Nutrition and physical activity: An Obesity Medicine Association (OMA) Clinical Practice Statement 2022

Abstract

Background: This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on Nutrition and Physical Activity provides clinicians an overview of nutrition and physical activity principles applicable to the care of patients with increased body fat, especially those with adverse fat mass and adiposopathic metabolic consequences.

Methods: The scientific information and clinical guidance is based upon referenced evidence and derived from the clinical perspectives of the authors.

Results: This OMA CPS on Nutrition and Physical Activity provides basic clinical information regarding carbohydrates, proteins, fats (including trans fats, saturated fats, polyunsaturated fats, and monounsaturated fats), general principles of healthful nutrition, nutritional factors associated with improved health outcomes, and food labels. Included are the clinical implications of isocaloric substitution of refined carbohydrates with saturated fats and vice-versa, as well as definitions of low-calorie, very low-calorie, carbohydrate-restricted, and fat-restricted dietary intakes. Specific dietary plans discussed include carbohydrate-restricted diets, fat-restricted diets, very low-calorie diets, the Mediterranean diet, Therapeutic Lifestyle diet, Dietary Approaches to Stop Hypertension (DASH), ketogenic (modified Atkins) diet, Ornish diet, Paleo diet, vegetarian or vegan diet (whole food/plant-based), intermittent fasting/time restricted feeding, and commercial diet programs. This clinical practice statement also examines the health benefits of physical activity and provides practical pre-exercise medical evaluation guidance as well as suggestions regarding types and recommended amounts of dynamic (aerobic) training, resistance (anaerobic) training, leisure time physical activity, and non-exercise activity thermogenesis (NEAT). Additional guidance is provided regarding muscle physiology, exercise prescription, metabolic equivalent tasks (METS), and methods to track physical activity progress.

Conclusion: This Obesity Medicine Association Clinical Practice Statement on Nutrition and Physical Activity provides clinicians an overview of nutrition and physical activity. Implementation of appropriate nutrition and physical activity in patients with pre-obesity and/or obesity may improve the health of patients, especially those with adverse fat mass and adiposopathic metabolic consequences.

Keywords: Clinical practice statement; Nutrition; Obesity; Physical activity.

Fig. 1

Nutrition Factors Associated with Improved Health Outcomes. Regarding medical nutrition therapy for obesity, the most effective approaches are evidence-based, consider both qualitative and qualitative aspects of dietary intake, and promote patient agreement and adherence. While possibly counterintuitive, randomized clinical trials do not necessarily support improved weight reduction when diets are based upon patient food preferences. In fact, meta-analyses suggest that patient choices in weight reduction strategies have no significant effect on duration or attrition, with greater weight reduction often occurring in the control groups. However, the effectiveness of any therapeutic intervention is likely enhanced when patients are engaged and agree to treatment plans [[6], [7], [8]].

Fig. 2

Macronutrient Effects on CVD Risk. The health effects of isocaloric substitutions depends on the macronutrient [13,[26], [27], [28], [29]]. Abbreviations: PUFA: Polyunsaturated Fatty Acids; MUFA: Monounsaturated Fatty Acids: CVD: Cardiovascular disease ∗ This figure is focused on isocaloric substitutions and does not necessarily reflect health effects of substitutions that result in changes in weight.

Fig. 3

Macronutrient Effects on CVD Risk. The health effects of isocaloric substitutions depends on the macronutrient [13,[26], [27], [28], [29]]. Abbreviations: PUFA: Polyunsaturated Fatty Acids; MUFA: Monounsaturated Fatty Acids: CVD: Cardiovascular disease ∗ This figure is focused on isocaloric substitutions and does not necessarily reflect health effects of substitutions that result in changes in weight.

Fig. 4

Dietary Energy Consumption Intended to Cause Negative Caloric Balance and Reduction of Fat Mass. This figure summarizes the types and definitions of different hypocaloric diets [[41], [42], [43], [44]].

Fig. 5

Obesity Medicine Association Physical Activity Goals. OMA physical activity goals include steps per day, specified exercise intensities and durations, and recommended resistance training sessions per week [118,121,124]. The OMA physical activity goals specifically include steps as a way to achieve daily, dynamic physical activity goals, with even greater aerobic activity providing additional health benefits.