Analyse critique des régimes riches en protéines pour le traitement de l'obésité

The importance of the composition of a diet for obesity management is debated. There is increasing interest in the efficacy of diets that have a high protein content with a moderate carbohydrate and fat content. Ad libitum consumption of a low-carbohydrate, high-protein diet, results in short-term weight loss. However, in long-term studies (1-2 years), the specific macronutrient content is of minor importance, the weight loss is generally not sustained beyond 6 months or 1 year. Greater weight loss with low-carbohydrate high-protein diets under conditions of ad libitum diet as compared with isoenergetic diets may be ascribed to the satiating effects of high protein content. When energy is reduced, protein influences modestly body weight loss and weight maintenance via its effects on satiety, thermogenesis and body composition (reduction of fat mass and preservation of lean mass). The prevention of weight regain is crucial. Adherence to dietary prescriptions and other behavioral prescriptions (e.g. instructions to increase physical activity) is considered to be very important for successful medical management of any chronic disease states. Substantially diminished adherence after the first few months is typical in weight-loss trials. So diets have to be tailored to individual patients on the basis of their personal and cultural preferences. A modest increase in protein content, a modest reduction in the glycemic index and in fat, have been shown to improve study completion and maintenance of weight loss, especially in patients who have a good initial weight loss. As far as weight maintenance is concerned, it is critical to prevent the decline in the size of lean mass and a lowering of the rate of metabolism per mass unit of tissues and organs (i.e. adaptation). Absolute protein intake seems to be more important than is the proportion of proteins in the diet. Expressed in grams/day the protein content should be normal. Sustained physical activity is a second key factor for weight maintenance. Finally, therapeutic patient education could improve health outcomes, including quality of life, due to its possible impact on patient adherence and the patient-physician relationship. Obesity management needs to develop individualized approach that is sensitive to patient's needs and hopes.