1. Why are Americans gaining Weight? √ Decreased Activity √ Increased Food Portions

2. US Food portions are growing 1977 cheeseburger = 397 kcals 1996 cheeseburger = 533 kcals Typical Fast Food Meal Today: 1610 Kcals 237 g CHO 63 g FAT 16 g SFA JAMA, January 22/29,2003 Vol 289, No. 4

3. 1950s Burger Meal = Today’s Happy Meal? 590 kcals 90 g CHO 20 g FAT 6g SFA *1950s average soda was 8 oz

4. Television and Weight Nurse’s Health Study: 50,000 women over 6 years 23% increased risk of obesity and 14% increased risk of diabetes for every two hours of TV watched daily JAMA Vol 289(14) April 9, 2003.1785-1791

5. The Low Carb Theory Carbohydrate foods are bad because they stimulate insulin response Hyperinsulinemia causes weight gain Excess kcals cause weight gain

6. Efficacy and Safety of Low- Carbohydrate Diets 107 articles-3268 participants on diets with <60 g CHO/day Weight–loss among subjects was principally associated with decreased caloric intake NOT reduced carbohydrate JAMA April 9,2003 Vol 289, No.14

7. ↓ Carbohydrate diets- Potential Problems: All Fats are not Equal Allowing unlimited bacon, sausage and cheese could result in huge intake of saturated fat What about brain function on 20 grams CHO/d? The Institute of Medicine Recommends a minimum 130 grams CHO/d for brain function

8. Decreased Bone Mineral Density? Renal Calcium excretion increased with ketosis Kidney Disease? Increased nephrolithiasis Gout? Elevated Uric acid Long-term Cancer risk with minimal fruits and vegetables?

9. Dieting American Style The Lure of “the Right Mix” Eat all you want as long as it is: (Choose one)  Fat Free  Carbohydrate-free  High Protein  Compatible with Your Blood Type  In the “Zone”

10. There is no magic mix that allows you to ignore energy balance Energy IN = Food CHO + Fat + Pro + Etoh (4) (9) (4) (7) Energy Burned BMR + TEF + Activity (60%) (10%)(30%)

11. It’s the Calories!! You cannot ignore the simple fact that calories count. The single most important dietary change for the overweight IR or diabetic individual is to reduce overall kcal intake Decreased caloric intake improves metabolic factors even before weight loss

12. One extra Oreo Cookie a day in = 5 pound weight gain in one year Energy IN > Energy Out

13. Burn an extra 100 kcals/day = 10 lb weight-loss in one year Energy Out > Energy In

14. Get Moving The DPP participants randomized to lifestyle intervention reduced risk of Type 2 by 58 % with 7% weight loss (12 lbs for a 170 lb person) and 150 minutes exercise per week  21 minutes walking per day!

15. Each one hour per day of brisk walking associated with a 24% reduction in obesity and a 34% reduction in diabetes. Nurses health study cohort JAMA, volume 289 (14) April 9, 2003

16. The Two most Critical Lifestyle Changes are simply: 1. Decrease Calories 2. Increase Activity The Most Powerful Modulators of insulin action are differences in the degree of obesity and physical activity which may account for 50% of the variability in insulin- mediated glucose disposal Am J Physiol. 1985;248

17. Big Grab Bag 3.5 oz 490 kcals 60 g CHO 25 g Fat

18. Putting it all together….. What does this eating plan look like?  40-45% CHO  15-20% Protein  35-45% Good Fat

19. High CHO Low Fat Plan 1 Cinnamon Raisin Bagel (4 oz) 8 oz Fresh Orange Juice 420 kcals 82% CHO (88g) 5% FAT 12% PRO Moderate CHO Plan 1 Slice Whole Grain Bread 1.5 Tbsps Natural Peanut Butter 4 oz Plain Nonfat Yogurt ¾ Cup Fresh Blueberries 4 Walnut Halves 410 Kcals 45% CHO (50g) 40% FAT (5% SFA,) 15% PRO

20. Breakfast: ½ cup Bran Flakes 4 oz 1% lowfat Milk ¾ cup fresh Blueberries 12 Walnut Halves Lunch: Turkey/Avocado Sandwich: 2 slices Whole Grain Bread ½ Avocado 2 oz lean deli Turkey breast Tomato/Lettuce 1 teaspoon Mayonnaise 1 Fresh Orange 2 Tbsps Roasted Almonds Dinner: 3 oz Salmon ½ cup black beans 1 Cup mixed salad greens 1 Tbsp olive oil 1 cup steamed asparagus 6 oz “light “yogurt 1 cup Fresh Strawberries 1525 kcals 40% FAT (6% SFA) 41% CHO 19% PRO 37 g Fiber

21. Portions Matter! This Bagel is “sugar- free/fat-free” but contains 50% more calories than this chocolate bar (~380 kcal bagel vs 220 kcal candy bar) One Noah’s Bagel has 85 g carbohydrate!

22. Measurable Goals Walk 20 minutes every day Switch from Regular to diet soda Eat only 1 cup of Rice with Dinner Eat 2 cups of non-starchy vegetables daily Replace morning Bagel with 2 slices whole grain bread

23. Take-home Message: 1. Reduce calories Eat LESS! 1. Avoid SFA/Trans-fats while including more MUFA/PUFA sources 2. Increase activity