Dietary Assessment

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Although diets for obesity treatment may vary according to financial, personal, cultural, religious and social beliefs, it is essential before any such diet is prescribed that a background describing the patient's habitual eating habits is obtained. Dietary habits can be assessed by numerous techniques. In specialist clinics where dieticians are available sophisticated methods can be used and also evaluated. In a primary health care setting where specialists may not be available to interpret a diet, simpler techniques may have to be relied upon.

Specialists are well aware of the numerous pitfalls associated with the interpretation of dietary records. For many patients, the suggestion to keep a diet record in itself is provocative and may cause even violent reactions and questioning. For others, the records may actually serve as a helpful and constructive tool to identify eating habits, of which the subject was actually unaware until a record was kept. For others again, the diet record may be a frustrating and painstaking process leading to conscious or unconscious omission of important dietary items.

Several studies have demonstrated that many obese patients report considerably less than what is estimated from predicted equations for such obese persons in energy balance (1). This could be explained in several different ways. It is possible that these patients underreport at the time of the diary period and especially that they underreport food items which they are aware that they should avoid. However, as stated above, it is also possible that the recording period in itself will lead to a diet period during the recording process, in which case the dietary record actually reflects a true energy intake, but only for a period which is not representative of the general eating pattern of the patient.

There is general agreement that dietary assessments are worthwhile and should be compared to the energy intake from predictive equations to allow a realistic dietary prescription. As pointed out by Frost, it is not uncommon that the dietary advice will contain more energy than what is reported by the obese person, and surprisingly such a paradoxical recommendation may work well (2).

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