Shahar Madjar, MD, Journal columnist

So many diets, so much controversy and the obesity epidemic (yes, a different pandemic) is still raging.

One unresolved controversy is whether diets that are different in their contents of fat, protein, and carbohydrates result in different degrees of weight loss.

Some believe that carbs are more fattening than the same amount of calories from fat. Others believe that proteins help you forget you’re hungry. And Dr. Atkins’ diet recommends butter and bacon, a lot of it. Which diet is really better?

Dr. Frank M. Sacks and his colleagues tried to answer this question. They recruited 811 overweight adult volunteers and randomly assigned them to four different diets with different percentages of fat, protein, and carbohydrates.

These volunteers were interviewed and those who had “insufficient motivation” were not included in the study. The food items on the four different menus were similar, but the quantities of the different items were different. For example, everyone was encouraged to eat a poached egg for breakfast, and 1/2 a cup of cooked red peppers and 1/2 a cup of cooked mushrooms for lunch.

But, at lunch, participants in the high protein group were supposed to eat 2 ounces of cooked boneless turkey while those in the average protein group were not.

Sacks invited the participants to individual and group instructional sessions. Those who attended lost more weight.

Most of the weight loss took place in the first 6 months. At 6 months, the average weight loss in all four groups was similar, 6 kg, or 7% of the initial weight. After 6 months, the different groups started to regain some of their weight, and at two years, those who completed the study (80% of the participants) lost, on average, 4 kg. Some participants had better results with 14-15% of them losing at least 10% of their body weight. And all groups had similar weight loss, sensation of hunger, satiety, and satisfaction with their diet.

Dr. Sacks’ conclusion may sound familiar to some: no matter what the source of your calories are, a calorie is a calorie, a diet is a diet, and if you stick to it, you will lose weight. But a deeper examination of the findings tells a different story:

First, the study design called for the low-carb group to consume significant amount of carbohydrates (35% of their total calories) which is much higher than the amount of carbohydrates recommended by traditional low-carb diets such as the Atkin’s diet. Second, the participants did not fully adhere to their diet recommendations, and the diets in the four different groups was more similar to each other than originally planned. For example, protein intake was supposed to differ by 10% between the high- and low-protein groups, but, in reality, the difference was only 1-2%. Is it, then, a great surprise that the weight loss in the four different groups was similar?

Perhaps we can learn from this study less about the role fat, protein, and carbohydrates plays in our diet, and more about human nature. Dr. Sacks’ study was conducted by experienced researchers and published in a leading medical journal, The New England Medical Journal. The participants were carefully selected and highly motivated. Most of them, I am sure, made a sincere effort to adhere to their diet for a long period of time. Yet, the diet plans weren’t followed precisely, the weight loss was modest, and some of the weight lost was regained. Why is it so hard to lose weight and to keep it off? Why are we gaining so much weight?

I have a pictures in my mind of jars of free cookies, food that comes in buckets, ice-cream in 32 flavors, all-you-can’t-resist buffets, and I can clearly hear steaks that sizzle. I will return with some “postcards” — pictures etched in my memory — of my first impressions of foodscapes in America.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.