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Weight Management: Popular Approaches. Formula Diets and Meal Replacements Meal formats and nutritional profiles varyMeal formats and nutritional profiles.

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Presentation on theme: "Weight Management: Popular Approaches. Formula Diets and Meal Replacements Meal formats and nutritional profiles varyMeal formats and nutritional profiles."— Presentation transcript:

1 Weight Management: Popular Approaches

2 Formula Diets and Meal Replacements Meal formats and nutritional profiles varyMeal formats and nutritional profiles vary Total calories range from 1000-1600 kcals day with meal replacement drinks or bars replacing two meals during weight loss or one meal for weight maintenanceTotal calories range from 1000-1600 kcals day with meal replacement drinks or bars replacing two meals during weight loss or one meal for weight maintenance

3 Formula Diets and Meal Replacements There is evidence that meal replacements can be as effective as standard low- calorie diets in promoting weight lossThere is evidence that meal replacements can be as effective as standard low- calorie diets in promoting weight loss

4 Evaluation of Major Commercial Weight Loss Programs Reviewed research regarding the efficacy of 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 SensiblyReviewed research regarding the efficacy of 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 (Tsai and Wadden, Ann Int Med 2005; 142:56-66)

5 Evaluation of Major Commercial Weight Loss Programs Weight Watchers had the strongest studies to support itWeight Watchers had the strongest studies to support it Best study: participants lost 5% of their initial body weight (about 10 pounds) and kept off 3% (about 5 pounds) at 2 yearsBest study: participants lost 5% of their initial body weight (about 10 pounds) and kept off 3% (about 5 pounds) at 2 years No published high-quality studies of Jenny Craig or LA Weight LossNo published high-quality studies of Jenny Craig or LA Weight Loss (Tsai and Wadden, Ann Int Med 2005; 142:56-66)

6 Evaluation of Major Commercial Weight Loss Programs Studies of VLCDs were of limited qualityStudies of VLCDs were of limited quality Patients who stayed on the program lost 15- 20% of initial body weight in 6 monthsPatients who stayed on the program lost 15- 20% of initial body weight in 6 months Many patients dropped out of these programsMany patients dropped out of these programs Those who completed the program regained half of lost weight in 1-2 years after treatmentThose who completed the program regained half of lost weight in 1-2 years after treatment Studies of internet-based programs of limited quality and produced minimal weight lossStudies of internet-based programs of limited quality and produced minimal weight loss (Tsai and Wadden, Ann Int Med 2005; 142:56-66)

7 Atkins Diet Premise Stabilizes insulin production by limiting carb intake. This forces the body from glucosis into lipolysis, thus ketones are burned as the primary energy source.Stabilizes insulin production by limiting carb intake. This forces the body from glucosis into lipolysis, thus ketones are burned as the primary energy source. This results in a metabolic advantage of low carbohydrate: dieters can lose weight while eating more caloriesThis results in a metabolic advantage of low carbohydrate: dieters can lose weight while eating more calories

8 Atkins Diet: Induction Phase “Induction Phase”: 2 weeks, 20 g carb/day“Induction Phase”: 2 weeks, 20 g carb/day Eliminate fruit, bread, grains, starchy vegetables, dairy products except cheese, cream, butterEliminate fruit, bread, grains, starchy vegetables, dairy products except cheese, cream, butter 20 g carb: 3 cups salad greens, or 2 cups salad plus 2/3 cups cooked vegetables such as asparagus, summer squash, green beans20 g carb: 3 cups salad greens, or 2 cups salad plus 2/3 cups cooked vegetables such as asparagus, summer squash, green beans

9 Atkins- Sample Menu Phase 1 B: scrambled eggs and ham, butter, decaffeinated coffee or teaB: scrambled eggs and ham, butter, decaffeinated coffee or tea L: Bacon cheeseburger, no bun, small tossed salad, selzer waterL: Bacon cheeseburger, no bun, small tossed salad, selzer water D: shrimp cocktail with mustard and mayo, clear consomme, steak, roast, fish or fowl, tossed salad, diet gelatin with whipped cream, sf beverageD: shrimp cocktail with mustard and mayo, clear consomme, steak, roast, fish or fowl, tossed salad, diet gelatin with whipped cream, sf beverage

10 Atkins Phase 2: OWL “Ongoing weight loss phase” or “Owl.”“Ongoing weight loss phase” or “Owl.” Add carbohydrate at a rate of 5 grams a day until weight loss stopsAdd carbohydrate at a rate of 5 grams a day until weight loss stops This is the CCLL: critical carbohydrate level for losingThis is the CCLL: critical carbohydrate level for losing May be 45, or 33, or 19 grams/dayMay be 45, or 33, or 19 grams/day Continue at this level until desired weight is reachedContinue at this level until desired weight is reached

11 Atkins: Sample menu OWL B: Western omelet, 3 ounces tomato juice, 2 carbo grams of bran crispbread, decaf coffee or teaB: Western omelet, 3 ounces tomato juice, 2 carbo grams of bran crispbread, decaf coffee or tea L: Chef’s salad with ham, cheese, chicken and egg; zero carbohydrate or oil and vinegar dressing, iced herbal teaL: Chef’s salad with ham, cheese, chicken and egg; zero carbohydrate or oil and vinegar dressing, iced herbal tea D: Seafood salad, poached salmon, 2/3 cup vegetable from permitted list, half cup of strawberries in creamD: Seafood salad, poached salmon, 2/3 cup vegetable from permitted list, half cup of strawberries in cream

12 South Beach Diet Premise “Addiction” to carbs is a psychological need for comfort food and is likely a real, physiological phenomenon“Addiction” to carbs is a psychological need for comfort food and is likely a real, physiological phenomenon Eating bad carbs leads to cravings for more which is “ultimately responsible for our obesity epidemic”Eating bad carbs leads to cravings for more which is “ultimately responsible for our obesity epidemic” States that Atkins may limit carbs too severelyStates that Atkins may limit carbs too severely Stresses glycemic index as the biggest determinant of a food’s potential impact on body weightStresses glycemic index as the biggest determinant of a food’s potential impact on body weight

13 South Beach Diet: Phase 1 (2 weeks) Carbs limited to low-carb vegetables, salads, 1% milk, fat-free buttermilk, nonfat yogurt.Carbs limited to low-carb vegetables, salads, 1% milk, fat-free buttermilk, nonfat yogurt. Proteins: unlimited lean meats, poultry, fish, low fat cheese, tofuProteins: unlimited lean meats, poultry, fish, low fat cheese, tofu Nuts included, but limitedNuts included, but limited “Good” fats including olive, canola oils“Good” fats including olive, canola oils Sugar-free hard candies, diet gelatin, sugar subsSugar-free hard candies, diet gelatin, sugar subs NO fatty meats, starchy vegetables like corn, potatoes, carrots, fruits, grains, alcoholNO fatty meats, starchy vegetables like corn, potatoes, carrots, fruits, grains, alcohol

14 South Beach: Sample Day Phase 1 B: 6 oz tomato juice, 1/4-1/2 cup liquid egg substitute, decaf coffee or tea, non-fat milk, sugar substituteB: 6 oz tomato juice, 1/4-1/2 cup liquid egg substitute, decaf coffee or tea, non-fat milk, sugar substitute snack: 1-2 turkey roll upssnack: 1-2 turkey roll ups L: SB chopped salad with tuna, sf gelatinL: SB chopped salad with tuna, sf gelatin snack: celery, 1 wedge Laughing Cow Light Cheesesnack: celery, 1 wedge Laughing Cow Light Cheese D: baked chix breast, roasted eggplant and peppers, salad, lo sugar dressingD: baked chix breast, roasted eggplant and peppers, salad, lo sugar dressing Dessert: Mocha Ricotta CremeDessert: Mocha Ricotta Creme

15 South Beach: Sample Day Phase 2 B: 1 cup blueberries; 1 scrambled egg w/ salsa; oatmeal mixed with 1 cup nonfat milk, sprinkled with cinnamon and walnuts; coffee or teaB: 1 cup blueberries; 1 scrambled egg w/ salsa; oatmeal mixed with 1 cup nonfat milk, sprinkled with cinnamon and walnuts; coffee or tea Snack: 4 oz non-fat sugar-free yogurtSnack: 4 oz non-fat sugar-free yogurt L: Tuna salad w/ celery, mayo, tomato, onion in whole wheat pitaL: Tuna salad w/ celery, mayo, tomato, onion in whole wheat pita Snack: 1 part-skim mozzarella cheese stickSnack: 1 part-skim mozzarella cheese stick D: Pan roasted steak and onions, South Beach salad, steamed broccoli; chocolate-dipped strawberriesD: Pan roasted steak and onions, South Beach salad, steamed broccoli; chocolate-dipped strawberries

16 South Beach Diet: Phase 2 Reintroduces most fruits, whole grains (sparingly) including popcorn, legumes such as pinto beans, starchy vegetables such as peas, carrots and sweet potatoes, flavored nonfat yogurt, semisweet or bittersweet chocolate, wineReintroduces most fruits, whole grains (sparingly) including popcorn, legumes such as pinto beans, starchy vegetables such as peas, carrots and sweet potatoes, flavored nonfat yogurt, semisweet or bittersweet chocolate, wine Still forbidden: white flour and products made from it including breads, cookies, pasta; potatoes, white rice, corn; fruits including bananas, canned fruit, pineapple, raisins, watermelonStill forbidden: white flour and products made from it including breads, cookies, pasta; potatoes, white rice, corn; fruits including bananas, canned fruit, pineapple, raisins, watermelon Dieters stay in this phase until goal weight achievedDieters stay in this phase until goal weight achieved

17 South Beach: Sample Day Phase 2 B: 1 cup blueberries; 1 scrambled egg w/ salsa; oatmeal mixed with 1 cup nonfat milk, sprinkled with cinnamon and walnuts; coffee or teaB: 1 cup blueberries; 1 scrambled egg w/ salsa; oatmeal mixed with 1 cup nonfat milk, sprinkled with cinnamon and walnuts; coffee or tea Snack: 4 oz non-fat sugar-free yogurtSnack: 4 oz non-fat sugar-free yogurt L: Tuna salad w/ celery, mayo, tomato, onion in whole wheat pitaL: Tuna salad w/ celery, mayo, tomato, onion in whole wheat pita Snack: 1 part-skim mozzarella cheese stickSnack: 1 part-skim mozzarella cheese stick D: Pan roasted steak and onions, South Beach salad, steamed broccoli; chocolate-dipped strawberriesD: Pan roasted steak and onions, South Beach salad, steamed broccoli; chocolate-dipped strawberries

18 South Beach Diet: Phase 3 Maintenance- no foods are forbiddenMaintenance- no foods are forbidden Continue to limit high carb, refined or heavily processed foods.Continue to limit high carb, refined or heavily processed foods. Return to earlier phase if weight gain occursReturn to earlier phase if weight gain occurs

19 South Beach vs Atkins Phase 1 Atkins Proteins: All meats, poultry, fish, shellfish, eggs, cheese are unlimitedProteins: All meats, poultry, fish, shellfish, eggs, cheese are unlimited Fats: vegetable oils, butter, mayonnaise, heavy cream, baconFats: vegetable oils, butter, mayonnaise, heavy cream, bacon Vegetables: 3 cups salad or 2 cups salad and 2/3 cup low carb vegetablesVegetables: 3 cups salad or 2 cups salad and 2/3 cup low carb vegetables NO: artificial sweeteners, margarine, fruits, grains, breads, starchy vegetables, dairy, alcoholNO: artificial sweeteners, margarine, fruits, grains, breads, starchy vegetables, dairy, alcohol South Beach Proteins: Lean beef, pork, skinless poultry, low fat cheese, seafood, eggs Fats: Canola and olive oil Vegetables: salad greens, beans, tomatoes, cabbage, summer squash, broccoli, all low carb are unlimited Dairy: Fat free or 1% milk or yogurt NO: fatty meat, high fat cheese; fruits, grains, breads, starchy vegetables, butter, margarine, alcohol

20 High Carbohydrate Low Fat Diets The Pritikin Weight Loss BreakthroughThe Pritikin Weight Loss Breakthrough Eat More, Weigh Less (Dean Ornish)Eat More, Weigh Less (Dean Ornish)

21 High Carb Low Fat Diets Rationale: diet is high in bulk and fiber, low in calorie density producing early satiety and weight lossRationale: diet is high in bulk and fiber, low in calorie density producing early satiety and weight loss Description: 50-75% carbohydrate calories, relatively less meat, fish, fats and oils, more grains, cereals, breads, fruits, vegetablesDescription: 50-75% carbohydrate calories, relatively less meat, fish, fats and oils, more grains, cereals, breads, fruits, vegetables

22 Sample Menu: High Carb Low Fat B: 1 cup blueberries; oatmeal mixed with 1 cup nonfat milk, sprinkled with cinnamon and walnuts; coffee or teaB: 1 cup blueberries; oatmeal mixed with 1 cup nonfat milk, sprinkled with cinnamon and walnuts; coffee or tea Snack: 4 oz non-fat sugar-free yogurtSnack: 4 oz non-fat sugar-free yogurt L: Vegetarian vegetable soup, fresh orange, nonfat yogurtL: Vegetarian vegetable soup, fresh orange, nonfat yogurt D: Grilled salmon with yogurt-dill sauce, bulgur with raisins, steamed broccoli; strawberries over angelfood cakeD: Grilled salmon with yogurt-dill sauce, bulgur with raisins, steamed broccoli; strawberries over angelfood cake Snack: air popped popcornSnack: air popped popcorn

23 Very Low Fat Diets <10% of calories from fat<10% of calories from fat May be vegetarianMay be vegetarian Includes The Pritikin Program and Dean Ornish’s Program for Reversing Heart DiseaseIncludes The Pritikin Program and Dean Ornish’s Program for Reversing Heart Disease Elimination of fat makes the diet less energy denseElimination of fat makes the diet less energy dense May be difficult for some people to adhere toMay be difficult for some people to adhere to

24 Research on Macronutrient Mix in Weight Loss Diets

25 A Low- Carbohydrate, Ketogenic Diet versus a Low- Fat Diet To Treat Obesity and Hyperlipidemia Objective: Compare effects of a low-carb, ketogenic diet with those of a low-fat, low chol, reduced calorie dietObjective: Compare effects of a low-carb, ketogenic diet with those of a low-fat, low chol, reduced calorie diet Design: Randomized, controlledDesign: Randomized, controlled Subjects: 120 overweight, hyperlipidemic volunteersSubjects: 120 overweight, hyperlipidemic volunteers Intervention: Low carb diet (initially <20 g carb/day) plus nutritional supplementation, exercise recommendation, and group meetings or low-fat diet (<30% energy from fat, <300 mg chol, deficit of 500- 1000 kcal/d) plus exercise recommendation and group meetingsIntervention: Low carb diet (initially <20 g carb/day) plus nutritional supplementation, exercise recommendation, and group meetings or low-fat diet (<30% energy from fat, <300 mg chol, deficit of 500- 1000 kcal/d) plus exercise recommendation and group meetings Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777

26 Low Carb vs Low Fat Diet Measurements: body weight, body composition, fasting serum lipid levels and group meetingsMeasurements: body weight, body composition, fasting serum lipid levels and group meetings Results: 76% of the low-carb group and 57% of the low- fat group completed the study. At 24 weeks weight loss was greater in the low-carb group (12.9%) than in the low-fat group (6.7%)Results: 76% of the low-carb group and 57% of the low- fat group completed the study. At 24 weeks weight loss was greater in the low-carb group (12.9%) than in the low-fat group (6.7%) Pts in both groups lost more fat mass (-9.4 kg low carb, - 4.8 kg low-fat) than fat free mass (-3.3 kg vs -2.4 kg)Pts in both groups lost more fat mass (-9.4 kg low carb, - 4.8 kg low-fat) than fat free mass (-3.3 kg vs -2.4 kg) Low carb diet subjects had > decreases in serum triglycerides (-74.2 mg.dL vs. -27.9 mg/dL)Low carb diet subjects had > decreases in serum triglycerides (-74.2 mg.dL vs. -27.9 mg/dL)

27 Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777 Expected mean body weight over time, by diet group

28 Low Carb vs. Low Fat Low carb group had > increases in HDL-C (5.5 mg/dL vs. -1.6 mg/dL P increases in HDL-C (5.5 mg/dL vs. -1.6 mg/dL P<0.001) Changes in LDL-C were not significantChanges in LDL-C were not significant Low carb group had greater participant retention and greater weight loss over 24 weeksLow carb group had greater participant retention and greater weight loss over 24 weeks Minor adverse effects were more frequent in the low- carb diet groupMinor adverse effects were more frequent in the low- carb diet group Limitations: Effects of the low-carb diet and of the nutritional supplements could not be separated. Participants were healthy and were followed for only 24 weeks.Limitations: Effects of the low-carb diet and of the 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

29 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 groups randomized to these dietsObjective: Review the 1-year outcomes of two groups randomized to these diets 132 obese adults, BMI 35 or greater; 83% had diabetes or metabolic syndrome132 obese adults, BMI 35 or greater; 83% had diabetes or metabolic syndrome Participants were counseled to either restrict carb intake to < 30g/day or reduce calories by 500 cals/day with <30% of cals from fatParticipants were counseled to either restrict carb intake to < 30g/day or reduce calories by 500 cals/day with <30% of cals from fat Stern, L. et. al. Ann Intern Med 2004;140:778-785

30 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)

31 Low carb vs. conventional 1 year follow up By 1 year, mean weight change for persons on the low 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)By 1 year, mean weight change for persons on the low 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) Triglycerides decreased more on low carb diet, HDL levels decreased less, HbA1c improved moreTriglycerides decreased more on low carb diet, HDL levels decreased less, HbA1c improved more Changes in other lipids (LDL, total-C) and insulin sensitivity did not differ between groupsChanges in other lipids (LDL, total-C) and insulin sensitivity did not differ between groups Limitations: 34% drop out rate, suboptimal dietary adherence; relatively small net weight loss in both groupsLimitations: 34% drop out rate, suboptimal dietary adherence; relatively small net weight loss in both groups Stern, L. et. al. Ann Intern Med 2004;140:778-785

32 Low Carb vs. Conventional Diet Outcomes Between 6 months and 1 year, persons in the low carb group began to regain weight while persons on the conventional diet continued to lose weightBetween 6 months and 1 year, persons in the low carb group began to regain weight while persons on the conventional diet continued to lose weight By 6 months, there was no significant difference in weight loss between the two groupsBy 6 months, there was no significant difference in weight loss between the two groups Intake data suggest that differences in weight loss, where they exist, are the result of differences in calorie intakes, not a metabolic advantage of low carbIntake data suggest that differences in weight loss, where they exist, are the result of differences in calorie intakes, not a metabolic advantage of low carb

33 Atkins vs Zone vs Ornish vs Learn 311 overweight women ages 20 to 50 were randomized to one of four diets incrementally different in CHO311 overweight women ages 20 to 50 were randomized to one of four diets incrementally different in CHO Subjects were given books explaining the diet and attended weekly instruction for eight weeks; then remained on the diets for another 10 months (total = 1 year)Subjects were given books explaining the diet and attended weekly instruction for eight weeks; then remained on the diets for another 10 months (total = 1 year) Gardner CD, et al. JAMA 2007;297:969-977

34 Gardner CD et al. JAMA 2007; 297:969-977. Changes from baseline at 12 months Outcome Atkin s Zon e LEA RN Ornis h Weight (kg) -4.7-1.6-2.6-2.2 LDL (mg/dL) 0.80.00.16-3.8 HDL (mg/dL) 4.92.22.80.0 Triglycerides-29.3-4.2-14.6-14.9 Systolic BP -7.6-3.3-3.1-1.9


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