Medical nutrition therapy in obesity management

ABSTRACT

Healthy eating is important for all Canadians, regardless of body size, weight or health condition. Key messages from Canada's Food Guide for Healthy Eating can be used as a foundation for nutrition and food-related education (Figure 1). Use evidence-based nutrition resources to give your patients nutrition and behaviour change advice that aligns with their values, preferences and social determinants of health. (Figure 1) There is no one-size-fits-all eating pattern for obesity management. Adults living with obesity may consider various nutrition intervention options that are client-centred and flexible. Evidence suggests this approach will better facilitate long-term adherence. (Table 1, Figure 2) Nutrition interventions for obesity management should focus on achieving health outcomes for chronic disease risk reduction and quality of life improvements, not just weight changes. 5 Table 2 outlines health-related outcomes to support patients/clients in obesity management. Nutrition interventions for obesity management should emphasize individualized eating patterns, food quality and a healthy relationship with food. Including mindfulness-based eating practices that may help lower food cravings, reduce reward-driven eating, improve body satisfaction and improve awareness of hunger and satiety. 6­11 Caloric restriction can achieve short-term reductions in weight (i.e.< 12 months) but has not shown to be sustainable long-term (i.e. > 12 months). Caloric restriction may affect neurobiological pathways that control appetite, hunger, cravings and body weight regulation that may result in increased food intake and weight gain.64-66 People living with obesity are at increased risk for micronutrient deficiencies including but not limited to vitamin D, vitamin B12 and iron deficiencies. Restrictive eating patterns and obesity treatments (e.g. medications, bariatric surgery) may also result in micronutrient deficiencies and malnutrition. Assessment including biochemical values can help inform recommendations for food intake, vitamin/mineral supplements, and possible drug-nutrient interactions. Collaborate care with a registered dietitian who has experience in obesity management and medical nutrition therapy. 12 Dietitians can support people living with obesity who also have other chronic diseases, malnutrition, food insecurity or disordered patterns of eating. Future research should use nutrition-related outcomes and health behaviours in addition to weight and body composition outcomes. Characterization of population sample collections should use the updated definition of obesity as a chronic, progressive and relapsing disease characterized by the presence of adiposity that impairs health and social well-being rather than BMI exclusively. Qualitative data is needed to understand the lived experience of people with obesity.