Review of common weight loss diets. September 15, 2016 Karmella Thomas, RDN, LD,CDE

Transcription

1 Review of common weight loss diets September 15, 2016 Karmella Thomas, RDN, LD,CDE

2

3 Development of Obesity Obesity can develop only from an excess of energy intake over expenditure.» N Engl J Med 1997;337: For weight loss, only calories count. N Engl J Med 2009;360: Calories alone account for increases in body fat. JAMA 2012;307(1):47-55

4 Disconnect: Lack of Understanding of the Relationship Between Calories and Weight Gain Exists 70% of Americans do not believe calories cause weight gain Only 12% could accurately estimate the calories of foods More than 80% of those watching their weight don t watch their calories 90% don t know their calorie budget. 2009, 2010, 2011 Food and Health Survey USDA

5

6 Obesity Treatment Guidelines BMI Category Treatment >40 Lifestyle Therapy* With Comorbid. With Comorbid. YES YES YES Pharmacotherapy With Comorbid. YES YES YES Surgery With Comorbid. Lifestyle therapy - diet, physical activity, and behavioral therapy - is the cornerstone of obesity treatment YES *Consider pharmacotherapy only if a patient has not lost 1 pound per week after 6 months of combined lifestyle therapy.

7 Low Carbohydrate/High Protein Diets Paleo Diet Atkins Diet Ketogenic Diet

8 Paleo Diet Typically 23% Carbohydrates, 38% protein, and 39% fat Can vary depending upon preference Have EAT foods and Don t EAT foods Restrict cereal grains, legumes, dairy, potatoes, salt, refined sugar and oils, processed foods

9 Atkins Very low carbohydrate diet Flip the body s metabolic switch from burning carbs to burning fat Has 4 phases of gradual increased carb intake for each phase Phase 1: 20 grams of carbs per day Phase 2: 25 grams of net carbs per day Phase 3: 25 grams grams of carbs more/day Phase 4: 25 g (more or less) personal preference

10 Atkins 40 Plan

11 The A to Z Weight Loss Study: Randomized Trial Compared 4 weight loss diets (low to high carb intake) and effect on weight loss and metabolic variables in 1 year s time 12 month randomized trial with 311 overweight/obese women (premenopausal, nondiabetic) with BMI between Atkins, Zone, LEARN, Ornish diets Weekly instruction for 2 months and additional 10 month follow up JAMA. 2007;297(9): doi: /jama

12 Diets Atkins: 20g/d or less for first 2-3 months and then 50 g/day or less for ongoing weight loss phase Zone: 40% carbs, 30% protein, 30% fat LEARN: 55%-60% carbs, 10% fat, calorie restriction, increased exercise, and behavior modification Ornish: 10% or less calories from fat, physical activity, behavior modification

13

14 Results At the 2 and 6 month intervals, the Atkins group had significantly greater weight loss than all groups Weight loss between ZONE, LEARN and Ornish did not differ significantly at any time Body fat and waist-hip ratio did not achieve statistically significance between groups Only HDL and triglycerides findings were significant and favored Atkins group LDL changes favored LEARN and Ornish diets at 2 months but differences diminished at 6 & 12 months

15 Concerns What does 20 grams per day or less of carbohydrates look like? oz of bread 1-2 cups of fruit 1/3 cup of rice or pasta 3 cups of popcorn ½ cup of ice cream

16 Ketogenic Diet Ketosis is a metabolic state that occurs when dietary carbohydrates are in such low quantities that your body relies almost exclusively on fatty acid oxidation and ketone metabolism to produce ATP Used for Dementia and Epilepsy in Medical Nutrition Therapy Developed by Dr. Russell wilder at Mayo Clinic in 1924

17 The basics Intention to put the body into ketosis 70% calories from fat, 25% protein, 5% carbs 2,000 calorie diet = 20 g carbs, 155g fat and 125g protein Meals should be protein, veggies, and extra side of fat Just be sure to know that the first week usually gives you some killer headaches and lethargy

18 Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity. Hall, Kevin D, et al. Inpatient metabolic balance study Examine the effect of selective isocaloric reduction of dietary carbs vs fat on body weight, energy expenditure, and fat balance Small study (19 obese adults) 10 males and 9 females Cell Metab September 1; 22(3): doi: /j.cmet

19 Cell Metab September 1; 22(3): doi: /j.cmet

20 Cell Metab September 1; 22(3): doi: /j.cmet

21 Cell Metab September 1; 22(3): doi: /j.cmet

22 Results Experimental diets were 30% lower in calories than baseline diet (carb and fat varied, protein stayed same) The carb restricted diet led to decreased insulin secretion and increase in net fat oxidation but fat restricted diet did not Both diets resulted in body fat loss, but the reduced fat diet led to significantly more fat loss than the reduced carb diet Concluded that reducing dietary fat can lead to greater body fat loss than reducing dietary carbs in adults with obesity

23 US News and World Reports Best Weight-Loss Diet #1 Weight Watchers #2 HMR Program (Health Management Resources) #3 Biggest Loser Diet New Category this year Best Fast Weight Loss Diet HMR program and Biggest Loser (tie for 1 st )

24 Weight Watchers New SmartPoints plan No food is off limits Each food is given a number based upon calories, saturated fat, sugar, and protein Online Plus Meetings Personal coaching

25 Randomised controlled trial of four commercial weight loss programmes in the UK: initial findings from the BBC diet trials Compared Atkins, Slim Fast, Weight Watchers, and Rosemary Conley s eat yourself slim diet and fitness plan Measured weight and body fat changes over 6 months Similar weight loss among diet groups compared to control Average weight loss of 5.9 kg and average fat loss of 4.4 kg BMJ Jun 3; 332(7553):

26 BMJ Jun 3; 332(7553):

27 Weight Watchers 2015 introduced Beyond the Scale Program Emphasizes 3 components: Eating healthier Fitness that fits your life developing the skills and connections to tune in and unlock inner strength

28 Biggest Loser Diet Six weeks of healthy food & regular exercise Pyramid 4 servings of fruits and vegetables 3 servings of lean protein 2 servings of whole grains 200 calories of extras (desserts) Exercise at a high level Some meal plans go below 1,200 calories/day

29 Weight Loss Results 2011 American Journal of Medicine study Small 14 Biggest Loser contestants 7 months of intense exercise and reduced calorie diet (moderate) Lost average of 133 pounds (39% of initial weight) Improvements in atherosclerosis risk, carotid vascular function, lipids, insulin resistance, and inflammatory biomarkers Am J Med Oct;124(10): doi: /j.amjmed Epub 2011 Jul 27.

30 Meal Replacements Meta and pooling analysis from 6 studies on safety and effectiveness of partial meal replacements (1 or more meal replacements per day) for long term weight management 800 to 1,600 calories/day using meal replacements and other healthy foods for at least 3 months in overweight adults compared to conventional reduced calorie diet International Journal of Obesity (2003) 27, doi: /sj.ijo

31

32 Results 6 data sets produced 249 meal replacements subjects and 238 control subjects 46 years old, 75% women and mean BMI of 31 kg/m2 (119 had type 2 diabetes) Weight loss was significant in both groups, but greater in the meal replacement group At 3 months, meal replacement group lost 7% of weight compared to 4% in reduced calorie diet Sustained at the 1 year mark

33 HMR Program In-clinic and at-home program options 200 different clinics (one located here at UNRSOM) Meal Replacements and Physical Activity 2 diet options (More is Better strategy) Decision Free (5 shakes per day) Healthy Solutions (3 shakes + 2 Entrees + 5 c V/F)

34 Other meal replacement diets Slim Fast Jenny Craig Nutri-system Optifast

35 What does it come down to? What will the patient do? What medications are they on? What can they do now, but also in 6 months? What does their support look like?

36 THANK YOU!