Elsevier

Appetite

Volume 83, 1 December 2014, Pages 117-124
Appetite

Research report
Factors associated with choice of a low-fat or low-carbohydrate diet during a behavioral weight loss intervention,☆☆

https://doi.org/10.1016/j.appet.2014.08.023Get rights and content

Highlights

  • We examined choice of low-fat or low-carbohydrate diet during a weight loss trial.

  • Diet choice was not associated with age, race, sex, education, BMI, or diabetes.

  • Diet choice was associated with habitual macronutrient intake and food preferences.

  • Top rated influences on diet choice were similar for those choosing either diet.

  • Few participants switched diets when given the option 12 weeks into 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.

Section snippets

Participants

Study participants were recruited from the Durham Veterans Affairs (VA) Medical Center between June 2011 and June 2012 through flyers, brochures, and advertisements. VA health care personnel were informed of the study and encouraged to refer patients to the study through the VA's electronic referral option. Additionally, a search of electronic health records for patients meeting study criteria was conducted, with potentially eligible patients contacted via a recruitment letter with a telephone

Results

Our study sample included 105 participants randomized to the diet choice arm (see Table 1 for sample characteristics). The low-fat/low-calorie diet was chosen by 44 participants (42%) and the low-carbohydrate diet by 61 participants (58%).

In bivariate analyses, higher percentage of fat intake and lower percent of carbohydrate intake at baseline were associated with choosing the low-carbohydrate diet (Table 2). Based on their FPQ results, 77 participants had food preferences aligned with a

Discussion

This manuscript describes the results of providing participants a choice between a low-fat/low-calorie or low-carbohydrate diet upon initiation of a behavioral weight loss program. Increasingly, there is recognition that several dietary approaches to weight loss are safe and effective, and that individuals have a choice among these various dietary approaches. This is the first study to report on the frequency of choosing either a low-fat diet or low-carbohydrate diet, associations of diet

References (30)

  • CraigC.L. et al.

    International physical activity questionnaire: 12-country reliability and validity

    Medicine and Science in Sports and Exercise

    (2003)
  • DrewnowskiA.

    Taste preferences and food intake

    Annual Review of Nutrition

    (1997)
  • FogelholmM. et al.

    International physical activity questionnaire. Validity against fitness

    Medicine and Science in Sports and Exercise

    (2006)
  • FosterG.D. et al.

    A randomized trial of a low-carbohydrate diet for obesity

    The New England Journal of Medicine

    (2003)
  • FurstT. et al.

    Food choice. A conceptual model of the process

    Appetite

    (1996)
  • Cited by (16)

    • Food choice motivations: Profiling low-carbohydrate, high-fat dieters

      2019, Appetite
      Citation Excerpt :

      The similarity in sensory appeal between both diet groups in the current study is consistent with the finding by McVay et al. (2014) that found no difference between low-fat and low-carbohydrate dieters in terms of the importance of taste. Furthermore, McVay et al. (2014) identified that the alignment of taste preferences to a specific diet pattern was predictive of diet selection. The current findings suggest that the main barriers to dieting and LCHF diet choice are price and convenience.

    • Fat preference and fat intake in individuals with and without anorexia nervosa

      2019, Appetite
      Citation Excerpt :

      Although absolute nutrient intakes differed across these studies, patients with AN consistently consumed fewer kcal and a lower percentage of kcal from fat compared to healthy individuals. The utility of the FPQ has been demonstrated in studies of healthy (King et al., 2018) and obese (McVay et al., 2014; Yancy et al., 2013) individuals; however, self-reported fat preference on the FPQ was compared to measured food intake in only one study of nine healthy adult males (Geiselman et al., 1998). The current study compared self-reported fat preference (FPS) to fat intake (MIMS) in large samples of healthy females and low-weight patients with AN.

    • Low-carbohydrate, high-fat dieters: Characteristic food choice motivations, health perceptions and behaviours

      2017, Food Quality and Preference
      Citation Excerpt :

      The study results identified that, taking into account sex and age, prior fat and carbohydrate intake and food preferences consistent with a low-carbohydrate diet were found to be related to LCHF diet choice. However, only food preferences predicted diet choice (McVay et al., 2014). In addition, food preferences, expected weight loss and improved health were identified as the most influential reasons for diet choice.

    • Postmenopausal women with abdominal obesity choosing a nutritional approach for weight loss: A decisional needs assessment

      2016, Maturitas
      Citation Excerpt :

      McVay et al., studying factors associated with choice of a low-fat or low-carbohydrate diet among overweight adults, pointed out that food preferences and diet’s positive effects on weight and health influenced the decision the most. These factors are similar to sensory aspect and physiological impacts found in our study [29]. Interestingly, decisional conflict associated with uncertainty about the choice of the LOFAT or the RFV diet did not seem to have clearly emerged in the discussions.

    View all citing articles on Scopus

    Acknowledgements: Funding for the trial was provided by the U.S. Department of Veterans Affairs (IIR 09-381). Funding for Megan McVay, Ph.D, was provided by fellowship grant T32 HS00079 from the Agency for Healthcare Research and Quality. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; nor preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, Duke University, Pennington Biomedical Research Center, Louisiana State University, or Virginia Commonwealth University. Paula Geiselman, PhD and the Board of Supervisors of Louisiana State University and Agricultural and Mechanical College have a financial interest in the Geiselman Food Preference Questionnaire (FPQ), as she receives royalties from Pennington Biomedical Research Center for use of the FPQ. None of the other authors had any conflicts of interest to disclose. Sources of Support: This research was supported by VA HSR&D (IIR 09-381).

    ☆☆

    Clinical Trial Registry: NCT01152359.

    View full text