Results Summary
What was the research about?
In the United States, 69 percent of adults have obesity or are overweight. These people are at increased risk of health problems, such as heart disease or diabetes.
The US Department of Agriculture, or USDA, suggests two approaches to help people keep a healthy weight or lose weight:
- Calorie counting. In this approach, people try to burn more calories than they eat by exercising, limiting the calories they eat, eating low-calorie foods like fruits and vegetables, and limiting sugary drinks.
- USDA’s MyPlate. MyPlate suggests people think more about the types of food on their plate than about how many calories foods have. For example, fruits and vegetables should take up half the plate and whole grains one quarter of the plate.
In this study, the research team compared two programs—one based on calorie counting and one using MyPlate—for 12 months to see if they helped adults increase their meal satisfaction and reduce their body fat.
What were the results?
After 12 months, people in the two programs changed about the same amount in most of what the research team measured. People in both programs
- Had less body fat around the waist
- Felt fuller after eating and were more satisfied with their meals
- Had improved mental health and quality of life
- Were highly satisfied with their assigned program
The people who counted calories also reported feeling less hungry.
People in the MyPlate program had lower blood pressure six months after starting the study, but not after 12 months. People in the calorie-counting program didn’t have any changes in blood pressure.
Body weight didn’t change for people in either program.
Who was in the study?
The study included 261 adults with obesity or who were overweight. Of these, 86 percent were Latino and 8 percent were African American. The average age was 41, and 95 percent were women.
What did the research team do?
The research team recruited people with obesity or who were overweight from a waiting room in a health clinic in California. The team assigned people by chance to one of the two programs.
The research team trained four bilingual community health workers to coach people about each program’s weight-loss approach. The team also offered 11 training sessions over six months to all people in the study. Two training sessions took place at people’s homes and one group session took place at a grocery store. Other sessions took place by phone. The MyPlate program also included two group cooking classes.
People filled out surveys before the programs started and then again 6 and 12 months later. The surveys asked how hungry people felt, if they felt full after eating, and if they were satisfied with their meals. The survey also asked about people’s mental health, quality of life, and whether they liked their program. The research team also measured each person’s weight, waist size, and blood pressure. The team compared changes at the start and end of the study for each person.
Throughout this study, the research team worked with Spanish- and English-speaking patients with obesity, doctors, dieticians, and community representatives.
What were the limits of the study?
Most people in this study were Latina women receiving care at one health clinic in California. Results may differ for men, people from other ethnic or racial backgrounds, or people in other places.
Future research could test programs based on calorie counting and MyPlate with people from other ethnic groups or in more locations. Studies could also compare other types of weight-management programs to one or both programs.
How can people use the results?
Health clinics can consider using either the MyPlate or calorie counting program to help patients reduce and keep off excess body fat.
Professional Abstract
Objective
To compare the effects of two government-recommended lifestyle-change approaches to healthy weight loss on satiety and body-fat composition among adults who have obesity or are overweight
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 261 participants with a BMI ≥27 and ≤40 |
| Interventions/ Comparators |
|
| Outcomes |
Primary: satiety, measured by reported postmeal hunger, feeling full, and meal satisfaction; body-fat composition, measured by body weight and waist circumference (primary medical outcome) Secondary: resting systolic blood pressure, health-related quality of life, mental health, satisfaction with the program |
| Timeframe | 1-year follow-up for primary outcomes |
This randomized controlled trial compared the effectiveness of two government-recommended approaches to weight loss: MyPlate and calorie counting.
Researchers recruited 261 adults in the waiting room of a federally qualified health center in California to take part in the study. Of these, 86% were Latino, and 8% were African American. The average age of participants was 41, and 95% were female. Participants’ body mass indexes (BMI) ranged from 27 to 40.
Researchers randomized participants to one of two weight-loss approaches:
- MyPlate. MyPlate, part of the US Department of Agriculture’s (USDA’s) Dietary Guidelines for Americans, focuses on increasing fruit and vegetable intake to fill half of a person’s plate, increasing intake of whole grains, replacing high-fat dairy with low-fat or nonfat dairy, replacing sugary drinks with water, and reducing sodium intake.
- Calorie counting. The traditional USDA recommendations for weight loss focus on burning more calories than consumed by counting calories, increasing physical activity, reducing portion sizes, increasing fruit and vegetable consumption, and limiting consumption of sugary beverages.
Participants in both groups worked with trained bilingual community health workers and could participate in 11 health-education sessions during a six-month period. Two sessions took place at participants’ homes, one group session took place at a grocery store to demonstrate how to make healthy food choices, and others took place by phone. Participants in the MyPlate group also took part in two group cooking demonstrations.
Researchers collected data at baseline and again after 6 and 12 months using surveys and by taking participant weight and waist measurements.
Throughout the development of these interventions, researchers worked with Spanish- and English-speaking patients with obesity, physicians, dieticians, the local YMCA, and other community representatives.
Results
After 12 months, participants in the two programs changed about the same amount in body composition, satiety, health-related quality of life, and mental health. Participants in both programs
- Experienced a significant reduction in waist circumference (MyPlate, p<0.01; calorie counting, p=0.02)
- Reported significant increases in feeling full after eating (both p<0.017) and in meal satisfaction (both p<0.017)
- Reported improved mental health (both p<0.001) and health-related quality of life (both p<0.001)
- Reported high satisfaction with their assigned program
Body weight did not change significantly from baseline to 12 months in either group. Only participants in the calorie-counting group reported a significant reduction in postmeal hunger (p=0.004).
At the six-month follow-up, participants in the MyPlate group showed a significant decline in blood pressure (p<0.017); they did not maintain this decline at the 12-month follow-up. Participants in the calorie-counting group did not show significant changes in blood pressure.
Limitations
Most participants in the study were Latina women recruited from an urban clinic that serves patients with low incomes. Results may not apply to other populations. The self-reported measures may be subject to greater error than the biological assessments the team made.
Conclusions and Relevance
The study did not detect differences between the MyPlate and calorie-counting approaches in helping participants with excess weight reduce body fat and keep it at a lower level. The study found that both approaches resulted in increased satiety, improved mental health and quality of life, and high participant satisfaction.
Future Research Needs
Future research could test the MyPlate and calorie-counting approaches with a more diverse patient sample and in different geographic locations. Studies could also compare other types of weight-management programs to one or both programs.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer review identified the following strengths and limitations in the report:
- Reviewers noted that the researchers did not report differences between the groups for the 6- and 12-month follow-up periods. The researchers revised the report to present these outcomes. The researchers noted that they believed changes to the counting-calories approach accounted for some of the small difference between the two interventions at these time periods. Researchers explained that they changed the approach to make the intervention more patient centered by allowing participants to focus on eating more fruits and vegetables.
- Reviewers expressed interest in the researchers’ hypothesis that increasing fruit and vegetable intake, which also increases dietary fiber intake, was a key element in the weight changes in both groups. The investigators added data and a discussion of the reasons for this hypothesis to the results section.
- Reviewers asked the investigators to include all results, not just those that seemed to support the study hypothesis. The researchers revised the discussion and conclusion sections to clarify the presentation of results of between-groups tests for satiety and weight change, which did not support the study hypothesis.
- In response to reviewers’ questions about the cultural context of the study, the investigators expanded their description of the study’s qualitative phase. The investigators wrote that the qualitative phase helped them understand the social issues and cultural context surrounding eating in the Latino and African-American communities.