Low-carbohydrate diets and realities of weight loss.

Obesity is a worldwide epidemic and will be followed by a worldwide epidemic of diabetes. While diet, lifestyle, and exercise are the cornerstones of current approaches to treat obesity, they have been ineffective in stemming the current epidemic. In this issue of THE JOURNAL, the article by Bravata et al systematically reviews and synthesizes the literature on the use of low-carbohydrate diets for treatment of obesity. Their findings add to the review of popular diets published by Freedman et al. Among the principal findings in the analysis by Bravata et al are that lower-carbohydrate ( 60 g/d of carbohydrate) diets were associated with reduced calorie intake and that weight loss was predicted by calorie intake, diet duration, and baseline body weight, but not by carbohydrate content. At the end of their analysis, Bravata et al note several gaps in the current literature on lowcarbohydrate diets, including the need for better follow-up and for use of intent-totreat analyses.