Great Diets For Weight Reduction
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Great Diets For Weight Reduction

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Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen ...

Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag. Der Vortrag ist auf einem hohen Niveau und richtet sich ausschliesslich an professionelle Leser mit fundierten Vorkenntnissen.

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Great Diets For Weight Reduction Great Diets For Weight Reduction Presentation Transcript

  • Great Diets for Weight Reduction
    Dr. Clarence P. Davis
    Bergstrasse 8
    CH-8702 Zollikon
  • Diet and/or behavior modification:
    Long-term results
    -5
    0
    -5
    WEight change (kg)
    VLCD
    Modified diet + behavior modification
    VLCD + behavior modification
    -10
    -15
    -20
    1
    2
    3
    4
    5
    Years after intervention
    Intervention
    (adapdet from Wadden TA. Ann Intern Med 1993; 119:688-93)
  • Behavior modification
    2
    [months]
    0
    6
    18
    0
    Standard behavioral
    -2
    Treatment (SBT)
    SBT + structered
    -4
    meal plans
    -6
    SBT + fat reduction
    SBT + caloric
    -8
    restriction
    -10
    SBT + walking
    program 3d/week
    -12
    -14
    [weight loss % of initial weight]
    -16
    [Sherwood et al. Int J Obes 1999;23:485-93
  • Focus of every overweight therapy
    should lie on a
    LIVELONG
    continuing
    weight reduction
  • activity
    milleniumscenturies decades
    energy density
  • Cause: Genetics versus Environment
    OBESITY
    Catherine Christie, PhD, RD, LD/N, 2003
  • Population percentage
    with BMI > 30kg/m2
    Prof. P James, et al., IOTF Unpublished Data.
    Obesity Rates Could Double in 25 Years
  • BIG EATER
  • Definition: BIG EATER
    Has no or only short lasting feeling of satiety
    Eats at least once a day more than a normal restaurant size serving
    Usually not more than 4 meals per day
    No feelings of discomfort even after very opulent meals.
  • BBC 2003
    'Big portions' health warning
    http://news.bbc.co.uk/1/hi/health/3112718.stm
    Hamburgers are 112% bigger than they were 20 years ago
    BBC 2003:
    Fast food 'as addictive as heroin'
    http://news.bbc.co.uk/1/hi/health/2707143.stm
    BBC 2002
    Snack food sales rocket
    http://news.bbc.co.uk/1/hi/uk/2262816.stm
     BBC 2003
    Court dismisses
    McDonald's obesity case
    http://news.bbc.co.uk/1/hi/world/americas/2685707.stm
    BB2 2002
    Junk food battle hits
    US schools
    http://news.bbc.co.uk/1/hi/world/americas/2016819.stm
    NEWS Tbo 2004:
    Fast Food As Health Food?
    http://news.tbo.com/news/MGALX4Y1WPD.html
  • Increased Portion Sizes
    Catherine Christie, PhD, RD, LD/N, 2003
  • Comparison of Energy Densities
    Nielsen SJ et al JAMA. 2003 Jan 22-29;289(4):450-3
  • Comparison of Energy Densities
    Prentice AM et al Obes Rev. 2003 Nov;4(4):187-94
  • Changes in body weight, fat mass and fat-free mass in overweight people during intervention with sucrose vs. artificial sweeteners.
    10 week-followup
    ● sucrose; mean BMI 28.0; n=21
    ∆ artificial sweetners; mean BMI 27.6; n=20
    Over study period, significant differences between changes in:
    body weight- P < 0.001
    fat mass- P < 0.05
    At different time points:
    * P < 0.05
    ** P < 0.001
    *** P < 0.0001
    Mean±SEM
    Raben A, et al. Am J Clin Nutr 2002;76:721-9.
  • „Energy-density“of typical fast-food
    145% more energy per meal compared with a traditional African diet
    A.M. Prentice et al. Obes Rev. 2003;4:187-194
  • Summary:Energy density
    Energy content of fast food is
    +145% higher of Gambian traditional food
    Energy density correlates best with fat content
    No adaptation process
     PASSIVE over-consumption
    Results in:
    Higher fat intake
    Weight gain
  • Case 1
    Male, 56 y
    Sales representative
    „lots of business lunches“
    BW: 93.4; FM: 26.1 kg (28%); LBM: 67.3 kg
    BMI: 32.3
    ~ 1000 km of cycling every month
    Actual Medication:
    • Diamicron (Gliclazidum): 0-0-1
    • Glucophage 1000 (Metformin): 1-0-0
    • Selipran (Pravastatin): ½-0-½
  • Case 1
    Therapy:
    Ketogenic diet (1200 kcal/d) for 6 wk
    200 g of meat/fish/poultry/(tofu)
    Vegetable side dish
    salad
    Slight reduction of endurance activities
    Adaptation of diabetic medication according to blood glucose
  • WM male 56 years
  • Ketogenic Diet
    Definition:
    • The KD is both a high-fat/low-non-fat diet, and a diet that is calorie-restricted
    • Any diet providing nutritional or body fat for the generation of ketones that serve as an alternative fuel to body tissues may be called “ketogenic”
    Side effects
    • Usually none to only slight side effects if carried out properly
    • hyperuricemia
    • gout
    • gallstones
    Indication
    • Weight reduction under medical supervision and normal metabolic status
    • age < 60 y
    • BMI ≥ 30 kg/m2
  • Ketogenic Diet
    • Contraindications:
    • Absolute:
    • Low serum potassium
    • Hyperuricemia
    • Any form of renal dysfunction
    • Nephrolithiasis
    • Instable angina
    • Myocardial infarction within the last 6 months
    • Epilepsy
    • Pregnancy and lactation
    • Malignancies
    • Relative
    • certain professions
    • Drivers
    • Pilots
    • etc.
    • Eating disorders
  • Ketogenic Diet: Procedure
    Thorough clinical examination:
    • Exclusion of contraindications
    Evaluation of protein need
    • Rule of thumb: per 10 kg of target weight 10 g of protein (may be increased)
    Patient instruction
    • Basic principles
    • Permitted and not permitted food
    • Preparation techniques (fat- and CHO-restricted cooking)
    • Possibly self control with ketone sticks
    • Slow resumption of CHO after diet
    Regular weight control in your office
    Transition phase
  • Ketogenic Diet: food choice
    Protein need based on target weight:
    • 10 g of biological valuable protein per 10 kg of target weight
    • Dairy products
    • 300 ml: skim milk, buttermilk, whey protein drinks
    • 2 x 180 yogurt (preferentially skim milk yogurt)
    • 100 g cottage cheese, tofu
    • 50 g of 50% fat cheese
    • Eggs
    • 1 egg
    • Fish
    • 60 g of fish (any kind, preferentially lean types) or canned fish in water
    • Meat
    • 50 g of lean meat (pork, beef, veal, horse, poultry, venison)
    • 30 g of dried meat
  • Ketogenic Diet: food choice
    In addition to the protein a vegetable side dish for the main course is allowed. A total of two servings per day are allowed. They may be taken from either group.
    • Vegetable group 1 (1 serving = 200 g)
    • Eggplant, artichoke, broccoli, cauliflower, cucumber, salt cucumber, pepperoni, cabbage (all types), mushrooms, radish, spinach, asparagus, tomato, chicory, onions, zucchini, celery, fennel
    • Vegetable group 2 (1 serving = 150 g)
    • Green beans, green lattice, dandelion, carrots, pumpkin
    One green salad per main course is extra
  • Herniated disc impedes physical activity
    Severe illness of close family member
    WM male 56 years
  • FAT EATER
  • Nutritional Fat
    Typical nutrition composition
    Recommended nutrition composition
    Protein
    Protein
    15-20%
    15-20%
    CHO
    CHO
    40-50%
    Fat 40%
    Fat 30%
    45-55%
  • Case 2
    Femal, 58 y
    Yoga instructor
    „can’t move my body properly anymore“
    BW: 86.9; FM: 38.2 kg (44%); LBM: 48.7 kg
    BMI: 31.9
    ~ apart from Yoga no other physical activity
    Actual Medication:
    • HRT
  • Case 2
  • Low-fat Diet
    Definition:
    • Any diet with a restriction of fat may be called a low-fat diet.
    • Mostly a low-fat diet will also have some sort of fat-modification.
    Side effects
    • Usually none if fat restriction is not absolute
    Indication
    • A modified composition of fat should be part of every healthy nutrition. It may play a special role in
    • Cardiovascular disease (Mediterranean diet, PUFA-rich diets, DASH-diet, etc) for the prevention/therapy of dyslipidemia, and the primary and secondary prevention of arteriosclerosis
    Contraindications:
    • None. Basically a fat-modified diet may be carried out at any time without side effects or hazards to the health, as long as the fat restriction is not too harsh (HDL-Cholesterol may decrease, and cancer risk increase) and a healthy mix of nutrition is maintained
  • Low-fat Diet: Procedure
    Thorough clinical examination:
    • Evaluation of cardiovascular risk factors
    • Blood lipids
    • Blood pressure
    Diet modification
    • Reduction of fat below 30% of total energy intake (max. 60-70 g fat/d)
    • Distribution of fat-types: SFA:MUFA:PUFA=<1:1-1.5:<1
    • Cholesterol < 300 mg/d
    • Avoid/reduce trans fatty acids
    • Increase of fibers to ≥ 30 g/d
    • Diet should be high in CHO (~ 55-60% of total energy intake)
    • Avoid alcohol or strict alcohol reduction
    Regular weight control in your office
    Well suited as lifelong diet
  • Low-fat Diet: food choice
    • Ask your dietitian!
  • „Fat-Quiz“
    Recognize and estimate hidden fat!
    Would you have know it?
  • 9 g of fat
    0,7 g of fat
  • 1 handful = 50 g
    1 handful = 40 g
    12 g of fat
    1,3 g of fat
  • 1 handful = 20 g
    1 handful = 40 g
    2 g of fat
    7 g of fat
  • 1 plate
    1 Pizza
    10 g of fat
    32 g of fat
  • 1 serving = 180 g
    1 seving (side dish) = 60 g
    0,4 g of fat
    32 g of fat
  • 1 sausage = 110 g
    1 chicken breast = 150 g
    26 g of fat
    2,4 g of fat
  • Active center lipase
    CHONH
    OH
    Xenical®
    H2NCO
    OH
    Stable Xenical-complex blocks fat digestion
    Low-fat Diet: medical treatment
  • 42
    Xenical prevents the absorption of up to 30% of dietary fat...
  • 30% of
    triglycerides
    pass
    undigested and are excreted.
    …which pass through the body undigested and are excreted.
  • Placebo + diet
    Xenical + diet
    Weight loss (%)
    p&lt;0.001
    12
    p&lt;0.001
    p&lt;0.001
    10.2%
    9.7%
    10
    8.8%
    8
    6.6%
    6.1%
    5.8%
    6
    4
    2
    0
    Sjöström
    Rössner
    Davidson
    Consistent weight loss in clinical trials
    Sjöström L et al Lancet. 1998 Jul 18;352(9123):167-72Rössner S et al Obes Res. 2000 Jan;8(1):49-61
    Davidson MH et al JAMA. 1999 Jan 20;281(3):235-42
  • 0
    Placebo
    Xenical® 60mg
    Xenical® 120mg
    -2
    *p&lt;0.01
    -4
    Veränderung Körpergewicht (%)
    -6
    -8
    -10
    60
    70
    80
    90
    104
    -4
    0
    10
    20
    30
    40
    52
    Xenical: Long-term weight reduction
    Sjöström L et al Lancet. 1998 Jul 18;352(9123):167-72
  • Placebo + lifestyle modification
    Xenical + lifestyle modification
    (kg)
    0
    –3
    –4,1 kg
    –6
    –6,9 kg
    –9
    p&lt;0.001 vs. Placebo
    –12
    0
    52
    104
    156
    208
    Woche
    Xenical: XENDOS-results
    Torgerson JS et al Diabetes Care. 2004 Jan;27(1):155-61
  • Low-fat Diet