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The Fattest Town In Britain: “We Send Kebabs To The Same Address Three Times A Day”Obesity and nutrition -
However, recent studies show that it is no more likely to cause obesity than other foods with a similar number of calories in sugar. Larger portion sizes at restaurants and in packaged foods and beverages encourage people to overeat.
Also, restaurant and packaged foods are often prepared in ways that add calories. As a result, people may consume more calories than they realize. Obesity tends to run in families. However, families share not only genes Genes Genes are segments of deoxyribonucleic acid DNA that contain the code for a specific protein that functions in one or more types of cells in the body or the code for functional ribonucleic read more but also environment, and separating the two influences is difficult.
Genes can affect how quickly the body burns calories at rest and during exercise. They can also affect appetite and thus how much food is consumed. Genes may have a greater effect on where body fat accumulates, particularly fat around the waist and in the abdomen, than on how much body fat accumulates.
Many genes influence weight, but each gene has only a very small effect. Obesity rarely results when only one gene is abnormal. The gene for the melanocortin 4 receptor: Receptors are structures on the surface of cells that inhibit or produce an action in the cell when certain substances such as chemical messengers bind with them.
Melanocortin 4 receptors are located mainly in the brain. They help the body regulate its use of energy. The ob gene: This gene controls the production of leptin, a hormone made by fat cells. Leptin travels to the brain and interacts with receptors in the hypothalamus the part of the brain that helps regulate appetite.
The message carried by leptin is to decrease food intake and increase the amount of calories energy burned. A mutation in the ob gene prevents leptin production and results in severe obesity in a very small number of children. In these cases, administration of leptin reduces weight to a normal amount.
Certain characteristics can increase the risk of becoming overweight or obese. They include the following:. Obesity during childhood Obesity in Adolescents Obesity is defined as a body mass index BMI equal to or greater than the 95th percentile for age and gender.
read more , which tends to persist into adulthood. Adverse childhood events or a childhood history of verbal, physical, or sexual abuse are associated with a higher risk of obesity. Gaining weight during pregnancy is normal and necessary.
However, pregnancy can be the beginning of weight problems if women do not return to their prepregnancy weight. Having several children close together may compound the problem. Breastfeeding can help women return to their prepregnancy weight.
If a pregnant woman is obese or smokes, weight regulation may be disturbed, contributing to weight gain during childhood and later. After menopause Menopause Menopause is the permanent end of menstrual periods, ovulation, and fertility.
For up to several years before and just after menopause, estrogen levels fluctuate widely, periods become irregular read more , many women gain weight.
This weight gain may result from reduced activity. Hormonal changes may cause fat to be redistributed and accumulate around the waist. Fat in this location increases the risk of health problems such as metabolic syndrome Metabolic Syndrome Metabolic syndrome is characterized by a large waist circumference due to excess abdominal fat , high blood pressure, resistance to the effects of insulin insulin resistance or diabetes, Obesity becomes more common as people age see Obesity in Older Adults Obesity is a chronic, recurring complex disorder characterized by excess body weight.
Obesity is influenced by a combination of factors that includes genetics, hormones, behavior, and the environment As people age, body composition may change as muscle tissue decreases. The result is a higher percentage of body fat and a lower basal metabolic rate because muscle burns more calories.
Sleep deprivation or lack of sleep usually considered less than 6 to 8 hours per night can result in weight gain. Sleeplessness results in hormonal changes that increase appetite and cravings for energy-dense foods.
Stopping smoking usually results in weight gain and may deter people from stopping smoking. Nicotine decreases appetite and increases the metabolic rate. When nicotine is stopped, people may eat more food, and their metabolic rate decreases, so that fewer calories are burned.
Cushing syndrome Cushing Syndrome In Cushing syndrome, the level of corticosteroids is excessive, usually due to taking corticosteroid drugs or overproduction by the adrenal glands.
Cushing syndrome usually results from taking read more is caused by excessive levels of cortisol in the body. The syndrome can result from a benign tumor in the pituitary gland pituitary adenoma or from a tumor in the adrenal gland or elsewhere, such as in the lungs.
Cushing syndrome typically causes fat to accumulate in the face, making it look full called moon face , and behind the neck called a buffalo hump. Polycystic ovary syndrome Polycystic Ovary Syndrome PCOS Polycystic ovary syndrome is characterized by irregular or no menstrual periods and often obesity or symptoms caused by high levels of male hormones androgens , such as excess body hair and Affected women tend to be overweight or obese.
Levels of testosterone and other male hormones are increased, causing fat to accumulate in the waist and abdomen, which is more harmful than the fat that is distributed throughout the body. Binge eating disorder Binge Eating Disorder Binge eating disorder is an eating disorder characterized by the repeated consumption of unusually large amounts of food binge eating with a feeling of loss of control during and after the read more is characterized by bingeing—eating large amounts of food during a short amount of time—and usually by feeling guilty, remorseful, or out of control.
Most affected people do not purge for example, by vomiting or using laxatives or diuretics. Binge eating disorder is diagnosed when bingeing episodes occur at least twice a week for 6 or more months. Night-eating syndrome involves not eating much during the day, consuming a lot of food or calories in the evening, and awakening to eat in the middle of the night.
Rarely, taking the sleeping pill zolpidem can cause similar problems. Many medications used to treat common disorders promote weight gain. These medications include those used to treat the following:. Some mental health disorders including depression antidepressants Medications for Treatment of Depression Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors SSRIs Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine Seizures antiseizure medications Antiseizure medications In seizure disorders, the brain's electrical activity is periodically disturbed, resulting in some degree of temporary brain dysfunction.
Many people have unusual sensations just before a seizure High blood pressure antihypertensives Medications for Treatment of High Blood Pressure High blood pressure is very common.
It often does not cause symptoms; however, high blood pressure can increase the risk of stroke, heart attack, and heart failure. Therefore, it is important read more , such as beta-blockers. Corticosteroids Corticosteroids Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints Diabetes mellitus Medication Treatment of Diabetes Mellitus Many people with diabetes require medication to lower blood glucose levels, relieve symptoms, and prevent complications of diabetes.
There are two types of diabetes mellitus Type 1, in which Having obesity increases the risk of many health problems. Virtually every organ system can be affected.
These weight-related health problems can cause symptoms, such as shortness of breath, difficulty breathing during activity, snoring, skin abnormalities including stretch marks, and joint and back pain.
High blood pressure High Blood Pressure High blood pressure hypertension is persistently high pressure in the arteries.
read more hypertension. Metabolic syndrome Metabolic Syndrome Metabolic syndrome is characterized by a large waist circumference due to excess abdominal fat , high blood pressure, resistance to the effects of insulin insulin resistance or diabetes, read more , which includes resistance to the effects of insulin called insulin resistance , abnormal levels of cholesterol and other fats in the blood, and high blood pressure.
Coronary artery disease Overview of Coronary Artery Disease CAD Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary Diabetes Diabetes Mellitus DM Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar glucose levels to be abnormally high.
read more or a high blood sugar level that is not high enough to be considered diabetes prediabetes Prediabetes Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar glucose levels to be abnormally high.
Gallstones Gallstones Gallstones are collections of solid material predominantly crystals of cholesterol in the gallbladder. The liver can secrete too much cholesterol, which is carried with bile to the gallbladder read more and other gallbladder disorders. Gastroesophageal reflux Gastroesophageal Reflux Disease GERD In gastroesophageal reflux disease, stomach contents, including acid and bile, flow backward from the stomach into the esophagus, causing inflammation in the esophagus and pain in the bottom read more GERD.
A low testosterone level, erectile dysfunction Erectile Dysfunction ED Erectile dysfunction ED is the inability to attain or sustain an erection satisfactory for sexual intercourse. See also Overview of Sexual Dysfunction in Men.
Every man occasionally has read more , and reduced fertility in men. Menstrual disorders Menstrual Disorders and Abnormal Vaginal Bleeding , infertility Overview of Infertility Infertility is usually defined as the inability to achieve a pregnancy after 1 year of regular sexual intercourse without birth control.
Frequent intercourse without birth control usually results read more , increased risk of miscarriage Miscarriage A miscarriage is a pregnancy loss before 20 weeks of pregnancy. Miscarriages are very common, especially early in pregnancy. Most of the time, the cause of a miscarriage is unknown, but it may read more in women, and polycystic ovary syndrome Polycystic Ovary Syndrome PCOS Polycystic ovary syndrome is characterized by irregular or no menstrual periods and often obesity or symptoms caused by high levels of male hormones androgens , such as excess body hair and Varicose veins Varicose Veins Varicose veins are abnormally enlarged superficial veins in the legs.
Varicose veins may cause your legs to ache, itch, and feel tired. Doctors can detect varicose veins by examining the skin Fatty liver Fatty Liver Fatty liver is an abnormal accumulation of certain fats triglycerides inside liver cells. People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms read more and cirrhosis Cirrhosis of the Liver Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue.
The scar Blood clots deep vein thrombosis Deep Vein Thrombosis DVT Deep vein thrombosis is the formation of blood clots thrombi in the deep veins, usually in the legs.
Blood clots may form in veins if the vein is injured, a disorder causes the blood to clot read more and pulmonary embolism Pulmonary Embolism PE Pulmonary embolism is the blocking of an artery of the lung pulmonary artery by a collection of solid material brought through the bloodstream embolus —usually a blood clot thrombus or Obstructive sleep apnea Sleep Apnea Sleep apnea is a serious disorder in which breathing repeatedly stops long enough to disrupt sleep and often temporarily decrease the amount of oxygen and increase the amount of carbon dioxide Arthritis Osteoarthritis OA Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function.
Arthritis due to damage of joint read more , gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid hyperuricemia.
The accumulations of crystals cause flares attacks read more , low back pain Low Back Pain Low back pain and neck pain are among the most common reasons for health care visits.
The pain usually results from problems with the musculoskeletal system—most notably the spine, including read more , and other joint disorders. It may follow a recent People typically spend hours read more can develop if excess fat in the neck compresses the airway during sleep. Breathing stops for a few moments, as often as hundreds of times a night.
This disorder is often undiagnosed. It can cause loud snoring and excessive daytime sleepiness and increases the risk of high blood pressure Metabolic Syndrome Metabolic syndrome is characterized by a large waist circumference due to excess abdominal fat , high blood pressure, resistance to the effects of insulin insulin resistance or diabetes, read more , abnormal heart rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms arrhythmias are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart.
Heart disorders are read more , metabolic syndrome Metabolic Syndrome Metabolic syndrome is characterized by a large waist circumference due to excess abdominal fat , high blood pressure, resistance to the effects of insulin insulin resistance or diabetes, read more , heart attacks Acute Coronary Syndromes Heart Attack; Myocardial Infarction; Unstable Angina Acute coronary syndromes result from a sudden blockage in a coronary artery.
This blockage causes unstable angina or a heart attack myocardial infarction , depending on the location and amount read more , and strokes Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply cerebral infarction.
Symptoms occur suddenly Obesity can increase the risk of early death. The more severe the obesity, the higher the risk.
It is the second most common cause of preventable death cigarette smoking is the most common. Obesity can lead to social, economic, and psychologic problems. For example, people with obesity may be underemployed or unemployed, or they may have a poor body image and low self-esteem.
After weight loss, most people return to their pretreatment weight within 5 years. Also, when weight-loss medications are stopped, weight tends to be gained back. Obesity is diagnosed by determining the body mass index BMI Obesity.
However, BMI has some limitations. The BMI does not take sex and age into consideration and makes only a few adjustments based on ethnic group. For people who are of Asian descent and some other ethnic groups, the BMI that is considered overweight is slightly lower. DNPAO Home Page.
Minus Related Pages. Healthy Growth and Brain Development. State and Local Programs. Featured Articles. State and Local Strategies. Healthy Weight, Nutrition, and Physical Activity. Active People, Healthy Nation SM. A week randomized controlled trial compared the effect of a high-protein versus a low-protein breakfast in subjects who did not routinely eat breakfast, with a control group who continued to skip breakfast.
In this study, the amount of protein eaten at breakfast did not influence body fat percentage and weight gain [ ]. Another week randomized controlled study compared the consumption of a high-fiber, low-fat breakfast with a control group that consumed their habitual breakfast and found no effect of the high fiber content on body weight [ ].
Despite conflicting results on the subject, future studies should control for factors associated with obesity that might confound the results such as sleeping habits and circadian rhythm and also can influence body weight and explain the associations between breakfast and obesity [ ]. There is no conclusive evidence if breakfast plays a causal role both for weight gain and weight loss.
According to the VIGITEL Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey [ ], In addition, the recommended intake of at least 5 daily portions of fruits and vegetables was observed in only Fruits and vegetables contribute significantly to human nutrition, being a major source of micronutrients, phytochemicals, and dietary fiber [ ].
Low intake of these foods is inversely associated with an increased risk of noncommunicable chronic diseases, including cardiovascular diseases CVDs and certain types of cancer [ , , , ]. The investigation by Wang et al.
In parallel, in a systematic review of 23 publications, increased intake of fruits and vegetables concomitant with decreased intake of high energy density foods led to lower adiposity in adults [ ].
In a review of 27 cohort studies and RCTs, higher intake of fruits and vegetables was associated with less weight gain or regain in pre and post-menopausal women [ ]. Fruits and vegetables figure as a significant dietary source of micronutrients, phytochemicals and fiber, contributing to decreased risk of developing noncommunicable chronic diseases and, associated with reduce caloric intake, promotes weight loss.
Encouraging the intake of fresh fruits and vegetables, associated with a hypocaloric diet, contributes to weight management. The term fast food refers to convenience meals prepared out of the home, planned to be readily available for consumption, being usually produced by a highly mechanized process [ ].
In particular, an expansion of fast food restaurant chains that sell unhealthy foods is observed in Latin America [ ] and the increased consumption contributes to excessive calorie intake and, consequently, increased risk of obesity [ , ].
The urbanization and economic growth processes of low and medium income countries have promoted changes in eating patterns, encouraging the intake of foods with high energy density and poor nutritional quality [ , ].
Among the determinants of fast food consumption is the proximity and density of this type of establishment in the surroundings, even though the influence results mainly from the interaction between economic and sociocultural factors [ ].
Weekly frequency of fast food consumption was 2. In a prospective cohort with 10, adults followed by approximately 4. Even though there is a need for more researches for elucidation regarding strategies to promote change in food systems and food services, initiatives to reformulate fast food meals, aiming to improve nutritional quality [ ], ensure transparency of nutrition information and the ingredients of the commercialized products [ , ], promote consumer awareness about portion size [ ], as well as regulations to set proportional prices for foods and beverages in order to create incentives to prevent excessive portion sizes [ , ] might be relevant to mitigate the risk of excess weight.
Eating patterns characterized by high consumption of fast-food meals, typically presenting high energy density and poor nutritional quality, contributes to excessive calorie intake and, consequently, increased risk of obesity. Ultraprocessed foods are those with ingredients which are not used in culinary preparations corn syrup, hydrogenated or interesterified fats and other substances used to increase palatability or make the product more attractive, including flavor enhancers, emulsifiers, bulkers, and coloring agents [ ].
Furthermore, it is important to mention that these products are prepared with high amounts of sugars and fats, a combination that is not present in natural unprocessed foods, and can also include high amounts of salt. A recent systematic review and meta-analysis with data from , participants revealed that the intake of ultraprocessed foods was associated with increased risk of overweight, obesity, abdominal obesity, metabolic syndrome, and all-cause mortality in adults and also with metabolic syndrome and dyslipidemia in children [ ].
The consumption of ultraprocessed foods is associated with excessive calorie intake and weight gain. Sugar-sweetened beverages contribute to a positive energy balance and are known for its strong association with weight gain, contributing to the global obesity epidemic [ , ], representing a serious public health problem [ ].
In contrast, the per capita intake of nectar juices virtually doubled in compared to [ ]. Excessive fructose intake both from sucrose or corn syrup increase plasma levels of triglycerides by the activation of hepatic lipogenic pathways via the Carbohydrate Responsive Element Binding Protein ChREBP , a transcription factor that promotes the synthesis of hepatic lipogenic enzymes involved in the synthesis of fatty acids [ ].
Fructose present in sugars induces a faster synthesis of fatty acids compared to glucose, because of the lack of a negative feedback mechanism in the liver [ , , ]. Furthermore, excess fructose leads to increased synthesis of hepatic glucose, insulin resistance and higher adipose tissue inflammation [ ].
Alcoholic beverages also increase the risk of T2DM [ , ]. However, habitual intake of sugary beverages was likewise associated with higher incidence of T2DM, regardless of the degree of adiposity [ ]. In addition, contribute to increased cardiovascular disease risk [ , , , , , , ].
The systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group NutriCoDE study [ ] demonstrated that sugar-sweetened beverages increase the risk of CVDs and T2DM and the BMI [ ]. A systematic review and meta-analysis of fifteen cohort studies with 1,, participants showed that an additional mL of sugar-sweetened or artificially-sweetened beverages resulted in increased total and cardiovascular mortality [].
A randomized crossover blind trial conducted in Brazil assessed the effect of the consumption of sugar-sweetened beverages in 17 adults who practiced regular physical activity and had an average BMI of The total volume of the drink was 1.
The consumption of sugar led to increased weight, waist circumference and plasma levels of triglycerides. Besides that, it decreased physical performance and the cardiovascular response during exercise [ ].
The presence of frailty was assessed every four years from to , and the association with the consumption of sweetened beverages was investigated. The Dietary Guidelines for the Brazilian Population [ ] and the — Dietary Guidelines for Americans [ ] recommend limiting the intake of sugar, sugar-sweetened beverages and fruit juices, even unsweetened.
Fruit juices not always offer the same benefits of whole fruits, which are important sources of fiber and other essential nutrients.
Sugar-sweetened beverages represent a significant source of sugar in the diet, contributing to positive energy balance and weight gain, in addition to higher risk of CVDs and T2DM development. Sweetened beverages or even unsweetened fruit juices contribute to increased calorie intake and body weight, and should be discouraged for the prevention and treatment of obesity.
Sweeteners are classified as nutritive or non-nutritive [ , ], contain very little calories or are calorie-free [ ]. This committee determines the acceptable daily intake ADI for each additive [ , ]. The consumption of sweeteners has increased in recent years and beverages have been its main source [ ].
Intake is higher among individuals with obesity and increases with age [ ]. However, an important study conducted in Chile revealed that children can exceed the safe levels of sweeteners consumption by consuming large amounts of artificially sweetened foods [ ].
A double-blind study [ ] conducted in normal-weight men tested the acute effects of beverages sweetened with stevia or aspartame or a beverage sweetened with 65 g of sucrose, and showed that the artificially sweetened beverages induced higher scores for the desire to eat and hunger and a lower feeling of fullness.
Some studies demonstrated the benefit of using sweeteners [ , , ], while others showed association with weight gain [ ] and increased risk of T2DM [ ]. A randomized clinical study compared the effect of sweetener consumption on weight loss in individuals with obesity or overweight [ ].
All participants were included in a weight loss program and instructed to consume mL of water or artificially sweetened beverages for one year 12 weeks of weight loss followed by 40 weeks of maintenance.
Therefore, the authors suggest that the inclusion of artificially sweetened beverages in the meal plan contributes to the treatment of obesity. As limitations to the study, they mention the fact that only individuals who already habitually used sweeteners were included [ ].
However, a systematic review and meta-analysis with data from MEDLINE, Embase, and Cochrane, conducted with seven randomized controlled trials with a follow-up of up to 6 months participants and thirty prospective studies with a follow-up of 10 years , participants , do not support the same benefits attributed to the use of artificial sweeteners [ ].
Evidence from prospective population studies showed that the consumption of sweeteners was associated with an increase in body weight and waist circumference, in addition to a higher incidence of hypertension, T2DM, metabolic syndrome, and cardiovascular events [ ]. In another systematic review, 57 observational and clinical studies were evaluated for qualitative and quantitative analysis of the effect of sweeteners [ ] on body weight.
Healthy adults or children with or without overweight or obesity were included. In general, studies have not shown an association between sweetener consumption and body weight or eating behavior [ ]. The analyses were adjusted for the participants' BMI and similar results were observed with the consumption of whole-fruit juices or those sweetened with sugar [ ].
A systematic review with meta-analysis including data from fifteen cohort studies showed a positive association between the consumption of artificial sweeteners and all-cause mortality and mortality from cardiovascular causes, both with a linear dose—response relationship [ ].
Also, having difficulty to manage weight increased the likelihood of consuming these products by 2 to 3 times.
The difficulty in maintaining body weight was reported by In several guidelines on nutritional recommendations there is no indication for the use of sweeteners as a strategy for the treatment of obesity.
In the Guideline Recommendations for Obesity Management, a document prepared by researchers at Johns Hopkins University, sweeteners are not listed in the fifteen recommended nutritional approaches [ ]. The Canadian Guidelines: Medical Nutrition Therapy in Obesity Management [ ] discusses that it is possible that the use of sweeteners may contribute to the treatment of obesity, but this is not confirmed in RCTs.
The Dietary Guidelines for Americans — , developed for the general population, do not include the use of sweeteners as part of a healthy eating pattern [ ].
The American Diabetes Association [ ], on the other hand, indicates that sweeteners can help to reduce overall calorie and carbohydrate intake, in general, when they replace sugar, but as long as individuals are not compensating with additional calories from other foods.
Individuals should be advised to decrease both sweetened and nonnutritive-sweetened beverages. They suggest the importance of indicating other alternatives, emphasizing a proper hydration through water intake [ ]. Current evidence from studies related to the use of sweeteners and obesity are divergent.
Sweeteners can be used in the treatment of individuals with obesity, but it must be part of a balanced diet that is part of the lifestyle change. There is inconclusive evidence about the effect on weight loss of sweeteners when used alone, without healthy food choices accompanied by an energy deficit.
The identification of effective strategies for long-term weight management is crucial for the reduction of the alarming global prevalence of overweight and obesity. The treatment of obesity using different forms of nutrition intervention requires the achievement of negative energy balance through a decreased energy intake [ ].
The proportion of macronutrients in the diet fat, carbohydrate and protein relative to the TEI has received substantial attention in the last decades because of its potential relevance for weight loss and maintenance [ , ].
It is well established in the literature that a calorie-restricted diet for weight loss is the first line treatment for individuals with overweight and obesity [ ].
The structure of the LCD can be divided in two categories: prescription of a conventional LCD meal plan, in which every food choice and portion size for all meals and snacks are defined [ , , ]; and as part of a meal plan that includes one or two portion controlled meal replacements MR associated with a LCD including conventional meals and snacks [ ].
The methods used with the aim of elaborating a structured diet, with an organized meal plan, are considered very useful to increase the adherence to the LCD, since they are convenient and reduce the need to make food choices, which can be difficult for some individuals [ 6 ].
Besides that, MR can increase diet adherence providing controlled portions and greater convenience [ , , ]. Although there are publications showing positive results of calorie-restricted diets on weight loss in the short term, in clinical practice it is frequent that doctors, dietitians and patients are disappointed with the long-term results, which reveal a high frequency of weight regain [ , ].
Most of the study participants regained weight and the dropout was high [ ]. The authors mention as limitations of this review that fact that few studies reported outcomes related to weight loss maintenance, besides the high heterogeneity among the studies included, such as absence of control groups and high dropout rates [ ].
The high frequency of weight regain observed after a calorie-restricted diet is partially explained by the reduced metabolic adaptation, as demonstrated in a study that compared individuals that reached the weight loss goal compared to another group that did not reach the goal [ ].
In this study, the participants were submitted to a LCD to kcal. Considering these findings about the results of LCDs, it is important to consider the concurrent use of other interventions that foster lifestyle changes. In this sense, relevant studies, such as the Diabetes Prevention Program DPP and the Look Ahead study were conducted to promote lifestyle change.
The Diabetes Prevention Program Outcomes Study DPPOS followed the participants from the DPP to investigate the persistence of these effects in the long term. In the year follow-up since the randomization for the DPP trial , the original lifestyle change group lost and then partially regained weight, reaching the end of the study with a weight loss of 2 kg.
The modest weight loss reached with metformin was maintained. Diabetes incidence during the study was 4. The Look Ahead study followed individuals with diabetes and overweight or obesity for 8 years [ ].
The study had two arms: the first was an intensive program consisting of frequent meetings, individual nutrition counseling and exercise program, and the second was a less intensive program with counseling meetings about diet and exercise every four months during the first year, and annually thereafter.
Overall, weight loss was 2. The Look Ahead study shows that the rate of weight regain is very high between 2 and 3 years after the beginning of the weight-loss intervention.
After 3 years, even though there is still some weight regain, the rate becomes stable and an estimate of the long-term effect on weight can de done [ ]. Food intake was assessed using a semi-quantitative food frequency questionnaire and a h dietary recall.
Adequate weight loss was defined as a reduction of 2 kg from the initial weight after the clinical intervention period. Fifty individuals lost 2 or more kg and were included in the small weight-loss group, and 49 individuals lost less than 2 kg and were included in the unsuccessful group.
In the long term, the first group presented lower levels of inflammatory cytokines and less inflammation-induced oxidative stress in individuals with overweight and obesity [ ]. A long duration RCT 4 years subjected postmenopausal women with overweight or obesity to a lifestyle change intervention or to a Health Education group control [ ].
The intervention group followed a healthy eating pattern with specific recommendations, such as: 1 reduce the intake of sweets, sweetened beverages, total fat, saturated and trans fats; 2 reduce caloric intake; 3 increase the consumption of foods rich in soluble fiber; 4 increase the consumption of fruits, vegetables, and whole grains.
Changes in eating pattern were positively associated with weight loss. The authors observed that the decrease in the consumption of desserts and sweetened beverages was associated with weight loss both in the short 6 months and in the long term 48 months and with weight maintenance, while the adoption of the habit of eating fruits and vegetables, together with a reduced intake of meat and cheese, were additional factors that contributed to long-term weight loss [ ].
A meta-analysis of six randomized trials compared weight loss after a LCD using conventional foods or with MR for individuals with overweight or obesity. The intake of prescribed calories was the same for both groups.
Based on these findings, the LCD was considered more efficient than very low-calorie diets VLCDs, — kcal for 2 to 4 weeks in the preoperative period of bariatric surgery [ ]. Even though adiponectin is secreted by the adipose tissue, its serum concentrations are inversely correlated to body fat mass and obesity [ ].
There is evidence showing increased adiponectin levels in patients following a LCD, with the intake of polyunsaturated fatty acids, fish oil, protein, and the adherence to balanced diets, including the Mediterranean Diet [ ].
A systematic review and meta-analysis of 13 clinical trials examined the effect of LCDs on adiponectin levels compared to control groups without calorie restriction [ ].
The study showed that the weight loss diet results in increased adiponectin levels. This result can be explained by the increased adherence to the prescribed diet in the short term [ ].
Results from RCTs and systematic reviews reinforce the effectiveness of LCDs for the treatment of obesity. However, to ensure long-term success, lifestyle changes are required in the process. Low-calorie diets are fundamental for obesity treatment and the management of the meal plan must be associated with lifestyle changes.
Even though VLCDs are used in some clinical situations that require rapid weight loss, they are not routinely recommended for obesity treatment [ ]. They usually involve partial or total replacement of meals and snacks with complete pre-packaged MR such as shakes, soups or bars [ , ], depending on the availability of these products in the country.
A systematic review investigated the use of VLCDs for weight loss [ 7 ] and concluded that they are effective in the short term, but not in the long term 1 year or more [ ]. A meta-analysis of six RCTs that compared the long-term effectiveness of LCDs and VLCDs for weight loss showed that, although VLCDs result in significantly greater weight loss in the short term 4 months , A systematic review and meta-analysis of RCTs assessed the clinical effectiveness and safety of the use of VLCDs for weight loss.
The interventions proposed in the studies involved three comparisons: VLCD vs. behavioral program alone. The authors concluded that most of the studies showed that the association of VLCDs with a behavioral program led to greater weight loss at medium and long term compared to behavioral programs alone [ ].
The study outcomes were functional and physical abilities, body composition and nutritional parameters albumin, vitamins B12 and D, ferritin, and folate. After 12 weeks, the percentage of weight loss was 3. The authors concluded that VLCD can be of particular benefit in older adults who suffer from the immediate impact of obesity on their physical and functional abilities [ ].
s ince VLCDs should be supplemented with vitamins, minerals, electrolytes, and essential fatty acids to ensure an adequate nutrition and are effective in the short term, they must be recommended only in limited circumstances and always with medical and nutritional support.
Dietary patterns can be defined as the amount, proportion, variety or the combination of different foods and beverages in the diet, and the frequency with which they are habitually consumed [ ]. This concept is attributed to the fact that people do not eat nutrients in isolation, but a variety of components that comprise the diet.
It is well stablished in the literature that dietary patterns that combine varied food groups are more efficient for the prevention and treatment of diseases such as obesity, T2DM, and cardiovascular disease. The most well-known and studied are the Mediterranean diet [ ] and the DASH [ ].
Therefore, international guidelines reinforce this concept and state that nutritional recommendations should not be based only on the percentage energy from macronutrients carbohydrates, protein and fat , but on the food matrix of the meal.
Despite some individual particularities, dietary patterns present common features including foods rich in fiber fruits, vegetables, and whole grains , lean meats, low-fat dairy products and a low consumption of ultraprocessed foods high in sugar, saturated fats, and trans fat [ , ].
In this sense, adherence scores were developed to assess the adherence to healthy dietary patterns such as the Mediterranean diet [ ] and the DASH diet [ ]. In the United States, the HEI, elaborated with 13 components that reflect adherence to the US Dietary Guidelines [ ] is used.
The standardization of quality indexes is widely used in prospective studies to investigate the relationship between diet quality and risk factors for certain non-communicable chronic diseases [ ]. From these findings, this pattern was exhaustively studied in clinical and epidemiological studies with the aim of assessing its association with the prevention and treatment of cardiometabolic diseases.
In particular, the Mediterranean diet also includes that consumption of nuts walnuts, nuts, and almonds and olive oil OO [ ]. Another dietary pattern internationally recognized is the DASH diet, that was originally developed as a non-pharmacological therapeutic strategy to reduce arterial blood pressure [ 24 ].
This diet presents particular characteristics, including a lower percentage of fat and limited sodium intake.
The preliminary study was conducted with individuals with hypertension that were randomized in three groups with diets with high, moderate or low amounts of sodium [ 24 ]. The first group was taken as the control group and the second and the third groups were advised to follow a DASH diet.
The greater benefit for blood pressure reduction was obtained with the combination of reduced sodium intake and DASH diet, with high vegetable intake [ 24 ]. The efficiency of this dietary pattern for the prevention and treatment of cardiometabolic diseases was tested in several clinical and epidemiological studies.
In the subsequent years, the DASH diet was also tested with regard to other cardiometabolic outcomes, and a systematic review with meta-analysis using Grading of Recommendation Assessment, Development and Evaluation GRADE , showed that this dietary pattern was associated with reduced incidence of cardiovascular disease, stroke, hypertension, T2DM and obesity [ ].
A study conducted in Brazil with a representative sample of adolescents had the objective to assess the association between a DASH diet score and the prevalence of obesity and overweight in this population [ ].
The study sample comprised 71, adolescents from the database of the Study of Cardiovascular Risks in Adolescents ERICA [ ]. Among the most frequently consumed foods, sweetened beverages, red meats and processed meats stood out.
The study did not show association between the DASH diet score and body weight. The authors attributed this lack of association to the fact that the adolescents that presented high intake of foods that characterize the DASH diet also consumed high amounts of non-healthy foods.
Therefore, the adherence to the DASH diet was not able to outweigh the detrimental effect of the high consumption of foods rich in sugar and saturated fatty acids [ ]. Another study with 2, adolescents 12 to 21 years old selected from the database of the NHANES compared the Healthy Eating Index AHEI dietary pattern to the DASH diet and showed an inverse association between high adherence scores to these dietary patterns and the presence of metabolic syndrome [ ].
The participants with higher adherence scores presented lower intake of calories and total fat and lower fasting insulin compared to those with the lowest DASH diet adherence score. In addition, there was in inverse association between DASH diet adherence and insulin resistance. Therefore, the authors concluded that DASH diet contributes to a favorable metabolic profile in individuals with excess weight [ ].
The participants were divided in two groups, differing only in the amount of red meat intake, of 85 g or g, respectively. At the end of the study, although there was no difference in body weight, the DASH diet led to decreased waist circumference associated with increased insulin sensitivity, regardless of the amount of red meat consumed [ ].
Another crossover intervention study was conducted with 31 individuals with T2DM, randomized to a DASH diet intervention or to a control group, each for 8 weeks [ ]. Both groups followed a kcal diet, that in the DASH dietary pattern was based on low energy—density foods.
There was a 4-week washout period between each diet. The DASH diet resulted in significant weight loss and decreased waist circumference, as well as lower fasting glucose and glycated hemoglobin [ ]. A cross-sectional study with people from the Gulf region assessed the Mediterranean diet score in adults aged from 20 to 55 years [ ].
A point validated questionnaire was used, and the average adherence score was of 5. The average rate of adherence was The Mediterranean pattern was associated with higher intake of fiber and monounsaturated fatty acids. All of the groups lost weight in the first 6 months, but weight loss was higher in participants following the low-carb diet and the Mediterranean diet compared to the low-fat diet.
At the end of 2 years, weight loss was higher in the Mediterranean diet group compared to the low-carb group. This study also showed that, in the subgroup of participants with T2DM, fasting glucose levels and HOMA-IR were only reduced with the Mediterranean diet [ 18 ].
The effect of behavioral and nutrition interventions was investigated in a multicentric study conducted in 23 centers of Spain, involving 6, adult male participants with metabolic syndrome [ ]. The participants were randomly allocated to a Mediterranean diet group or to a calorie-restricted Mediterranean diet group.
The total study period was 12 months and the goals were to promote weight loss and to assess the degree of adherence to the proposed diets, using a dietary intake score.
The calorie restriction intervention included monthly group meetings, motivational interviewing MI sessions, and frequent contact by phone.
The control group only had two meetings with the team during the study. The participants were adherent to the diets and the study showed that the Mediterranean diet contributes to weight loss when associated with caloric restriction [ ]. The effect of the Mediterranean diet on the plasma levels of endocannabinoids and N-acylethanolamines of individuals with risk factors for metabolic syndrome was assessed.
The study included 82 individuals with overweight or obesity, with sedentary lifestyle and habitual Western diet [ ]. The participants were randomized in two groups: the first consumed a Mediterranean diet tailored for their habitual energy intake and the second maintained their habitual diet.
All of these changes occurred independent of body weight changes and were associated with the amelioration of insulin sensitivity and inflammation [ ]. The Mediterranean diet provides high amounts of antioxidants, such as polyphenols including hydroxycinnamic acid, flavonoids quercetin and catechin , resveratrol, oleuropein, and hydroxythyrosol, which exert antioxidant and anti-inflammatory actions by modulating the NF-κB pathway [ , , , ].
Taken collectively, the properties of the Mediterranean diet [ ], involving the antioxidant activity of foods, intake of healthy fats, and high fiber intake, explain the metabolic benefits observed in individuals with excess weight.
Plant-based diets aim to promote the intake of foods from vegetable origin and, at the same time, reduce the intake of processed foods, fats, and animal products including meat, eggs, and dairy.
It is a dietary pattern that encourages the intake of diverse vegetables raw and cooked , fruits, whole-grains, legumes, and nuts. There is no consensus in the literature with regard to the presence of animal products in the plant-based diet. Some authors mention the inclusion of such products, particularly moderate amounts of eggs and dairy [ ], while others define the plant-based diet as a strict vegetarian vegan diet, therefore including no animal product [ ].
Vegetarian diets, in turn, are those that exclude all types of meat and meat-derived products beef, chicken, pork, lamb, fish, seafood, among others, and products such as sausages, canned tuna, etc. A review of data from observational studies and controlled clinical trials showed that vegetarian diets were associated with lower mean BMI, as well as decreased risk of cardiovascular disease, hypertension, diabetes and obesity, independent of the practice of physical activity [ ].
Kahleova et al. The authors relate the increased postprandial metabolism to increased insulin sensitivity resulting from a high-carbohydrate, low-fat diet [ ]. In a cross-sectional study, Montalcini et al. The results showed a significantly higher resting energy expenditure in vegetarians than in non-vegetarians [ ].
To investigate the effect of the prescription of vegetarian diets on changes in body weight, Barnard et al. Greater weight loss was reported in studies with participants with higher baseline weights, smaller proportions of female participants, older participants, or longer durations, and in studies in which weight loss was a goal [ ].
Huang et al. The possible mechanism underlying the effect of vegetarian diets on weight loss was attributed to the higher intake of whole-grains, fruits, and vegetables [ ]. The authors concluded that vegetarian diets can be recommended for weight management without compromising quality of life.
The analysis of data from the NHANES — showed that vegetarians had higher intake of fiber, vitamins A, C, E, B1, and B2, folic acid, calcium, and magnesium compared to non-vegetarians [ ].
The factors that can explain the benefits of a vegetarian diet on weight management include the low energy density, higher fiber intake and the beneficial effect on gut microbiota [ , , ].
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eben man was in diesem Fall machen muss?