1. Introduction
Addressing the global rise in overweight and obesity is crucial for mitigating associated health risks and improving public health outcomes [1]. Obesity, a complex condition influenced by various factors, is increasingly prevalent, necessitating effective and sustainable intervention strategies [2]. While multifaceted approaches are often required, the cornerstone of obesity treatment remains dietary management, frequently combined with increased physical activity and behavioral modifications. For specific patient groups, medical interventions such as weight loss medication and bariatric surgery may also be recommended within a comprehensive Arch Health Care Weight Loss Program [4,5].
Dietary recommendations for weight loss are diverse and often debated within the scientific community, reflecting the complexities of nutritional management and the need for personalized approaches [5,6]. Despite a plethora of weight loss diets available, identifying a universally superior strategy remains challenging, as individual responses and long-term sustainability vary significantly [7]. Therefore, an effective arch health care weight loss program should consider individual needs and preferences, offering a range of evidence-based dietary options.
The optimal balance of macronutrients – fat, carbohydrates, and protein – in a weight loss diet has been a subject of extensive research [8]. While some argue for the primacy of calorie reduction regardless of macronutrient composition [9], others emphasize the importance of specific macronutrient ratios or overall diet quality focusing on whole, unprocessed foods [10,11,12,13]. A holistic arch health care weight loss program recognizes the validity of these perspectives and integrates them into a balanced and personalized dietary plan.
This review aims to outline general principles and practical recommendations for dietary obesity management, exploring key components of an optimal dietary intervention within an arch health care weight loss program. We will critically discuss various dietary approaches, including low-fat, low-carbohydrate, high-protein, very low-calorie diets with meal replacements, the Mediterranean diet, and intermittent energy restriction, to define elements of a safe, effective, and sustainable weight loss strategy for adults seeking to manage overweight and obesity.
2. Core Principles of an Arch Health Care Weight Loss Program
A fundamental principle for any successful arch health care weight loss program is achieving a consistent negative energy balance [14]. Weight loss occurs when energy intake is less than energy expenditure [14]. Initially, macronutrient composition was considered a critical factor in weight loss, with theories suggesting that specific ratios could enhance satiety, promote fat burning, and preserve lean mass [15]. However, while short-term studies have explored macronutrient-focused diets [16,17,18], longer-term research indicates that manipulating macronutrient ratios may not be as crucial for sustained weight management as previously thought [19,20,21]. An effective arch health care weight loss program prioritizes overall dietary patterns and sustainable lifestyle changes over rigid macronutrient restrictions.
Setting realistic weight loss goals is paramount in an arch health care weight loss program. Unrealistic expectations can lead to discouragement and program abandonment [22]. Aiming for a 5–10% reduction in initial body weight within the first six months is a clinically meaningful and achievable goal that significantly improves cardiometabolic risk factors [5,6]. Long-term adherence is a major challenge in weight management, and an arch health care weight loss program should emphasize strategies to promote sustained engagement and prevent weight regain [23].
Weight loss maintenance is often more challenging than initial weight loss itself. The body adapts physiologically to weight reduction, increasing appetite-stimulating hormones (ghrelin) and decreasing satiety hormones (leptin, peptide YY, cholecystokinin), while also reducing resting energy expenditure and diet-induced thermogenesis [24,25,26,27]. These adaptations can persist for up to a year, contributing to weight regain [30]. Consequently, long-term weight loss success rates remain low [31,32,33]. An arch health care weight loss program must incorporate robust strategies for weight maintenance, including continuous support, education, and personalized plans.
An ideal weight maintenance diet, as part of an arch health care weight loss program, should be sustainable, easy to adhere to, and low in energy density [34,35]. Predictors of successful long-term weight maintenance include regular self-monitoring of weight, medical supervision for support and feedback, consistent eating patterns, breakfast consumption, lower fat intake, reduced consumption of unhealthy snacks, and regular physical activity [36,37,38,39,40,41,42]. Emerging research also suggests that meal consumption speed may influence satiety hormones and weight management [43,44], warranting further investigation within arch health care weight loss program strategies.
3. Conventional Hypocaloric Diets in Weight Loss Programs
Conventional hypocaloric diets, often a starting point in an arch health care weight loss program, typically aim to reduce daily energy intake by 500–750 kcal, resulting in diets of 1200–1500 kcal/d for women and 1500–1800 kcal/d for men [45]. These diets are generally low-fat, with a macronutrient composition of approximately 30% fat, 50% carbohydrate, and 20% protein [45]. Emphasis is placed on reducing saturated fat intake and increasing fiber-rich foods like fruits and vegetables, which promote satiety and provide essential micronutrients [45]. A 500–600 kcal daily reduction can lead to about 0.5 kg weekly weight loss, although this rate typically slows over time due to physiological adaptations [24].
Individualization is crucial for conventional diets within an arch health care weight loss program, considering individual preferences and weight loss progress for long-term adherence [45]. While modestly effective for short-term weight loss [46], individual responses vary, and long-term adherence remains a challenge [47]. Therefore, an arch health care weight loss program may utilize conventional hypocaloric diets as a foundation but incorporate other strategies for enhanced and sustained outcomes.
4. Low-Fat Diets: A Component of Health Care Weight Loss Programs?
Low-fat diets have been a cornerstone of weight loss recommendations for decades, often integrated within broader health care weight loss programs. The rationale is based on several observations: fat is less satiating than carbohydrate, promoting passive overconsumption [48,49,50]; fat is efficiently absorbed, minimizing fecal energy loss; carbohydrate is more thermogenic than fat [51,52]; and high-fat diets may negatively impact the gut microbiome and metabolic health [53]. Furthermore, fat contains more than double the calories per gram compared to carbohydrates or protein (9 kcal/gram vs. 4 kcal/gram), making fat reduction a seemingly direct route to calorie reduction.
However, clinical trials have not consistently demonstrated the superiority of low-fat diets for long-term weight loss compared to other dietary approaches. Meta-analyses suggest low-fat diets are as effective as other diets in terms of weight loss, with no significant differences in qualitative aspects or compliance [54]. Studies have shown similar weight loss outcomes between low-fat and higher-fat diets when both emphasize high-quality food choices, such as low saturated fat, low glycemic index foods, and high fiber intake [8]. When compared to usual diets, low-fat diets are more effective for weight reduction, but against other intensive dietary interventions, particularly when adherence is high, low-fat diets may be equally or less effective for long-term weight control [55]. Therefore, while low-fat approaches can be part of a health care weight loss program, they are not necessarily the most effective strategy for all individuals.
5. Low-Carbohydrate Diets in Modern Weight Management
Low-carbohydrate diets, evolving from the ketogenic Atkins diet [56], represent another dietary strategy considered in arch health care weight loss programs. Modern low-carbohydrate diets are less restrictive than the original Atkins diet but still involve significant carbohydrate reduction with increased fiber intake [45]. Long-term adherence can be challenging and potentially risky due to potential increases in LDL cholesterol and mortality risk associated with high fat intake and severe carbohydrate restriction [58].
Meta-analyses indicate that very low-carbohydrate ketogenic diets can be more effective than other diets for short-term weight loss and metabolic improvements in diabetic patients [10]. However, evidence on low-carbohydrate diets is mixed. Some meta-analyses suggest better weight loss outcomes compared to low-fat diets, but with potential LDL cholesterol risks [59]. Others show comparable short-term weight loss to isoenergetic balanced [60] or low-fat diets [61]. Some research suggests low-carbohydrate diets without calorie restriction can be as effective as energy-restricted low-fat diets, with potential benefits for triglycerides and HDL cholesterol [62]. However, long-term safety and efficacy data are limited, making long-term recommendations challenging.
The Eurodiet program, a low-carbohydrate approach applied in Greece, involves a phased carbohydrate reduction and reintroduction, culminating in a Mediterranean-style balanced diet with moderate carbohydrate restriction [63]. Combined with psychological monitoring and behavior modification, this program demonstrates enhanced effectiveness [63]. This structured approach highlights the potential of incorporating elements of low-carbohydrate diets within a comprehensive arch health care weight loss program, particularly when personalized and monitored.
6. High-Protein Diets: Enhancing Satiety in Weight Loss Programs
High-protein diets, where protein constitutes 20–30% of daily energy intake [64], are considered in arch health care weight loss programs for their potential to enhance weight loss. These diets are suggested to be more effective than lower-protein diets (15–20%) due to increased satiety, lean mass preservation, and diet-induced thermogenesis [65,66]. Clinical studies have shown that ad libitum high-protein diets can lead to greater weight loss by increasing satiety compared to high-carbohydrate diets [67]. Energy-restricted, high-protein diets may also provide equal or greater weight loss and metabolic benefits compared to high-carbohydrate diets in obese women [68].
Furthermore, higher protein intake during weight loss may improve body composition, lipid profiles, and glucose homeostasis, potentially mediated by satiety and lower glycemic load [69,70]. High protein intake may also mitigate lean mass loss during weight loss, improving insulin sensitivity [71,72], though this effect may not be observed at very low energy intakes [73]. Studies in overweight individuals with insulin resistance or type 2 diabetes have shown that high-protein weight loss diets enhance fat loss compared to isocaloric high-carbohydrate diets [74,75]. Overall, higher-protein diets may facilitate short-term weight loss compared to lower-protein diets, but long-term data remain limited and inconsistent [66].
The optimal protein amount and sources are still debated. Animal-derived proteins have been linked to obesity and weight gain in some studies, while plant-based proteins may be protective [19,20]. High-protein diets can also vary in saturated fat content and nutritional composition, raising concerns about serum lipids and cardiovascular risk [76]. Additionally, high-protein diets, especially animal-based, may increase the risk of nephrolithiasis, diabetes, atherosclerosis, and kidney damage in susceptible individuals [77]. A balanced approach within an arch health care weight loss program would be to replace refined carbohydrates with lean protein sources, prioritizing plant-based options where appropriate. Formula diets, discussed next, are a specific type of high-protein diet used in weight management.
7. Formula Diets: Very-Low-Calorie Diets in Specialized Programs
Formula diets, also known as very-low-calorie diets (VLCDs, 78], are evidence-based interventions used in arch health care weight loss programs for significant energy deficit and rapid weight loss. Following initial rapid weight loss, strategies for maintenance and weight regain prevention, such as high-protein diets, anti-obesity medications, meal replacements, and increased physical activity, are crucial [79]. With these strategies, weight loss maintenance after VLCDs is achievable [79]. After desired weight loss, food is gradually reintroduced within a healthy, balanced dietary plan. Physiologically, VLCDs reduce carbohydrate intake, increase blood ketones, and potentially reduce hyperinsulinemia, suppressing hunger and improving compliance [80]. The rapid initial weight loss can also motivate patients and enhance adherence [78,81].
Formula diets in an arch health care weight loss program are intended for short-term use (maximum 12 weeks) under strict medical supervision and with comprehensive education and psychological support. When appropriately applied, VLCDs can deliver significant weight loss and health benefits, improving metabolic profiles and symptoms in conditions like diabetes [82], osteoarthritis [83], obstructive sleep apnea [84], psoriasis [85], and in pre-operative preparation for bariatric surgery by reducing liver size [86].
8. Mediterranean Diet: A Health-Promoting Approach to Weight Management
The Mediterranean diet, often recommended within an arch health care weight loss program, was compared to low-carbohydrate and low-fat diets in the DIRECT study involving 322 obese subjects [87]. After two years, weight loss was 2.9 kg for low-fat, 4.4 kg for Mediterranean, and 4.7 kg for low-carbohydrate diets. Vegetable intake and reduced sweets/cakes predicted successful weight loss at six months [87]. At six years, weight loss was 0.6 kg for low-fat, 3.1 kg for Mediterranean, and 1.7 kg for low-carbohydrate groups. Mediterranean and low-carbohydrate diets were superior to low-fat for long-term weight maintenance [88].
Adherence to the Mediterranean diet is also associated with reduced mortality and increased longevity [89]. Studies suggest that diets supplemented with Mediterranean foods like extra-virgin olive oil and nuts may reduce cardiovascular events [90] and improve glucose and lipid levels in high-risk populations (PREDIMED study) [91]. While epidemiological evidence for the Mediterranean diet’s health benefits is strong, its long-term weight control efficacy requires further investigation in diverse populations and cultures. The specific components responsible for its benefits, whether individual or synergistic, also need further research. However, the Mediterranean diet is a valuable and health-promoting option within an arch health care weight loss program.
9. Intermittent Diets: Exploring Flexible Energy Restriction Strategies
Intermittent energy restriction (IER), involving cyclical periods of reduced and unrestricted food intake [92,93], is an emerging area in arch health care weight loss programs. Common IER regimens include energy restriction on two consecutive days per week, alternate-day energy restriction (60–70%), and alternate-day complete fasting (intermittent fasting, IF) [92]. Reviews indicate a lack of high-quality evidence supporting the superiority or equivalence of intermittent diets to continuous energy restriction for long-term safety and efficacy [94].
Limited randomized studies comparing intermittent and continuous hypocaloric diets show similar weight loss efficacy for up to 6 months [95,96,97]. No studies suggest intermittent diets prevent weight gain in normal-weight individuals. Data on IER’s impact on ectopic fat, adipocyte function, lean mass, insulin resistance, and metabolic flexibility are limited and inconsistent [98]. Some animal and human studies raise safety concerns about detrimental effects on metabolic homeostasis [96,99]. IER, particularly reduced energy restriction days rather than complete fasting, may be preferable due to better compliance, lower stress response, and milder metabolic fluctuations [92].
The optimal IER pattern, severity, and macronutrient composition remain unclear. Given knowledge gaps and unanswered questions, the increasing popularity of intermittent diets highlights the need for rigorous long-term randomized studies across patient subgroups. Individualized assessment is crucial to determine if intermittent diets are suitable for specific individuals within an arch health care weight loss program, considering their context and health conditions.
10. Diet Quality vs. Quantity in Arch Health Care Weight Loss
The principle of negative energy balance for weight loss is well-established. However, the relative importance of calorie counting versus diet quality for long-term weight loss is debated. The DIETFITS trial addressed this question, randomizing 609 overweight/obese adults to healthy low-fat or low-carbohydrate diets, emphasizing minimally processed, whole foods without calorie limits [13]. Both diets resulted in significant weight loss (5.3 kg low-fat, 6 kg low-carbohydrate) and similar improvements in waist circumference, body fat, glucose, and blood pressure, independent of genotype or carbohydrate tolerance [13].
The study concluded that diet quality, defined by low added sugars and processed foods and high intake of fruits, vegetables, and whole grains, is fundamental for weight loss, irrespective of energy intake. Predicting diet effectiveness based on genetics or insulin response was not possible with assessed candidate genes [13]. While highlighting diet quality’s importance, several points are relevant. Long-term sustainability was not assessed. Both groups consumed fewer calories despite no calorie counting instructions (approximately 500–600 kcal deficit). The modest 6 kg weight loss required intensive, time-consuming educational sessions by healthcare professionals focusing on behavior modification. This underscores the importance of comprehensive support within an arch health care weight loss program.
11. Conclusions and Recommendations for Arch Health Care Weight Loss Programs
The ideal diet for obesity treatment within an arch health care weight loss program is safe, effective, healthy, nutritionally adequate, culturally acceptable, economically affordable, and promotes long-term compliance and weight maintenance. While various dietary plans show promise for weight loss, the optimal diet remains debated, and individualization is crucial.
Conventional hypocaloric diets are safe, healthy, and modestly effective. Evidence does not support the superiority of low-fat diets over other intensive higher-fat interventions for long-term weight loss. Low-carbohydrate diets are effective short-term but raise long-term adherence and potential health risk concerns. High-protein diets may enhance satiety and preserve muscle mass but can be challenging long-term and potentially hazardous for specific subgroups. Formula diets are most effective for rapid weight loss but are for short-term use in select patients. The Mediterranean diet is as effective as low-carbohydrate diets for weight loss and offers broader health benefits. Intermittent diets are promising, but long-term data and optimal protocols are needed.
Ultimately, energy intake plays a role, but shifting to a healthy dietary pattern, aligned with individual preferences and lifestyles, is most effective for long-term weight loss and cardiometabolic health. This pattern should limit added sugars, refined grains, and processed foods, emphasizing fruits, vegetables, whole grains, and low-fat dairy, potentially without strict calorie counting. Combining this dietary pattern with education, motivation, and behavior modification within an arch health care weight loss program facilitates steady weight loss and broader health improvements.
Setting realistic weight loss goals and focusing on weight maintenance are crucial. Sustainable diets and lifestyle changes are key. Consuming high-quality fats and carbohydrates in a balanced diet not only promotes weight loss but also prevents chronic diseases. A healthy diet, rich in fruits, vegetables, whole grains, and quality proteins, and low in processed foods, enables better weight control without strict calorie counting. Physical activity is essential for weight management. The most effective diet is one that individuals can adhere to long-term, and an arch health care weight loss program should prioritize personalized, sustainable strategies.
Author Contributions
C.K. reviewed literature and wrote the manuscript; T.S., M.S., M.-E.B. and D.M. reviewed literature; N.K. edited the manuscript, provided critical input, and coordinated the other authors.
Funding
This research received no external funding.
Conflicts of Interest
The authors declare that they have no conflict of interest.
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