Weight Management Popular Approaches

Weight Management Popular Approaches - Weight Management:...

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Unformatted text preview: Weight Management: Popular Approaches Formula Diets and Meal Replacements • • Meal formats and nutritional profiles vary Total calories range from 1000-1600 kcals Total day with meal replacement drinks or bars replacing two meals during weight loss or one meal for weight maintenance one Formula Diets and Meal Replacements • There is evidence There that meal replacements can be as effective as standard lowstandard calorie diets in calorie promoting weight loss loss Evaluation of Major Commercial Weight Loss Programs • Reviewed research regarding the efficacy of Reviewed commercial weight loss programs including Weight Watchers, Jenny Craig, LA Weight Loss, HMR, OPTIFAST, commercial Internet programs (e-diets.com); Overeaters Anonymous and Take Off Pounds Sensibly Anonymous (Tsai and Wadden, Ann Int Med 2005; 142:56­66) Evaluation of Major Commercial Weight Loss Programs • Weight Watchers had the strongest studies Weight to support it to • Best study: participants lost 5% of their Best initial body weight (about 10 pounds) and kept off 3% (about 5 pounds) at 2 years kept • No published high-quality studies of No Jenny Craig or LA Weight Loss Jenny (Tsai and Wadden, Ann Int Med 2005; 142:56­66) Evaluation of Major Commercial Weight Loss Programs • • Studies of VLCDs were of limited quality • Patients who stayed on the program lost 1520% of initial body weight in 6 months • Many patients dropped out of these programs • Those who completed the program regained Those half of lost weight in 1-2 years after treatment half Studies of internet-based programs of limited Studies quality and produced minimal weight loss quality (Tsai and Wadden, Ann Int Med 2005; 142:56­66) Atkins Diet Premise • • Stabilizes insulin production by limiting Stabilizes carb intake. This forces the body from glucosis into lipolysis, thus ketones are burned as the primary energy source. burned This results in a metabolic advantage of low This carbohydrate: dieters can lose weight while eating more calories eating Atkins Diet: Induction Phase • • • “Induction Phase”: 2 weeks, 20 g carb/day Induction Eliminate fruit, bread, grains, starchy Eliminate vegetables, dairy products except cheese, cream, butter cream, 20 g carb: 3 cups salad greens, or 2 cups salad 20 plus 2/3 cups cooked vegetables such as asparagus, summer squash, green beans asparagus, Atkins- Sample Menu Phase 1 • • • B: scrambled eggs and ham, butter, B: decaffeinated coffee or tea decaffeinated L: Bacon cheeseburger, no bun, small L: tossed salad, selzer water tossed D: shrimp cocktail with mustard and mayo, D: clear consomme, steak, roast, fish or fowl, tossed salad, diet gelatin with whipped cream, sf beverage cream, Atkins Phase 2: OWL • • • • • “Ongoing weight loss phase” or “Owl.” Ongoing Add carbohydrate at a rate of 5 grams a day Add until weight loss stops until This is the CCLL: critical carbohydrate level This for losing for May be 45, or 33, or 19 grams/day Continue at this level until desired weight is Continue reached reached Atkins: Sample menu OWL • • • B: Western omelet, 3 ounces tomato juice, 2 B: carbo grams of bran crispbread, decaf coffee or tea coffee L: Chef’s salad with ham, cheese, chicken L: and egg; zero carbohydrate or oil and vinegar dressing, iced herbal tea vinegar D: Seafood salad, poached salmon, 2/3 cup D: vegetable from permitted list, half cup of strawberries in cream strawberries South Beach Diet Premise • • • • “Addiction” to carbs is a psychological need for Addiction” comfort food and is likely a real, physiological phenomenon phenomenon Eating bad carbs leads to cravings for more Eating which is “ultimately responsible for our obesity epidemic” epidemic” States that Atkins may limit carbs too severely States Stresses glycemic index as the biggest Stresses determinant of a food’s potential impact on body weight weight South Beach Diet: Phase 1 (2 weeks) • • • • • • Carbs limited to low-carb vegetables, salads, Carbs 1% milk, fat-free buttermilk, nonfat yogurt. Proteins: unlimited lean meats, poultry, fish, Proteins: low fat cheese, tofu Nuts included, but limited “Good” fats including olive, canola oils Sugar-free hard candies, diet gelatin, sugar subs NO fatty meats, starchy vegetables like corn, NO potatoes, carrots, fruits, grains, alcohol potatoes, South Beach: Sample Day Phase 1 • • • • • • B: 6 oz tomato juice, 1/4-1/2 cup liquid egg B: substitute, decaf coffee or tea, non-fat milk, sugar substitute substitute snack: 1-2 turkey roll ups L: SB chopped salad with tuna, sf gelatin snack: celery, 1 wedge Laughing Cow Light snack: Cheese Cheese D: baked chix breast, roasted eggplant and D: peppers, salad, lo sugar dressing peppers, Dessert: Mocha Ricotta Creme South Beach: Sample Day Phase 2 • • • • • B: 1 cup blueberries; 1 scrambled egg w/ salsa; B: oatmeal mixed with 1 cup nonfat milk, sprinkled with cinnamon and walnuts; coffee or tea cinnamon Snack: 4 oz non-fat sugar-free yogurt L: Tuna salad w/ celery, mayo, tomato, onion in L: whole wheat pita whole Snack: 1 part-skim mozzarella cheese stick D: Pan roasted steak and onions, South Beach salad, D: steamed broccoli; chocolate-dipped strawberries steamed South Beach Diet: Phase 2 • • • Reintroduces most fruits, whole grains (sparingly) Reintroduces including popcorn, legumes such as pinto beans, starchy vegetables such as peas, carrots and sweet potatoes, flavored nonfat yogurt, semisweet or bittersweet chocolate, wine bittersweet Still forbidden: white flour and products made Still from it including breads, cookies, pasta; potatoes, white rice, corn; fruits including bananas, canned fruit, pineapple, raisins, watermelon fruit, Dieters stay in this phase until goal weight Dieters achieved achieved South Beach: Sample Day Phase 2 • • • • • B: 1 cup blueberries; 1 scrambled egg w/ salsa; B: oatmeal mixed with 1 cup nonfat milk, sprinkled with cinnamon and walnuts; coffee or tea cinnamon Snack: 4 oz non-fat sugar-free yogurt L: Tuna salad w/ celery, mayo, tomato, onion in L: whole wheat pita whole Snack: 1 part-skim mozzarella cheese stick D: Pan roasted steak and onions, South Beach salad, D: steamed broccoli; chocolate-dipped strawberries steamed South Beach Diet: Phase 3 • • • Maintenance- no foods are forbidden Continue to limit high carb, refined or Continue heavily processed foods. Return to earlier phase if weight gain occurs South Beach vs Atkins Phase 1 • • • • Atkins Atkins Proteins: All meats, poultry, Proteins: fish, shellfish, eggs, cheese are unlimited unlimited Fats: vegetable oils, butter, Fats: mayonnaise, heavy cream, bacon bacon Vegetables: 3 cups salad or 2 Vegetables: cups salad and 2/3 cup low carb vegetables vegetables NO: artificial sweeteners, NO: margarine, fruits, grains, breads, starchy vegetables, dairy, alcohol dairy, • • • • • South Beach Proteins: Lean beef, pork, Proteins: skinless poultry, low fat cheese, seafood, eggs seafood, Fats: Canola and olive oil Vegetables: salad greens, beans, Vegetables: tomatoes, cabbage, summer squash, broccoli, all low carb are unlimited unlimited Dairy: Fat free or 1% milk or Dairy: yogurt yogurt NO: fatty meat, high fat cheese; NO: fruits, grains, breads, starchy vegetables, butter, margarine, alcohol alcohol High Carbohydrate Low Fat Diets • • The Pritikin Weight Loss Breakthrough Eat More, Weigh Less (Dean Ornish) High Carb Low Fat Diets • • Rationale: diet is high in bulk and fiber, low Rationale: in calorie density producing early satiety and weight loss and Description: 50-75% carbohydrate calories, Description: relatively less meat, fish, fats and oils, more grains, cereals, breads, fruits, vegetables grains, Sample Menu: High Carb Low Fat • • • • • B: 1 cup blueberries; oatmeal mixed with 1 cup B: nonfat milk, sprinkled with cinnamon and walnuts; coffee or tea walnuts; Snack: 4 oz non-fat sugar-free yogurt L: Vegetarian vegetable soup, fresh orange, nonfat L: yogurt D: Grilled salmon with yogurt-dill sauce, bulgur D: with raisins, steamed broccoli; strawberries over angelfood cake angelfood Snack: air popped popcorn Very Low Fat Diets • • • • • <10% of calories from fat May be vegetarian Includes The Pritikin Program and Dean Includes Ornish’s Program for Reversing Heart Disease Disease Elimination of fat makes the diet less Elimination energy dense energy May be difficult for some people to adhere May to to Research on Macronutrient Mix in Weight Loss Diets A Low- Carbohydrate, Ketogenic Diet versus a LowFat Diet To Treat Obesity and Hyperlipidemia • • • • Objective: Compare effects of a low-carb, ketogenic Objective: diet with those of a low-fat, low chol, reduced calorie diet diet Design: Randomized, controlled Design: Subjects: 120 overweight, hyperlipidemic volunteers Intervention: Low carb diet (initially <20 g carb/day) Intervention: plus nutritional supplementation, exercise recommendation, and group meetings or low-fat diet (<30% energy from fat, <300 mg chol, deficit of 500(<30% 1000 kcal/d) plus exercise recommendation and group 1000 meetings meetings Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777 Low Carb vs Low Fat Diet • • • • Measurements: body weight, body composition, fasting body serum lipid levels and group meetings serum Results: 76% of the low-carb group and 57% of the lowfat group completed the study. At 24 weeks weight loss fat was greater in the low-carb group (12.9%) than in the low-fat group (6.7%) low-fat Pts in both groups lost more fat mass (-9.4 kg low carb, Pts -4.8 kg low-fat) than fat free mass (-3.3 kg vs -2.4 kg) -4.8 Low carb diet subjects had > decreases in serum Low triglycerides (-74.2 mg.dL vs. -27.9 mg/dL) triglycerides Expected mean body weight over time, by diet group Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777 Low Carb vs. Low Fat • Low carb group had > increases in HDL-C (5.5 Low mg/dL vs. -1.6 mg/dL P<0.001) mg/dL • Changes in LDL-C were not significant Low carb group had greater participant retention and Low greater weight loss over 24 weeks greater Minor adverse effects were more frequent in the lowcarb diet group Limitations: Effects of the low-carb diet and of the Limitations: nutritional supplements could not be separated. Participants were healthy and were followed for only 24 weeks. • • • Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777 Effects of Low-Carbohydrate vs Conventional Weight Loss Diets in Severely Obese Adults: One Year Follow Up of a Randomized Trial • • • Objective: Review the 1-year outcomes of two Objective: groups randomized to these diets groups 132 obese adults, BMI 35 or greater; 83% had 132 diabetes or metabolic syndrome diabetes Participants were counseled to either restrict carb Participants intake to < 30g/day or reduce calories by 500 cals/day with <30% of cals from fat cals/day Stern, L. et. al. Ann Intern Med 2004;140:778-785 Comparison of mean weight loss in kg between participants on the conventional diet and participants on the low-carbohydrate diet at 6 months (n = 118) and at 1 year (n = 126) Stern, L. et. al. Ann Intern Med 2004;140:778-785 Low carb vs. conventional 1 year follow up • • • • By 1 year, mean weight change for persons on the low By carb diet was -5.1 +/- 8.7 kg compared with -3.1 +/- 8.4 kg for persons on a conventional diet. Differences were not significant (P= 0.20) significant Triglycerides decreased more on low carb diet, HDL Triglycerides levels decreased less, HbA1c improved more levels Changes in other lipids (LDL, total-C) and insulin Changes sensitivity did not differ between groups sensitivity Limitations: 34% drop out rate, suboptimal dietary Limitations: adherence; relatively small net weight loss in both groups adherence; Stern, L. et. al. Ann Intern Med 2004;140:778-785 Low Carb vs. Conventional Diet Outcomes • • • Between 6 months and 1 year, persons in the low Between carb group began to regain weight while persons on the conventional diet continued to lose weight on By 6 months, there was no significant difference By in weight loss between the two groups in Intake data suggest that differences in weight Intake loss, where they exist, are the result of differences in calorie intakes, not a metabolic advantage of low carb advantage Atkins vs Zone vs Ornish vs Learn • • 311 overweight women ages 20 to 50 were 311 randomized to one of four diets incrementally different in CHO incrementally Subjects were given books explaining the Subjects diet and attended weekly instruction for eight weeks; then remained on the diets for another 10 months (total = 1 year) another Gardner CD, et al. JAMA 2007;297:969-977 Changes from baseline at 12 months Outcome Outcome Atkin Zon LEA s e RN Ornis h Weight (kg) LDL (mg/dL) HDL (mg/dL) Triglycerides Systolic BP -4.7 0.8 4.9 -29.3 -7.6 -2.2 -3.8 0.0 -14.9 -1.9 -1.6 0.0 2.2 -4.2 -3.3 Gardner CD et al. JAMA 2007; 297:969­977. -2.6 0.16 2.8 -14.6 -3.1 ...
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