Paul Clayton FDIN 28/6/07 - Weight Management -. Paul Clayton FDIN 28/6/07 - Weight Management - -...

Paul ClaytonFDIN 28/6/07

- Weight Management -

Paul ClaytonFDIN 28/6/07

- Weight Management -

- still waiting …

18971897

19191919

1952

1952

1952

2001

Ob / ob/ob normal

Reduced energy expenditureReduced energy expenditure

1600

1800

2000

2200

2400

2600

2800

60 65 70 75 80 85 90 95Year

kcal

per

day

DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

1940 50 60 70 80

Positive Positive energyenergy balance balance

1600

1800

2000

2200

2400

2600

2800

60 65 70 75 80 85 90 95Year

kcal

per

day

DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

1940 50 60 70 80

Obesogenic culture (AHA ’03)Obesogenic culture (AHA ’03)

Avge US adult sedentary 8 hours / day, < 2,000 steps / day (NYS Public Health Assocn ‘05)

Amish 16,000 steps /day: obesity 9% women, 0% men (Bassett et al ’04)

MRI

* 28 yr man

* Good diet

* Desk worker

Yellow = fat

TOFI – something to chew onTOFI – something to chew on

Thin Outside – Fat Inside

Dangers of inner fat (J Bell, Imp. College)

Inner fat prevalent when normal BMI maintained by diet: 45% women, 60% men

Lean people get CAD, NIDDM too

Exercise the only way to reduce inner fat

Unfitness more dangerous than fatness

Why is weight gain so easy?Why is weight gain so easy?

Multiple satiation mechanisms (enteroendocrine)Protein (Protein (’s, fish > whey > casein)’s, fish > whey > casein)Fat (FA’s esp LCP’s) Fat (FA’s esp LCP’s) Digestible carbs (glucose, CNS)Digestible carbs (glucose, CNS)Fermentable carbs (propionic acid, liver?)Fermentable carbs (propionic acid, liver?)Insufficient calorific throughputInsufficient calorific throughputSocial / stress over-rideSocial / stress over-rideHigh calorific density foods / ‘fast foods’High calorific density foods / ‘fast foods’

AHA 2002: ‘obesogenic culture’AHA 2002: ‘obesogenic culture’

Fewer bus-stops, remote parking

Exercise to be mandatory at all levels of educational system

No ‘junk foods’ to be sold / served in schools

Fat - but starvingFat - but starving

W.H.O. ‘02: ‘Globally, overweight greater health problem than underweight.’

W.H.O./F.A.O ’03: ‘Poor diet the major cause of degenerative disease’.

U.N. ’06: Overweight but malnourished40-60% hospital admissions malnourished (1-3)

25-30% malnourished in the community J Nutr Hlth Ageing 3:133-139, ‘99

> > 3.6 million malnourished in UK (BANT ’07)

Percentage of Population DepletedPercentage of Population DepletedIn Vitamins (USDA 1997)In Vitamins (USDA 1997)

C E A B1 B2 C E A B1 B2 NiacinNiacin Folate Folate B6 B12 B6 B12------------------------------------------------------------------------------------------------------------------------------------------37 68 55 32 31 27 34 54 1737 68 55 32 31 27 34 54 17

Vitamins

%

* Gregory et al 2000. National Diet and Nutrition Surveys, HMSO

Iron from all sources (including supplements)% of children of all ages with intakes below RNI and LRNI

84

57

14

28

39

59 60

96

43

93

16

40 1 1 3 3

44

2

48

0

10

20

30

40

50

60

70

80

90

100

<4 >4 Boys Girls Boys Girls Boys Girls Boys Girls

1.5 - 4.5 Age 4-6 Age 7-10 Age 11-14 Age 15-18

% < RNI

% < LRNI

* Gregory et al 2000. National Diet and Nutrition Surveys, HMSO

Vitamin A from food% of children of all ages with intakes below RNI and LRNI

0

10

20

30

40

50

60

70

80

<4 >4 Boys Girls Boys Girls Boys Girls Boys Girls

1.5 - 2.5 Age 4-6 Age 7-10 Age 11-14 Age 15-18

% < RNI

% < LRNI

RSM 2005: Pathogenic culture?RSM 2005: Pathogenic culture?

Type 2 diabetes

.

RSM 2005: Pathogenic culture?RSM 2005: Pathogenic culture?

Type 2 diabetes increased heart disease, stroke, cancers,

. kidney disease, blindness, Alzheimer’s

RSM 2005: Pathogenic culture?RSM 2005: Pathogenic culture?

Type 2 diabetes increased heart disease, stroke, cancers,

. kidney disease, blindness, Alzheimer’s

asthma, allergy food intolerance / eosinophilic GI disease

osteoporosis

lymphoma, leukaemia, melanoma, germ cell tumours in teens & young adults

ARMD ADD / ADHD / dysphasia / dyspraxia

Positive Positive energyenergy balance balance

1600

1800

2000

2200

2400

2600

2800

60 65 70 75 80 85 90 95Year

kcal

per

day

DoH ’98, USDA ’02, NIH ’03, NCHS ‘04

1940 50 60 70 80

Fat – but starvingFat – but starving

Do we really want to encourage people to eat less?

They can at least eat better:

Increased nutrient / calorie ratios

(functional foods, nutraceuticals, supplements)

OROR

Be more physically active so they can eat more?

Burn more calories without exercise? (thermogenic strategies)

Low fat / cholesterolLow fat / cholesterol

Reduced fat / cholesterol contentReduced fat / cholesterol absorption Olestra (sucrose esters)

"... will very probably increase the risks of cancer, heart disease, stroke and blindness." Willett & Stampfer, Harvard School of Public Health Reduced cholesterol absorption ANDReduced lipophile absorptionTake Control, Benecol etc (sterol/stannol esters)

Fat vs carb reductionFat vs carb reduction

Lose more calories by reducing fat

Health issues?

Reducing carbs loses fewer calories

But probably a healthier option

Projected benefits of reducing CHO by 30gProjected benefits of reducing CHO by 30g

1. Salmeron et al 1997ab; Meyer et al, 2000

30% 30% reduction in reduction in type-2 DMtype-2 DM

1

Projected benefits of reducing CHO by 30gProjected benefits of reducing CHO by 30g

1. Salmeron et al 1997ab; Meyer et al, 2000

2. Diabetes Control and Complications Trial, 1996

30% 30% reduction in reduction in type-2 DMtype-2 DM

1.0 % fall in 1.0 % fall in HbAHbA1c1c 25% 25%

reduction in reduction in retinopathyretinopathy

1

2

Projected benefits of reducing CHO by 30gProjected benefits of reducing CHO by 30g

1. Salmeron et al 1997ab; Meyer et al, 2000

2. Diabetes Control and Complications Trial, 1996

3. De Vegt et al 1999; Khaw et al, 2001

30% 30% reduction in reduction in type-2 DMtype-2 DM

1.0 % fall in 1.0 % fall in HbAHbA1c1c

25% 25%

reduction in reduction in retinopathyretinopathy

1

2

3>30% reduction >30% reduction

in CHDin CHD

Projected benefits of reducing CHO by 30gProjected benefits of reducing CHO by 30g

1.2% fall in1.2% fall in

HbAHbA1c1c

Potential appetite suppressorsPotential appetite suppressors

Pinoleic acid: 6 PUFA from Korean pine nut oil. (‘PinnoThin’, Lipid Nutrition Nl)PUFA’s in small bowel trigger cholecystokinin (CCK)PUFA’s at end of small bowel trigger Glucagon-like peptide 1 (GLP1)CCK and GLP1 influence meal terminationClinical trial ‘inconclusive’

Potrential appetite suppressorsPotrential appetite suppressors

Oleoylethanolamide Oleoylethanolamide (cannabinoid receptor blocker): (cannabinoid receptor blocker): cocoa, soybeans, hazelnuts, oatscocoa, soybeans, hazelnuts, oats

Fish & whey protein isolates (anti-stress)Fish & whey protein isolates (anti-stress)

PeptideA, LactiumPeptideA, Lactium

Caralluma fimbriataCaralluma fimbriata

Indian food plant – edible succulentIndian food plant – edible succulent1 g/day, 4 weeks, n=26: weight loss, no adx1 g/day, 4 weeks, n=26: weight loss, no adx

(Lawrence & Choudhary, 12(Lawrence & Choudhary, 12thth World Conf Anti-aging World Conf Anti-aging Medicine, ’04)Medicine, ’04)

1 g/day, 8 weeks, n=501 g/day, 8 weeks, n=50Appetite reduction, weight loss, no adx Appetite reduction, weight loss, no adx (Kuriyan et al, Appetite 48:338-44, ’07)(Kuriyan et al, Appetite 48:338-44, ’07)Some evidence of adipocte inhibitionSome evidence of adipocte inhibition

Pre-adipocyte

Immature adipocyte

Immature multilocular adipocyte

Mature unilocular adipocyte

Differentiation of pre-adipocyte into mature adipocyte

Metabolic shiftMetabolic shift

Capsiate: sweet red pepper CH-19 (1)

Up-regulates UCP 1, 2 (1) and 3 (2)

BUT, increases physical endurance (3)

Animal weight /fat loss data (4)

Clinical studies underway in Japan, USA

Anti-cancer effects (5, 6)

NIDDM, CAD? (7)

Metabolic shiftMetabolic shift

Adrenaline REsearch

Thermo-regulatory clothing

Thermal receptors at base of brain

Up-regulate brown adipose tissue

Up-regulate UCP 1 and 2

Appetite increase, weight loss

..dubious …..dubious …

USA: ‘Weight loss’ patches. Guarana, Garcinia, Menthol, Fucus Vesiculosus (kelp)

UK: hypnosis. ‘You don’t have to clear your plate’

Austria: caffeine-laced tights. ‘The caffeine is absorbed locally and breaks down cellulite’.

The BacklashThe Backlash

Fat Acceptance Movement ’86Fat Liberation ’88Fat Pride ‘89Fat Positive ‘93National Association to Advance Fat Acceptance Council on Size and Weight Discrimination International Society for Size Acceptance

Co-conspiratorsCo-conspirators

For every $ spent on food in the US, 48 cents is spent in fast food restaurants …

… which operate in a very competitive commercial environment …

… and are extremely sensitive to changing consumer demands

BK’s ‘Enormous Omelet Sandwich’BK’s ‘Enormous Omelet Sandwich’

730 calories, 70 g fat: $2.99730 calories, 70 g fat: $2.99

Hardee’s ‘Monster Thickburger’Hardee’s ‘Monster Thickburger’

1420 calories, 107 g fat: $5.491420 calories, 107 g fat: $5.49

Atkins and other low-GL dietsAtkins and other low-GL diets

Efficacy? (6 vs 12 months; 1 +ve vs 3 –ve)

High fat / protein, low fruit / veg diet increases risk of bowel & other cancer1 in 3 adults have renal impairment; worsened by high protein diet Knight et al ’03

low phytate diet Curran et al ‘04

Who has renal impairment? Overweight, IGT Overweight, IGT

Low cal-GL / high micronutrientLow cal-GL / high micronutrient

Low GL

5 – 9 portions fruit and vegetables

Vegetable >> animal protein

Increased intake of fermentable carbs

Limited amounts of fats and oils

V limited digestible carbs

Supplements

New Food PyramidNew Food Pyramid

Wide variety fruits / veg (not potatoes): 800g

Pulses, legumes, seeds, nuts, soy: 300g

Meat, dairy: 150g

Oils, fats: 25g

High GL

supplements

Cals/g 9

3

0.5

New Food PyramidNew Food Pyramid

Wide variety fruits / veg (not potatoes): 800g

Pulses, legumes, seeds, nuts, soy: 300g

Meat, dairy: 150g

Oils, fats: 25g

High GL

supplements

Cals/g 9

3

0.5

Total calories less than 2000 / dayTotal calories less than 2000 / day

Paul Claytonpaulrclayton@gmail.com

- Weight Management -

- still waiting …