods they habitually eat by increasing protein and fiber intake while reducing energy intake simultaneously. 15 Strong evidence supports that increasing protein intake per healthy body weight and decreasing energy intake simultaneously is required to optimize the safety and effectiveness of weight loss diet. 18 , 19 This optimization cannot be achieved by simple portion size reduction or calorie counting because when calorie intake is decreased, protein intake also decreases in these approaches.…”

“… 20 , 21 , 22 The iDip also replaced daily calorie counting with the provision of a weekly weight chart based on daily weighing for participants to visualize their progress and monitor energy balance (Figure S2 ). 15 …”

“…Also, limitations included a short follow‐up period (six months) and the lack of body composition measurements. 15 As such, the objective of this study is to identify factors that affect the weight‐loss outcome of participants using intra‐cohort variation analysis. Here, the first 12‐month outcomes for the revised iDip2 program are reported.…”