Impact of dietary and lifestyle modification on nutrient intake and energy expenditure in overweight women: An intervention study

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. The major cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.  Increased intake of energy-dense foods that are high in fat and sugars and increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization are the contributing factors of overweight and obesity (1). Overweight and obesity increase the risk for chronic diseases such as diabetes, and cardiovascular diseases.  Obese people are at a higher risk of suffering from certain kinds of cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon). Moreover, being overweight also places the individual at an increased risk of death due to COVID-19.

Once considered a high-income country problem, overweight and obesity are rising worldwide affecting more than 44% of the world’s population. The NFHS 5 data shows that obesity has increased by 4 per cent in both men and women in India during the last five years. In NFHS-5, the percentage of overweight or obese women is 24, up from 20.6 per cent in NFHS-4 (2015-16) (NFHS, 2019). With increase in overweight and obesity, there is a need to focus on prevention of obesity related malnutrition.

Numerous studies have examined relationships between single nutrients, particularly dietary fat, and obesity, but dietary determinants of weight gain remain controversial (Motswagole et al., 2020). However, since food is consumed in combinations, it is important to analyze interaction of different nutrients on predisposition of weight gain. The main cause of obesity is an imbalance between calories consumed and calories expended, although in a small number of cases, genetics and diseases such as hypothyroidism, Cushing’s disease, depression, and use of medications such as antidepressants and anticonvulsants are responsible for fat accumulation in the body (Fock and Khoo, 2013).

Sedentary lifestyles and high intakes of energy-dense, micronutrient-poor foods increase the risk of obesity. Also, the intense marketing of energy-dense foods and fast-food outlets, high intakes of sugar-sweetened soft drinks and fruit juices with adverse socio-economic conditions are contributing to the increased risk of obesity (Seidel et al., 2005).

Nutrition remains the cornerstone for the management of obesity, supplemented by physical exercise and supported by cognitive behavioral therapy. Calorie-restriction strategies are one of the most common dietary plans. Regular physical exercise enhances the efficiency of diet through increase in the satiating efficiency of a meal, and is useful in maintaining diet-induced weight loss (Fock and Khoo, 2013).

Increasing physical activity is an effective way to maintain body composition and potentially prevent obesity. Physical activity has been shown to induce health related benefits in males and females of all age groups. In fact, physical activity appears to be the most beneficial prevention practice (Richardson et al., 2019).

Behavioral therapy is an effective method of preventing obesity, when combined with low calorie diet. Behavior changes strategies involve techniques in stimulus control. The simplest form of behavior therapy involves advice to avoid situations that tempt overeating. Other forms of advice are keeping food out of sight or eating only at the table. Practice eating management such as eating slowly is also included under behavior therapy. Behavior substitution, such as exercising instead of eating when angry can also be adopted (Ogunbode et al., 2011). With this background, a study was conducted to study the effect of dietary approach and lifestyle intervention on nutrient intake and energy expenditure.

Group I: Low calorie high fiber food formulation+ Nutrition education and awareness on lifestyle practices;

Group II: Nutrition education and awareness on lifestyle practices;

Group III: control

During the past half-century mechanization has impinged upon our modes of living in diverse ways. Consequently, energy expenditure required for daily living has continuously declined. A recent study has reported that daily energy expenditure due to work related physical activity has decreased by more than 100 kcal during the last 50 years in both men and women, and this reduction is associated with the increase in mean body weight.  Substantial reductions in daily energy expenditure have also occurred in developing countries such as China and Brazil, which have the highest absolute and relative rates of decline in total physical activity due to reductions in movement at work. For this reason, it is believed that the obesity epidemic has also penetrated to low-income countries, particularly urban areas (Wiklund, 2016).

Table 4 shows the energy expenditure of subjects before and after the intervention. Energy expenditure significantly increased from 1701.5±84.1 to 2217±83.21kcal in group I and 1761±162.7 to 2010.5±77.8 kcal in group II, whereas no significant change was observed in group III.

According to Wiklund, (2016), domestic mechanization of daily tasks (with the advent of labor-saving devices such as washing machines and dishwashers) has reduced energy expenditure over the years. Housework-related energy expenditure has been substantial contributors to the rise in prevalence of obesity in women, as labor-saving devices are habitually used in all affluent societies. Domestic mechanization has also contributed to increased sedentariness, as time spent in house work has been replaced by sedentary activities such as watching television and use of other screen-based media.

Drenowatz et al., (2015) reported an increase in total daily energy expenditure upon exercise by 443± 126 kcal/day and 239± 152 kcal/day for aerobic and resistance exercise, respectively. A higher energy expenditure with physical exercise along with potentially decreased energy intake results in energy balance and hence a significant change in body weight can be achieved.

The findings of the study show a significant positive impact of a combined dietary intervention and lifestyle modification on overweight women. Nutrient intake of subjects showed that energy and fat were consumed in excess whereas protein, fiber and other micronutrients were consumed less than the RDA. Significant change in the individual nutrient intake was observed after the intervention with developed flour mix and lifestyle modifications. This is because, low calorie product contained good amount of nutrients such as protein, iron, calcium, β Carotene and was rich in fiber. Along with nutrition education and dietary counselling resulted in increased intake of essential nutrients and reduced consumption of energy and fat. Balanced intake of nutrients with reduced energy density combined with lifestyle modification to increase the energy expenditure can help in weight reduction, a long-term, sustainable approach, making the weight loss achievable and maintainable.

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