Download Weight Management

- Weight Management -
Paul Clayton
FDIN 28/6/07
- Weight Management - still waiting …
Paul Clayton
FDIN 28/6/07
1897
1919
1952
1952
1952
2001
Ob / ob/ob
normal
Reduced energy expenditure
2800
kcal per day
2600
2400
2200
2000
1800
1600
60
1940
65
70
50
75
60 80
Year
85 70
90
95
80
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
Positive energy balance
2800
kcal per day
2600
2400
2200
2000
1800
1600
60
1940
65
70
50
75
60 80
Year
85 70
90
95
80
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
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 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?
Multiple satiation mechanisms
(enteroendocrine)
Protein (aa’s, fish > whey > casein)
Fat (FA’s esp LCP’s)
Digestible carbs (glucose, CNS)
Fermentable carbs (propionic acid, liver?)
Insufficient calorific throughput
Social / stress over-ride
High calorific density foods / ‘fast foods’
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 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 malnourished
40-60% 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 Depleted
In Vitamins (USDA 1997)
Vitamins C
%
E A B1 B2 Niacin Folate B6 B12
--------------------------------------------------------------------37 68 55
32 31
27
34
54
17
Iron from all sources (including supplements)
% of children of all ages with intakes below RNI and LRNI
100
90
96
% < RNI
84
93
% < LRNI
80
70
60
50
44
39
40
48
43
28
30
20
60
59
57
16
14
4
10
0
1
1
3
3
Boys
Girls
Boys
Girls
Boys
2
0
<4
>4
1.5 - 4.5
Age 4-6
Age 7-10
Girls
Age 11-14
* Gregory et al 2000. National Diet and Nutrition Surveys, HMSO
Boys
Girls
Age 15-18
Vitamin A from food
% of children of all ages with intakes below RNI and LRNI
80
% < RNI
70
% < LRNI
60
50
40
30
20
10
0
<4
>4
1.5 - 2.5
Boys
Girls
Age 4-6
Boys
Girls
Age 7-10
Boys
Girls
Age 11-14
* Gregory et al 2000. National Diet and Nutrition Surveys, HMSO
Boys
Girls
Age 15-18
RSM 2005: Pathogenic culture?
Type 2 diabetes
.
RSM 2005: Pathogenic culture?
Type 2 diabetes
increased heart disease, stroke, cancers,
.
kidney disease, blindness, Alzheimer’s
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 energy balance
2800
kcal per day
2600
2400
2200
2000
1800
1600
60
1940
65
70
50
75
60 80
Year
85 70
90
95
80
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
Fat – 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)
OR
Be more physically active so they can eat more?
Burn more calories without exercise?
(thermogenic strategies)
Low fat / cholesterol
Reduced fat / cholesterol content
Reduced 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 AND
Reduced lipophile absorption
Take Control, Benecol etc (sterol/stannol esters)
Fat 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 30g
Projected benefits of reducing CHO by 30g
1

30% reduction
in type-2 DM
1.
Salmeron et al 1997ab; Meyer et al, 2000
Projected benefits of reducing CHO by 30g

1
2
1.0 % fall in
HbA1c

30% reduction
in type-2 DM
25% reduction
in retinopathy
1.
2.
Salmeron et al 1997ab; Meyer et al, 2000
Diabetes Control and Complications Trial, 1996
Projected benefits of reducing CHO by 30g

1
2
3

1.2% fall in

HbA
1.0 % fall in
HbA1c
1c
30% reduction
in type-2 DM
25% reduction
in retinopathy
>30% reduction
in CHD
1.
2.
Salmeron et al 1997ab; Meyer et al, 2000
Diabetes Control and Complications Trial, 1996
3.
De Vegt et al 1999; Khaw et al, 2001
Potential appetite suppressors
Pinoleic acid: q6 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 termination
Clinical trial ‘inconclusive’
Potrential appetite suppressors
Oleoylethanolamide (cannabinoid receptor blocker):
cocoa, soybeans, hazelnuts, oats
Fish & whey protein isolates (anti-stress)
PeptideA, Lactium
Caralluma fimbriata
Indian food plant – edible succulent
1 g/day, 4 weeks, n=26: weight loss, no adx
(Lawrence & Choudhary, 12th World Conf Anti-aging
Medicine, ’04)
1 g/day, 8 weeks, n=50
Appetite reduction, weight loss, no adx
(Kuriyan et al, Appetite 48:338-44, ’07)
Some evidence of adipocte inhibition
Differentiation of pre-adipocyte into mature adipocyte
Pre-adipocyte
Immature
adipocyte
Immature multilocular
adipocyte
Mature unilocular
adipocyte
Metabolic 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 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 …
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 Backlash
Fat Acceptance Movement ’86
Fat Liberation ’88
Fat Pride ‘89
Fat Positive ‘93
National Association to Advance Fat
Acceptance
Council on Size and Weight Discrimination
International Society for Size Acceptance
Co-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’
730 calories, 70 g fat: $2.99
Hardee’s ‘Monster Thickburger’
1420 calories, 107 g fat: $5.49
Atkins 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 cancer
1 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
Low 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
Cals/g
9
3
High GL
Pyramid
Oils, fats: 25g
Meat, dairy: 150g
Pulses, legumes, seeds, nuts, soy: 300g
0.5
Wide variety fruits / veg (not potatoes): 800g
supplements
New Food
Cals/g
9
3
High GL
Pyramid
Oils, fats: 25g
Meat, dairy: 150g
Pulses, legumes, seeds, nuts, soy: 300g
0.5
Wide variety fruits / veg (not potatoes): 800g
Total calories less than 2000 / day
supplements
- Weight Management - still waiting …
Paul Clayton
[email protected]