More recent assessments of the efficacy of semi-starvation diets tend to be studies that set out to evaluate the efficacy of low-fat, calorie-restricted diets, but because they do so by comparing these diets with more balanced calorie-restricted diets, they provide evidence for the efficacy of the latter as well. In 2002, a Cochrane Collaboration review of the evidence concluded that low-fat diets induced no more weight loss than calorie-restricted diets, and in both cases the weight loss achieved “was so small as to be clinically insignificant.” A similar analysis was published in 2001 by the U.S. Department of Agriculture. In this case, the authors identified twenty-eight relevant trials of low-fat diets, of which at least twenty were also calorie-restricted. The overweight subjects consumed, on average, less than seventeen hundred calories a day for an average weight loss of not quite nine pounds over six months. Only one of these studies tracked its participants for more than a year, and in that case the subjects reportedly reduced their caloric intake to thirteen hundred calories for eighteen months. In other words, these subjects reportedly consumed fewer calories per day than had Keys’s conscientious objectors, they maintained this semi-starvation regimen for three times as long—and they emerged from the trial having gained, on average, a pound. In the Women’s Health Initiative, discussed earlier (see Chapter 4) twenty thousand women were prescribed a low-fat diet and reportedly reduced their calorie consumption by an average of 360 calories a day. After almost eight years of this regimen, they weighed only two pounds less than when they started, and their average waist circumference, which is a measure of abdominal fat, had increased.