Truth About Fad DietsObesity, Health and the Student

Presented By:Maria Kobylinski, MD

Goals

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Determine how to assess obesity and additional medical problems caused by excess

weight

Understand how to read a food label

Identify appropriate ways to incorporate healthy

foods into your diet

Half are overweight

On-fourth are obese

Direct Medical Cost >$51 billion/year for weight-related diseases

US AdultsMen Women

African American

56.5% 65.8%

Mexican American

63.9% 65.9%

Caucasian American

61% 49.2%

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Dollars and SenseU.S. spends 33 billion on weight loss (6 million Americans morbidly obese)

Adults trying to lose weight: 35-40% of women and 20-24% of men22% of this population get regular physical activity

39.3 million workdays are lost/year

11% of youth (6-17 years) overweight

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Health Risk of Excess WeightHeart Disease, HTN, HyperlipidemiaCancer: Colon, Breast, Endometrial, Pancreatic, Prostate,

Uterine, CervicalInfertilityVaricose VeinsStrokeSnoring

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And The List Goes On…

Kidney StonesOsteoarthritisGoutDiabetes Mellitus

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Components of Body WeightWater 60-65%

Muscle, bones, organs

Adipose Tissue Protection of organs/nerves, insulation, preserves body heat,

maintains body temp and vitamin absorption Women 20-25%, essential 12% Men 12-15%, essential 4-7%

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Assessment of ObesityIdeal Body Weight

Metropolitan Life Insurance Company Men: 106# for 5ft, 6# for every inch over Women: 100# for 5ft, 5# for each inch over

Body Mass Index Weight in kg/height in m2 Caution With: Increased muscle mass, edema

Waist-Hip Ratio >88cm women, >102cm men for those with BMI <40

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Ideal Body Weight Classifications

Underweight <100%Ideal 100%Overweight 110%Obese 135%Medically Significant 160%Morbidly Obese 200%Super Obese 225%

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How to Classify BMI

Underweight <18Normal 19-25Overweight 26-29Obesity1 30-35Obesity 2 36-40Morbidly Obese >45.1

Fat Distribution

Gynoid Type (Pear) Thigh/Buttocks Energy Reserves

Android Type (Apple) Waist/Upper Abdomen HTN, Insulin Resistance, Heart

Disease

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Recent Studies

20% Increase in Weight Increases Risk for Type 2 DM, HTN, CAD, Lipid NHANES: Women BMI >28 had 2x risk for

disability/mobility problems

Nurses Health Study BMI 23-25 had a four-fold

increase in Diabetes BMI >35 was associated with

risk of 93.2% for Diabetes

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Etiology of ObesityLong-term Imbalance BetweenEnergy intake and energy expenditure

Must be Closely Related 2% over needs (50 kcal/d) for someone who

required 2500 kcal/d If over one year weight gain: 1.5 kg

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Role of Heredity Hormonal Factors Determined

Genetically Satiety signals Feeding activity Number/size fat cells Resting metabolic rate

Studies of Twins/Adoptees Evidence that a Genetic

component accounted for 67% 540 Danish adoptees were

found to correlate with the weight of biological parent

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Human vs. Animal Animal Model of Obesity are Characterized by One Single Gene Ob/ob mouse Genetic defect for coding the protein leptin. Leptin normally produced in fat cells in proportion to fat mass. Binds to receptors in hypothalamus and causes a decrease in

food intake and increase in thermogenesis. Few leptin deficient obese adults have been identified. Obese adult usually has a higher levels of leptin indicating they

are resistant to the hormone. Trials are underway.

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Body’s Fuel Source Primarily CHO Brain uses solely Converts protein/fat into glucose

Gluconeogenesis

Healthy DietCHO 50-60%Pro 15-20%Fat 25-30%

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Calories Carbohydrate 4 kcal/gm

Protein 4 kcal/gm

Fat 9 kcal/gm

Alcohol 7 kcal/gm

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Food Guide PyramidA Guide to Daily Food Choices

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Common Weight Loss Methods

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Attempts to Lose the WeightLow Fat DietBody weight associated to fat intakeTend to eat same amount of caloriesObese people tend to underreport their intake (30-47%)

Starvation DietsBreak down muscle and fatTend to store more when begin to eat again

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ObesityOver 50 percent of Americans are overweightOne in three adults is obese – why?Sedentary lifestylePoor food choicesObsession with dieting Lack of time

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The U.S. Diet IndustryAlmost $40 billion per year industry, includes: Diet books Diet foods Diet programs Weight-loss gimmicks

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Do You Remember? 1960 Drinking Man’s Diet

Steak and Wine 1967 Dr. Stillman’s Diet 1972 Dr. Atkin’s Diet 1973 Richard Simmons

Fitness Guru 1978 Scarsdale Diet 1979 Pritikin Diet 1980 Beverly Hills Diet

1981Cabbage Soup Diet 1988 Optifast Liquid Diet 1991 Protein Power 1991 Fen Phen Diet Pill 1995 Enter the Zone 1997 Fen Phen – Pulled

From Market

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Fad Diets: The Zone Claim: Boost protein, cut carbs achieve peak athletic

performance

Why You Lose: Very low calorie

Downfall: Few carbs can cause fatigue, weakness in athlete and few fiber foods

Most Useful Tip: Choose low fat protein sources, eat several meals/snacks per day

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Fad Diet: Sugar Busters Claim: Break sugar starch habit and enjoy eggs, cheese, wine

Why You Lose: Reduced total calorie, not CHO

Downfall: Deprivation can set up binge mentality, low in calcium and zinc

Digestive Downside: Constipation

Most Useful Tip: Cut back on added sugar

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Tips For Evaluating Fad Diets Does it exclude major food groups Does it promote supplement or pill use Does it suggest to avoid any one certain food

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How to Recognize a Fad Diet Is the author credible? Diets that advocate: Magic or miracle foods Rapid weight loss/quick fix No exercise Rigid menus, “good” vs. “bad” foods, specific food

combinations Recommendations based on a single study or studies

published without a peer review Sounds too good to be true

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Fad Diet Alert! Steer Clear of These Claims: Fast, easy weight loss Breakthrough miracle Banish fat Secret formula, new discovery Cure Balances hormones Enzymatic process

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DIETS DON’T WORK50% of Americans Diet Annually Average diet lasts 42 days Only 5-10 percent maintain a significant weight loss (=10

percent or more of starting weight) No scientific data from commercial programs No scientific data from any diet-book programs Some cause significant health problems

Source: John Foreyt, Baylor College of Medicine

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Dieter Beware: Current Fad Diets Enter the Zone Dr. Atkin’s Diet Revolution Protein Powder Dr. Arnot’s Revolutionary Weight Control Program Sugar Busters! Eat 4 Your Blood Type

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NO RESEARCH TO SUPPORT DIETS All Six Diets Reviewed Lack Research Use testimonials Base validity on opinions not facts Lack any peer review

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ENERGY 101

Calories are supplied by: Carbohydrates Fat Protein

Calories In > Calories Out = Weight Gain Calories In < Calories Out = Weight Loss

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CARBOHYDRATES

Carbohydrate Intake ⇒ Glucose + Insulin = Energy

Extra Glucose: Glycogen stores Fat stores

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High Protein DietsCommon Claims

Lose weight quickly Never be hungry Carbohydrate intake

creates Increased appetite Addiction to sugar High blood sugar Insulin resistance Increased body fat

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INSULIN: A Closer Look

Insulin Resistance: The cells are resistant to absorbing insulin and glucose to use for energy so glucose must be stored as fat.

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INSULIN: A Closer Look Insulin Resistance: The cells are resistant to

absorbing insulin and glucose to use for energy so glucose must be stored as fat.

High Protein Diet Theory: 75% of dieters are insulin resistant. A high carbohydrate intake leads to a dramatic surge of insulin. Because of insulin resistance, the glucose cannot be used for energy, so it is stored as fat. Therefore, carbohydrates make you FAT!

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INSULIN: The Reality

10-25% of dieters are insulin resistant

Most with insulin resistance are Obese Sedentary (insulin receptor sites and glycogen stores are full

Glucose stored as fat).

Treatment Increase activity and decrease weight. This will deplete glycogen

stores and increase blood glucose absorption. Less insulin is needed.

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High Protein DietsThe Inefficient Energy Machine Protein breakdown = Energy + Nitrogen Fat breakdown (no glucose) = Energy + Ketones Increased fluid requirements Increased electrolyte loss Increased strain on kidneys and liver Increased uric acid in blood (gout) Ketosis

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Ketones in Blood = KetosisAcidic Waste From Fat Breakdown in the

Absence of Carbohydrate Ketosis: Dizziness Nausea Decreased appetite Dehydration Electrolyte Imbalance

Lethargy Bad Breath: acetone

evaporation in lungs Bone Loss: Calcium buffers

changes in blood pH

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High Protein Diets: A Closer Look Low in calories; 1200 or less High in protein / low in carbohydrate Low in vitamins, minerals, phytochemicals High in saturated fat and cholesterol Increased risk for:

Cardiovascular disease Cancer Osteoporosis

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High Protein Diets – Common Claims Lose weight quickly

Never be hungry

Carbohydrate Intake Creates Increased appetite Addiction to sugar High blood sugar Insulin resistance Increased body fat

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Sugar Busters!H. Leighton Steward; Morrison C. Berthea, M.D.; Sam S. Andrews, M.D.; and Luis A. Balart, M.D.

Premise: Sugar is toxic, causing the body to release insulin and store excess glucose as body fat. High glycemic index foods should be eliminated. Minimal fluids with meals so digestive juices are not diluted (1200 kcal).

Negative Health Implications: Kidney and liver damage, fatigue, weakness and irritability. Vitamin and mineral deficiency. ↑ Risk for heart disease.

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High Glycemic Index Foods

Sugar Busters!H. Leighton Steward; Morrison C. Berthea, M.D.; Sam S. Andrews, M.D.; and Luis A. Balart, M.D.

Carrots Potatoes Beets Pasta Bread (refined flour) Rice (white) Fruit (must be eaten by itself)

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Enter the ZoneBarry Sears, Ph.D.

Premise: “Zone”: A metabolic state where the mind is relaxed and focused and the body is fluid and strong. Follow rigid, obscure rules, such as eating in “macronutrient blocks” and limiting carbohydrates.

Negative Health Implications: Nutrient deficiency, increased risk of coronary heart disease, high cholesterol.

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Enter the ZoneBarry Sears, Ph.D.

Claims: Weight easy to lose on 40:30:30 plan. Carbohydrates make you fat because 75% of

Americans are genetically defective and over produce insulin. We must achieve an insulin zone.

Diet lowers risk for disease by decreasing production of bad eicosanoids (hormones).

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Protein PowerMichael Eades, M.D. and Mary Eades, M.D.

Premise: Low in fiber, high in fat, claims human body has no physical need for carbohydrates; should be completely avoided. Success of diet is demonstrated by the sales and popularity of the book.

Negative Health Implications: Increased risk for coronary heart disease, high cholesterol, nutrient deficiency.

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Dr. Bob Arnot’s Revolutionary Weight Control ProgramRobert Arnot, M.D.

Premise: Foods are drugs: Some make you feel good and others make you feel bad (crack). Refined carbohydrates can cause rapid weight gain. A diet low in carbohydrates and high in protein will decrease hunger and lead to weight loss.

Negative Health Implications: May take a psychological toll on its followers by labeling foods “good” and “bad.” Avoiding these foods causes a person to miss out on valuable nutrients.

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Fad diet: Dr. Atkins Diet Revolution Claim: Cut out Carbs, go into ketosis and drop the pounds

Why you lose: Leads to fluid loss, CHO is store with water

Downfalls: Associated with osteoporosis, impaired renal function, kidney stones, Colorectal cancer and cardiovascular disease (legal liability)

Most useful tip: None

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Dr. Atkin’s New Diet RevolutionRobert Atkins

Premise: Carbohydrates make you fat, limit intake to 20g/day. Eat as much meat as you want. Never be hungry, lose weight fast.

Negative Health Implications: Increased risk for heart disease and nutrient deficiency, ketosis. Decreased benefits from plant-based nutrients.

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Eat 4 Your Blood TypePeter D’Adamo

Premise: Blood type is an evolutionary marker of which foods each person will process well and which will be useless calories or lead to illness and death.

Negative Health Implications: Promotes “good foods/ bad foods”. Nutrient deficient diet lacking carbohydrate, vitamins and minerals.

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I’m Still Looking for the Magic!

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Lifelong Healthy Weight

Positive attitude Are you ready to change? Motivation: Internal not external Health: Healthy weight not lowest weight Increased energy Self esteem Personal control

Eat for the long haul; Choose a life-long plan

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Take an Honest Look:Why You Weigh What You Weigh

Activity: What and how much? Food: What and how much? Stress: Is food your answer to life’s

problems? Physiologic and genetic make-up Age and health status

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Here’s the Magic!!!Eating For Good Health And Eating To Control

Weight Are Virtually The Same

Incorporate regular physical activity into your schedule.

Enjoy a variety of foods from the Food Guide Pyramid.

Maintain a positive attitude.

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Physical Activity = Success! Choose something you enjoy Combined total of 30 minutes most days Benefits

Healthy weight! Healthy heart! Strong bones! Great sleep! Stress relief! Increased energy! Positive and confident outlook!

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High Carbohydrate Diet

Increases Intake Of: Fiber Calcium Vitamins Minerals Antioxidants Phytochemicals

Lowers Risk For: Heart Disease Cancer Osteoporosis Diabetes High Blood Pressure

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Diets that WorkWeight WatchersIntuitive Eating by Evelyn TriboleOutsmarting the Midlife Fat Cell by Debra WaterhouseOutsmarting the Female Fat Cell by Debra WaterhouseThin for Life. 10 Keys to Success from People Who Have

Lost Weight and Kept it Off by Anne FletcherThe Solution: Winning Ways to Permanent Weight Loss

by Laurel Mellin

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Lifestyle Change Be realistic – Small changes over time Be adventurous – Expand your tastes Be flexible – Balance food and activity over several days Be sensible – Enjoy all food in moderation Be active – Walk the dog, don’t just watch the dog walk

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The Student Diet

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Problems With Student Diet Study long hours No time to cook healthy meals Do not have time to grocery shop Easier to eat out or drive thru Very little exercise

= Sedentary lifestyle

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Eating Out 1 of 3 meals Drinks: High kcal Appetizer: Onion mum

(1/2 = 20 oz steak with 80 gm fat & 1000 kcal)

Salad: Caesar salad 300 kcal, 25 gm fat

Steak: 16 oz prime rib 1300 kcal, 94 gm fat

Dessert: Cheesecake 500 kcal, 30 gm fat 3100 kcal, 229 gm

fat (not counting drinks)

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Alcoholic Beverages 70-200 kcals/drink 12 oz serving Mainly fat & some CHO

EsophagealGI cancer

Linked to Many Forms of Cancer

Anthocyanin AntioxidantSame pigment in grape skins

Red Pigmentation

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How To Eat Out Sensibly Avoid all-you-can eat

buffets Choose baked or grilled Avoid white or cheese

sauces Ask for dressing or

condiments on the side Request a take-home

container

Look for light or heart healthy menu

Order calorie free beverages Watch for key words signaling

high kcal: Fried, creamed, pan-fried,

sautéed, alfredo or gravy

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Caffeine and Calcium

Caffeine beverages High Mg & Phos Pulls Vit D from bones Increases heart rate Limit to 1-2 per day

Calcium (1000mg/d) Required for Nerve conduction, muscle

contraction, blood clotting, Prevent osteoporosis

Impairs absorption Fiber, high protein diets,

High Na diets, soybeans Take separately from MVI

b/c impairs iron & zinc69

Ideas At Home Prepare meals and freeze Go in with a friend Don’t keep trigger foods in the house Always eat at the table Slow down

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Myths About Dieting Eating late at night is

sure to pack on the pounds

You can lose weight by eating fewer calories

Never have seconds Deny cravings; they are

all in your head

Don’t eat between meals Eating breakfast makes you

hungry all day To lose weight, become a

vegetarian You can eat anything you

want as long as it is fat free

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Tips For Success Regular exercise Permanent changes Avoid skipping meals Do not eat while

studying/watching TV Eat only when hungry

Do not use food as a reward

Drink only calorie-free beverages

Do not grocery shop when hungry

NO fad diets Choose a variety of foods

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Goals Decrease Regular soda intake Decrease caffeine Limit meat servings Increase fruits/vegetables Fiber

Increase calcium Multivitamin

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Healthy Snacks When You Have The Munchies

Fresh, frozen, canned fruit Light or low-fat yogurt String cheese Low fat cheese and wheat crackers Vanilla wafers & skim milk Baked chips Low fat popcorn Sugar free hard candy Frozen fruit bars

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Thank you