Greater Healthful Dietary Variety Is Associated with Greater 2-Year Changes in Weight and Adiposity in the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) Trial

J Nutr. 2016 Aug;146(8):1552-9. doi: 10.3945/jn.115.224683. Epub 2016 Jun 29.


Background: Greater healthful dietary variety has been inversely associated with body adiposity cross-sectionally; however, it remains unknown whether it can improve long-term weight loss.

Objective: This study prospectively examined associations between healthful dietary variety and short-term (6 mo) and long-term (2 y) changes in adiposity in the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) weight-loss trial completed in 2007.

Methods: Healthful dietary variety was assessed from 24-h recalls with the use of the US Healthy Food Diversity index among participants aged 30-70 y with overweight/obesity (n = 367). Changes in the index between baseline and 6 mo were divided into tertiles representing reduced (T1), stable (T2), or increased variety (T3). Body weight and waist circumference (WC) were measured every 6 mo, and the percentage of body fat and trunk fat were measured at 6 mo and 2 y. Associations between changes in variety and short-term and long-term changes in adiposity were analyzed by use of multivariable-adjusted generalized linear models and repeated-measures ANOVA.

Results: Regardless of dietary arm, T3 compared with T2 was associated with greater reduction in weight (-8.6 compared with -6.7 kg), WC (-9.1 compared with -6.1 cm), and body fat at 6 mo (β = -4.61 kg, P < 0.05). At 2 y, individuals in T3 compared with those in T2 or T1 maintained greater weight loss [-4.0 (T3) compared with -1.8 kg (T2 and T1), P = 0.02] and WC reduction [-5.4 (T3) compared with -3.0 (T2) and -2.9 cm (T1), P = 0.01]. Total body fat and trunk fat reductions were similarly greater in T3 than in T2.

Conclusions: Increasing healthful food variety in energy-restricted diets may improve sustained reductions in weight and adiposity among adults with overweight or obesity on weight-loss regimens. This trial is registered at as NCT00072995.

Keywords: POUNDS Lost; dietary variety/dietary diversity; healthy food diversity; obesity; weight loss; weight maintenance.

MeSH terms

  • Adipose Tissue / metabolism*
  • Adiposity*
  • Body Weight Maintenance
  • Caloric Restriction*
  • Diet, Healthy*
  • Diet, Reducing*
  • Energy Intake
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity / diet therapy*
  • Obesity / prevention & control
  • Overweight
  • Prospective Studies
  • Waist Circumference
  • Weight Loss*

Associated data