Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome: ABESO 2022

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.info:eu-repo/semantics/publishedVersio

Effect of mindful eating weight loss intervention in women with obesity: ATENTO study

INTRODUÇÃO: A obesidade é uma doença com causa multifatorial e um fator de risco para doenças cardiovasculares, diabetes e alguns cânceres, entre outras doenças. Atualmente, a prevalência da obesidade continua a aumentar no Brasil e no mundo, sendo sua prevenção e tratamento complexos. Uma abordagem recente, o programa de treinamento em consciência alimentar baseado em atenção plena (Mindfulness based eating awareness training) tem sido sugerido para o tratamento do transtorno da compulsão alimentar, através do controle do comportamento alimentar e do desenvolvimento da consciência dos sinais de fome e saciedade, porém sem foco na perda de peso. Recentemente, muitos estudos vêm mostrando que áreas cerebrais responsáveis pela tomada de decisões e o sistema de recompensa podem ser alteradas após exercícios de atenção plena, o que poderia melhorar o consumo alimentar e levar à perda de peso. OBJETIVO: Avaliar o efeito da orientação baseada em exercícios de comer com atenção plena na perda de peso em mulheres adultas com obesidade, nos parâmetros metabólicos, de consumo e comportamento alimentar, de satisfação corporal, depressão, ansiedade, estresse e qualidade de vida. MÉTODOS: Mulheres com obesidade classes I e II foram incluídas randomicamente em três grupos de intervenção: grupo controle (dieta hipocalórica balanceada), grupo intervenção 1 (exercícios de comer com atenção plena) e grupo intervenção 2 (dieta hipocalórica balanceada associada a exercícios de comer com atenção plena). O seguimento das pacientes foi mensal por 6 meses. Foram avaliados parâmetros antropométricos, metabólicos e intensidade de atividade física, e utilizados questionário de três fatores alimentares, escala de compulsão alimentar periódica, escala de silhuetas de Stunkard, questionário de qualidade de vida, escala de depressão, ansiedade e estresse e escala de atenção e consciência plenas. O consumo alimentar foi avaliado através do registro alimentar de três dias e o tempo de meditação foi contabilizado. RESULTADOS: Foram incluídas no estudo 138 pacientes, destas, 70 finalizaram a intervenção com perda de peso e redução no consumo energético significativas e semelhantes nos três grupos. Houve baixa adesão por parte das pacientes aos exercícios de comer com atenção plena e maior taxa de abandono no grupo intervenção 1 que no grupo controle. A melhora nos parâmetros metabólicos foi superior no grupo controle. Ocorreu maior redução no descontrole alimentar no grupo intervenção 1 que no grupo controle e maior redução na alimentação emocional no grupo intervenção 1 que nos demais grupos. Foi observada redução na restrição cognitiva apenas no grupo intervenção 1. Os três grupos apresentaram melhora na média de escore da escala de compulsão alimentar periódica e redução da insatisfação corporal. Ao final do estudo, não houve diferença entre os grupos para sintomas de depressão, ansiedade, estresse e componentes relacionados à qualidade de vida. CONCLUSÕES: A abordagem baseada em comer com atenção plena isolada levou à perda ponderal semelhante à orientação nutricional habitual, mas com uma maior taxa de abandono do estudo. A associação da abordagem baseada em comer com atenção plena à dieta balanceada hipocalórica não promoveu maior perda de peso. Benefícios em parâmetros metabólicos foram superiores nas pacientes que receberam a orientação nutricional habitual.INTRODUCTION: Obesity is a multifactorial pathology and a risk factor for diseases such as cardiovascular disease, diabetes and some cancers. The prevalence of obesity continues to rise in Brazil and worldwide, and its prevention and treatment are complex. A recent approach, the mindfulness-based eating awareness training program has been suggested for treatment of binge eating disorder, addressing eating behavior and developing awareness of hunger and satiety cues, without a specific focus for weight loss. Recently, many studies have shown that the brain areas responsible for decision making as well as the reward system can be altered after mindfulness practice, which could improve food ingestion and weight management. OBJECTIVE: To assess the effect of mindful eating on weight loss in adult women with obesity, on metabolic parameters, food ingestion and eating behavior, body image satisfaction, depression, anxiety, stress and quality of life. METHODS: Women with class I and II obesity were randomly assigned to three intervention groups: control group (balanced low-calorie diet), intervention group 1 (mindful eating approach) and intervention group 2 (balanced low- calorie diet associated with mindful eating approach). Patients were followed up monthly for 6 months. Anthropometric parameters, metabolic parameters and intensity of physical activity were assessed. The three-factor eating questionnaire, the binge eating scale, the Stunkard figure rating scale, the Short Form 36 questionnaire, the depression, anxiety and stress scale and the mindful attention awareness scale were applied. Food ingestion was assessed using the three-day food record and meditation practice was timed. RESULTS: One hundred and thirty-eight patients were included in the study and 70 completed the intervention. Mean weight loss and reduction in energy ingestion were significant, without statistical difference between groups. Patients in the mindful eating intervention had poor engagement in home practice. A higher attrition rate was observed in the intervention group 1 than in the control group. Improvement in metabolic parameters was superior in control group. There was a greater reduction in uncontrolled eating in intervention group 1 than in the control group and a greater reduction in emotional eating in the intervention group 1 than in the control and intervention 2 groups. There was reduction in cognitive restraint only in the intervention group 1. All groups showed amelioration in mean binge eating scale scores and reduction in body image dissatisfaction. At the end of the study, there was no difference between groups for symptoms of depression, anxiety, stress and components related to quality of life. CONCLUSIONS: The mindful eating approach led to weight loss similar as standard nutritional care, but with a higher attrition rate. Association of mindful eating approach to a balanced low-calorie diet did not promote greater weight loss. The usual approach with a low-calorie diet was associated with greater metabolic improvement