Box 1.
Summary of nutrition recommendations for the treatment of overweight and obesity
| Diet/Strategy | Statement | Class of recommendation | Level of evidence | Does ABESO recommend? |
|---|---|---|---|---|
| Energy density | Consumption of foods and beverages with low energy density associated with energy deficit from diet can be useful in the treatment of obesity | IIb | B | Y |
| Portion control | Portion size control can help to reduce the excessive consumption of foods and beverages | IIb | B | Y |
| Foods | ||||
| Fruits and vegetables | Encouraging the intake of fresh fruits and vegetables, associated with a hypocaloric diet, contributes to weight management | IIa | A | Y |
| Fast-food | The intake of fast-food meals high in sugars, sodium, and saturated and/or trans fat is not recommended | IIb | C | N |
| Ultraprocessed food | The consumption of ultraprocessed foods is associated with excessive calorie intake and weight gain | III | B | N |
| Sweetened beverages | 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 | I | A | N |
| Calorie-based interventions | ||||
| Low-calorie diets | Low-calorie diets are fundamental for obesity treatment and the management of the meal plan must be associated with lifestyle changes | I | A | Y |
| Very low-calorie diets | VLCDs should not be the first option for obesity treatment | IIa | A | Specific situations |
| Meal replacements | Meal Replacements can help to structure a LCD and increase diet adherence | IIa | A | Y* |
| Based on dietary patterns | ||||
| Mediterranean | The Mediterranean diet has cardiovascular benefits to the individual with obesity | I | A | Y |
| Plant-based and vegetarian | Vegetarian or plant-based diets with reduced intake of ultraprocessed foods can be an option for the prevention and treatment of obesity | IIa | A | Y* |
| Based on macronutrients | ||||
| Low-carb | Low-carb diets promote weight loss in short and medium duration (3 to 6 months) | IIa | A | N |
| Low-carb diets do not promote more weight loss compared to other diet types in long-term studies | IIa | A | ||
| Ketogenic | The ketogenic diet should not be recommended for the treatment of obesity as it does not promote a balanced diet or favor adherence to healthy eating habits | III | A | N |
| Low-GI | Glycemic Index as a measure of carbohydrate quality appears to be a minor determinant for body weight, weight loss and obesity prevention | IIb | B | N |
| Based on | ||||
| Meal frequency and timing | Intermittent calorie restriction presents similar weight loss results as meal plans with continuous calorie restriction | IIb | A | N |
| Weight loss is induced by the energy deficit, and not by the fasting period per se or the number of daily meals | IIb | A | ||
| Late consumption of most of the daily calories can negatively impact body weight | IIb | B | ||
| Breakfast consumption | There is no conclusive evidence if breakfast plays a causal role both for weight gain and weight loss | IIb | A | Y |
| Sweeteners | There is inconclusive evidence about the effect on weight loss of sweeteners when used alone, without healthy food choices accompanied by an energy deficit | IIb | B | N* |
| Supplements | ||||
| Phytotherapics | There is no recommendation to use phytotherapics for weight loss | III | B | N |
| Caffeine | The use of caffeine supplements should not be considered as a strategy for weight loss and obesity treatment | III | B | N |
| Whey protein supplements | The prescription of whey protein is not indicated as a therapy for weight loss | III | A | N |
| Coconut fat | There is no scientific evidence to support the indication of coconut oil as a weight loss strategy | III | B | N |
| Probiotics | There is not enough scientific evidence for the use of probiotic supplementation for weight management | III | A | N |
| There is not enough scientific evidence for performing gut microbiota tests in clinical practice for the treatment of obesity | III | A | N | |
| Eating behavior | ||||
| Cognitive behavioral therapy | Cognitive-Bevahioral Therapy should be used for weight management in patients with overweight and obesity | I | A | Y |
| Motivational interviewing | Motivational Interviewing can be considered and used for weight management in patients with overweight and obesity | IIa | A | Y |
| Mindful eating | The results related to Mindfulness-Based Interventions in the treatment of obesity are still divergent, and it is yet not possible to guarantee that this is an appropriate approach for all patients | IIa | A | Y* |
Y Yes, N No
*The strategy might be used as part of the hypocaloric diet; the individual’s profile must be always assessed