# Presentation: 020370

## The Weight DebateContinues

## The Obesity Epidemic

- Sixty percent of American adults are overweight
- Over thirty percent are obese
- CDC reports the nation is spending $93 billion on weight related diseases
- Health consequences include hypertension, hyperlipidemia, hyperinsulinemia, osteoarthritis, increased risk of some forms of cancer, nonalcoholic fatty liver disease, heart disease, reflux, sleep apnea, respiratory problems, gallbladder disease and stroke
- 80% of obese adults have at least one of these conditions
- Results in decreased quality of life, shorter lifespan

## Economic Cost of Obesity

- time off  for sick days and doctor’s appointments
- Higher food and medication bills
- More gas used

## Why is it so hard to lose weight?

- Preventing weight loss is a biological need for survival

## Body systems will fight to maintain weight

- Ingestion of food sends neural messages and hormones to the brain which signals satiety regulating meal size and energy balance

## Leptin

- Leptin is a hormone made by fat cells that suppresses appetite and signals us to stop eating when fat stores are full
- Leptin resistance is common in obese people meaning their brain does not register satiety
- Low leptin and insulin levels in the brain during weight loss stimulate eating and suppress energy expenditure

## Ghrelin

- Ghrelin is a hormone produced in the stomach, the levels of which rise when hungry and decline after meals
- In a 2002 study in which subjects lost 17% of body weight, ghrelin output rose 25%
- May 23,2002, *New England Journal of Medicine*
- Dieters who lose weight make more ghrelin than they did before dieting as if the body is trying to regain lost fat

## Pre-breakfast levels of leptin were 20% lower in men who slept only 4 hours as compared to a night they slept nine hours.

- Their ghrelin levels were elevated by more than 25% during their day and they ate more crackers and sweets than when they were well rested.
- VanCauter, University of Chicago, November 2004,
*Journal of* *Clinical Endocrinology and Metabolism*

## Research at BNL

- Identified brain circuits that lead to overeating in the obese
- These are the same pathways that cause cravings in addicted individuals

## On the Horizon

- Obestatin is a hormone discovered in late 2005 found to decrease appetite
- Research scientists at Scripps have developed an anti-obesity vaccine which is directed at ghrelin.  The vaccine binds to target sites preventing ghrelin from reaching the central nervous system leading to a reduction in weight gain.

## Battling Mother Nature

- Our bodies fight us to regain the lost weight
- Biological and physiological mechanisms defend  extra fat and try to return the body to the weight it was
- Research shows that people who have lost weight are hungrier and not just for any food
- Weight loss signals the brain that you are starving and will slow metabolism
- Keep in mind that metabolic rate is linked to the amount of lean and muscle tissue you have
- The only way to counter this is to exercise more

## More Bumps in the Road

- Lipoprotein lipase, an enzyme that promotes fat storage, goes up in fat tissue when you lose weight so you tend to store fat rather than burn it
- The good news is that you won’t gain weight unless you eat more

## The Weight Equation

**Energy In=Energy Out**
- A caloric deficit can be achieved by decreasing calorie intake, increasing energy expenditure or both

## Strategies for Weight Loss and Weight Maintenance

## National Weight Control Registry Members

- Consume approximately 1400 calories about 24% of those calories from fat
- Expend about 400 calories each day in physical activity

## Why This Works

- Low calorie diets can reduce body weight by an average of 8% while reducing abdominal fat
- When weight loss occurs, the loss is about 75% from fat and 25% from lean tissue
- Consuming fewer than 800 calories/day may lead to nutrient deficiencies, produce same weight loss after a year as LCDs but with more regained, does not lead to behavior changes, increase risk of developing gallstones

## The Volumetrics Eating Plan

- Latest research by Barbara Rolls at Penn State University
- Based on studies of portion size, fat content and calorie density
- Key to hunger control while losing or maintaining weight is satiety
- High water content lowers calorie density giving you a larger portion for the same number of calories

## Several supporting studies have shown that eating a broth type soup or low fat salad prior to the meal reduces calorie intake for the whole meal.
Drinking water will not reduce hunger.  The water has to be in the food.
Along with the water, the fiber in fruits and vegetables helps you feel fuller and has been shown to reduce calorie intake

- Drinking water will not reduce hunger.  The water has to be in the food.
- Along with the water, the fiber in fruits and vegetables helps you feel fuller and has been shown to reduce calorie intake

## Do beverages help with weight loss?

- They are low density
- Hunger and thirst are regulated by separate mechanisms
- 150 calories from 12 ounces of soda, milk, orange juice consumed before a meal were found to raise total calorie consumption in that meal by 104 calories
- No adjustment is usually made in food intake to adjust for the calories from beverages

## Very Low Calorie Density

- Cucumber
- Celery
- Chicken broth
- Lettuce
- Tomato
- Asparagus
- Broccoli
- Grapefruit
- Strawberries
- Fat free Italian dressing

- Vegetable soup
- Watermelon
- Cantaloupe
- Winter squash
- Carrots
- Peaches
- Fat free, sugar free yogurt
- Apple
- Blueberries
- Orange

## Low Calorie Density

- Oatmeal made with water
- Low fat yogurt
- Grapes
- Chicken noodle soup
- Low fat cottage cheese
- Split pea soup
- Green peas
- Corn on the cob
- Banana
- Grapes

- Sweet potato
- Baked potato with skin
- Shrimp or scallops
- Flounder or sole
- Light ice cream
- Rice
- Pasta
- Tuna, packed in water
- Lean Ham

## It may not be what you are eating, but how much that will make a difference.Portion size relates to the ‘energy in’ side of the equation.

## Overeat on carrots or cookies, you are going to store the extra calories 

## For an eye opening look at the change in portion sizes in thepast twenty years go tohttp://hp2010.nhlbihin.net/portion/index.htm

## In Barbara Roll’s lab the researchers combined the principles of calorie density and portion control

**The calorie savings was an astounding 800 calories a day**

## Another perk, people ate healthier because they were eating more fruits, vegetables and whole grains and less saturated and trans fats

## Successful weight loss happens slowly over time

**A realistic goal is 1-2% of your body weight per month**
- Gradual weight loss will also preserve your lean body tissue and decrease risk of damage to your gallbladder

## Without permanent change in food choices or portion sizes, the weight is regained 

- This is the phenomenon called yo-yo dieting

## Fad diets drastically reduce your usual calorie intake causing quick weight loss.

- Your brain and hormones that control your body weight will fight to keep your body weight from changing drastically.
**This control will bring your body back to it’s set point**

## Atkins

- Lack of carbs in diet cause loss of glycogen stores from muscles leading to water loss
- Looks like rapid weight loss but the water is replaced when returned to a  balanced diet causing regain
- After one year approximately the same weight loss results from Atkins and other diets
- Questionable health consequences from long term low carbohydrate, high protein intake

## Weight Watchers Point System

- Focuses on low calorie foods, whole grains, fruits and vegetables, healthy fats, exercise encouraged
- Group meetings designed to motivate and encourage
- Participants tend to focus on weight loss instead of healthy eating
- Without individual counseling health problems may be overlooked
- Gradual weight regain if dieters stop counting points when goal is reached

## Jenny Craig

- Participants are encouraged to adopt an active lifestyle, eat three meals and two snacks per day, eat smaller portions, increase fruit and vegetable intake
- High membership fees, cost of Jenny Cuisine food plus self purchased fruits and vegetables

## The French Woman’s Diet

- Mireille Guiliano wrote about a healthy lifestyle, promoting exercise, eating slowly, smaller portions and eating fruits and vegetables in season
- Eat three meals per day eliminating problem foods identified by journaling
- Add problem foods back into diet in smaller portions, increase exercise and water intake
- Weigh and measure everything for a few weeks to retrain your eye to what a normal portion is
- Not designed for weight loss

## Sonoma Diet

- Use whole foods and eliminate processed foods, simple carbs and saturated fats
- Focus is on what to eat, food combining and portion size
- No measuring and weighing, participants encouraged to eat consciously, concentrating on flavor and satisfaction from the meal
- Plan gets high marks for health benefits
- Eliminating favored foods may set some up for   failure

##  Fat Flush Plan

- Low carb diet eliminates wheat and dairy as “metabolism blockers” and includes several diuretic beverages each day along with a gamma-linolenic acid supplement touted to help burn fat
- No evidence that metabolism-blocking foods exist
- Eliminating wheat and dairy eliminate essential nutrients as well

## Calorie Restriction

- Not a weight loss plan but a lifestyle shown in studies to slow aging  and increase lifespan
- Participants have lower rates of heart disease and diabetes, lower BMI, lower bp
- Advocates consume 10-25% fewer calories than normal
- Extreme diet taking tremendous motivation, 50% reported low moods or depression, not recommended for most people

## Studies suggest the most significant factor in successful weight loss is sticking to it, regardless of the method chosen

- Most diets with moderate restrictions hold up against lifestyle needs, food preferences, determination while the extremes do not

## Forget the hype and the fads

- Fad diets do not lead to permanent weight loss
- High protein low carbohydrate dieting will lead to quick but unsustainable weight loss
- No foods burn fat
- Natural or herbal weight loss products are not necessarily safe

## How totip the scales in your favor

- Engage in physical activity
- Eat a low calorie/low fat diet
- Choose carbohydrates that are high in fiber
- Eat breakfast daily

- Stop eating in front of the television
- Maintain a consistent eating pattern and calorie intake
- Don’t skip your evening snack
- Get enough protein
- Do not drink your calories
- Monitor your weight
- Sleep

**Notes:**

People who watch tv during a meal eat an average of 288 more calories according to UMass scientists
Evening snacks prevents overeating, helps dieters psychologically by decreasing the feeling of deprivation. St Louis researchers found that a predetermined snack 90 minutes after dinner helped nighttime bingers lose 5 pounds in two months
Sweetened beverages do not satisfy hunger like solid foods, most people do not compensate with reduced calories from food
Too little sleep lowers leptin and boosts ghrelin, appetite is also for high carb and high sugar foods, may also increase insulin resistence

## The Debate Continues

- Fast Food Industry
- Creation of the fitness industry
- 48% with health problems directly related to weight
- The next generation at risk

## Tried and True?

- No definitive method for weight reduction
- Most of the time, overweight is a result of too many calories and not enough physical activity
- Physiological changes we are born with or develop as a result of overweight make it difficult to lose weight
- Choose a calorie reduction plan and exercise program that fits your lifestyle and stick to it

## There is an opportunity for success in every bite you take

- The next **step** is up to you

## Nutrisense Inc.Amy Shapiro RD, CDN

- 373 Route 111
- Smithtown New York 11787
- (631) 979-6699