Adherence
Macronutrient composition (high-carb/low-fat, high-fat/low-carb, or high-protein) has no significant independent effect on long-term weight loss compared to isocaloric diets when behavioral adherence and caloric deficit are controlled.
Stop searching for the 'perfect' macronutrient ratio (keto, low-fat, high-protein). The specific type of diet matters less than your ability to stick to a caloric deficit. Focus on behavioral strategies, counseling, and sustainable habits rather than restricting specific food groups, as all diets yield similar modest weight loss (3-4 kg) over 2 years if adherence is maintained.
Sacks et al. to conclude that behavioral factors rather than macronutrient composition are the main influences on weight loss... differences in macronutrient intake were too small... If behavior rather than diet composition is the key to weight loss, macronutrient composition may be of secondary importance anyway.
Why this rating
Based on a large, long-term trial (Sacks et al.) with objective biomarkers and low dropout, though the author notes the macronutrient differences achieved were smaller than planned.
Source
Weight-Loss Diets for the Prevention and Treatment of Obesity
Mira Katan · New England Journal of Medicine · 2009
DOI 10.1056/nejme0810291
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