Obesity, the most effective diets for weight loss
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In 2025, one in four adults in Europe will be obese. The alarm comes from European medical associations which, on the basis of data collected in various studies, have identified the most suitable nutritional therapies for dealing with overweight and obesity. More than 50 clinical trials were scrutinized by researchers in an attempt to identify recent evidence on the different types of medical nutrition therapy available to European obesity specialists. A sort of hit parade has emerged of the diets considered most effective in countering what is now considered a real epidemic all over the world. In our country, according to the latest data from the 4th Italian Barometer Obesity Report, created in collaboration with Istat, there are more than 25 million people who are overweight. Of these, 6 million are obese, corresponding to 12% of the entire population. Even among children and adolescents the percentages are worrying: 26.3% of Italian minors between the ages of 3 and 17, or 2 million 200,000 people, have weight problems.
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The European Society for the Study of Obesity (EASO) and the European Federation of Dietitians (EFAD) have published a position paper to provide an update on possible options for medical nutrition therapy for obesity. A document intended for health professionals and political institutions, committed to finding effective solutions to combat obesity.
The position paper is based on a systematic review of 56 clinical studies and meta-analyses published between 2018 and 2021. In addition to identifying the most effective diets, this paper also brought out other important aspects. “The results of the analysis – he explains Renata Bracaleprofessor of Nutrition, specialist in Food Science at the University of Molise – demonstrate that, while options involving calorie restriction are effective in promoting weight loss in the short term, to achieve greater adherence to the diet with long-term behavioral changes, it is necessary to support the diet with interventions based on changes in eating habits, food quality and awareness (mindfulness) of the choices of what one brings to one’s table”.
The five most effective diets
The review confirms the effectiveness of five diets: the Mediterranean diet, vegetarian diets, the Dietary Approaches to Stop Hypertension (DASH) diet, the Nordic diet and low-carb diets which are associated with better health in terms of metabolism, regardless of changes in body weight. “It is necessary to focus not only on weight loss, but also on improving the patient’s health and well-being. From this point of view, I am convinced that the Mediterranean diet represents the best model since providing larger portions of fruit and vegetables per day is the most rich in vitamins, minerals and antioxidants, capable of fighting cellular ageing”. Therefore, it is the most effective diet in combating age-related pathologies and the comorbidities of obesity itself, such as dyslipidemia, arterial hypertension, insulin resistance and diabetes.
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These eating patterns (Dash, Nordic, and low-carb diets) include low salt, added sugars, alcohol, tropical oils, and processed foods high in non-starchy vegetables, fruits, whole grains, and legumes. “Protein tends to come primarily from plant sources such as legumes, beans or nuts, along with fish or seafood, lean poultry, and low-fat or fat-free meat and dairy products,” she said. Instead, vegetarian, or even vegan, low-fat diets also emphasize the consumption of vegetables, fruits, whole grains, legumes, and nuts, while limiting alcohol and foods and beverages with added sugars.
“However – Bracale points out – restrictions in the vegan eating pattern can make it more difficult to follow it in the long term or when eating out. Following a vegan eating pattern can increase the risk of vitamin B-12 deficiency, which can cause blood cell abnormalities leading to anemia; therefore, supplementation may be recommended by doctors.”
The Nordic diet with canola oil
While the Mediterranean one, the low carb ones and even the Dash are quite well known, the Nordic diet is less known probably because it is based on the traditional foods of the Nordic countries. “It’s a diet that includes potatoes and other root vegetables, berries, whole grains, cabbage, apples, pears, oats, rye, milk, and fermented milk,” Bracale explains. A difference compared to the Mediterranean diet, however, is the type of oil used: “If in our latitudes we prefer the use of extra virgin olive oil, the Nordic diet promotes canola oil or rapeseed oil. It is an oil which has less saturated fat than extra virgin olive oil and can be used in the kitchen and in the oven at higher temperatures. On the other hand, extra virgin olive oil boasts a greater quantity of antioxidants”, adds the nutritionist.
Does the ketogenic diet work?
The one elaborated by the European Society for the Study of Obesity (EASO) and the European Federation of Dietitians is the first scientific document that includes the ketogenic diet in the recommended treatment for obesity. “By analyzing studies lasting up to 6 months, with this type of diet that completely excludes carbohydrates and greatly limits the consumption of vegetables and therefore of fiber, minerals and vitamins – continues Bracale – improvements in body weight and blood sugar have been demonstrated , only in the first few months. However, after a year, most improvements are no different than the results of a less restrictive diet. Restrictions on fruits, whole grains, and legumes can result in reduced fiber intake. Additionally, these diets are rich in saturated fats, i.e. animal.The consumption of high levels of saturated fats and low levels of fibers are both linked to the development of cardiovascular diseases, as well as being diets that are no longer sustainable for the environment.The Mediterranean diet was instead the ecologically more sustainable”.
Ketogenic diet, very low calorie
Among the diets considered effective in combating obesity there is also the very low-calorie ketogenic diet (Vlckd), a highly hypocaloric and hypoglycidic food protocol which aims to induce ketosis. Compared to a traditional low-calorie diet it is beneficial on hunger, muscle maintenance, inflammation and weight loss. “After the first strictly ketogenic phase with a very low calorie content – explains Bracale – the calories are slightly increased (800 – 1500 kcal?day) and glucidic foods are gradually reintroduced starting from those with a lower glycemic index such as fruit and dairy products, then continuing with legumes and, finally, adding bread, pasta and cereals of various kinds”.
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Food education, awareness and empathy
This phase, however, must be adequately accompanied by a path of food education that allows the patient to reintroduce foods gradually and aware of the nutritional principles they contain. The patient must also be introduced to a progressive increase in physical activity. This second phase concludes when 100% of the target weight loss has been achieved and all foods have been incorporated into the diet.
The final objective, therefore, is to lead the patient towards a balanced Mediterranean-style diet with a caloric intake between 1500 – 2000 kcal which allows him to maintain the results in the long term. “Personally – concludes the expert – I believe that at the basis of the dietary approach there is the need to make patients aware of the change that sometimes comes simply through the understanding of the fact that the simplest choice is the best. We don’t need to extravagant diets, the real revolution is normality. The empathy we put into providing a diet model is much more important than the calories we remove. It is during the discussion with the specialist that we discover the most important aspirations for the patient : riding a bicycle, walking the dog or climbing stairs without getting tired, fitting into a certain size of clothes or wearing a swimsuit. These are fundamental details because the quality of life of people affected by obesity is greatly compromised” .
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