Practical pathways for medical weight loss: CRD program development, plateau management, and the application of nutritional meal replacements.

3. Development of a Restricted Energy Balanced Diet Plan (1) Obtaining Total Daily Energy: Taking a diet that reduces the target intake by about 500 kcal as an example, the total daily energy can be obtained in the following two ways. 1) Based on height and weight, standard weight (kg) × 20~25 (kcal·kg⁻¹·d⁻¹); 2) Based on body composition determination of lean body mass: BMR = 370 + 21.6 × lean body mass (kg) Recommended energy intake = BMR × activity coefficient - 500 (kcal) (2) Macronutrients: The proportion of macronutrient energy supply is 15%-20% protein (1.2-1.5 g/kg), 20%-30% fat (consistent with normal diet), and 40%-55% carbohydrates. (3) Developing a Restricted Energy Balanced Diet Plan: The daily dietary sources should include grains and tubers, vegetables and fruits, poultry, meat, eggs and dairy products, soybeans and nuts, etc. It is recommended to maintain a healthy and balanced diet, consuming at least 12 different types of food daily and at least 25 different types weekly. Adults should consume no more than 5g of salt per day and drink sufficient water. If adults drink alcohol, men should consume no more than 25g of alcohol per day, and women no more than 15g. III. Precautions for a Limiting Energy Balanced Diet: 1. Rapid weight loss (≥10% per month): Due to individual differences, it is difficult to judge whether the body is normal or abnormal solely based on weight loss. For example, diabetic patients may experience a weight loss of up to 10kg per month, while other cancer patients may experience even more severe cases. Different situations require further examination at the hospital. 2. Hunger: First, increase the frequency of meals by moving some of the regular three meals to snacks. For example, move a glass of milk to a morning snack or a piece of fruit to an afternoon snack. Second, increase or replace some foods with dietary fiber-rich foods. For example, replace regular staple foods with foods rich in dietary fiber that increase satiety, such as potatoes, sweet potatoes, and yams. The conversion ratio is 4:1, for example, 200g of potatoes = 50g of rice. You can also increase your satiety by adding 250-500g of fiber-rich vegetables, such as cucumbers, tomatoes, and konjac. Additionally, ensuring adequate water intake can also reduce hunger. 3. Slow weight loss and plateaus: Due to physiological reasons, weight loss tends to be spiral-like, so small plateaus may occur during weight loss. As the dieter adheres to the weight loss prescription and the body gradually establishes a new balance, weight will decrease further. Nutritional meal replacement weight loss prescription: I. Definition of nutritional meal replacements: Meal replacement foods are specially processed and formulated to meet the nutritional needs of adults during weight control, replacing one or two meals without the need for other dietary intake. Each meal replacement should provide at least 835kJ (200kcal) and no more than 1670kJ (400kcal). Partial meal replacement foods: These are specially processed and formulated energy-controlled foods designed to meet the nutritional needs of adults during weight control, replacing a portion of one or two meals. They need to be consumed in combination with other foods such as milk, fruits, and vegetables to ensure balanced nutrition. Each partial meal replacement should provide at least 334 kJ (80 kcal) and less than 835 kJ (200 kcal). When combined with other foods, each meal should provide at least 835 kJ (200 kcal) and no more than 1670 kJ (400 kcal). II. Applicable Population and Evidence for Nutritional Meal Replacements 1. Evidence: A foreign study comparing the weight loss effects of a restricted diet group and a meal replacement group showed that the use of meal replacements can achieve significant weight loss.