Thinking About Obesity Management

Some research suggests that maintaining 3-5% weight loss can improve clinical parameters, and those classified as having obesity could aim for 7-15% weight loss.^[1] But as the majority of high quality studies in those with obesity suggest that most weight lost is regained 3-years post intervention ^[2]  and that weight loss does not always lead to improved health outcomes,^[3] where does this leave us? Well Obesity Canada recommends that “Nutrition interventions for obesity management should focus on achieving health outcomes for chronic disease risk reduction and quality of life improvements, not just weight changes”.^[4] As there is not a one size fits all approach for obesity management any health focused dietary interventions should take into account a persons preferences, values, culture, social determinants of health. ^[5]

The Role of Diet and Physical Activity

Exercise alone is not the most effective weight loss method unless performed in extremely high volumes. A study tracking over ten thousand people who have been successful in losing at least 30 pounds and maintaining this weight loss for at least one year found that 98 percent of participants in the registry modified their food intake and 94 percent increased their physical activity (mainly walking).^[6] Most report that their approach involved adhering to a low-calorie, low-fat diet and doing high levels of activity (about one hour of exercise per day). Moreover, most members eat breakfast every day, watch fewer than ten hours of television per week, and weigh themselves at least once per week. About half of them lost weight on their own, and the other half used some type of weight-loss program. In most scientific studies, successful weight loss is accomplished only by changing the diet and increasing physical activity. Doing one without the other limits the amount of weight lost and the amount of time that weight loss is sustained.

Below are some evidence-based dietary and physical activity recommendations for improving health/ potential weight loss.

Dietary Recommendations For Health

Canada’s Food Guide offers specific recommendations for dietary changes that may be beneficial to health. These recommendations suggest following a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level. Some nutritional suggestions for improving health are detailed below:^[7]

1. Protein is satiating, so high protein diets can help keep you full for longer.  A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products. Choose plant based protein more often.
2. Limit ultra processed foods as they encourage you to consume more food.
3. Plant based/ Mediterranean diets are beneficial to health.
4. Consuming the AI for fibre can help
5. Consume lots of variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
6. Consume lots of fruits, especially whole fruits
7. Consume whole grains, pulses, nuts, and dairy
8. Make water your drink of choice

A healthy eating pattern limits:

1. Saturated fats and trans fats
2. Added sugars

Behavioural Dietary Recommendations For Health

1. Be mindful while eating
2. When possible, cook more often
3. Enjoy food and eat with others
4. Notice when you are hungry and full
5. Plan what you eat and involve others in this planning

Physical Activity Recommendations For Health

The other part of the energy balance equation is physical activity. The Canadian Society for Exercise Physiology (CSEP) in partnership with Participaction have developed physical activity guidelines for Canadians of all ages. The recommendations for adults (18-64 years of age) include 150 minutes of moderate to vigorous-intensity aerobic physical activity per week in bouts of 10 minutes or more. It is also beneficial to add strength training activities 2 days per week.^[8] Increased physical activity has been found in scientific studies to lower the risk of heart disease, stroke, high blood pressure, Type 2 diabetes, colon, breast, and lung cancer, falls and fractures, depression, and early death. Increased physical activity not only reduces disease risk, but also improves overall health by increasing cardiovascular and muscular fitness, increasing bone density and strength, improving cognitive function, and assisting in weight loss and weight maintenance.^[9]

The key guidelines for adults are the following (those for pregnant women, children, and older people will be given in Chapter 13):

1. Even small amounts of activity are beneficial to your health.
2. More substantial health benefits are obtained by doing at least two hours and thirty minutes per week of moderate-intensity, one hour and fifteen minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination thereof. Aerobic activity has better benefits if performed for at least ten minutes at a time, spread throughout the week.
3. More extensive health benefits occur when moderate-intensity physical activity is increased to five hours per week, or two hours and thirty minutes of vigorous-intensity aerobic physical activity, or a combination thereof. Additional health benefits are gained by going beyond these recommended amounts of physical activity.
4. Muscle-strengthening activities at moderate or high intensity involving all major muscle groups two or more days per week provides additional health benefits to aerobic exercise.

Moderate physical activities are described as those when “you can talk while you do them, but can’t sing” and vigorous activities are those when “you can only say a few words without stopping to catch your breath.”