Get Lean, Stay Lean
Dr Joanna McMillan
getlean.com.au
Factors affecting weight
control
support

motivation

happiness
cultural
backgroun
d

sleep

stress

Energy in

Energy
out
Risk factors for
overweight/obesity
High fat diet

No high
intensity
exercise

Low dietary
calcium

Short sleep

High
disi...
“eat less and move
more?”
If only it were that
simple.
It IS harder for some
Twin studies show us that
susceptibility to gaining weight
with overfeeding & sensitivity to –
ve en...
We are all individuals
Sleep & weight control


Short sleep duration increases risk of weight gain



Quebec Family Study: combination of short...
Sleep & weight gain
short
duration
sleepers
sleep to 7-8hrs

maintained short
sleep
after 6 yrs

Greater
increase
in BMI &...
Sleep & alcohol intake
Odds ratio for
exceeding
weekly
recommendatio
n for alcohol

•
•
•
•

Adults sleeping ⩽6h/night con...
Dieting leads to unfavourable eating
behaviours
uncontrolled
eating disinhibition

rigid control
of eating

History of die...
Sedentary behaviour


In older Japanese population, less TV ass. with
lower risk of overweight, independent of
meeting ex...
Sitting & mortality
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0

mortality
CVD

Increased daily sitting time
Diets to get lean?

All diets work in the short term, but
none of them work in the long-term
Is Paleo the way forward?
Little change to human genome during
last 10,000 yrs
Our diet & lifestyle progressively more
d...
What is a Paleo diet?


Most studies have estimated diets for 229 populations… i.e
there is not one paleo diet, but many
...
Modern Paleo… is it true Paleo?



Foods including bacon, butter, sausages & ham were not consume



Not just the lean f...
Comparison of diets
paleo

low-carb

low-fat

Mediterranea
n

protein

high

mod

low

mod

cho

mod

low

high

mod

fat
...
Can we use Paleo with our
clients?







The idea sells.. particularly to
men
Minimising processed food –
great
Over...
Intermittent fasting









Eat what you like for 5 days
& on 2 non-consecutive
days you fast
Long term compliance...
My Get Lean Plate Model

getlean.com.au
Pack your vase with
nutrient-dense foods
& don‟t waste space
on kJ without
nutrients

Don‟t fill
up if
trying to
utilise f...
Carbs are not a food group







Teach clients carbohydrate is a
macronutrient ie a fuel for our bodies
30% of blood...
GI is a tool – not the central
mechanism
Not all low GI foods are smart choices e.g. icecream is clearly not best food for...
Diogenes – diet best to stay lean?
LP-HGI &
Control
Most Weight
Regain
HP or LGI
alone
moderate
benefit
0.93 kg less
gain ...
Staying lean: importance of selfmonitoring
N=3003 consistent self-weighing improved
weight loss maintenance
 “catch weigh...
Long-Term Maintenance
Study
To maintain their weight loss, subjects report
 high levels of physical activity ( approximat...
Who succeeds in staying
lean?
More initial weight loss
 Reaching selfdetermined goal
weight
 Active lifestyle
 Regular ...
Who is more likely to regain?
History of weight cycling
 Disinhibited eating
 Binge eating
 More hunger
 Eating in res...
Take home points
Getting lean & staying lean is not as simple as
eating less & moving more
 It is harder for some than ot...
Thank you 

getlean.com.
au
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Get Lean, Stay Lean by Dr Joanna McMillan www.weightlossinstitute.com.au

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2013 Australian & New Zealand Weight Loss Leaders Summit (Sydney)

Dr Joanna McMillian is one of Australia’s best-known nutrition and healthy lifestyle experts, and is an author of several books including the award winning Inner Health Outer Beauty and the internationally published The Low GI Diet.
In her insightful presentation Dr Joanna will reveal:

The controversies in weight loss diets, the facts and the myths.
Food is more than the nutrients it contains – this information is a MUST for educating your clients.
A template for healthy eating, what does the doctor recommend?
Helping your clients take control of their own diet and lifestyle.

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  • 2005 review by S Rossner’s group
  • Get Lean, Stay Lean by Dr Joanna McMillan www.weightlossinstitute.com.au

    1. 1. Get Lean, Stay Lean Dr Joanna McMillan getlean.com.au
    2. 2. Factors affecting weight control support motivation happiness cultural backgroun d sleep stress Energy in Energy out
    3. 3. Risk factors for overweight/obesity High fat diet No high intensity exercise Low dietary calcium Short sleep High disinhibition eating behaviour Lower socioeconomic status Family lifestyle Prevalence of obesity in family & friends genetics
    4. 4. “eat less and move more?” If only it were that simple.
    5. 5. It IS harder for some Twin studies show us that susceptibility to gaining weight with overfeeding & sensitivity to – ve energy balance from exercise is genetically determined “There are individuals at risk of gaining weight and body fat or who are resistant to weight loss” Bouchard & Tremblay 1997 J Nutr 127:943S
    6. 6. We are all individuals
    7. 7. Sleep & weight control  Short sleep duration increases risk of weight gain  Quebec Family Study: combination of short sleep + a disinhibition eating trait 2.5x as likely to be overweight & gained weight & waist circumference over 6 yrs (Chaput et al 2011, Sleep 34:1291)
    8. 8. Sleep & weight gain short duration sleepers sleep to 7-8hrs maintained short sleep after 6 yrs Greater increase in BMI & fat mass Chaput et al 2012 Int J Obesity 36:7526
    9. 9. Sleep & alcohol intake Odds ratio for exceeding weekly recommendatio n for alcohol • • • • Adults sleeping ⩽6h/night consume more alcohol than those sleeping ⩽7h/night. Short sleepers exceed the recommendations for sensible weekly alcohol intake. The prevalence of binge drinking is more common in men than women. Short sleepers with a high disinhibition eating behaviour trait consume more alcohol. Chaput et al 2012 Appetite 59; 650655
    10. 10. Dieting leads to unfavourable eating behaviours uncontrolled eating disinhibition rigid control of eating History of dieting associated with rigid control & disinhibition  Harms long-term regulation of weight  Gallant et al 2012 Br J Nutr 14;108:1976-9
    11. 11. Sedentary behaviour  In older Japanese population, less TV ass. with lower risk of overweight, independent of meeting exercise guidelines (Inoue et al 2012 J Epidemiol 22:50-6) Breaking up sedentary activity reduces waist circumference (Owen et al Exerc Sport Sci Rev 2010;38:105-13)
    12. 12. Sitting & mortality 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 mortality CVD Increased daily sitting time
    13. 13. Diets to get lean? All diets work in the short term, but none of them work in the long-term
    14. 14. Is Paleo the way forward? Little change to human genome during last 10,000 yrs Our diet & lifestyle progressively more divergent from our ancient ancestors “Socially, we are people of the 21st century, but genetically we remain citizens of the Paleolithic era” Loren Cordain Is our high rate of hypertension, CVD, diabetes & metabolic syndrome the result of this?
    15. 15. What is a Paleo diet?  Most studies have estimated diets for 229 populations… i.e there is not one paleo diet, but many  Diets varied depending on geographical location, seasonality  Our ancestors essentially adapted to whatever food was available  The ability of humans to adapt to a number of different diets is undoubtedly part of our relative success as a species  But common features all their food came from hunting (animals & birds), gathering (wild plants & small land fauna) & fishing (including shell fishing)
    16. 16. Modern Paleo… is it true Paleo?  Foods including bacon, butter, sausages & ham were not consume  Not just the lean fillet consumed – bone marrow, organ meats, smaller animals etc.  Even vegetables today are far different – all influenced by agriculture  Debate over when grains were introduced  Watch paleontologist Christina Warriner “debunking the paleo diet”
    17. 17. Comparison of diets paleo low-carb low-fat Mediterranea n protein high mod low mod cho mod low high mod fat mod high low mod sfa mod high low low mufa high mod low mod omega-3 high low low high fibre high low high high fruit & veg high low high high nuts & seeds mod low low mod salt low high low mod GL low low high low closest to paleo O‟Keefe JH & Cordain L, 2004 Mayo Clin Proc 79;101-
    18. 18. Can we use Paleo with our clients?      The idea sells.. particularly to men Minimising processed food – great Overly restrictive – poor long term compliance Use aspects & then modify Include (ancient) wholegrains, legumes, dairy – in „close-to-nature‟ forms
    19. 19. Intermittent fasting       Eat what you like for 5 days & on 2 non-consecutive days you fast Long term compliance? Effect of gene expression? Do we just train ourselves to get better at dealing with famine? Nutrient intakes? I‟m not convinced
    20. 20. My Get Lean Plate Model getlean.com.au
    21. 21. Pack your vase with nutrient-dense foods & don‟t waste space on kJ without nutrients Don‟t fill up if trying to utilise fat stores Overflo w goes to fat stores
    22. 22. Carbs are not a food group      Teach clients carbohydrate is a macronutrient ie a fuel for our bodies 30% of blood glucose goes to fuel brain Essential for endurance & tough training sessions “when the going gets tough, the tough eat carbs” Louise Burke Cannot put all foods containing carbs in one basket Moderate intake of low GI quality carb-rich foods
    23. 23. GI is a tool – not the central mechanism Not all low GI foods are smart choices e.g. icecream is clearly not best food for getting lean!  Use it to choose between nutrient-rich foods  Fibre, nutrient-density & other nutritional factors important  Keep it simple – no need to know the numbers 
    24. 24. Diogenes – diet best to stay lean? LP-HGI & Control Most Weight Regain HP or LGI alone moderate benefit 0.93 kg less gain in HP & 0.95 kg less in low GI HP-LGI best Larsen et al 2010 NEJM 363;2102
    25. 25. Staying lean: importance of selfmonitoring N=3003 consistent self-weighing improved weight loss maintenance  “catch weight gains before they escalated”  Decreasing self-weighing frequency associated with greater weight gain  Obesity 2007 Dec;15(12):3091-6
    26. 26. Long-Term Maintenance Study To maintain their weight loss, subjects report  high levels of physical activity ( approximately 1 h/d)  eating a low-calorie, low-fat diet  eating breakfast regularly  self-monitoring weight  maintaining a consistent eating pattern across weekdays and weekends. Weight loss maintenance may get easier over time; after individuals have successfully maintained their weight loss for 2-5 yrs, the chance of longer-term success greatly increases. Continued adherence to diet and exercise strategies, low levels of depression and disinhibition, and medical triggers for weight loss are also associated with long-term success. Am J Clin Nutr. 2005 Jul;82(1 Suppl):222S-225S.
    27. 27. Who succeeds in staying lean? More initial weight loss  Reaching selfdetermined goal weight  Active lifestyle  Regular meals including breakfast  Healthier eating  Control of over-eating  Self-monitoring of behaviours  Internal motivation  Social support  Better coping strategies  Ability to handle stress  Self-efficacy  Autonomy  Assuming responsibility in life  Psychological strength & stability  Obes Rev 2005 Feb;6(1):67-85
    28. 28. Who is more likely to regain? History of weight cycling  Disinhibited eating  Binge eating  More hunger  Eating in response to negative emotions & stress  Passive reactions to problems 
    29. 29. Take home points Getting lean & staying lean is not as simple as eating less & moving more  It is harder for some than others  Protein rich, moderate carbs, healthy fat  Vase analogy – fill with nutrient-dense foods  Rigid eating plans leads to disinhibition & overeating  Monitor progress & maintenance  Support from peers & family  Good sleep essential  Manage stress & work/life balance  It‟s a complete lifestyle 
    30. 30. Thank you  getlean.com. au

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