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Paul Clayton FDIN 28/6/07 - Weight Management -. Paul Clayton FDIN 28/6/07 - Weight Management - - still waiting …

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Presentation on theme: "Paul Clayton FDIN 28/6/07 - Weight Management -. Paul Clayton FDIN 28/6/07 - Weight Management - - still waiting …"— Presentation transcript:

1 Paul Clayton FDIN 28/6/07 - Weight Management -

2 Paul Clayton FDIN 28/6/07 - Weight Management - - still waiting …

3 1897

4 1919

5 1952

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8 2001

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11 Ob / ob/ob normal

12 Reduced energy expenditure DoH 98, USDA 02, NIH 03, NCHS 04 1940 50 60 70 80

13 Positive energy balance DoH 98, USDA 02, NIH 03, NCHS 04 1940 50 60 70 80

14 Obesogenic culture (AHA 03) Avge US adult sedentary 8 hours / day, < 2,000 steps / day (NYS Public Health Assocn 05) Amish 16,000 steps /day: obesity 9% women, 0% men (Bassett et al 04)

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16 MRI * 28 yr man * Good diet * Desk worker Yellow = fat

17 TOFI – something to chew on Thin Outside – Fat Inside Dangers of inner fat (J Bell, Imp. College) Inner fat prevalent when normal BMI maintained by diet: 45% women, 60% men Lean people get CAD, NIDDM too Exercise the only way to reduce inner fat Unfitness more dangerous than fatness

18 Why is weight gain so easy? Multiple satiation mechanisms (enteroendocrine) Protein ( s, fish > whey > casein) Fat (FAs esp LCPs) Digestible carbs (glucose, CNS) Fermentable carbs (propionic acid, liver?) Insufficient calorific throughput Social / stress over-ride High calorific density foods / fast foods

19 AHA 2002: obesogenic culture AHA 2002: obesogenic culture Fewer bus-stops, remote parking Exercise to be mandatory at all levels of educational system No junk foods to be sold / served in schools

20 Fat - but starving W.H.O. 02: Globally, overweight greater health problem than underweight. W.H.O./F.A.O 03: Poor diet the major cause of degenerative disease. U.N. 06: Overweight but malnourished 40-60 % hospital admissions malnourished (1-3) 25-30% malnourished in the community J Nutr Hlth Ageing 3:133-139, 99 > > 3.6 million malnourished in UK (BANT 07)

21 Percentage of Population Depleted In Vitamins (USDA 1997) C E A B1 B2 Niacin Folate B6 B12 --------------------------------------------------------------------- 37 68 55 32 31 27 34 54 17 Vitamins %

22 * Gregory et al 2000. National Diet and Nutrition Surveys, HMSO

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24 RSM 2005: Pathogenic culture? Type 2 diabetes.

25 RSM 2005: Pathogenic culture? Type 2 diabetes increased heart disease, stroke, cancers,. kidney disease, blindness, Alzheimers

26 RSM 2005: Pathogenic culture? Type 2 diabetes increased heart disease, stroke, cancers,. kidney disease, blindness, Alzheimers asthma, allergy food intolerance / eosinophilic GI disease osteoporosis lymphoma, leukaemia, melanoma, germ cell tumours in teens & young adults ARMD ADD / ADHD / dysphasia / dyspraxia

27 Positive energy balance DoH 98, USDA 02, NIH 03, NCHS 04 1940 50 60 70 80

28 Fat – but starving Do we really want to encourage people to eat less? They can at least eat better: Increased nutrient / calorie ratios (functional foods, nutraceuticals, supplements) OR Be more physically active so they can eat more? Burn more calories without exercise? (thermogenic strategies)

29 Low fat / cholesterol Reduced fat / cholesterol content Reduced fat / cholesterol absorption Olestra ( sucrose esters) "... will very probably increase the risks of cancer, heart disease, stroke and blindness." Willett & Stampfer, Harvard School of Public Health Reduced cholesterol absorption AND Reduced lipophile absorption Take Control, Benecol etc (sterol/stannol esters)

30 Fat vs carb reduction Lose more calories by reducing fat Health issues? Reducing carbs loses fewer calories But probably a healthier option

31 Projected benefits of reducing CHO by 30g

32 1.Salmeron et al 1997ab; Meyer et al, 2000 30% reduction in type-2 DM 1 Projected benefits of reducing CHO by 30g

33 1.Salmeron et al 1997ab; Meyer et al, 2000 2.Diabetes Control and Complications Trial, 1996 30% reduction in type-2 DM 1.0 % fall in HbA 1c 25% reduction in retinopathy 12 Projected benefits of reducing CHO by 30g

34 1.Salmeron et al 1997ab; Meyer et al, 2000 2.Diabetes Control and Complications Trial, 1996 3.De Vegt et al 1999; Khaw et al, 2001 30% reduction in type-2 DM 1.0 % fall in HbA 1c 25% reduction in retinopathy 123 >30% reduction in CHD Projected benefits of reducing CHO by 30g 1.2% fall in HbA 1c

35 Potential appetite suppressors Pinoleic acid: 6 PUFA from Korean pine nut oil. (PinnoThin, Lipid Nutrition Nl) PUFAs in small bowel trigger cholecystokinin (CCK) PUFAs at end of small bowel trigger Glucagon-like peptide 1 (GLP1) CCK and GLP1 influence meal termination Clinical trial inconclusive

36 Potrential appetite suppressors Oleoylethanolamide (cannabinoid receptor blocker): cocoa, soybeans, hazelnuts, oats Fish & whey protein isolates (anti-stress) PeptideA, Lactium

37 Caralluma fimbriata Indian food plant – edible succulent 1 g/day, 4 weeks, n=26: weight loss, no adx (Lawrence & Choudhary, 12 th World Conf Anti-aging Medicine, 04) (Lawrence & Choudhary, 12 th World Conf Anti-aging Medicine, 04) 1 g/day, 8 weeks, n=50 Appetite reduction, weight loss, no adx (Kuriyan et al, Appetite 48:338-44, 07) Some evidence of adipocte inhibition

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39 Pre-adipocyte Immature adipocyte Immature multilocular adipocyte Mature unilocular adipocyte Differentiation of pre-adipocyte into mature adipocyte

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41 Metabolic shift Capsiate: sweet red pepper CH-19 (1) Up-regulates UCP 1, 2 (1) and 3 (2) BUT, increases physical endurance (3) Animal weight /fat loss data (4) Clinical studies underway in Japan, USA Anti-cancer effects (5, 6) NIDDM, CAD? (7)

42 Metabolic shift Adrenaline REsearch Thermo-regulatory clothing Thermal receptors at base of brain Up-regulate brown adipose tissue Up-regulate UCP 1 and 2 Appetite increase, weight loss

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44 ..dubious … USA: Weight loss patches. Guarana, Garcinia, Menthol, Fucus Vesiculosus (kelp) UK: hypnosis. You dont have to clear your plate Austria: caffeine-laced tights. The caffeine is absorbed locally and breaks down cellulite.

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46 The Backlash Fat Acceptance Movement 86 Fat Liberation 88 Fat Pride 89 Fat Positive 93 National Association to Advance Fat Acceptance Council on Size and Weight Discrimination International Society for Size Acceptance

47 Co-conspirators For every $ spent on food in the US, 48 cents is spent in fast food restaurants … … which operate in a very competitive commercial environment … … and are extremely sensitive to changing consumer demands

48 BKs Enormous Omelet Sandwich 730 calories, 70 g fat: $2.99

49 Hardees Monster Thickburger 1420 calories, 107 g fat: $5.49

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54 Atkins and other low-GL diets Efficacy? (6 vs 12 months; 1 +ve vs 3 –ve) High fat / protein, low fruit / veg diet increases risk of bowel & other cancer 1 in 3 adults have renal impairment; worsened by high protein diet Knight et al 03 low phytate diet Curran et al 04 Overweight, IGT Who has renal impairment? Overweight, IGT

55 Low cal-GL / high micronutrient Low GL 5 – 9 portions fruit and vegetables > Vegetable > animal protein Increased intake of fermentable carbs Limited amounts of fats and oils V limited digestible carbs Supplements

56 New Food Pyramid Wide variety fruits / veg (not potatoes): 800g Pulses, legumes, seeds, nuts, soy: 300g Meat, dairy: 150g Oils, fats: 25g High GL supplements Cals/g 9 3 0.5

57 New Food Pyramid Wide variety fruits / veg (not potatoes): 800g Pulses, legumes, seeds, nuts, soy: 300g Meat, dairy: 150g Oils, fats: 25g High GL supplements Cals/g 9 3 0.5 Total calories less than 2000 / day

58 Paul Clayton paulrclayton@gmail.com - Weight Management - - still waiting …


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