Energy diet (low) - weight management
This document is part of the ACI Diet Specifications for Paediatric Inpatients. It is not to be used for patient education.
Aim
To provide an energy-controlled diet with a wide variety of foods that will allow steady weight loss or prevent weight gain in low activity patients. For children over the age of 2 years only.
Characteristics
Foods should be low or reduced fat, low energy and may include artificial sweeteners. Low Glycemic Index (GI) foods should be included in every meal.
Target energy will depend on individual dietetic assessment and age of child as determined by the on-site clinical dietitian.
Aim for the following macronutrient distribution:
Carbohydrate: 45-50%E; Fat: <30%E (<10% energy from saturated fat); Protein: 20%E
A structured meal plan is recommended, to be planned by the dietitian according to patients’ individual needs. Intake should be regular and spread evenly through the day in appropriate serve sizes.
Midmeals to contain 1 serve protein containing food. Examples include:
- low fat cheese
- reduced fat yoghurt
- ½ lean meat sandwich with poly- or monounsaturated spread
- low fat milk.
Indications
For patients requiring a low energy diet for:
- overweight and obesity
- low activity patients (e.g. spinal injury)
- increased appetite due to medications (e.g. mental health patients).
Nutritional adequacy
Nutritionally adequate.
Precautions
Dietitians may manipulate diet selections to individualise total energy prescription. Note this diet is not suitable for children under 2 years of age.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | Main dishes ≤30% energy from total fat and ≤10% energy from saturated fat Lean meat, skinless chicken, fish, eggs Soy products (e.g. tofu, TVP) Cooked legumes | Fried foods and dishes in cream sauces High fat meats (e.g. sausages, bacon) Pies and pastries |
| Sauces, gravies | Vinegar, tomato sauce, small serve low fat gravy | White sauces, sour cream |
| Starchy vegetables/pasta/rice | All without added fat or < 1g fat per serve Small amounts of mono- or polyunsaturated oil (e.g. mashed and steamed potato, sweet potato) Use low GI rice (e.g. basmati or doongara) if possible (see GI website for full list) Single serves of pasta, rice, noodles | Fried and chipped potatoes Fried rice |
| Vegetables | All without added fat Steamed/boiled in water, stewed/baked without using fat | Fried, or served with margarine or white/cheese sauces |
| Soups | All with < 2g fat per serve (e.g. clear and low fat soups) Clear, vegetable and low fat soups | Cream soups |
| Sandwiches | All with < 8g fat per serve Salad vegetables/cottage cheese/ricotta Tuna/lean meats/egg white Wholemeal/wholegrain (low GI varieties) bread default Spreads to be mono- or polyunsaturated margarines (max 1 portion per 2 slices of bread) | Peanut butter, cheese High fat meats, salmon |
| Salads, dressings | < 2g fat per serve Low fat or low joule dressing | Cream, mayonnaise or full fat dressing |
| Breads, cereals | All breads, preferably wholemeal/wholegrain (low GI varieties) Rolled oats made on water Higher fibre breakfast cereals only (e.g. rolled oats, muesli, bran cereals, Guardian®, Weet-Bix™). At least 2 low GI cereal choices per breakfast (See GI website for full list) | Highly sugared breakfast cereals (> 30% sugar, unless primarily from added fruit) Sweet breads |
| Spreads | Mono- or polyunsaturated margarine (max 1 portion per 2 slices) Honey, jam, Vegemite™, peanut butter (portion controlled/slice) | Saturated fats (e.g. butter, shortening, lard, cooking margarine, coconut milk, palm oil) |
| Hot breakfast choices | Baked beans, spaghetti, mushrooms, boiled/ poached egg, scrambled egg using low fat milk | Fried egg, bacon, sausages Hash browns |
| Fruit | All fresh and canned fruit in juice/water | Dried fruit, fruit canned in syrup Juice |
| Yoghurt | Low fat and diet yoghurts | Full-fat yoghurt |
| Desserts | All with <2 g fat per serve Low-fat dairy desserts, low-joule jelly Low fat ice-cream (maximum 2 times per week) | Cakes and pastries, sugared jelly, cream Full-fat ice-cream and toppings |
| Milk and cheese | All reduced fat dairy Low fat milk Ricotta or cottage cheese | Full fat milk Hard cheese |
| Beverages | Water Reduced fat milk Reduced fat soy beverage Low joule cordial or soft drinks | Full fat or flavoured milk Cordial, soft drink Juice |
| Biscuits | <2g fat per serve Corn, rice cakes, crackers, wafers | All others |
| Miscellaneous | Lemon wedge All midmeals to contain at least 1 protein containing food 1 sachet artificial sweetener per meal for children >13 years | Sugar sachet Artificial sweetener sachets for children <13 years of age Nuts, chocolate, chips |
References
- Agency for Clinical Innovation. Nutrition standards for paediatric inpatients in NSW hospitals. Sydney 2011.
- Agency for Clinical Innovation. Nutrition standards for adult inpatients in NSW hospitals. Sydney 2011.
- Dietitians Association of Australia. 2009. Nutrition manual 8th ed. Canberra: DAA.
- American Dietetic Association. Paediatric Nutrition Care Manual. Chicago: ADA.
- American Diabetes Association: Clinical recommendations for people with diabetes. 2008
- Thomas DE, Elliott EJ, Baur L Low glycaemic index or low glycaemic load diets for overweight and obesity (review); The Cochrane Collaboration and published in The Cochrane Library Issue 3, 2007.
- Luttikhuis HO et al Interventions for treating obesity in children The Cochrane Library Issue 2 2008
- Sydney Children’s Hospitals Network fact sheets:
- Shaw V and Lawson M. Clinical Paediatric Dietetics. 3rd Edition. 2007. Blackwell Publishing.
- University of Sydney Glycemic Index.
- Diabetes Australia Glycaemic Index.