Box 1 Summary of nutrition recommendations for the treatment of overweight and obesity

Energy density

Consumption of foods and beverages with low energy density associated with energy deficit from diet can be useful in the treatment of obesity

IIb

B

Y

Portion control

Portion size control can help to reduce the excessive consumption of foods and beverages

IIb

B

Y

Foods

 Fruits and vegetables

Encouraging the intake of fresh fruits and vegetables, associated with a hypocaloric diet, contributes to weight management

IIa

A

Y

 Fast-food

The intake of fast-food meals high in sugars, sodium, and saturated and/or trans fat is not recommended

IIb

C

N

 Ultraprocessed food

The consumption of ultraprocessed foods is associated with excessive calorie intake and weight gain

III

B

N

 Sweetened beverages

Sweetened beverages or even unsweetened fruit juices contribute to increased calorie intake and body weight, and should be discouraged for the prevention and treatment of obesity

I

A

N

Calorie-based interventions

 Low-calorie diets

Low-calorie diets are fundamental for obesity treatment and the management of the meal plan must be associated with lifestyle changes

I

A

Y

 Very low-calorie diets

VLCDs should not be the first option for obesity treatment

IIa

A

Specific situations

 Meal replacements

Meal Replacements can help to structure a LCD and increase diet adherence

IIa

A

Y*

Based on dietary patterns

 Mediterranean

The Mediterranean diet has cardiovascular benefits to the individual with obesity

I

A

Y

 Plant-based and vegetarian

Vegetarian or plant-based diets with reduced intake of ultraprocessed foods can be an option for the prevention and treatment of obesity

IIa

A

Y*

Based on macronutrients

 Low-carb

Low-carb diets promote weight loss in short and medium duration (3 to 6 months)

IIa

A

N

Low-carb diets do not promote more weight loss compared to other diet types in long-term studies

IIa

A

 Ketogenic

The ketogenic diet should not be recommended for the treatment of obesity as it does not promote a balanced diet or favor adherence to healthy eating habits

III

A

N

 Low-GI

Glycemic Index as a measure of carbohydrate quality appears to be a minor determinant for body weight, weight loss and obesity prevention

IIb

B

N

Based on

 Meal frequency and timing

Intermittent calorie restriction presents similar weight loss results as meal plans with continuous calorie restriction

IIb

A

N

Weight loss is induced by the energy deficit, and not by the fasting period per se or the number of daily meals

IIb

A

Late consumption of most of the daily calories can negatively impact body weight

IIb

B

 Breakfast consumption

There is no conclusive evidence if breakfast plays a causal role both for weight gain and weight loss

IIb

A

Y

Sweeteners

There is inconclusive evidence about the effect on weight loss of sweeteners when used alone, without healthy food choices accompanied by an energy deficit

IIb

B

N*

Supplements

 Phytotherapics

There is no recommendation to use phytotherapics for weight loss

III

B

N

 Caffeine

The use of caffeine supplements should not be considered as a strategy for weight loss and obesity treatment

III

B

N

 Whey protein supplements

The prescription of whey protein is not indicated as a therapy for weight loss

III

A

N

 Coconut fat

There is no scientific evidence to support the indication of coconut oil as a weight loss strategy

III

B

N

 Probiotics

There is not enough scientific evidence for the use of probiotic supplementation for weight management

III

A

N

There is not enough scientific evidence for performing gut microbiota tests in clinical practice for the treatment of obesity

III

A

N

Eating behavior

 Cognitive behavioral therapy

Cognitive-Bevahioral Therapy should be used for weight management in patients with overweight and obesity

I

A

Y

 Motivational interviewing

Motivational Interviewing can be considered and used for weight management in patients with overweight and obesity

IIa

A

Y

 Mindful eating

The results related to Mindfulness-Based Interventions in the treatment of obesity are still divergent, and it is yet not possible to guarantee that this is an appropriate approach for all patients

IIa

A

Y*