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Healthy Weight Loss StrategiesHealthy Weight Loss Strategies
Lisa Pawloski, PhDLisa Pawloski, PhD
Assistant ProfessorAssistant Professor
College of Nursing and Health College of Nursing and Health ScienceScience
Email: Email: [email protected]@gmu.edu
OverweightOverweight
Over half of the adults in the U.S. Are now Over half of the adults in the U.S. Are now considered overweight.considered overweight.
The prevalence of overweight is higher The prevalence of overweight is higher among women, the poor, African among women, the poor, African Americans, and Latin Americans.Americans, and Latin Americans.
Many believe it is an epidemic.Many believe it is an epidemic.
Fat Cell DevelopmentFat Cell Development The amount of fat in the body reflects The amount of fat in the body reflects
the number and the size of the fat the number and the size of the fat cells.cells.
Fat cells expand as they fill with fat Fat cells expand as they fill with fat and then they may divide: they can and then they may divide: they can increase their size by 20 fold and their increase their size by 20 fold and their number by several thousand fold.number by several thousand fold.
With fat loss, the size of the fat cell With fat loss, the size of the fat cell shrinks, but not the number.. Thus shrinks, but not the number.. Thus prevention of obesity is critical during prevention of obesity is critical during the growing years when fat cells the growing years when fat cells increase in number.increase in number.
Causes of ObesityCauses of Obesity Set Point Theory Set Point Theory Genetics Genetics
– If both parents are obese, then 80% risk that If both parents are obese, then 80% risk that children are obese.children are obese.
– If neither parent is obese, then risk is less than If neither parent is obese, then risk is less than 10%10%
– Twin studies – Identical twins are more likely to Twin studies – Identical twins are more likely to weigh the same as fraternal twins – even when weigh the same as fraternal twins – even when reared apart.reared apart.
– Food intake, tastes, BMR, number of fat cells, Food intake, tastes, BMR, number of fat cells, enzymes all may be influenced by genetics.enzymes all may be influenced by genetics.
– Anthropologists have hypothesized are bodies Anthropologists have hypothesized are bodies are adapted to storing fat due to times of famine.are adapted to storing fat due to times of famine.
Causes of Obesity (Continued)Causes of Obesity (Continued)
Lipoprotein Lipase – Enzyme which promotes fat Lipoprotein Lipase – Enzyme which promotes fat storage in fat cells and muscle cells.storage in fat cells and muscle cells.
Leptin – Hormone which influences appetite and Leptin – Hormone which influences appetite and energy balance. It increases satiety and energy. energy balance. It increases satiety and energy. Ob gene has been found to code for leptin.Ob gene has been found to code for leptin.
Peptide PYYPeptide PYY Environmental StimuliEnvironmental Stimuli Learned BehaviorLearned Behavior Physical InactivityPhysical Inactivity
EnvironmentEnvironment OvereatingOvereating
– ““Toxic food environment”Toxic food environment”
– Increased dietary variety. Studies have shown Increased dietary variety. Studies have shown that more than one flavor encourages people to that more than one flavor encourages people to eat.eat.
– Soft drink consumption. Drinking calories does Soft drink consumption. Drinking calories does not reduce hunger.not reduce hunger.
– Growing portion sizes. Adults (and children) Growing portion sizes. Adults (and children) eat more when served larger portions.eat more when served larger portions.
Environment (Continued)Environment (Continued)
– Too delicious. Some research suggests that Too delicious. Some research suggests that delicious foods may cause the body to feel hungry delicious foods may cause the body to feel hungry sooner.sooner.
– Snacking. People now eat about 1.5 snacks a day Snacking. People now eat about 1.5 snacks a day compared to 1, in the 70’s and 80’s. Snacks have compared to 1, in the 70’s and 80’s. Snacks have more calories too (80 calories from an apple to a more calories too (80 calories from an apple to a 250 calorie candy bar).250 calorie candy bar).
– Eating out. People who eat at least 13 times a Eating out. People who eat at least 13 times a month, consume an average of 32% more calories month, consume an average of 32% more calories than those who eat out 5 or fewer times per month.than those who eat out 5 or fewer times per month.
EnvironmentEnvironment
Physical InactivityPhysical Inactivity
– Activity can actually curb appetite and Activity can actually curb appetite and help people stay motivated to continue help people stay motivated to continue exercise.exercise.
– Life requires less exertion.Life requires less exertion.
– Television.Television.
Percent who exercisePercent who exercise
Yo-Yo DietingYo-Yo Dieting
Aggressive Treatments of ObesityAggressive Treatments of Obesity DrugsDrugs
– Over-the-counter: Diuretics, Appetite Suppressor, Over-the-counter: Diuretics, Appetite Suppressor, herbal supplements, herbal supplements,
» Only 1 has FDA approval: Benzocaine (anesthetizes Only 1 has FDA approval: Benzocaine (anesthetizes tongue)tongue)
» Phenylpropanolamine was recommended to be banned, Phenylpropanolamine was recommended to be banned, causes hypertension, rapid heart rate, kidney failure, causes hypertension, rapid heart rate, kidney failure, seizures, strokes.seizures, strokes.
– Herbal Products – Herbal Products – » Ephedrine has been linked with heart attacks, seizures, Ephedrine has been linked with heart attacks, seizures,
and death.and death.
» ““Dieter’s tea” can cause nausea, vomiting, and crampingDieter’s tea” can cause nausea, vomiting, and cramping
Aggressive Treatment of ObesityAggressive Treatment of Obesity(Continued)(Continued)
– Prescriptions: Prescriptions: » Sibutramine – inhibits uptake of serotonin (meridia), Sibutramine – inhibits uptake of serotonin (meridia),
most effective in combination with reduction of most effective in combination with reduction of calories and exercise. Side effects are dry mouth, calories and exercise. Side effects are dry mouth, headache, constipation, insomnia, and high blood headache, constipation, insomnia, and high blood pressure.pressure.
» Orlistat –(xenical) inhibits pancreatic lipase activity Orlistat –(xenical) inhibits pancreatic lipase activity and blocks dietary fat digestion by 30%. Must be and blocks dietary fat digestion by 30%. Must be active and reduce calories. Side effects include gas, active and reduce calories. Side effects include gas, frequent bowel movements, and reduced absorption frequent bowel movements, and reduced absorption of fat soluble vitamins.of fat soluble vitamins.
Aggressive Treatments Cont’dAggressive Treatments Cont’d
Very Low Kilocalorie DietsVery Low Kilocalorie Diets SurgerySurgery
– ““Stomach stapling”Stomach stapling”– Gastric BypassGastric Bypass
Fad DietsFad Diets
Criticism of most fad diets has been Criticism of most fad diets has been concern that diets do not last. People get concern that diets do not last. People get bored and often return to their old habits.bored and often return to their old habits.
Diet and health recommendations should Diet and health recommendations should follow years of sound research that has been follow years of sound research that has been reviewed by panels of scientists before reviewed by panels of scientists before being offered to the public.being offered to the public.
Most fad diets are typically low Most fad diets are typically low carbohydrate and high protein.carbohydrate and high protein.
Popular Diets: Low carb dietPopular Diets: Low carb diet Low carb diets typically blame carbs on the obesity crisis. Low carb diets typically blame carbs on the obesity crisis.
And who can resist the promise of weight loss when allowed And who can resist the promise of weight loss when allowed to eat freely from a list of favorite foods?to eat freely from a list of favorite foods?
Bravata et al (2003, JAMA. 289:1837-1850) reviewed over Bravata et al (2003, JAMA. 289:1837-1850) reviewed over 107 articles concerned with low carbohydrate diets.107 articles concerned with low carbohydrate diets.
They found that weight loss was associated with those with a They found that weight loss was associated with those with a longer diet duration and restriction of caloric intake, but longer diet duration and restriction of caloric intake, but NOT with reduced carbohydrate intake.NOT with reduced carbohydrate intake.
Low carbohydrate diets have some long-term health concerns Low carbohydrate diets have some long-term health concerns including: increased saturated fat intake, nausea, fatigue, including: increased saturated fat intake, nausea, fatigue, constipation, low blood pressure, elevated uric acid ( kidney constipation, low blood pressure, elevated uric acid ( kidney problems), bad breath, foul taste in mouth, increased problems), bad breath, foul taste in mouth, increased problems with thyroid disorders, and ultimately ketosis.problems with thyroid disorders, and ultimately ketosis.
Insulin and Low Carb DietsInsulin and Low Carb Diets One common misconception lies around insulin.One common misconception lies around insulin. High protein diets say that carbs are bad because they are High protein diets say that carbs are bad because they are
absorbed easily and raise blood glucose and then insulin is absorbed easily and raise blood glucose and then insulin is secreted to cause fat to be absorbed.secreted to cause fat to be absorbed.
Insulin does facilitate the transport of glucose into cells, the Insulin does facilitate the transport of glucose into cells, the storage of fatty acids as fat, and the synthesis of cholesterol.storage of fatty acids as fat, and the synthesis of cholesterol.
Insulin however, is only one of many factors that is involved Insulin however, is only one of many factors that is involved in weight regulation.in weight regulation.
Many carbs produce less of an insulin response than high Many carbs produce less of an insulin response than high protein foods (ex. Whole wheat pasta vs. beef).protein foods (ex. Whole wheat pasta vs. beef).
Insulin only causes problems with insulin resistance.Insulin only causes problems with insulin resistance. Insulin resistance is not caused by carbs, protein, or fat, it is Insulin resistance is not caused by carbs, protein, or fat, it is
associated with a person being overweight.associated with a person being overweight.
Low Carb Diet’s AchievementsLow Carb Diet’s Achievements
Lowered calorie intakeLowered calorie intake High protein foods can increase satiety.High protein foods can increase satiety. Many need a kind of plan to follow.Many need a kind of plan to follow.
Low Carb diet’s shortcomingsLow Carb diet’s shortcomings
Too much fatToo much fat Unbalanced nutritionUnbalanced nutrition Too little varietyToo little variety
How to Identify Fad DietsHow to Identify Fad Diets Promote dramatic weight loss.Promote dramatic weight loss.– Weight loss should be gradual and not exceed 2 pounds per week.Weight loss should be gradual and not exceed 2 pounds per week.
Promote diets that are nutritionally unbalanced or extremely low in Promote diets that are nutritionally unbalanced or extremely low in kilocalories.kilocalories.– Reasonable caloric intake is not less than 1200 per day.Reasonable caloric intake is not less than 1200 per day.– Protein around .8 g/kg of body weight.Protein around .8 g/kg of body weight.– Fat around 20 to 30% of calories.Fat around 20 to 30% of calories.– At least 100 g of carbs per day and 20 to 30 g of fiber per day.At least 100 g of carbs per day and 20 to 30 g of fiber per day.– Variety of fruits and vegetables.Variety of fruits and vegetables.– At least 1 liter of water per day.At least 1 liter of water per day.
Use liquid formulas rather than foods.Use liquid formulas rather than foods. Attempt to make clients dependent upon special foods, devices, or Attempt to make clients dependent upon special foods, devices, or
herbal remedies.herbal remedies. Does not include exercise plan.Does not include exercise plan. Fail to encourage realistic lifestyle changes.Fail to encourage realistic lifestyle changes.
Reasonable Strategies for Weight LossReasonable Strategies for Weight Loss
Realistic Energy Intake Realistic Energy Intake Nutritional AdequacyNutritional Adequacy Small PortionsSmall Portions Choose fats sensiblyChoose fats sensibly Watch for other empty caloriesWatch for other empty calories Adequate waterAdequate water Physical ActivityPhysical Activity
Realistic Energy IntakeRealistic Energy Intake
No less than 1200 calories per dayNo less than 1200 calories per day It takes 3500 calories to make a pound of It takes 3500 calories to make a pound of
body fat. So reducing your calorie intake body fat. So reducing your calorie intake by 500 calories per day, should theoretically by 500 calories per day, should theoretically cause one pound of weight loss per weekcause one pound of weight loss per week
To quickly determine your energy needs To quickly determine your energy needs you can use the following formula:you can use the following formula:– Men: kg x 24 = kcal/dayMen: kg x 24 = kcal/day– Women: kg x 23 = kcal/dayWomen: kg x 23 = kcal/day
Nutritional AdequacyNutritional Adequacy
One easy method is to follow the Food One easy method is to follow the Food Guide Pyramid. You can download a copy Guide Pyramid. You can download a copy from the following website:from the following website:
http://www.nal.usda.gov:8001/py/pmap.htm http://www.nal.usda.gov:8001/py/pmap.htm
Food Guide PyramidFood Guide Pyramid
Serving Sizes for Breads, Serving Sizes for Breads, Cereals, and Other GrainsCereals, and Other Grains
1 slice of bread1 slice of bread ½ cup cooked cereal, rice, or pasta½ cup cooked cereal, rice, or pasta 1 ounce ready to eat cereal1 ounce ready to eat cereal ½ bun, bagel, or English muffin½ bun, bagel, or English muffin 1 small roll, biscuit, or muffin1 small roll, biscuit, or muffin 3 to 4 small or 2 large crackers3 to 4 small or 2 large crackers
Portion SizesPortion Sizes Eating less food is often what is needed, so one Eating less food is often what is needed, so one
piece of chicken instead of 2 and decreasing piece of chicken instead of 2 and decreasing portion sizes.portion sizes.
Don’t feel guilty for leaving food behind in a Don’t feel guilty for leaving food behind in a restaurant.restaurant.
Quick and easy estimates of portion sizes:Quick and easy estimates of portion sizes:– 1 small fruit is the size of a tennis ball.1 small fruit is the size of a tennis ball.– 1 cup of cooked vegetables is about the size of your 1 cup of cooked vegetables is about the size of your
fist.fist.– ½ cup of ice cream is about the size of a racquetball.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.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.1 ounce of cheese is about the size of four stacked dice.
Choose Fats SensiblyChoose Fats Sensibly
These foods include margarine, salad These foods include margarine, salad dressing, oils, lards, mayonnaise, sour dressing, oils, lards, mayonnaise, sour cream, cream cheese, butter, gravy, sauces, cream, cream cheese, butter, gravy, sauces, potato chips, chocolate bars.potato chips, chocolate bars.
Choose foods that are less than 30% fat Choose foods that are less than 30% fat calories.calories.
Watch for Other Empty CaloriesWatch for Other Empty Calories
Sugars and fats hidden in foods.Sugars and fats hidden in foods.– Juices, fruit, vegetables cooked in butter, Juices, fruit, vegetables cooked in butter,
muffins, and prepared breadsmuffins, and prepared breads Alcohol.Alcohol.
WaterWater
Water is critical for maintaining hydration, Water is critical for maintaining hydration, however some studies have shown it helps however some studies have shown it helps to prevent snacking.to prevent snacking.
Foods high in water such as broths are often Foods high in water such as broths are often a good starter for those trying to lose weight a good starter for those trying to lose weight because they fill the stomach before less because they fill the stomach before less nutrient dense foods are consumed.nutrient dense foods are consumed.
Yes, 8 glasses a day is a good Yes, 8 glasses a day is a good recommendation.recommendation.
Physical ActivityPhysical ActivityModestly contributes to weight lossModestly contributes to weight loss
May increase basal metabolismMay increase basal metabolism
Increases lean body massIncreases lean body mass
May decrease abdominal fat May decrease abdominal fat
Can control appetite for some peopleCan control appetite for some people
Can reduce stress (increases serotonin levels)Can reduce stress (increases serotonin levels)
Increases cardiorespiratory fitnessIncreases cardiorespiratory fitness
Increase Physical ActivityIncrease Physical Activity
• Do both sustained activity and weight trainingDo both sustained activity and weight training• Spot reducing does not workSpot reducing does not work• Most important in preventing weight regain Most important in preventing weight regain • Health benefits independent of weight lossHealth benefits independent of weight loss• Start slowly and increase graduallyStart slowly and increase gradually
— Can be single session or intermittentCan be single session or intermittent— Start with walking 30 minutes 3 days/weekStart with walking 30 minutes 3 days/week— Increase to 45 minutes 5 or more days/weekIncrease to 45 minutes 5 or more days/week— Encourage increased “lifestyle” activitiesEncourage increased “lifestyle” activities
Gradual Weight LossGradual Weight Loss
Diet Analysis PlusDiet Analysis Plus
One method to help you count calories and One method to help you count calories and ensure your nutrient intake is adequate.ensure your nutrient intake is adequate.
To use this you must first record your food To use this you must first record your food intake for 2 to 5 days.intake for 2 to 5 days.
Go to Innovation Hall Room 301 or Go to Innovation Hall Room 301 or Johnson Center computer labs to use Diet Johnson Center computer labs to use Diet Analysis Plus 6.0.Analysis Plus 6.0.
The program is also available for purchase The program is also available for purchase in the bookstore.in the bookstore.
