Are ketogenic diets, intermittent fasting, probiotics, and fecal microbiota transplants effective?

The more fat you are, the more health risks you will face. From a nutritional perspective, how can you lose weight scientifically and maintain a normal weight?

The recently released "Guidelines for Medical Nutritional Therapy of Overweight/Obesity in China (2021)" provides a detailed explanation of the problems involved.

1. Reduce calories

Based on the target calories, reduce 1/3 of the daily calories, or reduce the recommended calories by about 500~1000 kcal, which is 1200~1400 kcal/d for men and 1000~1200 kcal/d for women.

2. High protein: can increase weight loss compliance

It can increase satiety, reduce hunger, help enhance weight loss compliance in severely obese people, and maintain weight loss results.

It helps overweight/obese patients with type 2 diabetes lose weight and improve blood sugar control.

3. Low Carbohydrate: Long-term Safety and Effectiveness Unknown

In the short term, it is beneficial for controlling weight and improving metabolism, but its long-term safety and effectiveness need further study.

In overweight/obese patients with type 2 diabetes, a low carbohydrate diet may improve glycemic control in the short to medium term.

4. Ketogenic diet: short-term diet under the guidance of a clinical nutritionist

With full consideration of safety, after other weight loss dietary patterns have been tried and failed, short-term ketogenic diet management can be implemented under the guidance of a clinical nutritionist. In addition to monitoring blood ketones, changes in liver and kidney function and body composition should also be monitored, and blood lipid levels should be closely monitored.

5. Intermittent Caloric Restriction (IER): May Reduce Weight

It is a dietary intervention that involves fasting or limited energy intake within a specified period of time according to a certain rule.

Intermittent calorie restriction can reduce weight and improve lipid metabolism markers in overweight/obese individuals compared with a conventional diet.

In non-diabetic overweight/obese individuals, intermittent calorie restriction can improve their insulin resistance levels and increase insulin sensitivity, but the effect on blood sugar is still unclear.

6. Low glycemic index diet: can increase satiety

A low-glycemic index diet that limits total energy can reduce weight in obese people, and its short-term weight loss effect is better than a high-glycemic index diet.

Short-term use of a low glycemic index diet can increase satiety and improve insulin resistance.

7. DASH diet: for weight loss

Compared with a conventional diet, the DASH diet can effectively reduce the weight, BMI and body fat content of overweight/obese people; it can also help reduce the weight of patients with diabetes and metabolic syndrome and postpartum women.

8. Meal replacement foods: long-term safety needs to be studied

Meal replacement foods are energy-controlled foods that are specially processed and formulated to meet the nutritional needs of one or two meals for adults during weight control and to replace part of the meals.

Choose meal replacement foods that meet the standards and combine them with multivitamin and mineral supplements to ensure adequate nutrition during weight loss.

The short-term use of meal replacement foods for weight loss is safe, with few serious adverse reactions and good tolerance. However, long-term safety still needs further study.

Short-term use of meal replacement foods by diabetic patients can improve blood sugar by reducing weight.

Short-term use of meal replacement foods can effectively control the weight of patients with metabolic syndrome and cardiovascular disease and reduce their risk factors for cardiovascular events.

9. Biological rhythms and weight loss: research results are inconsistent

Time-restricted feeding (TRF) refers to a diet that limits daily eating time and fasts for 3 to 21 hours, either during the day or at night.

TRF may improve fasting blood sugar, but research results on its effects on insulin resistance and lipid metabolism are inconsistent.

10. Regarding calcium and iron supplementation: People at risk should pay attention

During medical nutrition weight loss, people at risk of deficiency should supplement with calcium and/or vitamin D; in addition, during this period, an individualized dietary plan should be adopted to prevent iron deficiency.

11. Probiotics: Specific strains of probiotics may aid weight loss

Obese adults can help lose weight by taking probiotics containing specific strains, thereby improving metabolic markers.

Lactobacillus reuteri can help patients with nonalcoholic fatty liver disease lose weight, reduce BMI and waist circumference.

A compound probiotic containing Lactobacillus, Bifidobacterium and Streptococcus thermophilus combined with a weight loss diet can improve BMI, insulin resistance and appetite-related hormone levels in patients with metabolic syndrome.

Children or obese adults can achieve better weight loss results by taking specific prebiotics or prebiotic-rich foods for a short period of time.

12. Fecal microbiota transplantation: some obese people may consider it

It is not recommended that obese people routinely lose weight through fecal microbiota transplantation. However, obese people with complications such as diabetes and metabolic syndrome may consider short-term fecal microbiota transplantation to improve bacterial colonization.

A diet rich in dietary fiber has a better weight loss effect for people with a high Prevotella/Bacteroides ratio.

13. Drug treatment: Orlistat, metformin, GLP-1A and SGLT2i are effective

On the basis of lifestyle interventions such as diet control, exercise regulation and behavioral intervention, the use of orlistat can further effectively reduce weight.

Metformin is the first-line treatment for type 2 diabetes and is suitable for overweight/obese type 2 diabetes patients to help them lose weight.

GLP-1A can significantly benefit overweight/obese T2DM patients in terms of weight loss. SGLT2i can effectively control blood sugar and reduce the weight of diabetic patients.

14. Bariatric Surgery:

Different surgical procedures should supplement the required nutrients in a targeted manner to reduce the risk of malnutrition-related complications.

Perioperative nutritional management should be based on a multidisciplinary comprehensive treatment collaboration model; applying the concept of accelerated recovery after surgery to perioperative comprehensive nutritional management can bring more benefits to patients.

Implementing a restricted energy, high-protein diet for 3 to 6 months is more helpful in maintaining weight.

15. Obesity-related gene testing: some patients may consider

Obese people who find it difficult to lose weight with traditional treatment methods may consider obesity-related gene testing and corresponding dietary intervention.

16. Exercise to lose weight: aerobic exercise combined with resistance training

It is recommended to combine aerobic exercise with resistance training as a way of exercise for weight loss.

Compared with moderate-intensity continuous exercise, high-intensity interval exercise can be used as an effective exercise method for losing weight, reducing fat and improving cardiopulmonary function, and it has the advantage of time effectiveness.

For individuals with poor exercise compliance, they can use fragmented time to accumulate multiple short exercises. With the same amount of exercise, the weight loss effect may be even better than a single continuous long exercise.

17. Psychotherapy:

Obese people with mental disorders, especially symptoms such as anxiety, depression and binge eating, should combine psychological treatment with medical weight loss.

Cognitive therapy can help treat obesity caused by bulimia, and can also be integrated with other psychotherapy methods, such as interpersonal therapy and mindfulness therapy.

Source: China Circulation Magazine