1. Other Dietary Practices

2. Other Dietary Practices for Weight Loss and Weight Control High-Protein and Low Carbohydrate Diets Mediterranean Diets Vegetarian Diets Pharmacological Agents Unsafe approaches

3. High Protein Diets for Weight loss High protein but NOT low carb Not a lot of studies done but the few done look promising. High = Above the.8g/kg/day  30% of kcal  46%-34% 20% (twice the amount) Increase satiety and thermogenesis and maintenance FFM Subjects loss more BF than those in typical low fat diets

4. High Protein Diets (Not Low Carb) Dates back to the 1860’s Individuals report feeling fuller  thermogenesis and satiety improved on a 30% protein Appears to help in keeping the weight off by increasing protein for individuals on maintenance. Increasing from 15% to as high as 20% 50% of individuals did not regain weight and reported feeling fuller when protein levels increased. Those that gain weight, gained FFM. Research indicates that a modest increase (20% instead of 15%) in protein may be recommended for those individuals that struggle with a weight problem. Continued…

5. High Fat Diets Claim is that it has an effect on satiety and thermogenesis. But research says quite the opposite is true. Less likely to provide satiety during meal and throughout the day. Incompatible with weight loss  body more easily converts the fat to body fat.

6. Carbohydrate-restricted Diets Less than 20% of calories from Carbs or 20-60 grams/day… ◦ aka Atkins diet Modified low  still below the acceptable carb range of 45-65%  more like high protein diets ◦ Zone ◦ South beach Low Carb associated with deficiencies in vitamin A, B6, C and E; folate; calcium; magnesium; iron; potassium; and fiber Headaches and constipation also a problem.

7. Research on Carb Restricted Diets Initial weight loss greater at 6 months but no difference after a year. Diets with 1.05g/kg/day of CHO (~ carb 35 to 41%): ◦ Greater amount of body fat and body weight loss ◦ BUT  greater FFM lost than those on low fat diets Data insufficient to support claim that low carb better. Best advice for weight loss: ◦ A little higher on the protein may be beneficial during caloric restriction because of satiety ◦ Choose complex unrefined carbohydrates (aka: fruits and vegetables and whole grains )

8. Mediterranean Diets Although different Mediterranean countries have their own dietary habits, there are similarities relating to their food intake Common dietary features: ◦ Whole grains, potatoes and pasta ◦ High in complex carbs and fiber ◦ Vegetables and legumes ◦ Yogurts, feta and mozzarella cheeses ◦ Nuts ◦ Fruits (grapes and figs) ◦ Little meat and egg consumption ◦ Some seafood and poultry consumption ◦ Sources of fat are olives, olive oil, nuts and fish ◦ High in monounsaturated and polyunsaturated fat intake ◦ Low saturated fat intake Research suggests that the Mediterranean diet leads to lower incidences of heart disease, certain cancers, and other diseases As might be expected, because of the lower incidence of disease, life expectancy is high

9. Vegetarian Diets No meat, fish, poultry, dairy or eggs Considered helpful although more challenging for some Lacto-ovo-vegetarian does eat dairy and eggs Vegan-no animal products or derivatives Vegetarian diets are: ◦ Low in saturated fat & cholesterol ◦ High in fiber, folate and vitamin C & E, carotenoids ◦ Lower rates of obesity, death from CVD, Hypertension, type 2 diabetes & prostate and colon cancer

10. Pharmacological Agents for Weight Loss Lipase Inhibition: Fat Malabsorption Agents Appetite Suppressants and Energy Expenditure-Increasing Agents

11. Lipase Inhibition (fat blockers) Orlistat (Xenical)  (alli –half the strength) Blocks digestion and absorption of triglycerides  excreted in stool undigested Shows modest results Side effects: ◦ Flatulence, oily stool, fecal urgency, incontinence, abdominal pain ◦ Also decreased absorption of fat soluble vitamins! ◦ Compensatory increase in kcal through carbs

12. Appetite Suppressants and Energy Expenditure Increasing Agents Fen-Phen ◦ Phentermine & fenfluramine ◦ Amphetamine like  caused appetite suppression and weight loss ◦ Not safe  pulmonary hypertension & heart valves problem ◦ Has been taken off market Sibutramine ◦ Meridia ◦ To decrease appetite by reducing feelings of hunger in brain ◦ Modes results  may lead to dry mouth, constipation and insomnia ◦ Does seem to improve lipid profiles ◦ May help some obese individuals

13. Unsafe Approaches to Weight Loss Fad diets Calories per day too low Fasting Diet pills (over the counter) Very-low calorie diets (<1200 kcal) without medical supervision

14. Evaluating Fad Diets Promises a “quick fix.” Claims that sound to good to be true. Simplistic conclusion drawn from complex study. Recommendations based on a single study or “no studies” or opinions based on studies published without peer review. Dramatic statements that are refuted by reputable scientific organizations. List of “good” and “bad” foods or “forbidden.” Advice given to help sell a product.

15. Fasting Skipping meals or high levels of physical activity that do no match food intake. Leads to decrease in: ◦ Glycogen stores ◦ Lean body mass ◦ Decrease in RMR ◦ Bone mineral density

16. Evaluating the Quality of a Diet How does the diet cut calories? Is it healthy? What is the nutrient density of the diet? Does the diet advocate exercise? Does it make sense? Where is the evidence? Does it meet the clients individual needs? How much does it cost? What kind of social support does the individual have? How easy is it to adhere to the diet?