Energy balance: the key to a unified message on diet and physical activity

The aim of this commentary is to highlight the advantages of an energy-balance framework to unify diet and physical activity messages. Despite an array of pharmacotherapies, lifestyle modification remains the first-line approach for preventing obesity, cardiometabolic diseases, and cancer. Yet, patients, let alone professionals, often perceive recommendations on diet to be separate from, or even competitive with, those on physical activity. They perceive these as 2 sets of unrelated guidelines. This is a mistaken and unfortunate view. Nutrition and physical activity are highly interrelated, complementary, and synergistic. As exemplified by findings from the National Weight Control Registry, the power of combining a wise diet and a physically active lifestyle is compelling. Accordingly, the American Cancer Society and the American Heart Association have integrated their respective diet/physical activity/body weight recommendations into single documents. Corresponding follow-through at the clinical level is overdue. The diet versus physical activity question is passé. Let us move forward by teaching our patients about energy balance, the inclusive concept that captures the synergy between diet and physical activity. Adopting an energy-balance framework can improve the relevancy and potency of lifestyle messages to patients and better enable them to develop and apply effective behavior-change skills.