Weight Management for Grade 9 and 10 Students

The most important component of an effective weight-management program must be the prevention of unwanted weight gain from excess body fat. The military is in a unique position to address prevention from the first day of an individual's military career. Because the military population is selected from a pool of individuals who meet specific criteria for body mass index (BMI) and percent body fat.

1. Importance of Weight Importance of Weight
ManagementManagement

2. 
Weight management is Weight management is
important to prevent and control important to prevent and control
diseases.diseases.

Diabetes, heart-diseases, stroke Diabetes, heart-diseases, stroke
and cancer.and cancer.

Generated by unhealthy eating Generated by unhealthy eating
habits, genes, environment, and habits, genes, environment, and
lifestyle.lifestyle.

3. The War on WeightThe War on Weight

Importance of Importance of
healthy eating habits.healthy eating habits.

Should not focus on Should not focus on
temporary weight temporary weight
loss.loss.

Takes time and Takes time and
consistency.consistency.

25% of men and 40% 25% of men and 40%
of women are trying of women are trying
to lose weightto lose weight

4. 
Eating healthy foods partnered with Eating healthy foods partnered with
exercise and physical activities.exercise and physical activities.

Air, Water and Food are the Air, Water and Food are the
physiological needs that should be physiological needs that should be
met for human survival.met for human survival.

Well balanced meal to support Well balanced meal to support
growth and development.growth and development.

Imbalance intake of food may lead Imbalance intake of food may lead
to overweight or obesity.to overweight or obesity.

5. 
Calorie Calorie is the measurement of is the measurement of
energy we get from food.energy we get from food.

Caloric balance Caloric balance is like a scale.is like a scale.

6. An Overview of Obesity in the An Overview of Obesity in the
PhilippinesPhilippines

Overweight and obesity Overweight and obesity
are defined as abnormal or are defined as abnormal or
excessive fat accumulation excessive fat accumulation
that may impair health that may impair health
(WHO).(WHO).

May reduce life May reduce life
expectancy.expectancy.

In Philippines (3) out of (10) In Philippines (3) out of (10)
Filipinos are now obese.Filipinos are now obese.

7. Factors that may lead to Factors that may lead to
OBESITYOBESITY
A.A.Inactive Physical LifestyleInactive Physical Lifestyle
B.B.Improper food selectionsImproper food selections
C.C.Engaging on inactive recreationEngaging on inactive recreation
D.D.GeneticsGenetics

8. Health Problems Associated Health Problems Associated
with Obesitywith Obesity

Childhood obesity may lead to Childhood obesity may lead to
adulthood obesity.adulthood obesity.

Major effects to human lifeMajor effects to human life

Low self-esteem, social problems Low self-esteem, social problems
and even daily performances.and even daily performances.

Obesity increases the risk of non-Obesity increases the risk of non-
communicable diseases or lifestyle-communicable diseases or lifestyle-
related diseases.related diseases.

9. How to know if you are How to know if you are
overweight or obese?overweight or obese?

BMI – Body Mass IndexBMI – Body Mass Index

10. A. Non-modifiableA. Non-modifiable

AgeAge

GenderGender

HeredityHeredity
Risk FactorsRisk Factors

11. B. ModifiableB. Modifiable

StressStress

SmokingSmoking

Alcohol intakeAlcohol intake

PersonalityPersonality

12. Weight management Weight management
TacticsTactics

Become more activeBecome more active

Have a healthier approach to the Have a healthier approach to the
whole family’s eating habitswhole family’s eating habits

Do not skip mealsDo not skip meals

Consult the doctor or any Consult the doctor or any
professional for adviceprofessional for advice

13. THANK YOU……..THANK YOU……..

14. Lifestyle Vs. Weight LossLifestyle Vs. Weight Loss

Prevention of obesity is easier than curingPrevention of obesity is easier than curing

Balance energy in(take) with energy Balance energy in(take) with energy
out(put)out(put)

Focus on improving food habitsFocus on improving food habits

Focus on increased physical activitiesFocus on increased physical activities

15. What It Takes To Lose a What It Takes To Lose a
PoundPound

Body fat contains 3500 kcal/lbBody fat contains 3500 kcal/lb

Fat storage (body fat plus Fat storage (body fat plus
supporting lean tissues) contains supporting lean tissues) contains
2700 kcal/lb2700 kcal/lb

Must have an energy deficit of 2700-Must have an energy deficit of 2700-
3500 kcal to lose a pound per week3500 kcal to lose a pound per week

16. Do the MathDo the Math
To lose one pound, you must create a deficit of
2700-3500 kcal
So to lose a pound in 1 week (7 days), try cutting
back on your kcal intake and increase physical
activity to create a deficit of 400-500 kcal per day
- 500 kcal x 7 days = - 3500 kcal = 1 pound of weight loss
day week in 1 week

17. Sound Weight Loss Sound Weight Loss
ProgramProgram

Rate of lossRate of loss

FlexibilityFlexibility

IntakeIntake

Behavior ModificationBehavior Modification

Overall HealthOverall Health

18. Cutting Back Cutting Back

1200-1500 kcals per day1200-1500 kcals per day

Control calorie intake by being aware of Control calorie intake by being aware of
kcal and fat content of foodskcal and fat content of foods

““Fat Free” does not mean “Calories Free” Fat Free” does not mean “Calories Free”
(or “All You Can Eat”)(or “All You Can Eat”)

Read food labelsRead food labels

Estimate kcal using the exchange systemEstimate kcal using the exchange system

Keep a food diaryKeep a food diary

19. Regular Physical ActivityRegular Physical Activity

Fat use is enhanced with regular Fat use is enhanced with regular
physical activityphysical activity

Increases energy expenditureIncreases energy expenditure

Duration and regularity are Duration and regularity are
importantimportant

Make it a part of a daily routineMake it a part of a daily routine

20. Behavior ModificationBehavior Modification

Modify problem (eating) behaviorsModify problem (eating) behaviors

Chain-breakingChain-breaking

Stimulus controlStimulus control

Cognitive restructuringCognitive restructuring

Contingency managementContingency management

Self-monitoringSelf-monitoring

21. Chain-BreakingChain-Breaking

Breaking the link between two Breaking the link between two
behaviorsbehaviors

These links can lead to excessive These links can lead to excessive
intakeintake
SnackingSnacking while while watching T.Vwatching T.V..

22. Stimulus ControlStimulus Control

Alternating the environment to Alternating the environment to
minimize the stimuli for eatingminimize the stimuli for eating

Puts Puts youyou in charge of temptations in charge of temptations

23. Cognitive RestructuringCognitive Restructuring

Changing your frame of mind Changing your frame of mind
regarding eatingregarding eating

Replace eating due to stress with Replace eating due to stress with
“walking”“walking”

24. The Philippine Food The Philippine Food
Pyramid/My Food PlatePyramid/My Food Plate

25. Contingency Contingency
ManagementManagement

Forming a plan of action in response Forming a plan of action in response
to a situationto a situation

Rehearse in advance appropriate Rehearse in advance appropriate
responses to pressure of eating at responses to pressure of eating at
partiesparties

26. Self-MonitoringSelf-Monitoring

Tracking foods eaten and conditions Tracking foods eaten and conditions
affecting eatingaffecting eating

Helps you understand your eating Helps you understand your eating
habitshabits

27. Weight MaintenanceWeight Maintenance

Prevent relapsePrevent relapse
–Occasional lapse is fine, but take charge Occasional lapse is fine, but take charge
immediatelyimmediately
–Continue to practice newly learned behaviorContinue to practice newly learned behavior
–Requires “motivation, movement, and Requires “motivation, movement, and
monitoring”monitoring”

Have social supportHave social support
–Encouragement from friends/ family/ Encouragement from friends/ family/
professionalsprofessionals

28. Weight Loss TriadWeight Loss Triad
Control Energy
Intake
Perform Regular
Physical Activity
Control “Problem”
Behaviors

29. Dieting Can Be Hazardous Dieting Can Be Hazardous
To Your HealthTo Your Health

Weight regained consists of a Weight regained consists of a
higher percentage of body fat higher percentage of body fat
than beforethan before

Less healthy than before dietingLess healthy than before dieting

Weight loss diet should Weight loss diet should notnot be be
considered unless you are considered unless you are
committed and motivatedcommitted and motivated

30. Diet Drugs: Amphetamine Diet Drugs: Amphetamine
(Phentermine)(Phentermine)

Prolongs the activity of epinephrine and Prolongs the activity of epinephrine and
norepinephrine in the brainnorepinephrine in the brain

Decreases appetiteDecreases appetite

Not recommended for long term use Not recommended for long term use
(dependency)(dependency)

31. Sibutramine (Meridia)Sibutramine (Meridia)

Enhances norepinephrine and Enhances norepinephrine and
serotonin activityserotonin activity

Decreases appetite (eat less)Decreases appetite (eat less)

Not recommended for people with Not recommended for people with
HTNHTN

32. Orlistat (Xenical)Orlistat (Xenical)

Inhibits fat digestionInhibits fat digestion

Reduces absorption of fat in the small Reduces absorption of fat in the small
intestineintestine

Fat is deposited in the feces, causing side Fat is deposited in the feces, causing side
effectseffects

Must control fat intakeMust control fat intake

Malabsorption of fat-soluble vitaminsMalabsorption of fat-soluble vitamins

Supplements neededSupplements needed

33. Very Low-Calorie Diets Very Low-Calorie Diets
(VLCD)(VLCD)

Recommended for people >30% above their Recommended for people >30% above their
healthy weighthealthy weight

400-800 kcal per day400-800 kcal per day

Low carbohydrates and high proteinLow carbohydrates and high protein

Causes ketosisCauses ketosis

Lose ~3-4 pounds a weekLose ~3-4 pounds a week

Requires careful physician monitoringRequires careful physician monitoring

Health risks includes cardiac problems and Health risks includes cardiac problems and
gallstonesgallstones

34. Bariatric SurgeryBariatric Surgery

An increasingly popular option for An increasingly popular option for
severely obese people who are severely obese people who are
unlikely to lose weight through unlikely to lose weight through
conventional meansconventional means

Cost: $20-$35,000Cost: $20-$35,000

Some insurers cover itSome insurers cover it

35. Candidates for Bariatric Candidates for Bariatric
SurgerySurgery

BMI of 40 or more—about 100 pounds BMI of 40 or more—about 100 pounds
overweight for men and 80 pounds for overweight for men and 80 pounds for
women women

BMI between 35 and 39.9 and a serious BMI between 35 and 39.9 and a serious
obesity-related health problem such as obesity-related health problem such as
type 2 diabetes, heart disease, or severe type 2 diabetes, heart disease, or severe
sleep apneasleep apnea

Willingness to make associated lifestyle Willingness to make associated lifestyle
changes changes

36. Bariatric SurgeryBariatric Surgery

RestrictiveRestrictive

MalabsorptiveMalabsorptive

Combination Combination
restrictive/malabsorptiverestrictive/malabsorptive

37. Restrictive Surgery: Restrictive Surgery:
Adjustable Gastric BandAdjustable Gastric Band

38. Diet After SurgeryDiet After Surgery

After restrictive surgeries, patients After restrictive surgeries, patients
can only eat ½ cup to 1 cup of food at can only eat ½ cup to 1 cup of food at
a timea time

Foods often must be soft and chewed Foods often must be soft and chewed
thoroughlythoroughly

Patients who eat too fast or the Patients who eat too fast or the
wrong kinds of food may have wrong kinds of food may have
vomitingvomiting

39. Restrictive/Malabsorptive: Restrictive/Malabsorptive:
Roux en YRoux en Y

40. Diet Books: Big BusinessDiet Books: Big Business

The original Dr. Atkins Diet Revolution is The original Dr. Atkins Diet Revolution is
one of the ten best selling books of all timeone of the ten best selling books of all time

Dr. Atkins New Diet Revolution is still #14 on Dr. Atkins New Diet Revolution is still #14 on
the NYT paperback advice bestseller list the NYT paperback advice bestseller list
(11/04) having been on the list for years(11/04) having been on the list for years

The South Beach Diet has been on the NYT The South Beach Diet has been on the NYT
hardcover advice bestseller list for 81 hardcover advice bestseller list for 81
weeks, and is currently #4. weeks, and is currently #4.

41. Low Carbohydrate Diets Low Carbohydrate Diets
(Past)(Past)

The Scarsdale Medical The Scarsdale Medical
DietDiet

The Drinking Man’s The Drinking Man’s
DietDiet

Dr. Atkins Diet Dr. Atkins Diet
RevolutionRevolution

The Marine Corps DietThe Marine Corps Diet

The Last Chance DietThe Last Chance Diet

The “Mayo Clinic” DietThe “Mayo Clinic” Diet

42. Low Carbohydrate Diets Low Carbohydrate Diets
(Recent)(Recent)

Enter the ZoneEnter the Zone

Dr. Bob Arnot’s Revolutionary Weight Dr. Bob Arnot’s Revolutionary Weight
Control ProgramControl Program

Protein PowerProtein Power

Sugar BustersSugar Busters

Dr. Atkins New Diet RevolutionDr. Atkins New Diet Revolution

Feed Your Kids Well (Atkins for Kids)Feed Your Kids Well (Atkins for Kids)

The Fat Flush Plan (Gittleman)The Fat Flush Plan (Gittleman)

The South Beach DietThe South Beach Diet

43. Atkins Diet PremiseAtkins Diet Premise

Stabilizes insulin production by limiting Stabilizes insulin production by limiting
carb intake. This forces the body from carb intake. This forces the body from
glucosis into lipolysis, thus ketones are glucosis into lipolysis, thus ketones are
burned as the primary energy source.burned as the primary energy source.

This results in a metabolic advantage This results in a metabolic advantage
of low carbohydrate: dieters can lose of low carbohydrate: dieters can lose
weight while eating more caloriesweight while eating more calories

44. Atkins DietAtkins Diet

““Induction Phase”: 2 weeks, 20 g carb/day Induction Phase”: 2 weeks, 20 g carb/day

Eliminate fruit, bread, grains, starchy Eliminate fruit, bread, grains, starchy
vegetables, dairy products except cheese, vegetables, dairy products except cheese,
cream, buttercream, butter

20 g carb: 3 cups salad greens, or 2 cups 20 g carb: 3 cups salad greens, or 2 cups
salad plus 2/3 cups cooked vegetables salad plus 2/3 cups cooked vegetables
such as asparagus, summer squash, such as asparagus, summer squash,
green beansgreen beans

45. Atkins DietAtkins Diet

Supplements are recommended for Supplements are recommended for
everyone: a multivitamin, lecithin, L-everyone: a multivitamin, lecithin, L-
glutamine, chromium piccolinateglutamine, chromium piccolinate

Can purchase supplements from the Can purchase supplements from the
Atkins InstituteAtkins Institute

Recommends exerciseRecommends exercise

46. Atkins Phase 2: OWLAtkins Phase 2: OWL

““Ongoing weight loss phase” or “Owl.” Ongoing weight loss phase” or “Owl.”

Add carbohydrate at a rate of 5 grams a Add carbohydrate at a rate of 5 grams a
day until weight loss stopsday until weight loss stops

This is the CCLL: critical carbohydrate level This is the CCLL: critical carbohydrate level
for losingfor losing

May be 45, or 33, or 19 grams/dayMay be 45, or 33, or 19 grams/day

Continue at this level until desired weight Continue at this level until desired weight
is reachedis reached

47. Atkins MaintenanceAtkins Maintenance

Determine CCLM: critical Determine CCLM: critical
carbohydrate level for maintenance carbohydrate level for maintenance
(the level at which weight stabilizes)(the level at which weight stabilizes)

Most will stabilize at 25 to 90 Most will stabilize at 25 to 90
grams/daygrams/day

If weight gain occurs, return to If weight gain occurs, return to
induction dietinduction diet

48. Atkins- Sample Menu Atkins- Sample Menu
Phase 1Phase 1

B: scrambled eggs and ham, butter, B: scrambled eggs and ham, butter,
decaffeinated coffee or teadecaffeinated coffee or tea

L: Bacon cheeseburger, no bun, small L: Bacon cheeseburger, no bun, small
tossed salad, selzer watertossed salad, selzer water

D: shrimp cocktail with mustard and D: shrimp cocktail with mustard and
mayo, clear consomme, steak, roast, mayo, clear consomme, steak, roast,
fish or fowl, tossed salad, diet gelatin fish or fowl, tossed salad, diet gelatin
with whipped cream, sf beveragewith whipped cream, sf beverage

49. Atkins: Sample menu OWLAtkins: Sample menu OWL

B: Western omelet, 3 ounces tomato B: Western omelet, 3 ounces tomato
juice, 2 carbo grams of bran crispbread, juice, 2 carbo grams of bran crispbread,
decaf coffee or teadecaf coffee or tea

L: Chef’s salad with ham, cheese, L: Chef’s salad with ham, cheese,
chicken and egg; zero carbohydrate or chicken and egg; zero carbohydrate or
oil and vinegar dressing, iced herbal teaoil and vinegar dressing, iced herbal tea

D: Seafood salad, poached salmon, 2/3 D: Seafood salad, poached salmon, 2/3
cup vegetable from permitted list, half cup vegetable from permitted list, half
cup of strawberries in creamcup of strawberries in cream

50. South Beach Diet PremiseSouth Beach Diet Premise

““Addiction” to carbs is a psychological need for Addiction” to carbs is a psychological need for
comfort food and is likely a real, physiological comfort food and is likely a real, physiological
phenomenonphenomenon

Eating bad carbs leads to cravings for more Eating bad carbs leads to cravings for more
which is “ultimately responsible for our obesity which is “ultimately responsible for our obesity
epidemic”epidemic”

States that Atkins may limit carbs too severely States that Atkins may limit carbs too severely

Stresses glycemic index as the biggest Stresses glycemic index as the biggest
determinant of a food’s potential impact on determinant of a food’s potential impact on
body weightbody weight

51. South Beach Diet: Phase 1 (2 South Beach Diet: Phase 1 (2
weeks)weeks)

Carbs limited to low-carb vegetables, salads, 1% Carbs limited to low-carb vegetables, salads, 1%
milk, fat-free buttermilk, nonfat yogurt. milk, fat-free buttermilk, nonfat yogurt.

Proteins: unlimited lean meats, poultry, fish, low Proteins: unlimited lean meats, poultry, fish, low
fat cheese, tofu fat cheese, tofu

Nuts included, but limitedNuts included, but limited

““Good” fats including olive, canola oilsGood” fats including olive, canola oils

Sugar-free hard candies, diet gelatin, sugar subsSugar-free hard candies, diet gelatin, sugar subs

NO fatty meats, starchy vegetables like corn, NO fatty meats, starchy vegetables like corn,
potatoes, carrots, no fruits, no grains, no alcoholpotatoes, carrots, no fruits, no grains, no alcohol

52. South Beach: Sample Day South Beach: Sample Day
Phase 1Phase 1

B: 6 oz tomato juice, 1/4-1/2 cup liquid egg B: 6 oz tomato juice, 1/4-1/2 cup liquid egg
substitute, decaf coffee or tea, non-fat milk, sugar substitute, decaf coffee or tea, non-fat milk, sugar
substitutesubstitute

snack: 1-2 turkey roll upssnack: 1-2 turkey roll ups

L: SB chopped salad with tuna, sf gelatinL: SB chopped salad with tuna, sf gelatin

snack: celery, 1 wedge Laughing Cow Light snack: celery, 1 wedge Laughing Cow Light
CheeseCheese

D: baked chix breast, roasted eggplant and D: baked chix breast, roasted eggplant and
peppers, salad, lo sugar dressingpeppers, salad, lo sugar dressing

Dessert: Mocha Ricotta CremeDessert: Mocha Ricotta Creme

53. South Beach Diet: Phase 2South Beach Diet: Phase 2

Reintroduces most fruits, whole grains (sparingly) Reintroduces most fruits, whole grains (sparingly)
including popcorn, legumes such as pinto beans, including popcorn, legumes such as pinto beans,
starchy vegetables such as peas, carrots and sweet starchy vegetables such as peas, carrots and sweet
potatoes, flavored nonfat yogurt, semisweet or potatoes, flavored nonfat yogurt, semisweet or
bittersweet chocolate, winebittersweet chocolate, wine

Still forbidden: white flour and products made from Still forbidden: white flour and products made from
it including breads, cookies, pasta; potatoes, white it including breads, cookies, pasta; potatoes, white
rice, corn; fruits including bananas, canned fruit, rice, corn; fruits including bananas, canned fruit,
pineapple, raisins, watermelonpineapple, raisins, watermelon

Dieters stay in this phase until goal weight achievedDieters stay in this phase until goal weight achieved

54. South Beach: Sample Day South Beach: Sample Day
Phase 2Phase 2

B: 1 cup blueberries; 1 scrambled egg w/ salsa; B: 1 cup blueberries; 1 scrambled egg w/ salsa;
oatmeal mixed with 1 cup nonfat milk, sprinkled oatmeal mixed with 1 cup nonfat milk, sprinkled
with cinnamon and walnuts; coffee or teawith cinnamon and walnuts; coffee or tea

Snack: 4 oz non-fat sugar-free yogurtSnack: 4 oz non-fat sugar-free yogurt

L: Tuna salad w/ celery, mayo, tomato, onion in L: Tuna salad w/ celery, mayo, tomato, onion in
whole wheat pitawhole wheat pita

Snack: 1 part-skim mozzarella cheese stickSnack: 1 part-skim mozzarella cheese stick

D: Pan roasted steak and onions, South Beach D: Pan roasted steak and onions, South Beach
salad, steamed broccoli; chocolate-dipped salad, steamed broccoli; chocolate-dipped
strawberriesstrawberries

55. South Beach Diet: Phase 3South Beach Diet: Phase 3

Maintenance- no foods are Maintenance- no foods are
forbiddenforbidden

Continue to limit high carb, refined Continue to limit high carb, refined
or heavily processed foods. or heavily processed foods.

Return to earlier phase if weight Return to earlier phase if weight
gain occursgain occurs

56. South Beach vs Atkins South Beach vs Atkins
Phase 1Phase 1
Atkins Atkins

Proteins: All meats, Proteins: All meats,
poultry, fish, shellfish, poultry, fish, shellfish,
eggs, cheese are unlimitedeggs, cheese are unlimited

Fats: vegetable oils, butter, Fats: vegetable oils, butter,
mayonnaise, heavy cream, mayonnaise, heavy cream,
baconbacon

Vegetables: 3 cups salad or Vegetables: 3 cups salad or
2 cups salad and 2/3 cup 2 cups salad and 2/3 cup
low carb vegetableslow carb vegetables

NO: artificial sweeteners, NO: artificial sweeteners,
margarine, fruits, grains, margarine, fruits, grains,
breads, starchy vegetables, breads, starchy vegetables,
dairy, alcoholdairy, alcohol
South BeachSouth Beach

Proteins: Lean beef, pork, Proteins: Lean beef, pork,
skinless poultry, low fat skinless poultry, low fat
cheese, seafood, eggscheese, seafood, eggs

Fats: Canola and olive oilFats: Canola and olive oil

Vegetables: salad greens, Vegetables: salad greens,
beans, tomatoes, cabbage, beans, tomatoes, cabbage,
summer squash, broccoli, all summer squash, broccoli, all
low carb are unlimitedlow carb are unlimited

Dairy: Fat free or 1% milk or Dairy: Fat free or 1% milk or
yogurtyogurt

NO: fatty meat, high fat NO: fatty meat, high fat
cheese; fruits, grains, cheese; fruits, grains,
breads, starchy vegetables, breads, starchy vegetables,
butter, margarine, alcoholbutter, margarine, alcohol

57. High Carbohydrate Low High Carbohydrate Low
Fat DietsFat Diets

The Pritikin Weight Loss The Pritikin Weight Loss
BreakthroughBreakthrough

Eat More, Weigh Less (Dean Ornish)Eat More, Weigh Less (Dean Ornish)

American Heart Association dietsAmerican Heart Association diets

NHLBI TLC dietNHLBI TLC diet

58. High Carb Low Fat DietsHigh Carb Low Fat Diets

Rationale: diet is high in bulk and Rationale: diet is high in bulk and
fiber, low in calorie density fiber, low in calorie density
producing early satiety and weight producing early satiety and weight
lossloss

Description: 50-75% carbohydrate Description: 50-75% carbohydrate
calories, relatively less meat, fish, calories, relatively less meat, fish,
fats and oils, more grains, cereals, fats and oils, more grains, cereals,
breads, fruits, vegetablesbreads, fruits, vegetables

59. Sample Menu: High Carb Sample Menu: High Carb
Low FatLow Fat

B: 1 cup blueberries; oatmeal mixed with 1 B: 1 cup blueberries; oatmeal mixed with 1
cup nonfat milk, sprinkled with cinnamon cup nonfat milk, sprinkled with cinnamon
and walnuts; coffee or teaand walnuts; coffee or tea

Snack: 4 oz non-fat sugar-free yogurtSnack: 4 oz non-fat sugar-free yogurt

L: Vegetarian vegetable soup, fresh orange, L: Vegetarian vegetable soup, fresh orange,
nonfat yogurt nonfat yogurt

D: Grilled salmon with yogurt-dill sauce, D: Grilled salmon with yogurt-dill sauce,
bulgur with raisins, steamed broccoli; bulgur with raisins, steamed broccoli;
strawberries over angelfood cakestrawberries over angelfood cake

Snack: air popped popcornSnack: air popped popcorn

60. Research on Macronutrient Research on Macronutrient
Mix in Weight Loss DietsMix in Weight Loss Diets

61. Low Carb vs Low Fat DietLow Carb vs Low Fat Diet

Objective: Compare effects of a low-carb, ketogenic Objective: Compare effects of a low-carb, ketogenic
diet (Atkins) with those of a low-fat, low chol, diet (Atkins) with those of a low-fat, low chol,
reduced calorie dietreduced calorie diet

Design: Randomized, controlled Design: Randomized, controlled

Subjects: 120 overweight, hyperlipidemic volunteersSubjects: 120 overweight, hyperlipidemic volunteers

Intervention: Low carb diet (initially <20 g carb/day) Intervention: Low carb diet (initially <20 g carb/day)
plus nutritional supplementation, exercise plus nutritional supplementation, exercise
recommendation, and group meetings or low-fat recommendation, and group meetings or low-fat
diet (<30% energy from fat, <300 mg chol, deficit of diet (<30% energy from fat, <300 mg chol, deficit of
500-1000 kcal/d) plus exercise recommendation and 500-1000 kcal/d) plus exercise recommendation and
group meetingsgroup meetings
Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777

62. Low Carb vs Low Fat DietLow Carb vs Low Fat Diet

MeasurementsMeasurements: body weight, body composition, : body weight, body composition,
fasting serum lipid levels and group meetingsfasting serum lipid levels and group meetings

ResultsResults: 76% of the low-carb group and 57% of the : 76% of the low-carb group and 57% of the
low-fat group completed the study. At 24 weeks low-fat group completed the study. At 24 weeks
weight loss was greater in the low-carb group weight loss was greater in the low-carb group
(12.9%) than in the low-fat group (6.7%)(12.9%) than in the low-fat group (6.7%)

Pts in both groups lost more fat mass (-9.4 kg low Pts in both groups lost more fat mass (-9.4 kg low
carb, -4.8 kg low-fat) than fat free mass (-3.3 kg vs -carb, -4.8 kg low-fat) than fat free mass (-3.3 kg vs -
2.4 kg)2.4 kg)

Low carb diet subjects had > decreases in serum Low carb diet subjects had > decreases in serum
triglycerides (-74.2 mg.dL vs. -27.9 mg/dL)triglycerides (-74.2 mg.dL vs. -27.9 mg/dL)

63. Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777
Expected mean body weight over time, by diet group

64. Low Carb vs. Low FatLow Carb vs. Low Fat

Low carb group had > increases in HDL-C (5.5 mg/dL Low carb group had > increases in HDL-C (5.5 mg/dL
vs. -1.6 mg/dL P<0.001)vs. -1.6 mg/dL P<0.001)

Changes in LDL-C were not significantChanges in LDL-C were not significant

Low carb group had greater participant retention and Low carb group had greater participant retention and
greater weight loss over 24 weeksgreater weight loss over 24 weeks

Minor adverse effects were more frequent in the low-Minor adverse effects were more frequent in the low-
carb diet groupcarb diet group

Limitations: Effects of the low-carb diet and of the Limitations: Effects of the low-carb diet and of the
nutritional supplements could not be separated. nutritional supplements could not be separated.
Participants were healthy and were followed for only Participants were healthy and were followed for only
24 weeks. 24 weeks.
Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777

65. Low carb vs. conventional Low carb vs. conventional
1 year follow up1 year follow up

Objective: Review the 1-year outcomes of two Objective: Review the 1-year outcomes of two
groups randomized to these dietsgroups randomized to these diets

132 obese adults, BMI 35 or greater; 83% 132 obese adults, BMI 35 or greater; 83%
had diabetes or metabolic syndromehad diabetes or metabolic syndrome

Participants were counseled to either restrict Participants were counseled to either restrict
carb intake to < 30g/day or reduce calories carb intake to < 30g/day or reduce calories
by 500 cals/day with <30% of cals from fatby 500 cals/day with <30% of cals from fat
Stern, L. et. al. Ann Intern Med 2004;140:778-785

66. Low carb vs. conventional Low carb vs. conventional
1 year follow up1 year follow up

By 1 year, mean weight change for persons on the By 1 year, mean weight change for persons on the
low carb diet was -5.1 +/- 8.7 kg compared with -3.1 low carb diet was -5.1 +/- 8.7 kg compared with -3.1
+/- 8.4 kg for persons on a conventional diet. +/- 8.4 kg for persons on a conventional diet.
Differences were not significant (P= 0.20)Differences were not significant (P= 0.20)

Triglycerides decreased more on low carb diet, HDL Triglycerides decreased more on low carb diet, HDL
levels decreased less, HbA1c improved morelevels decreased less, HbA1c improved more

Changes in other lipids (LDL, total-C) and insulin Changes in other lipids (LDL, total-C) and insulin
sensitivity did not differ between groupssensitivity did not differ between groups

Limitations: 34% drop out rate, suboptimal dietary Limitations: 34% drop out rate, suboptimal dietary
adherence; relatively small net weight loss in both adherence; relatively small net weight loss in both
groupsgroups
Stern, L. et. al. Ann Intern Med 2004;140:778-785

67. Stern, L. et. al. Ann Intern Med 2004;140:778-785
Comparison of mean weight loss in kg between participants on the
conventional diet and participants on the low-carbohydrate diet at 6 months
(n = 118) and at 1 year (n = 126)

68. Low Carb vs. Conventional Diet Low Carb vs. Conventional Diet
OutcomesOutcomes

Between 6 months and 1 year, persons in the Between 6 months and 1 year, persons in the
low carb group began to regain weight while low carb group began to regain weight while
persons on the conventional diet continued to persons on the conventional diet continued to
lose weightlose weight

By 6 months, there was no significant difference By 6 months, there was no significant difference
in weight loss between the two groupsin weight loss between the two groups

Intake data suggest that differences in weight Intake data suggest that differences in weight
loss, where they exist, are the result of loss, where they exist, are the result of
differences in calorie intakes, not a metabolic differences in calorie intakes, not a metabolic
advantage of low carbadvantage of low carb

69. Summary: High Pro Low Summary: High Pro Low
Carbohydrate DietsCarbohydrate Diets

Pros: Pros:
–High pro low carb diets appear to High pro low carb diets appear to
produce greater short term weight lossproduce greater short term weight loss
–In studies, there was a lower dropout In studies, there was a lower dropout
rate with high pro low carb dietsrate with high pro low carb diets
–High pro low carb diets produced High pro low carb diets produced
favorable lipid changesfavorable lipid changes

70. Summary: High Pro Low Summary: High Pro Low
Carbohydrate DietsCarbohydrate Diets

ConcernsConcerns
–long term safety (effects of high pro diet on kidney long term safety (effects of high pro diet on kidney
function, lack of phytochemicals, association of function, lack of phytochemicals, association of
↑

↑
red meat and red meat and sfa
↑
sfa
↑
intake with intake with
↑

↑
cancer)cancer)
–questionable rationale (protein stimulates insulin questionable rationale (protein stimulates insulin
release)release)
–difficult to follow long termdifficult to follow long term
–epidemiological evidence shows vegetarians are epidemiological evidence shows vegetarians are
slimmerslimmer
–at risk nutrients: calcium, potassium, vitamin C, at risk nutrients: calcium, potassium, vitamin C,
vitamin Dvitamin D

71. High Carb Low Fat DietsHigh Carb Low Fat Diets

ProsPros
–Fits most major dietary guidelines Fits most major dietary guidelines
including U.S. Dietary Guidelines, TLC diet, including U.S. Dietary Guidelines, TLC diet,
AHA diet; high in fiber and plant foods AHA diet; high in fiber and plant foods
associated with health benefitsassociated with health benefits
–Epidemiological evidence associates high Epidemiological evidence associates high
carb low fat diets with lower rates of heart carb low fat diets with lower rates of heart
disease, cancer, obesitydisease, cancer, obesity
–Consistent with pattern reported by Consistent with pattern reported by
successful dieters in the National Weight successful dieters in the National Weight
Control RegistryControl Registry

72. Summary: High Carb Low Fat Summary: High Carb Low Fat
DietsDiets

ConsCons
–Produces more gradual weight loss than Produces more gradual weight loss than
high protein diets; dieters become high protein diets; dieters become
discourageddiscouraged
–Very high carb low fat diets associated Very high carb low fat diets associated
with unfavorable lipid changes (may with unfavorable lipid changes (may
need to choose whole grains, replace need to choose whole grains, replace
some carb with MFA) some carb with MFA)
–At risk nutrients: B12, D, E, ZincAt risk nutrients: B12, D, E, Zinc

73. Weight Loss By Any Method Weight Loss By Any Method
WillWill::

Reduce blood lipid levels including Reduce blood lipid levels including
TC, LDL-C, HDL-C, and TgTC, LDL-C, HDL-C, and Tg

Improve glycemic controlImprove glycemic control

Reduce blood pressureReduce blood pressure
Especially during active weight lossEspecially during active weight loss!!

74. Low Carb vs Low FatLow Carb vs Low Fat

Weight loss is caused by a deficit in Weight loss is caused by a deficit in
calories, not a metabolic advantage calories, not a metabolic advantage
of one over the otherof one over the other

Persons with the greatest calorie Persons with the greatest calorie
deficit lost the most weightdeficit lost the most weight

A high protein diet may offer some A high protein diet may offer some
advantages, perhaps in simplicity, advantages, perhaps in simplicity,
limiting options, or increased satietylimiting options, or increased satiety

75. Low Carb vs Low FatLow Carb vs Low Fat

Many VLCD programs offer a high Many VLCD programs offer a high
protein, low carb, low fat approachprotein, low carb, low fat approach

People should be offered options in People should be offered options in
weight managementweight management

The major issue in diet success is The major issue in diet success is
how persons plan to keep the how persons plan to keep the
weight offweight off

76. Diet Quality of Popular Diet Quality of Popular
DietsDiets
CSFII Data: Healthy Eating IndexCSFII Data: Healthy Eating Index
0
10
20
30
40
50
60
70
80
LOW CHO MOD CHO HIGH CHO
HEI SCORE

77. Energy Intake of Adults on Energy Intake of Adults on
Popular DietsPopular Diets
CSFII DATACSFII DATA
1750
1800
1850
1900
1950
2000
2050
2100
2150
2200
LOW CHO MOD CHO HIGH CHO
Energy (kcal)

78. BMI of Adults on Popular BMI of Adults on Popular
DietsDiets
CSFII DATACSFII DATA
10
12
14
16
18
20
22
24
26
28
LOW CHO MOD CHO HIGH CHO
MEN
WOMEN

79. BMI Vegetarians/Non BMI Vegetarians/Non
VegetariansVegetarians
CSFII DATACSFII DATA
15
17
19
21
23
25
27
VEG NON-VEG
Men
Women

80. Energy Intake Vegetarians/ Energy Intake Vegetarians/
Non-VegetariansNon-Vegetarians
(CSFII DATA)(CSFII DATA)
0
500
1000
1500
2000
2500
VEG NON-VEG
Energy (kcal)

81. NHLBI Recommendations: NHLBI Recommendations:
Diet Therapy for Weight Diet Therapy for Weight
MgmtMgmt

Low calorie diets are recommended Low calorie diets are recommended
for weight loss in overweight and for weight loss in overweight and
obese personsobese persons

Reducing fat as a part of LCD is a Reducing fat as a part of LCD is a
practical way to reduce calories.practical way to reduce calories.

Plan for a deficit of 500-1000 Plan for a deficit of 500-1000
kcal/day for weight loss of 1-2 lb/wk kcal/day for weight loss of 1-2 lb/wk

82. NHLBI Recommendations: NHLBI Recommendations:
Physical ActivityPhysical Activity

Physical activity modestly contributes to Physical activity modestly contributes to
weight loss, may decrease abdominal weight loss, may decrease abdominal
fat, increases cardiorespiratory fitnessfat, increases cardiorespiratory fitness

VERY important for wt maintenanceVERY important for wt maintenance

Initially 30-45 minutes moderate Initially 30-45 minutes moderate
activity, 3-5 days a weekactivity, 3-5 days a week

Long term: 30 minutes + of moderate Long term: 30 minutes + of moderate
intensity activity on most/all daysintensity activity on most/all days

83. National Weight Control National Weight Control
RegistryRegistry

Self-selected data base of people who Self-selected data base of people who
have lost at least 30 lb and kept it off at have lost at least 30 lb and kept it off at
least one yearleast one year

Published data on 784 persons, 80% Published data on 784 persons, 80%
female, 97% white, 56% with college female, 97% white, 56% with college
degrees, mean age 45 yearsdegrees, mean age 45 years

Had average maximum BMI of 35; most Had average maximum BMI of 35; most
had attempted wt loss numerous timeshad attempted wt loss numerous times

84. NWCR: Weight Loss NWCR: Weight Loss
MethodsMethods
0
10
20
30
40
50
60
70
80
90
% of Resp
Diet and activity
Limit certain foods
Formal prog (incl RD)
Limit quantity of foods
Count calories
Limit fat kcals
Limit fat grams

85. NWCR: Weight NWCR: Weight
Maintenance MethodsMaintenance Methods
0
10
20
30
40
50
60
70
80
90
100
% of Resp
Limits certain foods
Burns >1000 kcal
exercise/wk
Weighs self weekly
Limits quantity of food
Limits kcal from fat
Counts kcals
Counts fat grams

86. Underweight is Also a Underweight is Also a
ProblemProblem

15-25% below healthy weight or BMI 15-25% below healthy weight or BMI
of <18.5of <18.5

Associated with increased deaths, Associated with increased deaths,
menstrual dysfunction, pregnancy menstrual dysfunction, pregnancy
complications, slow recovery from complications, slow recovery from
illness/surgeryillness/surgery

Causes are the same as for obesity Causes are the same as for obesity
but in the opposite routebut in the opposite route

87. Treatment for Treatment for
UnderweightUnderweight

Intake of energy-dense foods Intake of energy-dense foods
(energy input)(energy input)

Encourage meals and snacksEncourage meals and snacks

Reduce activity (energy output)Reduce activity (energy output)

To gain a pound you need a total To gain a pound you need a total
excess intake of 2700-3500 kcalexcess intake of 2700-3500 kcal

88. 
If a person often consumes If a person often consumes
unhealthy food then he or she is unhealthy food then he or she is
prone to lifestyle diseases such as prone to lifestyle diseases such as
heart diseases, obesity, and heart diseases, obesity, and
diabetes,diabetes,