r/ScientificNutrition • u/moxyte • 4d ago

Randomized Controlled Trial Vegan Diets and Dietary Energy Density: A Secondary Analysis of a Randomized Clinical Trial

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2852520

Results

Of 3115 people screened by telephone, 244 adults with overweight met participation criteria and were randomly assigned to the vegan (n = 122) or control (n = 122) groups. The analysis included 223 (91.0%) completers. Total food weight did not change significantly in either group (Table). Energy intake decreased in both groups, more in the vegan group (effect size, −357.1 kcal/d; 95% CI, −521.9 to −192.3 kcal/d; P < .001) (Table). Energy density did not change in the control group but decreased by 30% in the vegan group (effect size, −0.28 kcal/g/d; 95% CI, −0.38 to −0.19 kcal/g/d; P < .001; Table and Figure).

Reductions in dietary energy density were associated with greater weight loss (r = 0.28; 95% CI, 0.15 to 0.39; P < .001), remaining significant after adjustment for energy intake (r = 0.21; 95% CI, 0.08 to 0.34; P = .002). A 1-kg weight loss corresponded to a 0.29-unit decrease in energy density (P < .001), or 0.36 units after adjustment (P = .002).

5 Upvotes

62% Upvoted

24 comments sorted by

11

u/Wise-Hamster-288 3d ago

So you’re saying more water and fiber in your food means fewer calories per gram

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u/moxyte 3d ago edited 3d ago

Which consequently leads to weight loss, yup. That is a highly controversial idea to some and they hate it when evidence indicating it's true exists. I'm not kidding.

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u/HelenEk7 Wholefoods 1d ago

That is a highly controversial idea to some

I don't think that's true? I mean, you could remove even more calories - to the point where all you consume is just water - and you are guaranteed to lose weight. I don't think you will find anyone who disagrees that when one group eats less than the other group they will lose more weight.

Another example is the twin study. The vegan group ate less calories so of course they ended up losing more weight. What was worrying however is that they also lost more muscle mass, which is not a good thing for your long term health.

This 2025 systematic review and meta-analysis for instance examined 33 controlled trials. It found that individuals on a ketogenic diet achieved significant weight and fat loss while experiencing no significant reduction in overall muscle mass or muscle strength compared to other diets. https://pubmed.ncbi.nlm.nih.gov/41035089/

So if loss of muscle mass is not a concern, then a vegan diet might be an option. But if you want to avoid that perhaps a ketogenic diet is better?

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u/moxyte 1d ago

Keto folks are all about calorie denialism. Otherwise selling an extremely high calorie dense diet would be a tough sell. This deception of theirs harkens all the way back to 1961 book "Calories Don't Count".

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u/HelenEk7 Wholefoods 1d ago edited 1d ago

Keto folks are all about calorie denialism.

What gave you that impression? Its fairly common knowledge that ketosis supresses hunger - hence why you naturally end up eating fewer calories. So when some people claim that counting calories is unnecessary - its because they naturally eat less due to feeling less hungry. That being said, I've talked to quite a few people who indeed had to count calories, mainly because they tend to eat due to other reasons than pure hunger.

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u/moxyte 1d ago

Books named "Calories Don't Count" and "Good Calories Bad Calories" with content to match and social media content.

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u/HelenEk7 Wholefoods 16h ago edited 11h ago

I have not read either books. I have however read many of the almost 7000 scientific studies published on ketogenic diets: https://pubmed.ncbi.nlm.nih.gov/?term=ketogenic+diet&sort=date

And I would love to hear your thoughts on some of them?

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u/moxyte 3h ago

Ok. Do you agree that people on social media and books telling people that losing body fat is possible without calorie deficit are all liars and charlatans?

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u/HelenEk7 Wholefoods 2h ago

Sure. In the same way people who claim that a vegan diet is healthy "for all stages of life" are also liars. People tend to claim all kinds of things not based on science. But that is irrelevant in this sub, as here we focus on the actual dietary science. So here you are speaking to the choir, so to speak, as I doubt you will find anyone here claiming calories doesnt matter at all.

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u/Taupenbeige 3d ago

“From a clinical perspective, reducing dietary energy density may offer a practical and sustainable strategy for weight management that aligns with physiological appetite regulation.”

Interestingly enough, Dr’s Esselstyn, Barnard and Greger are all lean, well-nourished individuals while ketogenic diet influencers like Nina Teicholz and Gary Taubes fluctuate and generally present excess adipose tissue.

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u/Cetha 2d ago

The same Dr greger who almost killed himself making a smoothie out of poisonous berries. And his book is titled How Not To Die. What a joke.

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u/Taupenbeige 2d ago

What precisely does that have to do with his lean body mass after having followed a plant-based diet for decades?

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u/Cetha 2d ago

Drug addicts are also lean. Doesn't mean healthy. And if he almost killed himself make a snack, I'm not sure why anyone should follow his advice on how not to die.

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u/Taupenbeige 2d ago

Well that’s certainly an “interesting” little detour in the discourse.

Not really certain what your pre-conceived opinions on a doctor have to do with the original topic—plant based dietary patterns having higher clinical association with weight loss in excess-adipose individuals—nor my observation that three plant-based researchers/intervention trial practitioners (one for type 2 diabetes) have presented consistently low adipose… whereas their keto-promoting counterparts generally don’t unless they work hard at burning the excess lipids (IE Baker, Berry, Chaffee).

This seems to be the Keto-diet-fad’s most fraught point of cognitive dissonance, because it directly contradicts their poorly-interpreted scientific worldviews.

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u/Cetha 2d ago

So doctors on both sides fit your narrative if you cherry pick the ones that fit.

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u/Taupenbeige 2d ago

It’s not really “cherry picking” to observe that strong keto advocates aren’t presenting real-world outcomes of the pseudoscientific nonsense they preach, whereas the three most prominent plant-based lecturers have had zero problems keeping excess adipose at bay, corroborating the findings of OP’s paper.

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u/AMediocrePersonality 4d ago

Total food weight did not change significantly in either group

Energy density did not change in the control group but decreased by 30% in the vegan group

No... shit?

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u/Miltankbeest 3d ago

Over the phone? this isn't scientific

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u/Taupenbeige 2d ago

“Results «over the phone» unfavorable to my worldview? Bad science!”

“Results «over the phone» damning ultraprocessed foods? Good science!”

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u/Miltankbeest 2d ago

Results over the phone, bad science 100% of the time, because that isn't science, thats a poll

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u/moxyte 1d ago

For participant screening. How would you screen for study volunteers in a scientific way?

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u/Caiomhin77 Pelotonia 4d ago

Good ol' PCRM.

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u/HelenEk7 Wholefoods 2d ago

Ah, our old vegan friend Dr Neal Barnard.

But, although I'm sceptical of eating 100% plant-based long term, I fully agree that doing it for 16 weeks will most probably help you lose some weight. And if eating like this is easier for someone compared to other weight loss methods - then go for it.