Abstract
Dietary modification is critical in obesity treatment. Energy intake must fall below energy expenditure, but not so low that excess lean tissue is lost, hunger escalates, diet quality declines, and health is compromised. Reductions in energy consumption of 500 to 1000 kilocalories per day should result in appropriate rates of weight loss in most obese patients. Very low-calorie diets are sometimes used when excess body weight poses an acute risk, but such diets carry potential for many complications, and their long-term results are often no better than low-calorie diets. Macronutrient composition is not as important as overall energy defi cit in terms of weight loss, so dieters have some flexibility in choosing combinations that suit their preferences and needs, as long as they promote long-term healthy weight management. Diets with extremes of macronutrients are usually defi cient in micronutrients and are diffi cult to follow for long periods of time, so they should not be advocated. Resources for implementing dietary recommendations include registered dietitians, selected Web sites, and an assortment of products and services. Patients should be guided to resources that are evidence based and do not make unrealistic promises for weight loss. Prevention of recidivism should be built into the treatment plan.