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Transcript of Great Diets For Weight Reduction
Great Diets for Weight Reduction
Dr. Clarence P. Davis
Bergstrasse 8
CH-8702 Zollikon
Diet and/or behavior modification:
Long-term results
(adapdet from Wadden TA. Ann Intern Med 1993; 119:688-93)
VLCD
Modified diet + behavior modification
VLCD + behavior modification
WE
igh
t ch
an
ge (
kg
)
-201 2 3
Years after interventionIntervention
4 5
-15
-10
-5
0
-5
-16
-14
-12
-10
-8
-6
-4
-2
0
20 6 18
Behavior modification
Standard behavioralTreatment (SBT)
SBT + structeredmeal plans
SBT + fat reduction
SBT + caloricrestriction
SBT + walkingprogram 3d/week
[months]
[weight loss % of initial weight][Sherwood et al. Int J Obes 1999;23:485-93
Focus of every overweight
therapy
should lie on a
LIVELONG
continuing
weight reduction
activity
milleniums centuries decades
Cause: Genetics versus
Environment
Catherine Christie, PhD, RD, LD/N, 2003
OBESITY
Prof. P James, et al., IOTF Unpublished Data.
Obesity Rates Could Double in
25 Years
Population percentage
with BMI > 30kg/m2
BIG EATER
Definition: BIG EATER
• Has no or only short lasting feeling of satiety
• Eats at least once a day more than a normal
restaurant size serving
• Usually not more than 4 meals per day
• No feelings of discomfort even after very
opulent meals.
BBC 2003:
Fast food 'as addictive as heroin'http://news.bbc.co.uk/1/hi/health/2707143.stm
NEWS Tbo 2004:
Fast Food As Health Food?
http://news.tbo.com/news/MGALX4Y1WPD.html
BBC 2002
Snack food sales rockethttp://news.bbc.co.uk/1/hi/uk/226
2816.stm
BB2 2002
Junk food battle hits US schoolshttp://news.bbc.co.uk/1/hi/world/americas/2016819.stm
BBC 2003
'Big portions' health warninghttp://news.bbc.co.uk/1/hi/health/3112718.stm
Hamburgers are 112% bigger than they were 20 years ago
BBC 2003
Court dismisses McDonald's obesity casehttp://news.bbc.co.uk/1/hi/world/americas/2685707.stm
Increased Portion Sizes
Catherine Christie, PhD, RD, LD/N, 2003
Comparison of Energy Densities
Nielsen SJ et al JAMA. 2003 Jan 22-29;289(4):450-3
Comparison of Energy Densities
Prentice AM et al Obes Rev. 2003 Nov;4(4):187-94
10 week-followup
● sucrose; mean BMI 28.0; n=21
∆ artificial sweetners; mean BMI 27.6; n=20
Over study period, significant differences
between changes in:
body weight- P < 0.001
fat mass- P < 0.05
At different time points:
* P < 0.05
** P < 0.001
*** P < 0.0001
Mean SEM
Changes in body weight, fat mass and fat-free
mass in overweight people during
intervention with sucrose vs. artificial
sweeteners.
Raben A, et al. Am J Clin Nutr 2002;76:721-9.
„Energy-density“of typical fast-food
A.M. Prentice et al. Obes Rev. 2003;4:187-194
145% more energy
per meal compared
with a traditional
African diet
Summary:
Energy density
• Energy content of fast food is
+145% higher of Gambian traditional food
• Energy density correlates best with fat content
• No adaptation process
• PASSIVE over-consumption
• Results in:
– Higher fat intake
– Weight gain
Case 1
Male, 56 y
Sales representative
„lots of business lunches“
BW: 93.4; FM: 26.1 kg (28%); LBM: 67.3 kg
BMI: 32.3
~ 1000 km of cycling every month
Actual Medication:
-Diamicron (Gliclazidum): 0-0-1
-Glucophage 1000 (Metformin): 1-0-0
-Selipran (Pravastatin): ½-0-½
Case 1
Therapy:
1) Ketogenic diet (1200 kcal/d) for 6 wk
1) 200 g of meat/fish/poultry/(tofu)
2) Vegetable side dish
3) salad
2) Slight reduction of endurance activities
3) Adaptation of diabetic medication according to
blood glucose
WM male 56 years
60
65
70
75
80
85
90
95
10
.05
.01
20
.05
.01
30
.05
.01
09
.06
.01
19
.06
.01
29
.06
.01
09
.07
.01
19
.07
.01
29
.07
.01
08
.08
.01
18
.08
.01
28
.08
.01
07
.09
.01
17
.09
.01
27
.09
.01
07
.10
.01
17
.10
.01
27
.10
.01
06
.11
.01
16
.11
.01
26
.11
.01
06
.12
.01
03
.01
.02
13
.01
.02
23
.01
.02
02
.02
.02
12
.02
.02
22
.02
.02
KG
0
2
4
6
8
10
12
14
16
KG
Blutz.
Ketogenic Diet1) Definition:
• The KD is both a high-fat/low-non-fat diet, and a diet that is
calorie-restricted
• Any diet providing nutritional or body fat for the generation of
ketones that serve as an alternative fuel to body tissues may
be called “ketogenic”
2) Side effects• Usually none to only slight side effects if carried out properly
- hyperuricemia
- gout
- gallstones
3) Indication• Weight reduction under medical supervision and normal
metabolic status- age < 60 y
- BMI ≥ 30 kg/m2
Ketogenic Diet• Contraindications:
• Absolute:
- Low serum potassium
- Hyperuricemia
- Any form of renal dysfunction
- Nephrolithiasis
- Instable angina
- Myocardial infarction within the last 6 months
- Epilepsy
- Pregnancy and lactation
- Malignancies
• Relative
- certain professions
• Drivers
• Pilots
• etc.
- Eating disorders
Ketogenic Diet: Procedure
1) Thorough clinical examination:• Exclusion of contraindications
2) Evaluation of protein need• Rule of thumb: per 10 kg of target weight 10 g of protein
(may be increased)
3) Patient instruction• Basic principles
• Permitted and not permitted food
• Preparation techniques (fat- and CHO-restricted cooking)
• Possibly self control with ketone sticks
• Slow resumption of CHO after diet
4) Regular weight control in your office
5) Transition phase
Ketogenic Diet: food choice
1) Protein need based on target weight:• 10 g of biological valuable protein per 10 kg of target weight
- Dairy products
300 ml: skim milk, buttermilk, whey protein drinks
2 x 180 yogurt (preferentially skim milk yogurt)
100 g cottage cheese, tofu
50 g of 50% fat cheese
- Eggs
1 egg
- Fish
60 g of fish (any kind, preferentially lean types) or
canned fish in water
- Meat
- 50 g of lean meat (pork, beef, veal, horse, poultry,
venison)
- 30 g of dried meat
Ketogenic Diet: food choice
2) In addition to the protein a vegetable side dish for the
main course is allowed. A total of two servings per day
are allowed. They may be taken from either group.• Vegetable group 1 (1 serving = 200 g)
- Eggplant, artichoke, broccoli, cauliflower, cucumber, salt
cucumber, pepperoni, cabbage (all types), mushrooms, radish,
spinach, asparagus, tomato, chicory, onions, zucchini, celery,
fennel
• Vegetable group 2 (1 serving = 150 g)- Green beans, green lattice, dandelion, carrots, pumpkin
3) One green salad per main course is extra
WM male 56 years
60
65
70
75
80
85
90
95
10
.05
.01
06
.06
.01
03
.07
.01
30
.07
.01
26
.08
.01
22
.09
.01
19
.10
.01
15
.11
.01
12
.12
.01
26
.01
.02
22
.02
.02
21
.03
.02
20
.04
.02
21
.05
.02
18
.06
.02
16
.07
.02
14
.08
.02
10
.09
.02
11
.10
.02
07
.11
.02
11
.12
.02
07
.01
.03
03
.02
.03
02
.03
.03
29
.03
.03
25
.04
.03
26
.05
.03
24
.06
.03
21
.07
.03
22
.08
.03
25
.09
.03
KG
0
2
4
6
8
10
12
14
16
KG
Blutz.
Severe illness of close
family member
Herniated
disc
impedes
physical
activity
FAT EATER
Nutritional Fat
Typical nutrition
composition
Recommended nutrition
composition
Fat 40%
Protein15-20%
Protein15-20%
CHO
40-50% Fat 30%CHO
45-55%
Case 2
Femal, 58 y
Yoga instructor
„can’t move my body properly anymore“
BW: 86.9; FM: 38.2 kg (44%); LBM: 48.7 kg
BMI: 31.9
~ apart from Yoga no other physical activity
Actual Medication:
-HRT
Case 2
Low-fat Diet1) Definition:
• Any diet with a restriction of fat may be called a low-fat diet.
• Mostly a low-fat diet will also have some sort of fat-
modification.
2) Side effects• Usually none if fat restriction is not absolute
3) Indication• A modified composition of fat should be part of every healthy
nutrition. It may play a special role in- Cardiovascular disease (Mediterranean diet, PUFA-rich diets,
DASH-diet, etc) for the prevention/therapy of dyslipidemia, and
the primary and secondary prevention of arteriosclerosis
4) Contraindications:• None. Basically a fat-modified diet may be carried out at any
time without side effects or hazards to the health, as long as
the fat restriction is not too harsh (HDL-Cholesterol may
decrease, and cancer risk increase) and a healthy mix of
nutrition is maintained
Low-fat Diet: Procedure
1) Thorough clinical examination:• Evaluation of cardiovascular risk factors
• Blood lipids
• Blood pressure
2) Diet modification• Reduction of fat below 30% of total energy intake (max. 60-
70 g fat/d)
• Distribution of fat-types: SFA:MUFA:PUFA=<1:1-1.5:<1
• Cholesterol < 300 mg/d
• Avoid/reduce trans fatty acids
• Increase of fibers to ≥ 30 g/d
• Diet should be high in CHO (~ 55-60% of total energy intake)
• Avoid alcohol or strict alcohol reduction
3) Regular weight control in your office
4) Well suited as lifelong diet
Low-fat Diet: food choice
• Ask your dietitian!
„Fat-Quiz“
Recognize and estimate hidden fat!
Would you have know it?
9 g of fat0,7 g of fat
12 g of fat 1,3 g of fat
1 handful = 40 g 1 handful = 50 g
2 g of fat 7 g of fat
1 handful = 40 g 1 handful = 20 g
10 g of fat 32 g of fat
1 plate 1 Pizza
0,4 g of fat 32 g of fat
1 seving (side dish) = 60 g 1 serving = 180 g
26 g of fat 2,4 g of fat
1 sausage = 110 g 1 chicken breast = 150 g
Low-fat Diet: medical treatment
Active
center
lipase
Stable Xenical-complex blocks fat digestion
OH
CHONH
H2NCO
OH
Xenical®
42
Xenical prevents the absorption of up to
30% of dietary fat...
…which pass through the body
undigested and are excreted.
30% of
triglycerides
pass
undigested and are excreted.
Consistent weight loss in clinical trials
6.1%6.6%
5.8%
10.2%9.7%
8.8%
0
2
4
6
8
10
12
Sjöström Rössner Davidson
Weight loss (%)
p<0.001p<0.001p<0.001
Placebo + diet
Xenical + diet
Sjöström L et al Lancet. 1998 Jul 18;352(9123):167-72
Rössner S et al Obes Res. 2000 Jan;8(1):49-61
Davidson MH et al JAMA. 1999 Jan 20;281(3):235-42
Xenical: Long-term weight reduction
Sjöström L et al Lancet. 1998 Jul 18;352(9123):167-72
Verä
nd
eru
ng
Kö
rperg
ew
ich
t (%
)
-4-10
-8
-6
-4
-2
0
0 10
PlaceboXenical® 60mgXenical® 120mg*p<0.01
20 30 40 60 70 80 90 10452
Xenical: XENDOS-results
Torgerson JS et al Diabetes Care. 2004 Jan;27(1):155-61
–4,1 kg
–6,9 kg
p<0.001 vs. Placebo
0 52 104 156 208–12
–9
–6
–3
0
Placebo +
lifestyle modification
Xenical +
lifestyle modification
Woche
(kg)
Low-fat Diet
Weight loss after 15 mts of low-fat diet and Xenical
86.9
82.8
79.377.6
74.7
71.4 71.372.3
60
65
70
75
80
85
90
06.05 08.05 10.05 01.06 03.06 05.06 07.06 09.06
kg