Manual of Clinical Nutrition Management C- 36 Copyright © 20 13 Compass Group, Inc.
CALORIE-CONTROLLED DIET FOR WEIGHT MANAGEMENT
Description
For the Calorie-Controlled Diet for Weight Management, the Regular Diet is modified by reducing energy
intake below what is necessary for maintenance of body weight. Intake of essential protein, vitamins, and
minerals is maintained by limiting the amount of fat and sugar in the diet and substituting low-energy foods
for foods of similar nutrient content that are higher in energy. Weight loss and weight maintenance therapy
should be based on a comprehensive weight management program including diet, physical activity, and
behavior therapy. The combination therapy is more successful than any one intervention alone (Grade I)* (1).
Indications
Weight reduction is desirable because obesity is related to increased mortality and because weight loss
reduces the risk factors for several chronic diseases. Thus, weight loss may help to both control diseases
worsened by obesity and decrease the likelihood of developing these diseases. Strong and consistent clinical
evidence supports weight loss in overweight or obese persons who have hypertension, hyperlipidemia, or
type 2 diabetes, as well as in overweight or obese persons who are at risk for developing these conditions
(Grade I) (1-6). Obesity is a significant risk factor for non-alcoholic fatty liver disease, an emerging condition that
is the most common cause of abnormal liver function tests in obese children and adults (7). Non-alcoholic
fatty liver disease can lead to significant liver damage including cryptogenic cirrhosis, steatohepatitis, and
hepatocellular carcinoma (7). In overweight and obese persons, weight loss is recommended to (1-7):
lower blood pressure in patients with hypertension (5)
lower total cholesterol, low-density lipoprotein cholesterol, and triglycerides levels in patients with
hyperlipidemia (4)
lower blood glucose levels in patients with type 2 diabetes (3,4,6)
prevent liver disease (7)
Fat is lost when the body is in a state of negative energy balance, which is achieved by reduced energy
intake, increased energy output (through muscle work), or both. The reduction of total energy intake vs. the
macronutrient composition of the diet is the most important component for achieving negative energy
balance and subsequent weight loss (8).
Body mass index (BMI), defined as weight (kg) divided by height^2 (m^2 ), and waist circumference should be
used to classify overweight and obesity, estimate risk for disease, and identify treatment options (Grade II) (1-3).
The BMI is highly correlated to obesity, fat mass, and risk of other diseases (Grade II) (1-3). For optimal health, a
BMI of 18.5 to 24.9 kg/m^2 is recommended for adults, based on evidence that this range is associated with
minimal risk of disease. Table C- 7 outlines the health risk classes associated with different BMI levels and
waist circumferences in adults aged 18 years and older.
Table C-7: Weight Classification by BMI, Waist Circumference, and Associated Health Risks
Health Risk Relative to Waist Circumference
Weight
BMI
(kg/m^2 )
Risk ClassMen 102 cm (40 inches)
Women 88 cm ( 35
inches)Men >102 cm (>40 inches)
Women >88 cm (>35
inches)
Underweight <18.5 – – –
Normal 18.5-24.9 0 – Increased
Overweight 25.0-29.9 0 Increased High
Obesity 30.0-34.9 I High Very high
35.0-39.9 II Very high Very high
Extreme
obesity
>40.0 III Extremely high Extremely highSource: National Heart, Lung, and Blood Institute Obesity Education Initiative Expert Panel. Clinical guidelines on the identification,
evaluation, and treatment of overweight and obesity in adults. Available at: http://www.nhlbi.nih.gov/nhbli/htm. Accessed January 21,
20 04.
Children and adolescents: Complications of obesity in children and adolescents include hypertension,
dyslipidemia, orthopedic disorders, sleep disorders, gall bladder disease, and insulin resistance (9). The
National Heart, Lung, and Blood Institute Obesity Education Initiative Expert Panel recommends evaluations
and possible treatment for: (1) children and adolescents who have a BMI greater than or equal to the 85th