Table 4.

MNT guidelines for adult obesity that remain unaffected by the latest evidence (adapted from Obesity Canada [19])

Evidence level	MNT recommendation
Level 1a	Adults living with obesity should receive individualized MNT provided by a registered dietitian (when available) to improve weight outcomes (BW, BMI), WC, glycaemic control, established blood lipid targets, including LDL-c, TGs, and BP (grade A)
	Adults living with obesity and impaired glucose tolerance (prediabetes) should consider intensive behavioural interventions that target 5–7% weight loss to improve glycaemic control, BP, blood lipids, reduce incidence of type 2 diabetes, microvascular complications, and cardiovascular and all-cause mortality (grade B)
	Adults living with obesity and type 2 diabetes should consider intensive behavioural interventions that target 7–15% weight loss to increase the remission of type 2 diabetes, reduce the incidence of nephropathy, obstructive sleep apnoea, and depression (grade A)
	Portfolio dietary pattern to improve established blood lipid targets, including LDL-c, apo B, and non-HDL-c (grade B)
	DASH dietary pattern to reduce BW and WC (grade B)
Level 2	Calorie-restricted dietary patterns emphasizing variable macronutrient distribution ranges (lower, moderate, or higher carbohydrate with variable proportions of protein and fat) to achieve similar BW reduction over 6–12 months (grade B)
	Mediterranean dietary pattern to improve glycaemic control, HDL-cholesterol, and TGs, reduce cardiovascular events, reduce risk of type 2 diabetes, and increase reversion of metabolic syndrome with little effect on BW and WC (grade C)
	Vegetarian dietary pattern to improve glycaemic control, established blood lipid targets, including LDL-c, and reduce BW (grade B)
	Portfolio dietary pattern to improve established CRP, BP, and estimated 10-year coronary heart disease risk (grade B) Pulses (i.e., beans, peas, chickpeas, lentils) to improve BW, improve glycaemic control, established lipid targets, including LDL-c, systolic BP (grades B-C)
	Vegetables and fruit to improve diastolic BP, glycaemic control (grade B)
	Nuts to improve glycaemic control (grade B)
	Whole grains (especially from oats and barley) to improve established lipid targets, including total cholesterol and LDL-c (grade B)
	Low-GI dietary pattern to reduce BW, glycaemic control, established blood lipid targets, including LDL-c, and BP (grade B)
	DASH dietary pattern to improve BP, established lipid targets, including LDL-c, CRP, glycaemic control (grade B)
	Nordic dietary pattern to reduce BW and BW regain, improve BP and established blood lipid targets, including LDL-c, apo B, non-HDL-c (grade B)
Level 3	Dairy foods to reduce BW, WC, BF and increase LM in calorie-restricted diets but not in unrestricted diets and reduce the risk of type 2 diabetes and cardiovascular disease (grade C)
	Nuts to improve established lipid targets, including LDL-C, and reduce the risk of cardiovascular disease (grade C)
	Vegetables and fruit to reduce the risk of type 2 diabetes and cardiovascular mortality (grade C)
	Pulses (i.e., beans, peas, chickpeas, lentils) to reduce the risk of coronary heart disease (grade C)
	Non-dieting approaches can improve quality of life, psychological outcomes (general well-being, body image perceptions), cardiovascular outcomes, BW, physical activity, cognitive restraint, and eating behaviours (grade C)
Level 4	Nutrition recommendations for adults of all body sizes should be personalized to meet individual values, preferences, and treatment goals to support a dietary approach that is safe, effective, nutritionally adequate, culturally acceptable, and affordable for long-term adherence (grade D)

 DASH, Dietary Approaches to Stop Hypertension; Low-GI, low glycaemic index; CRP, C-reactive protein; LDL-c, low-density lipoprotein cholesterol; TG, triglyceride; HDL-c, high-density lipoprotein cholesterol; LM, lean mass.