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Division of Therapeutic Patient Education for Chronic Diseases, University Hospital Geneva, Geneva, Switzerland; 2Department of
Internal Medicine, University Hospital Geneva, Geneva, Switzerland; 3Department of Psychiatry, University Hospital Geneva, Geneva,
Switzerland; and 4Servei d'Endocrinologia I Nutricio, Hospital Clinic, Barcelona, Spain
OBJECTIVE: The goal of this study was to evaluate the effect of two diets (`food combining' or dissociated vs
balanced) on body weight and metabolic parameters during a 6-week period in an in-hospital setting.
SUBJECTS AND DESIGN: 54 obese patients were randomly assigned to receive diets containing 4.5 MJ=day (1100
kcal=day) composed of either 25% protein, 47% carbohydrates and 25% lipids (dissociated diet) or 25% protein, 42%
carbohydrates and 31% lipids (balanced diet). Consequently, the two diets were equally low in energy and substrate
content (protein, fat and carbohydrate) but widely differed in substrate distribution throughout the day.
RESULTS: There was no signicant difference in the amount of weight loss in response to dissociated (6.2 0.6 kg) or
balanced (7.5 0.4 kg) diets. Furthermore, signicant decreases in total body fat and waist-to-hip circumference ratio
were seen in both groups, and the magnitude of the changes did not vary as a function of the diet composition.
Fasting plasma glucose, insulin, total cholesterol and triacylglycerol concentrations decreased signicantly and
similarly in patients receiving both diets. Both systolic and diastolic blood pressure values decreased signicantly
in patients eating balanced diets. The results of this study show that both diets achieved similar weight loss. Total fat
weight loss was higher in balanced diets, although differences did not reach statistical signicance. Total lean body
mass was identically spared in both groups.
CONCLUSION: In summary at identical energy intake and similar substrate composition, the dissociated (or `food
combining') diet did not bring any additional loss in weight and body fat.
International Journal of Obesity (2000) 24, 492496
Keywords: weight loss; dissociated diet; balanced diet
Introduction
Obesity is nowadays commonly accepted as a chronic
disease associated with known co-morbid conditions
such as type 2 diabetes mellitus,1 3 hypertension,
coronary artery disease, hypercholesterolaemia,
arthrosis, gout and cancer,4 6 as well as a reduction
in life expectancy. During the last decade a large
amount of information regarding its pathophysiology,
and more specically the adipocyte's signalling
mechanisms, has emerged. Despite several missing
links in the aetiology of this complex and heterogeneous disease, most authorities agree upon a disequilibrium between energy intake and expenditure being
a key factor in the development of obesity. Thus, total
energy intake plays a pivotal role in the development
and maintenance of obesity.
Patient education and dietetic counselling are mandatory as the rst steps in the therapeutic approach to
obesity. Concerning the inuence of qualitative diet
composition on weight loss, several authors7 10 agree
that the total energy intake, and not its composition,
*Correspondence: A Golay, Division of Therapeutic Education
for Chronic Diseases, University Hospital Geneva, 24 rue
Micheli-du Crest, 1211-Geneva-14, Switzerland.
E-mail: Alain.Golay@hcuge.ch
Received 4 May 1999; revised 17 September 1999; accepted
26 November 1999
Table 1
Age (y)
Height (cm)
Weight (kg)
BMI (kg=m2)
Waist circumference (cm)
Hip circumference (cm)
Waist-to-hip ratio
Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
Table 2
Balanced,
n 21F, 7 M
Dissociated,
n 20 F, 6 M
43.1 2.9
165.2 1.5
105.5 3.6
38.5 0.9
114.8 2.3
122.5 1.9
0.94 0.02
135.0 3.5
85.8 2.1
44.0 3.5
165.4 2.7
104.5 2.8
38.8 1.8
115.7 4.0
120.3 2.9
0.96 0.03
130.0 4.1
85.6 5.0
Balanced
Dissociated
4.6 0.08
114 4
42 1
38 1
31 1
72 1
27 0.4
71 3
4.5 0.04
123 3
47 1
29 2
25 2
71 2
27 0.9
71 4
Diet
Energy (MJ=day)
Carbohydrates (%) (g=day)
Lipids
(%) (g=day)
Proteins
(%) (g=day)
493
X s.e.m.
Table 3
Food items
Balanced diet
Breakfast:
low-fat skimmed milk (0%)
whole wheat bread
butter or margarine
Lunch:
low-fat meat or sh
vegetable
rice, pasta, or cereals
fruit
oil
Snack:
low-fat articially sweetened yogurt
Dinner:
low-fat meat or eggs
vegetable
rice, pasta, or cereals
oil
Snack:
Low-fat fresh cheese (20% fat)
fruit
Dissociated diet
Breakfast:
low-fat skimmed milk (0%)
wholewheat bread
articially sweetened marmalade
Lunch:
low-fat meat or sh
vegetable
low-fat fresh cheese (25%)
oil
Snack:
low-fat articially sweetened yogurt
Dinner:
low-fat skimmed cheese (0%)
vegetable
rice, pasta, or cereals
Snack:
fruit
Weight (g)
150
50
5
100
150
60
100
5
180
100
150
60
5
50
100
150
50
25
100
150
25
10
180
100
150
100
200
International Journal of Obesity
494
Table 4
Results
As depicted in Table 2, daily protein intake and
average protein losses were very similar in both
groups. Being equally low in energy, both diets
were similarly catabolic. Values for age, systolic and
diastolic blood pressure values, total body weight,
BMI, waist and hip circumferences, and waist-to-hip
ratio before the diets are given in Table 4. These
values were perfectly comparable between the two
groups at baseline. Total body weight, body mass
index, waist and hip circumferences (as well as their
ratio) decreased signicantly in both groups and the
magnitude of the changes did not vary as a function of
the type of diet; nevertheless the group receiving the
balanced diet showed a tendency to lose weight more
than the group on the dissociated diet (7.5 0.4 kg vs
6.2 0.6 kg, P NS).
Total weight loss occurred in a progressive and
similar way in both groups (Figure 1a). At the end of
the study both groups achieved similar signicant fat
body weight losses (Figure 1b).
Both systolic and diastolic blood pressure values
decreased signicantly in the group receiving
balanced diet, but not in the other group. However,
there were no differences between two groups.
Table 5 lists values for fasting plasma glucose,
insulin, cholesterol, HDL-cholesterol and triacylglycerol concentrations before and after 6 weeks of
dietary intervention. At baseline there were no signicant differences in either group. In both groups
plasma glucose, cholesterol, HDL-cholesterol and
triacylglycerol concentrations decreased signicantly.
Similarly, insulin concentrations decreased in both
groups at the end of the study.
Weight (kg)
BMI (kg=m2)
Waist circumference (cm)
Hip circumference (cm)
Waist=hip ratio
Systolic blood pressure (mmHg)
Diastolic blood pressure (mmHg)
a
X s.e.m.
*P < 0.05; **P < 0.01; ***P < 0.001.
Dissociated
Before
After
Before
After
105.5 3.6
38.5 0.9
114.8 2.3
122.5 1.9
0.94 0.02
135 3.5
85.8 2.1
98.1 3.3***
35.8 0.9***
105.9 2.3***
114.1 1.8***
0.92 0.02*
124.3 1.8**
81.0 2.3*
104.5 2.8
38.8 1.8
115.7 4.0
120.3 2.9
0.96 0.03
130.0 4.1
85.6 5.0
96.5 2.2***
35.2 1.3***
108.0 3.9***
114.8 2.2*
0.94 0.03
125.0 3.8
75.0 3.3
Acknowledgements
Discussion
In this study we evaluated the effects of two lowenergy diets (balanced and dissociated) on both
weight loss (total and fat body weight) and various
metabolic parameters. The amount of weight loss was
similar in response to the two diets (which had similar
energy and macronutrients contents (Table 2)) and
was apparently independent of the substrate distribution within meals, being principally related to total
energy intake, in accordance with previous works
Table 5
495
References
1 Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC.
Obesity, fat distribution and weight gain as risk factor for
clinical diabetes in men. Diabetes Care 1994; 17: 961 969.
2 Golay A, Munger R, Felber JP. Obesity and NIDDM: the
retrograde regulation concept. Diabetes Rev 1997; 5(1):
69 82.
Dissociated
Before
After
Before
After
5.6 0.3
16.3 1.7
6.0 0.3
1.12 0.06
2.5 0.4
5.0 0.1**
14.2 1.3
5.3 0.2***
0.94 0.04***
2.0 0.2*
5.1 0.3
14.2 2.8
6.1 0.4
1.26 0.08
2.3 0.3
4.4 0.2**
10.6 1.5
5.2 0.4**
1.02 0.09**
1.3 0.2**
X s.e.m.
*P < 0.05; **P < 0.01; ***P < 0.001.
International Journal of Obesity
496