Background – Low energy dense diets are associated with reduced energy intakes and are promoted as a sustainable strategy for long term weight control.
Objectives – To determine if eduction sessions on ways to reduce dietary energy density (ED) can successfully decrease the energy density of diets consumed by women following weight reduction.
Design – Overweight or obese women entering a 14 week weight maintenance education program following a weight loss diet (~5MJ/day for 8 weeks). Women were randomised to receive either standard eduction on Dietary Guidelines (six 30 minute sessions) or modified education sessions involving twelve 30 minute sessions on principles of ED. The ED education program included food examples, homework, and group discussion. Five day diet diaries were used to measure dietary intake and Nutritionist V (FirstDataBank Inc. San Bruno, CA) was used to determine energy intake, total weight of food consumed, and number of servings of each of the food groups. ED was calculated as kilocalories divided by total weight of food and beverages excluding water.
Outcomes – Compared with the group receiving standard nutrition eduction sessions (n=48), those receiving the reduced ED eduction (n=17) had a significant reduction in ED at the end of the study (0.94 vs 0.79,β -0.29 95%CI - 0.43, -0.06). The reduction was due to a decrease in the amount of servings from fats, oils and sweets food (9.8 vs 3.7, β -0.25 95% CI -4.45, -0.13), meat, fish, poultry and alternatives (1.8 vs 1.3, β -0.24 95% CI -0.71, -0.01) and breads, cereals rice and pasta (5.6 vs 4.2, β -0.28 95% CI -2.02, -0.23). No significant differences were seen between the groups with respect to number of servings of fruits (1.9 vs 1.5, β -0.09, 95% CI -0.96,0.40), vegetables (2.4 vs 2.3, β 0.03 95% CI -0.65, 0.81) or dairy products (1.8 vs 1.5, β -0.11, 95% CI-0.72,0.25).
Conclusion – Decreases in ED can be achieved following education sessions. However the reduction is largely achieved through decreased intake of high fat foods rather than an increase in low energy dense foods. The lack of significant increase in number of servings from low energy dense food groups (fruits and vegetables) suggest that this decrease may not be sustained over the long term.