Evidence-based reduction of obesity: Identification of a subculture's least fattening eating patterns

Public health nutritional interventions, like clinical treatments in medicine or psychology, should be based on direct evidence of their efficacy relative to prior existing modalities. Yet the contribution of applied human nutrition and the psychology of eating to research into ways of slowing the rise of obesity has been limited to the intake of energy nutrients and investigator-prejudged questions about appetite and food choices. In contrast, it is feasible to get members of the public to describe their patterns of eating in their own words. Self-assessed current frequency of each common potentially less or more fattening eating pattern can then be used to associate weight change with changes in habit frequency. This design has been used to identify the long-term least fattening eating patterns retrospectively and prospectively in several studies in England and Germany. Without using assessments of usual nutrient intake, these studies demonstrate that the least fattening patterns over 1-2 or more years are drinks between meals with no energy intake, cutting back on fat in all foods and replacing as much sitting and riding as feasible each day with walking or cycling. An hypothesis to be tested by this method is that the only known automatic mechanism for eating less dessert is the learnt effect of boosting the readily digested carbohydrate content of high-energy main courses. Such evidence-based advice as well as self-therapy for emotional eating and body-shape distress should be the front line of defence against unhealthy weight gain and re-gain. (C) 1999 Academic Press.