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OBESITY
Associated with increased
mortality
Obesity in U.S.
Average weight of men in U.S.
in 1970 was 170 lbs.; in 2012 is
195 lbs.
 Average weight of women in
1970 was 140 lbs; now is 165
lbs.
 Overweight and obesity among
children has increased.
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Obesity
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Fat cells produce leptin which decreases
appetite and increases metabolism
Obesity may be caused by a decreased
leptin sensitivity ( ? Hereditary)
Associated with an increased death from
cancer, cardiovascular disease, sleep
apnea, arthritis of hips & ? Knees, &
diabetes
Obesity
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CCK – an intestinal hormone that induces
satiety – lack of sensitivity to this causes
over-eating
Ghrelin – a stomach hormone that
stimulates appetite. Increases with any
rapid loss of weight.
Visceral fat – associated with heart
disease (abdominal obesity).
Willpower vs. genetics
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Weight loss (or liposuction) reduces fat
cell production of leptin leading to
increased appetite.
Weight loss is contra to our
evolutionary roots (hunter-gatherers).
Grains, nuts and berries – very little
meat and sugars. Energy storage was
of utmost importance.
Willpower vs, genetics
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Adopted twin studies indicate that
80% of variation in body weight is
genetically induced.
This may be from an alteration in the
brain’s pleasure center (dopamine
and serotonin), causing a craving for
high calorie foods.
Genetics is not necessarily destiny.
Fats
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Hydrogenated (saturated) – needed
for cholesterol, hormones, brain
development.
Non-hydrogenated (unsaturated) –
liquid at room temperature.
Trans-fats –super-heated nonhydrogenated fats, increase
triglycerides and oxidants.
All fats are high in calories (9 cal/gm)
Carbohydrates
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Stimulate insulin secretion by the pancreas.
Possibly promote insulin resistance
Glycemic index – highly refined sugars do all
the above.
Needed for energy production and stored as
glycogen in liver and muscles. Corn, sugar
and beets (glucose, sucrose and fructose).
4 cal/Gm.
Proteins
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Used to make cells (particularly
muscle)
> 20% make food unpalatable and
overwork kidneys to preserve protein
in blood.
Present in egg whites, beans, nuts
and lentils as well as meat and fish.
4 cal/Gm
Toxic Environment
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Large portion sizes
High calorie, sugar based drinks, high
fructose corn syrup (stimulates insulin
secretion and may lead to insulin resistance)
High salt intake – may increase BP
High fat content (9 calories / Gram)
The number of meals consumed outside the
home
Obesity prevention
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Decrease calories ( CHO & Proteins have 4
calories/Gm; Fats have 9). Fats should
make up < 20% of diet calories.
Increase fruits, veggies and grains.
Decrease portion size.
Increase expenditure of calories (exercise).
( 30-60 minutes daily). The first law of
thermodynamics applies – energy in =
energy out or else it’s stored.
Nutrition
Energy – In = Out ; calories in =
calories out to maintain weight
 Calories consumed = resting
metabolism + activity – for men
=900 + 10 X weight in Kgs. X
1.2 if sedentary; 1.4 for
moderate activity and 1.8 for
strenuous activity.
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Nutrition continued
Calorie expenditure for women –
700 + 7 X wt. in Kgs. X 1.2 or
1.4 or 1.8 (depending on activity
level).
 Composition of Regular diet:
Protein = 20% of calories
Fat = 20%
CHO = 60%
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Water intake = 1.5 ml/Calorie (1000
ml = 1 Liter) 0 calories.
Protein & CHO = 4 Calories/Gm.
Fat = 9 calories/Gm
BMI – body mass index <25 ideal, 25
– 30 overweight, 30-40 obese, > 40
morbidly obese.
Waist circumference indicates visceral
fat (men > 40”, women > 35”) .
Nutritional Myths
Eating before bedtime increases
weight
 Fat can be removed from specific
targeted areas
 Vitamin supplements are necessary,
especially if “natural”.
 OK to lose weight quickly.
 “Carb” load before exercise.
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Vitamins
A – 1000 ugm/day – stored,
colored veggies
 B - 1 mg/day – excreted – beans,
grains, meat. Atrophic gastritis, PA
 C - 60 mg/day - excreted , fruit
 D - 1000 IU/day - stored
 E - 8-10 ugm/day
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Vitamin B (complex)
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B 1 – (Thiamine) 50-100 mcg/d
B 2 – (Riboflavin)) 10-50 mg/d
B 3 – (Niacin, NA) 15 mg/d
B 5 – (pantothenic acid) 50 ng/d
B 6 – (Pyridoxine) 50-100 mg/d
B 7 – (Biotin) 35-70 mcg/d
B 9 – Folic acid – 500-1000 ug/d
B12 – (Cobalamin) 100-1000 mcg/d
Fatty Acids
Omega 3’s – DHA, EPA, ALA – May
benefit the heart (endothelium).
 How much? There are no guidelines.
Salmon, tuna, trout and sardines
(?Mercury).
 Walnuts, flaxseed ground or oil,
eggs.
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Minerals
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Iron – 15 mg/day
Zinc – 12 mg/day
Iodine – 150 ugm/day
Selenium – 55 ugm/day
Calcium – 1200 mg/day
Phosphorous – 700 mg/day
Magnesium – 320 mg/day
Folate (folic acid) – 400 mg/day
Choline – 425 mg/day
Salt
NaCl – 2300 mgs.(one teaspoon)
 Most in processed foods
 Problem for those with heart or
kidney disease, or high BP.
 Potassium – activates nitric oxide
which relaxes arteries, tends to
decrease heart disease. Present in
fruits and vegetables.
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Phytochemicals
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Studies in rats show decreased fat
cell growth and storage of lipids.
Promotes fat cell death, but not cell
production. “Soft” evidence.
Resveratrol – red wine, grapes,
blueberries, and peanuts. ? Decrease
LDL & promotes endothelial “health”.
Quercetin – apples, onions, red wine.
? anti-inflammatory & anti-allergic.
More Phytochemicals
Genestein – soy, garbanzo beans
 Lignans – flaxseed & grain ) may
have estrogen-like properties).
 Anti-oxidants – broccoli, brussel
sprouts, cabbage, tea (may
protect against cell damage).
 Anthocyanidins – grapes,
eggplant, radishes (ibid.)
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More Phytochemicals
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Ellagic acid – berries and walnuts (has
antiviral and antibacterial properties).
Carotenoids – yellow vegs and apricots
( ? “eye health”).
Lycopene – tomatoes, red peppers and
pink grapefruit ( anti-inflammatory
and anti-cancer claim studies are
inconclusive).
Cooking or “processing” of food may
destroy benefit, if any.
Phytochemical foods
Nutritional prevention
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There is no solid evidence, but “evidence
suggests”:
1.Breast Cancer – increased by animal fat (red
meat)
2. Heart Disease – saturated fats; ? Antioxidants ( but not Vit E or B – carotene)
3. Age related macular degeneration - ?
Carotenoids (broccoli, kale, spinach)
4. Immunity - ? Low saturated fat ; fruits and
veggies, exercise
5. Overall – IBW, exercise; decrease refined
sugar, red meat and trans fats (fried food)
Vitamin D
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Age related Increase in BP significantly
higher in Vit D deficiency
Skin + sun = 90% of Vit D (10,000
IU/day)
Vit D from food (fish, eggs, milk)=10%
Vit D status normally = >30ng/ml
Vit D deficiency = < 20ng/ml
Vitamin D Metabolism
Vitamin D from skin goes to liver
where it is converted to 25 , OH
vit D (D2), then to the kidney
where the bioactive form, 1-25
OH Vit D (D3) is made.
Vit D2 is measured, but
appropriate levels are not well
established.
Vit D supplementation
Vit D deficiency linked to cancer,
CV disease, depression, dementia,
autoimmune disease and more.
 Only musculo-skeletal health is
supported by evidence (falls and
hip fractures). Serum Vit D2 @
27.5ng/ml.
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Vitamin D Deficiency Rx
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1000 IU / day or 45,000IU/month
Toxicity > 10,000 IU/day – may
cause high blood calcium level
Vit D supplementation for other than
musculoskeletal reasons is not
adequately supported by evidence.
Vit D is a marker (association) for
some illnesses, but cause and effect
has not been established (no RCT’s)
What About Supplements?
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Vit E (anti-oxidants)- Associated with an
increased risk of death. Increased rate
of prostate cancer.
Vit A – increased incidence of lung
cancer in smokers, and prostate
cancer in men.
Vit D – decreases fractures, but >70
one study showed increased risk of
falls.
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Vit C – no reduction in cancer, CV
disease or URI’s.
Multivitamins – 38,772 women found
an increased mortality in those
regularly taking multivitamins.
Long term consumption of any
biologically active substance should
not be assumed to be free from risk.
A “Healthy” Diet
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A pattern of eating that fuels the
body without weight gain.
Avoid thinking of food as a source of
pleasure. Food is fuel and nutrition.
Eating is a comprehensive behavioral
activity. Changing behavior is a
lifelong endeavor.
Retrain the brain to decrease the
“reward value” of food
The Moral of the Story
The Japanese eat very little fat and drink
very little red. wine and suffer fewer heart
attacks than the British or Americans.
 The French eat a lot of fat and also suffer
fewer heart attacks than the British or
Americans.
 The Italians drink generous amounts of
red wine and suffer fewer heart attacks
then the British or Americans.
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Conclusion
 Eat
and drink what you like. It’s
speaking English that kills you.
 Post hoc ergo propter hoc.
 Associations are not causes.