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Energy density values, which vary from 0 to 9 kcal/g, are influenced by the water content and macronutrient composition of foods. This is illustrated using 1-g scale weights in which each dot on the scales represents 1 kcal. 

Energy density values, which vary from 0 to 9 kcal/g, are influenced by the water content and macronutrient composition of foods. This is illustrated using 1-g scale weights in which each dot on the scales represents 1 kcal. 

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Reducing caloric intake is the cornerstone of dietary therapy for long-term healthy weight management. Strategies individuals have typically used include limiting portion sizes, food groups, or certain macronutrients. Although such restrictive approaches can lead to weight loss in the short term, they can result in feelings of hunger or dissatisfac...

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... prevent gradual weight gain over time, the 2005 Dietary Guidelines for Americans recommend small decreases in energy from foods and beverages and increases in physical activity (1) . For individuals who need to lose weight, the guidelines encourage a slow, steady weight loss by decreasing energy intake while maintaining an adequate nutrient intake and increasing physical activity. Strategies individuals have typically used to reduce energy intake include limiting portion sizes, food groups, or certain macronutrients. Clinical trials have found that restrictive approaches such as low-fat or low-carbo- hydrate regimens, because of decreased caloric intake, have led to weight loss in the short term (6 mo or less) (2,3) . Restrictive approaches may, however, result in feelings of hunger or dissatisfaction, which can limit their acceptability, sustainability, and long- term effectiveness (4–6) . An alternative positive strategy to manage energy intake is for individuals to eat more foods that are low in calories for a given measure of food—that is, they are low in energy density (kcal/g). Encouraging individuals to eat these types of foods is one of the dietary strategies recommended in the Dietary Guidelines for Americans to manage energy intake. In the following sections, energy density as a dietary strategy for management of weight is discussed. Energy density is the amount of energy in a particular weight of food. It is generally presented as the number of calories in a gram (kcal/g). Foods with a low energy density provide less energy relative to their weight than foods with a high energy density. Therefore, for the same amount of energy, a larger, more satisfying portion size of food can be consumed of a food low in energy density, compared with a food high in energy density. Energy density values, which are influenced by the moisture content and macronutrient composition of foods, range from 0 kcal/g to 9 kcal/g (Fig. 1). The component of food with the greatest impact on energy density is water (7) . Water has an energy density of 0 kcal/g, as it contributes weight but not energy to foods. Fiber also has a relatively low energy density, providing 1.5 to 2.5 kcal/g, and can lower the energy density of foods. On the opposite end of the energy density spectrum, fat is the most energy-dense component of food. Fat provides 9 kcal/g, more than twice as much energy as carbohydrates or protein, which provide 4 kcal/g. Although most high-fat foods have a high energy density, increasing the water content lowers the energy density of all foods, even those high in fat. The energy density of a food can be calculated easily by using information that is readily available on the Nutrition Facts Panel of food labels. In order to better understand which foods are low or high in energy density, Table 1 classifies foods into four catego- ries. Water-rich foods, such as nonstarchy fruits and vegetables and broth-based soups, are very low in energy density (<0.6 kcal/g) (8,9) and should constitute a large proportion of each meal, be eaten as snacks, and be chosen as appetizers. In addition to foods with a very low energy density, low-energy-dense foods (0.6 to 1.5 kcal/g) such as starchy fruits and vegetables, cooked grains, legumes, lean meat and fish, and low-fat mixed dishes should accompany and/or be incorporated with very-low-energy-dense foods as the primary focus of meals. Foods with a medium (1.5 to 4.0 kcal/g) and high (4.0 to 9.0 kcal/g) energy density should be consumed less frequently and attention should be given to limiting their portion size. By consuming a diet low in energy density, caloric intake can be reduced without strictly limiting food portions. Figure 2 depicts the total amount of food that can be consumed on a 1600-kcal diet depending on the overall energy density of the diet. The energy density values in this figure correspond to a low- (1.4 kcal/g), medium- (1.9 kcal/ g), or high-energy-dense (2.2 kcal/g) diet, as defined by the average dietary energy density of a representative group of US adults (10,11) . When consuming a diet with an energy density of 1.4 kcal/g, which would be rich in low-energy-dense foods, more than 1100 g of foods can be consumed for 1600 kcal. However, only 725 g can be consumed on the high-energy-dense, 2.2 kcal/g diet. At any energy level, the lower the energy density of the diet, the greater the amount of food that can be consumed. This review will focus on several types of scientific evidence, including population- based studies, laboratory-based studies, and clinical trials, showing the influence ...

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... Furthermore, childhood obesity can increase the likelihood of adult obesity [15,16]. The purpose of the study was to determine the proportion of pediatricians (PEDs) and general practitioners (GPs) with pediatric patients who 1) screen for obesity using BMI-for-age at every well child visit; 2) are confident in explaining BMI-for-age results to children and their parents, 3) have access to a pediatric obesity specialty clinic; and 4) counsel on physical activity, TV viewing time, intake of energy dense foods (i.e., the amount of energy (kilocalories or kcal) in a gram (g) of food [17] ; foods with lower energy density such as raw carrots have fewer kilocalories per gram than those with higher energy density, such as French fries), fruits and vegetables, and sugar-sweetened beverages. The investigators tested for differences in use of BMI-for-age and counseling habits between PEDs and GPs. ...
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Screening for obesity and providing appropriate obesity-related counseling in the clinical setting are important strategies to prevent and control childhood obesity. The purpose of this study is to document pediatricians (PEDs) and general practitioners (GPs) with pediatric patients use of BMI-for-age to screen for obesity, confidence in explaining BMI, access to referral clinics, and characteristics associated with screening and counseling to children and their caregivers. The authors used 2008 DocStyles survey data to examine these practices at every well child visit for children aged two years and older. Counseling topics included: physical activity, TV viewing time, energy dense foods, fruits and vegetables, and sugar-sweetened beverages. Chi-square tests were used to examine differences in proportions and logistic regression to identify characteristics associated with screening and counseling. The final analytic sample included 250 PEDs and 621 GPs. Prevalence of using BMI-for-age to screen for obesity at every well child visit was higher for PEDs than GPs (50% vs. 22%, χ2 = 67.0, p ≤ 0.01); more PEDs reported being very/somewhat confident in explaining BMI (94% vs. GPs, 87%, p < 0.01); more PEDs reported access to a pediatric obesity specialty clinic for referral (PEDs = 65% vs. GPs = 42%, χ2 = 37.5, p ≤ 0.0001).In general, PEDs reported higher counseling prevalence than GPs. There were significant differences in the following topics: TV viewing (PEDs, 79% vs. GPs, 61%, χ2 = 19.1, p ≤ 0.0001); fruit and vegetable consumption (PEDs, 87% vs. GPs, 78%, χ2 = 6.4, p ≤ 0.01). The only characteristics associated with use of BMI for GPs were being female (OR = 2.3, 95% CI = 1.5-3.5) and serving mostly non-white patients (OR = 1.8, 95% CI = 1.1-2.9); there were no significant associations for PEDs. The findings for use of BMI-for-age, counseling habits, and access to a pediatric obesity specialty clinic leave room for improvement. More research is needed to better understand why BMI-for-age is not being used to screen at every well child visit, which may increase the likelihood overweight and obese patients receive counseling and referrals for additional services. The authors also suggest more communication between PEDs and GPs through professional organizations to increase awareness of existing resources, and to enhance access and referral to pediatric obesity specialty clinics.
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Background: Obesity is a key modifiable risk factor for non-communicable diseases. The modern food environment provides easy access to inexpensive, highly palatable, energy-dense and nutrient-poor foods and beverages, which are associated with increased BMI and reduced dietary quality. The NEEDNT Food List™, comprising ‘non-essential, energy-dense, nutritionally-deficient’ foods and beverages, was developed to help patients and consumers to clearly distinguish non-essential foods from core foods required for good health. In the present study, the original NEEDNT Food List™ was incorporated into preliminary ‘Moderation Guidelines’, which aim to provide quantified guidance for implementing the concept of dietary moderation, in the context of NEEDNT food and beverage intake. Objectives: The aims of the present study were to create a points and quota system for quantifying and monitoring energy intake from NEEDNT foods and beverages; to pre-test preliminary Moderation Guidelines among a representative group of potential users; and to make recommendations to further develop the Moderation Guidelines as a weight loss tool. Design: This study utilised an observational design and qualitative methods to obtain information-rich verbal data from study participants. Twelve people, aged 22 to 57 years, with a BMI ≥30 and a history of repeated weight loss attempts, were selected to pre-test the Moderation Guidelines over a 4-week period, and subsequently participated in one-on-one, semi-structured interviews. Interviews comprised eight open-ended questions, to explore participants’ views and experiences of the Moderation Guidelines, along with information relating to historical weight loss attempts and thoughts on dietary moderation. Interview data were recorded, transcribed verbatim and coded using NVivo software. Coded data were categorised and evaluated by thematic analysis using a general inductive approach. Results: Preliminary NEEDNT Foods Moderation Guidelines were presented in an A5 booklet format, with NEEDNT foods and beverages assigned 1 NEF (‘non-essential food’ value) per 100 kcal portion. Participants were allocated up to 19 NEFs weekly, representing around 1900 kcal. Participants varied in the extent of their previous dieting experiences. All expressed uncertainty around applying personal concepts of dietary moderation. Nine participants found the Moderation Guidelines usable and beneficial. Five participants self-reported weight losses of 2-4 kg during the 4-week period. Three participants found the Moderation Guidelines less appealing, unusable, or incomplete. All participants reported an improved understanding of dietary moderation generally. Seven participants intended to continue using the Moderation Guidelines. Suggested changes to the print booklet included revision of NEEDNT food and beverage categories, modification of terminology, integration of colour and graphics, clarification of serving sizes, and culture-specific versions. Most participants emphasised the need for support from a Dietitian or other health professional, for dietary guidance around core food groups, and behavioural change techniques. Participants said a NEEDNT-based smartphone app would increase functionality and appeal. Māori and Pacific participants requested culturally tailored NEEDNT-based education. Conclusion: Preliminary NEEDNT Foods Moderation Guidelines show potential for assisting obese persons to lose weight by moderating consumption of NEEDNT foods and beverages. Revision and retesting would further develop the Moderation Guidelines, and should incorporate participants’ recommendations, design principles, behavioural change theories, and best practices in nutrition education. An intervention trial is warranted, to evaluate the effectiveness of revised Moderation Guidelines as a dietary quality and weight loss tool. Further research opportunities include the development of a Moderation Guidelines smartphone app and website, tailored adaptation of the Moderation Guidelines for Māori and Pacific individuals and community groups, and a NEEDNT-based public health campaign. Keywords: NEEDNT Food List, NEEDNT Foods Moderation Guidelines, Moderation Guidelines, NEF, NEEDNT-FFQ, dietary moderation, energy density, nutrient density, overweight, obesity, qualitative research, qualitative evaluation, nutrition education.
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