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Which diet is the right one? A guide for supporting your patients…

by Melinda Maryniuk, MEd, RDN, CDCES

There is so much conflicting information about food-based approaches to support weight loss. Is the Mediterranean diet the right choice for your patients? What about keto? Here are some suggestions on how to guide your patients when they come to you with questions about the latest diet….

If a patient asks for your guidance, seek to understand their past experiences with diets, as well as barriers they’ve experienced and fears they might have. Digging deeper into the patient’s understanding about diets and weight loss can help clarify misconceptions and drive realistic expectations.

Some questions to explore with your patients include:
-What type of eating approach has worked for you in the past?
-What style of eating has been harder for you to stick with?
-Why do you think this eating approach would be right for you?
-What outcomes do you expect to see?
-How can I help support you?

While it is true that different diets work for different people – there are certain elements of medical nutrition therapy (MNT) that can help ensure success. To help you evaluate different eating approaches, here are the key elements for success:

Patient Centered – Let your patient drive the discussion. If they show interest in a particular meal planning approach, that is already one step in their favor of being successful. However, your role is important in ensuring that both pros and cons are understood. Client centered also means to individualize the diet – and tailor the recommendations to fit their preferences, culture, eating patterns, finances, etc.

Team Based – If possible, an approach that takes advantage of a multidisciplinary team is ideal. This might include medical professionals (to evaluate if any adjustments are needed in the patients’ pharmacotherapy), a registered dietitian (to oversee and provide support for the meal plan), and a behavioral health specialist (such as a psychologist or social worker to help shape a healthy relationship with food and self-concept). While it is not always possible to have access to all of these individuals, many of the structured programs (such as WW/Weight Watchers) include these important elements.

Quality Counts – While some approaches focus on quantity by counting calories or grams of carbs or fat, the data suggests that these tend to be less effective in the long-term. More effective and sustainable approaches focus on the overall quality of the foods… choosing more whole foods and minimizing ultra-processed foods. Meal plans that omit entire groups of foods such as fruits, or grains or dairy are generally not recommended.

Ongoing Support – The most success has been demonstrated when ongoing support is provided, either through regular brief meetings (virtual or live). Counselors trained in weight management, such as Registered Dietitians, can provide such ongoing support, as can peer support programs…even if they are virtual.

Realistic Expectations – Ensure patients have realistic expectations for success. Aiming for about a 1 pound/week weight loss (or ½ kilogram) is realistic. Discuss several success measures with your patient– and monitor them – including waist circumference, blood pressure, LDL cholesterol, triglycerides as well as some patient reported measures such as quality of sleep, energy level and overall quality of life. Monitor results – and if anticipated outcomes are not achieved, it may be time to either reassess the goals, reassess the understanding of the meal plan, identify if additional support is needed or… advance the therapeutic interventions – such as to consider adding pharmacotherapy.

Incorporate physical activity – While we know that exercise alone does not lead to sustainable weight loss, it a recommended part of a comprehensive weight loss program and can be critical for preventing weight re-gain. Have a discussion with patients to learn how they plan to make both aerobic and resistance exercise a part of their weekly routine.

In conclusion, keep in mind that while a particular “diet” may sound appealing to achieve some short-term results, the key objective is to help patients find sustainable eating patterns that will become part of their lives. Some eating patterns (such as Mediterranean, Vegetarian or the Plate Method) are meant for the long term – while others (such as Intermittent Fasting or Keto) have only been studied with short term outcomes. Thus, while some may be useful for short term – the overall goal is to help drive patients towards an eating pattern they will enjoy for life.

It’s also important to keep in mind that diet is not the only component of obesity management. As endocrinologist Dr. Sue Pedersen puts it, “for most people living with obesity, diet and exercise alone is not enough to help them reach a healthier weight.” Medical treatments (such as medications, psychological interventions or bariatric surgery) will be required. In short, diet and exercise are just one part (albeit a very important one) of the obesity management puzzle!

The Dietitian’s Review articles below that summarizes the pros and cons of the most popular weight loss approaches, and include a sample shopping list to highlight the foods each diet promotes. Feel free to share these with your patients.

A Dietitian’s Review: Intermittent Fasting

A Dietitian’s Review: The Keto Diet

A Dietitian’s Review: The Plate Method

A Dietitian’s Review: The Volumetric Diet

A Dietitian’s Review: Weight Watchers (WW)

A Dietitian’s Review: South Beach Diet and Atkins Diet

A Dietitian’s Review: The Paleo Diet

A Dietitian’s Review: The Mediterranean Diet

A Dietitian’s Review: The DASH Diet

A Dietitian’s Review: Calorie Counting

A Dietitian’s Review: The Whole30

Most importantly, here’s an article that underscores that there are many paths to success— the key is to find the one that’s right for each individual person.

Melinda Maryniuk is a registered dietitian, certified diabetes care and education specialist and serves as the Lead Clinical Consultant with My Weight What to Know.  For over thirty years Melinda worked at Joslin Diabetes Center and served as Director of Clinical Education Programs in Joslin’s Innovation Division.  She has authored over 100 publications and has lectured extensively on topics related to nutrition and diabetes around the world.  For the past four years, she has served as a co-director of Harvard Medical School’s Diabetes Update course for physicians and health professionals.  Melinda has served on the Board of Directors of the American Diabetes Association (ADA) and the Association of Diabetes Care and Education Specialists and has received numerous national awards including the Outstanding Diabetes Educator Award from ADA and the Medallion Award from the Academy of Nutrition and Dietetics.  

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