How can I effectively counsel patients on the benefits and risks of popular diets, such as ketogenic or intermittent fasting, in relation to metabolic

Effectively counselling patients on popular diets like ketogenic diets or intermittent fasting in relation to metabolic health involves several key points.

• Emphasise the importance of a nutritionally balanced diet in the long term, consistent with healthy eating advice such as the NHS Eatwell guide, rather than restrictive or unbalanced diets which are ineffective and potentially harmful over time.
• Explain that restrictive diets, including ketogenic or intermittent fasting, may have short-term benefits but are not recommended as long-term strategies due to risks such as weight cycling, weight regain, and potential adverse effects.
• For intermittent fasting, highlight that NICE currently recommends further research and does not endorse it as a standard approach for adults, so patients should be cautious and informed about the limited evidence base.
• Discuss that low-energy or very-low-energy diets should only be considered within specialist, multicomponent management strategies with clinical supervision, and are not suitable for general or long-term use.
• Inform patients about the likelihood of weight regain after restrictive diets and reassure them that this is not a personal failure, but part of the natural course, and discuss options for long-term weight maintenance including nutritional advice, physical activity, medicines, or surgery if appropriate.
• Encourage gradual, sustainable improvements in diet and physical activity that provide metabolic and overall health benefits beyond weight loss, such as improved mental wellbeing and reduced risk of chronic diseases.
• Tailor information to the individual’s needs, ensuring communication is clear, consistent, non-judgemental, and avoids weight stigma, supporting shared decision-making and informed consent.

In summary, counsel patients that while popular diets like ketogenic or intermittent fasting may offer some metabolic benefits, they should be approached cautiously, prioritising balanced nutrition, long-term sustainability, and professional support to minimise risks and optimise health outcomes.

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