Funded by the National Heart, Lung and Blood Institute at the National Institutes of Health, the study is one of the few studies to recruit a large percentage of African Americans as study participants (44 percent). African Americans have a higher risk of conditions that are aggravated by being overweight, including diabetes and heart disease. In this study, the majority of African American participants lost at least nine pounds of weight, which is higher than in previous studies.
"The more food records people kept, the more weight they lost," said lead author Jack Hollis Ph.D., a researcher at Kaiser Permanente's Center for Health Research in Portland, Ore. "Those who kept daily food records lost twice as much weight as those who kept no records. It seems that the simple act of writing down what you eat encourages people to consume fewer calories."
In addition to keeping food diaries and turning them in at weekly support group meetings, participants were asked to follow a heart-healthy DASH (a Dietary Approaches to Stop Hypertension) diet rich in fruits and vegetables and low-fat or non-fat dairy, attend weekly group sessions and exercise at moderate intensity levels for at least 30 minutes a day. After six months, the average weight loss among the nearly 1,700 participants was approximately 13 pounds. More than two-thirds of the participants (69 percent) lost at least nine pounds, enough to reduce their health risks and qualify for the second phase of the study, which lasted 30 months and tested strategies for maintaining the weight loss.
"More than two-thirds of Americans are overweight or obese. If we all lost just nine pounds, like the majority of people in this study did, our nation would see vast decreases in hypertension, high cholesterol, diabetes, heart disease and stroke," said study co-author Victor Stevens, Ph.D., a Kaiser Permanente researcher. For example, in an earlier study Stevens found that losing as little as five pounds can reduce the risk of developing high blood pressure by 20 percent.
The Kaiser Permanente Care Management Institute's Weight Management Initiative has recommended food journaling as a strategy for losing weight since 2002. The Weight Management Initiative unites clinicians, researchers, insurers, and policymakers to identify practical, effective, non-surgical approaches for the prevention and treatment of overweight and obesity.
"Keeping a food diary doesn't have to be a formal thing. Just the act of scribbling down what you eat on a Post-it note, sending yourself e-mails tallying each meal, or sending yourself a text message will suffice. It's the process of reflecting on what you eat that helps us become aware of our habits, and hopefully change our behavior," says Keith Bachman, MD, a Weight Management Initiative member. "Every day I hear patients say they can't lose weight. This study shows that most people can lose weight if they have the right tools and support. And food journaling in conjunction with a weight management program or class is the ideal combination of tools and support."
The study, coordinated by the Kaiser Permanente Center for Health Research in Portland, also was conducted at Duke University Medical Center, Pennington Biomedical Research Center, and Johns Hopkins University. In addition to Hollis and Stevens, the Kaiser Permanente research team included William M. Vollmer, Ph.D.; Cristina M. Gullion, Ph.D.; Kristine Funk, M.S.; and Daniel Laferriere, MR. Other study co-authors included Phillip J. Brantley, Ph.D. and Catherine M. Champagne, Ph.D. at Pennington; Jamy D. Ard, MD, at the University of Alabama at Birmingham; Thomas P. Erlinger, MD, MPH, at the University of Texas; Lawrence J. Appel, M.D., and Arlene Dalcin at Johns Hopkins; Pao-Hwa Lin, Ph.D., and Laura P. Svetkey, MD, at Duke University; Carmen Samuel-Hodge, Ph.D. from the University of North Carolina at Chapel Hill; and Catherine M. Loria, Ph.D., at the National Heart, Lung, and Blood Institute and National Institutes of Health.
Kaiser Permanente's Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Ore., Honolulu, Hawaii and Atlanta.
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