Mediterranean Diet and Weight Loss

Obesity has taken epidemic proportions in many industrialized nations including Spain and other countries of the Mediterranean basin. A health condition that has both a genetic and an epigenetic origin, obesity is associated with the occurrence of numerous diseases, such as hypertension, type II diabetes, coronary heart disease and even some forms of cancer.

In Europe and Pacific Asia the frequency of overweight and obesity has almost doubled in the last 20 years. In the US alone, the annual toll due to obesity is 300,000 deaths [1], while the economic burden is predicted to reach about $344 billion by 2018—one fifth of the health care spending.

The Mediterranean diet (MD) represents a group of dietary patterns adapted by inhabitants of countries around the Mediterranean Sea. It is a nutritional model that successfully brings together health and good taste.

The health benefits of the MD have been extensively studied. Adherence to the MD has been positively associated with longevity, lower incidence of metabolic syndrome, protection from hypertension, lower cardiovascular and cancer risk, low occurrence of osteoporosis and rheumatoid arthritis, protection against Parkinson’s disease and depression, better mental and physical health, and lower body weight.

Can the Mediterranean Diet Help With Weight Loss?

A number of studies have specifically examined whether adherence to the MD can decrease excess body weight as well as protect against weight gain.

Inverse Relationship Between MD and Obesity - The Attica Study

Perhaps the most referenced study associating obesity with MD is the ATTICA study. Named after the province of Attica where the capital of Greece, Athens, is located, the ATTICA study evaluated the nutritional habits of 3000 Greek women and men. The participants were asked to record the food that they consumed for one whole year. Their diet pattern was compared to that of the MD and a score was assigned signifying the level of adherence to the MD. Higher score implied closer adherence to the MD.

But what kind of food does the MD consist of? Portrayed as a food pyramid, the traditional MD involves daily consumption of fruits, unprocessed cereals, vegetables, olive oil and low fat dairy products.  Fish, nuts, eggs and sweets are consumed moderately—four to six servings weekly. Red meat is consumed infrequently—no more than 5 servings per month. One small glass of wine per day sits at the narrow end of the MD pyramid.  Further, the MD is characterized by a high ratio of monounsaturated to saturated fat, with olive oil being the principal source of added lipid.

Analysis of the data collected from the ATTICA project showed that there was an inverse relationship between obesity and adherence to the MD. The better the adherence the lower the odds of being obese. The waist and hip circumference as well as the waist-to-hip ratio—a measure of central adiposity—and BMI were lower in the participants with higher MD score. Specifically, people whose diet was very similar to the MD had half the chances of being obese compared to people whose diets were far from the MD profile.


Mediterranean Diet Helps You Lose Weight and Keep it off

Body Cell Mass (BCM) is the mass of all the cellular components in our body. It represents the metabolically active tissue of your body. The more the BCM the higher the energy we expend at rest. Common weight loss diets often result in loss of BCM thereby decreasing the resting energy expenditure of the dieter. This has detrimental effects on weight loss maintenance and is responsible for the high rate of recidivism observed with most weight loss programs.

A study conducted in Italy evaluated the effect of the MD on the preservation of BCM in obese women. Forty-seven women followed a low calorie version of the MD in combination with an exercise program, with the purpose of losing weight.

Within 2 months, body weight, BMI and fat mass significantly decreased in these women, as expected. In addition, cardiovascular disease factors improved. Good cholesterol (HDL) increased, bad cholesterol (LDL) and triglycerides decreased. The most interesting finding of this study was that BCM remained the same.

The maintenance of BCM after weight loss with the MD is very important because preservation of BCM—our energy consuming tissue—increases the chances of maintaining the weight loss following a diet.

Mediterranean Diet Prevents Weight Gain

In general, as we age our body weight increases. For example, the transition from high school to college has been linked to weight gain. A Cornell university study found that freshmen gain more than 4 pounds within their first 3 months on campus. Another stage in life when people tend to gain weight is after getting married or partnered. Moreover, pregnancy weight gain above the recommended is common, and so is carrying baby fat for life. Even moderate weight gain has been shown to increase the risk for cardiovascular disease in women [2].

How can getting heavier be avoided as you age? A recent study examined the effect of fruit and vegetable consumption—a fundamental component of the MD—on the weight gain of 206 Spanish from Valencia. The participants were surveyed on their nutritional habits in 1994 and then again in 2004. They were asked how often they consumed fruits (ie, grapes, orange, apple, apricot, peach, melon) and vegetables (ie, onion, garlic, tomato, carrot, spinach).

Of the participants, those who reported high consumption of fruits and vegetables at the beginning of the study, gained less weight at the 10 year follow up. This study is particularly interesting because it shows that weight gain can be prevented not necessarily by deliberate avoidance of certain foods, but by just increasing the fruit and vegetable intake.

Other studies have confirmed these results showing an inverse relationship between fruit and vegetable intake and weight gain [3-5].


Back in the 1950s, it was reported that people on the Greek island of Crete had an increased lifespan. Since then, many studies confirmed an association of  the MD with reduced risk for various diseases, including obesity. However, adherence to the traditional MD during the past two decades has noticeably declined in the Mediterranean nations paralleling an increase in obesity.

Adapting the MD lifestyle, which includes daily physical activity and a healthy diet, will not only help you lose weight but also facilitate prevention of future weight gain. Your Heart Needs The Mediterranean Diet book, written by Registered Dietitian Emilia Klapp, is an invaluable guide that will help you learn the healthy culinary lifestyle of southern Europe.


1. Allison DB, Fontaine KR, Manson JE, Stevens J, VanItallie TB. Annual deaths attributable to obesity in the US. JAMA 1999;282: 1530–8.

2. Willett WC, Manson JE, Stampfer MJ et al. Weight, weight change, and coronary heart disease in women. Risk within the “normal” weight range. JAMA 1995;273:461–465.

3. He K, Hu FB, Colditz GA, Manson JE, Willett WC, Liu S. Changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women. Int J Obes Relat Metab Disord 2004;28:1569–1574.

4. Epstein LH, Gordy CC, Raynor HA, Beddome M, Kilanowski CK, Paluch R. Increasing fruit and vegetable intake and decreasing fat and sugar intake in families at risk for childhood obesity. Obes Res 2001;9:171–178.

5. Singh RB, Niaz MA, Ghosh S. Effect on central obesity and associated disturbances of low-energy, fruit- and vegetable-enriched prudent diet in north Indians. Postgrad Med J 1994;70:895–900.