What do we really know about what makes us fat? Dr. Wolf Funfack, MD Internal Medicine & Nutritional Medicine

What do we really know about what makes us fat? The conventional wisdom on the treatment of obesity is very simple! Obese people have to eat less or exercise more! The conventional wisdom on the cause of obesity is very simple too! Obese people consume more than they expend! Put these two notions together and you find a dissonance because: These cornerstones of the treatment bring poor and not long lasting results!

Treatment of obesity brings poor reults! Rather than to solve the dissonance by questioning our believes we blame the obese people for not faithfully follow our advices! Hundreds of millions have been spent in the last years, to tell people: Eat less and exercise more! But the people in our countries are getting heavier developing more metabolc diseases every year! What`s going wrong with that approach? Wir wissen bis heute nicht genau woher das Übergewicht kommt, behandeln es aber erst einmal dadurch, dass wir weniger zu essen und mehr Bewegung empfehlen. Oft wird die Behandlung in die Hände von Psychologen gelegt, um das Essverhalten zu verändern, die Menschen zu gesünderem Essen zu motivieren, wobei ich nicht weiß, wie man ein 2-jähriges Kind, das schon viel zu dick ist psychologisch behandeln will! All diese Versuche haben keine zufriedenstellenden Ergebnisse gebracht, die Menschen werden immer dicker und kranker! Dennoch wird an den alten Annahmen festgehalten und die Schuld nicht der falschen Annahme gegeben sondern den willensschwachen und disziplinlosen Patienten.

Are we confounding cause and effect? Are obese people obese because they eat too much? or Do obese people eat too much because they are obese?

Are we confounding cause and effect? e.g. what can we do when it is getting warmer outside? But is this really the positive proof of global warming? To mix cause and effect! Wenn es z.B. zu warm wird, ziehen die Menschen sozusagen als Behandlung (Therapie) immer dünnere Kleidungsstücke an. Man kann aber nicht den Rückschluss ziehen, daß diese Therapie, das Anzeihen immer kleinerer Kleidungsstücke ein Beweis ist z.B. für die zunehmende Erderwärmung und den Klimawandel!

There are 3 ways our body can deal with food! Our body can ... Burn it as energy! Conserve it in storage, because currently there is no need for energy! Dispose of it, because currently there is no need for energy and the stores are full!

Our metabolism is designed for scarcity! Being able to store more engery translated into a survival advantage! Fat people often eat LESS than skinny people! Obesity is NOT a problem with energy balance! Obesity is a problem of storage!

What do we really know about treatment of obesity? Change exercise behavior Change eating behavior

Change exercise behavior 4 groups: Less than 1% Diet More than 9% Control Exercise Diet  Diät - Exercise Less than 1% Weight loss in % Die Gruppe, die nur ihr Bewegungsverhalten verändert hat (N=26) unterscheidet sich kaum von der Kontrollgruppe, (N=28) die nichts verändert hatte, in Bezug auf Gewichtsabnahme nach 52 Wochen. Bei den Gruppen, die nur ihr Essverhalten (N=26) bzw. beides, Bewegung und Essverhalten veränderten (N=27), zeigt sich ebenfalls kein Unterschied. Die ersten beiden Gruppen verloren weniger als 1% ihres Ausgangsgewichts. Die beiden letzteren fast 10%! More than 9% weeks Villareal DT et al. N Engl J Med 2011;364:1218-1229

Which tools can provide us? Change eating behavior Which tools can provide us? Eat less Less calories Less Fat

eating behavior: 1. less calories Change eating behavior: 1. less calories The Yo-Yo Effect after 62 weeks after 10 weeks before starting the diet 50 obese patients were set on a diet with protein shakes for ten weeks! Hunger Was passiert, wenn Patienten ihre Kalorienzufuhr massiv verringern? 50 übergewichtige Patienten ohne Diabetes wurden für 10 Wochen auf eine Formuladiät mit sehr wenigen (500-550) Kalorien gesetzt, so wie es die Beschreibung im Beipackzettel vorsieht! (Optifast von Nestlè) Vor Studienbeginn, direkt nach den 10 Wochen und danach nach 1 Jahr wurden sie nach ihrem Hungergefühl befragt. Das Hungergefühl war auch nach 1 Jahr nach Beendigung der Maßnahme nicht wieder auf seinen Ausgangswert angelangt, sogar noch höher als nach 10 Wochen! 30 60 120 180 240 min. Time after ingestion N Engl J Med Volume 365(17):1597-1604 October 27, 2011

9 Kcal 4 Kcal Change eating behavior: 2. less fat But: Calories and calories are not alike! 1 gram of fat results in 1 gram of CH results in 9 Kcal 4 Kcal Solution: We change fats with carbohydrates!

Effect of calorie intake after different breakfasts David S. Ludwig, Pediatrics: „High Glycemic Index Foods, Overeating, and Obesity“, 1999; 103;e26 Twelve overweight young adults ate three different breakfasts (randomly applied) over three days. After a 5 hour break they each ate the same meal for lunch. Breakfast 1: Omelette 30% fat, 30% protein, 40% carbohydrate Breakfast 2: Wholegrain muesli 20% fat, 16% protein, 64% carbohydrate Breakfast 3: Cornflakes 20% fat, 16% protein, 64% carbohydrate The three different breakfasts had an identical caloric load 13

Calories and calories are not alike! Effect of calorie intake after different breakfasts Calories and calories are not alike! following omelette = low glycemic load 2000 kcal following wholegrain muesli 3000 kcal (50% more calories) = medium glycemic load following cornflakes 3600 kcal (80% more calories) = high glycemic load The three different breakfasts had an identical caloric load 14

Low fat dairy products and central obesity Change eating behavior: 2. less fat Low fat dairy products and central obesity 1261 svedish men of normal weight (age 40 – 60) were followed up for 12 years. 197 (15%) developed “central obesity” (WHR >1) 1261 normalgewichtige schwedische Männer, zu Beginn im Alter zwischen 40 – 60 Jahren wurden 12 Jahre lang nachverfolgt. 197 Männer (15%) entwickelten eine “zentrale Adipositas”, gemesen am WHR (waist to hip ratio) größer oder gleich 1. normal fat Risk for central obesity low fat high fat Low fat dairy products increase the risk for central obesity by 53%! Scand. J.of Prim.Health Care, 2013 Holmberg.S. High dairy fat intake related to less central obeesity

What do we really know about what makes us fat? Obesity is NOT a problem with energy balance! Obesity is a problem of storage!

The hormone of storage is insulin! Blood lipids Antiinflamating hormones Antiaging hormones Stress- hormones Storing fat evokes Hunger Burning fat

How do we produce high insulin levels? by food 50 100 150 200 Blood sugar Blood Insulin Blood concentration Ravenous appetite Time [hrs] 1 2 3 4 5 Food intake 18

How can we keep insulin levels low? by food Blood concentration 50 100 150 200 Feeling of satiety Blood sugar Blood Insulin Time [hrs] 1 2 3 4 5 Food intake 19

Carbohydrates are built up in chaines from thousands of monosacharides

These long Carbohydrate chaines have to be split up into monosacharides Only monosacharides are small enough to pass through the bowel walls into blood

high/low insulin levels? How do we produce high/low insulin levels? Food Recommendations Usual recommendations: Carbohydrates 55 - 60 % Fats: 25 - 30 % Protein: 15 - 20 % Our recommendations: Carbohydrates 40 - 45 % Fats: 30 - 35 % Protein: 20 - 30 % Die 3 Makronährstoffe Die ausgewogene Verteilung und gezielte Auswahl von hochwertigen Lebensmitteln entspricht der modernen Ernährungslehre . Sie basieren auf den großen prospektiven Evaluationsstudien der Harvard Medical School Boston USA in denen über 120.000 Krankenschwestern und Ärzte über mahr als 20 Jahre regelmäßig auf ihren Gesundheitszustand und ihre Gesundheit untersucht wurden.: Nurses Health Study I 50.422 Krankenschwestern, begonnen 1976 (121.701) Nurses Health Study II 47.898 Krankenschwestern, begonnen 1989 (116.686) Health Professional Study 22.557 Ärzte begonnen 1986 ( 51,529) 40-45 % Kohlenhydrate, 30-35 %Fett und 20-25 % Eiweiß. Diese Verteilung der Makronährstoffe, Kohlenhydrate, Fette und Eiweiß hat in den letzten 10 Jahren immer mehr Eingang in die moderne Ernährungsberatung gefunden. Immer mehr Untersuchungen zeigen, daß dies die medizinisch am besten nachvollziehbare Verteilung ist, um Gewicht abzunehmen und langfristig auch zu halten 1,2. So hat zum Beispiel die „Diogenes-Studie“, die am 25.11.2010 von Larsen T.M. und anderen im „New England Journal of Medicine“ 3 veröffentlicht wurde, belegt, daß diese Empfehlungen von metabolic balance® den modernsten wissenschaftlichen Erkenntnissen entsprechen. Bei dieser vergleichenden Studie zu verschiedenen Ernährungsmodellen schnitt die „Diät“-Variante am besten ab, die eine vergleichbare Zusammensetzung der Nahrung aufwies , wie sie in den metabolic-balance®-Plänen empfohlen wird. 5-6 Meals per day 3 Meals per day high low

Nutrient Database & Proprietary Method How do we produce low insulin levels? Creation of an individual nutrition plan! We use an improved Federal Food Code for our system, which lists all our available food products with their respective ingredients. The personal specifications of our clients, such as body size, age, sex, past illnesses, medication and food rejection and intolerance that should be considered in the preparation the individual dietary plan is found in a second recipient. If the content of certain minerals in the blood is too low, foods rich in these nutrients are selected. When the contents of other substances are too high, e.g. uric acid, foods low in uric acid are selected. In the diet plan, foods that are habitually consumed by the client do not usually appear since the client may already have enough of the nutrients from these foods. This is why foods that have been rarely eaten or not at all do appear in the plan. Nutrient Database & Proprietary Method Personal Information Laboratory Values Individual Meal Plan 23

Reduction in Body Weight 62,5 % of participatns reduced their weight by more than 5% and maintained it at least for one year. 50 % of participants need to reduce their weight by more than 5% and need to maintain it for more than one year. The definition of long-term success of a nutritional program for weight loss is that the original weight must be reduced by at least 5%, and this reduction must be maintained for at least 31,1% have lost even more than 10%, and maintained this loss for a year (S 97). Among our participants, 90% of those who wanted to lose weight have actually lost weight and maintained this loss for a year. Ten percent have not lost any weight or have even gained some additional weight. Other programs like weight watchers or the recommendations of the German Nutritional Society have worse results of between 22% - 26%. Other methods, that use protein powders reach about 35% metabolic balance® International recommendations for long-term success of an efficient weigh management program

Comparison of weight reduction programs 62,5% 50% Meffert, Cornelia; Gerdes, Nikolaus: Journal of Nutrition and Metabolism, 2010, Article ID 197656 “ProgramAdherence and Effectiveness of a Commercial Nutrition Program: The Metabolic Balance Study” metabolic balance® Jolly, Kate et al. BMJ, 2011, 343; d6.500 “Comparison of range of commercial or primary care led weight reduction programmes . randomised controlled trial”

The hybernating hedgehog Please do not disturb 26

Source: http://www.evolvehealth.nl/mental-coaching/ Take the next Step Get Dr. Funfack's eBook at Amazon.Com “metabolic balance® – Nutrition basics: Introduction to the success program” Get Dr. Funfack's Book through our Offices „metabolic balance® – Your Personalized Nutrition Roadmap“ Contact one of our Coaches via www.metabolic-balance.com Contact our Canadian or U.S. Offices Canada: 1-289-291-3959 USA: 1-727-851-0071 Source: http://www.evolvehealth.nl/mental-coaching/ 27 27

Thank you For your ! Attention !