Receipt date: 02/12/25 Revision date: 05/12/25 Acceptance date: 02/06/26

Introduction

Overweight and obesity, defined by a Body Mass Index (BMI) > 25 kg/m² and > 30 kg/m², respectively, along with their associated comorbidities, have reached pandemic proportions, with no clear signs of reversal [1].

In 2022, approximately 43% of the world's population was overweight, and 16% was obese. The World Health Organization (WHO) estimates that by 2030, nearly 1 trillion adults and 340 million children could be living with obesity [2]. In 2023, 61.4% of the Brazilian adult population was overweight, and 24.3% was obese [3].

In the United States, obese individuals incur medical expenses that are 41% higher [4]. In 2020, the overall economic impact of obesity in the Americas accounted for more than 3% of the Gross Domestic Product [5]. In Brazil, it was 1.98% in 2019, with projections of 4.66% for 2030 [5].

Comorbidities include cardiovascular disease, type 2 diabetes, certain types of cancer, hypertension, and chronic kidney disease, among others, which significantly contribute to a reduction in quality of life and life expectancy [6].

The excellent metabolic and cardiovascular health of hunter-gatherers, a result of their lifestyle, leads them to be considered ideal models for public health promotion [7].

They were nomads and maintained a varied diet consisting of fruits (both sweet and non-sweet), non-starchy tubers, cruciferous vegetables, lean animal products, mushrooms, nuts, and honey. They engaged in adequate levels of physical activity, which helped maintain their energy and metabolic balance [8].

Metabolic flexibility allows the body to switch between fats and carbohydrates as energy sources, enabling it to adapt well to seasonal and regional variations in food supply, with weight fluctuations within parameters considered healthy [8].

With an average life expectancy of less than 30 years, the leading causes of death were: infections, high infant mortality, accidents, and violence [9]. Even among people over 50, noncommunicable diseases were very rare [10]. What changed?

The causes of obesity are complex and can be grouped into the following categories: genetics, physical activity, mental health, diet, and environmental pollutants.

It is estimated that genetics could account for between 40% and 70% of the predisposition to developing obesity [2]. However, the transition from hunter-gatherer societies to modern lifestyles was too brief to allow for major genetic changes that would contribute to obesity. What happened was that the environmental changes were so drastic that genetics did not have time to adapt to the new conditions [11].

We constantly hear that one of the causes of obesity is a sedentary lifestyle. However, while hunter-gatherers engage in higher levels of physical activity (they walk a lot, move around, and forage), recent studies show that their daily energy expenditure was not significantly higher than that of the average modern population [10].

This explains why the WHO's recommendations are moderate: 150 to 300 minutes per week of moderate-intensity aerobic activity, or 75 to 150 minutes of vigorous-intensity activity, or an equivalent combination. In addition, older adults should engage in muscle-strengthening activities that involve all major muscle groups at least two days a week [12]. 

Even so, it is estimated that approximately 81% of adolescents (ages 11–17) and 27.5% of adults worldwide do not meet the recommended levels of physical activity [13]. 

The relationship between mental health and obesity is complex and bidirectional, with interdependent effects [14], including: chronic stress, anxiety, depression, emotional eating, sleep disorders, and issues related to self-image and self-esteem [15].

The transition to modern lifestyles transformed the neuropsychological processes involved in appetite, satiety, and energy regulation. The brain's reward circuit, which evolved to respond to food scarcity, is now overstimulated by highly palatable processed foods. In addition, sleep disturbances and circadian rhythm disruption—which are common in urban environments—alter key hormones such as leptin (satiety) and ghrelin (hunger) [16]. These endocrine changes are accompanied by mechanical eating behavior (eating without feeling hungry) and reduced physical activity. Taken together, the interplay of heightened reward sensitivity, reduced inhibitory control, hormonal disruption, and automated habits creates a psychological and neural environment conducive to excess calorie intake, overweight, and noncommunicable diseases.

In Brazil, approximately 60% of patients with obesity have some form of psychiatric disorder—particularly stress, depression, and binge-eating disorder [17]. Mental health is also closely linked to nutrition. Even marginal nutritional deficiencies negatively affect brain and nervous system function [18]. Obesity, for its part, promotes a state of hidden chronic inflammation, a factor recognized in the pathophysiology of depression and other neurological disorders [19].

A significant portion of the “traditional” diet of hunter-gatherers was replaced by the “new” foods of the modern diet. The mastery of fire made it possible to consume starchy foods (grains, starchy tubers, and legumes). The agricultural revolution led to an abundance of these foods, [8,20,21]. Fatty meats from domestic animals replaced lean meats from game [22]. We use milk and milk products. The Industrial Revolution led to the widespread use of refined foods (white wheat flour and white rice). It also made it possible to produce highly refined foods, such as sugars, oils and fats, starches, and distilled alcohols [23]. All of these new foods replaced a significant portion of the foods from Origins [24]. 

At the beginning of the last century, the food industry revolution led to the development of a wide range of food additives (colors, flavorings, acidulants, emulsifiers, preservatives, antioxidants, non-caloric sweeteners, thickeners, anti-caking agents, among others) [25], many of which are highly controversial in terms of their safety [26].

These additives, along with advances in food processing and the communications revolution, paved the way for the industrialization of cookies [27], bread [28,29], pasta [30], potato chips [31], refined sugar [32]. In addition, carbonated beverages appeared for the first time: 1904 [33], refined vegetable oils: 1920 [34] fast food: 1921 [35], ready-to-use industrial cake mix: 1940 [36], corn flakes: 1930 [37], hydrogenated oils (trans fats): [34], In addition, the consumption of french fries at fast-food chains became popular [31], as did pizza with the advent of quick delivery services: 1980 [38], industrialization of rice cultivation and refining: 1940 [39] and the spread of the rice-and-beans combination in Brazil: 1960 [39]. All of this comes together in a Perfect Food Storm.

This led to significant changes in nutrition, the most important of which were: an increase in the consumption of foods with high caloric density and low nutritional density, and an increase in the glycemic load (GL) of meals.

a) Caloric Density

One of the keys to losing weight is to increase calorie expenditure and reduce calorie intake to maintain a deficit.

Based on U.S. food composition tables. [40] The ranges of caloric density (calories per 100 g) were determined for different food groups. Figure 1 illustrates a comparison between “Traditional” and “New” foods, with the latter having a significantly higher calorie density, which is associated with overweight and obesity [41].

Figure 1: Caloric density 

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b) Nutritional Density

There has recently been growing concern about ensuring an adequate intake of essential nutrients to combat the “double burden of malnutrition” (obesity caused by consuming too many calories, combined with nutritional deficiencies caused by eating nutrient-poor foods). These nutritional deficiencies, even when mild, are enough to disrupt our metabolic, physical, and mental performance, hindering efforts to lose weight and maintain a healthy weight [42]. Unfortunately, nutritional deficiencies are common in many restrictive diets [43]. One consequence of these nutritional deficiencies is low-grade (hidden) chronic inflammation, which, although it does not cause any direct symptoms, is responsible for most comorbidities in people who are overweight or obese [44].

Guiding the population in a simple and effective way toward an adequate intake of nutritious foods is a challenge due to factors such as: low nutritional/food literacy [45], information overload and misinformation [45], resistance to changing habits, socioeconomic and food access barriers, and limitations among health professionals [46].

Various initiatives have been implemented, including dietary re-education [47], dietary guidelines [48], nutrition labeling [49], nutrition claims [50] and front-of-package labeling [51], with results falling short of expectations.

A recent proposal is the concept of Nutritional Density [52]. For this paper, the following definition was chosen: “times the daily requirement for a nutrient, based on the amount of food that meets the daily requirement in terms of calories.” 

To operationalize this concept, the Recommended Daily Intake (RDI) values for each nutrient, as defined by the Food and Nutrition Board of the U.S. National Academies, were used. [53], in combination with data from U.S. food composition tables. [40], allowing for the calculation of the percentage of a nutrient’s daily requirement present in 2,000 calories (the requirement for an average adult male). Next, the average was calculated for 12 vitamins, 8 minerals, fiber, and protein.

It was observed that foods within the same group tend to be rich or poor in the same nutrients [54]. This allowed us to estimate the representative average nutritional density for a food group, taking into account the most characteristic foods.

In Figure 2, we can see that “Original” foods have high nutritional density, while most “New” foods have low nutritional density; some of them are even “empty calories” (they provide calories but little or no other essential nutrients).

Although this assessment does not include polyphenols—since no RDI has been established for them—we know that fruits (both sweet and non-sweet), cruciferous vegetables, non-starchy tubers, mushrooms, and nuts are rich in these nutrients. The polyphenol content of modern foods, especially refined ones, is already significantly lower [55,56], which underscores the high nutritional value of Orígenes foods.

Figure 2: Average Nutritional Density by Food Group

Furthermore, by comparing Figures 1 and 2, we can see that most foods with low caloric density also have high nutritional density, establishing a synergy between the two concepts and making it easier to choose more appropriate foods [57].

It is striking to note that 45.2% of the calories in the modern Western diet come from empty calories (refined oils, fats, and sugars) and 21.9% from foods with low nutritional density (grains and starchy tubers). Fruits and vegetables account for just 4.4% of the calories. Foods of animal origin account for 25%, while legumes, nuts, and oilseeds—which have an average nutritional density—account for just 4.4% [24]. This explains the high prevalence of nutritional deficiencies. 

c) Glycemic Load (GL)

It is recommended to prioritize foods with a low glycemic index (GI) [58]. However, it is the CG (GI multiplied by the amount of carbohydrates in a serving) that determines a meal’s glycemic response, which is classified as low < 10 g, moderate 11 to 19 g, and high > 20 g [59].

Frequent consumption of meals with a high glycemic load results in constant, sharp spikes in blood glucose and insulin levels, which are associated with obesity and its comorbidities [60].

Excess glucose is stored as glycogen in the muscles and liver. As glycogen stores become saturated, excess glucose is converted into fatty acids and stored in adipose tissue. Calories from fat and excess protein follow the same path. As a result, the body's metabolism is geared toward using glucose as its primary source of energy. To burn fat (both stored fat and fat from food), it is necessary to moderate the glycemic load of meals to reduce glycogen stores, which allows the metabolism to shift. [61].

Although it is difficult to estimate the ketogenic potential (CG) of the hunter-gatherers’ diet, all evidence suggests that it was extremely low, fluctuating between ketogenic periods (very low) and low periods (around 10 g) [62]. A recent assessment found that the average daily carbohydrate intake in the U.S. is 133 g, which is equivalent to 44 g per meal (assuming the population eats 3 meals per day) [63], well above the diet described in *Origins*.

d) Other Changes

Heat treatment destroys vitamins and promotes adverse reactions, such as the formation of acrylamide (resulting from the interaction between starches and proteins) and nitrosamines (formed by the reaction of nitrite with proteins), both of which are recognized as carcinogens [64]. 

Convenience, combined with today’s fast-paced lifestyle, has altered traditional eating patterns: greater reliance on fast food, frequent eating away from home, and less time spent preparing meals, all of which negatively impact the nutritional quality of the diet [64].

Genetic selection has made it possible to select plants and animals with favorable genetic traits, such as resistance to environmental variations, disease tolerance, higher productivity, and better organoleptic qualities [65]. However, varieties with lower nutritional value and higher levels of toxins and antinutrients were inadvertently selected [65].

In addition, environmental pollution worsened as a result of the introduction of chemical compounds that persist in the environment [66]. Among these, endocrine disruptors (such as bisphenol A, phthalates, pesticides, and flame retardants) stand out, as they are implicated in hormonal and metabolic dysfunction [67], antibiotics, and growth-promoting hormones used in animal feed, whose residues induce bacterial resistance and potential endocrine imbalances in consumers [64]. The role of pesticide/agrochemical use in the onset or worsening of chronic noncommunicable diseases is increasingly well documented [68]. At the same time, nanoparticles (<100 nm) originating from industrial processes were detected; their toxic effects include oxidative stress, inflammation, and possible cellular damage [69,70]. The environment was also contaminated with heavy metals, such as lead and cadmium [71], as well as complex chemical mixtures (pesticides, herbicides, PCBs, PFAS) [72]. Finally, combustion gases generate a variety of air pollutants—gases and particulate matter—that contribute significantly to the development or worsening of noncommunicable diseases [73].

Various medications can contribute to the development of obesity by increasing appetite, causing fatigue, or interfering with nutrient absorption. Notable among these drugs are those used to treat diabetes, epilepsy, and high blood pressure, as well as antipsychotics and antidepressants [74]. Treating a comorbidity can contribute to the onset or worsening of obesity, which will make it more difficult to treat the comorbidity being addressed and may lead to the development of other comorbidities.

The dramatic decline in height following the onset of the agricultural revolution was already a warning sign. Reliance on a limited variety of foods and living in settlements led to a decrease in life expectancy, an increase in infectious diseases, and a rise in nutritional deficiencies [75].

The refining of foods during the Industrial Revolution led to an increase in nutritional deficiencies: scurvy (vitamin C), pellagra (niacin), beriberi (vitamin B₁), iron-deficiency anemia (iron), goiter (iodine), xerophthalmia (vitamin A), spina bifida (folic acid), among others [23].

Overcrowding in permanent settlements, combined with reduced immunity, contributed to the spread of infectious diseases [75]. At the same time, changes in diet led to alterations in the composition of the gut microbiota [75].

It is estimated that more than 50% of deaths from noncommunicable diseases are related to low-grade (hidden) chronic inflammation [44]. There is a vicious cycle between hidden inflammation and obesity. Silent inflammation disrupts metabolism and negatively affects the regulation of hunger and satiety, leading to an increase in adipose tissue, which, in turn, contributes to the production of elevated levels of inflammatory cytokines, thereby perpetuating the cycle of silent inflammation [76]. This inflammation is caused by: spikes in blood glucose and insulin levels [77] high consumption of trans fats [78]; a high omega-6 to omega-3 ratio [79]; additives in processed meats [80]; excessive alcohol consumption [81]; allergies [82]; gut microbiota dysbiosis [83]; lactose intolerance [84]; gluten intolerance [85]; artificial additives [86]; environmental contaminants, pesticides, heavy metals [87]; nutritional deficiencies, particularly of antioxidant and anti-inflammatory nutrients [88]; stress [89]; sedentary lifestyle [90]; low intake of soluble fiber [91]; smoking [92]; endocrine disruptors [93] and sleep disturbances [94] Various studies indicate that, to combat hidden inflammation, it is necessary to reduce exposure to the aforementioned inflammatory agents and adopt a diet rich in anti-inflammatory compounds [95].

Starting in the 20th century, there were major advances in vaccines, antibiotics, sanitation, medical care, disease diagnosis and treatment, better education, food fortification, increased purchasing power, and a reduction in smoking, all of which contributed to increased life expectancy [96]. Conversely, the rise in noncommunicable diseases due to changes in diet is causing life expectancy to begin to decline [97].

The modern Western diet causes an imbalance in the gut microbiota (dysbiosis), which is associated with metabolic problems, inflammatory diseases, mental health issues (such as anxiety and depression), and gastrointestinal disorders [98].

The intervention program focuses on managing the three most important hormonal systems involved in regulating satiety: 1) Maintain stable blood glucose and insulin levels by eating meals with a moderate glycemic load [99]. 2) Keep ghrelin levels low by choosing foods that remain in the stomach longer [100–102], where, for proteins, it is longer than for saturated fats and longer than for fiber [103]. 20 to 30 g of protein produce a feeling of fullness that lasts 3 to 6 hours. Larger amounts do not significantly increase this effect  [104]. 3) Maintain an adequate intake of protein, soluble fiber, polyphenols, and omega-3 fatty acids, all of which play a crucial role in regulating appetite through the hormone GLP‑1 (glucagon-like peptide) [105].

Strategies for combating obesity include: dietary education, diets, regular physical activity, medication, meal replacements, and bariatric surgery [106].

Diets include calorie, fat, or carbohydrate restriction; alternative eating patterns (Mediterranean, Paleolithic, vegetarian/vegan, ketogenic, and carnivore); intermittent fasting; and the use of meal replacements [107,108].

Governments have contributed by developing dietary guidelines [109], nutrition labeling [110], front-of-package labeling [111], nutritional claims [112] and taxes on foods considered unhealthy. 

Despite the individual advantages of each strategy, the “rebound effect” remains a common problem. In addition, the effectiveness of weight loss tends to decrease with successive attempts [113].

The importance of healthcare professionals is clear [114]. However, many doctors do not feel adequately prepared [115]. In addition, clinical practice often focuses on pharmacological treatments, while lifestyle changes receive less attention [115]. The importance of psychology has recently been highlighted [116]. A holistic approach involving doctors, nutritionists, and psychologists yields better results [117].

The media has a complex relationship with obesity and noncommunicable diseases. The industry frequently advertises unhealthy products [118], Promotion of healthy foods is rare and limited to isolated initiatives by small producers or regional associations [119]. In addition, digital media often portray unrealistic body standards and lifestyles, promoting harmful eating and physical activity habits [120]. Misinformation and vague advice increase consumer confusion, leading them to make poor choices [118]. Incorrect information tends to persist in the media, prolonging the confusion [118].

Information Technology (IT) solutions can be used to develop healthy habits. In Brazil, most people own a cell phone [121] and spend an average of more than 4 hours on social media, with WhatsApp, Facebook, and Instagram being the most widely used [122]. Advances in 5G technology enable fast data transmission, leading to a better experience [123]. The Brazilian healthcare market is rapidly adopting IT [124,125]. There are already apps for tracking habits, physical activity, nutrition, heart rate, and sleep patterns. There are communities for sharing experiences and providing mutual support [126]. Virtual coaching services provide personalized professional guidance through digital platforms. Artificial intelligence is rapidly making inroads into the Brazilian healthcare sector [127].

A recent publication evaluated 8 studies that used web-based platforms and showed good results [128]. Another meta-analysis found that interventions using IT produce better results [129].

Changing habits requires considerable effort and time [130]. Barriers include: lack of motivation, an unfavorable environment, lack of knowledge, fear of failure, old habits that are difficult to break, lack of social support, unrealistic expectations, lack of time, and resistance to change [131,132]. Deep-rooted misconceptions cause confusion and are difficult to change [133].

Nutrition is a relatively new and highly complex science that requires large-scale, long-term research and significant resources, which means that areas of uncertainty still exist (for example: margarine or butter, whether or not to eat eggs, fruit for people with diabetes, etc.) [134]. Commercial and political interests, as well as inappropriate professional practices, contribute to this confusion (for example, the myth—dating back more than 70 years—about the harmful effects of saturated fats) [135].

To make matters more complicated, we have to deal with the forgetting curve (in a week, we’ll remember about 20% of what we saw today) [136]. Frequent reinforcement at short intervals is more effective than spaced reinforcement in promoting sustainable changes [137].

The cost of in-person professional coaching makes it difficult for many people to attend frequent sessions aimed at changing habits [138].

Table 1 provides a summary of the holistic restructuring plan under review:

Table 1: Elements of the intervention plan

Method

To assess the effectiveness of the proposed program, an experimental, longitudinal, descriptive study with a mixed-methods approach (qualitative and quantitative) was designed and approved by the Brazilian Ethics Committee.

Participants were selected using non-probability sampling, by sending a WhatsApp message to the researcher’s circle of contacts. Eligible participants were those over 18 years of age, with a BMI > 27.5, who were comfortable using cell phones, who wished to lose weight, and who were able to attend the initial and final in-person meetings. Pregnant women, people with eating disorders (bulimia, anorexia nervosa, and binge eating disorder), and vegans were excluded.

A total of 50 participants completed the online medical history questionnaire, which asked about gender, age, height, weight, target weight, physical activity, diagnosed comorbidities (type 2 diabetes, hypertension, depression, high cholesterol, constipation, fatty liver, hypothyroidism, anemia, osteoporosis, sarcopenia), use of supplements, weight-loss medications, and regularly taken medications, food intolerances, stress levels, and general aspects of eating habits and attitudes.

Of the 28 people who signed the Informed Consent Form and began the program, four dropped out (a dropout rate of 14%). Two people were unable to participate in the final event (one had a leg in a cast and the other was on a business trip), but these are not considered withdrawals. Twenty-two people completed the program (20 women and 2 men), with an average age of 57.5 years.

Participants were added to a WhatsApp forum to share experiences and ask questions, and they registered on the support platform (www.praam.net), which provides daily videos ranging from 5 to 10 minutes in length. In addition, the platform provides a summary of the appropriate serving sizes for 10 g of CC (culinary units, weight, calories, and nutritional density) for the most common foods,

Participants were asked to complete online questionnaires on Eating Habits (developed and validated by the ELSA‑Brazil project [139], which measures the frequency of food consumption) and Physical Activity (developed and validated by the ELSA-Brazil project [140], which assesses the type, frequency, duration, and intensity of activity).

Based on the responses, individual evaluations—including areas for improvement and personalized action plans—were sent (via private WhatsApp). In the most challenging cases, a personalized virtual meeting was held to exchange ideas. Participants with high levels of stress and depression were advised to seek additional professional support. To prevent demotivation, those with unrealistic goals were advised to adjust their goal to losing about 10 kg during the first three months of the program.

Participants were invited to an in-person session for fasting weight measurement (between 8:00 a.m. and 9:00 a.m.) using bioimpedance (an Omron scale, model HBF-226, which measures: weight (kg ± 100 g), total body fat (% of total weight ± 0.1%), visceral fat (% of total body fat ± 1%), and skeletal muscle mass (% of total weight ± 0.1%)). After weigh-in and breakfast, there was a brief introduction to the program.

In order to correct any preexisting nutritional deficiencies and dysbiosis that could compromise the program’s effectiveness, it was suggested that a vitamin-mineral supplement, probiotic, prebiotic, and omega-3 be included during the first month.

We have asked that you post your fasting weight on Fridays—using your own scale—either on the forum or via personal WhatsApp. In return, they received feedback through the same channel, with the goal of boosting their self-esteem and identifying opportunities for improvement, in line with the concept of the spiral of continuous improvement.

The content and sequences of the daily videos were designed to persuade and gradually encourage the changes listed in Table 1.

The virtual group meetings, held every Saturday and lasting about an hour (recorded so participants could watch them later if necessary), supported the process of changing habits by answering questions and sharing experiences.

If necessary, participants were able to contact the program mentor privately (via WhatsApp) to discuss confidential matters. Similarly, the mentor reached out to participants who were underperforming in order to assess their challenges and support them through the process of change.

At the end of 12 weeks, another in-person visit was held to measure the final body composition (weight, total body fat, visceral fat, and skeletal muscle mass), and participants were asked to complete the Dietary Habits and Physical Activity questionnaires again. In addition, participants were asked to complete the “How Was My Journey?” questionnaire, which assessed their perceptions of improvements in health (overall and regarding preexisting conditions) and their level of satisfaction with the videos (number viewed, clarity, and relevance of the content), virtual meetings (participation and usefulness), the WhatsApp forum (participation and usefulness), and their willingness to recommend the program.

After the 12-week intensive period ended, participants continued in the program for another 9 months, with the difference that there were no longer daily videos and the virtual meetings became monthly, aimed at reinforcing the changes in habits they had developed.

Results

Table 2 shows the p-values for Student’s t-test for paired samples and the effect size measured by Cohen’s d, confirming that there was a statistically significant increase in the frequency of consumption of “Traditional” foods and a statistically significant decrease in the frequency of consumption of “New” foods. Among the Orígenes foods, there was a statistically significant increase in the consumption of sweet fruits, leafy greens, and vegetable soup. The reduction in non-sweet fruit is at the statistical threshold. In the “New” food group, a statistically significant decrease was observed for: cereals, starchy tubers, legumes, dairy products, processed animal-based foods, and refined oils and fats. These changes are in line with the goal of reducing the intake of foods with high caloric density (Figure 1) and increasing the intake of foods with high nutritional density (Figure 2).

Table 2: Changes in Eating Habits

In addition, a significant change in CG was observed for each participant, with the mean decreasing from 53.9 to 23.1 g/meal (p = 6.2 × 10⁻⁸ and Cohen’s d = 1.72).

With regard to physical activity, a statistically significant difference was observed only for the total time spent on each activity (walking / light activity / vigorous activity), which increased from 185.1 to 241.5 minutes per week (p = 0.0051 and Cohen’s d = 0.67), exceeding the 150 minutes per week recommended by the WHO.

Table 3 shows the anthropometric variations

Table 3: Anthropometric Variations

Figure 3 shows the weekly changes in average weight for the half of the participants who lost weight more quickly (-7.9 kg) and the half who lost weight more slowly (-3.2 kg), in accordance with the guidelines that each participant chooses their own rate of weight loss.

Figure 3: Weight Loss Curve

According to a recent meta-analysis that compared 14 programs over a six-month period, the ones that stood out the most were: South Beach, losing 9.9 kg; Jenny Craig, 7.8 kg; Volumétrica, 6 kg; and Atkins, 5.5 kg. [141]. With an average weight loss of 5.6 kg achieved in half the time (3 months), this program ranks among the best in the world.

Figure 4: Perceived improvements in health in general 

Figure 4 shows the number of participants who reported improvements in their overall health. No one mentioned any damage. Figure 5 shows the number of participants who reported improvements in their preexisting health conditions. Only one case reported worsening constipation, with suspected causes unrelated to the program. Several participants reported improvements in self-esteem and immunity, as well as a reduction in feelings of guilt. During the first and second weeks, some participants reported mild headaches, which were attributed to a blood glucose level well below the recommended range. After the treatment, the symptoms disappeared. 

There was a wide range in the number of videos viewed. 90% found the videos clear and relevant. Sixty percent considered participation in the weekly meetings to be “very useful,” and nearly 50 percent felt that the Forum helped with the process. Everyone said they would recommend the program.

Figure 5: Perceived improvements in preexisting health conditions

Discussion and Conclusions

Changes in eating habits and physical activity confirm a shift toward a more mindful and intuitive approach, which is key to losing weight quickly and healthily. The virtual tools (initial assessment, support platform, videos, modules, forum, weekly meetings, WhatsApp conversations) and the use of psychological approaches (defining the big picture, the spiral of continuous improvement, CBT, mindfulness, and combating stress and the cycle of restrictions-frustrations-guilt) worked in holistic synergy to help participants achieve their goals.

Moderate Caloric Density

Counting calories versus moderating calorie density is a recent debate [142,143].

• Counting calories provides an accurate picture of energy balance, which is useful for those seeking detailed control, but it requires discipline and can lead to stress or obsession, in addition to not taking into account factors such as satiety and hormonal responses.
• Choosing foods with low calorie density allows you to eat larger portions, increases feelings of fullness, and promotes more intuitive eating, although it can lead to monotony.

Table 2 confirms that the strategy of moderating caloric density, as supported by Figure 1, helped reduce calorie intake, as one might expect.

Choose Nutritional Density

Table 2 also confirms the increase in consumption of foods with higher nutritional density, as shown in Figure 2.

Since several participants reported difficulty estimating portion sizes in the dietary habits questionnaire, it was not possible to quantify the variation in calorie and essential nutrient intake.

Moderate CG

After decades of debate over the benefits of reducing fat versus limiting carbohydrates, current evidence suggests that, in the long term (12 to 24 months), there are no significant differences. In the short term (6 to 12 months), moderate-carbohydrate diets appear to be more effective. The most important thing is to maintain a calorie deficit and stick to the program, regardless of the type of dietary restriction [144]. 

The program evaluated adopted a hybrid approach: prioritizing low-calorie-density foods (which includes reducing fats and other sources of calories) and limiting total fat intake to about 10 g. Changes in dietary habits (Table 2) and anthropometric results (Table 3) confirm the effectiveness of this approach. 

Participants had no difficulty adopting this hybrid approach, in contrast to what has been reported in the literature, which indicates that extremely low-carbohydrate diets (ketogenic and carnivore) are difficult to follow and pose health risks [145]. 

This program was highly effective in alleviating the symptoms of most participants with type 2 diabetes, as shown in Figure 5, a finding that is widely supported in the literature [146].

It is important to note that there is significant variation in the glycemic response from one person to another and from one meal to another in the same individual, even for the same glycemic index (GI). People with higher levels of insulin resistance show more pronounced responses [147]. The state of the gut microbiome alters the response [147]. In people with a morning chronotype, the response to the same CG is greater at night than in the morning [148]. The food matrix (fiber, fat, protein) [149] and the order in which macronutrients are consumed also has an influence [150].

Moderate physical activity and enjoyable

The metabolic and psychological benefits of physical activity are numerous [151].

However, exercise reaches its full potential when combined with nutritional, behavioral, and healthy lifestyle interventions [151].

The program’s recommendations to engage in moderate and enjoyable physical activity achieved their goal, reducing sedentary behavior and increasing the number of participants who engaged in at least 150 minutes of physical activity per week, as recommended by the World Health Organization [12].

Anthropometric changes: Weight

As shown in Figure 3, the program's performance ranks it among the best programs worldwide

Anthropometric changes: Visceral fat

The program promoted lifestyle changes for which there is evidence of their benefits in reducing visceral fat, such as: physical activity [152,153]. a low-calorie diet [154,155], adequate protein intake [156,157], low glycemic load [158] and an anti-inflammatory diet [158], which explains why virtually all participants reduced their visceral fat, by an average of 1.5 kg 

Anthropometric changes: Skeletal Muscles

Bioimpedance results show an average increase of 1% in the percentage of skeletal muscle. However, when viewed in context, along with the total weight loss, we find that there was a non-significant average reduction of 0.4 kg, as shown in Table 3. It is important to note that when switching from a high-carbohydrate diet to one with moderate carbohydrate content, a reduction in muscle and liver glycogen (and bound water) is to be expected. Since the bioimpedance scale does not distinguish between muscle mass and glycogen, it is not possible to draw a reliable conclusion from the measurements.

Improvements Beyond Weight

Several authors point out that rapid weight loss (> 5 to 10% in less than six months) is associated with substantial health risks [159,160], including: 

• Nutritional: pale skin, weakness, fatigue, hair loss, unusual cravings, constipation, depression, numbness or tingling in the joints, difficulty concentrating, among others (93),
• Psychological: irritability, fatigue, hunger, depression, anxiety, compulsive eating, and obsession with food [159],
• Physical: headaches, dizziness, constipation, menstrual irregularities, hair loss, and loss of muscle mass [161], 
• Sleep: poor quality [162].

Participants lost an average of 6.8% of their body weight in just 3 months, with none of the associated risks observed. On the contrary, as shown in Figures 4 and 5, significant perceived improvements were observed in both overall health and preexisting health problems.

Holistic Approach

Traditional diets and weight-loss programs focus primarily on dietary education and physical activity. The mental aspect is often overlooked. This study helps provide evidence regarding the importance of incorporating psychological tools, such as: defining a “big picture” [163,164]; a spiral of continuous improvement [163,165]; mindfulness [166]; cognitive-behavioral therapy [167]; stress management [168]; breaking the cycle of restrictions – frustrations – guilt [169] and reducing the forgetting curve [136]. 

Customization

The value of adopting a personalized approach, as opposed to a “one-size-fits-all” model, was demonstrated [170]. Weekly meetings, the Forum, and one-on-one interactions would help identify individual characteristics and needs, allowing for personalized approaches to achieve better results—such as lacto-ovo-vegetarianism, lipedema, congenital cognitive impairments, and self-sabotage patterns, among others.

Dropout Rate

The dropout rate for this study was 14%, a notable result when compared to systematic reviews that report rates ranging from 20% to 80% [171–173].

Several participants expressed at various times their intention to drop out of the program, due to skepticism, feelings of being unique (“I’m different”), limiting beliefs, a perception of stagnation (I stopped losing weight), a slow metabolism, misinterpretation of the scale, lack of time, stress, depression, feelings of guilt, cognitive distortions, travel, illness, accidents, and work-related exhaustion (“burnout”).

The support tools and holistic approach were essential for identifying and addressing these situations early on, while maintaining a high level of motivation, commitment, and performance, along with a low dropout rate.

Cost-Effectiveness

The Incremental Cost-Effectiveness Ratio (ICER) is used to compare two intervention programs; it is defined as the difference in costs divided by the difference in the effect achieved by both programs [174,175]. Digital weight-loss interventions show evidence of being cost-effective compared to in-person care [174,175].

Without attempting to provide a detailed analysis, the findings of this study show that it is highly effective for weight loss and improving health. At the same time, the cost estimate was lower than initially projected. This result suggests that this program has the potential to establish itself as a promising alternative in the field of healthy weight loss services, while also being cost-effective.

Conclusions

The results of this study confirm that the program under evaluation achieved its overall goal of promoting healthy weight loss.   

The rapid and significant changes in dietary habits and physical activity, the evident improvements in health, the high effectiveness compared to other programs, the ease of customization, the low dropout rate, and the good cost-effectiveness ratio show that the program has the characteristics to rank among the most effective and innovative globally, benefiting both those who wish to lose weight and the professionals who implement it.

Among the limitations were: 1) bioimpedance analysis proved difficult to use for assessing changes in muscle mass; 2) the dietary habits questionnaire did not provide reliable data for assessing changes in calorie and essential nutrient intake; and 3) the results regarding health and well-being were based on participants’ perceptions, which poses a risk of subjective bias. These are areas worth exploring in the future.

Given the chronic nature of obesity and the challenges associated with weight maintenance, it is worthwhile to conduct follow-up longitudinal studies with participants to assess the long-term sustainability of the results achieved.

Acknowledgments: To my wife, for her unconditional support. To Simone Ushikusa (Nutritionist) and Daniel Vieira (Psychologist) for their support in developing the support platform.

Conflict of interest: 

The author states that he is interested in launching a startup based on the results presented in this study. This initiative did not influence the study design, data collection, or data analysis; the research was conducted independently, and all procedures, methodological decisions, and results accurately reflect the original data.

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