What is the best diet to recommend when treating obesity?
2. The choice between high-carbohydrate, high-fat and high-protein options.
Objective. The objective of this three-part narrative review is to examine empirical data on the best type of diet to recommend to clients with established obesity that are being treated by an exercise-centred weight reduction programme. The present section of the review considers the relative merits of high-carbohydrate, high-fat, and high-protein options. Methods. Information obtained from Ovid/Medline, PubMed and Google Scholar through to August 2019 was supplemented by a search of the author's extensive personal files. Results. Any proposed diet must meet basic needs for protein, essential fatty acids and micronutrients, but once such demands have been satisfied there is a vigorous competition between proponents of high-carbohydrate, high-fat, and high-protein dietary emphases. Discussion has focused on the respective abilities of these choices to prolong satiety and encourage adherence to the recommended regimen, to conserve lean tissue, to stimulate thermogenesis and to encourage the metabolism of fat. However, to date randomized controlled experiments have shown relatively little difference in the long-term weight reductions achieved with the three options. The main determinant of successin weight loss seems not the choice of diet but rather faithful adherence to whichever regimen is chosen. Conclusions. The optimal approach to weight loss comprises a moderate but consistent reduction of daily energy intake and faithful adherence to a programme of moderate physical activity. There seems little difference in the long-term weight-loss achieved by following a high-carbohydrate, a high-fat or a high-protein diet. The challenge for health professionals is to develop safe methods of reaching an effective dose of exercise, and to sustain the enthusiasm of programme participants for both dieting and increased physical activity until weight-reduction goals have been met.
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