Structured Modified Dietary Intervention
Participants in the Why WAIT program receive dietary evaluation by the program RDs. The evaluation includes review of dietary history and 24-hour dietary recall of typical daily intake, review of adherence to dietary instructions during previous weight management attempts, and evaluation of possible barriers to following the program’s structured meal plan.
Based on gender and typical caloric intake from the 24-hour dietary recall, each participant receives a meal plan with a calorie reduction rounded to the nearest 1200, 1500 or 1800 calorie level. These meal plans were developed according to the Joslin Nutrition Guidelines for obese patients with type 2 diabetes, providing approximately 40-45% of calories from carbohydrate, <35% from fat with saturated fat <7%, and 1-1.5 gm/kg of adjusted body weight from protein and 15 gm/1000 calories of fiber.
All participants are instructed to use glycemia-targeted specialized nutrition (GTSN) as meal replacements for both breakfast and lunch for the initial 6 weeks. The GTSN used is either BOOST® Glucose Control™ , BOOST Calorie Smart™ (Nestle Medical Nutrition Inc, Minneapolis, MN) or Glucerna Hunger Smart (Abbott Nutrition, Columbus, OH). Participants are encouraged to eat two snacks between meals. A list of six choices of 100-calorie and 200-calorie snacks is provided. For dinner, participants are instructed to select from 14 different menus. Each dinner menu includes meal ingredients, nutrition facts and cooking instructions. Three menu books are designed for the 1200, 1500, and the 1800-calorie meal plans.
The full meal plans are low in glycemic index, and low in sodium (< 2300 mg/day). Each participant is provided with a written description of the meal plan and a dietary logbook and is asked to record food intake throughout the program. Participants who fail to achieve 3% weight loss by the 4th week or 5% by the 8th week are usually advanced to the second lower caloric level. At the 6th week, participants are provided with alternative menus for breakfast and lunch, which are equivalent in caloric content and composition to the meal replacements. Participants are given the option to either continue to use the GTSN, the natural food for breakfast and lunch or to alternate between them.
To learn more about the full dietary intervention of the Why WAIT either join the Why WAIT program at the Joslin Diabetes Center in Boston and read the Diabetes Breakthrough Book (Harvard Health Publication)
Copyright Osama Hamdy, MD, PhD