Calorie-Controlled Diet for Weight Management
Manual of Clinical Nutrition Management C- 38 Copyright © 2 013 Compass Group, Inc.
How to Order the Diet
The physician may specify any of the following:
“Weight Reduction Diet”: The dietitian determines an appropriate weight loss goal and energy level.
“____ kcal Diet”: The dietitian plans an individualized meal plan within the energy prescription.
Restriction of sodium, fat, cholesterol or another dietary component: If a restriction is required, it should
be prescribed along with the diet order.
Initiation of a weight reduction diet is not usually recommended in a hospital setting. Weight loss and
weight maintenance therapy should be based on a comprehensive weight management program including
diet, physical activity, and behavior therapy (Grade I) (1). Medical nutrition therapy for weight loss should last at
least 6 months or until weight loss goals are achieved, with implementation of a weight maintenance program
after that time (Grade I) (1). A greater frequency of contacts between the patient and practitioner may lead to
more successful weight loss and weight loss maintenance (Grade I) (1).
Moderate energy restriction for weight loss is recommended (2,3). Individualized meal plans of 1,200 to
1,500 kcal/day for women and 1,400 to 2,000 kcal/day for men can promote retention of lean body mass
while facilitating weight reduction when combined with physical activity and behavioral modification (2,3).
Reducing dietary fat and/or carbohydrate is a practical way to create an energy deficit of 500 to 1,000 kcal
below estimated energy needs and should result in a weight loss goal of 1 to 2 lbs/week (Grade I) (1). Portion
control should be included as part of a comprehensive weight management program. Portion control at
meals and snacks results in reduced energy intake and weight loss (Grade II) (1). In addition, total energy intake
distributed throughout the day, achieved by the consumption of four or five meals/snacks per day (including
breakfast), may be preferable and result in greater weight loss than eating in the evening (Grade II) (1). For
people who have difficulty with self selection or portion control, meal replacements (eg, liquid meals, meal
bars, energy-controlled packaged meals) may be used as part of a comprehensive weight management
program (Grade I) (1). Substituting one or two daily meals or snacks with meal replacements is a successful
weight loss and weight maintenance strategy (Grade I) (1). When setting goals with patients, the dietitian should
establish a realistic and practical target, such as a 5% to 10% decrease in the baseline weight or a decrease of
2 BMI units (Grade I) (1-3).
Successful weight reduction requires a commitment to behavioral change, family support, and attention to
physical activity patterns (Grade I) (1-3). Behavioral therapy should use multiple strategies including self-
monitoring, stress management, stimulus control, problem solving, contingency management, cognitive
restructuring, and social support (Grade I) (1). Moderate physical activity promotes the maintenance of lean
body mass, contributes to the energy deficit needed for weight loss, and may help with the maintenance of
weight loss (Grade I) (1). Physical activity should be assessed with individualized long-term goals established to
accumulate at least 30 minutes of moderate-intensity physical activity on most, and preferably all, days of the
week, unless medically contraindicated (Grade I) (1).
Weight loss medications approved by the Food and Drug Administration may be part of a comprehensive
weight management program (1). Clinicians should collaborate with other members of the health care team
regarding the use of these weight loss medications for people who meet the criteria. A BMI of 30 kg/m^2 or
greater with no comorbid conditions or a BMI exceeding 27 kg/m^2 with comorbid conditions should be one
criterion for the use of medications to treat obesity (3). Other criteria include: failure to manage weight with
more conservative behavioral methods; number and severity of associated comorbidities; absence of
contraindications, such as depression or ischemic heart disease; and the need for short-term weight loss to
reduce operative risk (2). Depending on the type of medication, a loss of 10% to 15% of the baseline weight
has been observed with the adjunct of lifestyle modification (low-energy diet and increased physical activity)
(Grade I) (1,13). Weight regain occurs after drug withdrawal; thus, long-term use is required to maintain the
weight loss (13). Data on the use of weight loss medication for longer than 2 years are limited, and the efficacy
and safety of long-term treatment with pharmacologic agents remains unclear (1,13). Pharmacologic agents
are a useful adjunct to, but not a substitute for, necessary changes in diet and physical activity. The
effectiveness of pharmacologic intervention depends on its use with appropriate dietary nutrition
intervention, increased physical activity, and lifestyle change (1,2). Refer to Section IB: Nutrition Management
of Bariatric Surgery and Section III: Obesity and Weight Management for more information.