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Can the Healthy Eating Index and Attention to Total Protein Foods Help Patients with Obesity Lose Weight?

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Can the Healthy Eating Index and Attention to Total Protein Foods Help Patients with Obesity Lose Weight?

— By Dawn M. Sweet, Ph.D

Discussing the Healthy Eating Index and Dietary Guidelines for Americans with patients with obesity provides a framework for thinking about the importance of a healthy eating plan.

Developed in 1995 as a collaboration between the U.S. Department of Health and Human Services’ National Cancer Institute and the U.S. Department of Agriculture (USDA) Center for Nutrition Policy and Promotion1, the Healthy Eating Index (HEI) is a tool that measures how well Americans are following the recommendations set forth in the Dietary Guidelines for Americans (DGA).2

The HEI and DGA are updated every five years by the USDA and HHS to ensure dietary recommendations are aligned with the most current empirically-based nutrition recommendations. Comprised of 13 components (e.g., total fruits, whole fruits, whole grains, and total protein foods), HEI foods are mapped to a dietary recommendation from the DGA.2 The HEI uses a scoring system to assign point values, and scores range from 0 to 100.3 Higher HEI scores reflect a diet that is aligned with the DGA. (Details on scoring standards can be found here.)

Health care professionals should consider talking with their patients with obesity about the HEI and DGA because these guidelines provide a framework for shaping a conversation about a healthy eating plan and what that looks like in the context of the most up-to-date recommendations. Of particular importance and interest in the context of weight loss is total protein foods.

Total Protein Foods

Total protein foods are measured as the consumption of all foods that are classified as proteins (e.g., lean meats and poultry, eggs, beans [legumes], and peas).4,5,6 Consuming the recommended daily allowance of protein is important, particularly for adults with obesity who are actively trying to lose weight. For example, as reported in a recent cross-sectional analysis of data curated from the National Health and Nutrition Examination Survey (NHANES)7, results suggest that less adipose tissue was observed in those whose diets included higher amounts of protein. In another recent report8, several benefits of higher protein diets were noted. For example, benefits included preservation of lean body mass, greater weight loss, blood pressure reductions, decreased waist circumference, lower serum triglycerides, and greater satiety.

In another cross-sectional study, protein intake was investigated in a cross-sectional study using three cycles of data (n=7,547 adults) from NHANES.9 This study investigated both quantity of total protein and protein source. The metric for quantity of protein was g/kg/d, which was derived by averaging daily protein intake across two 24-hour periods. The metric for protein sources was the Healthy Eating Index (HEI). The three protein sources were dairy, total protein foods, and seafood and plant proteins. A higher score correlates with better adherence to the HEI.

Participants’ physical activity was also measured (i.e., Global Physical Activity Questionnaire). Physical activity was a dichotomous measure, yes / no, for meeting the 150-minute recommendation of moderate weekly activity or 75 minutes of vigorous weekly activity or an equal combination. Lean mass was also calculated by dividing total lean mass (excluding BMC) by height in meters squared, e.g., LMI (kg/m2). Lean mass for arms and legs was calculated by dividing lean mass in arms and legs by height in meters squared (also excluding BMC); e.g., ALMI (kg/m2).

Results suggest that total protein intake was negatively correlated with LMI and ALMI, though higher quality protein sources (total protein foods and seafood and plant proteins) coupled with physical activity were positively associated. Those participants who did not meet physical activity recommendations were more likely to have low LMI and ALMI.

Conclusions and Implications for Clinical Practice

Weight loss is complex and multi-faceted issue that warrants a multifaceted strategy. The utility of the Healthy Eating Index and the Dietary Guidelines for Americans is evinced in their efficacy for fostering health-promoting behaviors and mitigating the risks of chronic diseases such as type 2 diabetes, cancer and cardiovascular disease, which are significant health risks for adults with obesity.2,3

Research suggests that the quantity and source of protein is important for wight loss and the preservation of lean muscle. Pairing physical activity with total protein foods is also an important part of a weight loss strategy. The Healthy Eating Index can help health care professionals build a healthy eating plan that not only meets their patients’ nutritional needs but also helps them achieve their weight loss goals.

When considering the Healthy Eating Index to shape a conversation with patients with obesity, nutritionally-formulated meal replacements warrant consideration. To ensure nutritional needs are being met, pre-packaged, nutritionally formulated meal replacement offer convenience and satisfy daily recommendations for vitamins and minerals. A Low Calorie Diet (LCD) or Very Low Calorie Diet (VLCD) should also be considered as part of an overall healthy eating plan.


1 Overview & background of The Healthy Eating Index

2 Update of the Healthy Eating Index: HEI-2015

3 How the HEI is scored

4 Dietary Guidelines for Americans

5 What we eat in America

6 The Healthy Eating Index 2010

7 Dietary protein and muscle mass: Translating science to application and health benefit

8 Dietary protein content for an optimal diet: A clinical review

9 The relationship between total protein intake, protein sources, physical activity, and lean mass in a representative sample of the US adults

About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.

About Robard: For 45 years, Robard Corporation’s medical obesity treatment programs and nutrition products have been utilized by physicians, surgeons and hospitals across the United States to successfully treat patients living with obesity. To learn more about us and how we can help your practice and patients, visit us online at, email us at, or call (800) 222-9201.

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