New Dietary Recommendations Give Patients Guidance for Weight Loss

For physicians helping overweight patients navigate the flood of special diets and weight-loss techniques touted through television, books and magazines, a new tool has arrived.

Established by the National Academy of Sciences under the auspices of the Institute of Medicine's Food and Nutrition Board, the new Dietary Reference Intakes, or DRIs, expand upon Recommended Daily Allowances (RDAs) and include indicators of good health and the prevention of chronic disease, as well as potential adverse effects of over- or under-consumption of macronutrients: fats, carbohydrates and proteins.

"Not all information patients may read is necessarily bad information," says Brenda Richardson, M.D., chair of the MMS Committee on Nutrition. But, she notes, physicians should carefully examine particular diets, as well as a patients' exercise and dietary intake needs.

"Obesity is a medical problem," says Dr. Richardson. "When assessing a diet or exercise program, the physician needs to keep the patient's general medical condition in mind." Special considerations may need to be made, for example, for patients with medical and chronic conditions, including diabetes, renal insufficiency, chronic bowel disease, or cardiac problems.

The DRI report recommends that adults and children, regardless of weight, spend a total of at least one hour each day in moderately intense physical activity, double the daily minimum goal set by the 1996 Surgeon General's report.

Moderate intensity activity might include the following:

• Walking 2 miles in 30 minutes
• Pushing a stroller 1¹/₂ miles in 30 minutes
• Bicycling 5 miles in 30 minutes
• Stairwalking for 15 minutes
• Dancing fast for 30 minutes

Dr. Richardson acknowledges, "Beginning an exercise routine is the difficult part." She recommends that patients begin with regular exercise of any duration and gradually increase the length of time and intensity. In setting attainable initial goals for weight-loss, physicians can help patients succeed and emphasize that weight maintenance is a lifelong process.

If patients are interested in more structured weight loss programs, the National Heart Lung and Blood Institute suggests making sure the program is staffed by qualified health professionals and counselors, and it provides adequate time, instruction and counseling for permanent change of eating and exercise habits and other lifestyle factors.

- Robyn Alie

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