The Importance of Nutrition Quality in the Treatment of Obesity

“Let food be thy medicine, thy medicine shall be thy food.” These words from Hippocrates, an ancient Greek physician, still hold true today.

First, it is important to step back and recognize that obesity is a complex and chronic medical condition. Comprehensive obesity management ideally should utilize a spectrum of treatments -- nutrition therapy, physical activity, behavior modifications and medical interventions such as medication management. Medical nutrition therapy is an essential pillar regarding treatment of patients with obesity.

Nutrition quality is just as critical as calorie reduction in obesity treatment. The types of calories consumed have a significant impact on hunger cues, satiety, and metabolism through their effects on the anorexigenic and orexigenic pathways in the brain.

A nutrient-dense nutrition plan high in dietary fiber, particularly soluble fiber, is associated with improved insulin sensitivity and lower levels of insulin resistance. Several studies showed that high total and soluble fiber intake decreased fasting glucose, fasting insulin, and lowered insulin resistance. (Source: https://pubmed.ncbi.nlm.nih.gov/23218116/)

Dietary fiber also prolongs satiety. A number of mechanical and endocrine signals from the gastrointestinal tract are stimulated by fibers and their fermentation products, reach regions of the brain involved in the regulation of appetite, and ultimately reduce food intake. Gastric distention, delayed gastric emptying, prevention of hypoglycemia, increased amounts of unabsorbed nutrients reaching the ileum, and stimulation of enteroendocrine cells for secretion of cholecystokinin, glucagon-like peptide-1 (GLP-1), and peptide YY are among the mechanisms of fibers in decreasing hunger and prolonging satiety. (Source: https://pubmed.ncbi.nlm.nih.gov/36193993/)

Including high-quality foods like lean proteins and hitting ideal protein goals can lower the powerful hormone called ghrelin, also known as the hunger hormone. It is theorized that there is a high association between ghrelin, glucose, insulinotropic polypeptide (GIP), and glucagon that help reduce hunger signals. By reducing hunger signals, patients may find it easier to adhere to their nutritional goals. (Source: https://pubmed.ncbi.nlm.nih.go...)

Additionally, minimizing added sugars may play a role in reversing leptin resistance, potentially improving satiety and appetite regulation. ¹

Ultra-processed foods (UPFs) play a significant role in the development and progression of obesity. They can be defined as ultra-processed foods of minimal nutritional value such as “sweets,” “junk foods,” cakes, cookies, candy, pies, chips, sugar-sweetened beverages.

Multiple studies have demonstrated a positive association between the consumption of UPFs and weight gain. ²

The effectiveness of different nutrition plans for weight management has been extensively studied. The Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH), and plant-forward diets each offer distinct benefits and varying levels of evidence supporting their role in obesity care. Source https://pubmed.ncbi.nlm.nih.gov/32059053/

The Mediterranean diet has the most consistent evidence for weight management and cardiometabolic benefits. It is associated with significant weight loss and improvements in cardiovascular risk factors, such as blood pressure and lipid profiles. The Mediterranean Diet is not a defined diet per se, but rather a generalized meal pattern that encourages consumption of olive oil, vegetables, fruits, legumes, whole grains, nuts, seeds, seafood, fermented dairy products, poultry, eggs, and red wine in moderation while limiting red meat and ultra-processed carbohydrates. The DASH diet prioritizes vegetables, fruits, whole grains, lean proteins, nuts, seeds, and legumes while limiting red and processed meats, added sugars, and sugar-sweetened beverages. When following a 2,100-calorie DASH plan, sodium intake should remain below 2,300 mg per day, total fat should comprise less than 27% of daily calories, and cholesterol should be limited to under 150 mg per day. The effect of the DASH diet with supervised physical activity decreases body weight, waist circumference, and fat mass. They also noted lipid profile improvement. (Source: https://pubmed.ncbi.nlm.nih.go...)

When guiding patients on dietary choices, it is essential to consider cost and accessibility. We can address cost by focusing on budget-friendly options like plant proteins (beans, lentils), frozen options (vegetables). Clinicians can also support patients by teaching meal planning strategies, including bulk cooking and shopping tips. In the multi-cultural society we live in, it's also important to respect cultural preferences. A good way to start is to simply ask. Some swaps can be used to adapt to different dietary preferences.

Focusing on quality promotes a balanced diet that feels less restrictive and more satisfying, increasing the likelihood of maintaining healthy habits over time. By combining calorie reduction with nutrient-rich, high-quality food choices, we increase the chances of weight loss as well as building a foundation for better energy, health, and long-term success.

For clinicians seeking additional guidance, the 2024 OMA Obesity Algorithm—Important Principles for the Effective Treatment of Patients with Obesity is a valuable resource and is free for OMA members. The OMA Academy offers evidence-based, peer-reviewed obesity education, including free courses for members. Additionally, the Obesity Pillars journal provides up-to-date research and insights to support clinical practice.