Q&A: MyPlate intervention may be 'practical alternative' to counting calories
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Key takeaways:
- MyPlate focuses on adherence to the DASH diet rather than counting calories.
- A study author told Healio that both strategies successfully reduce excess body fat, but MyPlate could be easier for some patients.
The United States Department of Agriculture’s MyPlate intervention could be a practical weight management alternative for patients who struggle with counting calories, according to researchers.
William J. McCarthy, PhD, MA, a professor at UCLA, and colleagues wrote in Annals of Family Medicine that U.S. authorities have supported the MyPlate intervention, which emphasizes adherence to the DASH diet, and calorie counting since 2011. The researchers conducted a study to compare the effect of both approaches on satiation and body fat composition.
They found that waist circumference was significantly decreased in both groups and satiation scores increased for both groups, but only MyPlate reduced systolic BP at 6 months. This effect, however, was not sustained at 12 months.
Additionally, the participants in both groups reported greater quality of life and high satisfaction with their weight-loss program, according to the researchers.
Healio spoke with McCarthy to learn more about the study’s findings, if he would recommend one approach over the other and more.
Healio: Will you briefly describe your findings and their importance?
McCarthy: The U.S. government via the CDC recommends the Diabetes Prevention Program (DPP) for adults at risk of type 2 diabetes because of excess body weight. The U.S. government via the U.S. Department of Agriculture also recommends adhering to the Dietary Guidelines for Americans as a way to prevent type 2 diabetes by minimizing excess weight gain.
The MyPlate icon is an iconic distillation of the Dietary Guidelines for Americans. The DPP approach implicitly says that what you eat is less important than making sure that the number of calories consumed each day creates an energy deficit for achieving optimal weight control. The MyPlate approach implies that limiting the number of daily calories consumed is less important than eating the right kind of foods for achieving optimal weight control. The significance of the MyPlate approach is that it is more accessible to low-income patients, who typically lack the numeracy level and the tools (eg, calculator, Excel spreadsheet, computer access to apps that track calories consumed and calories expended each day) needed to ensure a calorie deficit each day.
Our initial reasoning was that the MyPlate approach would boost consumption of fresh fruits, fresh vegetables and fiber-rich plant foods, which have lower energy density than fast food. If people fill up sooner on water-rich, fiber-rich foods like fresh fruits and vegetables, then they have less room for the more calorie dense foods associated with obesity. Better adherence to MyPlate, in short, was expected to increase satiety and reduce risk of overconsuming calories without the need to count calories.
The intervenors were community health workers, two of whom were Spanish bilingual. In both conditions, the study participants received 11 health coaching sessions over a 3-month period, two of which were home visits, two of which were group education sessions and seven of which were brief coaching calls. Participants were randomized to condition. At 1-year follow-up, both groups achieved significant reductions in their waist circumference, which reflects a reduction in excess body fat.
Healio: Given the results, would you recommend one strategy over the other for certain patients?
McCarthy: Both strategies successfully reduced excess body fat, as predicted. For people with the numeracy level and the tools needed to count calories expended and calories consumed daily, either approach would be good for achieving measurably less body fat at 1-year follow-up. For low-income patients with lower numeracy aptitude or without the tools needed to track calories, the MyPlate approach is the approach more likely to result in successful reduction in body fat.
Healio: What are the clinical implications of your study?
McCarthy: For clinicians frustrated by their patients’ inability to count calories and sustain a daily energy deficit long enough to lose significant body fat, the MyPlate approach represents a practical alternative.
Healio: Is there anything else you’d like to add?
McCarthy: Going into this study, we were confident that increasing patients’ adherence to MyPlate dietary recommendations would help patients with overweight lose some of their excess body fat because of the lower energy density of fresh fruits and vegetables. What we did not know then is the significant role that our gut microbiota plays in regulating our satiety.
The emerging science of the gut microbiota is providing additional justification for urging Americans to adhere to MyPlate guidelines because it turns out that our gut microbes thrive best on traditional, predominantly plant-based dietary patterns like the Mediterranean dietary pattern or the DASH diet, both of which are recommended in the Dietary Guidelines for Americans. There are 500+ microbial species in our gut, each with its own nutritional niche. The wide range of complex carbohydrates and polyphenols needed by these gut microbial species to thrive are most accessible when consuming a traditional plant-based dietary pattern and are less accessible when consuming fast food or other highly processed foods.