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Review of common weight loss dietsSeptember 15, 2016Karmella Thomas, RDN, LD,CDE

Development of Obesity “Obesity can develop only from an excess of energyintake over expenditure.”»N Engl J Med 1997;337:396-407 For weight loss, only calories count.”N Engl J Med 2009;360:859-873 “Calories alone account for increases in body fat.”JAMA 2012;307(1):47-55

Disconnect:Lack of Understanding of the Relationship BetweenCalories and Weight Gain Exists 70% of Americans do not believe calories cause weightgain Only 12% could accurately estimate the calories of foods More than 80% of those watching their weight don’twatch their calories 90% don’t know their calorie budget.2009, 2010, 2011 Food and Health Survey USDA

www.encha.com/fat-cell-development

Obesity Treatment GuidelinesBMI CategoryTreatmentLifestyle 27-29.930-34.935-39.9 Comorbid.YESLifestyle therapy - diet, physical activity, and behavioraltherapy - is the cornerstone of obesity treatment*Consider pharmacotherapy only if a patient has not lost 1 pound per weekafter 6 months of combined lifestyle therapy.

Low Carbohydrate/High Protein Diets Paleo Diet Atkins Diet Ketogenic Diet

Paleo Diet Typically 23% Carbohydrates, 38% protein,and 39% fat Can vary depending upon preference Have ‘EAT” foods and “Don’t EAT” foods Restrict cereal grains, legumes, dairy,potatoes, salt, refined sugar and oils,“processed” foods

Atkins Very low carbohydrate diet “Flip the body’s metabolic switch” from burning carbsto burning fat Has 4 phases of gradual increased carb intake foreach phase Phase 1: 20 grams of carbs per day Phase 2: 25 grams of net carbs per day Phase 3: 25 grams 5-10 grams of carbs more/day Phase 4: 25 g (more or less) personal preference

Atkins 40 Plan

The A to Z Weight Loss Study: Randomized Trial Compared 4 weight loss diets (low to high carbintake) and effect on weight loss and metabolicvariables in 1 year’s time 12 month randomized trial with 311overweight/obese women (premenopausal,nondiabetic) with BMI between 27-40 Atkins, Zone, LEARN, Ornish diets Weekly instruction for 2 months and additional 10month follow upJAMA. 2007;297(9):969-977. doi: 10.1001/jama.297.9969

DietsAtkins: 20g/d or less for first 2-3 months andthen 50 g/day or less for ongoing weight lossphaseZone: 40% carbs, 30% protein, 30% fatLEARN: 55%-60% carbs, 10% fat, calorierestriction, increased exercise, and behaviormodificationOrnish: 10% or less calories from fat, physicalactivity, behavior modification

Results At the 2 and 6 month intervals, the Atkins group hadsignificantly greater weight loss than all groups– Weight loss between ZONE, LEARN and Ornish did not differsignificantly at any time Body fat and waist-hip ratio did not achievestatistically significance between groups Only HDL and triglycerides findings were significantand favored Atkins group LDL changes favored LEARN and Ornish diets at 2months but differences diminished at 6 & 12 months

Concerns What does 20 grams per day or less ofcarbohydrates look like? 1 – 1.5 oz of bread1-2 cups of fruit1/3 cup of rice or pasta3 cups of popcorn½ cup of ice cream

Ketogenic Diet Ketosis is a metabolic state that occurs whendietary carbohydrates are in such low quantitiesthat your body relies almost exclusively on fattyacid oxidation and ketone metabolism toproduce ATP Used for Dementia and Epilepsy in MedicalNutrition Therapy– Developed by Dr. Russell wilder at Mayo Clinic in 1924

The basics Intention to put the body into ketosis 70% calories from fat, 25% protein, 5% carbs 2,000 calorie diet 20 g carbs, 155g fat and125g protein “Meals should be protein, veggies, and extraside of fat” “Just be sure to know that the first week usuallygives you some killer headaches and lethargy ”

Calorie for calorie, dietary fat restriction results inmore body fat loss than carbohydrate restriction inpeople with obesity. Hall, Kevin D, et al. Inpatient metabolic balance study Examine the effect of selective isocaloricreduction of dietary carbs vs fat on bodyweight, energy expenditure, and fat balance Small study (19 obese adults)– 10 males and 9 femalesCell Metab. 2015 September 1; 22(3):427-436. doi:10.1016/j.cmet.2015.07.021

Cell Metab. 2015 September 1; 22(3):427-436. doi:10.1016/j.cmet.2015.07.021

Cell Metab. 2015 September 1; 22(3):427-436. doi:10.1016/j.cmet.2015.07.021

Cell Metab. 2015 September 1; 22(3):427-436. doi:10.1016/j.cmet.2015.07.021

Results Experimental diets were 30% lower in calories than baselinediet (carb and fat varied, protein stayed same) The carb restricted diet led to decreased insulin secretionand increase in net fat oxidation but fat restricted diet did not Both diets resulted in body fat loss, but the reduced fat dietled to significantly more fat loss than the reduced carb diet Concluded that reducing dietary fat can lead to greater bodyfat loss than reducing dietary carbs in adults with obesity

US News and World Reports Best Weight-Loss Diet#1 Weight Watchers#2 HMR Program (Health Management Resources)#3 Biggest Loser Diet New Category this year – Best Fast WeightLoss Diet– HMR program and Biggest Loser (tie for 1st)

Weight Watchers New SmartPoints plan– No food is off limits– Each food is given a number basedupon calories, saturated fat, sugar, andprotein Online Plus Meetings Personal coaching

Randomised controlled trial of four commercial weightloss programmes in the UK: initial findings from theBBC “diet trials” Compared Atkins, Slim Fast, Weight Watchers, andRosemary Conley’s eat yourself slim diet and fitnessplan Measured weight and body fat changes over 6 months Similar weight loss among diet groups compared tocontrol Average weight loss of 5.9 kg and average fat loss of 4.4kgBMJ. 2006 Jun 3; 332(7553): 1309–1314.

BMJ. 2006 Jun 3; 332(7553): 1309–1314.

Weight Watchers 2015 introduced Beyond the ScaleProgram Emphasizes 3 components:– Eating healthier– Fitness that fits your life– “developing the skills and connections totune in and unlock inner strength”

Biggest Loser DietSix weeks of healthy food & regular exercise4-3-2-1 Pyramid– 4 servings of fruits and vegetables– 3 servings of lean protein– 2 servings of whole grains– 200 calories of “extras” (desserts)Exercise at a high levelSome meal plans go below 1,200 calories/day

Weight Loss Results 2011 American Journal of Medicine study Small – 14 Biggest Loser contestants 7 months of intense exercise and reduced caloriediet (moderate) Lost average of 133 pounds (39% of initial weight) Improvements in atherosclerosis risk, carotidvascular function, lipids, insulin resistance, andinflammatory biomarkersAm J Med. 2011 Oct;124(10):978-82. doi: 10.1016/j.amjmed.2011.02.032. Epub 2011 Jul 27.

Meal Replacements Meta and pooling analysis from 6 studies on safety andeffectiveness of partial meal replacements (1 or moremeal replacements per day) for long term weightmanagement 800 to 1,600 calories/day using meal replacements andother healthy foods for at least 3 months in overweightadults compared to conventional reduced calorie diet International Journal of Obesity (2003) 27, 537–549.doi:10.1038/sj.ijo.0802258

Results 6 data sets produced 249 meal replacementssubjects and 238 control subjects 46 years old, 75% women and mean BMI of 31kg/m2 (119 had type 2 diabetes) Weight loss was significant in both groups, butgreater in the meal replacement group At 3 months, meal replacement group lost 7% ofweight compared to 4% in reduced calorie diet– Sustained at the 1 year mark

HMR Program In-clinic and at-home program options200 different clinics (one located here at UNRSOM)Meal Replacements and Physical Activity2 diet options (More is Better strategy)– Decision Free (5 shakes per day)– Healthy Solutions (3 shakes 2 Entrees 5 cV/F)

Other meal replacement diets Slim FastJenny CraigNutri-systemOptifast

What does it come down to? What will the patient do? What medications are they on? What can they do now, but also in 6months? What does their support look like?

THANK YOU!

#3 Biggest Loser Diet New Category this year – Best Fast Weight Loss Diet – HMR program and Biggest Loser (tie for 1st) Weight Watchers New SmartPoints plan – No food is off limits – Each foo