There are a record number of overweight adults and children in the United States today. In fact, one of the health objectives for 2010 is to reduce the prevalence of obesity among adults to less than 15%. The number of overweight and obese adults and adolescents continues to rise considerably. Because of this epidemic, healthcare teams will be faced with caring for an increased number of overweight and obese residents. Poor diet and physical inactivity are the most important factors contributing to an epidemic of overweight and obesity. (4)

Being overweight or obese is described as having an excess of body weight according to standards for height. A more specific measurement would be body mass index (BMI), refer to Appendix 5. A BMI of 25 to 29.9 kg/m² is considered overweight. Obesity is defined as a BMI of greater than 30 kg/m². In older adults, maintaining a higher BMI may not necessarily be bad as it has been associated with lower mortality rates. (2) The best BMI for subjects greater than 60 years of age has been shown to be greater than 27. In a study of body weight in older subjects aged 84 to 88 years it was observed that mortality is increased when BMI is less than 22, but is not increased when BMI is greater than 30. (1)

Obesity is the second preventable cause of death in the United States. The economic impact has been estimated at near $117 billion when all health affects are taken into consideration. Being overweight or obese are known risk factors for type 2 diabetes, cardiopulmonary disease, stroke, hypertension (high blood pressure), gallbladder disease, osteoarthritis, sleep apnea, and some forms of cancer. Obesity is also associated with hyperlipidemia (high blood cholesterol), complications associated with pregnancy, irregular menses, stress incontinence, depression, and increased surgical risk if such procedures are needed.

Treatment for being overweight or obese includes diet and behavior therapy. Exercise is a key part of the treatment and should be customized to the patient’s ability. Patient motivation and readiness to make changes should also be evaluated as well as the individual’s understanding of the causes of obesity and how obesity contributes to disease. Patients’ own personal goals must always be considered prior to the initiation of a weight management program.

WEIGHT MANAGEMENT DIET

Use

The use of calorie-controlled diets for weight management follow the principals of the General Diet, except that the portion sizes and fat content are decreased based on the patient’s nutritional needs and weight management goals. Weight management includes medical nutrition therapy, physical activity, and behavior therapy. People who are most successful at achieving and maintaining a healthy weight do so through continued attention to consuming only enough calories from foods and beverages to meet their needs and by being physically active. (4) Medications may be used in treatment for individuals who meet criteria established by National Heart, Lung, and Blood Institute (NHLBI). (3)

Medical nutrition therapy for weight loss should last at least 6 months or until the individual reaches his or her goal weight at which time a weight maintenance plan should be implemented. Positive outcomes include:

• Promoting weight loss by reducing calorie needs by 500 to 1,000 calories/day.
  
• Promoting weight maintenance by providing adequate calories based on expenditure once a weight loss goal is met.
  
• Achieving optimal serum lipid levels (cholesterol, HDL and LDL cholesterol, and triglycerides).
  
• Preventing long-term complications such as hypertension (high blood pressure), cardiovascular disease, and diabetes.
  
• Improving overall health through optimal nutrition and long-term behavior changes.

Adequacy

Very low calorie diets do not meet energy requirements or nutrient requirements and should only be used under medical supervision. Calorie levels less than 1,200 for most women and 1,500 for most men should be discouraged. These levels lack adequate intake to meet Dietary Reference Intakes (DRIs) and a multivitamin or mineral supplement should be considered. The diet should be based on the individual’s nutritional needs and anticipated energy output.

Diet Principals