Manual of Clinical Nutrition

Calorie Controlled Diet for Weight Management

Manual of Clinical Nutrition Management C- 37 Copyright © 20 13 Compass Group, Inc.

percentile and complications of obesity; and (2) children and adolescents who have or a BMI greater than the
95 th percentile with or without complications of obesity (9). The use of weight maintenance vs weight loss to
achieve weight goals depends on the patient’s age, baseline BMI percentile, and the presence of medical
complications (9). The committee recommends treatment that begins early, involves family, and institutes
permanent changes in a stepwise manner (9). (Refer to Section III: Obesity and Weight Management.)

Contraindications
Weight reduction is not recommended for the following groups:

 pregnant women (Energy restriction during pregnancy that is sufficient to produce weight loss can be
dangerous for the development of the fetus.) (10)
 patients with unstable mental or medical conditions, unless medically supervised (2)
 patients with anorexia nervosa or a history of this disorder, unless medically supervised (2)
 terminally ill patients (2)

See Section III: Clinical Nutrition Management for additional information on:
 Heart Failure
 Gastroesophageal Reflux Disease (Gerd)
 Hypertension
 Hypertriglyceridemia
 Hypoglycemia
 Obesity And Weight Management

Nutritional Adequacy
The precise level at which energy intake is insufficient for an adequate diet is difficult to define without taking
into consideration the age and sex of the individual and the corresponding Dietary Reference Intakes. Diets
that provide 1,200 kcal or less of energy are generally inadequate to meet Dietary Reference Intakes.
Therefore, a daily multivitamin is recommended when energy levels of this range are prescribed (2,3).
Determining the energy level that promotes weight loss is difficult in overweight and obese individuals, and
estimated energy needs should be based on resting metabolic rate (RMR) (Grade I) (1). Whenever possible, RMR
should be measured (eg, indirect calorimetry). If RMR cannot be measured, the Mifflin-St. Jeor equation using
actual weight is the most accurate method for estimating RMR for overweight and obese individuals (Grade I) (1).
(Refer to Section II: Estimating Energy Expenditures.) Meta-analysis of the literature has identified that 1,200
kcal/day for women and 1,400 to 1,500 kcal/day for men (2,3,8,11) are acceptable energy intake levels that
promote gradual and safe weight loss of 0.5 to 1 lb/week (2,3,8). An individualized reduced energy diet along
with energy expended through physical activity should reduce body weight at an optimal rate of 1 to 2
lbs/week for the first 6 months and achieve an initial weight loss goal of up to 10% from baseline. These
goals are realistic, achievable, and sustainable (Grade I) (1).

Recent studies have evaluated the impact of total energy and macronutrient composition on weight loss.
The US Department of Agriculture has found that diets high in carbohydrate (>55%) and low to moderate in
fat (15% to 30%) tend to be lower in total energy and higher in diet quality when compared to low-
carbohydrate diets (<30%). In these studies, the BMI was significantly lower for men and women on the
high-carbohydrate diet; the highest BMIs were noted for individuals on a low-carbohydrate diet. Based on
these findings, weight loss is independent of macronutrient composition, and energy restriction is the key
variable associated with short-term weight reduction (8,11). A randomized controlled trial investigated weight
loss outcomes using a low-carbohydrate diet compared to a low-fat, low-energy, high-carbohydrate
(conventional) diet. Initial weight loss was significantly greater in the low-carbohydrate group; however,
after 1 year the difference between the groups was not statistically significant (Grade II) (1,12). The difference in
weight loss between the two groups in the first 6 months was attributed to overall greater energy deficit in
the low-carbohydrate group (Grade II) (1,12). The low-carbohydrate diet was associated with a greater
improvement in some risk factors for coronary heart disease. Adherence was poor and attrition was high in
both groups (12). Results of this study should be interpreted with caution, given the relatively small sample
size and short duration (12). Longer and larger studies are required to determine the long-term safety and
efficacy of low-carbohydrate, high-protein, high-fat diets (12). A low-glycemic index diet is not recommended
for weight loss or weight maintenance because it has not been shown to be effective in these areas (Grade I) (1).