NUTRITION AND WEIGHT LOSS IN ADULTS

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1 NUTRITION AND WEIGHT LOSS IN ADULTS Jonathan Baalman, MD, PG1 University of Kansas School of Medicine- Wichita Family Medicine Residency at Wesley Medical Center 2016 Annual Meeting Kansas Grown: Strong, Healthy & Caring Overland Park, KS

2 Objectives Accept that you have an obese practice Relearn the importance of calories Understand the importance of macronutrients Learn about future research in weight loss

3

4 USA 34% Mexico 29.5% New Zealand 26.5% France 11.5% Italy 10% Japan 3%

5 Overweight and Obese

6 Why Does It Matter? Chronic Disease Diabetes Mellitus Dyslipidemia Coronary Artery Disease Hypertension Urinary incontinence Obstructive Sleep Apnea Depression Back Pain Knee Pain Cancer Life expectancy reduced by about 10% from 78 years US average to 64 to 72 years depending on level of obesity

7 Standard American Diet 50% carbohydrate 15% protein 35% fat

8 Standard American Diet

9 Simple Advice Eat food, mostly plants, not too much Michael Pollan, In Defense of Food: An Eater s Manifesto Sean Lucan, MD

10 Nutrition versus Exercise Which is more important? Nutrition Exercise Neither Both

11 Nutrition versus Exercise Running a half marathon Calories burned in one mile: 110 Distance 13.1 miles Calories burned 1500 Eating a Red Robin Monster burger: 1670 calories or more for fries(bottomless) + your favorite adult beverage

12 How Many Calories? How are calories in food determined? How are calories burned determined? How do we keep track of all this?

13 How Many Calories? 0-400: Starvation or near starvation, never recommended : Very Low Calorie Diet (VLCD) : Low Calorie Diet (LCD) Above 1500: Balanced Deficit Diet (BDD) Estimate of 1 lb weight lose per 3,500 calorie deficit, different for everyone, necessary calorie deficit increases as we lose weight

14 Does Fat Matter? Low carb, high protein and Mediterranean diets more effective than low fat diets. Low fat (20%) vs moderate fat (30%) similar weight loss at 7 months, but moderate fat dieters maintained weight at 14 months. Moderate fat diets (>35%) were associated with greater compliance.

15 Does Fat Matter? Diets with reduced fat intake produced additional 1.6 kg weight loss compared to normal fat intake. Functional fats: Conjugated linoleic acid (CLA 4g/d) reduced abdominal fat, chol, LDL, TG, glucose Olibra (fat emulsion of palm and oat oils) decreased food intake and helped sustain weight loss Medium chain triglycerides improved weight loss when added to program

16 Do Carbohydrates Matter? Low carbohydrate (<60g/day) diet showed greater weight loss (3.6kg) than control (2.1 kg) Low carb diets resulted in a weight loss of 3.3 kg relative to low fat diets at 6 months. Low glycemic index diets produced an average 1.1kg more weight loss. Low carb diets and Mediterranean diets gave greater weight loss relative to high protein diets

17 Do Carbohydrates Matter? Reduced sugar intake led to 0.8 kg of weight loss Low glycemic index diets can help with weight loss contribute to satiety reducing post prandial insulin secretion result in losses in fat free mass leading to weight regain. Glycemic index used to predict increase in blood sugar in response to consuming food, not completely useful for predicting satiety or food intake. Baked potato(gi 117) lowered desire to eat more than pasta(gi 108) and brown rice(gi 132)

18 Does Protein Matter? High protein diets show significant improvement in weight loss vs controls in a meta analysis of 15 trials. High protein diets result in 0.79kg more weight loss after 12 weeks. Differences of 5% in protein intake led to 1 kg reduction in fat mass compared to normal protein intake.

19 Does Protein Matter? High protein diets (25-30%) improve adherence and result in weight loss from adipose tissue while preserving lean mass and resting energy expenditure. Protein intake suppresses short term food intake for 1-3h. A high protein snack can lower the amount you eat at the next meal.

20 Future of Nutrition in Weight Loss Personalized nutrition based on genetic variations Estimated that 25-70% of body weight variability is influenced by genetics with approximately 50 genes identified as being associated with regulation of energy metabolism. These include genes encoding leptin, the leptin receptor and melanocortin 4 receptor

21 Future of Nutrition in Weight Loss Gastric inhibitory peptide receptor polymorphisms affected weight loss on low fat diet Transcription factor 7-like 2 variations affected weight loss when on low fat diet and on high fiber diet. Direct to consumer genetic tests already exist for other conditions, may be helpful in giving dietary advice in the future.

22 Conclusions Genetics will start to play a role in how we manage nutrition for weight loss. Higher fat diets not a bad thing for weight loss, may be better than low fat. Low carbohydrate diets beneficial in weight loss, but may reduced lean body mass and result in future weight gain. High protein diets result in weight loss and improve adherence.

23 Conclusions More than 65% of our patients, friends and families are overweight and at risk of dying sooner because of it. Calorie counting is extremely challenging and may be a waste of time. Focusing on eating more plant based/real foods easier and more beneficial. Nutrition more important in losing weight, exercise important in maintaining and overall health.

24 Thank You Questions?

25 References Last, Allen R.; Wilson, Stephen A. (2006). "Low-Carbohydrate Diets". American Family Physician 73 (11): PMID Wang X, et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ. 2014;349:g4490. Martinez J, et al. Personalized weight loss strategies the role of macronutrient distribution. Nature Reviews Endocrinology Fleming J, et al. Macronutrient Content of the Diet: What do we know about energy balance and weight maintenance. Current Obesity Research. April Bellissimo, N, et al. Effect of Macronutrient Composition on Short term food intake and Weight loss. Advances in Nutrition S-308S. Smith J, et al. Changes in intake of protein foods, carbohydrate amount and quality, and log-term weight change: results form 3 prospective cohorts. American Journal of Clinical nutrition

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