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Great Diets for Weight Reduction

Dr. Clarence P. Davis


Bergstrasse 8
CH-8702 Zollikon
Diet and/or behavior modification:
Long-term results
-5

0
WEight change (kg)

-5

-10 VLCD
Modified diet + behavior
modification
-15 VLCD + behavior modification

-20
1 2 3 4 5
Intervention Years after intervention
(adapdet from Wadden TA. Ann Intern Med 1993; 119:688-93)
Behavior modification

2 [months]
0 6 18
0
Standard behavioral
-2 Treatment (SBT)
-4 SBT + structered
meal plans
-6 SBT + fat reduction
-8 SBT + caloric
restriction
-10 SBT + walking
program 3d/week
-12
-14
-16 [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

energy density
OBESITY
Cause: Genetics versus
Environment

Catherine Christie, PhD, RD, LD/N, 2003


Obesity Rates Could Double in
25 Years

Population percentage
with BMI > 30kg/m2

Prof. P James, et al., IOTF Unpublished Data.


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

'Big portions' health warning


http://news.bbc.co.uk/1/hi/health/3112718.stm

BBC 2003:
Fast food 'as addictive as heroin'
http://news.bbc.co.uk/1/hi/health/2707143.stm

Hamburgers are
112% bigger than
they were 20 years
ago

BBC 2002

Snack food sales


rocket  BBC 2003
http://news.bbc.co.uk/1/hi/uk/2262816.stm
Court dismisses
McDonald's obesity case
B2 2002 http://news.bbc.co.uk/1/hi/world/americas/2685707.stm

unk food battle hits


NEWS Tbo 2004:
US schools Fast Food As Health Food?
tp://news.bbc.co.uk/1/hi/world/americas/2016819.stm
http://news.tbo.com/news/MGALX4Y1WPD.html
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


Changes in body weight, fat mass and fat-
free mass in overweight people during
intervention with sucrose vs. artificial
sweeteners.

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
Raben A, et al. Am J Clin Nutr 2002;76:721-9.
„Energy-density“of typical fast-food

145% more
energy per
meal compared
with a
traditional
African diet

A.M. Prentice et al. Obes Rev. 2003;4:187


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
Ketogenic Diet
1) 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
4) One green salad per main course is extra
KG

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
family member

21.03.02
20.04.02
21.05.02
Severe illness of close

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
WM male 56 years

25.04.03
26.05.03
24.06.03
21.07.03
22.08.03
25.09.03
0
2
4
6
8
10
12
14
16

KG
Blutz.
disc

activity
impedes
physical
Herniated
FAT EATER
Nutritional Fat

Typical nutrition Recommended


composition nutrition
composition
Protein Protein
15-20% 15-20%
CHO
CHO
Fat 40% 40-50% Fat 30% 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 Diet
1) 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?
0,7 g of fat 9 g of fat
1 handful = 40 g 1 handful = 50 g

12 g of fat 1,3 g of fat


1 handful = 40 g 1 handful = 20 g

2 g of fat 7 g of fat
1 plate 1 Pizza

10 g of fat 32 g of fat
1 seving (side dish) = 60 g 1 serving = 180 g

0,4 g of fat 32 g of fat


1 sausage = 110 g 1 chicken breast = 150 g

26 g of fat 2,4 g of fat


Low-fat Diet: medical treatment

Active
center CHONH
lipase OH

Xenical®
H2NCO

OH

Stable Xenical-complex blocks fat digestion


Xenical prevents the absorption of up to
30% of dietary fat...

4242
…which pass through the body
undigested and are excreted.

30% of
triglycerides
pass
undigested and are excreted.
Consistent weight loss in clinical trials

Weight loss (%) Placebo + Xenical +


diet diet
12 p<0.001 p<0.001
10.2% p<0.001
10 9.7%
8.8%
8
6.1% 6.6%
6 5.8%

0
Sjöström Rössner Davidson

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

Veränderung Körpergewicht (%)


0 Placebo
Xenical® 60mg
-2 Xenical® 120mg
*p<0.01
-4

-6

-8

-10
-4 0 10 20 30 40 52 60 70 80 90 104

Sjöström L et al Lancet. 1998 Jul 18;352(9123):167-72


Xenical: XENDOS-results

Placebo + Xenical +
(k lifestyle modification lifestyle modification
g) 0

–3
–4,1 kg
–6
–6,9 kg
–9
p<0.001 vs. Placebo

–12
0 52 104 156 208
Woche

Torgerson JS et al Diabetes Care. 2004 Jan;27(1):155-61


Low-fat Diet