The Academy of Nutrition and Dietetics (AND) New Position Paper on Interventions for the Treatment of Overweight and Obesity in Adults

scales-1536960I like to share the most recent news regarding anything to do with weight loss or dieting. Every month I receive the Journal of the Academy of Nutrition and Dietetics (AND) which used to be the American Dietetic Association (ADA). It was hard for me to get used to the new name as I am an older dietitian and for a few decades it has been ADA to me. Anyway, the journal always comes because I pay my fees and it has lots of articles, mostly research (not always interesting to me, I have to admit). But I just love when they publish a new Position Paper because many dietitians have reviewed years of research (not the most fun thing to do) and then let us know how we should do our job. As a Registered Dietitian, I don’t have time to do that ( FYI a Registered Dietitian is an RD or RDN, Registered Dietitian Nutritionist, a newer designation I think recently added because people like the word “nutritionist” better than dietitian, and anyone, yes anyone, can call themselves a nutritionist, but only those of us who have gone through 4 years of college as well as a clinical training or internship and then passing a national exam can then call ourselves a “dietitian”). So when you are seeking advice about nutrition you really need to talk to an RD or RDN.

So I love Position Papers because it saves me all that reading of research which I do enjoy but takes time. Anyway, the new Position Paper on treating obesity that just came out was to update the last one of 2009. I wanted to share with you the important points just so that you know what the research says. For many of the questions there is not enough research to prove anything. So I am going to briefly summarize what I think you may want to know. I am a bit disappointed because the non-diet approach was not addressed. I also do not like that weight loss was the focus and we all know that an “obese” BMI (Body Mass Index) does not mean someone is unhealthy. This is where I think it gets hairy. There are so many other factors that are so much more important such as lifestyle, genetics, etc. that affect health. So I just hate that everyone thinks a certain BMI indicates a problem.  What I have seen is that people tend to have a normal weight for them but sometimes their lifestyle and habits change, they may yo-yo diet, or become sedentary, have unhealthy lifestyles, gain weight above what their bodies really want to naturally be, and then yes, there may be health consequences. Dieting is not the answer but identifying those unhealthy lifestyle changes and working on those is the answer. Weight slowly will return to what is normal for them, and then health parameters typically return to normal too. For example, I have seen adults who maintained a certain weight for most of their lives, gone through some life change where they became more sedentary, gained weight, and had an increase in cholesterol level. When they added back their normal activities, eventually they would lose the small amount of unnatural weight gain and blood levels returned to normal.

Anyway, here is the take home messages I think people might want to know:

  1. Reducing sugar sweetened beverages (SSB) does result in weight loss. I am all for decreasing soda in your diet because it really does not add anything. On occasion, fine. But as a daily thing (and I have had patients who get in the habit of drinking a liter a day) well, that is just a bad habit. Have a soda on occasion if you love it, but if it is a habit, it may be a good one to break.
  2. Very Low Calorie Diets (VLCD) did not produce any better weight loss in the long term compared to the typical low calorie diet. I do not promote counting calories at all, or any restrictive diet. However, I know people do it and so I want to be sure you know that going below 1200-1600 calories is never a good idea.
  3. It does not matter if you focus on fat or carbohydrates or anything else. “Macronutrients” are protein, carbohydrate and fat. Many diets focus on restricting “carbs”, or fat or focus on protein. None of these extreme diets work better than just focusing on being healthy. Yes, some of these diets may have some beneficial health benefits (the Mediterranean Diet was mentioned and that it may improve cardiovascular risk factors such as blood pressure, blood glucose and lipids) but that more research was needed.
  4. Eating frequency and timing of eating: as it turns out, there just is not enough research to demonstrate that eating more frequently promotes weight loss. However, there is evidence that eating most of your calories earlier in the day improves weight loss outcomes. And although there is not enough research on breakfast consumption and weight, it does seem to be clear that if you want to be your most healthy weight then you need to eat more during the day. Think about it. I know I have seen many patients who try to restrict all day long and then only end up overeating at night. It makes sense. So eat a good breakfast, enjoy a great lunch, have a snack in the afternoon and then, when you are ready for dinner, you won’t be starving. The research proves this is the best way to have a healthy body.
  5.  Physical activity  was another intervention mentioned, and a very important one. I loved that the paper stated that “physical activity interventions may assist in weight management via mechanisms that are not well understood”. In other words, it is not all about “burning calories” which is one of my pet peeves. I just hate when people are doing something really fun and then say something regarding the calories they are burning. Doing fun things like hiking or swimming or biking or just walking with a friend are so good for you in so may ways. I just want people to embrace the pure joy of moving and how good it feels. Yes, your body will get stronger and you will feel better with more moving in your life. And yes, you may like the way you look when your body gets stronger. But it is so much more than that. The Position Paper did mention some specifics. The recommendation was to encourage 150 to 420 minutes of physical activity a week (depending on intensity and medical contraindications). So that just means 30 minutes, 5 times a week (also mentioned was that 10 minute increments were acceptable), or if you are going for the upper limit, 420 minutes translates into an hour a day. That sounds like a lot to me and I am pretty antsy. My advice: start where you are. Do what makes you happy and feel good.
  6. Reducing “sedentary behaviors” was addressed. This means decreasing things like “screen time” or TV, videos, computer, etc. It appears there is insufficient research to show if this is something we should focus on. From my experience, I like the general recommendations, especially for kids, to limit this to 2 hours a day. I think all of the great technology (which we all love) does make it easier to sit…and sit….and sit…So being aware of how much sitting you are doing is a smart thing. For instance, tonight is the first American Idol of the season. I am taping it. I could easily get addicted ( I love that show!) But I do not want to be tied to the TV and so by recording it I will be able to watch it while doing other things (like folding my laundry this weekend) and can fast forward through the commercials. Enjoy your screens but it is smart to be aware.
  7. Computer based and e-health interventions: the use of the Smart phone was addressed, and the fact that there are many apps that can be helpful in eating healthy. Also, many dietitians are starting to do coaching over the phone or skype or facetime, etc because people really do want the one-on-one individual help but don’t have the time to travel to an appointment. It is the future of healthcare, and dietitians have joined in providing this service. Research is needed to see how effective e-health interventions will be.
  8. It is important to use other interventions such as Cognitive Behavioral Therapy (CBT) as well as increasing mindfulness when it comes to promoting healthy eating. The paper addresses a variety of behavioral and psychological interventions that are helpful and makes it clear that merely prescribing a “diet” is not enough. We need to do more to help our patients.
  9. Medications and Surgery: the paper does address some medications as well as bariatric surgery (gastric bypass, sleeve, gastric banding) and reviews some of the side effects of both. The point is made that dietitians need to work with a multidisciplinary team to support the patient. Medications and surgery are not for everyone. I have to admit to being very opinionated when it came to both of these interventions. I am not a fan. However, after working in this field for so many years, and especially learning more about individuals with metabolic and genetic disorders, I have changed my opinion. I believe everyone is different and we should never judge. I have learned that reputable bariatric programs promote healthy eating and lifestyles first. Surgery is not a magic answer and it is not an easy road. People have to make really hard lifestyle changes.  They can’t have surgery if they don’t make the changes. It is not easy. Anyway, only your doctor knows if you are a candidate for any of these pretty drastic measures. I promote a healthy lifestyle to be the best you can be. But sometimes, people are successful with making changes and it is not enough and they still have health issues that can’t be resolved. Please don’t be judgmental of anyone with weight issues who are just doing the best they can.

The Position Paper also discusses policy level interventions as well as the scope of the dietitian and the importance of working with other professionals to support our patients (such as psychologists, physicians, therapists, school systems, etc.). The bottom line message to me was that we still have a lot to learn. Our health behaviors are very complex and depend on our environment, habits and psychological make up. Our bodies and lives are all different, and YOU are the expert on your own life. Being healthy and feeling your best are good goals to have, but there is no “one size fits all” when it comes to eating.

For more information, visit the Academy of Nutrition and Dietetics website at http://www.eatright.org

 

 

 

 

 

 

 

 

 

 

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s