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Rationale: Weight loss is recommended to treat obstructive sleep apnea (OSA).Objectives: To determine whether the initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA se...

Competing models of obesity and its treatment often contrast the relative roles of dietary fat versus carbohydrate. Advocates of low-carbohydrate diets posit that intake of high glycemic carbohydrates leads to elevated postprandial insulin thereby promoting body fat accumulation while increasing hunger and energy intake according to the carbohydrate-insulin model of obesity. Alternatively, proponents of low-fat diets argue that high fat intake promotes body fat storage due to passive overconsumption of energy resulting from the high energy density of dietary fat. To test these competing models, 20 adults without diabetes aged (mean±SE) 29.9±1.4 y with BMI=27.8±1.3 kg/m2 were admitted as inpatients to the NIH Clinical Center and randomized to consume ad libitum either a plant-based, low-fat (PBLF) diet (75.2% carbohydrate, 10.3% fat, non-beverage energy density = 1.1 kcal/g) or an animal-based, ketogenic, low-carbohydrate (ABLC) diet (75.8% fat,10.0% carbohydrate, non-beverage energy density = 2.2 kcal/g) for two weeks followed immediately by the alternate diet for two weeks. Three daily meals plus snacks amounting to twice each subject’s estimated energy requirements were provided and subjects were instructed to eat as much or as little as desired. The PBLF diet resulted in substantially greater glucose and insulin levels whereas the ABLC diet led to increased blood ketones of ~3 mM which is thought to suppress appetite. However, ad libitum energy intake was 689±73 kcal/d lower during the PBLF diet as compared to the ABLC diet (p