Patient freedom to choose a weight loss diet in the treatment of overweight and obesity: a randomized dietary intervention in type 2 diabetes and pre-diabetes

Offering the overweight or obese patient the option of choosing from a selection of weight loss diets has not been investigated in type 2 diabetes. The aim of the study was to investigate if the option to choose from, and interchange between a selection of diets ("Choice"), as opposed to being prescribed one set diet ("No Choice"), improves drop out rates and leads to improved weight loss and cardio-metabolic outcomes
The study was a 12 month, randomized parallel intervention. A total of 144 volunteers with type 2 diabetes or pre-diabetes and a BMI >27 were randomized to "No Choice" or "Choice". Those in the No Choice group were placed on a set weight loss diet (CSIRO) with no change permitted. Those in the Choice group could choose from, and interchange between, the CSIRO, South Beach or Mediterranean diets
There were no differences in attrition rates or weight loss between the "Choice" and "No Choice". In a secondary analysis of the intention-to-treat weight loss data with last measured weight carried forward gave a highly significant diet group by time by gender interaction (p = 0.002) with men doing better in the No Choice group overall (maximum difference "No Choice "-2.9 +/- 4.6 kg vs. "Choice"-6.2 kg +/- 5.3 kg at 6 months) and women doing better in the Choice group overall (maximum difference Choice -3.1 +/- 3.7 kg vs. "No Choice" -2.0 kg +/- 2.6 kg at 6 months)
Men prefer direction in their weight loss advice and do less well with choice. A gender-specific approach is recommended when prescribing weight loss dietsTrial registration: ACTRN12612000310864.

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