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NICE – Interventions to change diet

  • Tailor dietary changes to food preferences and allow for a flexible and individual approach to reducing calorie intake.​
  • Do not use unduly restrictive and nutritionally unbalanced diets, because they are ineffective in the long term and can be harmful.​
  • Encourage people to improve their diet even if they do not lose weight, because there can be other health benefits.​
  • The main requirement of a dietary approach to weight loss is that total energy intake should be less than energy expenditure.​
  • Diets that have a 600 kcal/day deficit (that is, they contain 600 kcal less than the person needs to stay the same weight) or that reduce calories by lowering the fat content (low-fat diets), in combination with expert support and intensive follow-up, are recommended for sustainable weight loss.​
  • Consider low-calorie diets (800–1600 kcal/day), but be aware these are less likely to be nutritionally complete.​
  • Do not routinely use very-low-calorie diets (800 kcal/day or less) to manage obesity (defined as BMI over 30).​
  • Only consider very-low-calorie diets, as part of a multicomponent weight management strategy, for people who are obese and who have a clinically assessed need to rapidly lose weight (for example, people who need joint replacement surgery or who are seeking fertility services). Ensure that:

    • the diet is nutritionally complete
    • the diet is followed for a maximum of 12 weeks (continuously or intermittently)
    • the person following the diet is given ongoing clinical support.
  • Before starting someone on a very-low-calorie diet as part of a multicomponent weight management strategy:

    • Consider counselling and assess for eating disorders or other psychopathology to make sure the diet is appropriate for them.
    • Discuss the risks and benefits with them.
    • Tell them that this is not a long-term weight management strategy, and that regaining weight may happen and is not because of their own or their clinician's failure.
    • Discuss the reintroduction of food following a liquid diet with them.
    • Provide a long-term multicomponent strategy to help the person maintain their weight after the use of a very-low-calorie diet (see implementing lifestyle interventions in this pathway).
    • Encourage people to eat a balanced diet in the long term, consistent with other healthy eating advice. 
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