The document discusses various dietary approaches for weight reduction, emphasizing behavior modification alongside different dietary methods such as very low-calorie diets and low-fat diets. It highlights the impact of energy density in food and presents case studies demonstrating the effectiveness of ketogenic and low-fat diets for specific individuals. Additionally, it addresses the importance of long-term dietary changes and the role of medical supervision in weight management strategies.

2. Great Diets for Weight ReductionDr. Clarence P. DavisBergstrasse 8CH-8702 Zollikon

3. Diet and/or behavior modification:Long-term results-50-5WEight change (kg)VLCDModified diet + behavior modificationVLCD + behavior modification-10-15-2012345Years after interventionIntervention(adapdet from Wadden TA. Ann Intern Med 1993; 119:688-93)

4. Behavior modification2[months]06180Standard behavioral-2Treatment (SBT)SBT + structered-4meal plans-6SBT + fat reductionSBT + caloric-8restriction-10SBT + walkingprogram 3d/week-12-14[weight loss % of initial weight]-16[Sherwood et al. Int J Obes 1999;23:485-93

5. Focus of every overweight therapyshould lie on aLIVELONGcontinuingweight reduction

6. activitymilleniumscenturies decadesenergy density

7. Cause: Genetics versus EnvironmentOBESITYCatherine Christie, PhD, RD, LD/N, 2003

8. Population percentage with BMI > 30kg/m2Prof. P James, et al., IOTF Unpublished Data.Obesity Rates Could Double in 25 Years

9. BIG EATER

10. Definition: BIG EATERHas no or only short lasting feeling of satietyEats at least once a day more than a normal restaurant size servingUsually not more than 4 meals per dayNo feelings of discomfort even after very opulent meals.

11. BBC 2003'Big portions' health warninghttp://news.bbc.co.uk/1/hi/health/3112718.stmHamburgers are 112% bigger than they were 20 years agoBBC 2003:Fast food 'as addictive as heroin'http://news.bbc.co.uk/1/hi/health/2707143.stmBBC 2002Snack food sales rockethttp://news.bbc.co.uk/1/hi/uk/2262816.stm BBC 2003Court dismisses McDonald's obesity casehttp://news.bbc.co.uk/1/hi/world/americas/2685707.stmBB2 2002Junk food battle hits US schoolshttp://news.bbc.co.uk/1/hi/world/americas/2016819.stmNEWS Tbo 2004:Fast Food As Health Food?http://news.tbo.com/news/MGALX4Y1WPD.html

12. Increased Portion SizesCatherine Christie, PhD, RD, LD/N, 2003

13. Comparison of Energy DensitiesNielsen SJ et al JAMA. 2003 Jan 22-29;289(4):450-3

14. Comparison of Energy DensitiesPrentice AM et al Obes Rev. 2003 Nov;4(4):187-94

15. 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=20Over study period, significant differences between changes in:body weight- P < 0.001fat mass- P < 0.05At different time points:* P < 0.05** P < 0.001*** P < 0.0001Mean±SEMRaben A, et al. Am J Clin Nutr 2002;76:721-9.

16. „Energy-density“of typical fast-food145% more energy per meal compared with a traditional African dietA.M. Prentice et al. Obes Rev. 2003;4:187-194

17. Summary:Energy densityEnergy content of fast food is +145% higher of Gambian traditional foodEnergy density correlates best with fat contentNo adaptation process PASSIVE over-consumptionResults in:Higher fat intakeWeight gain

18. Case 1Male, 56 ySales 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 monthActual Medication:Diamicron (Gliclazidum): 0-0-1

19. Glucophage 1000 (Metformin): 1-0-0

20. Selipran (Pravastatin): ½-0-½Case 1Therapy:Ketogenic diet (1200 kcal/d) for 6 wk200 g of meat/fish/poultry/(tofu)Vegetable side dishsaladSlight reduction of endurance activitiesAdaptation of diabetic medication according to blood glucose

21. WM male 56 years

22. Ketogenic DietDefinition:The KD is both a high-fat/low-non-fat diet, and a diet that is calorie-restricted

23. 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 effectsUsually none to only slight side effects if carried out properly

24. hyperuricemia

25. gout

26. gallstonesIndicationWeight reduction under medical supervision and normal metabolic status

27. age

28. BMI ≥ 30 kg/m2Ketogenic DietContraindications:

29. Absolute:

30. Low serum potassium

31. Hyperuricemia

32. Any form of renal dysfunction

33. Nephrolithiasis

34. Instable angina

35. Myocardial infarction within the last 6 months

36. Epilepsy

37. Pregnancy and lactation

38. Malignancies

39. Relative

40. certain professions

41. Drivers

42. Pilots

43. etc.

44. Eating disordersKetogenic Diet: ProcedureThorough clinical examination:Exclusion of contraindicationsEvaluation of protein needRule of thumb: per 10 kg of target weight 10 g of protein (may be increased)Patient instructionBasic principles

45. Permitted and not permitted food

46. Preparation techniques (fat- and CHO-restricted cooking)

47. Possibly self control with ketone sticks

48. Slow resumption of CHO after dietRegular weight control in your officeTransition phase

49. Ketogenic Diet: food choice Protein need based on target weight:10 g of biological valuable protein per 10 kg of target weight

50. Dairy products

51. 300 ml: skim milk, buttermilk, whey protein drinks

52. 2 x 180 yogurt (preferentially skim milk yogurt)

53. 100 g cottage cheese, tofu

54. 50 g of 50% fat cheese

55. Eggs

56. 1 egg

57. Fish

58. 60 g of fish (any kind, preferentially lean types) or canned fish in water

59. Meat

60. 50 g of lean meat (pork, beef, veal, horse, poultry, venison)

61. 30 g of dried meatKetogenic Diet: food choiceIn 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)

62. Eggplant, artichoke, broccoli, cauliflower, cucumber, salt cucumber, pepperoni, cabbage (all types), mushrooms, radish, spinach, asparagus, tomato, chicory, onions, zucchini, celery, fennel

63. Vegetable group 2 (1 serving = 150 g)

64. Green beans, green lattice, dandelion, carrots, pumpkinOne green salad per main course is extra

65. Herniated disc impedes physical activitySevere illness of close family memberWM male 56 years

66. FAT EATER

67. Nutritional FatTypical nutrition compositionRecommended nutrition compositionProteinProtein15-20%15-20%CHOCHO40-50%Fat 40%Fat 30%45-55%

68. Case 2Femal, 58 yYoga instructor „can’t move my body properly anymore“BW: 86.9; FM: 38.2 kg (44%); LBM: 48.7 kgBMI: 31.9~ apart from Yoga no other physical activityActual Medication:HRTCase 2

69. Low-fat DietDefinition:Any diet with a restriction of fat may be called a low-fat diet.

70. Mostly a low-fat diet will also have some sort of fat-modification.Side effectsUsually none if fat restriction is not absoluteIndicationA modified composition of fat should be part of every healthy nutrition. It may play a special role in

71. Cardiovascular disease (Mediterranean diet, PUFA-rich diets, DASH-diet, etc) for the prevention/therapy of dyslipidemia, and the primary and secondary prevention of arteriosclerosisContraindications: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 maintainedLow-fat Diet: ProcedureThorough clinical examination:Evaluation of cardiovascular risk factors

72. Blood lipids

73. Blood pressureDiet modificationReduction of fat below 30% of total energy intake (max. 60-70 g fat/d)

74. Distribution of fat-types: SFA:MUFA:PUFA=

75. Cholesterol

76. Avoid/reduce trans fatty acids

77. Increase of fibers to ≥ 30 g/d

78. Diet should be high in CHO (~ 55-60% of total energy intake)

79. Avoid alcohol or strict alcohol reductionRegular weight control in your officeWell suited as lifelong diet

80. Low-fat Diet: food choice Ask your dietitian!„Fat-Quiz“Recognize and estimate hidden fat!Would you have know it?

81. 9 g of fat0,7 g of fat

82. 1 handful = 50 g1 handful = 40 g12 g of fat1,3 g of fat

83. 1 handful = 20 g1 handful = 40 g2 g of fat7 g of fat

84. 1 plate1 Pizza10 g of fat32 g of fat

85. 1 serving = 180 g1 seving (side dish) = 60 g0,4 g of fat32 g of fat

86. 1 sausage = 110 g1 chicken breast = 150 g26 g of fat2,4 g of fat

87. Active center lipaseCHONHOHXenical®H2NCOOHStable Xenical-complex blocks fat digestionLow-fat Diet: medical treatment

88. 42Xenical prevents the absorption of up to 30% of dietary fat...

89. 30% of triglycerides pass undigested and are excreted.…which pass through the body undigested and are excreted.

90. Placebo + dietXenical + dietWeight loss (%)p<0.00112p<0.001p<0.00110.2%9.7%108.8%86.6%6.1%5.8%6420SjöströmRössnerDavidsonConsistent weight loss in clinical trialsSjöström L et al Lancet. 1998 Jul 18;352(9123):167-72Rössner S et al Obes Res. 2000 Jan;8(1):49-61Davidson MH et al JAMA. 1999 Jan 20;281(3):235-42

91. 0PlaceboXenical® 60mgXenical® 120mg-2*p<0.01-4Veränderung Körpergewicht (%)-6-8-1060708090104-401020304052Xenical: Long-term weight reductionSjöström L et al Lancet. 1998 Jul 18;352(9123):167-72

92. Placebo + lifestyle modificationXenical + lifestyle modification(kg)0–3–4,1 kg–6–6,9 kg–9p<0.001 vs. Placebo–12052104156208WocheXenical: XENDOS-resultsTorgerson JS et al Diabetes Care. 2004 Jan;27(1):155-61

93. Low-fat Diet