Obesity and diets are thought to be interlinked. Different types of diets exist, each one claiming benefits over the other, often confusing the reader about which is the best diet for him or for her. We attempt to offer a comprehensive summary about how you can choose the best diet for yourself. Diets have a better role in prevention of obesity as well as maintenance of weight loss, however dietary therapy alone for weight loss has not offered the best results for long term “weight loss maintenance”.
Rachel Freire has published a great summary in his review article published in ‘Nutrition’ Journal which included a study of different types of diets like intermittent fasting, keto diet, calorie restricted diet, Very low calorie diet, low carbohydrate diet (most commonly adopted diets) , and concluded as follows:

1. The creation of new diets will continue to follow popular trends. However, the belief that these diets promote weight loss has emerged more from personal impressions and reports published in books, rather than from rigorously controlled research.
2. Over several decades, efforts have been concentrated on clinical trials to determine the best diet for the treatment of obesity. Unfortunately, the evidence remains inconclusive and contested, and the trials present important limitations.
3. In the “short term” diet promote different degrees of success, but in the “long term”, the small difference does not instill confidence for prescribing one diet over another.https://pubmed.ncbi.nlm.nih.gov/31525701/

Despite the above conclusion, people do experience different types of response or success in losing weight.However, the response remains unpredictable and grossly variable among people .This clearly suggests that there are some factors in the human body which modulate or govern the response to a therapy .These could be the genetic tendency, epigenetic expression ,intestinal bacteria/gut microbiota ,environmental and socio economic factors ,sleep cycle , stress, associated medical conditions , nutritional status ,etc., which have an impact on the body’s tendency to store a certain percentage of fat also known as ‘the set point of obesity’ in that individual. Eventually, the hormonal response generated in the body by all the factors mentioned above may induce an imbalance in the metabolism resulting in the disease of obesity in an individual. Hence the treatment of the disease of obesity should be based on evidence based scientific protocol just like the treatment of any other chronic disease e.g., Hypertension, cancers, etc.

Unfortunately, patients with obesity are blamed for unhealthy eating habits and /or lifestyle. This is more commonly seen as a bias especially when viewed by a normal weight or a lean individual or clinician or any therapist. This is simply because of a tendency to compare one’s own habits and response and an attempt to apply the same to others. I would like to state here that many scientific organizations in the world like AMA,American Medical Association, OSSI,Obesity Surgery Society of India declared “Obesity as a disease’’and‘not just a lifestyle disorder’.Even bariatric surgery started being called metabolic surgery after better understanding of the altered metabolism in people with obesity. Bariatric surgery got included in the insurance cover, which clearly explains that obesity is accepted as a disease.

I would like to discuss some important and common myths about Obesity.

Myth 1 : OBESITY IS CAUSED ONLY BECAUSE OF WRONG DIETS
We often see people who eat freely and still maintain their weight and also those who try to eat less but still remain in the category of overweight or obesity. Some are thought to be blessed with a metabolism to remain thin or normal weight ever.At the same time those who are not blessed with such metabolism are blamed. Prof. Lee Kaplan et al published the explanation for this after a multigenerational multicentered study known as “MARS”. I strongly recommend all those who feel that” those who cannot lose weight do not have willpower “to read the Myth published in “MARS”. https://jnjinstitute.com/en-

The study clearly states a myth which even doctors and clinicians find difficult to believe. The MARS study clearly concluded that “weight cannot be reliably controlled by voluntarily adjusting energy balance through diet and exercise “. The converse is also true for very lean and thin who try to gain weight by increasing calories and still don’t succeed .

Myth 2 : ANY GRADE OF OBESITY CAN BE TREATED WITH DIET INTERVENTION AND EXERCISE.

As mentioned earlier, obesity is a disease and needs to be treated like all other diseases. Treatment of any disease is based on grade, severity, and stage of the disease. Forexample, the treatment for cancer varies depending on the type and grade of disease and it is well known that the best results are seen only in those who are diagnosed early and treated in time as per the best available evidence-based therapy of that cancer. Needless to say that the same thing holds true for the treatment of obesity at various stages.

Evidence based/BMI (Body Mass Index) based algorithm for obesity.
Note : Even though BMI has its limitations , the algorithm can be generally applicable to all , with some exceptions.

The algorithm shows that diet and exercise are present in all the approaches for the treatment of obesity but this algorithm also indicates that diet and lifestyle change cannot be a single line of treatment when you cross a certain grade of obesity and it should always be accompanied by other complimentary therapies.

In conclusion, diet for weight loss can be adopted a jumpstart. Caution is required for each diet and hence it should be the diet supervised by a qualified nutritionist. Maintenance of weight loss may require supervision from qualified obesity experts. Failure of therapy should not be considered as failure on part of the patient. Start a dietary change which has “no expiry date”.

Diets most often fail to work in patients with morbid obesity. Metabolic and bariatric surgery is the only proven long-term treatment for morbid obesity till further research would invent medications which can mimic the metabolic and hormonal change after bariatric surgery.

Homemade Vegetable Soup Recipe

Soup is one of the easiest and wholesome thick liquid option to those who want to lose weight.Soups can be a good hydration option as it helps to increase your liquid intake throughout the day. It gives you satiety due to the fibres from vegetables / lentils / pulses / etc.

It is a healthier option of one pot meal which includes all essential components like Protein+fiber+antioxidants +vitamins+ minerals.

It Enhances Nutritious value of your meal while maintaining your portion size and calorie count.

It is one of the tasty forms of protein, fibre and low calorie option.

Which soup you should not take if you are aiming for healthy weight loss?

Thinking to lose weight initiates us to focus on every food choice we make nutritiously.

In case of soups, not all soups are the same. In today’s busy lifestyle, one who wishes to lose weight through healthy diet options are prone to select the easiest preparing ready to make food choices.

Packed/canned soups or few soups at the restaurants are loaded with hidden fat and sugar sources in the form of preservatives. The ingredients used are not of fresh quality, leaving the major content of the soup to be starchy, sugar and sodium.

The vegetable content of any instant soup is almost negligible besides containing depleted nutrients.

Just having soup for being healthy is not correct. One has to understand contents, which are not ideal for weight loss and prepare/consume soup accordingly and then only it can be considered healthy.

Checking food labels for the for better food choices in important.

Making soup at home without preservatives and low fat ingredients will help to enhance the value of it. Using
substitutes like fat-free or low-fat milk instead of heavy cream, almond milk, soya milk, blanched vegetable
over canned ones. You can use chicken broth to thicken the soup with pureed vegetables, lentils, beans or
tofu. Simple ingredients like ginger, garlic, cloves and herbs, nutmeg, spices enhances the natural flavours and
promote better absorption of nutrients. Sometimes vegetable soup simply isn’t an option for some people. For
improving the thickness and increasing the satiety level one can add fibre to soups in the form of simple
changes like of oats flour instead of corn flour, soybean flour, unsweetened SMP, etc. Instead of munching on
unhealthy snacks, switching to broth based soups will give you sense of fullness or better satiety.

Avoid using the following ingredients while preparing soups :

• Sugar, Sausages, sodium in high amount
• cornbread, cheese, croutons
• Heavy Cream
• Corn flour / refined flour
• White Rice.
• Cheese sauce / mayonnaise.
• Coconut milk.
• Canned Veggies / Hummus.
• Monosodium glutamate ( MSG ) i.e. Aginomoto.

It’s not just soup, but it’s the complete diet and lifestyle changes that help you lose weight. Tailor-made
diets by the experts are necessary for better results and weight loss.

Here are some concerns which come to my mind:

Bariatric surgery does induce volume restriction and the principal is to maintain that restriction for a longer period. It may not be easy to achieve the composition like the keto diet, for example, 70 per cent calories from fat, without compromising on the necessary elements like protein, fibre and minerals. At the same time, absorption of those calories is not certain in bypass procedures which may defy the mechanism of the diet. On the other hand, in some individuals or after procedures like sleeve gastrectomy or at times even bypass, it is likely that the total calories may even exceed than the usual bariatric norms.

The basic mechanism of the keto diet is the preferential use of fat as energy by inducing ketosis. There is no evidence to know whether this state of ketosis can be induced in the same manner after bariatric surgery, as if in a normal individual. The change in hormones after bariatric surgery and subsequent change in metabolism induces weight loss, rather fat loss.

Even though bypass procedures have fat malabsorption, one does not know whether we should offer this challenge of excess fat in these patients. It may induce rapid transit, frequency of stools, loose motions and malodourous stools in some procedures. It is not known whether dumping would be frequent and whether frequent dumping would be favourable. This different phenomenon may define a different ‘keto flu’ like syndrome in these patients after keto diet.

There would certainly a change in gut microbiota induced by a keto-type diet rich in fat and low in fibre. Whether it would lead to adaptation for better fat absorption is still not known. If it does, it may compromise the result of the procedure over the long term, especially with the question whether the keto-type of diet would be sustainable over the long term. In my experience, a few of the patients who attempted keto diet, succeeded in losing weight for a short period and eventually all 32 of them became candidates for revision in the next two to three years.

It appears that Keto-type of diet after bariatric surgery will aggravate protein, mineral and vitamin deficiency. Guidelines for these supplements may need to be modified while the individual is on a keto diet and will need further studies.

Keto diet may have to be modified, (if at all it needs to be attempted in a patient after bariatric surgery), studied with reference to efficacy, absorption, ketone levels, deficiencies, hormonal changes, impact on NASH, etc. Studies with longer follow up are needed before recommending it to a patient after bariatric surgery.

The keto diet does not work well after bariatric surgery for the following reasons:

• The high-fat content of the keto diet (70% of calories) does not allow for the consumption of adequate protein or carbohydrates.
• A high-fat diet may lead to fatty diarrhoea (steatorrhea) and reduced absorption of nutrients because food tends to travel faster through the intestinal tract after bariatric surgery. There is a risk for nutritional deficiencies after bariatric surgery; severely limiting specific food groups (whole grains, fruits, and many vegetables) only increases the chance that deficiencies will occur.
• Fat contains 9 calories per gram, while carbohydrates and protein contain 4 calories per gram—making fat a very concentrated source of calories. It is very easy to exceed calorie needs when consuming a high fat, low carb diet. Calorie intake 1 year or longer after bariatric surgery typically ranges from 800–1100 for women and 1000-1500 for men per day.
• The keto diet is low in fibre. This increases the risk of constipation, which can be a concern after weight loss surgery. Fibre may also reduce the risk of developing various conditions, including heart disease, diabetes, and diverticular disease.

Although the keto diet does show some short-term promising results for weight loss, it is not a good diet strategy after bariatric surgery. A lifestyle that supports a healthy weight after bariatric surgery is something that can be followed life-long, with protein at the centre of the diet. The keto diet with its extremely high-fat content, very low carb content, exclusion of grains and fruit, and low fibre content are potential concerns for overall health. This is even more of a concern after bariatric surgery when portions are limited and nutritional deficiencies are a risk.