PHILADELPHIA — Weight was once an afterthought in the treatment of diabetes, dyslipidemia, and hypertension, but that approach has now shifted, with many physicians seeing weight management as a first-line treatment.
But many physicians are still uncomfortable counseling their patients about nutrition and don't know what to recommend, Diana Cullum-Dugan said at Endocrinology in the News, sponsored by Boston University, INTERNAL MEDICINE NEWS, and FAMILY PRACTICE NEWS.
A range of diets have been studied in regard to weight loss efficacy and their effects on cholesterol and glucose. The best diet is the one patients will follow, said Ms. Cullum-Dugan, a registered dietitian who is in private in practice in Boston.
A study comparing the Atkins diet (very low carbohydrate, high fat), the Zone diet (moderate carbohydrate, moderate fat), Weight Watchers (high carbohydrate, moderate fat), and the Ornish diet (high carbohydrate, very low fat) and found that with each of the diets 20%-25% of subjects sustained modest weight loss beyond 1 year (JAMA 2005;293:43–53).
Ms. Cullum-Dugan tries not to focus on what patients are giving up, but instead, on what new, healthy foods they can add to their diets to feel full, such as olive oil, avocado, nuts, fruits, and vegetables. “Let those crowd out some of [the] high-fat choices they might make.”
In general, there is consensus around having a diet that is 30% fat, 40% carbohydrate, and 30% protein, with 25–38 g/day of fiber, Ms. Cullum-Dugan said. With a diet of less than 40% carbohydrates, patients risk having a diet with too much fat and not enough fiber, but if they fill 60%-65% of their diet with carbohydrates, they run the risk of not getting enough fat and protein.
Protein can include lean meats, fish, legumes, and low-fat dairy. Emerging data suggest protein plays a role in energy intake, satiety, and long-term weight loss (Diabetes Care 2004;27:S55–7).
Fat intake should be about 30%-35% of the total caloric intake, with less than 10% from saturated fats. Ms. Cullum-Dugan doesn't usually counsel patients to limit their fat intake unless they are obese but tries to help them choose foods with monosaturated fats and omega-3 polyunsaturated fats, such as nuts, olive and canola oil, flaxseed, and fish. She advises fish oil for those who won't eat fish.
Daily fiber intake should be 25–38 g/day, with the target for women at the lower end of that range and for men, at the upper end. Half cup of all-bran cereal, an apple, a half cup of broccoli, two slices of whole wheat bread, a pear, and a half cup of lentils make up around 28 g fiber.
Ms. Cullum-Dugan also tries to get patients away from just counting calories. She recommends they fill half their plate with vegetables, a quarter with protein, and a quarter with starches. She also advises consistency-patients should eat about the same amount of food at about the same time of day.