Five strategies for embracing plant-based diet in obesity treatment
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Adults with obesity are more likely to experience meaningful, long-term weight-loss when prescribed a plant-based eating plan vs. alternative diet options, and community-based strategies can help influence adherence, according to a speaker.
“Plant-based diets are a healthy and viable option for obesity treatment with benefits around improvements in diet quality,” Brie Turner-McGrievy, PhD, MS, RD, FTOS, associate professor of health promotion, education and behavior at the University of South Carolina Arnold School of Public Health, and deputy director of TecHealth Center, told Healio. “However, there are important intervention strategies that should be used to help with the adoption of plant-based diets, so we should not expect to simply hand people some recipes and think they will be successful on their own.”
Appeal of plant-based plans
A plant-based eating plan offers individuals several advantages over other popular diets, Turner-McGrievy said during a virtual presentation at ObesityWeek Interactive.
“One of the appeals is that you don’t have to track your calorie intake,” Turner-McGrievy said. “Calories tend to naturally come down based on the foods that you are eating. I would also argue that complete adherence to plant-based may not be necessary, whereas with dietary tracking and self-monitoring, you really do need to adhere to that every day.”
Dietary intake spans a spectrum, ranging from no animal product intake, or vegan, to eating all animal products, or omnivorous, with in-between categories of semi-vegetarian and pesco-vegetarian. Most diet recommendations tend to fall in the semi-vegetarian category, promoting white meat and fish consumption along with plant-based meals, Turner-McGrievy said.
Research suggests that individuals assigned to a vegan eating plan are just as likely to adhere to the plan at 6 months when compared with other diets that incorporate plants, white meat and fish.
“Some people on the vegan diet did revert to an omnivorous diet, but fewer did this on the vegan diet than on the semi-vegetarian diet,” Turner-McGrievy said. “If we want to push people further down the spectrum, to eat more plant-based foods, it may be beneficial to make more aggressive recommendations vs. just limiting some meat.”
Lessons from NEW Soul
Turner-McGrievy and colleagues are currently conducting the Nutritious Eating with Soul, or NEW Soul trial, an NHLBI-funded 2-year intervention program examining two dietary approaches that emphasize soul food — vegan and a standard, low-fat diet — for the prevention of cardiovascular disease. The project was inspired by the underrepresentation of Black adults in behavioral nutrition and obesity intervention work, Turner-McGrievy said.
“There is such a thing as vegan soul food,” Turner-McGrievy told Healio. “Vegan soul food generally takes traditional soul food and makes it healthier, focusing on being plant-based, higher in fiber, cholesterol-free, and lower in saturated fat. This would include things like egg- and dairy-free cornbread, pinto beans, collard greens cooked without fatback, brown rice, and vegan mac-n-cheese.”
Participants in the program were randomly assigned to one of the two healthy versions of a soul food diet, with behavior change informed by social cognitive theory. The program offers cooking demonstrations by guest chefs and soul food restaurant owners, as well as hands-on group cooking — though classes have transitioned to virtual events due to COVID-19, Turner-McGrievy said.
“We do not just give them a meal plan and tell them to go on their way,” Turner-McGrievy said. “We work really hard to ensure that our participants have the support and information they need to be successful.”
Set up for success
Turner-McGrievy cited five strategies used in NEW Soul that can help obesity medicine specialists, dietitians and other providers improve adherence to a plant-based eating plan:
Find community partners, such as local chefs and restaurant owners, to be your champions and demonstrate new recipes. “Address potential barriers, like cooking or the palatability of foods,” Turner-McGrievy said.
Know the challenges your population faces. What barriers to adopting healthier diets are your patients facing? “We partner with an organization called Food Share, which offers produce boxes,” Turner-McGrievy said. “You can use SNAP benefits to purchase the boxes. We do a food challenge where participants receive a box from Food Share and they have to come up with a recipe using the foods provided that week.”
Provide many ways to deliver content. Leverage email and text messages, social media and private Facebook groups; send interesting nutrition news and useful recipes; conduct polls to boost engagement; and hold in-person sessions when safe to do so.
Tailor eating plans to the culture. Food guides like the Oldways African Heritage Pyramid stress appropriate healthy foods that are accessible, Turner-McGrievy said.
Don’t try to guess who will be successful. Showcase the expertise of successful past participants to help inspire new patients who are looking for mentors, Turner-McGrievy said.
“More long-term studies among diverse populations need to be conducted, and finding ways we can help people adopt and sustain these diets will continue to be necessary,” Turner-McGrievy told Healio.
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Turner-McGrievy. Farm to table – plant-based diets. Presented at: ObesityWeek Interactive; Nov. 2, 2020 (virtual meeting).
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