In part 1 of this Exclusive Interview, Dr. Scott Kahan talks with Diabetes in Control Associate Medical Editor Joy Pape during the AACE 2018 convention in Boston, MA about his recommendations to health care providers for chronic weight management and what to share with their patients when it comes to what to eat.
Scott Kahan, MD, MPH is the Director of the National Center for Weight and Wellness in Washington, D.C.
Transcript of this video segment:
Pape: Hello this is Joy Pape with Diabetes In Control and we are at the AACE (American Association of Clinical Endocrinologists) 2018 meeting. I have the pleasure of interviewing and talking with my friend and colleague, Scott Kahan. You spoke today, Scott, and the title of your presentation was, “Best Nutrition Practices for Chronic Weight Management.” Well, what a subject! The big question – from healthcare providers, to people who have diabetes, to people who have obesity – is “what should I eat.” So, what would you recommend to healthcare providers to help their patients know what to eat and how to eat?
Kahan: Yes, so in the first part of my talk, the question I tried to answer was, “What’s the best diet?” We actually have quite a bit of data on this. When it comes to the outcome of interest being weight loss, the answer seems to be pretty clear and that is, there is no best diet. Assuming caloric intake is the same, whether people go on a low-carb diet or a very low-carb diet, or a low-fat diet or a very low-fat diet, a Mediterranean diet, vegetarian diet, and on and on, assuming caloric intake is the same, people lose about the same amounts of weight in the short-term, the intermediate-term, and in the long-term. That has been codified in the guidelines, both the AACE guidelines for weight management and also the NIH (National Institute of Health) guidelines for weight management. So, that is part of the answer. Now, I do not think it is the whole answer though. First of all, there’s still more that we are going to learn and so as the science evolves, maybe that answer will change over time. But even now, based on what we do know, I think there are some other really important practical factors.
First, even if people are trying to lose weight, that really isn’t the only outcome of interest. And so, let’s say if a patient has a very high triglyceride level, that will probably, all else being equal, improve more with a lower carb diet than with a lower fat diet. And vice versa, for people who have higher LDL (low-density lipoprotein), that will probably improve more with a lower fat diet than a lower carb diet. So, we can go through a number of different scenarios and outcomes of interest there that may also help the clinician to best give advice to patients.
On top of that, and I think perhaps the most important out of all of this, is personal preference. So, there are lots of dietary patterns which is good because there are lots of different people and different people like different things and have different fits for different types of dietary patterns. And so, I think one of the most valuable things we can do is listen to our patients and allow them to have the autonomy to make the decision for themselves or, at least, in combination with their provider. And that may come down to something like taste; some people just like low-fat dietary patterns because they can eat lots of vegetables and fruits and they can eat more sugary foods and so forth. Other people really like savory foods and protein-type foods and such and they prefer low-carb diets. And again, all else being equal, that’s not a problem but if we follow our patients tastes on those, it may lead to the patient being more successful with that dietary pattern. So that is the first question that I try to answer.
In the second part of my presentation, I went through a framework of some tips that providers who don’t work in this day-in and day-out like you and me can take back to their practice to be able to incorporate just a little bit of nutrition and a little bit of weight management counseling into otherwise busy endocrinology and primary care practices.