Importance of Weight

Management
 The War on Weight
 Importance of healthy
eating habits.
 Should not focus on
temporary weight
loss.
 Takes time and
consistency.
 25% of men and 40%
of women are trying
to lose weight
 Weight management is important
to prevent and control diseases.
 Diabetes, heart-diseases, stroke
and cancer.
 Generated by unhealthy eating
habits, genes, environment, and
lifestyle.
 Eating healthy foods partnered with
exercise and physical activities.
 Air, Water and Food are the
physiological needs that should be met
for human survival.
 Maslow’s Hierarchy of Needs (1943)

 Well balanced meal to support growth

and development.
 Imbalance intake of food may lead to
overweight or obesity.
 Calorieis the measurement of
energy we get from food.
 Caloric balance is like a scale.
 An Overview of Obesity in the
Philippines
 Overweight and obesity
are defined as abnormal
or excessive fat
accumulation that may
impair health (WHO).
 May reduce life
expectancy.
 In Philippines (3) out of
(10) Filipinos are now
obese.
 Factors that may lead to
OBESITY

A. Inactive Physical Lifestyle

B. Improper food selections
C. Engaging on enactive recreation
D. Genetics
 Health Problems Associated
with Obesity
 Childhood obesity may lead to
adulthood obesity.
 Major effects to human life

 Low self-esteem, social problems and

even daily performances.
 Obesity increases the risk of non-
communicable diseases or lifestyle-
related diseases.
 How to know if you are
overweight or obese?

 BMI
 If a person often consumes
unhealthy food then he or she is
prone to lifestyle diseases such as
heart diseases, obesity, and
diabetes,
A. Non-modifiable

 Age
 Gender
 Heredity
B. Modifiable

 Stress

 Smoking

 Alcoholintake
 Personality
 The Philippine Food
Pyramid/My Food Plate
 Weight management
Tactics

 Become more active

 Have a healthier approach to the
whole family’s eating habits
 Do not skip meals

 Consult the doctor or any

professional for advice
Lifestyle Vs. Weight Loss

 Prevention of obesity is easier than curing

 Balance energy in(take) with energy
out(put)
 Focus on improving food habits
 Focus on increased physical activities
What It Takes To Lose a
Pound
 Body fat contains 3500 kcal/lb
 Fat storage (body fat plus supporting
lean tissues) contains 2700 kcal/lb
 Must have an energy deficit of 2700-
3500 kcal to lose a pound per week
 Do the Math

To lose one pound, you must create a deficit of

2700-3500 kcal
So to lose a pound in 1 week (7 days), try cutting
back on your kcal intake and increase physical
activity to create a deficit of 400-500 kcal per day

- 500 kcal x 7 days = - 3500 kcal = 1 pound of weight loss

day week in 1 week
Sound Weight Loss
Program
 Rate of loss
 Flexibility
 Intake
 Behavior Modification
 Overall Health
Cutting Back

 1200-1500 kcals per day

 Control calorie intake by being aware
of kcal and fat content of foods
 “Fat Free” does not mean “Calories
Free” (or “All You Can Eat”)
 Read food labels
 Estimate kcal using the exchange
system
 Keep a food diary
Regular Physical Activity

 Fat use is enhanced with regular

physical activity
 Increases energy expenditure
 Duration and regularity are important
 Make it a part of a daily routine
Behavior Modification

 Modify problem (eating) behaviors

 Chain-breaking
 Stimulus control
 Cognitive restructuring
 Contingency management
 Self-monitoring
Chain-Breaking

 Breaking the link between two

behaviors
 These links can lead to excessive
intake

Snacking while watching T.V.

Stimulus Control

 Alternating the environment to

minimize the stimuli for eating
 Puts you in charge of temptations
Cognitive Restructuring

 Changing your frame of mind

regarding eating
 Replace eating due to stress with
“walking”
Contingency Management

 Forming a plan of action in response

to a situation
 Rehearse in advance appropriate
responses to pressure of eating at
parties
Self-Monitoring

 Tracking foods eaten and conditions

affecting eating
 Helps you understand your eating
habits
 Weight Maintenance
 Prevent relapse
– Occasional lapse is fine, but take charge
immediately
– Continue to practice newly learned behavior
– Requires “motivation, movement, and
monitoring”
 Have social support
– Encouragement from friends/ family/
professionals
Weight Loss Triad
Control Energy
Intake

Perform Regular Control “Problem”

Physical Activity Behaviors
Dieting Can Be Hazardous
To Your Health
 Weight regained consists of a
higher percentage of body fat than
before
 Less healthy than before dieting

 Weight loss diet should not be

considered unless you are
committed and motivated
Diet Drugs: Amphetamine
(Phentermine)

 Prolongs the activity of epinephrine and

norepinephrine in the brain
 Decreases appetite
 Not recommended for long term use
(dependency)
Sibutramine (Meridia)

 Enhances norepinephrine and

serotonin activity
 Decreases appetite (eat less)
 Not recommended for people with HTN
Orlistat (Xenical)
 Inhibits fat digestion
 Reduces absorption of fat in the small
intestine
 Fat is deposited in the feces, causing
side effects
 Must control fat intake
 Malabsorption of fat-soluble vitamins
 Supplements needed
Very Low-Calorie Diets
(VLCD)
 Recommended for people >30% above
their healthy weight
 400-800 kcal per day
 Low carbohydrates and high protein
 Causes ketosis
 Lose ~3-4 pounds a week
 Requires careful physician monitoring
 Health risks includes cardiac problems
and gallstones
Bariatric Surgery

 An increasingly popular option for

severely obese people who are
unlikely to lose weight through
conventional means
 Cost: $20-$35,000
 Some insurers cover it
Candidates for Bariatric
Surgery
 BMI of 40 or more—about 100 pounds
overweight for men and 80 pounds for
women
 BMI between 35 and 39.9 and a serious
obesity-related health problem such as type
2 diabetes, heart disease, or severe sleep
apnea
 Willingness to make associated lifestyle
changes
Bariatric Surgery

 Restrictive
 Malabsorptive
 Combination restrictive/malabsorptive
Restrictive Surgery:
Adjustable Gastric Band
Diet After Surgery

 After restrictive surgeries, patients can

only eat ½ cup to 1 cup of food at a
time
 Foods often must be soft and chewed
thoroughly
 Patients who eat too fast or the wrong
kinds of food may have vomiting
Restrictive/Malabsorptive:
Roux en Y
Diet Books: Big Business

 The original Dr. Atkins Diet Revolution is

one of the ten best selling books of all time
 Dr. Atkins New Diet Revolution is still #14
on the NYT paperback advice bestseller list
(11/04) having been on the list for years
 The South Beach Diet has been on the NYT
hardcover advice bestseller list for 81
weeks, and is currently #4.
Low Carbohydrate Diets
(Past)
 The Scarsdale Medical
Diet
 The Drinking Man’s
Diet
 Dr. Atkins Diet
Revolution
 The Marine Corps Diet
 The Last Chance Diet
 The “Mayo Clinic” Diet
 Low Carbohydrate Diets
(Recent)
 Enter the Zone
 Dr. Bob Arnot’s Revolutionary Weight Control
Program
 Protein Power
 Sugar Busters
 Dr. Atkins New Diet Revolution
 Feed Your Kids Well (Atkins for Kids)
 The Fat Flush Plan (Gittleman)
 The South Beach Diet
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.
 This results in a metabolic advantage
of low carbohydrate: dieters can lose
weight while eating more calories
 Atkins Diet
 “Induction Phase”: 2 weeks, 20 g
carb/day
 Eliminate 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 beans
Atkins Diet

 Supplements are recommended for

everyone: a multivitamin, lecithin, L-
glutamine, chromium piccolinate
 Can purchase supplements from the
Atkins Institute
 Recommends exercise
Atkins Phase 2: OWL

 “Ongoing weight loss phase” or “Owl.”

 Add carbohydrate at a rate of 5 grams
a day until weight loss stops
 This is the CCLL: critical carbohydrate
level for losing
 May be 45, or 33, or 19 grams/day
 Continue at this level until desired
weight is reached
Atkins Maintenance

 Determine CCLM: critical carbohydrate

level for maintenance (the level at
which weight stabilizes)
 Most will stabilize at 25 to 90
grams/day
 If weight gain occurs, return to
induction diet
Atkins- Sample Menu
Phase 1
 B: scrambled eggs and ham, butter,
decaffeinated coffee or tea
 L: 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 beverage
Atkins: Sample menu
OWL
 B: 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
tea
 D: Seafood salad, poached salmon,
2/3 cup vegetable from permitted list,
half cup of strawberries in cream
South Beach Diet Premise
 “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”
 States that Atkins may limit carbs too
severely
 Stresses glycemic index as the biggest
determinant of a food’s potential impact on
body weight
South Beach Diet: Phase 1
(2 weeks)
 Carbs limited to low-carb vegetables, salads, 1%
milk, fat-free buttermilk, nonfat yogurt.
 Proteins: unlimited lean meats, poultry, fish, low fat
cheese, tofu
 Nuts included, but limited
 “Good” fats including olive, canola oils
 Sugar-free hard candies, diet gelatin, sugar subs
 NO fatty meats, starchy vegetables like corn,
potatoes, carrots, no fruits, no grains, no alcohol
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 substitute
 snack: 1-2 turkey roll ups
 L: SB chopped salad with tuna, sf gelatin
 snack: celery, 1 wedge Laughing Cow Light
Cheese
 D: baked chix breast, roasted eggplant and
peppers, salad, lo sugar dressing
 Dessert: Mocha Ricotta Creme
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, 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, watermelon
 Dieters stay in this phase until goal weight achieved
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 tea
 Snack: 4 oz non-fat sugar-free yogurt
 L: Tuna salad w/ celery, mayo, tomato, onion in
whole wheat pita
 Snack: 1 part-skim mozzarella cheese stick
 D: Pan roasted steak and onions, South Beach
salad, steamed broccoli; chocolate-dipped
strawberries
South Beach Diet: Phase
3
 Maintenance- no foods are forbidden
 Continue to limit high carb, refined or
heavily processed foods.
 Return to earlier phase if weight gain
occurs
South Beach vs Atkins
Phase 1
Atkins
 Proteins: All meats, poultry,
fish, shellfish, eggs, cheese
are unlimited
 Fats: vegetable oils, butter,
mayonnaise, heavy cream,
bacon
 Vegetables: 3 cups salad or
2 cups salad and 2/3 cup
low carb vegetables
 NO: 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
High Carbohydrate Low
Fat Diets
 The Pritikin Weight Loss Breakthrough
 Eat More, Weigh Less (Dean Ornish)
 American Heart Association diets
 NHLBI TLC diet
High Carb Low Fat Diets

 Rationale: 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, vegetables
Sample Menu: High Carb
Low Fat
 B: 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 yogurt
 L: Vegetarian vegetable soup, fresh orange,
nonfat yogurt
 D: Grilled salmon with yogurt-dill sauce,
bulgur with raisins, steamed broccoli;
strawberries over angelfood cake
 Snack: air popped popcorn
Research on Macronutrient
Mix in Weight Loss Diets
 Low Carb vs Low Fat Diet
 Objective: Compare effects of a low-carb, ketogenic
diet (Atkins) with those of a low-fat, low chol,
reduced calorie diet
 Design: Randomized, controlled
 Subjects: 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 meetings
Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777
Low Carb vs Low Fat Diet
 Measurements: 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%)
 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)
 Expected mean body weight over time, by diet group

Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777

 Low Carb vs. Low Fat
 Low carb group had > increases in HDL-C (5.5
mg/dL vs. -1.6 mg/dL P<0.001)
 Changes in LDL-C were not significant
 Low carb group had greater participant retention
and greater weight loss over 24 weeks
 Minor 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.
Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777
 Low carb vs. conventional
1 year follow up

 Objective: Review the 1-year outcomes of two

groups randomized to these diets
 132 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 fat
Stern, L. et. al. Ann Intern Med 2004;140:778-785
 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)
 Triglycerides 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 groups
 Limitations: 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
 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)

Stern, L. et. al. Ann Intern Med 2004;140:778-785

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 weight
 By 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 carb
 Summary: High Pro Low
Carbohydrate Diets
 Pros:
– High pro low carb diets appear to produce
greater short term weight loss
– In studies, there was a lower dropout rate
with high pro low carb diets
– High pro low carb diets produced favorable
lipid changes
 Summary: High Pro Low
Carbohydrate Diets
 Concerns
– long term safety (effects of high pro diet on kidney
function, lack of phytochemicals, association of ↑ red
meat and ↑ sfa intake with ↑ cancer)
– questionable rationale (protein stimulates insulin
release)
– difficult to follow long term
– epidemiological evidence shows vegetarians are
slimmer
– at risk nutrients: calcium, potassium, vitamin C,
vitamin D
 High Carb Low Fat Diets
 Pros
– Fits most major dietary guidelines including
U.S. Dietary Guidelines, TLC diet, AHA diet;
high in fiber and plant foods associated
with health benefits
– Epidemiological evidence associates high
carb low fat diets with lower rates of heart
disease, cancer, obesity
– Consistent with pattern reported by
successful dieters in the National Weight
Control Registry
Summary: High Carb Low
Fat Diets
 Cons
– Produces more gradual weight loss than
high protein diets; dieters become
discouraged
– Very high carb low fat diets associated
with unfavorable lipid changes (may need
to choose whole grains, replace some
carb with MFA)
– At risk nutrients: B12, D, E, Zinc
Weight Loss By Any Method
Will:
 Reduce blood lipid levels including TC,
LDL-C, HDL-C, and Tg
 Improve glycemic control
 Reduce blood pressure

Especially during active weight loss!

Low Carb vs Low Fat

 Weight loss is caused by a deficit in

calories, not a metabolic advantage of
one over the other
 Persons with the greatest calorie
deficit lost the most weight
 A high protein diet may offer some
advantages, perhaps in simplicity,
limiting options, or increased satiety
Low Carb vs Low Fat

 Many VLCD programs offer a high

protein, low carb, low fat approach
 People should be offered options in
weight management
 The major issue in diet success is how
persons plan to keep the weight off
Diet Quality of Popular
Diets
CSFII Data: Healthy Eating Index
80
70
60
50
40
HEI SCORE
30
20
10
0
LOW CHO MOD CHO HIGH CHO
Energy Intake of Adults on
Popular Diets
CSFII DATA

2200
2150
2100
2050
2000
1950 Energy (kcal)
1900
1850
1800
1750
LOW CHO MOD CHO HIGH CHO
BMI of Adults on Popular
Diets
CSFII DATA
28
26
24
22
20
MEN
18 WOMEN
16
14
12
10
LOW CHO MOD CHO HIGH CHO
BMI Vegetarians/Non
Vegetarians
CSFII DATA

27

25

23

21 Men
Women
19

17

15
VEG NON-VEG
Energy Intake Vegetarians/
Non-Vegetarians
(CSFII DATA)

2500

2000

1500
Energy (kcal)
1000

500

0
VEG NON-VEG
NHLBI Recommendations:
Diet Therapy for Weight
Mgmt
 Low calorie diets are recommended for
weight loss in overweight and obese
persons
 Reducing fat as a part of LCD is a
practical way to reduce calories.
 Plan for a deficit of 500-1000 kcal/day
for weight loss of 1-2 lb/wk
NHLBI Recommendations:
Physical Activity
 Physical activity modestly contributes
to weight loss, may decrease
abdominal fat, increases
cardiorespiratory fitness
 VERY important for wt maintenance
 Initially 30-45 minutes moderate
activity, 3-5 days a week
 Long term: 30 minutes + of moderate
intensity activity on most/all days
National Weight Control
Registry
 Self-selected data base of people who
have lost at least 30 lb and kept it off
at least one year
 Published data on 784 persons, 80%
female, 97% white, 56% with college
degrees, mean age 45 years
 Had average maximum BMI of 35;
most had attempted wt loss numerous
times
NWCR: Weight Loss
Methods
90
80
70 Diet and activity
60 Limit certain foods
50 Formal prog (incl RD)
40 Limit quantity of foods
30 Count calories
Limit fat kcals
20
Limit fat grams
10
0
% of Resp
NWCR: Weight
Maintenance Methods
Limits certain foods
100
90
Burns >1000 kcal
80 exercise/wk
70 Weighs self weekly
60
50 Limits quantity of food
40
30 Limits kcal from fat
20
10 Counts kcals
0
% of Resp Counts fat grams
Underweight is Also a
Problem
 15-25% below healthy weight or BMI
of <18.5
 Associated with increased deaths,
menstrual dysfunction, pregnancy
complications, slow recovery from
illness/surgery
 Causes are the same as for obesity but
in the opposite route
Treatment for
Underweight
 Intake of energy-dense foods (energy
input)
 Encourage meals and snacks
 Reduce activity (energy output)
 To gain a pound you need a total
excess intake of 2700-3500 kcal