Your Best Weight and Nutrition

Obesity is a complex and chronic disease with many contributing factors [1], and its prevalence has been increasing over the years [2].

Management of obesity involves more than just reducing numbers on the weight scale; the goal should be to improve one's overall health and quality of life in the long-term.  Given that there are many different causes of, and contributing factors for, obesity, care plans should be individualized, and may involve various treatment approaches listed below [3] :

·       Nutrition

·       Exercise

·       Psychology

·       Medications

·       Surgery

Healthy nutrition is understood to be a fundamental foundation for managing and preventing chronic disease, including obesity [4,5].  No matter the individual, each person can always benefit from adopting healthier eating patterns.  There are many medical nutrition therapy strategies from which adults living with obesity can consider.

Obesity Canada is an organization that has set some dietary recommendations to prevent or manage weight. Here are some of the key points they recommend below, but you should speak with your healthcare provider about what is right for you. You can see all their patient resources here

Eating Patterns

Caloric restriction is one common method of achieving a lower body weight.  Calories are a unit of food energy, so the idea here is to limit overall energy input into the body.  Calories can come from any of the macronutrients: carbohydrates, fats, proteins, and alcohol.  (This is in contrast to micronutrients—vitamins and minerals—which are vital for health, but do not provide energy.)  As each of these macronutrients have varying effects on the body, dietary therapies may also target their respective intake levels.  Examples include low-carbohydrate, low-fat, and high-protein strategies.  Meal replacement therapies can incorporate many of these principles.

Other dietary strategies do not focus so strictly on these macronutrients, but place greater emphasis on the quality of the foods consumed (such as whole foods instead of highly processed ones) and/or specific food types (such as whole grains instead of refined grains).  Examples include Mediterranean (sample meal plan), Nordic, Portfolio, Dietary Approaches to Stop Hypertension (DASH), plant-based, and low-glycemic index.

Finally, other dietary approaches incorporate changes in timing of food intake.  Intermittent fasting is an example of this strategy.

As dietary strategies that might be beneficial  and conducive to long-term adherence can differ greatly between people  [6], nutritional therapy should be tailored to each individual. 

One should also be cautious about imposing severe restrictions in food intake, as this may result in physiologic changes that can result in weight regain [6].

Another approach is to look at general eating patterns or substitutions that fit into your eating preferences. In this case you blend together different dietary patterns to find your best diet. For example:

1. Increase plant-based food

Maximize vegetable and fruit (may want to try for more vegetables)
Wheat noodles → zucchini pasta
Mascarpone cream → fresh fruit for dessert
Meat bolognese → vegetable bolognese

2. Increase dietary fibre intake to at least 25 to 35 g a day by adding whole grain products, legumes, vegetables, fruits.

White noodles → whole grain noodles
White bread → whole grain bread
Rice → legumes

3. Drink caloric-free/low calorie beverages
Water and tea, coffee without sugar

4. Try to eat protein with all meals and snacks

Tips to get started and resources

Although it may be difficult to change long-standing dietary habits, it is never too late to start.  Finding the right resources, tools, and support networks can be of great benefit here.

There are multiple organizations dedicated to tackling the challenge that is obesity.  Obesity Canada is amongst the most prominent, and it manages a directory of various resources, ranging widely from educational materials to tools for patient advocacy.

There are many behavioural tools and strategies that can help encourage sticking to healthier habits.  Amongst these is keeping a log of one's own food intake; when it comes to weight management, those who keep food records tend to do better than those who do not [7].  A simple pen-and-paper approach can work, but there are specific smartphone apps that can be used as well, including RxFood.

Having appropriate emotional supports throughout the weight management journey is very much helpful in achieving success.  Reaching out and discussing one's struggle with family and friends can be a productive first step.  There are also community-based groups that assemble in person, online, or both, with regular meetings.  Finally, consider seeking out local medical and allied health professionals who specialize in obesity management.  This is particularly important, as medical nutrition therapy is only one treatment approach for obesity and should be implemented alongside other interventions [3].

Other resources:

  • Tips to help with healthy eating and exercise from the Obesity Society here and here

  • British Columbia Weight Management Page here

  • Obesity Matters has fantastic resources and events here

  • American College of Physicians resource here

References

[1] Lau DCW, Wharton S. Canadian Adult Obesity Clinical Practice Guidelines: The Science of Obesity. Available from: https://obesitycanada.ca/guidelines/science. Accessed May 24, 2023.

[2] NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017;390:2627–42

[3] Wharton S et al. Obesity in adults: a clinical practice guideline. CMAJ 2020;192(31):E875-91.

[4] Raynor HA, Champagne CM. Position of the Academy of Nutrition and Dietetics: interventions for the treatment of overweight and obesity in adults. J Acad Nutr Diet 2016;116:129–47

[5] Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364:2392-404.

[6] Brown J, Clarke C, Johnson Stoklossa C, Sievenpiper J. Canadian Adult Obesity Clinical Practice Guidelines: Medical Nutrition Therapy in Obesity Management. Available from: https://obesitycanada.ca/guidelines/nutrition. Accessed May 28, 2023.

[7] Hollis JF et al.  Weight loss during the intensive intervention phase of the weight-loss maintenance trial.  Am J Prev Med. 2008;35:118-26.