DOI: 10.1089/obe.2008.0118 ©Mary Ann Liebert, Inc. February 2008 Obesity Management 25

I have overweight patients who have begun an exercise regime. What should I tell them about their dietary choices, specifically what they need to eat?

Some researchers have described our environment as “obeseogenic,” referring to the fact that it promotes positive energy balance and compromises weight-loss

or weight-maintenance efforts. The two main components that were thought to lead to this problem were sedentary life-style and high-fat diets, and a number of very large clinical trials agree with this observation.

There are definite benefits of weight loss even at a small range of 5 to 10% body weight if maintained over the long term. The goal in exercise, as in diet, is for small changes that are maintained such that they become a per-manent lifestyle.

There is still abundant evidence suggesting that a low-fat diet is the optimal choice for preventing weight gain and obesity. But eliminating one’s favorite foods is not

really accepted by most individuals. So, dietary advice needs to focus on small changes to the habitual diet to ensure the probability of success. Small frequent meals high in carbohydrate may keep hunger at bay. This type of eating pattern actually works well with an active life-style. Advice for foods that would fit into the exercising individual’s needs would focus on low-fat snacks, includ-ing fruit, low-fat yogurt, bagels, and cereal bars, and other types of higher-complex carbohydrate, fairly lower-calo-rie foods that support energy needs.

For the active, exercising individual, there does not

appear to be one specific dietary recommendation. A high-protein diet has been shown to be as effective as a low-fat, high-carbohydrate diet in supporting activity needs and improving body composition. The dietary regi-men that leads to achieving and maintaining an acceptable weight can efficiently support additional caloric require-ments for increased levels of physical activity. Your patients should eat a variety of foods, emphasizing pasta, rice, bread, and other whole-grain foods as well as fruits and vegetables. These foods are filling but lower in calo-ries than foods rich in fats or oils.

Generally, the dietary advice to give to the exercising overweight patient would be the same as the overall rec-ommendations they would receive about food choices as follows:

To Decrease Calorie Intake:

• Eat a variety of foods that are low in calories and high in nutrients; check the Nutrition Facts Label.

• Eat less fat and fewer high-fat foods. • Eat smaller portions and limit second helpings of

foods high in fat and calories. • Eat more vegetables and fruits without fats and sugars

added in preparation or at the table. • Eat pasta, rice, breads, and cereals without fats and

sugars added in preparation or at the table. • Eat fewer sugars and sweets (such as candy, cookies,

cakes, and soda). • Drink less or no alcohol.

What exercise guidelines should I recommend for my over-weight patients?

The latest recommendation for activity to maintain a healthy body weight is 60 minutes of moderate-intensity activity, such as brisk walking, on most days of the week. This is twice the previous recommendation and the differ-ence between the two is that although 30 minutes a day is associated with many cardiovascular and metabolic health benefits, the higher recommendation is needed for the prevention of obesity.

Clinical Q & ADietary Advice for the Exercising Overweight Patient

The goal in exercise, as in diet, is for small

changes that become a permanent lifestyle.

Ask OM

26 Obesity Management February 2008

From a more practical standpoint, in 2007, the Ameri-can College of Sports Medicine and the American Heart Association updated their physical activity guidelines for healthy and older adults. These recommendations are available at <www.acsm.org>. For healthy adults under age 65, these basic recommendations include: 1) doing moderately intense cardio 30 minutes a day for 5 days a week or doing vigorously intense cardio 20 minutes a day for 3 days a week, and 2) doing 8 to 10 strength-training exercises, with 8 to 12 repetitions of each exercise twice a week. For those older than age 65, the cardio recom-mendation is the same and the number of strength-train-ing exercises is the same, but the number of repetitions is increased to 10 to 15 and the frequency from 2 to 3 times a week.

Older adults are advised to perform balance exercises if they are at risk of falling and to have a physical activ-ity plan in place (preferably developed with the help of a health professional) to maximize the benefits of physical activity while ensuring safety.

How can I guide my patient toward a healthy calorie deficit—food energy in versus activity energy out?

For those who are mathematically inclined, one option for maintaining an appropriate weight would be to figure out the caloric expenditure associated with an activity and plan an increase in calories around that number. (See the examples provided at: <www.nutristrategy.com/activ-itylist3.htm>.) One of these examples is brisk walking, which is probably appropriate for most people. For the following weights, this activity burns the approximate number of calories shown:

Activity: Walking, 4 mph at a very brisk paceWeight 130 lb 155 lb 190 lbkilocalories burned per hour 236 281 345

Here’s an example: A 190-pound person is given a calorie-restricted diet of 1500 kcal per day to promote an ideal weight loss of 1 pound per week. The person wants to adhere to that weight loss, as well as to add 30 minutes of exercise five times a week for the cardiovascular ben-efits. Using the information provided above, the person could assume the following:

30 minutes ✕ 5 times a week = 2.5 hours of brisk walking2.5 hours ✕ 345 kcal = 862.5 kcal that can be added

to the weekly diet, can be used to accelerate weight loss, or can be used as a combination of accelerated weight

loss with greater weekly calorie allowance.

If a patient prefers to use this additional calorie bank to allow more food in the diet, sources might include a meal replacement bar at the time of exercise, extra snacks spread out during the week, or an extra calorie-controlled meal option, such as frozen entrées produced by Lean Cuisine,™ Healthy Choice,™ etc. It can be an emotional boost for compliant people to have greater flexibility with their meal plan. Health professionals can play a vital role working together to encourage an integrated strategy, including diet and exercise, for the management of over-weight and obesity. ■

—Catherine M. Champagne, Ph.D., R.D., LDN, FADAProfessor of Research

Pennington Biomedical Research CenterBaton Rouge, LA

Suggested Reading1. Astrup A, Buemann B, Flint A, Raben A. Low fat diets and energy balance: How does the evidence stand in 2002? Proceedings of the Nutrition Society. 2002;61:299-309.

2. Booth DA, Blair AJ, Lewis VJ, Back SH. Patterns of eating and movement that best maintain reduction in overweight. Appetite. 2004;43:277-283.

3. Cook CM, Haub MD. Low-carbohydrate diets and performance. Current Sports Medicine Reports. 2007;6:225-229.

4. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health. Updated recommendation for adults from the American Col-lege of Sports Medicine and the American Heart Association. Circula-tion. 2007;116:1081-1093.

5. Haskell WL, Lee, IM, Pate RR, et al. Physical activity and public health. Updated recommendation for adults from the American Col-lege of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1423-1434.

6. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1094-1105.

7. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1435-1445.

8. Stanton RA. Nutrition problems in an obeseogenic environment. Medical Journal of Australia. 2006;184:76-79.

9. World Health Organization. Report of a Joint FAO/WHO Expert Consultation on Diet Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series, 916, 2003.