Treatment of the Obese Patient

Abstract

Reducing caloric intake is the cornerstone of dietary therapy for long-term healthy weight man- agement. Strategies individuals have typically used include limiting portion sizes, food groups, or certain macronutrients. Although such restrictive approaches can lead to weight loss in the short term, they can result in feelings of hunger or dissatisfaction, which can limit their acceptability, sustainability, and long-term effectiveness. An alternative positive strategy to manage energy intake is for individuals to eat more foods that are low in calories for a given measure of food—that is, they are low in energy density (kcal/g). Data have shown that people eat a fairly consistent amount of food on a day-to-day basis; therefore, the energy density of the foods an individual consumes influences energy intake. Encouraging patients to eat more foods low in energy density and to substitute these foods for those higher in energy density allows them to decrease their energy intake while eating satisfying portions, thereby controlling hunger and lowering energy intake. This type of diet fits with the current Dietary Guidelines for Americans in that it incorporates high quantities of fruits, veg- etables, and fiber, which are often suboptimal in typical low-calorie diets, and it provides ample intakes of numerous micronutrients. Moreover, studies have found that individuals who consume lower-energy-dense diets consume more food by weight and have lower body weights compared with individuals who consume higher-energy-dense diets. This chapter reviews the evidence sup- porting the use of diets rich in low-energy-dense foods for weight management and provides prac- tical approaches to lowering the energy density of the diet.