Maria Hassapidou – Dietary Guidelines for Obesity in Europe

YINI attended the 2024 ECO congress to gather scientific updates and expert’s advice on the role of diet and dairy in the management and prevention of obesity. The congress offered a great opportunity to meet with experts from various fields of expertise. Here Maria Hassapidou, Professor of Nutrition and Dietetics at the Alexander Technological Educational Institution of Thessaloniki (Greece) tells us about her work on the dietary guidelines for Obesity in Europe.

Can you introduce yourself?

I am a Professor of Nutrition and Dietetics at the International Hellenic University in Thessaloniki, Greece, and I chair the ESDN Obesity of EFAD, the specialized dietetic group on obesity of the European Federation of the Association of Dietitians. Additionally, I co-chair the Nutrition Working Group of the European Association for the Study of Obesity (EASO).

For the past decade, our collaboration between dietitians and obesity experts has been immensely beneficial. This synergy between the two groups was instrumental in the joint publication of the guidelines.

During the Congress, we observed that a multidisciplinary approach is crucial for managing obesity. Can you share the method used to develop the dietary guidelines?

As I mentioned during my presentation, our journey began with an EU umbrella project, providing an opportunity to develop dietary guidelines for obesity, particularly focusing on medical nutrition therapy. We conducted surveys across Europe to assess the existing guidelines and published comparative studies to identify similarities and differences. This process highlighted the need for unified European guidelines, which was strongly supported by scientists and healthcare professionals across various countries.

To address this, we collaborated between EFAD and EASO, forming working and writing groups. We conducted a systematic literature review, drawing heavily on the comprehensive Canadian guidelines for obesity treatment. By extending their methodology up to 2023 and sharing our findings with our Canadian colleagues, we benefited greatly from this collaboration. Simultaneously, we developed guidelines for children with obesity, incorporating significant contributions from Australian researchers and maintaining the same rigorous methodology.

Our guidelines categorize the strength of evidence into various grades and levels based on the methods used. I hope, as I mentioned, that we have produced a well-received consensus document. Initial feedback from dietitians and the European Federation Association has been positive, but it will take time to evaluate the practical implementation and effectiveness of these guidelines.

What are according to you the main highlights from these dietary guidelines?

As I mentioned during my presentation, the key point of these guidelines for both adults and children is the emphasis on treating comorbidities. These guidelines are not solely focused on weight loss or reducing BMI: their primary goal is to improve overall health. Medical nutrition therapy aims to reduce comorbidities, making health improvement the main objective. Different diets are graded based on evidence, demonstrating their effectiveness in reducing factors like cholesterol or blood pressure. While losing weight is important, maintaining overall health is paramount.

Another important aspect is the grading of different diets. We have gathered extensive information, including evidence on specific food groups. Common questions often revolve around the effects of particular foods, such as nuts or vegetables. For example, there is strong evidence that increasing vegetable intake can help reduce body weight. A significant focus of the guidelines is dedicated to food groups, with particular interest in dairy products.

Regarding dairy, we have a specific recommendation based on evidence. There was a substantial number of studies showing positive results for certain health parameters related to dairy consumption. Overall, the inclusion of dairy, and specifically yogurt, is supported by evidence in our guidelines.

In March 2024, the FDA accepted a qualified health claim on the preventive role of yogurt in type 2 diabetes. Is it something that could lead to an update of dietary guidelines?

There are European guidelines for diabetes that are updated every few years, managed by specialists in that field. Our focus is on obesity, so I can’t provide specific data on diabetes. However, as a nutritionist, I can say that yogurt plays a significant role in the microbiota, which is related to both obesity and diabetes. The type of yogurt matters, and there is substantial evidence supporting its benefits through physiological mechanisms.

Where or how can dietitians find the guidelines?

Dietitians can access our guidelines by downloading the free papers available online. They are also accessible on the EASO and EFAD websites. To encourage their use, we are planning workshops and webinars for health professionals to ensure they are aware of these guidelines. These efforts are being made through EASO, EFAD, and national associations. While it will take some time for the guidelines to be fully integrated, initial feedback from health professionals, especially dietitians, has been very positive, and they have expressed their intention to use them.

References:

• European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians
• EASO and EFAD Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Children and Adolescents