A two-year study in North Carolina found that Mediterranean-style eating matches calorie counting for weight loss. the report, published in JAMA Network Open, followed 360 adults with a BMI over 30.
The 3.4% weight loss parity between Med-South and WeightWatchers
Weight loss results were nearly identical between the Med-South and WeightWatchers groups, with both achieving approximately 3.5% reduction over the two-year period. As the study reported, the Med-South group—an eating pattern adapted for the Southern United States—saw a 3.4% reduction, while the calorie-focused WeightWatchers group saw a 3.5% reduction.
Most participants in the trial were already managing chronic conditions such as hypertension or diabetes.. Despite the different methods, the report notes there was no significant difference between the two groups regarding outcomes like blood prressure.
A 95% recommendation rate for Mediterranean-style eating
Participant satisfaction levels showed a stark difference, with 95% of those in the Mediterranean-style program stating they would recommend it. This stands in contrast to the 68% endorsement rate reported for the calorie-focused control group.
The Med-South group also demonstrated superior diet quality by significantly increasing their intake of whole grains, nuts, vegetable oils, and non-starchy vegetables. This behavioral shift suggests that the Mediterranean approach may be more palatable or easier to integrate into daily life than strict calorie restriction.
The debate over diet quality as a secondary outcome
The question of whether higher diet quality actually drives weight loss remains unverified, as the study was not primarily designed to isolate that variable. christopher Gardner, a professor at the Stanford Prevention Research Center, pointed out that diet quality was a secondary outcome rather than the primary focus of the research. This leaves it unclear if the quality of food is a cause of weight loss or merely a byproduct of the Mediterranean pattern.
Several speecific details remain unaddressed in the current reporting. The source does not explain why the WeightWatchers group had a significantly lower recommendation rate, nor does it clarify if the dietitian-led structure of the Med-South program was the primary driver of its high adherence. Additionally, the report does not account for the specific reasons why the calorie-focused group struggled more with long-term endorsement.
Lessons from the DIETFITS trial on adherence and quality
The DIETFITS trial provides a historical parallel to these findings, suggesting that the most successful weight loss occurs when high diet quality and high adherence are achieved simultaneouusly. This underscores a growing trend in nutritional science that moves away from simple calorie counting toward a focus on nutrient density.
Kristin Kirkpatrick, a registered dietitian at the Cleveland Clinic, argued that lower-calorie diets can be difficult to sustain and may lead to reduced nutrient intake over time. This perspective suggests that for readers looking to manage weight, the focus should perhaps shift from merely creating an energy deficit to choosing foods like fruits, vegetables, and whole grains that support long-term health and chronic disease prevention.
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