American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines For Medical Care of Patients with Obesity

Controversial alternative diets in the light of current dietary recommendations for overweight and obesity treatment

“…In the obesity management guidelines by the American Association Of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE), an elementary principle of obesity prevention was defined in accordance with the theses articulated in The Ottawa Charter for Health Promotion. The creation of pro-health policy is of the utmost importance, favouring a health promoting lifestyle, with consideration of healthy eating patterns in combination with actions aimed at better access to treatment which, as has been emphasized should include the engagement and participation of patients [9]. In the light of guidelines by the Polish Association of Dietitians, an important precondition of the effectiveness of therapy is individualization of dietary management, considering the patient's needs and eating habits, based on the competences and professional experience of the dietician [8].…”

“…However, with the reservation that the BMI index does not consider inter-individual differences related with gender, age, muscle mass, hydration status, oedemas, large tumours, and sarcopenia [9], therefore, the assessment of the state of nutrition should be expanded by analysis of the body composition, including, among others, an evaluation of adipose tissue content, fat-free body mass, muscle mass, and content of water in the body, performed with the use of the BIA method (Bioelectrical Impedance Analysis) [8][9][10]. The Polish Association of Dietitians also recommends the performance of biochemical diagnostics with consideration of, among others, lipid profile, parameters of carbohydrate homeostasis (taking into consideration fasting glycaemia, casual glycaemia, HBA1c, and insulin), as well as hepatic aminotransferases, uric acid, creatinine, measurement of arterial blood pressure or, potentially, other parameters in accordance with the physician's decision [8,10].…”

“…It is recommended to strive towards obtaining a long-term preservation of body weight reduced by 5-10% in reference to the current body weight, at the same time drawing attention to the fact that in the case of patients with high risk of CVD, even the slightest reduction of body weight by 3-5% results in metabolic benefits [8,10]. The optimum pace of body weight loss should be from 0.5-1 kg/week during the first 3-6 months of therapy, according to the individual response of the patient to the dietary therapy applied [8][9][10]. In accordance with the recommendations by the Polish Association of Dietitians, the starting point in establishing an individual demand for energy in obese persons should be the measurement of Resting Metabolic Rate by the method of indirect calorimetry, whereas in the situation of lack of such possibility, the equation by Mifflin et al may be used [8].…”

“…In accordance with the recommendations by the Polish Association of Dietitians, the starting point in establishing an individual demand for energy in obese persons should be the measurement of Resting Metabolic Rate by the method of indirect calorimetry, whereas in the situation of lack of such possibility, the equation by Mifflin et al may be used [8]. The daily calorie deficit should be from 500 to 800 kcal, according to age, current state of health, level of motivation, physical activity, eating habits and preferences of the patient [8][9][10]. In practice, caloric value of weight loss diet with a moderate energy deficit for women should be approximately 1,200-1,300 kcal/daily, and for men approximately 1,400-1,500 kcal/daily [8].…”

“…According to the guidelines of American and European societies (including Polish) dealing with the scope of problems concerning nutrition in obesity [8][9][10][11], an obesity management pattern in all adult patients should start with the performance of basic anthropometric measurements, including the BMI and waist circumference. However, with the reservation that the BMI index does not consider inter-individual differences related with gender, age, muscle mass, hydration status, oedemas, large tumours, and sarcopenia [9], therefore, the assessment of the state of nutrition should be expanded by analysis of the body composition, including, among others, an evaluation of adipose tissue content, fat-free body mass, muscle mass, and content of water in the body, performed with the use of the BIA method (Bioelectrical Impedance Analysis) [8][9][10].…”