Weight Loss 101 - Thiboutot

80
Weight Loss 101 What really helps? Presented by Jeff Thiboutot MS,CN,ACE-Health Coach

Transcript of Weight Loss 101 - Thiboutot

Page 1: Weight Loss 101 - Thiboutot

Weight Loss 101

What really helpsPresented by

Jeff Thiboutot MSCNACE-Health Coach

Outline3 Fundamental Principles

of Weight Loss

Some ImportantBiological amp Psychological Aspects

of Weight Loss

QuestionsWeight Loss 101 What Really Helps

Han

dout

Fundamental Principle 1Weight loss is SIMPLE

First Law of ThermodynamicsEs (energy stores) = EI (energy in) ndash Eo (energy out)

More EI than Eo always leads to increase in Es(weightmass)

Less EI than Eo always leads to decrease in Es(weightmass)

What Really HelpsWeight Loss 101

Fundamental Principle 2

What Really HelpsWeight Loss 101

Weight loss is COMPLEX amp DIFFICULT

Fundamental Principle 2Weight loss is COMPLEX amp DIFFICULT

What Really HelpsWeight Loss 101

What Really HelpsWeight Loss 101

Fundamental Principle 2

Bio-Psycho-SocialModel

Fundamental Principle 3

People have a FINITE amount of

Time Money Effort

Pereto Principle ndash 8020 rule

Focus efforts on ldquowhatrdquo will likely helpand have the greatest benefit

What Really HelpsWeight Loss 101

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 2: Weight Loss 101 - Thiboutot

Outline3 Fundamental Principles

of Weight Loss

Some ImportantBiological amp Psychological Aspects

of Weight Loss

QuestionsWeight Loss 101 What Really Helps

Han

dout

Fundamental Principle 1Weight loss is SIMPLE

First Law of ThermodynamicsEs (energy stores) = EI (energy in) ndash Eo (energy out)

More EI than Eo always leads to increase in Es(weightmass)

Less EI than Eo always leads to decrease in Es(weightmass)

What Really HelpsWeight Loss 101

Fundamental Principle 2

What Really HelpsWeight Loss 101

Weight loss is COMPLEX amp DIFFICULT

Fundamental Principle 2Weight loss is COMPLEX amp DIFFICULT

What Really HelpsWeight Loss 101

What Really HelpsWeight Loss 101

Fundamental Principle 2

Bio-Psycho-SocialModel

Fundamental Principle 3

People have a FINITE amount of

Time Money Effort

Pereto Principle ndash 8020 rule

Focus efforts on ldquowhatrdquo will likely helpand have the greatest benefit

What Really HelpsWeight Loss 101

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 3: Weight Loss 101 - Thiboutot

Han

dout

Fundamental Principle 1Weight loss is SIMPLE

First Law of ThermodynamicsEs (energy stores) = EI (energy in) ndash Eo (energy out)

More EI than Eo always leads to increase in Es(weightmass)

Less EI than Eo always leads to decrease in Es(weightmass)

What Really HelpsWeight Loss 101

Fundamental Principle 2

What Really HelpsWeight Loss 101

Weight loss is COMPLEX amp DIFFICULT

Fundamental Principle 2Weight loss is COMPLEX amp DIFFICULT

What Really HelpsWeight Loss 101

What Really HelpsWeight Loss 101

Fundamental Principle 2

Bio-Psycho-SocialModel

Fundamental Principle 3

People have a FINITE amount of

Time Money Effort

Pereto Principle ndash 8020 rule

Focus efforts on ldquowhatrdquo will likely helpand have the greatest benefit

What Really HelpsWeight Loss 101

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 4: Weight Loss 101 - Thiboutot

Fundamental Principle 1Weight loss is SIMPLE

First Law of ThermodynamicsEs (energy stores) = EI (energy in) ndash Eo (energy out)

More EI than Eo always leads to increase in Es(weightmass)

Less EI than Eo always leads to decrease in Es(weightmass)

What Really HelpsWeight Loss 101

Fundamental Principle 2

What Really HelpsWeight Loss 101

Weight loss is COMPLEX amp DIFFICULT

Fundamental Principle 2Weight loss is COMPLEX amp DIFFICULT

What Really HelpsWeight Loss 101

What Really HelpsWeight Loss 101

Fundamental Principle 2

Bio-Psycho-SocialModel

Fundamental Principle 3

People have a FINITE amount of

Time Money Effort

Pereto Principle ndash 8020 rule

Focus efforts on ldquowhatrdquo will likely helpand have the greatest benefit

What Really HelpsWeight Loss 101

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 5: Weight Loss 101 - Thiboutot

Fundamental Principle 2

What Really HelpsWeight Loss 101

Weight loss is COMPLEX amp DIFFICULT

Fundamental Principle 2Weight loss is COMPLEX amp DIFFICULT

What Really HelpsWeight Loss 101

What Really HelpsWeight Loss 101

Fundamental Principle 2

Bio-Psycho-SocialModel

Fundamental Principle 3

People have a FINITE amount of

Time Money Effort

Pereto Principle ndash 8020 rule

Focus efforts on ldquowhatrdquo will likely helpand have the greatest benefit

What Really HelpsWeight Loss 101

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 6: Weight Loss 101 - Thiboutot

Fundamental Principle 2Weight loss is COMPLEX amp DIFFICULT

What Really HelpsWeight Loss 101

What Really HelpsWeight Loss 101

Fundamental Principle 2

Bio-Psycho-SocialModel

Fundamental Principle 3

People have a FINITE amount of

Time Money Effort

Pereto Principle ndash 8020 rule

Focus efforts on ldquowhatrdquo will likely helpand have the greatest benefit

What Really HelpsWeight Loss 101

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 7: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Fundamental Principle 2

Bio-Psycho-SocialModel

Fundamental Principle 3

People have a FINITE amount of

Time Money Effort

Pereto Principle ndash 8020 rule

Focus efforts on ldquowhatrdquo will likely helpand have the greatest benefit

What Really HelpsWeight Loss 101

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 8: Weight Loss 101 - Thiboutot

Fundamental Principle 3

People have a FINITE amount of

Time Money Effort

Pereto Principle ndash 8020 rule

Focus efforts on ldquowhatrdquo will likely helpand have the greatest benefit

What Really HelpsWeight Loss 101

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 9: Weight Loss 101 - Thiboutot

Fundamental Principle 3

ldquoWhatrdquo is referring to ldquothe best evidencerdquo

httpguideslibraryyaleeducontentphppid=9786ampsid=73113What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 10: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 1A pound of bodyfat

contains about 3500 calories

FACTThe amount of calories stored in a pound of bodyfat is about 3500

A pound of muscle tissue onlycontains about 600 calories

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 11: Weight Loss 101 - Thiboutot

Adipose Tissue

What Really HelpsWeight Loss 101

Adipose tissue is a complex essential and highly active metabolic and

endocrine organ (p2548)

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 12: Weight Loss 101 - Thiboutot

Adipose TissueWhy this matters

What Really HelpsWeight Loss 101

Larger amounts of adipose tissue (fat) particularly visceral fat are associated with and likely a significant causal component

to many diseases and poor healthbull Coronary heart diseasebull Type 2 diabetesbull Cancers (endometrial breast and

colon)bull Hypertension (high blood pressure)bull Dyslipidemia (for example high total

cholesterol or high levels of triglycerides)

bull Strokebull Liver and Gallbladder diseasebull Sleep apnea and respiratory problemsbull Osteoarthritis (a degeneration of

cartilage and its underlying bone within a joint)

bull Gynecological problems (abnormal menses infertility)

httpwwwcdcgovobesityadultcauses

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 13: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 2Eating more often will

speed up your metabolism

FACTIt has been shown many times that eating frequency does NOT affect

metabolic rate Eating a certain amount of calories

over widely varying meal frequencies will

result in the same amount ofweight loss

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 14: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Meal FrequencyThermic Effect of Food (TEF)

6 meals 3 mealsMeal Size TEF (10) Meal Size TEF (10)

250 25 500 50250 25 0 0250 25 500 50250 25 0 0250 25 500 501500 150 1500 150

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 15: Weight Loss 101 - Thiboutot

Meal Frequency

Weight Loss 101 What Really Helps

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 16: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Meal FrequencyThe current evidence finds that a range of meal frequencies(from not eating for a day (intermittent fasting) to 6 meals a

day)seems to be health promoting and NO one meal frequency is

bestThe effect of the timing of food intake on metabolism has been the subject of active investigating of gt40 y Indeed whether it is ldquobetterrdquo to eat many small meals a days is one of the questions most frequently posed by the lay public

Comparing the potential benefits of nibbling and of gorging has been the focus of much animal and human research but no clear consensus has

emerged (p3)

The limited evidence to date suggests that the manipulation of EF [eating frequency] has limited utility as a weight and health management strategy

Longer term randomized controlled trials investigating the impact of EF on weight and health outcomes during weight loss and weight

maintenance phases are required in order to guide population recommendations for weight management (p379)

hellipindividuals in the health-care professions and in the lay press have repeatedly stated that consumption of smaller and more frequent meals is healthier than that of larger and less frequent meals This advice is given

despite the lack of clear scientific evidence to justify it (p1978)

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 17: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 3(A) Skipping a meal

will likely lead to eating substantially more later and (B)

slow downyour metabolism

FACT(A)Skipping a meal may increase the size of

the next meal BUT the increase is usually much LESS than the amount of

the calories that wouldhave been eaten in the skipped meal(B) Skipping a meal will NOT reduce

Metabolic rate It takes 36 to 72 hoursof NO food before any reduction

in BMR will occur

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 18: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Skipping a Meal and Subsequent Intake

The results from the present study demonstrate women do not compensate for one day of partial or total fast by increasing their food

intake over the subsequent four days of measurement Although counterintuitive these findings are consistent with the few studies that have examined the questionhellipThese findings are also consistent with the literature

concerning the effects of skipping breakfast or mid-meals snacks Skipping meals fails to result in an increase in energy intake sufficient to compensate for

the reduction in energy intake (p498)Eating behavior appears to be more responsive to external

environmental cues than internal physiological signals (p499)

These three studies do not support the hypothesis that a lower meal frequency when compared with a higher meal frequency might result in more positive

energy by inducing a lower energy expenditure or a higher energy intake in the short term A period of fasting does not result in over-compensation but

in fact results in lower total intake (non-significant) (p525)

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 19: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Skipping a Meal Does NOT Reduce

Metabolic Rate

INCREASE in metabolic rate over 96 hours

In lean subjects The responses could be different for overweight and obese individuals There may not be an increase in BMR However it is

likely that there still would NOT be a reduction in BMR during these time frames Additionally these responses were for much long times than just

missing a meal

INCREASE in metabolic rate over 36 hours

INCREASE in metabolic rate over 48 hours

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 20: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 4Eating relatively

higher amounts of protein can make it

easierto eat less andlose more fat

FACTThe RDA for protein intake is 8gkg

The research about protein intake and weight management has repeatedly demonstrated that intakes above the

RDAin the range of 12 to 16 gkgis a helpful dietary strategy

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 21: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Higher Protein Intakes

ManyAuthors

Papers

StudiesOver

2 plusDecade

sShowin

gBenefits

From Relative

lyHigherProteinIntakes

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 22: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Higher Protein Intakes

180 lb 5rsquo-5rdquo female BMI 30 following a 1500 calorie diet

RDA (8gkg

) cal 12gkg

(55glb) cal 16gkg (73glb) cal

65g 17 98g 26 131g 35

Increased satiety

Increased energy expenditure

Increased fat loss

Better retention of lean tissue

Better weight loss maintenance

Greater thermic effect

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 23: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Higher Protein Intakes

Food Size Calories

Proteingrams

of protein

of fat

ofcarbs

Whole egg 1 large 77 6Egg white 1 large 16 4Chicken breast 4 ounces 184 36Tuna-canned in water 4 ounces 128 28Salmon 4 ounces 204 28Beef ground (8020) 4 ounces 304 32Tofu firm style 4 ounces 80 8Tempeh 4 ounces 220 20Peanuts 1 ounce 164 7Almonds 1 ounce 167 6Yogurt-low fat 2 plain 8 ounces 154 13Yogurt-Greek low fat 2 plain

8 ounces 173 23

Cheddar cheese low fat 1 ounce 48 7Cottage cheese 2 fat 8 ounces 204 31Lentils 8 ounces 230 18Quorn-grounds 4 ounces 147 17Whey protein powder 1 scoop

(33g)130 23

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 24: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 5There are

NOfattening foods

FACTA calorie is a calorie

Many studies varying macronutrient ratiosas well as food sources for nutrients result

invirtually the same amount of weight loss

No food is inherently fatteningit is the QUANTITY of the food

and the total calorie intakethat is important

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 25: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

8 weeks1800

calories dayTwo-

thirds ldquojunkrdquo foodLoses 27lbs

No

Fatt

enin

g Fo

ods

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 26: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

No Fattening Foods

BEGINNINGWeight-197Glucose-104Cholesterol-

214Triglycerides-

135

60 DAYS LATERWeight-176Glucose-94Cholesterol-

147Triglycerides-

75

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 27: Weight Loss 101 - Thiboutot

Resultsbull Average weight loss for ALL groups was 15 pounds with NO

statistically significant difference between the groupsbull The authors state ldquoa high intake of sucrose from a low-fat

hypoenergetic diet did not adversely affect weight loss or other metabolic indexesrdquo (p912)

Two groups eating about 1100 calories a day for 6 weeks (42 females ~BMI 35 ~Age 40)-Group 1 got 4 of their total calories from sucrose-Group 2 got 43 of their total calories from sucrose

Weight Loss 101 What Really Helps

No Fattening Foodsthat includes Sugar

All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)-Group 1 got 10 of their total calories from HFCS-Group 2 got 20 of their total calories from HFCS-Group 3 got 10 of their total calories from sucrose-Group 4 got 20 of their total calories from sucrose

ResultsAll groups lost weight and there was no statistically significant difference in weight loss between the groups

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 28: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 6Your Basal Metabolic

Rate (BMR) is the MAIN determinant of

Total Energy Expenditure

FACTYour Basal Metabolic Rate typically

contributes 60-80 of your Total Energy Expenditure

Mifflin-St Jeor Equation for BMRMen

(10 x weight in kg) + (625 x height in cm) ndash (492 x age) + 5

Women(10 x weight in kg)

+ (625 x height in cm) ndash (492 x age) ndash 161

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 29: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

BMR amp TEETEETotal Energy ExpenditureREEBMRResting Energy ExpenditureNREENon-Resting Energy Expenditure EAT Exercise Activity Thermogenesis NEAT Non-Exercise Activity Thermogenesis TEF Thermic Effect of Food

MacLean et al pR588

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 30: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

BMR Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI314

BMI315

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 31: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

TEE Calculatorhttpwwwfreedietingcomtoolscalorie_calculatorhtm (internal use

only)

BMI315

BMI314

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 32: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 7Gaining muscle is likely to happen when someone is

LOSING weight(calorie deficit)

andworking out

FACTDuring weight loss it is very UNLIKELY that people will gain muscle Usually 10-20 of weight loss will come from lean tissue However it is possible to

gain somemuscle tissue during weight loss

but even then it isin the range of 1-5 lbs

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 33: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Muscle Changes During Weight Loss

Overwhelming evidence points to the fact that it is much more likely that muscle mass will be LOST while dieting However major

determining factors aredegree of calorie deficit protein intake exercise or not type of

exercise age gender and degree of excess bodyfatFor MOST people losing weight the ability to maintain their current

level of muscle tissue is more realistic and should be the focus during weight loss and

people losing weight should be aware of this reality

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 34: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 8A great way to increase your

metabolic rate is to gain some muscle

FACTA POUND of skeletal muscle

only burns about 5-10 calories a day Therefore for most people the

differencefrom a change in muscle tissue willNOT have a meaningful effect on

overall metabolic rate iecalories burned in a day

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 35: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Skeletal Muscle and Metabolic Rate

Every 10-kg difference in lean mass translates to a difference in energy expenditure of asymp 100 kcald assuming a constant rate of protein turnover (p477)

At rest skeletal muscle consumes 544 kJkg (130 kcalkg) per day This is larger than adipose tissue (fat) at 188 kJkg (45 kcalkg) and bone at 96 kJkg (23 kcalkg)

(pE132)

For each kilogram of FFM an average 175 and 209 kcald was expended in the sleeping and basal states respectively whereas 265 kcald was expended when the subjects were fed

and able to move (24EE) After correcting for the effect of activity an estimated 205 kcald were accounted for by each kilogram of FFM which did not differ from that measured for

BMR (209 kcalkg FFM d) (p1575)

5 calories

6 calories

10 calories

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 36: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 9Muscle weighs more

than fat

FACT5lbs of muscle and 5lbs of fat weigh

the sameHowever muscle and fat have different

weight densities

Muscle is about18 smaller than fat

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 37: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

>

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 38: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 10To lose weight

creating a calorie deficit is the most

important determinant of

weight loss

FACTA calorie deficit is THE biological factor

that determines if weight loss will happen It is likely obvious but it often

gets lost in themany other nutritional and exercise

aspects that are related toweight loss

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 39: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Calories are King

ConclusionsReduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize (p859)

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 40: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Calories are King

All 4 diets resulted in modest statistically significant weight loss at one year with no

statistically significant differences between dietshellipall diets achieved modest

although statistically significant improvements in several cardiac risk factors at

one yearhellipIn the long run however sustained adherence to a diet rather than diet type was the key predictor of weight loss and cardiac risk factor reduction in

our study (pp48-52)

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 41: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Calories are King

bull 5 obese patients in a hospital metabolic wardbull Fed liquid diets for ge10 weeksbull 800-1200 caloriesday (tailored per patient) to induce rapid weight lossbull Every 3-4 weeks diet composition changed

bull protein (ranging from 14 percent to 36 percent of calories)bull fat (12 percent to 83 percent)bull carbohydrate (3 percent to 64 percent)

bull All patients lost weight at a constant rate regardless of diet compositionAuthors concluded

It is therefore obvious that the significant factor responsible for weight loss is reduction of calories irrespective of the composition of the diet

We conclude that a calorie is a calorie (p904S)

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 42: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Calories are King buthellip

bull Modify appetite and cravings

bull Modify adherence during weight loss

bull Modify maintenance of weight lost

bull Modify biometric changes

bull Modify the type of tissue lost

bull Modify the ability to increase lean tissue

Macro IntakeDifferences amp

SourcesCan

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 43: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Calories are Kingbut how many

From the NIH (National Institute of Health)

Practical Guide to the Identification Evaluation and Treatment of Overweight and

Obesity in AdultsCaloric intake should be reduced by 500 to 1000 calories a day from the current [maintenance]

level (p2)

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 44: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 11If your calorie intake

is very low it will likely inhibit weight

loss often referred to as

ldquostarvation moderdquo

FACTAs typically stated the starvation mode is a

myth There are metabolic adaptions to reduced calorie intakes such as adaptive

thermogenesis but the adaptation is relatively small To function the

body has to use a good amount of calories regardless of intake Everyone who eats a

low amount of calories consistentlywill always lose weight

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 45: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

No ldquostarvation moderdquo

A 27 year old man weighing 456lbs started a medically supervised fast which lasted 382 days (1 year 2

weeks and 4 days) This was a true fast meaning there were NO calories

ingested and only non-calorie beverages and a few vitamin and

mineral supplements were prescribed During this time he lost 276lbs which means he averaged about a

5lb loss per week

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 46: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

No ldquostarvation moderdquoBut there is real starvationand this is what it looks like

(p1350) Kalm L amp Semba R (2005) They starved so that others could be feed better Remembering Ancel Keys and the Minnesota Experiment J Nutrition

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 47: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 12Short sleep duration is likely an important factor in weight gain amp the ability to lose

weight

FACTThe epidemiological research has shown a clear and negative relationship between

short sleep durations and higher bodyweights

The intervention studies have largely supported

this association Therefore getting theproper amount of sleep is likely tohelp with bodyweight problems

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 48: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Sleep and WeightShort sleep duration and obesity are common occurrence in todayrsquos society An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain However causality cannot be inferred from such studies Clinical intervention studies have examined whether reducing sleep in normal sleepers typically sleeping 7-9 hnight can affect energy intake energy expenditure and endocrine regulators of energy balancehellip Most studies support the notion that restricting sleep increases food intake but the effects on energy expenditure are mixed (p73)

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 49: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Sleep and Weight

ldquoBased on a review of the literature we

conclude that sleep loss represents an

important risk factor for weight gain insulin

resistance type 2 diabetes and

dyslipidaemia Therefore an adequate

sleep pattern is fundamental for the

nutritional balance of the body and should be

encouraged by professionals in the

areardquo (p195)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 50: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 51: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 13Drinking 2 cups of

water (fluid) before a meal will typically

cause a decrease in food

intake forthat meal

FACTThe current research shows that

drinking about 16 ounces of water about 30 min before meals can

decrease calorie intake in older adults The best evidence supports the

benefits of replacing sugar-basedbeverages with water as a helpful

weight managementstrategy

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 52: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Water Intake and WT Loss

Consumed 16 fl oz (500ml) of bottled water prior to each of the three daily

meals Intervention was 12 weeks long

Both groups lost weight

Water group lost about 45lbs more weight than the

control group which equates to about 13

pound per weekldquoIncreasing daily water consumption is widely recognized as a weight loss strategy in the

general public yet there is surprisingly little data supporting this practicerdquo (p1)ldquoTo our knowledge this is the first randomized controlled trial investigating the influence of

increased water consumption on weight lossrdquo (p7 emphasis added)

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 53: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Water Intake and WT Loss

The effects of consuming waterwith meals rather than drinking no beverage or various other beverages remains under-studiedhellip The literature for these comparisons is sparse and somewhat inconclusivehellip studies suggested a potentially important role for water in reducing energy intakes and by this means a role in obesity prevention A need for randomized-controlled trials exists (p505)

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 54: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 14Sugar

is addictive

FACTCurrently there is no good evidence

thatsugar by itself is addictive to humans

There is some good evidence that certain FOODS which are a

COMBINATION of nutrients and flavors particularly

sugar fat and salt canhave addictive like

properties

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 55: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

ldquoConclusion There is no support from

the human literature for the

hypothesis that sucrose may be

physically addictive or that addiction to sugar plays a role in eating disordersrdquo

Sugar is NOT addictive

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 56: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 15As we get older our metabolism slows down substantially

FACTBasal Metabolic Rate (BMR) and Total

Energy Expenditure (TEE) tend to decrease with aging The decrease in

BMR is relatively smallBMR decreases by about

2 for women and 29 for meneach decade after 20

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 57: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

BMR Does NOT Decrease Significantly

With Age

Taken together these observations indicate that BMR is indeed lower in the elderly compared

with young adultshellipbut the difference is so smallhellipthat it can

be considered insignificant

(p658emphasis added)

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 58: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 16Eating high volumehigh fiber

based foods such as non-starchy veggies and fruits can help increase the satiation of

a meal and lead to

eating less caloriesat that meal

FACTIn general high intakes of low-energy-dense

foods can help reduce total calorie intake High intakes of these foods during a

hypocaloric diet can increase feelings of fullness at a meal even though there

are less calories which can help with dietary adherence This effect tends to come from

eating the low-energy-dense foods15 to120 minutes before

the meal

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 59: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Eat Lots of Low-Energy-Dense Foods Energy density is the relationship of calories to the weight of

food( of calories per gram of food)

Several studies have demonstrated that eating low-energy-dense foods (such as

fruits vegetables and soups) maintains satiety while reducing

energy intake In a clinical trial advising individuals to eat portions of low-energy-dense foods was a

more successful weight loss strategy than fat reduction coupled with

restriction of portion sizes Eating satisfying portions of low-energy-dense foods can help to enhance satiety and control hunger while

restricting energy intake for weight management (p236S)

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 60: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Soups The findings from this study

confirm previous reports that consuming soup as a preload can significantly reduce subsequent entreacutee intake as well as total energy intake at the meal The

present study expanded upon prior investigations to show that varying the form and viscosity of soup by

changing the way in which identical ingredients were blended did not

significantly affect energy intake or satiety Therefore consuming a

preload of low-energy-dense soup in

a variety of forms is one strategy that can be used to moderate energy intake in adults (p633

emphasis added)

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 61: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 62: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 17Self-monitoring

(keeping track of certain behaviorsmetrics)is likely a helpful

tool for losingweight

FACTThere is pretty good evidence that frequent

monitoring of behaviors and metrics(diet exercise and weight)

will increases positive outcomesboth short-term and long-term

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 63: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Self-Monitoring

Overall ldquoA significant association between self monitoring and weight loss was consistently

found however the level of evidence was weak because of methodological limitationsrdquo (p92)

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 64: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Self-Monitoring of Body WeightMultiple reviews of the research in this area have come to

similar conclusions which are

Checking weight frequently daily to

weekly can help with weight loss and help with maintaining the

weight loss

Frequent weighing is unlikely to cause

negative psychological

outcomes

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 65: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Self-Monitoring of ExerciseActivity

When it comes to exercise self-monitoring can help with the

development of a consistent exercise habit This can be done through

recording amount of exercisestepsetc wearing a pedometer or other exercise

tracking device such as a FitBit

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 66: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 18If a person is able

to walk for 30 minutes for 5 days a

week they would likely lose one pound a week

FACTWhile exercise confers many

health benefits it causes minimal weight loss when used

alone and contributes little when paired with dietary calorie

restriction in weight loss trials

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 67: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Exercise for Weight Loss

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 68: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Exercise amp Calorie BurningWalking 3mph 5 TimesWeek for 30 Minutes

Calories Burned = 905

Weight Lost=frac14 Pound

Exercise for 30 Minutes Calories Burned (250 lbs person)

of Sessions to Lose 1 lb

Walking 3mph 181 19Waling 4mph 300 12Cycling 12mph (5 minute mile pace)

400 9

Jogging 5mph (12 minute mile pace)

733 5 While these calorie numbers are accurate they do not account for the increased food (calorie) consumption often seen in those who are

exercising and not carefully monitoring their food intake In other words regardless of these figures many people would fail to lose weight at these

exercise frequencies and intensities if their dietcalorie intake is not controlled

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 69: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

Why Exercisebull Delays all-cause mortalitybull Decreases risk of CHD stroke type 2 DI some cancersbull Lowers blood pressurebull Improves lipoprotein profile c-reactive protein and other

CHD biomarkersbull Enhances insulin sensitivityblood sugar regulationbull Preserves bone massbull Preserves muscle massbull Reduces risk of falling in older adultsbull Prevention and improvement of depression and anxietybull Enhances feelings of ldquoenergyrdquo well-being quality of life

cognitive function

adapted from Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory Musculoskeletal and Neuromotor Fitness in Apparently Healthy Adults Guidance for Prescribing Exercise (Garber et al 2011)

hellip But NOT for Weight Loss

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 70: Weight Loss 101 - Thiboutot

Weight Loss 101 What Really Helps

CONCEPT 19Meal replacements are

not a helpful strategy for losing weight

FACTIn general utilizing a variety of different

types of quick and convenient ldquomeal replacementsrdquo can be a helpful tool for

losing weight and maintaining the weight lost

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 71: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

Meal Replacements

ldquoMeal replacements provide portion- and calorie-controlled servings which can facilitate weight loss by reducing the consumption of inappropriate foods

Additionally meal replacements increase the reliability of estimated energy intake

decrease food options and provide structure to meal plans each of which increase compliance with a treatment

programrdquo (p27)

ldquoSubstituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance

strategyrdquo (p335)

ldquoConclusion The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement] plans for weight management suggest that these types of

interventions can safely and effectively produce sustainable weight loss and improve weight-related risk factors of diseaserdquo (p537)

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 72: Weight Loss 101 - Thiboutot

What Really HelpsWeight Loss 101

What are ldquoMeal Replacementsrdquo

ldquoPresently there are no standard definitions of ldquomealreplacementrdquo or PMR plans The term meal replacement

as applied in the scientific literature encompassesa wide range of food products including beverages

prepackagedshelf-stable and frozen entrees and meal snack

bars These foods can be used as the sole energysource for a meal or in combination with other foods

Meal replacements can be purchased at medically supervisedweight-loss clinics commercial weight-loss centers

over the counter on the Internet and throughindependent direct sales distributors The majority of

meal replacement products are vitamin-mineral fortified designed to replace 1 or 2 regular meals daily while providing

advice for a nutritionally balanced low-fat low energymeal planrdquo (Li et al p23-24)

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 73: Weight Loss 101 - Thiboutot

ReviewQuestions

e-mailSurvey

ampFeedback

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 74: Weight Loss 101 - Thiboutot

References

What Really HelpsWeight Loss 101

Fundamental principle 1 Simplebull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95 989-

994bull Schoeller D (2009) The energy balance equation looking back and looking forward are two very different views Nutrition

Reviews 67(5) 249-254

Fundamental principle 2 Complexitybull Power ML amp Schulkin J (2009) The evolution of obesity John Hopkins University Press Baltimore Marylandbull Ulijaszek SJ amp Lofink H (2006) Obesity in biocultural perspective Annu Rev Anthropol 35 337-360bull Zheng H amp Berthoud H (2008) Neural systems controlling the drive to eat Mind versus metabolism Physiology 23 75-83

Fundamental principle 3 Finite resourcesbull Pereto Principle httpwwwbsuedulibrariesahafnerawh-th-math-paretohtml

httpblogshbrorg201205the-unimportance-of-practicall httpenwikipediaorgwikiPareto_principle Evidence based practice referencesbull Guyatt G et al (2008) GRADE what is ldquoquality of evidencerdquo and why it is important to clinicians BMJ 336 995-998bull McKeon P et al (2006) Hierarchy of research design in evidence-based sports medicine Athletic Therapy Today 11(4)bull Shlonsky A amp Gibbs L (2004) Will the real evidence-based practice please stand up Teaching the process of evidence-

based practice to the helping professionals Brief treatment and crisis intervention 4(2)

1-A pound of body fat contains 3500 caloriesbull httpwwwhealthgovdietaryguidelinesdga2005healthieryouhtmlchapter5htmlbull Kershaw R amp Flier J (2004) Adipose tissue as an endocrine gland J Clin Endocrinol Metal 89(6)2548-56bull Wishnofsky M (1958) Caloric equivalents of gained or lost weight Am J Clin Nutr 6(5) 542-546bull Hamdy O et al (2006) Metabolic Obesity The Paradox Between Visceral and Subcutaneous Fat Current Diabetes Review

2(4) 1-7bull Waki H amp Tontonoz P (2007) Endocrine functions of adipose tissue Annu Rev Pathol Mech Dis 2 31-56

2-Eating more often and metabolic ratebull Bellisle F et al (1997) Meal frequency and energy balance Br J Nutr 77 (suppl 1) S57-S70bull Cameron J et al (2010) Increased meal frequency does not promote greater weight loss in subjects who were prescribed an

8-week equi-energetic energy-restricted diet Br J Nutr 103 1098-1101bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of

controlled feeding studies J Nutr 141 154S-157S

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 75: Weight Loss 101 - Thiboutot

References ndash cont3-Skipping a meal metabolic rate and its effects on subsequent energy intake

bull Leidy H amp Campbell W (2011) The effect of eating frequency on appetite control and food intake Brief synopsis of controlled feeding studies J Nutr 141 154S-157S

bull Levitsky D amp DeRosimo L (2010) One day of food restriction does not result in an increase in subsequent daily food intake in humans Physiology amp Behavior 99 495-499

bull Mattson M (2005) The need for controlled studies of the effects of meal frequency on health Lancet 365 1978-1980bull Palmer M et al (2009) Association between eating frequency weight and health Nutr Reviews 67(7) 379-390bull Parks E amp McCrory M (2005) When to eat and how often Am J Clin Nutr 81 3-4bull Saris WHM (1995) Effects of energy restriction and exercise on the sympathetic nervous system Inter J Obese Relat Metab Disord

Suppl 7 S17-S23bull Taylor MA amp Garrow JS (2001) Compared to nibbling neither gorging nor a morning fast affect short term energy balance in obese

patients in a chamber calorimeter Inter J Obesity 25 519-528bull Webber J amp Macdonald IA (1994) The cardiovascular metabolic and hormonal changes accompanying acute starvation in men and

women Br J Nutr 71 437-4474-Eating relatively higher amounts of protein

bull Carbone J et al (2012) Skeletal muscle responses to negative energy balance Effects of dietary protein Adv Nutr 3 119-126bull Bosse J amp Dixon B (2012) Dietary protein in weight management a review proposing protein spread and change theories Nutrition

amp Metabolism 981bull Westerterp-Plantenga M et al (2012) Dietary protein ndash its role in satiety energetics weight loss and health Br J Nutr 108 S105-

S112bull Layman D (2009) Dietary guidelines should reflect new understandings about adult protein needs Nutrition amp Metabolsim 612bull Layman D et al (2008) Protein in optimal health heart disease and type 2 diabetes Am J Clin Nutr 87 (suppl) 1571S-1575Sbull Protein content of selected foods retrieved from httpnutritiondataselfcombull httpwwwquornusproducts61grounds

5-There are no fattening foodsbull Park M (2010) Twinkie diet helps nutrition professor lose 27 pounds Retrieved from

httpwwwcnncom2010HEALTH1108twinkiedietprofessorbull 20 potatoes a day Retrieved from httpwww20potatoesadaycomindexhtmlbull Also see references for 10 Calorie Deficitbull Lowndes J et al (2012) The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on

weight loss and related parameters Nutr J 1155bull Surwit R et al (1997) Metabolic and behavioral effects of a high-sucrose diet during weight loss Am J Clin Nutr 65 908-915bull West JA amp de Looy AE (2001) Weight loss in overweight subjects following low-sucrose or sucrose-containing diets Int J Obes Relat

Metab Disord 25(8)1122-8

What Really HelpsWeight Loss 101

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 76: Weight Loss 101 - Thiboutot

References ndash cont6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditurebull MacLean P (2011) Biologyrsquos response to dieting the impetus for weight regain Am J Physiol Regul Comp Physiol 301

R581-R600bull Hall K et al (2012) Energy balance and its components implications for body weight regulation Am J Clin Nutr 95

989-994bull Levine JA (2007) Nonexercise activity thermogenesis ndash liberating the life-force J Intern Med 262 273-287bull Weijs P (2008) Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese

class I and II adults aged 18-65 y Am J Clin Nutr 88 959-970bull WebMD metabolic calculator Retrieved from httpwwwwebmdcomdiethealthtool-metabolism-calculator

7-Gaining muscle is likely to happen when someone is LOSING weight and working outbull Chaston TB Et al (2007) Changes in fat free mass during significant weight loss a systematic review Inter J Obesity

31 743-750bull Stiegler P amp Cunliffe A (2006) The role of diet and exercise for the maintenance of fat free mass and resting metabolic

rate during weight loss Sports Med 36(3) 239-262bull Weinheimer E et al (2010) A systematic review of the separate and combined effects of energy restriction and exercise

on fat free mass in middle aged and older adults implications for sarcopenic obesity Nutr Reviews 68(7) 375-388

8-A great way to increase your metabolic rate is to gain some musclebull Heymsfield S et al (2002) Body-size dependence of resting energy expenditure can be attributed to nonenergetic

homogeneity of fat-free mass Am J Physiol Endocrinol Metab 282 E132-E138 bull Ravussin E et al (1986) Determinants of 24-hour energy expenditure in man J Clinical Investigations 78 1568-1578 bull WolfeR (2006) The underappreciated role of muscle in health and disease Am J Clin Nutr 84475ndash82

9-Muscle weighs more than fatbull Muscle retrieved from httpenwikipediaorgwikiMuscle

What Really HelpsWeight Loss 101

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 77: Weight Loss 101 - Thiboutot

References ndash cont10-To lose weight creating a calorie deficit is the most important determinant of weight lossbull Alhassan S et al (2008) Dietary adherence and weight loss success among overweight women results from the A TO Z

weight loss study International Journal of Obesity 32 985ndash991bull Brehm B amp DrsquoAlessio D (2008) Weight loss and metabolic benefits with diets varying fat and carbohydrate content

seperating the wheat from the chaff Nature Clinical Practice 4(3) 140-146bull Buchholz A amp Schoeller D (2004) Is a calorie a calorie Am J Clin Nutr 79(suppl) 899S-906Sbull Das S et al (2007) Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence body

composition and metabolism a 1-y randomized controlled trial Am J Clin Nutr 85 1023-1030 bull Foreyt JP et al (2009) Weight-reducing diets Are there any differences Nutrition Reviews 67(suppl 1) S99-S101bull Hite A et al (2011) Low-Carbohydrate Diet Review Shifting the Paradigm Nutr Clin Pract 26(3) 300-308bull Martin CK et al (2011) Change in food cravings food preferences and appetite during a low carbohydrate and low fat diet

Obesity 19(10) 1963-1970 bull Sacks F et al (2009) Comparison of weight loss diets with different compositions of fat protein and carbohydrates NEJM

360 859-873bull Wycherley TP Et al (2012) Comparison of the effects of 52 weeks weight loss with either a high-protein or high-

carbohydrate diet on body composition and cardiometabolic risk factors in overweight and obese males Nutrition and Diabetes 2 e40

bull httpwwwpbsorgwgbhnovabodyis-a-calorie-a-caloriehtmlbull httpwwwfoodpoliticscom201208low-carb-or-low-fat-do-calories-countbull httphipstanfordeduonline-resourcesDocumentsIs20a20calorie20always20a20calorie20-20Gardner208Oct

20201220HIP20Webinarpdf

11-If your calorie intake is very low it will likely inhibit weight loss often referred to as ldquostarvation moderdquobull Stewart WK amp Fleming LW (1973) Features of a successful therapeutic fast of 382 days duration Postgraduate Medical J

49 203-209bull Heymsfield S et al (1995) The calorie myth measurement and reality Am J Clin Nutr 62(suppl) 1034S-1041Sbull Lichtman S et al (1992) Discrepency between self-reported and actual caloric intake and exercise in obese subjects New

Eng J Med 327 1893-1898bull de Boer J et al (1986) Adaptation of energy metabolism of overweight women to low-energy intake studied with whole-

body calorimeters Am J Clin Nutr 44 585-595 bull Robinson D (2012)Starvation mode fact or fiction Retrieved from

httpwwwbeyonddietscombeyonddiets-blog201239starvation-mode-fact-or-fictionhtml

What Really HelpsWeight Loss 101

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 78: Weight Loss 101 - Thiboutot

References ndash cont

What Really HelpsWeight Loss 101

12-Sleep duration can have a significant impact on appetite regulating hormonesbull Cripim CA et al (2007) The influence of sleep and sleep loss upon food intake and metabolism Nutr Research

Rev 20 195-212bull Patel S amp Hu F (2008) Short sleep duration and weight gain a systematic review Obesity 16(3) 643-653bull Sleep Foundation (nd) How much sleep do we need Retrieved from

httpwwwsleepfoundationorgarticlehow-sleep-workshow-much-sleep-do-we-really-needbull St-Onge MP (2013) The role of sleep duration in the regulation of energy balance Effects on energy intakes and

expenditure J Clin Sleep Med 9(1) 73-80bull Breus M (nd) Sleep Habits More Important Than You Think Retrieved from

httpwwwwebmdcomsleep-disordersfeaturesimportant-sleep-habitsbull Taheri S (2007) The Interactions Between Sleep Metabolism and Obesity INT J SLEEP WAKEFULNESS 1(1) 20-

29

13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that mealbull Daniels M amp Popkin B (2010) The impact of water intake on energy intake and weight status a systematic

review Nutr Rev 68(9) 505-521bull Dennis E et al (2010) Water consumption increases weight loss during a hypocaloric diet intervention in

middle-aged and older adults Obesity 18(2) 300-307bull Stookey J et al (2008) Drinking water associated with weight loss in overweight dieting women independent of

diet and activity Obesity 16 2481-2488

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 79: Weight Loss 101 - Thiboutot

References ndash cont14-Sugar is addictivebull Benton D (2010) The plausibility of sugar addiction and its role in obesity and eating disorders Clinical Nutrition 29

288-303bull Kessler D (2009) The end of overeating Taking control of the insatiable American appetite New York Rodale Booksbull Rogers P amp Smit H (2000) Food craving and food ldquoaddictionrdquo A critical review of the evidence from a biopsychosocial

perspective Pharmacol Biocehm Behav 66(1) 3-14bull Ziauddeen H et al (2012) Obesity and the brain how convincing is the addiction model Nature Reviews 13 279-286

15-As we get older our metabolism slows down substantiallybull Roberts S amp Rosenberg I (2006) Nutrition and aging Changes in the regulation of energy metabolism with aging

Physiology Review 86 651-667

16-Eating high volumehigh fiber based foods such as non-starchy veggies fruits and soups can help increase the satiation of a meal and lead to eating less calories at that mealbull Flood JE amp Rolls BJ (2007) Soup preloads in a variety of forms reduce meal energy intake Appetite 49(3)626-34bull Flood-Obbagy JE amp Rolls BJ (2009) The effect of fruit in different forms on energy intake and satiety at a meal

Appetite 52(2) 416-422bull What is energy density httpwwwnutritionorgukhealthylivingfullerwhat-is-energy-densitybull Almiron-Roig E et al (2013) Factors that determine energy compensation a systematic review of preload studies

Nutrition Reviews 71(7) 458-473bull CDC (nd) Low-energy-dense foods and weight management cutting calories while controlling hunger Retrieved from

httpwwwcdcgovnccdphpdnpanutritionpdfr2p_energy_densitypdfbull Ello-Martin J et al (2005) The influence of food portion size and energy density on energy intake implications for

weight management Am J Clin Nutr 82(suppl) 236S-241Sbull Rolls B et al (2005) Provisions of foods differing in energy density affects long-term weight loss Obesity Research

13(6) 1052-1060bull Rolls BJ et al (2005) Changing the energy density of the diet as a strategy for weight management J Am Diet Assoc

105 S98-S103

What Really HelpsWeight Loss 101

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)
Page 80: Weight Loss 101 - Thiboutot

References ndash cont17- Self-monitoringbull Burke L et al (2011) Self-monitoring in weight loss A systematic review of the literature J Am Diet Assoc 111(2) 92-

102bull Zheng Y et aal (2015) Self-weighing in weight management A systematic literature review Obesity 23(2) 256-265bull Pacanowski C et al (2014) Daily self-weighing to control bodyweight in adults A critical review of the literature SAGE

Open 1-16bull VanWormer J et al (2008) The impact of regular self-weighing on weight management A systematic literature review

Inter J Behavioral Nutr Physical Activity 554

18 Exercise and weightbull Garber CE Et al (2011) American College of Sports Medicine position stand Quantity and quality of exercise for

developing and maintaining cardiorespiratory musculoskeletal and neuromotor fitness in apparently healthy adults guidance for prescribing exercise Med Sci Sports Exerc 43(7)1334-59

bull Donnelly J Et al (2009) American College of Sports Medicine Position Stand Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults Med Sci Sports Exerc 41(2)459-71

bull King NA Et al (2008) Individual variability following 12 weeks of supervised exercise identification and characterization of compensation for exercise-induced weight loss Int J Obes 32(1)177-84

bull Miller WC Et al (1997) A meta-analysis of the past 25 years of weight loss research using diet exercise or diet plus exercise intervention Int J Obes Relat Metab Disord 21(10)941-7

bull Shaw K Et al (2006) Exercise for ovwerweight or obesity Cochrane Database of Systematic Reviews 4(CD003817)bull Wu T Et al (2009) Long-term effectiveness of diet-plus-exercise interventions vs diet-only interventions for weight

loss a meta-analysis Obes Rev 10(3)313-23

19 Meal replacements

What Really HelpsWeight Loss 101

  • Weight Loss 101
  • Outline
  • Handout
  • Fundamental Principle 1
  • Fundamental Principle 2
  • Fundamental Principle 2 (2)
  • Fundamental Principle 2 (3)
  • Fundamental Principle 3
  • Fundamental Principle 3 (2)
  • Slide 10
  • Adipose Tissue
  • Adipose Tissue Why this matters
  • Slide 13
  • Meal Frequency
  • Meal Frequency (2)
  • Meal Frequency (3)
  • Slide 17
  • Skipping a Meal and Subsequent Intake
  • Skipping a Meal Does NOT Reduce Metabolic Rate
  • Slide 20
  • Higher Protein Intakes
  • Higher Protein Intakes (2)
  • Higher Protein Intakes (3)
  • Slide 24
  • No Fattening Foods
  • No Fattening Foods (2)
  • No Fattening Foods that includes Sugar
  • Slide 28
  • BMR amp TEE
  • BMR Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • TEE Calculator httpwwwfreedietingcomtoolscalorie_calcula
  • Slide 32
  • Muscle Changes During Weight Loss
  • Slide 34
  • Skeletal Muscle and Metabolic Rate
  • Slide 36
  • Slide 37
  • Slide 38
  • Calories are King
  • Calories are King (2)
  • Calories are King (3)
  • Calories are King buthellip
  • Calories are King but how many
  • Slide 44
  • No ldquostarvation moderdquo
  • No ldquostarvation moderdquo (2)
  • Slide 47
  • Sleep and Weight
  • Sleep and Weight (2)
  • Slide 50
  • Slide 51
  • Water Intake and WT Loss
  • Water Intake and WT Loss (2)
  • Slide 54
  • Sugar is NOT addictive
  • Slide 56
  • BMR Does NOT Decrease Significantly With Age
  • Slide 58
  • Eat Lots of Low-Energy-Dense Foods
  • Soups
  • Slide 61
  • Slide 62
  • Self-Monitoring
  • Self-Monitoring of Body Weight
  • Self-Monitoring of ExerciseActivity
  • Slide 66
  • Exercise for Weight Loss
  • Exercise amp Calorie Burning
  • Why Exercise
  • Slide 70
  • Meal Replacements
  • What are ldquoMeal Replacementsrdquo
  • Review Questions e-mail Survey amp Feedback
  • References
  • References ndash cont
  • References ndash cont (2)
  • References ndash cont (3)
  • References ndash cont (4)
  • References ndash cont (5)
  • References ndash cont (6)

Weight Loss Vacations

Weight Loss Vacations

Effects of Weight Loss, Weight - Diabetes Care · Effects of Weight Loss, Weight Cycling, and Weight Loss Maintenance on Diabetes Incidence and Change in Cardiometabolic Traits in

Effects of Weight Loss, Weight - Diabetes Care · Effects of Weight Loss, Weight Cycling, and Weight Loss Maintenance on Diabetes Incidence and Change in Cardiometabolic Traits in

Powerpoint Weight Loss

Powerpoint Weight Loss

weight loss and weight loss maintenance in african american women

weight loss and weight loss maintenance in african american women

Fat Loss Weight Loss Regime

Fat Loss Weight Loss Regime

Weight Loss Strategies

Weight Loss Strategies

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