Lower Fat Intake as a Predictor of Initial and Sustained Weight Loss in Obese Subjects Consuming an Otherwise ad Libitum Diet

Objective To determine what predicts initial and sustained weight loss in subjects consuming a reduced-fat diet ad libitum and the relationship between achieved level of fat intake and weight loss.Design Placebo arm of a randomized, controlled trial of a weight-loss drug (dexfenfluramine) in the context of an ad libitum, reduced-fat, diet.Subjects Thirty-nine subjects (initial mean body mass index±standard deviation=34.9±3.4; body mass index is calculated as kg/m²) from the placebo group who completed the 9-month study.Intervention Dietary assessment and education (month 0) followed by monthly meetings during the single intervention of reducing fat intake (months 1 through 6); one follow-up at 9 months.Main outcome measures Initial weight loss (first 3 months) and sustained weight loss (over 9-month period).Statistics Dietary intake, body size, exercise levels, age, and gender were included in multiple regression linear models of initial and sustained weight loss if they were significant independent predictors.Results Greater initial weight loss was associated with a greater decrease in fat intake and a lower achieved fat intake at 3 months. Greater sustained weight loss was associated with a lower achieved fat intake, a higher baseline waist circumference, and higher moderate-intensity exercise levels (months 3 and 6). Weight loss occurred in all subjects who reported a fat intake of 40 g/day or less.Applications The obese persons most likely to achieve and sustain weight loss on an ad libitum, reduced-fat diet are those who can substantially reduce fat intake, those with high initial levels of abdominal fat, and those who undertake regular moderate-intensity exercise. A target of less than 40 g fat per day might be an appropriate goal to ensure weight loss, but dietary underreporting and the difficulty of sustaining very-low-fat intakes need to be considered. J Am Diet Assoc. 1998;98:35-39.     

Current state of dietetic services for inflammatory bowel disease patients in New Zealand: an observational study

Aim

Nutritional therapies for inflammatory bowel disease are increasingly recommended. This study aimed to gain insight from patients, dietitians and gastroenterologists into inflammatory bowel disease dietetic care in New Zealand.

Methods

Mixed-methods surveys were developed and then distributed online to patients with inflammatory bowel disease and dietitians and gastroenterologists that care for patients with inflammatory bowel disease. Quantitative survey data were analysed using nonparametric statistical tests. Qualitative survey data were analysed using thematic analysis.

Results

Responses were received from 406 inflammatory bowel disease patients, 79 dietitians and 40 gastroenterologists. Half of the patients (52%) had seen a dietitian for nutrition advice. Patients more likely to have seen a dietitian were/had: Crohn's disease (p = 0.001), previous bowel surgery (p < 0.001), younger (p < 0.001) or receiving biologic therapy (p = 0.005). Two-thirds (66%) of patients found the dietitian advice at least moderately useful. A common theme from patient comments was that dietitians needed better knowledge of inflammatory bowel disease. Almost all (97%) gastroenterologists reported that their inflammatory bowel disease patients ask about nutrition; 57% reported that there were inadequate dietitians to meet patient needs. Over 50% of dietitians saw inflammatory bowel disease patients infrequently and 39% were not confident that their knowledge of the nutritional management of inflammatory bowel disease was current. Dietitians desired greater links with the inflammatory bowel disease multidisciplinary team.

Conclusion

Current inflammatory bowel disease dietetic services in New Zealand are inadequate. Standardised care, increased resourcing, dietitian training in inflammatory bowel disease, and stronger links with the multidisciplinary team are suggested to improve services.