Popular Weight Loss Diet Fads and Obesity Guidelines: Is there an Ideal Diet for Weight Reduction?
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1 Popular Weight Loss Diet Fads and Obesity Guidelines: Is there an Ideal Diet for Weight Reduction? Geeta Sikand, MA, RDN,FAND,CDE,CLS,FNLA Associate Clinical Professor: Cardiology Director of Nutrition UC Irvine Preventive Cardiology Program University of California, Irvine
2 None Disclosure of Affiliations and Significant Relationships
3 University of California Irvine Comprehensive Lifestyle Management Program: Bimonthly visits Cardiologist Registered Dietitian Nutritionist (RDN) 32 Weeks UC Irvine Preventive Cardiology Lifestyle-Intervention Program Exercise Physiologist
4 Dieting on the Rise The dieting industry is a $61 billion dollar industry $70.0 $60.0 $50.0 $40.0 Money Spent on the Diet Industry (Billions) $30.0 $20.0 Money Spent on the Diet Industry (Billions) $10.0 $0.0 Marketdata Enterprises, Inc., 2011
5 Objectives Enumerate top 10 fad diets and the current ACC/AHA/TOS guidelines for weight reduction & weight maintenance. Identify three components of a comprehensive lifestyle management program for weight reduction. List three nutrition resources for weight management
6 And what does fad dieting mean? New Oxford s American Dictionary Dieting restrict oneself to small amounts or special kinds of food in order to lose weight Fad an intense and widely shared enthusiasm for something, especially one that is short-lived; a craze.
7 10. Cut out wheat to slim down. Top 10 Fad Diets 9. Get thin and healthy by controlling your body s ph balance. 8. Probiotics diet 7. Raw foods will cleanse you. 6. Sugar Consumption is a Drug Habit you have to kick. 5. Superfoods will save you from everything. 4. Juices will cleanse you and shrink your waistline like magic. 3. Paleo diets make us healthy as cave people. 2. Go vegan and go ultra low fat. 1. Grains are killing your brain
8 Meta-Analysis Weight Loss Programs Search of 6 electronic databases Looked at wt loss at 6 and 12 months Largest wt loss assoc with Low-carb diet: mo; yr Low-fat diet: mo; yr Between 6-12 months, behavior support and exercise were positively assoc with wt loss Johnston et al. Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults A Meta-analysis. JAMA 2014
9 Two year follow up of patients treated with a very-low calorie diet (VLCD) and exercise 30 obese women on a VLCD kcal/day for 4 months: exercise versus non-exercise groups. Average weight loss = 40 lbs At 2 years follow up: Exercise group: re-gained 50% Non-exercise group: re-gained 100 % Conclusion: Weight maintenance is the Achilles heel of VLCD diets. G Sikand, J P Foreyt, A Kondo, P Jones, A Gotto J Am Diet Assoc April 1988
10 What we know Rapid wt loss is due to loss of water, glycogen and lean tissue. Ketosis produces metabolic dehydration. % fat loss % water loss Balanced, low-cal diet 60% 40% Low carb, high protein 35% 65% Carb and protein is stored with water (each gram glycogen is stored with 4 grams water) When these stores are used, we lose water Composition of Weight Loss During Short-Term Weight Reduction. Journal of Clinical Investigation. Vol. 55. Sept Pgs
11 Fad Diets May Contribute to - Weight cycling Kruger et al, 2004; Strohacker & McFarlin, Increased risk for osteoporosis Bacon et al, 2004; Van Loan & Keim, Increased chronic psychological stress & cortisol production Tomiyama et al, Increased anxiety about weight Davison et al, 2003; Holms, Eating disorder behaviors Daníelsdóttir et al, Weight gain Neumark-Sztainer et al, Stigmatization and discrimination against fat individuals Puhl, 2008
12 Best Diets (US News 2014) Rated by panel of health experts Top-rated: easy to follow nutritious safe effective for weight loss (short and long term) effective against diabetes and heart disease
13 Top 12 Diets (US News 2014) Weight Loss Weight Watchers Biggest Loser Jenny Craig Raw Food Diet Volumetrics Diabetes DASH Biggest Loser Engine 2 Flexitarian Mayo Clinic Ornish Vegan
14 POUNDS LOST Study tested 4 diets 811 obese adults for 6 months 1. Low-fat, average protein, high carb: 20 % fat, 15 % protein, 65 % carb 2. Low-fat, high protein, moderate carb: 20 % fat, 25 % protein, 55 % carb 3. High-fat, average protein, low carb: 40 % fat, 15 % protein, 45 % carb 4. High-fat, high-protein, very low carb: 40 % fat, 25 % protein, 35 % carb Sacks et al 2009
15 POUNDS LOST Study Sacks et al 2009 Average weight loss: 13 lbs (6 mo) in all 4 diet groups with variability (20 lbs to weight gain). Maintained 9 lbs at 2 yrs, reduced waist by 1 to 3 Craving, fullness, hunger, diet satisfaction: similar all four diets. Predictors of success in all study groups: Attendance at their RD visits and group sessions, keeping a food diary
16 Maintenance of Weight Loss Key Concerns NIH Report Jan 2015 Obesity Weight regain after weight loss: significant problem in obesity treatment both body and mind conspire against individual efforts to maintain weight loss. Genetic and behavioral differences in individuals. We need to individualize interventions or target specific populations with evidence-based strategies. Innovative Research to Improve Maintenance of Weight Loss MacLean, co-chair NIH working group
17 Daily Weighing Improves Weight Loss and Adoption of Weight Control Behaviors 47 adults: Daily weighers lost significantly more weight (mean difference= 6.1 kg; 95% CI 10.2 to 2.1; P=0.004). Total number of weight control behaviors adopted greater in daily weighers (17.6±7.6 vs 11.2±6.4; P=0.004), produced greater weight loss versus weighing most days. Steinberg DM et al ANDJRNL.org Feb
18 Self-Determination Theory (SDT) Meta analysis: 184 Studies Conclusion Most important factor that emerged Patients perception of effectiveness in their own ability to change their undesirable health behaviors is critical to their ability to actually make that change. Ng et al Perspectives on Psychological Science July 2012
19 Empower with Motivational Interviewing Overweight and obese people come to us with so much emotional damage and baggage. Motivational Interviewing: tool that empowers them and nurtures their often-fragile self esteem helping them make wise food and activity choices. Motivational Interviewing in Health Care: Helping Patients Change Behavior by Rollnick et al 2008 The Guilford Press
20
21 2013 AHA/ACC/TOS Guidelines Focus 5 Critical Questions (CQ) CQ 1. Is weight loss good for your patient? CQ 2. How do you identify who is at risk sufficiently to mandate weight loss efforts? CQ 3. What is the efficacy of the different dietary intervention strategies to promote weight loss? CQ 4. What is the efficacy of a comprehensive approach (diet, physical activity and behavior therapy) to achieving and maintaining weight loss? CQ 5. What are the benefits and risks of bariatric surgery?
22 Grade A B C D E N Strength of Recommendation Strong recommendation: There is high certainty based on evidence that the net benefit is substantial. Moderate recommendation: There is moderate to high certainty based on evidence that the net benefit is moderate to substantial Weak recommendation: There is at least moderate certainty based on evidence that there is a small net benefit. Recommendation against: There is at least moderate certainty based on evidence that it has no net benefit or that risks/harms outweigh benefits. Expert opinion ( There is insufficient evidence or evidence is unclear or conflicting, but this is what the Panel recommends. ) Net benefit is unclear. Balance of benefits and harms cannot be determined because of no evidence, insufficient evidence, unclear evidence, or conflicting evidence, but the Panel thought it was important to provide clinical guidance and make a recommendation. Further research is recommended in this area. No recommendation for or against ( There is insufficient evidence or evidence is unclear or conflicting. ) Net benefit is unclear. Balance of benefits and harms cannot be determined because of no evidence, insufficient evidence, unclear evidence, or conflicting evidence, and the Panel thought no recommendation should be made. Further research is recommended in this area.
23 Executive Summary Highlights Identifying who is at risk? Use BMI as a screening method, not a diagnostic tool. BMI classifications of >25 kg/m 2 = overweight.' But not all people with excess weight per BMI need to lose weight. Achieving ideal BMI is not necessary and may not be possible for some people. Even 5% of weight loss could be beneficial AHA/ACC/TOS Obesity Guidelines
24 Table 11. Definition of Overweight and Obesity ACC/AHA/TOS BMI cut points Classification of Overweight & Obesity Classification BMI, kg/m 2 Classification BMI (kg/m 2) Underweight Less than 18.5 Normal Overweight Obesity Class I Class II Class III (extreme obesity) 40 or greater
25 Executive Summary Evidence statements graded high The greater the individual s BMI, the greater the risk of CVD and T2DM. Even modest weight loss (3-5% of body weight) can result in clinically meaningful benefits for TG, HbA1c and development of T2DM. Six months or more of lifestyle counseling with a nutritional professional e.g. RDN produces the most successful outcomes. Advise overweight & obese patients who have lost weight to participate in a long term (>1 year) comprehensive weight maintenance program AHA/ACC/TOS Obesity Guidelines
26 Executive Summary Which diet is most effective for weight loss? Research shows: no one diet is superior for weight loss. A negative energy balance must be present to produce weight loss. 15 dietary regimens were equally effective in inducing weight loss as long as they were calorie-restricted AHA/ACC/TOS Obesity Guidelines
27 Executive Summary Weight Reduction: Best Meal Plan? A variety of dietary approaches can produce weight loss in overweight and obese adults if reduction in dietary energy intake is achieved. Low fat Higher protein Low carbohydrate (30 g to 130 g) Adopting new dietary patterns such as DASH, Mediterranean or Vegetarian At least 14 visits over 6 months with a Registered Dietitian Nutritionist (RDN) for behavior modification and personalized meal planning AHA/ACC/TOS Obesity Guidelines
28 Executive Summary Most effective approach to lose weight? A comprehensive lifestyle management program: A reduced calorie diet. Increased physical activity Behavior changes that make it easier to eat fewer calories and become more active. At least 14 visits over 6 months with a trained interventionist e.g. RD 2013 AHA/ACC/TOS Obesity Guidelines
29 Executive Summary How can weight loss be maintained? Following weight loss, patients should continue regular contact (at least once a month) with a trained interventionist e.g. RD for monitoring. High physical activity (200 to 300 minutes per week), Consume a reduced calorie diet Monitor their body weight regularly. Continued participation in the same behaviors that produced weight loss will prevent regain AHA/ACC/TOS Obesity Guidelines
30 Summary 2013 ACC/AHA/TOS Obesity Guidelines A comprehensive lifestyle management program is the gold standard. Underscored one size fits all diet approach be avoided to achieve long term success. Refer to a registered dietitian nutritionist (RDN) to tailor weight loss program to patients individual preference and needs. Achieving ideal BMI is not necessary and may not be possible for some people. Even 5% of weight loss could be beneficial.
31 Nutrition Resources USDA: menu plans ood.htm To find a RD (RDN) in your area: Virtual Nutritionist: Personalize your experience by creating your profile, and get a meal plan tailored for you.
32 Thank you
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