what nutrition changes can be done to help those affected by obesity?
Med Clin Due north Am. Author manuscript; available in PMC 2019 January 1.
Published in final edited form as:
PMCID: PMC5726407
NIHMSID: NIHMS903650
DIETARY Management OF OBESITY: CORNERSTONES OF Salubrious EATING PATTERNS
ALISSA D. SMETHERS
DOCTORAL Educatee, Department OF NUTRITIONAL SCIENCES, THE PENNSYLVANIA STATE UNIVERSITY, Academy PARK, PA, USA
BARBARA J. ROLLS
PROFESSOR AND GUTHRIE CHAIR IN NUTRITION, Section OF NUTRITIONAL SCIENCES, THE PENNSYLVANIA STATE UNIVERSITY, UNIVERSITY PARK, PA, USA
SYNOPSIS
A number of dietary patterns, both macronutrient and food based, can pb to weight loss. A key strategy for weight direction that can be applied across dietary patterns is to reduce energy density. Clinical trials testify that reducing free energy density is constructive for weight loss and weight loss maintenance. A diverseness of practical strategies and tools tin help facilitate successful weight management past reducing energy density, providing portion command, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce free energy intake for sustainable weight loss.
Keywords: WEIGHT Direction, DIETARY STRATEGIES, Energy DENSITY, SATIETY, DIETARY PATTERNS
Introduction
The recent surge in rates of obesity is driven past eating behaviors and nutrient choices that promote excessive free energy intake.1–8 Current recommendations for weight management emphasize the importance of healthy eating patterns that include a diversity of nutrient-dense foods, limit portions of energy-dumbo foods, and reduce overall energy density.8 A number of dietary patterns that reduce energy intake in relation to energy expenditure atomic number 82 to similar weight loss. A unifying gene for weight loss across dietary patterns is energy density. Reducing a diet's energy density allows individuals to swallow satisfying amounts of food for fewer calories. Strategies that lower energy density are flexible and tin be applied to multiple dietary patterns to lucifer differences in energy needs, taste preferences, eating behaviors, food accessibility, and cultural backgounds.8,nine This article will discuss electric current prove related to dietary approaches for weight management, and will provide strategies and tools to create lower-energy-dense eating patterns that tin exist tailored to the individual to accomplish a sustainable and good for you weight direction program.
Current Bear witness on Dietary Patterns for Weight Loss
Macronutrient patterns for weight loss
Advice to alter the proportion of the macronutrients consumed has been the foundation for many weight loss diets.ten Fat, carbohydrate, and protein accept all been highlighted at different times equally the key to weight loss.xi–13 There continues to be controversy over whether a low-fat or low-carbohydrate diet is amend for weight loss, or whether the increased satiating effects of a higher-poly peptide diet help to sustain weight loss.10,14 An evidence-based study from the American College of Cardiology/American Centre Association Task Force on Practice Guidelines and The Obesity Society supports several energy-restricted dietary approaches for weight loss that focus on the macronutrients, including low-fat, lower-carbohydrate, moderate- and higher-protein, and macronutrient-targeted diets.fifteen While such diets can be effective, a number of systematic studies point that focusing on a item macronutrient for weight loss is non necessary. Dissimilar macronutrient recommendations have all led to similar clinically pregnant weight loss at half dozen months, one year, and even two years.12,16,17
1 large clinical trial that compared 4 diets with different proportions of macronutrients, The Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) study, found that weight loss was similar across the diets (See Effigy 1).12 While the macronutrient composition did non affect weight loss or maintenance of lost weight, regression assay showed that reductions in dietary energy density and increases in fiber intake were potent predictors for half-dozen-month weight loss in all diet groups.18–20 The fundamental dietary advice given to participants on all diets included strategies to lower the energy density of the diet, such equally increasing vegetable and fruit consumption and decreasing consumption of high-calorie foods.12,21 These results suggest that regardless of macronutrient composition, a goal for weight loss should be to adopt a pattern of eating that is lower in energy density.
Weight loss over 2 years in adults assigned to 1 of 4 diets with unlike proportions of Carbohydrate/Protein/Fat as listed. There was no significant difference in weight loss related to the macronutrient composition.
Data from Sacks FM, Bray GA, Carey VJ, et al. Comparing of weight-loss diets with different compositions of fat, protein, and carbohydrates. Due north Engl J Med 2009; 360(ix):859–873.
Food-based patterns for weight loss
In contempo years, dietary guidance has emphasized the importance of considering whole diets and patterns of consumption rather than a reductionist approach that focuses on single foods or nutrients.22 For example, the 2015 Dietary Advisory Commission recommends that individuals who have overweight and obesity attain weight loss by adopting a healthy eating pattern. Examples of such patterns are the Healthy U.S.-Fashion Eating Design, which represents the Dietary Approaches to Stop Hypertension (Nuance) diet, and the Healthy Mediterranean-Way Eating Blueprint.8 The Dash eating pattern recommends reducing intake of the less salubrious fats and keeping total fat intake to less than 25% of the diet'due south energy, as well as increasing the proportion of low-free energy-dumbo foods, such as vegetables and fruits (nine to 12 servings/day) and depression-fat dairy products (two to 3 servings/day).23 The DASH nutrition is a lower-free energy-dense pattern of eating that allows individuals to consume less free energy without reducing the weight of food they typically eat.24 The Mediterranean eating blueprint also emphasizes intake of low-energy-dense fruits, vegetables, legumes, seafood, and dairy foods.25 However, higher amounts of fat (thirty–40% of total energy), especially from olive oil, are recommended with the Mediterranean design.25 Fifty-fifty with this level of healthy fats, the high proportion of vegetables and fruits included in this design tin aid to keep the overall diet relatively depression in energy density.26 Table 1 provides guidance on food groups and amounts in several healthy eating patterns.
Table 1
Recommended daily amounts of food from each food group for the U.s. Healthy Eating Blueprint (DASH) and the Mediterranean Eating Design at ii calorie levels
| Healthy US-Way Eating Pattern | Healthy Mediterranean-Style Eating Blueprint | |||
|---|---|---|---|---|
| 1400 calories | 1800 calories | 1400 calories | 1800 calories | |
| Food Grouping | Daily corporeality from each food group | |||
| | ||||
| Vegetablesa | 1 ½ cups | 2 ½ cups | 1 ½ cups | 2 ½ cups |
| Fruitsb | 1 ½ cups | 1 ½ cups | 1 ½ cups | 2 cups |
| Grainsc | 5 oz | 6 oz | 5 oz | half-dozen oz |
| Dairyd | 2 ½ cups | 3 cups | 2 ½ cups | 2 cups |
| Poly peptide Foodse | 4 oz | 5 oz | 4 oz | 6 oz |
| Oils | 17 g | 24 g | 17 g | 24 g |
The influence of energy density on weight management
A key question is whether shifting to a healthy eating pattern that encourages individuals to lower the energy density of their diet will facilitate weight management.24,27 This was examined in the large multicenter PREMIER trial in which three intervention groups received data on nutrition and weight loss, with one group counseled to consume the Dash dietary pattern. Despite differences in handling, after half-dozen months, all 3 groups experienced similar weight loss. While the boilerplate modify in energy density of the three groups was similar, there was considerable variability within groups, making it possible to determine whether changes in energy density were related to weight loss. In a secondary analysis that combined the participants from all three groups, results showed that participants with larger reductions in dietary free energy density lost more weight than those who had smaller reductions in energy density.24 Furthermore, those who had large or moderate reductions in energy density consumed a greater weight of food and improved diet quality past increasing vegetable and fruit consumption.24 Thus, the adoption of strategies that lowered energy density had a greater bear upon on weight loss than the specific dietary advice given to the iii intervention groups.
Other clinical trials confirm that a lower-energy-dense eating pattern is an effective strategy for weight direction.28,29 In one trial that compared the incorporation of either a low-or high-free energy-dense food into a reduced-calorie diet, the reduction in dietary energy density was the main predictor of weight loss during the outset two months of the report.28 Over the year of the trial, the daily consumption of the depression-energy-dense food (soup) instead of higher-energy-dense dry snacks with the same calorie content increased the magnitude of weight loss.28 Encouraging regular consumption of low-free energy-dense foods tin reduce overall dietary free energy density and can exist an constructive strategy for weight management.
Some other clinical trial further explored the effectiveness of reducing energy density for weight management past comparing two energy density reduction strategies: reduced-fat or reduced-fat plus increased low-energy-dense vegetables and fruits.29 There were no specific goals for energy intake. Afterward ane year, participants in the grouping focused on eating more vegetables and fruits lost more weight, had a lower dietary energy density, consumed a greater weight of food (especially vegetables and fruits), and reported less hunger compared to participants focused just on fat reduction.29 An increase in the amount of food consumed when managing energy intake volition likely improve the long term acceptability of a depression-energy-dense eating design since information technology could help to control hunger.
Lowering dietary free energy density tin can besides assistance patients maintain their weight loss.xxx,31 In a dispensary-based weight loss program that encouraged consumption of depression-energy-dumbo foods, individuals who maintained their weight loss later on two years reported eating a lower-energy-dense diet than those who regained 5% or more of their body weight.32 In some other trial, educational activity on reducing dietary free energy density led to sustained weight loss 36 months after the start of the intervention.33
Patients demand education on implementing changes in their diet to lower energy density and replicating this in their personal food surround.33 The strategies individuals use to reduce free energy density can fit with a variety of good for you dietary approaches that are popular for weight loss. The next section focuses on dietary free energy density, with more in-depth word of prove-based principles that individuals can use to lower free energy density and create sustainable eating patterns for weight management.
Unifying principle of dietary patterns: free energy density
The energy density of a food or beverage can range from 0 calories per gram to ix calories per gram, and varies based on the proportions of h2o (0 calories per gram), cobweb (ii calories per gram), carbohydrate (4 calories per gram), protein (4 calories per gram), alcohol (seven calories per gram) and fat (9 calories per gram). Fatty is the nigh energy-dense macronutrient, so when the fat content of a food is reduced, energy density also decreases. Water, however, has the biggest influence on energy density since it adds weight to food without calculation calories. The more water a food contains, regardless of the fat content, the lower the energy density of the food. Low-energy-dense foods tin help to reduce energy intake by enhancing satiation and satiety through psychological and physiological mechanisms. This leads to terminating a repast sooner, prolonging the time until the next eating occasion, and reducing intake at the next meal.34,35
The energy density of a nutrient or potable determines the portion size that can exist eaten for a given number of calories: the lower the energy density, the larger the portion for the same number of calories. Figure two provides a visual instance of how the portion size of a 100-calorie snack can vary based on the energy density of the nutrient. For instance, a 100-calorie portion of raisins is about ¼ cup, while the same 100-calorie portion of cherry tomatoes is effectually 4 cups. Every bit seen in Figure 2, energy density tin can exist explained visually to patients to help them understand the human relationship between energy density and the portions that can be consumed. To aid farther understand this concept, energy density can be divided into four categories: very low free energy density, low free energy density, medium energy density, and high energy density (See Tabular array 2).34 No matter what dietary pattern an private uses for weight loss, the energy density of the foods they choose influences the amount of food they can consume to stay within their calorie goals. For weight loss, patients need to be encouraged to regularly make simple good for you shifts within their habitual eating pattern then that a reduction in dietary energy density leads to lower energy intake.35,36
The portion size of a 100-calorie snack varies depending on the free energy density (ED) of the nutrient. Jelly beans (ED 4.0 calories per gram) and raisins (ED three.i calories per gram) are high in energy density and provide minor portions. Grapes (ED 0.69 kcal/k), apples (ED 0.53 kcal/g), and cherry tomatoes (ED 0.18 kcal/grand) are lower in free energy density and provide much bigger portions.
Courtesy of The Penn State Laboratory for the Study of Human Ingestive Behavior, University Park, PA.
Table 2
Free energy density categories and examples of foods in each category
| Energy Density Category | Energy Density Range (calories per gram) | How to Eat | Examples of Foods |
|---|---|---|---|
| Very Depression Energy Density | 0.0 to 0.half-dozen | "Gratuitous" foods to eat anytime | Virtually fruits and vegetables, broth-based soups, non-fat milk |
| Low Energy Density | 0.6 to 1.5 | Eat reasonable portions | Cooked grains, depression-fat meats, beans and legumes, low-fat mixed dishes such as chili and pasta |
| Medium Energy Density | 1.v to 4.0 | Manage portions | Meats, cheese, bread, snack foods such equally popcorn and pretzels, mixed dishes such every bit pizza and macaroni & cheese |
| High Energy Density | iv.0 to 9.0 | Advisedly manage portions and frequency of eating | Crackers, chips, cookies, nuts, butter, oils |
Applied Dietary Strategies for Weight Management
Inquiry shows that a variety of eating patterns that include a reduction in energy intake can work for weight management, only patients may non know which foods to choose or nutrients to emphasize to build their own healthy pattern.eight In society to create a sustainable dietary design for weight loss, patients need to brand changes that manage free energy intake while receiving optimal nutrition, controlling hunger, and promoting satiety. This section volition hash out bear witness-based strategies that individuals tin can employ to lower dietary free energy density, promote satiety, and see nutrient recommendations.
Strategies to increase the proportion of low-free energy-dumbo foods
Substitute lower-free energy-dense foods for higher-free energy-dense foods
In order to emphasize the importance of eating low-energy-dumbo foods, the Dietary Guidelines include MyPlate to communicate to the public (https://world wide web.choosemyplate.gov).37 MyPlate reminds people that half of their meal should be vegetables and fruits. An advantage to emphasizing the proportions of dietary components that comprise a healthy diet is that the message can be practical regardless of accented energy needs.
Only does such communication affect beliefs? Numerous studies bear witness that the portion of a food that is served affects intake, such that the bigger the portion, the greater the intake.4,38–41 Increasing the proportion, and thus the portion size, of vegetables and fruits can increment their intake, but it is important that they are relatively palatable compared to the other foods bachelor.42 Thus, when advising patients to prefer MyPlate, they should be encouraged to find strategies to increase the palatability while non greatly increasing the energy density of the vegetables and fruits. The improver of herbs and spices, or the utilise of moderate amounts of healthy fats and sauces, tin encourage vegetable consumption43,44 Providing a diverseness of vegetables has been shown to increase vegetable intake compared to merely offering one.45 While increasing the portion of vegetables at a meal can increase vegetable intake, it will not necessarily reduce free energy intake. In order to subtract free energy intake at the meal, larger portions of vegetables or fruits must be substituted for foods higher in energy density so that the overall energy density of the meal is lowered.46 See Figure 3 for an instance of how substituting lower-energy-dense foods for higher-energy-dumbo foods tin create a more than satisfying meal.
These three plates all comprise steak, a baked murphy with toppings, and vegetables. The plate on the far left contains 800 calories, which is virtually half of a day's worth. However, if as shown in the eye movie, the portions of all foods are decreased to provide a 400-calorie meal, they do not announced very satisfying. The moving-picture show on the right too provides 400 calories but provides a more satisfying meal by increasing the portions of low-energy-dumbo foods, reducing the fatty content, and moderating the protein portion.
Courtesy of The Penn Land Laboratory for the Report of Homo Ingestive Behavior, University Park, PA.
Decrease the energy density of the chief course
Since the master course or entrée often contributes the almost calories to a repast, a reduction in its energy density can significantly subtract energy intake at a meal. Chiefly, studies show that lower-energy-dumbo entrées withal satisfy hunger and do non lead to compensation by consuming more food later in the day.47 Practical methods for modifying the energy density of an entrée include simple shifts such every bit reducing unhealthy fat and substituting water-rich ingredients such equally fruits or vegetables for those higher in energy density.48–50 For individuals who exercise not particularly like vegetables, the covert incorporation of vegetables into meals has been shown to ameliorate diet quality and manage energy intake.51,52
Add a low-energy-dense showtime class
Another mode to increment the proportion of low-energy-dense foods and reduce dietary energy density is through the addition of a low-energy-dense first class. "Filling up beginning" with a 100- to 150-calorie broth-based soup, leafy green salad, or whole fresh fruit before a meal is a elementary strategy to lower intake of higher-energy-dense main dishes and subtract meal energy intake.38,53–57
These strategies to increase consumption of low-energy-dense foods and reduce those college in energy density are flexible; patients can choose which foods to substitute and how the substitution volition fit into their nutrition. They should be encouraged to try a number of strategies until they find an approach that they tin can sustain.
Strategies to enhance satiety and meet nutrient needs with a low-energy-dense eating pattern
Manage fatty to lower energy density and moderate energy intake
For years, scientists thought reducing dietary fat was the fundamental to weight management, simply now evidence from multiple clinical trials shows that both low- and moderate-fat diets combined with an free energy restriction can be used to accomplish weight loss.fourteen,15,58 The government guidelines recommend a range of fat intake (See Tabular array 3) to meet daily energy requirements. The range allows individuals to make adjustments to fat intake in their dietary pattern based on food or cultural preferences in society to promote adherence.8 Recent studies show success at weight loss at both the high and low ends of authorities-recommended fat intakes.11,58
Tabular array 3
Summary of nutritional goals and practical dietary strategies for weight loss
| Element | Nutritional Goal | Recommendation |
|---|---|---|
| Fat | 20 to 35% of total calorie intake | Fat is high in free energy density. Choose appropriate portions of healthy fats to improve nutrition quality and meet nutritional needs.
|
| Protein | 10 to 35 % of total calorie intake | Include poly peptide to create satisfying meals and see nutrient needs.
|
| Sugar | 45 to 65% of full calorie intake | Switch to whole grains instead of refined grains.
|
| Fiber | twenty to 35 grams per day | Include cobweb to help increase satiety
|
| Added Saccharide | Limit to less than 10% of total calorie intake | Limit foods and beverages containing added sugars.
|
| Beverages | Select low-calorie beverages.
| |
| Dietary Strategy | Recommendation | |
| Monitor portions | Choose appropriately sized portions to assist meet daily energy requirements.
| |
| Increase the proportion of lower-energy-dumbo foods | Lower-energy-dense foods provide satisfying portions to assistance increase satiety.
| |
While there is a range in the amount of fat that is recommended in an eating pattern for weight loss, consuming as well much fat tin can lead to a college-free energy-dense diet and weight gain.vii Because of the high energy density of loftier-fat foods, their portion size needs to be chastened to stay within recommended energy intakes. Some methods for moderating fat intake at meals include switching to lower-fat alternatives such as grilled chicken instead of fried chicken or low-fat Greek yogurt instead of sour cream. Shifts should likewise be fabricated to decrease the corporeality of solid fats, which comprise saturated and trans fat, and to substitute with oils containing polyunsaturated and monounsaturated fats to improve nutrition quality and overall health.eight Patients should focus on using good for you fats in moderate amounts that improve their diet'south palatability.
Include protein and fiber to create satisfying meals
Both protein and cobweb have been suggested to promote satiety or feelings of fullness. Individuals are oft reluctant to brand changes to their dietary blueprint because they do non want to feel hungry, and higher protein intakes are ofttimes recommended to help manage hunger and increase satiety.59–61 Poly peptide is described as the virtually satiating macronutrient, and multiple studies advise that incorporating more than poly peptide tin can increase satiety and subtract daily energy intake.62,63 However, other laboratory-based studies have shown that when energy density is controlled, the corporeality of poly peptide served during a meal had no influence on daily energy intake or satiety.64 Research needs to keep to investigate the satiating properties of protein and to further evaluate the amounts and types of protein that show promise for trunk weight management.14,62,63,65,66 Patients should exist encouraged to incorporate recommended amounts of lean protein sources such as grilled chicken breast, legumes, or low-fat dairy to create satisfying low-energy-dumbo meals.34 Table 3 provides nutritional guidance on recommended amounts of protein and lean protein sources to include in a healthy eating pattern.
Dietary fiber is thought to promote feelings of fullness by increasing chewing time, promoting stomach expansion, and decreasing absorption efficiency.67 Studies bear witness that increasing fiber at meals tin lead to decreased free energy intake and increased ratings of fullness.68,69 Population-based studies suggest that diets containing higher amounts of fiber are associated with lower body weights and reduced disease risks.70 Some randomized controlled trials evaluating the addition of fiber-rich foods, such as legumes, have also found increased fiber to be benign for weight management.68 Fiber is often found in foods low in energy density, such as fruits and vegetables, and choosing cobweb-rich foods tin can assist enhance satiety, improve overall health, and support weight management (Encounter Table three).34,70
Manage added sugar intake and consider nonnutritive sweeteners
A goal to reduce consumption of foods and beverages containing added sugars should exist a function of every weight loss program.34 The main sources of added sugars are beverages (which will be discussed next), snacks, and sweets.8 Foods such as fruits, vegetables, and dairy products also incorporate sugar, but these items contain natural sugars, and the recommendations limit added sugars typically found in nutrient-poor, higher-energy-dense foods and beverages.8,71
One option to assistance manage added sugar and energy intake is the use of nonnutritive sweeteners.71,72 While observational studies suggest a link between nonnutritive sweeteners and weight gain, randomized controlled trials take consistently establish nonnutritive sweeteners to support weight loss.72,73 Multiple organizations support the use of nonnutritive sweeteners to help moderate energy intake when they are substituted for a higher-energy-dense food, similar saccharide.71
Cull water and other depression-calorie beverages to satisfy thirst
Even though most beverages are low in energy density because of their high water content, added sugar or fat tin apace increase the number of calories a drink contains. This ways that patients should be encouraged to choose water and other low-calorie beverages in identify of higher-calorie beverages. Beverages have been suggested to have low satiating properties, in that people do not reduce their nutrient intake to compensate for calories in beverages.34,74,75 This reinforces the importance of messages to patients emphasizing that drinking caloric beverages tin can lead to increased energy intake.34,74 Eliminating or reducing caloric beverage consumption is a promising strategy for weight direction; research suggests substituting h2o or nutrition beverages for caloric beverages can amend weight loss.72,73
Beverages that individuals may be unwilling to eliminate from their dietary blueprint are those containing alcohol. Alcoholic beverages tin can be included in moderation within recommended calorie limits.eight Individuals need to be aware that free energy from alcohol is poorly compensated for, meaning that they are unlikely to eat less because alcohol has been consumed at a meal or snack. So if having an alcoholic drink, they should consume lower-energy-dense foods to aid control free energy intake.34,75,76 When consuming alcoholic beverages, patients should make sure the free energy content fits inside their own personal eating pattern for weight management.viii,75,77
Daily intake patterns that tin can aid to lower dietary energy density
Breakfast
The pattern of food consumption over a day as either meals or snacks could impact weight direction. Most members of the National Weight Command Registry, people who accept lost thirty or more pounds and kept it off for at to the lowest degree a year, written report eating breakfast every mean solar day equally a strategy to help with maintenance of weight loss.78 Epidemiological studies have also institute breakfast consumption to be associated with lower body weights and lower daily energy density.78–81 Nevertheless, controlled intervention trials accept non found that consistently eating breakfast leads to greater weight loss than skipping the meal.81,82 If individuals are habitual breakfast eaters, including higher amounts of protein and fiber during breakfast may help increase satiety, decrease energy intake, and lower dietary free energy density.80,81
Snacking
The definition of snacking varies, simply it unremarkably refers to the consumption of foods and beverages between regular meals.83 Enquiry suggests that eating more than the standard three times per 24-hour interval has minimal influence on energy intake, merely that eating less than three times per day may negatively influence energy regulation.84 However, as the frequency of eating or snacking increases, the energy consumed from snacks loftier in energy density tin can as well increase.85 Patients should moderate their intake from medium- and high-energy-dumbo snacks, (similar chips, pretzels, and confectionary) to continue snack intake nether 200 calories per solar day and stay within free energy needs.8,34 They should instead choose lower-free energy-dense snacks so that they tin can have a larger, more satisfying portion for the aforementioned 200 calories, while likewise enhancing satiety and improving nutrition quality.83 Prove on the influence of snacking on trunk weight is mixed, but it does bespeak that choosing low-energy-dumbo snacks, such every bit vegetables and fruits, helps moderate energy intake.83,86
Tools to Reach Healthy Dietary Patterns
Providing individuals with tools and resources for managing portion sizes can help them brand sustainable changes to their dietary patterns. Tools can promote additional structure or provide visual cues to help individuals manage energy intake in the electric current obesogenic environment. This section volition discuss current tools that patients can utilize to help support weight loss and weight loss maintenance.
Incorporate pre-portioned foods or meal replacements
The employ of pre-portioned foods and repast replacements can assistance moderate intake by providing a structured meal plan with advisable portion sizes.87,88 Pre-portioned foods include liquid meal replacements, single-serving snacks, and frozen entrées packaged and portioned for consumption at a single meal. A number of randomized controlled trials show that replacing ane or two meals a day with liquid and solid pre-portioned foods can lead to substantial weight loss.87,88,ninety
While pre-portioned foods and meal replacements have proven to exist effective for weight loss, they have only recently been compared to other portion command strategies. The Portion Control Strategies Trial compared the effectiveness of three diet strategies (standard advice, portion selection, and pre-portioned foods) in a behavioral weight loss trial.91 The trial found that the pre-portioned foods group lost weight at a faster rate, but likewise regained weight at a greater charge per unit compared to the other groups.91 Adherence to the pre-portioned foods strategy declined over fourth dimension, possibly due to an increment in feelings of deprivation or to a decrease in the provision of vouchers for the pre-portioned foods.91 Further development is needed to determine the most effective strategies for incorporating pre-portioned foods in diets for weight management.
Include portion command tools
Portion control tools, such as plates, bowls, scales, serving spoons, measuring cups, and photographs, may help individuals to moderate free energy intake by providing visual cues and teaching appropriate serving sizes.87 The use of smaller dishware and utensils has been promoted; notwithstanding, simply using smaller plates has not consistently been plant to subtract energy intake and has non been tested for weight loss.92–94 Interventions have constitute that using plates designed to teach appropriate proportions to control free energy intake (such as those based on MyPlate) promotes weight loss.95–97 The studies institute that the portion-command plate groups accomplished greater short-term weight loss at vi months than the control groups.95–97 All the same, the studies reported poor compliance and high attrition rates, indicating that strategies are needed to maintain connected use of these portion-control tools.
Smartphone applications provide some other tool that may help control energy intake past providing a platform for individuals to monitor their dietary intake.98,99 Self-monitoring helps individuals become aware of the foods and portion sizes they are consuming, and has been associated with increased and sustained weight loss.100–102 Digital photography can be used to help monitor intake by providing estimates of nutrient portion sizes.103–105 Still, using photographs with smartphone applications has limitations. It is difficult to measure and appraise the free energy density of the food in a photo without knowing the recipes, and this limitation makes it challenging to estimate a patient'south energy intake. Portion command tools using smartphone applications and photographs seem promising, but most are not evidenced-based, so they require further evolution in gild to be improved for utilize in weight loss interventions.106
Incorporate regime recommended tools
A reduction in dietary energy intake is the foundation for all weight loss dietary patterns. Individuals are typically told to reduce energy intake past xxx% or 500 to 750 calories per twenty-four hours.fifteen On boilerplate, this equates to women consuming betwixt 1200 to 1500 calories per 24-hour interval and men consuming 1500 to1800 calories per twenty-four hour period.15 However, energy needs can vary widely based on torso composition and concrete activity level and must exist reevaluated as weight is lost. To conform for changing free energy requirements, the National Institutes of Health has launched the Torso Weight Planner based on mathematical models to create personalized energy prescriptions according to an individual'southward eating and practise habits (Refer to Ch14 in this book).107,108 The Torso Weight Planner can be used in combination with the U.South. Department of Agriculture's (USDA) Super Tracker and MyPlate to aid individuals create personalized eating patterns and monitor food intake.109
Time to come Directions
Over the past several decades, obesity research has debated what the optimal diet is for weight loss and weight maintenance. Emerging research indicates that diet recommendations should consider the variability that stems from individual characteristics.110,111 For instance, individuals with high insulin secretion or high fasting plasma glucose may achieve greater weight loss on a diet with a low glycemic load compared to normoglycemic individuals.111–113 Future research should take a more than personalized approach to determine how individuals' behaviors, genes, or metabolic profiles influence their weight.110–111 The rapid advances in technology and biology will provide exciting new opportunities to collect information that volition allow dietary patterns to exist individually tailored for effective and sustainable weight loss.
Conclusions
Obesity is a multifactorial disease, with both individual and environmental factors influencing dietary adherence.114,115 Dietary approaches with a reduction in energy intake that have led to success at weight loss have focused on macronutrient composition and food patterns. A unifying principle for weight loss across eating patterns is dietary energy density.12,16,116–118 In that location are a variety of strategies and tools that individuals can utilize to achieve a personalized healthy eating pattern, and physicians or nutrition professionals tin provide support and specific dietary advice on changes to improve an individual's eating behaviors.8 Table 3 provides a summary of nutritional goals and recommendations that can be used to help patients create sustainable and satisfying low-energy-dense eating patterns for weight loss.
Acknowledgments
DISCLOSURE STATEMENT: THIS Piece of work WAS SUPPORTED By THE NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES (GRANT NOS. DK059853 AND DK082580) AND Past THE U.S. Department OF Agriculture, NATIONAL INSTITUTE OF Nutrient AND AGRICULTURE (GRANT NO. 2011-67001-30117).
Footnotes
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Conflict OF INTEREST: BARBARA J. ROLLS RECEIVES ROYALTIES FROM THE VOLUMETRICS BOOKS.
Contributor Information
ALISSA D. SMETHERS, DOCTORAL STUDENT, Department OF NUTRITIONAL SCIENCES, THE PENNSYLVANIA Land UNIVERSITY, UNIVERSITY PARK, PA, Us.
BARBARA J. ROLLS, PROFESSOR AND GUTHRIE CHAIR IN NUTRITION, Section OF NUTRITIONAL SCIENCES, THE PENNSYLVANIA STATE UNIVERSITY, UNIVERSITY PARK, PA, USA.
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