This was a case study I presented on the effects of low carbohydrate diets in comparison to high protein diets.

1. +
Obesity and Low Carb/
High Protein Diets
By: Maria Di Nello

2. +
Objectives:

Pathophysiology of Obesity

Overveiw of Weight Loss Approaches

Focus of High Protein/High Fat/ Low Carbohydrates Diet
Outcomes.

3. +
Patient Profile
Pt’s Desired Wt. Loss Approach
Background

33yr old female

5’3’’

175lbs

BMI: 30.1 (Obesity Grade 1)

Cholesterol: 205

HDL: 39

LDL: 166

A1C: 6.4%

TG: 200

Has tried losing weight in the
past

Attempted many popular diets

Has been reading a lot on
Atkins diet

Currently: Walks outside for 30
min 4X/wk.

4. +
Why is Overweight/ Obesity a
Health Concern?
Social
Medical

CVD

DM

Stroke

Dislipidemia

Sleep apnea


Higher unemployment

Lower Salary

Depression
Joint Concerns

Low self-esteem

Cancers (endometrial, breast,
colon)

Embarrassment

HTN

Have stigmas from others

Liver and Gallbladder disease

Gynecological problems
Cost?: 2008 147 billion dollars spent on issues caused by obesity.
Overweight and obesity. Center for Disease Control and Prevention Web site. http://www.cdc.gov/obesity/adult/causes/index.html. Published April, 2007. Updated 2007.

5. Socioecological Model for Obesity:
+
Causes
Huang T, Drewnowski A, Kumanvika S, Glass T. A systems oriented multilevel framework for addressing obesity in the 21st century. Centers for Disease Control and Prevention Web site.
http://www.cdc.gov/pcd/issues/2009/jul/09_0013.htm. Updated 20092013.

6. +
Obesity Pathophysiology: Effects:
The obesity model. Obesity Web site. http://3.bp.blogspot.com/-vIsnMbILgng/UIRSnf8UIXI/AAAAAAAAD9Y/DUukmqOKheo/s1600/obesity-model.gif. Updated 2006

7. +
Common Approaches to Weight Loss:
Consumer

Weight watchers (most used in 2012)

Atkins

Jenny Craig

Supplements

Nutrisystem

Slimfast

Gluten free diet
The most popular diet trends of 2012. http://lols2go.com/?g=The-Most-Popular-Diet-Trends-Of-2012&img=7781. Updated 2012.

8. +
Traditional Weight Loss
Recommendations by MD:

Telling patient problems associated with obesity (48%)

Diet and Exercise (46.5%)

Referral to formal diet program (5.2%)

Prescribed weight loss medication (4.0%)

Non prescription weight loss product (1.8%)

Stomach bypass surgery (1.5%)
Shifman S, Sweeny C, Pillitteri J, Semhower M, Harkins A, Wadden T. Weight management advice: What do doctors recommend to their patients? Preventative Medicine. 2009;49(6):482-486.

9. +
High Protein/ Low Carb Diets
Defined:

High protein diet: ~30% of kcal


30-34% protein
Low carbohydrate diet:

20-90g/ day

1 study: 40%kcal/ day
Yancy W, Olsen M, Guyton J, Bakst R, Westman E. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Annals Of Internal
Medicine [serial online]. May 18, 2004;140(10):769-777. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed May 14, 2013.
Effects of protein intake and gender on body composition changes: a randomized clinical weight loss trial. Nutrition & Metabolism [serial online]. 2012;9(1):55-63. Available from: CINAHL Plus with
Full Text, Ipswich, MA. Accessed May 14, 2013.
Ornish D, Kelly J, Dansinger M. Comparison of diets for weight loss and heart disease risk reduction... Dansinger ML, Gleason JA, Griffith JL et al. Comparison of the Atkins, Ornish, Weight
Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43-53. JAMA: Journal Of The American Medical Association [serial online]. April 6,
2005;293(13):1589-1591. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed May 14, 2013.

10. +
Study 1: Yancy et al

Study Design: Randomized Controlled trial: 120 hyperlipidemic
participants

Methods: Low Cho diet (initially 20g/day) with nutritional supplementation,
exercise recommendation, and group meetings VS. low fat diet (<30% kcal,
<300mg cholesterol and deficit of 500-1000kcal/d) with exercise
recommendation and group meetings.

Looked at: Bodyweight, body composition, fasting serum lipids, and
tolerability.

Results: At 24wks, wt loss was greater in low CHO group (-12.9%vs -6.7%),
both groups lost more fat mass than fat free mass (-9.4kg vs. 4.8kg), Low
CHO had greater decreases in serum TG (-.84mmol vs. -.31mmol/L) and
greater increases in HDL (.14mmol/Lvs -.04mmol/L). LDL changes were
consistent in both groups. Greater retention in program in low CHO group
(76% vs. 57%)
Yancy W, Olsen M, Guyton J, Bakst R, Westman E. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Annals Of Internal
Medicine [serial online]. May 18, 2004;140(10):769-777. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed May 14, 2013.

11. +
Study 2: Evans et al
Study Design: 12 month parallel arm randomized clinical trial
(n=130)

Methods: 2 center weight loss train (4mon active weight loss, 8
month maintenance) Randomized into either Low Cho to
Protein ratio or High Cho to Protein Ratio.

Looked at: Lean mass and fat mass lost

Results: Males and females lost similar weights at 12 months.
However Pro was more effective in reducing body fat vs. high
CHO diet over 12 months.
Effects of protein intake and gender on body composition changes: a randomized clinical weight loss trial. Nutrition & Metabolism [serial online]. 2012;9(1):55-63. Available from: CINAHL Plus with
Full Text, Ipswich, MA. Accessed May 14, 2013.

12. +
Study 3: Dansinger et al
Study Design: Single center randomized trial (n=160)

Methods: 4 groups (Atkins, Zone, Weight Watchers, and
Ornish). 2 months max effort, then their own level of ability for
the remainder of study (1 yr total)

Looked at: weight loss

Results: At 1 yr. Atkins lost 2.1kg; 3.2kg for zone;3.0kg Weight
watchers; and 3.3kg for Ornish. Each diet moderately reduced
wt and LDL:HDL ratio. For all diets, with greater wt loss:
decrease in total chol, c reactive protein, and insulin at 1 yr.
Overall adherence was low.
Ornish D, Kelly J, Dansinger M. Comparison of diets for weight loss and heart disease risk reduction... Dansinger ML, Gleason JA, Griffith JL et al. Comparison of the Atkins, Ornish, Weight
Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293:43-53. JAMA: Journal Of The American Medical Association [serial online]. April 6,
2005;293(13):1589-1591. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed May 14, 2013.

13. Summary Slide:
Study 1
Study 2
Study 3
Design: *Randomized Control trial
*Paralell Arm
*Single center
n=120
Randomized Trial
Randomized Trial n=160
n=130
______________________________________________________________________
________
Similar wt loss in
At 1 yr: Weight watchers
Findings Greater wt loss in
low cho group.
low cho and high
and Ornish diet lost
Larger decrease in
cho groups . High
most weight. All diets
TG and increase in
pro was better at fat
reduced LDL:HDL ratio.
HDL.
loss vs high cho at 1
Low adherence to all at
yr.
1 yr.
______________________________________________________________________
________
Compared to low fat
Take
Pro was more
Each popular diet modestly
diet, a low cho
Away
effective at fat loss vs.
reduced body wt and
program had better
cho. No interactive
several cardiac risk factors
retention and wt. loss. effects of protein
at 1 yr. Overall dietary
During active wt loss,
intake and gender are
adherence rates were low
Serum TG dec, more
evident.
overall. Increased
and HDL increased
adherence had greater wt
more in low cho group
loss and dec. in cardiac risk
factors

14. +
Safety of Ketogenic Diet: Dashti et
al

Design: Prospective Study (n=83 obese patients) for 24 weeks (6 months)

Methods: All participants given ketogenic diet consisting of 20g to 30g CHO
in the forms of vegetables and salads, and 80g-100g of protein in the forms
of meat, cheese, fowl, fish, eggs and shellfish with supplemented PUFAS
and MUFA’s. After 12 weeks, 20g CHO added. Multivitamins given 1/day.

Looked at: Determining effects of Keto diet on Obese pts.

Results: Weight and BMI decreased significantly. Total Cholesterol
significantly decreased, HDL significantly increased, LDL significantly
decreased, TG level significantly decreased, blood glucose significantly
decreased, changes in urea and creatinine were not significant.

Conclusion: Beneficial effects of ketogenic diet long term.

15. +
What does this mean?
RD Role

Motivation

Maintenance

Help with regimen

Determine appropriate patients
RD as Expert in Nutrition

Collaboration with MD’s is KEY

16. +

17. +
References:
1
Overweight and obesity. Center for Disease Control and Prevention Web site.
http://www.cdc.gov/obesity/adult/causes/index.html. Published April, 2007. Updated 2007.
2
Huang T, Drewnowski A, Kumanvika S, Glass T. A systems oriented multilevel framework
for addressing obesity in the 21st century. Centers for Disease Control and Prevention
Web site. http://www.cdc.gov/pcd/issues/2009/jul/09_0013.htm. Updated 2009.
3
The obesity model. Obesity Web site. http://3.bp.blogspot.com/vIsnMbILgng/UIRSnf8UIXI/AAAAAAAAD9Y/DUukmqOKheo/s1600/obesity-model.gif.
Updated 2006
4
The most popular diet trends of 2012. http://lols2go.com/?g=The-Most-Popular-DietTrends-Of-2012&img=7781. Updated 2012.
5
Shifman S, Sweeny C, Pillitteri J, Semhower M, Harkins A, Wadden T.
Weight management advice: What do doctors recommend to their patients? Preventative
Medicine. 2009;49(6):482-486.
6
Yancy W, Olsen M, Guyton J, Bakst R, Westman E. A low-carbohydrate, ketogenic diet
versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial.
Annals Of Internal Medicine [serial online]. May 18, 2004;140(10):769-777. Available from:
CINAHL Plus with Full Text, Ipswich, MA. Accessed May 14, 2013.

18. +
References Cont.:
7
Ornish D, Kelly J, Dansinger M. Comparison of diets for weight loss and
heart disease risk reduction: a randomized trial. JAMA. 2005;293:43-53.
JAMA: Journal Of The American Medical Association [serial online].
April 6, 2005;293(13):1589-1591. Available from: CINAHL Plus with Full
Text, Ipswich, MA. Accessed May 14, 2013.
8
Effects of protein intake and gender on body composition changes: a
randomized clinical weight loss trial. Nutrition & Metabolism [serial
online]. 2012;9(1):55-63. Available from: CINAHL Plus with Full Text,
Ipswich, MA. Accessed May 14, 2013.
9
Dashti HM, Mathew TC, Hussein T, Asfar SK, Behbahani A, Khoursheed
MA, Al-Sayer HM, Bo-Abbas YY, Al-Zaid NS. Long-term effects of a
ketogenic diet in obese patients. Exp Clin Cardiol. 2004 Fall;9(3):200-5.
PubMed PMID: 19641727; PubMed Central PMCID: PMC2716748.