Energy Restricted Diets

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A decrease in energy intake is the most important dietary component of weight loss and maintenance. Low-calorie diets often reduce total body weight by an average of 8% over a period of 6 months. Included in this average are individuals who did not lose weight; thus a 10% loss is feasible. A decrease of 500-1000

kcal/d will produce a weight loss 1-2 lbs/week, and a decrease of 300-500 kcal/d, 1/2-1 lb/wk.

The weight loss component of dietary therapy consists mainly in instructing patients on how to consume fewer calories The key is a moderate reduction in caloric intake. This will achieve a slow but progressive weight loss. Caloric intake need be reduced only enough to maintain the desired weight. At this caloric intake, excess weight will gradually vanish. In practice, somewhat greater caloric deficits are generally used during active weight loss. Recommended dietary therapy for weight loss in overweight patients is a low-calorie diet (1000-1800 kcal/d). The low-calorie diet should be distinguished from a very low calorie diet (250-800 kcal/d); Very low calorie diets have generally failed to achieve and maintain weight loss over the long term. In fact, clinical trials reveal that low-calorie diets are as effective as very low calorie diets for producing weight loss after 1 year. Although more weight is initially lost with very low calorie diets, more is usually regained. Importantly, rapid weight reduction fails to allow for gradual acquisition of new eating behavior. Slower weight loss allows more time to adjust eating habits.

Follow-up of very low calorie diets reveal that patients are at increased risk of cholesterol gallstones. Low-calorie diets are more likely to be successful if a patient's food preferences are included. Certainly all of the recommended dietary allowances should be met, even if a dietary supplement is needed. During low-calorie diet therapy, educational efforts should focus on the following topics: energy value of different foods; food composition—fats, carbohydrates (including dietary fiber), and proteins; reading nutrition labels to determine caloric content and food composition; new habits of purchasing (preference to low-calorie) foods; food preparation and avoiding adding high-calorie ingredients during cooking (e.g., fats and oils); avoiding overconsumption of high-calorie foods (both high-fat and high-carbohydrate foods); maintain adequate water intake; reducing portion sizes; and limiting alcohol consumption.

The rate of weight loss generally diminishes after 6 months. Behavior therapy is helpful in addition to low-calorie diets. Frequent clinical visits during initial weight reduction will facilitate reaching the goals of therapy. During active weight loss, visits of once per month or more often with a health professional helps to promote weight reduction. Weekly group meetings are low cost, and can contribute to favorable behavior changes. Adequate time must be made available to convey information, to reinforce behavioral and dietary messages, and to monitor the patient's response.

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