British Journal of Nutrition

Full Papers

Behaviour, Appetite and Obesity

Adding cognitive behavioural treatment to either low-carbohydrate or low-fat diets: differential short-term effects

Heriberto Rodriguez-Hernandeza1a2, Uziel A. Morales-Amayaa3, Ramon Rosales-Valdéza3, Felipe Rivera-Hinojosaa4, Martha Rodriguez-Morana1a2 and Fernando Guerrero-Romeroa1a2 c1

a1 Biomedical Research Unit, Mexican Social Security Institute, Predio Canoas No. 100, Col. Los Angeles, 34067 Durango, Dgo, Mexico

a2 Research Group on Diabetes and Chronic Illnesses, D.A. Siqueiros 225 esq/Castañeda, Zona centro, 34000 Durango, Dgo, Mexico

a3 Psychology School, Jose Vasconcelos University, Calle Guadalupe No. 311, 34000 Durango, Dgo, Mexico

a4 Nutrition Department, General Hospital of Mexican Social Security Institute at Durango, Predio Canoas y Ave. La Normal, Col. Silvestre Dorador, 34067 Durango, Dgo, Mexico


To evaluate the efficacy of adding cognitive behavioural treatment (CBT) to either a low-carbohydrate (LC) diet or a low-fat (LF) diet in the treatment of weight loss of obese women, a randomised clinical intervention study was performed. A total of 105 healthy non-pregnant obese women (average age and BMI of 45·4 (sd 10·4) years and 36 (sd 4·3) kg/m2) were randomly allocated to the CBT or control (C) groups; within each group, women were randomly selected to receive either the LC or LF diet during 6 months. The pre-planned primary trial end-point was the weight loss. Differences between the groups were assessed using one-way ANOVA. There were three women (2·8 %) who dropped out, all of them in the CBT group. No differences in the anthropometric and laboratory characteristics at baseline were noted between women in the CBT (n 52) and control groups (n 50). Intention-to-treat analysis showed that weight loss in the CBT-LC (90 (sd 12·3) to 82·1 (sd 12·1) kg) and C-LC (89·4 (sd 10·0) to 85·8 (sd 9·8) kg) groups reached 8·7 and 4·0 %, respectively (P < 0·0001), and in the CBT-LF (87·9 (sd 11·4) to 79·4 (sd 11·8) kg) and C-LF (88·8 (sd 14·5) to 85·3 (sd 14·3) kg) groups it was 9·7 and 3·9 %, respectively (P < 0·05). Weight loss was higher in the CBT-LF group than in the CBT-LC groups (P = 0·049). The present results showed that adding CBT to either the LF or LC diet produced significantly greater short-term weight loss in obese women compared with diet alone. These finding support the efficacy of CBT in breaking previous dietary patterns and in developing healthier attitudes that reinforce a healthier lifestyle.

(Received December 01 2008)

(Revised May 13 2009)

(Accepted May 26 2009)

(Online publication August 14 2009)


c1 Corresponding author: Dr Fernando Guerrero-Romero, fax +52 618 8132014, email


Abbreviations: BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; CBT, cognitive behavioural treatment; CBT-LC, cognitive behavioural treatment with low-carbohydrate diet; CBT-LF, cognitive behavioural treatment with low-fat diet; C-LC, control group with low-carbohydrate diet; C-LF, control group with low-fat diet; LC, low-carbohydrate; LF, low-fat