Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.
Clinical Nutrition Unit, General Medicine, ICS MAUGERI IRCCS, Pavia, Italy.
Eat Weight Disord. 2024 Nov 26;29(1):74. doi: 10.1007/s40519-024-01702-3.
This narrative review aims to conduct a comparative analysis of dietary and non-dietary approaches in the management of weight and disordered eating behaviors (DEBs) in adults with obesity.
Studies were identified from Medline (PubMed), including only English-language manuscripts published from 1998 to 2024. To be included in the review the studies had to be RCTs that compared the effect of dietary and non-dietary approaches on weight loss and DEBs in adults with obesity not being treated with pharmacological treatments.
Seven randomized controlled trials (RCTs) reported in 8 manuscripts published between 1998 and 2024 met the inclusion criteria. The sample size ranged from a minimum of 16 subjects to a maximum of 219. All studies involved adult subjects, mainly women, with first-, second-, or third-degree obesity and most subjects had cognitive restriction and/or uncontrolled eating. Dietary approaches were characterized by moderate caloric restriction (CR) and restriction of fat intake. In contrast, non-dietary approaches focused on mindful eating (ME), intuitive eating (IE) and weight neutral (WN) approaches. Of the 7 RCTs included, 5 reported greater weight loss in the diet group compared to the non-diet group; however, only one of these sustained the result at follow-up. In contrast, 4 studies demonstrated greater improvements in DEBs in the non-diet group.
CR is essential for weight loss in individuals with obesity, but long-term weight management also hinges on their relationship with food. The psychological improvements reported in non-dietary versus dietary approaches should not be overlooked and can be a starting point for the development of multidisciplinary interventions involving synergistic actions between diet, exercise, and practices to improve DEBs with the goal of reducing the obesity epidemic. Level of evidence Level I, at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.
本叙述性综述旨在对成人肥胖患者体重管理和饮食失调行为（DEB）的饮食和非饮食方法进行比较分析。
从 Medline（PubMed）中确定研究，仅包括 1998 年至 2024 年发表的英文手稿。纳入综述的研究必须是 RCT，比较饮食和非饮食方法对未接受药物治疗的肥胖成人的体重减轻和 DEB 的影响。
7 项随机对照试验（RCT）在 8 篇发表于 1998 年至 2024 年的论文中报道，符合纳入标准。样本量从最少 16 名受试者到最多 219 名受试者不等。所有研究均涉及成年受试者，主要为女性，肥胖程度为第一、二或三度，大多数受试者存在认知限制和/或无法控制的进食行为。饮食方法的特点是中等热量限制（CR）和限制脂肪摄入。相比之下，非饮食方法侧重于正念饮食（ME）、直觉饮食（IE）和体重中立（WN）方法。在纳入的 7 项 RCT 中，有 5 项报告饮食组的体重减轻大于非饮食组；然而，只有一项在随访时维持了这一结果。相比之下，4 项研究表明非饮食组的 DEB 有更大的改善。
CR 对于肥胖个体的体重减轻至关重要，但长期的体重管理也取决于他们与食物的关系。非饮食方法与饮食方法相比报告的心理改善不应被忽视，它可以作为多学科干预措施的起点，涉及饮食、运动和改善 DEB 的实践之间的协同作用，以减少肥胖流行。证据水平 I 级，至少有一项设计合理的随机对照试验；系统评价和荟萃分析；实验研究。
