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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 P James, et al., IOTF Unpublished Data.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: ,[object Object]
Glucophage 1000 (Metformin): 1-0-0
Selipran (Pravastatin): ½-0-½,[object Object]
WM male 56 years
Ketogenic Diet Definition: ,[object Object]
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 ,[object Object]
hyperuricemia
gout
gallstonesIndication ,[object Object]
age < 60 y
BMI ≥ 30 kg/m2,[object Object]
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,[object Object]
Permitted and not permitted food
Preparation techniques (fat- and CHO-restricted cooking)
Possibly self control with ketone sticks
Slow resumption of CHO after dietRegular weight control in your office Transition phase

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Great Diets For Weight Reduction

  • 1.
  • 2. Great Diets for Weight Reduction Dr. Clarence P. Davis Bergstrasse 8 CH-8702 Zollikon
  • 3. 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)
  • 4. 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
  • 5. Focus of every overweight therapy should lie on a LIVELONG continuing weight reduction
  • 6. activity milleniumscenturies decades energy density
  • 7. Cause: Genetics versus Environment OBESITY Catherine Christie, PhD, RD, LD/N, 2003
  • 8. Population percentage with BMI &gt; 30kg/m2 Prof. P James, et al., IOTF Unpublished Data. Obesity Rates Could Double in 25 Years
  • 10. 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.
  • 11. BBC 2003 &apos;Big portions&apos; 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 &apos;as addictive as heroin&apos; 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&apos;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
  • 12. Increased Portion Sizes Catherine Christie, PhD, RD, LD/N, 2003
  • 13. Comparison of Energy Densities Nielsen SJ et al JAMA. 2003 Jan 22-29;289(4):450-3
  • 14. Comparison of Energy Densities Prentice 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=20 Over study period, significant differences between changes in: body weight- P &lt; 0.001 fat mass- P &lt; 0.05 At different time points: * P &lt; 0.05 ** P &lt; 0.001 *** P &lt; 0.0001 Mean±SEM Raben A, et al. Am J Clin Nutr 2002;76:721-9.
  • 16. „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
  • 17. 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
  • 18.
  • 20.
  • 21. WM male 56 years
  • 22.
  • 23.
  • 25. gout
  • 26.
  • 28.
  • 32. Any form of renal dysfunction
  • 35. Myocardial infarction within the last 6 months
  • 43. etc.
  • 44.
  • 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 office Transition phase
  • 49.
  • 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.
  • 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 activity Severe illness of close family member WM male 56 years
  • 67. Nutritional Fat Typical nutrition composition Recommended nutrition composition Protein Protein 15-20% 15-20% CHO CHO 40-50% Fat 40% Fat 30% 45-55%
  • 68.
  • 69.
  • 70.
  • 71.
  • 73.
  • 74. Distribution of fat-types: SFA:MUFA:PUFA=<1:1-1.5:<1
  • 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 office Well suited as lifelong diet
  • 80.
  • 81. 9 g of fat 0,7 g of fat
  • 82. 1 handful = 50 g 1 handful = 40 g 12 g of fat 1,3 g of fat
  • 83. 1 handful = 20 g 1 handful = 40 g 2 g of fat 7 g of fat
  • 84. 1 plate 1 Pizza 10 g of fat 32 g of fat
  • 85. 1 serving = 180 g 1 seving (side dish) = 60 g 0,4 g of fat 32 g of fat
  • 86. 1 sausage = 110 g 1 chicken breast = 150 g 26 g of fat 2,4 g of fat
  • 87. Active center lipase CHONH OH Xenical® H2NCO OH Stable Xenical-complex blocks fat digestion Low-fat Diet: medical treatment
  • 88. 42 Xenical 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 + 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
  • 91. 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
  • 92. 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