European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians

Abstract

<b><i>Introduction:</i></b> Obesity affects nearly 1 in 4 European adults increasing their risk for mortality and physical and psychological morbidity. Obesity is a chronic relapsing disease characterized by abnormal or excessive adiposity with risks to health. Medical nutrition therapy based on the latest scientific evidence should be offered to all Europeans living with obesity as part of obesity treatment interventions. <b><i>Methods:</i></b> A systematic review was conducted to identify the latest evidence published in the November 2018–March 2021 period and to synthesize them in the European guidelines for medical nutrition therapy in adult obesity. <b><i>Results:</i></b> Medical nutrition therapy should be administered by trained dietitians as part of a multidisciplinary team and should aim to achieve positive health outcomes, not solely weight changes. A diverse range of nutrition interventions are shown to be effective in the treatment of obesity and its comorbidities, and dietitians should consider all options and deliver personalized interventions. Although caloric restriction-based interventions are effective in promoting weight reduction, long-term adherence to behavioural changes may be better supported via alternative interventions based on eating patterns, food quality, and mindfulness. The Mediterranean diet, vegetarian diets, the Dietary Approaches to Stop Hypertension, portfolio diet, Nordic, and low-carbohydrate diets have all been associated with improvement in metabolic health with or without changes in body weight. In the November 2018–March 2021 period, the latest evidence published focused around intermittent fasting and meal replacements as obesity treatment options. Although the role of meal replacements is further strengthened by the new evidence, for intermittent fasting no evidence of significant advantage over and above continuous energy restriction was found. Pulses, fruit and vegetables, nuts, whole grains, and dairy foods are also important elements in the medical nutrition therapy of adult obesity. <b><i>Discussion:</i></b> Any nutrition intervention should be based on a detailed nutritional assessment including an assessment of personal values, preferences, and social determinants of eating habits. Dietitians are expected to design interventions that are flexible and person centred. Approaches that avoid caloric restriction or detailed eating plans (non-dieting approaches) are also recommended for improvement of quality of life and body image perceptions.

Could METS-VF provide a clue as to the formation of kidney stones?

“…The results of our study suggested that this relationship had distinct impact levels when grouped by gender, ethnicity, hypertension, and diabetes, implying that it could be pertinent to a broad range of individuals. The possible reasons are as follows: METS-VF is an indicator of obesity ( 17 ), Obese people usually have higher fat and calorie intake and control high blood pressure and diabetes ( 18 , 19 ), Thus reducing the correlation of METS-VF with kidney stones compared to the disease.…”

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“…6 Busetto concluded their presentation with a discussion on the EASO 2023 position statement on medical nutrition therapy for overweight and obesity in adults, which was developed in collaboration with the European Federation of the Associations of Dietitians (EFAD). 7 An update to the adult obesity guidelines was needed, whereby, based on the latest evidence, partial meal replacements were now recommended to help with a reduction in body weight and blood pressure, and improved glycaemic control. Intermittent or continuous calorie restriction may be included in future updates, but the evidence is 'currently inconclusive.'…”

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