Healthy Weight Loss Strategies

1. Healthy Weight Loss Strategies Lisa Pawloski, PhD Assistant Professor College of Nursing and Health Science Email: lpawlosk@gmu.edu Tel: lpawlosk@gmu.edu

2. Overweight • Over half of the adults in the U.S. Are now considered overweight. • The prevalence of overweight is higher among women, the poor, African Americans, and Latin Americans. • Many believe it is an epidemic.

3. Fat Cell Development • The amount of fat in the body reflects the number and the size of the fat cells. • Fat cells expand as they fill with fat and then they may divide: they can increase their size by 20 fold and their number by several thousand fold. • With fat loss, the size of the fat cell shrinks, but not the number.. Thus prevention of obesity is critical during the growing years when fat cells increase in number.

4. Causes of Obesity • Set Point Theory • Genetics • If both parents are obese, then 80% risk that children are obese. • If neither parent is obese, then risk is less than 10% • Twin studies – Identical twins are more likely to weigh the same as fraternal twins – even when reared apart. • Food intake, tastes, BMR, number of fat cells, enzymes all may be influenced by genetics. • Anthropologists have hypothesized are bodies are adapted to storing fat due to times of famine.

5. Causes of Obesity (Continued) • Lipoprotein Lipase – Enzyme which promotes fat storage in fat cells and muscle cells. • Leptin – Hormone which influences appetite and energy balance. It increases satiety and energy. Ob gene has been found to code for leptin. • Peptide PYY • Environmental Stimuli • Learned Behavior • Physical Inactivity

7. Environment • Overeating • “Toxic food environment” • Increased dietary variety. Studies have shown that more than one flavor encourages people to eat. • Soft drink consumption. Drinking calories does not reduce hunger. • Growing portion sizes. Adults (and children) eat more when served larger portions.

8. Environment (Continued) • Too delicious. Some research suggests that delicious foods may cause the body to feel hungry sooner. • Snacking. People now eat about 1.5 snacks a day compared to 1, in the 70’s and 80’s. Snacks have more calories too (80 calories from an apple to a 250 calorie candy bar). • Eating out. People who eat at least 13 times a month, consume an average of 32% more calories than those who eat out 5 or fewer times per month.

9. Environment • Physical Inactivity • Activity can actually curb appetite and help people stay motivated to continue exercise. • Life requires less exertion. • Television.

10. Percent who exercise

12. Yo-Yo Dieting

13. Aggressive Treatments of Obesity • Drugs • Over-the-counter: Diuretics, Appetite Suppressor, herbal supplements, • Only 1 has FDA approval: Benzocaine (anesthetizes tongue) • Phenylpropanolamine was recommended to be banned, causes hypertension, rapid heart rate, kidney failure, seizures, strokes. • Herbal Products – • Ephedrine has been linked with heart attacks, seizures, and death. • “Dieter’s tea” can cause nausea, vomiting, and cramping

14. Aggressive Treatment of Obesity(Continued) • Prescriptions: • Sibutramine – inhibits uptake of serotonin (meridia), most effective in combination with reduction of calories and exercise. Side effects are dry mouth, headache, constipation, insomnia, and high blood pressure. • Orlistat –(xenical) inhibits pancreatic lipase activity and blocks dietary fat digestion by 30%. Must be active and reduce calories. Side effects include gas, frequent bowel movements, and reduced absorption of fat soluble vitamins.

16. Aggressive Treatments Cont’d • Very Low Kilocalorie Diets • Surgery • “Stomach stapling” • Gastric Bypass

17. Fad Diets • Criticism of most fad diets has been concern that diets do not last. People get bored and often return to their old habits. • Diet and health recommendations should follow years of sound research that has been reviewed by panels of scientists before being offered to the public. • Most fad diets are typically low carbohydrate and high protein.

18. Popular Diets: Low carb diet • Low carb diets typically blame carbs on the obesity crisis. And who can resist the promise of weight loss when allowed to eat freely from a list of favorite foods? • Bravata et al (2003, JAMA. 289:1837-1850) reviewed over 107 articles concerned with low carbohydrate diets. • They found that weight loss was associated with those with a longer diet duration and restriction of caloric intake, but NOT with reduced carbohydrate intake. • Low carbohydrate diets have some long-term health concerns including: increased saturated fat intake, nausea, fatigue, constipation, low blood pressure, elevated uric acid ( kidney problems), bad breath, foul taste in mouth, increased problems with thyroid disorders, and ultimately ketosis.

19. Insulin and Low Carb Diets • One common misconception lies around insulin. • High protein diets say that carbs are bad because they are absorbed easily and raise blood glucose and then insulin is secreted to cause fat to be absorbed. • Insulin does facilitate the transport of glucose into cells, the storage of fatty acids as fat, and the synthesis of cholesterol. • Insulin however, is only one of many factors that is involved in weight regulation. • Many carbs produce less of an insulin response than high protein foods (ex. Whole wheat pasta vs. beef). • Insulin only causes problems with insulin resistance. • Insulin resistance is not caused by carbs, protein, or fat, it is associated with a person being overweight.

20. Low Carb Diet’s Achievements • Lowered calorie intake • High protein foods can increase satiety. • Many need a kind of plan to follow.

21. Low Carb diet’s shortcomings • Too much fat • Unbalanced nutrition • Too little variety

22. How to Identify Fad Diets • Promote dramatic weight loss. • Weight loss should be gradual and not exceed 2 pounds per week. • Promote diets that are nutritionally unbalanced or extremely low in kilocalories. • Reasonable caloric intake is not less than 1200 per day. • Protein around .8 g/kg of body weight. • Fat around 20 to 30% of calories. • At least 100 g of carbs per day and 20 to 30 g of fiber per day. • Variety of fruits and vegetables. • At least 1 liter of water per day. • Use liquid formulas rather than foods. • Attempt to make clients dependent upon special foods, devices, or herbal remedies. • Does not include exercise plan. • Fail to encourage realistic lifestyle changes.

24. Reasonable Strategies for Weight Loss • Realistic Energy Intake • Nutritional Adequacy • Small Portions • Choose fats sensibly • Watch for other empty calories • Adequate water • Physical Activity

25. Realistic Energy Intake • No less than 1200 calories per day • It takes 3500 calories to make a pound of body fat. So reducing your calorie intake by 500 calories per day, should theoretically cause one pound of weight loss per week • To quickly determine your energy needs you can use the following formula: • Men: kg x 24 = kcal/day • Women: kg x 23 = kcal/day

26. Nutritional Adequacy • One easy method is to follow the Food Guide Pyramid. You can download a copy from the following website: • http://www.nal.usda.gov:8001/py/pmap.htm

27. Food Guide Pyramid

29. Serving Sizes for Breads, Cereals, and Other Grains • 1 slice of bread • ½ cup cooked cereal, rice, or pasta • 1 ounce ready to eat cereal • ½ bun, bagel, or English muffin • 1 small roll, biscuit, or muffin • 3 to 4 small or 2 large crackers

30. Portion Sizes • Eating less food is often what is needed, so one piece of chicken instead of 2 and decreasing portion sizes. • Don’t feel guilty for leaving food behind in a restaurant. • Quick and easy estimates of portion sizes: • 1 small fruit is the size of a tennis ball. • 1 cup of cooked vegetables is about the size of your fist. • ½ cup of ice cream is about the size of a racquetball. • 3 ounces of meat is about the size of a deck of cards. • 1 ounce of cheese is about the size of four stacked dice.

31. Choose Fats Sensibly • These foods include margarine, salad dressing, oils, lards, mayonnaise, sour cream, cream cheese, butter, gravy, sauces, potato chips, chocolate bars. • Choose foods that are less than 30% fat calories.

32. Watch for Other Empty Calories • Sugars and fats hidden in foods. • Juices, fruit, vegetables cooked in butter, muffins, and prepared breads • Alcohol.

33. Water • Water is critical for maintaining hydration, however some studies have shown it helps to prevent snacking. • Foods high in water such as broths are often a good starter for those trying to lose weight because they fill the stomach before less nutrient dense foods are consumed. • Yes, 8 glasses a day is a good recommendation.

34. Physical Activity • Modestly contributes to weight loss • May increase basal metabolism • Increases lean body mass • May decrease abdominal fat • Can control appetite for some people • Can reduce stress (increases serotonin levels) • Increases cardiorespiratory fitness

35. Increase Physical Activity • Do both sustained activity and weight training • Spot reducing does not work • Most important in preventing weight regain • Health benefits independent of weight loss • Start slowly and increase gradually • Can be single session or intermittent • Start with walking 30 minutes 3 days/week • Increase to 45 minutes 5 or more days/week • Encourage increased “lifestyle” activities

36. Gradual Weight Loss

39. Diet Analysis Plus • One method to help you count calories and ensure your nutrient intake is adequate. • To use this you must first record your food intake for 2 to 5 days. • Go to Innovation Hall Room 301 or Johnson Center computer labs to use Diet Analysis Plus 6.0. • The program is also available for purchase in the bookstore.