Dean Ornish

The Eat More, Weigh Less plan didn’t start out as a weight-loss regimen. In its first incarnation, it was a program for reversing heart disease. But as it turns out, the same diet that unclogs arteries and helps many heart patients sidestep bypass surgery also peels off the pounds. Weight loss was so dramatic among patients enrolled in Ornish’s Lifestyle Heart Trials that he felt compelled to write a book about it.

Ornish assures dieters that they won’t have to face the deprivation and calorie restriction that come with plans like Weight Watchers and Jenny Craig; still, a diet this low in fat is no picnic. Most folks will have to make some major adjustments to follow such a stringent way of eating.

Basic principles:

At the core is one simple strategy: Dieters change the type of food they eat, not the amount. Rather than offer rules, the plan focuses on choices. But it’s clear that low-fat vegetarian choices are the preferred ones. In fact, Ornish suggests that making sweeping changes, like cutting out meat entirely, is much easier than just cutting down on portions.

How the diet works:

Stop counting calories and throw out the measuring cups. You dine ad lib on everything from pineapple to kidney beans to oats. Because a plant-based diet is naturally low in fat, calories are also low as a result. No biochemical smoke and mirrors here, just very low-fat eating. Currently, most Americans get around 35 percent of their total calories from fat. If that amount were to drop to Ornish’s recommended 10 to 20 percent, dieters could eat almost one-third more food each day yet still consume the same amount of calories, the doctor says. His regimen isn’t one that you go on and then off, but one you follow over the long haul.

What you can eat:

All the fruits, vegetables, legumes, and whole grains you want, but limited amounts of fats and oils. Small amounts of roasted or grilled skinless chicken breast, or lean seafood like perch, cod, sole, cod, and flounder, are OK in moderation. Red meat, nuts, avocados, and other high-fat fare—along with sugar, refined grains, and alcohol—should be avoided as much as possible.

Does the diet take and keep weight off?

Research shows that people who follow the Ornish program lose an average of 24 pounds in a year. But a report presented at the November 2003 American Heart Association meeting found that this plan is no better or worse at producing weight loss than other popular diets such as Weight Watchers, The Zone, and Atkins. The study specifics: 160 overweight volunteers were randomly assigned to one of these four plans. After a year, weight loss averaged a modest 5 percent, no matter what regimen dieters followed.

Is the diet healthy?

It seems to be. Study after study confirms that a vegetarian diet is best for overall health. As a group, vegetarians have lower cholesterol, weigh less, and suffer less chronic disease than their meat-eating counterparts. Still, some critics wonder whether the Ornish diet’s fat content might be too low. Plus, its high carb levels may pose a problem for people who have diabetes or insulin resistance.

What do the experts say?

“It’s nice to say there are no rules, only choices,” says Gail Frank, DPH, RD, professor of nutrition at California State University, Long Beach. “But after a few days on the diet, it starts looking like a very restricted menu. Discouraging a few nuts, two to three servings of dairy, and some alcohol calories in today’s social world makes the diet too pristine for the majority of people.” In a recent review of popular diets for The Journal of the American Medical Association, renowned obesity researcher Thomas Wadden, PhD, director of the Weight and Eating Disorders Program at the University of Pennsylvania, concluded that dieters would need to be “extremely vigilant” to stick to the Ornish regimen. “But I would have fewer health concerns about his diet than I would about the low-carb, high-fat diets,” he adds.

Who should consider the diet?

It’s a no-brainer for vegetarians. And it could be a smart start on prevention for dieters who have a family history of heart disease.

Bottom line:

Restricting fat this much is probably unnecessary, not to mention hard to do for very long. You’d be better off adding some good fats—olive oil, nuts, or avocado. A little more lean meat, fish, and chicken wouldn’t hurt either.

Lead writer: Maureen Callahan, M.S., R.D.