Obesity Treatment Ladder: Medical Nutrition Therapy and Physical Activity in Clinical Practice

Algorithms for treating obesity largely focus on pharmacological and surgical treatment options. Despite vast literature on different dietary approaches, focus has remained on comparing these approaches amongst themselves. The different dietary strategies result in similar weight loss in the unselected population over the long term. However, at an individual level, there should be an algorithm that will allow every individual a chance to be able to select a diet that works on a long term basis. A comprehensive and practical approach to the application of medical nutrition therapy (MNT), that amalgamates all different dietary strategies is currently lacking. An algorithm placing these diets in an ascending order of their complexity and restrictiveness is proposed to fill this gap in literature. Physical activity is an integral part of MNT for weight loss treatment. However, application of adequately intense and meaningful physical activity is often difficult in clinical practice. A step by step approach to build stamina gradually and achieve long term goal of weight loss and maintenance is discussed.