Successful weight loss and maintenance in everyday clinical practice with an individually tailored change of eating habits on the basis of food energy density.

BACKGROUND: Weight change was analyzed in a cohort of obese patients whose eating habits were changed individually mainly on the basis of food energy density (ED) to evaluate the feasibility of this concept for a larger controlled trial.
METHOD: Five hundred and thirteen outpatients were treated between January 2003 and December 2006. Dietary counseling was based on a pretreatment food diary. In January 2008, a follow-up (FU) was made. For pre- and post-change eating habits, 5184 dietary protocols of 189 patients were analyzed.
RESULTS: During 10.5 months of treatment, patients lost weight from an initial BMI of 38.8 ± 8.5 by -0.195 kg/m(2) per month; 36% had weight loss >5%, 44% lost 0-4.9% and 20% had weight gain. At follow-up, 413 patients (80.5%) were reached of whom 80 were still in treatment while 333 were considered as self-treatment (ST) group. The ST group had further weight loss by -0.053 kg/m(2) per month over 16.8 months (40% weight loss, 46% maintenance and 14% weight gain), and 164 patients with type-2-diabetes had greater weight loss compared to those without diabetes during ST (Δ-BMI-0.166 vs. -0.028 points/month; p < 0.0001). Energy intake (EI) was reduced by lower ED, beverages and number of meals. Average carbohydrate, fat and protein intake was reduced by 28, 42, and 7%, respectively.
CONCLUSION: In a unselected cohort of substantially obese patients, the individual change of eating habits based primarily on food ED in conjunction with beverage intake and meal frequency weight loss continued beyond the supported treatment phase indicating a good patient adherence. We consider these data as an encouraging pilot study that certainly requires confirmation under controlled conditions.