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Could a trip to McDonald’s for a bunless double bacon cheeseburger really be better for your heart and waistline than those green salads sans dressing that you’ve been having for lunch? A recent headline-making study of popular diets published in The Journal of the American Medical Association appeared to suggest that is indeed the case.

The study, cleverly designated the A to Z Weight Loss Study, compared four popular diets: Atkins, Ornish, LEARN (a diet-and-exercise-oriented plan for behavioral change) and the Zone. Researchers assigned 311 pre-menopausal women to one of the four diets for an entire year. At the end of that year, they found that women on the Atkins low-carb diet lost significantly more weight and had an overall decline in heart-disease-risk factors. But before you ditch that apple for a block of cheese, it’s important to examine the whole story.

As a weight-loss doctor who also specializes in reducing patients’ heart-disease risk, I was not surprised by the findings, but very interested in speaking with the lead researcher at Stanford University, Christopher Gardner, Ph.D., to learn what might not have made it into the final published paper. Here are three important points from our conversation:

• The women on the Atkins diet drank the most water, which is emphasized in that diet more than the others due to the fact that dieters tend not to replace the calories from high-sugar liquids like sodas by eating more food. Therefore, they were likely to be the most successful at cutting total calories.
• The participants found the Zone diet the most confusing, which suggests that they probably did not fully comply with its rules. Gardner noted that all the dieters had some trouble sticking with the diets’ dictates, either because they were too complicated or too onerous.
• All four diets resulted in losses of 30 pounds or more for some participants, although twice as many participants lost large amounts of weight on Atkins.

Although statistics from the study do seem to point to Atkins as “the winner,” Gardner’s two final conclusions, which echo what I see in my own practice, were more complex: First, all diets work for some people for some period of time, but the weight loss can only be permanent if you find an eating strategy that you can live with long term; and, second, that lower-carbohydrate diets can improve some aspect of dieters’ health (heart health, in Atkins’ case) just by reducing the consumption of refined, processed carbohydrates.

So what should all this mean to you when you go to pick “the best” diet of the bunch? Based on Gardner’s study and other research, it appears that some diets do work better for certain women than others. Specifically, women who carry their extra weight around their midsection, aka “apple shaped,” may do best with a higher-protein, lower-carbohydrate approach. Apple-shaped women tend to handle refined and sugary carbohydrates less effectively than pear-shaped women, who carry their extra fat mostly in the hips, thighs and buttocks.

But excess fat around the midsection isn’t just a cosmetic issue; it’s also more dangerous from a metabolic standpoint and often leads to a condition known as insulin resistance — which simply means the body becomes less and less sensitive to the role insulin plays in regulating blood sugar. This condition, also known as “pre-diabetes,” increases the risk of heart disease and stroke and can eventually lead to full-blown diabetes and all its complications.

ARE YOU AN APPLE OR A PEAR?

To identify your body type and determine which diet you should choose, take this simple test.

1.    Have you been prescribed medication for high blood pressure?

2.    Have you been prescribed medication for high cholesterol?

3.    Do you have diabetes or high-normal blood sugar?

4.    Is your waist size greater than 35 inches?

5.    Do you have high triglycerides or low “good” (HDL) cholesterol?

If you answer YES to at least three out of five questions, you are considered an apple and a lower-carbohydrate diet is probably best. If you answer NO to at least three out of five questions, you are a pear and carbohydrate restriction is less important for you, which gives you the option of choosing a diet based more on lifestyle and food preferences. (No matter which shape you are, you should still limit refined carbohydrates for optimal health.)

WHICH DIET IS RIGHT FOR YOU?

Now that you know your body type, think about your lifestyle and eating habits. It is important to find a diet that you can stay on long term or the weight will creep — or flood — back on when you return to your old eating habits. And don’t forget about regular exercise. That is just as important as diet for keeping the weight off!

Diet: Atkins, South Beach
Description: Low-carbohydrate
Best for Body Type: Apple
Pros & Cons: Difficult for women who travel, entertain or dine out often

Diet: Ornish
Description: Very lowfat
Best for Body Type: Pear
Pros & Cons: Good for women who enjoy larger portions; hHard dining out

Diet: French Women Don’t Get Fat
Description: Portion control
Best for Body Type: Pear
Pros & Cons: Great for the foodie who loves to cook; not great for women with portion-control issues

Diet: Zone, Sonoma
Description: Lower-carbohydrate
Best for Body Type: Apple or pear
Pros & Cons: Slightly more time-consuming; less flexible for travel and dining out

Diet: Weight Watchers
Description: Portion control
Best for Body Type: Pear
Pros & Cons: Convenient, easy, on-the-go options; great for busy women

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