Arthritis Today: Let’s talk about engagement. In your results, you point out that the people who lost the most weight were the most engaged. One way you measured that was by how many counseling sessions dieters attended. It seems to suggest then that all of us should kind of give up the idea of going with a radical diet and just portion control and get ourselves into some kind of support group.

Dr. Sacks:  Exactly, the result is actually a real, positive, optimistic result for people. It gives people a wide range of diets they can work with. They can try different things. If they want to try the Atkins diet –the Atkins organization has gradually improved their diet so it is healthier in terms of guidelines for heart disease. As long as it’s a healthy diet and they feel comfortable with it, and can stick with it, then that’s what counts. It’s not so much what particular fat or protein intake you’re eating. It’s what you can maintain, enjoy and keep intake down.

Arthritis Today: Was that a true result? In other words, do you think that people who were more engaged attended the counseling sessions because they were more committed to their goals, or do you think that the counseling itself was what was working?

Dr. Sacks: Oh, the counseling was very important. You know it kept them focused on what the goals are. So if they’re engaged in the program, hopefully they’re not sleeping through the program. You know, the sessions that I attended were pretty lively. I mean, people talked a lot about what they’re doing that’s helpful, problems they’ve had, things to surmount, challenges, and so forth, and people in the groups discussed it. You know there really weren’t too many people sleeping through the groups, and the dieticians were really positive and engaged themselves. Participants loved the dieticians and that was really important. You know, if you’re going to a group, you really have to have good chemistry with the group leaders, the dieticians, the group leaders… so find a group that you like, people that you get along with and keep going.

Arthritis Today: Diet composition didn’t seem to matter when it came to weight loss, but as you were crunching the numbers and analyzing the data, did you find that diet composition did have an effect when it came things like to blood lipids or insulin or glucose? When you have diabetes, people are often counseled to go on a low-carb diet.

Dr. Sacks: Well, we didn’t have diabetics in our study. I mean, nonetheless, for diabetics, the results of the study are certainly applicable with the proviso that they really have to be careful about carbohydrates. You know a diabetic can eat a higher-carb diet but then they really have to pick diets with low-glycemic carbohydrates. You know, in the future, I think that might be something to test, but diabetics have special nutritional needs and lower carbohydrates and certainly lower glycemic index of the carbohydrates they eat would be advisable.

Arthritis Today: Everyone’s goal [in the study] was to try to reduce their calories by 750 a day.

Dr. Sacks: Right, unless it got below 1200. So, for example, in a small woman who’s not so active, we don’t want calories to go below 1200. So with that proviso, the prescription was calorie needs minus 750.

Arthritis Today: But most people didn’t get that far, did they?

Dr. Sacks: Initially they did, like the editorial said, but over time they began to eat more, so they didn’t maintain that kind of caloric deficit, but that’s fine. I mean, for example, if you take a person who wants to lose weight, if they went down 250 calories a day, they’d lose a lot of weight over a period of a year, so you don’t really have to have minus 750.

Arthritis Today: You did counsel your participants to exercise, too, right, but it wasn’t very much, as I recall. It was about 90 minutes a week?