Dietary Therapy

Eating habits are partly instinctual and partly learned. We are hardwired to prefer sweet over bitter. This has been demonstrated in utero by increased fetal swallowing frequency when a sweet solution is instilled in to the amniotic fluid and decreased when a bitter solution is added.* Changing long standing dietary habits is very difficult and may require a multi-disciplinary, patient centered program which includes: primary care, dietician, peer and family support.

It must be understood that voluntary reduction in body fat and sustained weight loss is not achievable for all patients. A goal for these patients should be the prevention of further weight gain. Prevention of weight gain is also an appropriate goal for people with a BMI of 25 to 29.9 who are not otherwise at high risk.

For patients that are ready, willing and able to begin dietary weight loss therapy, an initial weight loss goal of 10 percent of body weight achieved over 6 months is a recommended target. The rate of weight loss should be 1 to 2 pounds each week. Greater rates of weight loss do not achieve better long-term results. After the first 6 months of weight loss therapy, the priority should be weight maintenance achieved through combined changes in diet, physical activity, and behavior. Further weight loss can be considered after a period of weight maintenance.

Dietary weight loss programs often reduced caloric intake by 500 to 1,000 calories per day (kcal/day) from the current level. The National Institutes of Health (NIH) recommend diets containing 1,000 to 1,200 kcal/day for most women; a diet between 1,200 kcal/day and 1,600 kcal/day for men and some women who weigh 165 pounds or more, or who exercise regularly. For male patients that can stick with the 1,600 kcal/day diet but does not lose weight, a 1,200 kcal/day diet should be tried. If a dieting patient complains of hunger, the diet can be increased by 100 to 200 calories per day.

Very low-calorie diets (VLCD) of 800 or less calories per day should never be implemented with out medical supervision. The risks of VLCD include gout, gallstones, and cardiac complications. Regardless of the type of diet program, weight regain can be expected within 5 year if the patient does not maintain the successful dietary and behavioral changes.*

Moderate physical activity should be a part of dietary weight loss therapy. Physical activity helps sustain weight loss attained through reduced calorie intake. A gradual increase in physical activity should be begun with care to avoid injury. A daily walking regimen starting with 10 minutes, 3 days per week and progressing to 30-45 minutes every day can expend an additional 100-200 kcal/day.