Katie Bohannon, Britnie Delozier, Lindsey French, Andrea Meiring,

Jennifer Tallent

Fad Diets

How much $ does the United States spend on weight loss products per year?

30 Billion dollars!

http://www.youtube.com/watch?v=98_5OgZieUA

American Dietetic Association. J Am Diet Assoc.2006;106:602

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2008

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2008

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Source: CDC Behavioral Risk Factor Surveillance System

“With rising rates of obesity, new and questionable diets appearing on the

market almost everyday, and the current trend toward marketing huge

portions, is it possible to control one’s weight with a nutritionally

sound, emotionally healthy, common-sense-based approach?”

Hannah Fiske. Today’s Dietitian. 2003;45

Today people are more susceptible to false claims of weight loss companiesWe are more health conscious and thus more susceptible

to misinformation

People are looking for fast, simple and quick ways to lose weight

“Lose 30 pounds in 30 days!”“Eat as much as you want and still lose weight!”“Try the thigh buster and lose inches fast!”

American Dietetic Association. J Am Diet Assoc. 2006;602

Fad Diet MisinformationMisinformation leads people to be confused about foodPeople may lose weight with these diets but it is only short term and not because of what the companies claimLow in energyDo not provide a good balance May be nutrient deficient

Scientific research reports

American Dietetic Association. J Am Diet Assoc. 2006;601

ADA

“unreasonable or exaggerated beliefs that eating (or not eating) specific foods, nutrient supplements or combination of certain foods may cure disease, convey special benefits or offer quick weight loss.”

http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/media_10819_ENU-HTML.htm.

The Source of InformationMedia

47% Magazines 34% Television 29% Books 28% Newspaper

Nutrition information and physicians21% Internet 19% Product labels 18% Friends and family 13% Dietetic professionals

American Dietetic Association. J Am Diet Assoc. 2006;603

Myth or Fact

Carbohydrates cause weight gain

Myth

Calories cause weight gain

• If you consume more calories than you expend you will begin to gain weight

American Dietetic Association at ww.eatright.org 2009

Myth or Fact

Occasionally following a fad diet is a safe way to

quickly lose weight

Myth

•Many creators of these fad diets do not have scientific background

•Some fad diets can be harmful to those with certain health problems

•You will lose weight quickly but it is most likely going to come back within months

American Dietetic Association. J Am Diet Assoc. 2006; 601

Myth or Fact

Snacking does not ruin a healthful diet

Fact

Healthy snacks and small frequent meals are a good way to control weight and food cravings

Pay attention to the foods you choose, the size of your portions, how frequently you snack, and the total amount of calories you consume

Myth or Fact

There are certain foods that can make or break a

healthful diet

MythThe most important thing to watch is your overall pattern of eatingA wide variety is best if consumed in moderation

Appropriate proportionsRegular physical activity

Starkey J, Dombrowski J, Ryan T. www.eatright.org 2007

Myth or Fact

In order to write a diet or food related book you must have appropriate

credentials

Myth

- Most of the food and diet books are written by- Celebrities- Fitness experts- psychologists

Myth or Fact

Certain foods, like grapefruit, celery, or

cabbage soup, can burn fat and make you lose

weight

Myth

- There are no foods that can burn fat

- Physical activity is needed to burn fat

- Eating a variety in moderation is the key to losing weight

Starkey J, Dombrowski J, Ryan T. www.eatright.org 2007

Myth or Fact

Natural or herbal weight-loss products are safe and

effective

Myth

Just because it says “natural” or “herbal” does not prove it to be safe

Many products are not scientifically tested or proven to work before they hit the shelves

National Institute of Diabetes and Digestive and Kidney Disease at http://win.niddk.nih.gov 2009

Myth or Fact

Eating after 8pm does not mean you will gain weight

Fact- The time of day is not what

matters most- Watch WHAT you eat- Watch HOW much you eat

- If you consume extra calories they will be stored as fat

Starkey J, Dombrowski J, Ryan T. www.eatright.org 2007

Fad Diet MythsWhy do people buy into these myths?

- All people have to eat- We live in a society focused on being thin

- Celebrity role models- People may have a false sense of security

about their health

American Dietetic Association. J Am Diet Assoc. 2006;603

As DietitiansNutrition professionals need to be aware

of the misinformation that is out thereMisinterpreted research

Work with the media to communicate science based nutrition information to consumers

Stay on top of current researchBe aware of a decrease in a person’s self-efficacy

The public’s view of health professionals

American Dietetic Association. J Am Diet Assoc. 2006;604

High-protein/Low-carbohydrate Diets

Some familiar fads…

All of these popular high-protein/low-carbohydrate diet books have reached The New York Times bestseller status.

-Amazon.com

High-protein/Low-carbohydrate DietsWhat makes these diets so appealing?

Promises of rapid weight lossEasy to follow plansDiets include many palatable foodsPhysical activity not required

High-protein/Low-carbohydrate DietsRapid weight-loss:

Many low-CHO diets report greater, and more rapid weight-loss when compared to other higher CHO diets.

The reality:This is short term (<6 months). After 12 months, this weight-loss dissipates, and total weight-loss is no more than traditional higher CHO diets. Nordmann AJ et al. (2006) Arch Intern Med 166: 285–29.•Possible mechanisms:

• Diuresis• Mobilzation of glycogen stores• Circulating ketone bodies

• Satiating effects of protein• Use of protein more energetically costly

• Not enough evidence

Atkins DietThe Premise:Severe restriction of dietary carbohydrate (<20% of daily caloric intake), with its resulting ketosis, promotes lipid oxidation, satiety, and increased energy expenditure, factors that should promote negative energy balance and weight loss

Carbohydrate intake creates:• High blood sugar• Insulin resistance• Increased body fat

Atkins R, Dr. Atkins’ New Diet Revolution. 1992.

High-protein/Low-carbohydrate DietsAtkins DietThe good: Initial rapid weight loss can be motivating.

The bad: Long-term CVD risks need to be better

studied

Nutrient deficienciesEffects of prolonged ketosis

High-protein/Low-carbohydrate DietsThe South Beach Diet

A more healthy version of the Atkins Diet that’s backed by solid evidence on fats and heart disease

The good: Doesn’t leave out any food groups

The bad: The first phase is much like the Atkins diet, very restrictive on CHO.

Restricts some fruits and vegetables such as carrots.

High-protein/Low-carbohydrate DietsAtkins vs. South Beach

A study done on the effects of three popular diets on lipids, endothelial function, and C-reactive protein during weight maintenance found that the Atkins diet was associated with higher total cholesterol and LDL cholesterol compared to the South Beach diet, which lowered overall cholesterol and LDL cholesterol during the maintenance period. Moreover, saturated fat intake correlated inversely with endothelial function as assessed by brachial artery reactivity testing.

M. Miller et al, J Am Diet Assoc 109 (2009), pp. 713–717.

High-protein/Low-carbohydrate Diets

Malik et al. Cardiovascular Medicine. 2007.

What are Meal Replacements?Beverages, prepackaged or frozen entrees,

and meal or snack bars that are designed to take the place of one or two meals

Contain a known energy and macronutrient content

Objective is to attain a 500 to 1,000 kcal/day energy deficit

The Slimfast diet plan is an example

Meal ReplacementsConvenient

Good for portion and calorie control

In some cases can improve a person’s nutritional status

How effective are meal replacements?Several studies have shown a greater weight loss

efficacy with structured meal replacement plans than compared to reduced calorie diet treatments

In a randomized controlled trial by Rothacker in 2001 a meal replacement diet was compared to a low-fat diet

After one year, the meal replacement group maintained their initial weight loss, while the other group regained most of the initial weight loss back

J Am Diet Assoc 2001; 101(3): 345-347

Meal ReplacementsMay not be a long-term solution

Encourages “eating on the run”

Concerns of nutritional inadequacies

May still feel hungry or may not be satisfying

Does not teach good eating habits or choices

What ADA says about meal replacementsAdvise on how to optimize the overall

nutrient content

Must be careful selection of the conventional foods that make up the non-meal replacement portion of the diet plan

Detox DietsWhat is a Detox DietPopular Detox DietsoThe Master Cleanse, also known as “The Lemonade Diet”

oThe Juice DietoThe Water Fast

http://vids.myspace.com/index.cfm?fuseaction=vids.individual&videoid=6518245

Pro’s of Detox DietsBeneficial in treating the side

effects of chronic diseasesStepwise detox program used to

eliminate bad eating habits, and reduce smoking and drinking addictions

Detoxing used as a “motivational tool”

Con’s of Detoxing

Lack of scientific research supporting detox diets

Nutrient deficiencies and electrolyte imbalances

Detoxing is extremely dangerous for certain groups of people

Negative physical effects

How Dietitians Feel About Detoxing

Stress the importance of being under the supervision of a dietitian while detoxing

Feel that more research needs to be done: which toxins are being removed from the body?

Believe in using detox diets to motivate people to lose weight and live healthier lifestyles

Important for patients to remember that it is what they eat after the cleanse is complete

“The best diet is one you can stick too”- Michael Dansinger- Director of Diabetes, New England Medical Center,

Boston

• ADA believes weight management to improve

overall health requires a lifelong commitment to healthy lifestyle behaviors emphasizing sustainable and enjoyable eating practices and daily physical activity.

• American Dietetic Association. J Am Diet Assoc. 2009;109:335,331.

FAD DietsLoss of NutrientsNo emphasis on physical activity

Healthy Weight Loss and ManagementMore than just a number on a scale!!Can be complex

Nutritional intakePhysical ActivityPsychological StatusSocial and Cognitive FunctionEmotional factorsFood accessEnvironment and Environmental triggersFunctional capacity for food preperation

Nutrition Care ProcessAssessment, Diagnosis, Intervention, Monitoring and Evaluation

• Baseline weight and health indexes which will guide weight management goals

• Health risks involved before starting exercise plan

• In addition to medical assessment a psychiatric evaluation for* Post-tramatic stress disorder* Depression* Binge eating disorder* BulemiaStudies show increased frequency in people with

excessive eating problemsMay require medicine and/or behavioral therapy

Ready…set…go!TeamRealistic goals and expectationRealistic expectations about time to achieve goalsEmphasize health rather than cosmetic goalsPortion control

Portion distortionEat more low energy dense foods

Know what’s in the foods your eatingDon’t skip breakfastTriggersPhysical Activity

30 -60 minutes moderate-vigerous activity most days of the week

Food Guide PyramidsVariety, Proportionality, and ModerationRD’s rely on this everyday Low fat

Fat is the most energy dense macronutrient but is known to have a weak effect on both satisfaction and making you feel full

Instead of all fats being bad…eat healthy fats. Instead of focusing only on complex carbs…limit

sugar and emphasize benefits of whole grains.2005 first to emphasize physical activity.Mypyramid.gov

Interactive website with educational modules

Follow upMonitorEvaluateModify plans to…

Prevent weight gainLong term weight management

“Slow and steady wins the race!”

ADA National Nutrition Month 07’

American Dietetics Association: www.eatright.org

“You can lose weight on virtually any diet, if you eat less, you will lose weight. The question is, can you maintain a healthy lifestyle over the long term – your life? The real key to reaching long-term goals is to focus on your overall health.”

-Roberta Anding, registered dietitian and ADA spokesperson

Key messages to enjoy a 100% Fad Free lifestyle:

Develop an eating plan for lifelong health.

Choose foods sensibly by looking at the big picture.

Find your balance between food and physical activity

Learn how to spot a food fad.Food and nutrition misinformation

can have harmful effects on your health and well-being.

American Dietetics Association: www.eatright.org

References1. American Dietetic Association. Position of the American Dietetic

Association: Food and nutrition misinformation. J Am Diet Assoc.2006;106:602.

2. American Dietetic Association. Nutrition: Fact vs. Fiction. 2009. Available at: http://www.eatright.org/ada/files/Nutrition_Fact_vs_Fiction.pdf. Accessed September 26, 2009.

3. Starkey J, Dombrowski J, Ryan T. Quick Fixes Aren’t the Answer for Healthful Weight Control: Learn to Spot Fads and Steer Clear – Then Seek Proven, Long-Term Solutions. 2007. Available at: http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/media_10819_ENU_HTML.htm. Accessed September 26, 2009.

4. American Dietetic Association. Position of the American Dietetic Association: Weight management. J Am Diet Assoc. 2002;102:1150.

5. American Dietetic Association. Position of the American Dietetic Association: Weight management. J Am Diet Assoc. 2009;109:335,331.

6. Atkins R 1992 Dr. Atkins’ new diet revolution. New York: Avon Books.7. Levine M.J., Jones J.M., Lineback D.R.Low-Carbohydrate Diets: Assessing

the Science and Knowledge Gaps, Summary of an ILSI North America Workshop (2006) Journal of the American Dietetic Association, 106 (12), pp. 2086-2094

References:

1. M. Miller, V. Beach, J.D. Sorkin, C. Mangano, C. Dobmeier, D. Novacic, J. Rhyne and R.A. Vogel, Comparative effects of three popular diets on lipids, endothelial function, and C-reactive protein during weight maintenance, J Am Diet Assoc 109 (2009), pp. 713–717.

2. Jackson, D. The Skinny on Meal Replacements for Weight Management. Today’s Dietitian. July 2004;23-24

3. Sherer, E. Examining the most popular weight loss diets: How effective are they? JAAPA. November 2008;31-34.

4. Spring Cleansing: Assessing the Risks and Benefits of Detox Diets. Today’s Dietitian. 2008; 34-38

5. Picco M. Nutrition and Healthy Eating: Do detox diets offer any health benefits? MayoClinic.com. 2008:1. Available at http://www.mayoclinic.com/health/detox-diets/AN01334. Accessed September 29, 2009.