Health Professional's Guide to Treatment of Overweight and Obesity

National Heart, Lung, and Blood Institute; it is characterized by the consumption of fruits, vegetables, whole grains, nonfat or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils, and by limited consumption of foods high in satu- rated fat, sugar-sweetened beverages, and sweets.62

Standard characterizations of a

DASH dietary pattern do not include an explicit energy restriction; however, weight loss occurred within a multicomponent behavioral intervention in which reduced total energy intake was emphasized (without an explicit prescription) within a DASH dietary pattern.63,64

The 2013 AHA/ACC/TOS guidelines do not specifically include the DASH dietary pattern as an approach to reducing energy intake.8

Low-Energy-Density Dietary Pattern Energy density is the amount of energy in a given weight of food and is presented as kilocalories per gram. Energy density can range from 0 to 9 kcal/g, depending on the macronutrient composition of the food or beverage in question. Fat and water have the greatest influence on energy density. Thus, a low-energy-density dietary pattern is one that contains foods higher in water content and lower in fat content (eg, fruits and vegetables). Because of their high water content, beverages have a low energy density and are often not included in energy-density calculations, as they would have a disproportionate impact on overall dietary energy density. No standard definition of a low-energy-density dietary pattern exists, but several cutoff values to define a food as having a low energy density have been proposed, and they range from 0.6 to 2.25 kcal/g.65-67

low-energy-density dietary pattern is associated with lower energy intake,68-70 this dietary pattern to be an effective strategy for weight loss.74,75

Consistent evidence from laboratory studies has shown that a and

consistent evidence from observational studies has shown that a low-energy-density pattern is associated with lower weight.71-73

Several intervention trials have shown Despite the need

for better-quality studies of longer duration, a low-energy-dense dietary pattern has been promoted as an effective approach for weight management,76-79 approach included in the 2013 AHA/ACC/TOS guidelines.8

but it is not an

As a dietary strategy, dietary patterns offer the opportunity to optimize diet qual- ity, and in combination with energy restriction, they can result in weight loss.80 Two dietary patterns, the Mediterranean-style and vegetarian-style, are supported by high-grade evidence for weight loss according to the 2013 AHA/ACC/TOS guidelines.8

Intermittent Fasting Dietary Approaches

While traditional dietary approaches have focused on what to eat, more recent dietary approaches have focused on when to eat. These new approaches are grouped into a category called intermittent fasting.81

The two most-investigated intermit-

tent fasting approaches focus on the number and pattern of days of energy restric- tion (periodic fasting) and when to eat during a 24-hour cycle (time-restricted eating).81

As this is a newer area of research, there are no graded recommendations for these dietary approaches.

Periodic Fasting Periodic fasting was initially proposed as a strategy for increasing adher- ence to energy restriction.82,83

Although standardized definitions are lacking, CHAPTER 11: Dietary Interventions 187

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