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  1. Kris-Etherton, Penny PhD, RD
  2. Champagne, Catherine PhD, RD
  3. McManus, Kathy MS, RD


A dramatic increase in the number of people who are overweight or obese in this country presents a growing public health problem. Successful weight loss requires diet, physical activity, and behavior modification interventions. Weight loss diets with distinctively different macronutrient profiles have resulted in short-term weight loss. There is great interest in identifying the most effective strategies to achieve long-term weight loss. Individualizing weight loss interventions, including diet, will be important to facilitate significant weight loss on a population basis. Nurses and nurse practitioners can play an integral role in supporting their patient's weight loss efforts.


The prevalence of overweight and obesity in the United States is skyrocketing. Based on data from the 1999-2000 NHANES Survey, 64.5% of the population is overweight. 1 Between 1988-1994 and 1999-2000 the prevalence of overweight increased from 55.9% to 64.5%, representing a 15% increase in just a decade. Moreover, the prevalence of obesity increased from 22.9% to 30.5% over the same timeline. Extreme obesity (body mass index [BMI] > 40) almost doubled during this time (increasing from 2.9% to 4.7%). 2 These changes occurred for both men and women of all ages including non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. Although the prevalence of obesity or overweight was similar in different ethnic groups for men, among women, the highest prevalence of obesity and overweight was observed for non-Hispanic black females. 2 Alarmingly, more than 80% of non-Hispanic black women aged 40 years or older were overweight and more than half were obese. And the growing prevalence of overweight among US children and adolescents raises concern. 1 The prevalence of overweight was 15.5% among 12- through 19-year-olds, 15.3% among 6- through 11-year-olds, and 10.4% among 2- through 5-year-olds in the 1999-2000 NHANES Survey. The previous survey (1988-1994) had reported an incidence of 10.5%, 11.3%, and 7.2% for the same cohorts.


These findings portend a major public health crisis because of the increased risk of coronary heart disease, type 2 diabetes, gallbladder disease, sleep apnea, osteoarthritis, and various forms of cancer. 3 Collectively, the higher risk is associated with higher mortality rates for many diseases. For example, obesity increases the risk of cardiovascular disease mortality 1- to 2-fold. 4,5 Moreover, women with type 2 diabetes, most commonly due to overweight/obesity, are at greater risk for cardiovascular disease than are men. 6 Additionally, overweight/obese women, because of their caregiver role, have unique challenges in managing daily living activities.


Major efforts have been launched to prevent and treat overweight and obesity. The urgency of this health message has touched many health care professions, including the nursing profession. 7,8 There is no debate that prevention is the key to reducing incidence of overweight and obesity. The alarming increase in prevalence of overweight and obesity necessitates intensive treatment efforts at this juncture. Lifestyle behaviors, including diet, exercise, and behavior modification strategies, are the traditional cornerstones for weight loss, recognizing that any weight loss is beneficial, and preferably, achieving and maintaining a healthy body weight. Ideally, achieving weight loss is a primary goal; however, preventing further weight gain is a secondary objective if concerted efforts directed at weight loss are unsuccessful. In all weight loss programs, an energy deficit must be attained to lose weight. This can be achieved only by decreasing food intake and/or increasing energy expenditure. While this approach is self-evident, the key is to determine the ideal diet for both achieving and maintaining a healthy body weight. Much has been written on the topic and there is growing debate in the scientific community about what the ideal macronutrient distribution should be to achieve successful, long-term weight loss. The ongoing discussion is fueled by science-based evidence demonstrating weight loss with low-fat diets, moderate fat diets, and high-protein diets (the latter for short-term weight loss). Additional studies for longer periods of time are needed to identify which diet(s) works best in achieving a successful and sustained weight loss.


This article reviews diets with different macronutrient profiles that are being evaluated for weight loss. The weight loss diets of primary interest are low-fat diets, moderate fat diets, and high-protein diets. The article focuses on the need for health care professionals and the patient/client to individualize weight loss diet options. Having diet options is important in a practice setting to achieve maximum adherence to a prescribed diet. Different diet approaches will be discussed in a way that will enable practitioners to select the most suitable weight loss diet for individuals. Because other integral components of a successful weight loss program include physical activity and behavior modification, strategies for implementing these will be discussed. Nurses and nurse practitioners, because of their frequent patient contact, are uniquely positioned to provide follow-up for the patient's weight loss/weight management program.