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Dietary treatment for obesity

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 672–681 (2008)Cite this article

Abstract

In patients with obesity, low-fat diets seem to result in a weight loss of 3–4 kg at 3 years, but long-term data are limited. Calorie-controlled diets seem to outperform low-fat diets with reported weight losses of 6–7 kg at 4 years, but, again, data are very limited; an initial very-low-calorie diet approach does not lead to greater weight loss than low-fat diets in the long term. Use of meal replacements can lead to an 8 kg weight loss at 4 years, but this finding has been reported only in one, uncontrolled study. High-protein, low-carbohydrate (or very-low-carbohydrate) diets have also been evaluated and seem to be superior to high-carbohydrate diets at least for up to 2 years. Very-low-carbohydrate diets can lead to elevations in LDL cholesterol levels in some individuals. Cognitive behavioral therapy added to diet therapy can facilitate approximately 5 kg additional weight loss, and exercise can facilitate an additional 1–1.5 kg weight loss. Drug treatment, particularly with sibutramine and rimonabant, can increase weight loss with a mildly hypocaloric diet by an additional 3–5 kg, but weight-loss drugs are costly and have adverse effects. If dietary and medical therapies fail, gastric banding can lead to a weight loss of ∼14% at 10 years, with greater losses of up to 25% with gastric bypass and gastroplasty. Bariatric surgery can also lead to a reduction in mortality and comorbidities but adverse effects can occur including nutritional deficiencies and gastrointestinal symptoms.

Key Points

  • Calorie-controlled diets can lead to weight losses of 6–7 kg at 4 years in patients with obesity, but response is extremely variable and mostly depends on compliance

  • A simple and perhaps more effective strategy than a calorie-controlled diet is the long-term use of meal replacements (once or twice daily)

  • Information on dietary therapy in patients with diabetes is limited and of poor quality, but exercise can improve glycemic and lipid control, and meal-replacement diets can lead to good weight loss at 12 months

  • Cognitive behavioral therapy can add significantly to a dietary approach

  • Drug therapy can increase weight loss with mildly hypocaloric diet by 3–5 kg; however, all weight-loss drugs have adverse effects

  • Only surgical therapy can lead to long-term weight loss of >15% and a reduction in mortality and comorbidities

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Author notes

  1. CSIRO, CSIRO Health Sciences and Nutrition, PO Box 10041 BC, Adelaide, SA 5000, Australia peter.clifton@csiro.au

Authors and Affiliations

  1. PM Clifton is an Affiliate Professor of Medicine and Biomedical Science at the University of Adelaide, Adelaide, and Obesity Team Leader of the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Preventative Health Flagship, Melbourne, Australia.,

    Peter M Clifton

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Clifton, P. Dietary treatment for obesity. Nat Rev Gastroenterol Hepatol 5, 672–681 (2008). https://doi.org/10.1038/ncpgasthep1283

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