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Original article

Vol. 143 No. 0304 (2013)

A multicentre weight loss study using a low-calorie diet over 8 weeks: regional differences in efficacy across eight European cities

  • Angeliki Papadaki
  • Manolis Linardakis
  • Maria Plada
  • Thomas M Larsen
  • Marleen A van Baak
  • Anna Karin Lindroos
  • Andreas F.H. Pfeiffer
  • J Alfredo Martinez
  • Teodora Handjieva-Darlenska
  • Marie Kunešová
  • Claus Holst
  • Wim H.M. Saris
  • Arne Astrup
  • Anthony Kafatos
  • on behalf of DiOGenes (project 'Diet, Obesity and Genes', supported by the European Community)
Cite this as:
Swiss Med Wkly. 2013;143:w13721


PRINCIPLES: The efficacy of low-calorie diets (LCDs) has not been investigated in large-scale studies or among people from different regions, who are perhaps unaccustomed to such methods of losing weight. The aim of the present study was to investigate changes in obesity measures among overweight/obese adults from eight European cities (from Northern, Central and Southern Europe) during the 8-week LCD phase of the DiOGenes study (2006–2007), a family-based, randomised, controlled dietary intervention.

METHODS: 938 overweight/obese adults completed baseline examinations and underwent an 8-week LCD, providing 3.3–4.2 MJ/day to replace all meals. Anthropometric measurements and body composition were assessed at baseline and post-LCD.

RESULTS: 773 (82.4%) adults (mean age, 43.1 y) completed the LCD successfully. The highest drop-out rate was observed in Southern (24.9%) and the lowest in Northern (13.3%) European cities. Overall, the LCD induced favourable changes in all outcomes, including an approximate 11.0% reduction in body weight and body fat percentage. Changes in outcomes differed significantly between regions, with North- and Central-European cities generally achieving higher percentage reductions in most anthropometric measurements assessed. Nonetheless, participants in Southern Europe reduced their body fat percentage significantly more than participants in Northern Europe (–11.8 vs. –9.5%, P = 0.017).

CONCLUSIONS: The LCD significantly improved anthropometric and body composition measurements in all cities participating in DiOGenes.



  1. World Health Organisation. Diet, nutrition and the prevention of chronic diseases. Geneva:Joint FAO/WHO; 2002.
  2. Franz MJ, Bantle JP, Beebe CA, Brunzell JD, Chiasson JL, Garg A, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002;25:148–98.
  3. National Task Force on the Prevention and Treatment of Obesity. Very-low-caloric-diets. JAMA. 1993;270:967–74.
  4. Donnelly JE, Jakicic J, Gunderson S. Diet and body composition. Effect of very low calorie diets and exercise. Sports Med. 1991;12:237–49.
  5. Saris WHM. Very-low-calorie diets and sustained weight loss. Obes Res. 2001;9:295S–301S.
  6. Jebb SA, Goldberg GR. Efficacy of very low-energy diets and meal replacements in the treatment of obesity. J Hum Nutr Diet. 1998;11:219–25.
  7. Kovacs EMR, Cheatham BR, Meullenet JF, Mela DJ. Comparing satiety profiles of different foods: The example of meal replacement drinks. Appetite. 2008;50:561.
  8. Torgerson JS, Lissner L, Lindroos AK, Kruijer H, Sjöström L. VLCD plus dietary and behavioural support versus support alone in the treatment of severe obesity. A randomised two-year clinical trial. Int J Obes Relat Metab Disord. 1997;21:987–94.
  9. Astrup A, Rössner S. Lessons from obesity management programmes: greater initial weight loss improves long-term maintenance. Obes Rev. 2000;1:17–9.
  10. Miura J, Arai K, Tsukahara S, Ohno M, Ikeda Y. The long term effectiveness of combined therapy by behavior modification and very low calorie diet: 2 years follow-up. Int J Obes. 1989;13:73–7.
  11. Ayyad C, Andersen T. Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obes Rev. 2000;1:113–99.
  12. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001;74:579–84.
  13. Moore CS, Lindroos AK, Kreutzer M, Larsen TM, Astrup A, van Baak M, et al. Strategy to manipulate ad libitum macronutrient intake, and glycaemic index, across eight European countries in the DIOGENES study. Obes Rev. 2010;11:67–75.
  14. Larsen TM, Dalskov S, van Baak M, Jebb S, Kafatos A, Pfeiffer A, et al. The Diet, Obesity and Genes (Diogenes) dietary study in eight European countries – a comprehensive design for long term intervention. Obes Rev. 2010;11:76–91.
  15. Saris WH, Harper A. DiOGenes: a multidisciplinary offensive focused on the obesity epidemic. Obes Rev. 2005;6:175–6.
  16. Papadaki A, Linardakis M, Larsen TM, van Baak M, Lindroos AK, Pfeiffer AFH, et al. The effect of protein and glycemic index on children’s body composition: The Diogenes randomized study. Pediatrics. 2010;126:e1143–52.
  17. Tsai AG, Wadden TA. The evolution of very-low-calorie diets: an update and meta-analysis. Obesity. 2006;14:1283–93.
  18. Claessens M, van Baak MA, Monsheimer S, Saris WHM. The effect of a low-fat, high protein or high-carbohydrate ad libitum diet on weight loss maintenance and metabolic risk factors. Int J Obes. 2009;33:296–304.
  19. Westerterp-Plantenga MS, Kempen KP, Saris WH. Determinants of weight maintenance in women after diet-induced weight reduction. Int J Obes Relat Metab Disord. 1998;22:1–6.
  20. Gasteyger C, Larsen TM, Vercruysse F, Pedersen D, Toubro S, Astrup A. Visceral fat loss induced by a low-calorie diet: a direct comparison between women and men. Diabetes Obes Metab. 2009;11:596–602.
  21. Gasteyger C LT, Vercruysse F, Astrup A. Effect of a dietary-induced weight loss on liver enzymes in obese subjects. Am J Clin Nutr. 2008;87:1141–7.
  22. Kreitzman SN, Beeson V. Obese patients in UK general practices lose 16 tonnes. VLCD Update. 1996;3:5–8.
  23. Packianathan I, Sheikh M, Boniface D, Finer N. Predictors of programme adherence and weight loss in women in an obesity programme using meal replacements. Diabetes Obes Metab. 2005;7:439–47.
  24. Ditschyneit HH, Flechtner-Mors M. Value of structured meals for weight management: risk factors and long-term weight maintenance. Obes Res. 2001;9 284S–9S.
  25. Anderlová K, Kremen J, Dolezalová R, Housová J, Haluzíková D, Kunesová M, et al. The influence of very-low-calorie-diet on serum leptin, soluble leptin receptor, adiponectin and resistin levels in obese women. Physiol Res. 2006;55:277–83.
  26. Hainer V, Štich V, Kunešová M, Parízková J, Žák A, Wernischová V, et al. Effect of 4-wk treatment of obesity by very-low-calorie diet on anthropometric, metabolic, and hormonal indexes. Am J Clin Nutr. 1992;56:281S–2S.
  27. Solá E, Vayá A, Contreras T, Falcó C, Corella D, Hernández A, et al. Effect of a hypocaloric diet on lipids and rheological profile in subjects with severe and morbid obesity. A follow-up study. Clin Hemorheol Microcirc. 2004;30:419–22.
  28. Moreno O, Meoro A, Martinez A, Rodriguez C, Pardo C, Aznar S, et al. Comparison of two low-calorie diets: a prospective study of effectiveness and safety. J Endocrinol Invest. 2006;29:633–40.
  29. Larsen TM, Dalskov SM, van Baak M, Jebb S, Papadaki A, Pfeiffer AF, et al. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010;363:2102–13.
  30. Moloney M. Dietary treatments of obesity. Proc Nutr Soc. 2000;59:601–8.
  31. Morgan WD, Ryde SSJ, Birks JL, Thomas DW, Kreitzman SN. Changes in total body nitrogen during weight reduction by very-low-calorie diets. Am J Clin Nutr. 1992;56:262S–4S.
  32. Kamrath RO, Plummer LJ, Sadur CN, Weinstein RL. Body composition and weight maintenance with a very-low-calorie diet for the treatment of moderate obesity. Am J Clin Nutr. 1992;56:286S–7S.
  33. Hoie LH, Bruusgaard D, Thom E. Reduction of body mass and change in body composition on a very low calorie diet. Int J Obes Relat Metab Disord. 1993;17:17–20.
  34. Foster GD, Wadden TA, Peterson FJ, Letizia KA, Bartlett SJ, Conill AM. A controlled comparison of three very-low-calorie diets: effects on weight, body composition and symptoms. Am J Clin Nutr. 1992;55:811–7.
  35. Ryttig KR, Rössner S. Weight maintenance after a very low calorie diet (VLCD) weight reduction period and the effects of VLCD supplementation. A prospective, randomized, comparative, controlled long-term trial. J Intern Med. 1995;238:299–306.
  36. Høie LH, Bruusgaard D. Compliance, clinical effects, and factors predicting weight reduction during a very low calorie diet regime. Scand J Prim Health Care. 1995;13:13–20.
  37. Wadden TA, Foster GD, Letizia KA, Stunkard AJ. A multicenter evaluation of a proprietary weight reduction program for the treatment of marked obesity. Arch Intern Med. 1992;152:961–6.
  38. Handjieva-Darlenska T, Handjiev S, Larsen TM, van Baak MA, Jebb S, Papadaki A, et al. Initial weight loss on an 800-kcal diet as a predictor of weight loss success after 8 weeks: the Diogenes study. Eur J Clin Nutr. 2010;64:994–9.
  39. Saris WHM. Exercise with and without dietary restriction and obesity treatment. Int J Obes. 1995;19:S113–6.