Weight Loss 101 - Thiboutot

Weight Loss 101
What really helps?
Presented by
Jeff Thiboutot MS,CN,ACE-Health Coach

Outline
3 Fundamental Principles
of Weight Loss
Some Important
Biological & Psychological Aspects
of Weight Loss
Questions
Weight Loss 101 What Really Helps?

Fundamental Principle #1
Weight loss is SIMPLE
First Law of Thermodynamics
Es (energy stores) = EI (energy in) – Eo (energy out)
More EI than Eo always leads to increase in Es(weight/mass)
Less EI than Eo always leads to decrease in Es(weight/mass)
What Really Helps?Weight Loss 101

Weight loss is COMPLEX & DIFFICULT

Bio-Psycho-Social
Model

People have a FINITE amount of
Time Money Effort
Pereto Principle – 80/20 rule
Focus efforts on “what” will likely help
and have the greatest benefit

“What” is referring to “the best evidence”
http://guides.library.yale.edu/content.php?pid=9786&sid=73113

CONCEPT #1:
A pound of bodyfat
contains about 3,500
calories
FACT:
The amount of calories stored in a pound of
bodyfat is about 3,500
A pound of muscle tissue only
contains about 600 calories

Adipose Tissue
Adipose tissue is a complex, essential, and
highly active metabolic and endocrine organ.
(p.2548)

Adipose Tissue
Why this matters
Larger amounts of adipose tissue (fat), particularly visceral fat, are
associated with, and likely a significant causal component, to many
diseases and poor health
• Coronary heart disease
• Type 2 diabetes
• Cancers (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (for example, high total
cholesterol or high levels of triglycerides)
• Stroke
• Liver and Gallbladder disease
• Sleep apnea and respiratory problems
• Osteoarthritis (a degeneration of cartilage and
its underlying bone within a joint)
• Gynecological problems (abnormal menses,
infertility)
http://www.cdc.gov/obesity/adult/causes/

CONCEPT #2:
Eating more often will
speed up your
metabolism
FACT:
It has been shown many times that eating
frequency does NOT affect metabolic rate.
Eating a certain amount of calories over
widely varying meal frequencies will
result in the same amount of
weight loss

Meal Frequency
Thermic Effect of Food (TEF)
6 meals 3 meals
Meal Size TEF (10%) Meal Size TEF (10%)
250 25 500 50
250 25 0 0
250 25 500 50
250 25 0 0
250 25 500 50
1,500 150 1,500 150

Meal Frequency

Meal Frequency
The current evidence finds that a range of meal frequencies
(from not eating for a day (intermittent fasting) to 6 meals a day)
seems to be health promoting and NO one meal frequency is best.
The effect of the timing of food intake on metabolism has been the subject of active
investigating of >40 y. Indeed, whether it is “better” to eat many small meals a days is one
of the questions most frequently posed by the lay public. Comparing the potential benefits
of nibbling and of gorging has been the focus of much animal and human research, but no
clear consensus has emerged. (p.3)
The limited evidence to date suggests that the manipulation of EF [eating frequency] has
limited utility as a weight and health management strategy. Longer term, randomized
controlled trials investigating the impact of EF on weight and health outcomes
during weight loss and weight maintenance phases are required in order to guide
population recommendations for weight management . (p.379)
…individuals in the health-care professions and in the lay press have repeatedly stated
that consumption of smaller and more frequent meals is healthier than that of larger and
less frequent meals. This advice is given despite the lack of clear scientific evidence
to justify it. (p.1978)

CONCEPT #3:
(A) Skipping a meal will
likely lead to eating
substantially more later
and (B) slow down
your metabolism
FACT:
(A) Skipping a meal may increase the size of the next
meal, BUT the increase is usually much LESS
than the amount of the calories that would
have been eaten in the skipped meal
(B) Skipping a meal will NOT reduce
Metabolic rate. It takes 36 to 72 hours
of NO food before any reduction
in BMR will occur

Skipping a Meal and Subsequent Intake
The results from the present study demonstrate women do not compensate for one
day of partial or total fast by increasing their food intake over the subsequent four
days of measurement. Although counterintuitive, these findings are consistent with the few
studies that have examined the question…These findings are also consistent with the
literature concerning the effects of skipping breakfast or mid-meals snacks Skipping meals
fails to result in an increase in energy intake sufficient to compensate for the reduction in
energy intake. (p.498)
Eating behavior appears to be more responsive to external, environmental cues, than
internal physiological signals. (p.499)
These three studies do not support the hypothesis that a lower meal frequency, when
compared with a higher meal frequency might result in more positive energy by inducing a
lower energy expenditure or a higher energy intake in the short term. A period of fasting
does not result in over-compensation, but in fact results in lower total intake (non-
significant). (p.525)

Skipping a Meal Does NOT Reduce Metabolic Rate
INCREASE in metabolic rate over 96 hours*
* In lean subjects. The responses could be different for overweight and obese individuals.
There may not be an increase in BMR. However, it is likely that there still would NOT be a
reduction in BMR during these time frames. Additionally, these responses were for much
long times than just missing a meal.

CONCEPT #4:
Eating relatively higher
amounts of protein can
make it easier
to eat less and
lose more fat
FACT:
The RDA for protein intake is .8g/kg
The research about protein intake and weight
management has repeatedly demonstrated that
intakes above the RDA,
in the range of 1.2 to 1.6 g/kg
is a helpful dietary strategy

Higher Protein Intakes
Many
Authors,
Papers,
Studies,
Over
2 plus
Decades
Showing
Benefits
From
Relatively
Higher
Protein
Intakes

180 lb, 5’-5” female, BMI 30
following a 1,500 calorie diet
RDA
(.8g/kg)
% cal
1.2g/kg
(.55g/lb)
% cal
1.6g/kg
(.73g/lb)
% cal
65g 17% 98g 26% 131g 35%
Increased satiety
Increased energy expenditure
Increased fat loss
Better retention of lean tissue
Better weight loss maintenance
Greater thermic effect

Food Size Calories Protein
grams
% of
protein
% of
fat
% of
carbs
Whole egg 1 large 77 6
Egg white 1 large 16 4
Chicken breast 4 ounces 184 36
Tuna-canned in water 4 ounces 128 28
Salmon 4 ounces 204 28
Beef, ground, (80/20) 4 ounces 304 32
Tofu, firm style 4 ounces 80 8
Tempeh 4 ounces 220 20
Peanuts 1 ounce 164 7
Almonds 1 ounce 167 6
Yogurt-low fat 2%, plain 8 ounces 154 13
Yogurt-Greek, low fat 2%, plain 8 ounces 173 23
Cheddar cheese, low fat 1 ounce 48 7
Cottage cheese, 2% fat 8 ounces 204 31
Lentils 8 ounces 230 18
Quorn-grounds 4 ounces 147 17
Whey protein powder 1 scoop (33g) 130 23

CONCEPT #5:
There are
NO
fattening foods
FACT:
A calorie is a calorie.
Many studies varying macronutrient ratios,
as well as food sources for nutrients, result in
virtually the same amount of weight loss.
No food is inherently fattening,
it is the QUANTITY of the food
and the total calorie intake
that is important

8 weeks,
1,800
calories
day,
Two-thirds
“junk”
food,
Loses
27lbs
NoFatteningFoods

No Fattening Foods
BEGINNING
Weight-197
Glucose-104
Cholesterol-214
Triglycerides-135
60 DAYS LATER
Weight-176
Glucose-94
Cholesterol-147
Triglycerides-75

Results;
• Average weight loss for ALL groups was 15 pounds with NO statistically significant
difference between the groups.
• The authors state “a high intake of sucrose from a low-fat, hypoenergetic diet did not
adversely affect weight loss or other metabolic indexes” (p.912)
Two groups, eating about 1,100 calories a day for 6 weeks (42 females, ~BMI 35, ~Age 40)
-Group 1 got 4% of their total calories from sucrose
No Fattening Foods,
that includes Sugar
All groups created a 500 calorie deficit for 12 weeks (162 people completed the study)
-Group 1 got 10% of their total calories from HFCS
-Group 2 got 20% of their total calories from HFCS
Results;
All groups lost weight and
there was no statistically
significant difference in weight
loss between the groups.

CONCEPT #6:
Your Basal Metabolic Rate
(BMR) is the MAIN
determinant of Total
Energy Expenditure
FACT:
Your Basal Metabolic Rate typically contributes
60-80% of your Total Energy Expenditure
Mifflin-St Jeor Equation for BMR:
Men:
(10 x weight in kg) + (6.25 x height in cm) – (4.92 x age) + 5
Women:
(10 x weight in kg)
+ (6.25 x height in cm) – (4.92 x age) – 161

BMR & TEE
TEE
Total Energy Expenditure
REE/BMR
Resting Energy Expenditure
NREE
Non-Resting Energy Expenditure
EAT
Exercise Activity Thermogenesis
NEAT
Non-Exercise Activity
Thermogenesis
TEF
Thermic Effect of Food
MacLean et al. p.R588

BMR Calculator
http://www.freedieting.com/tools/calorie_calculator.htm (internal use only)
BMI
31.4
BMI
31.5

TEE Calculator
http://www.freedieting.com/tools/calorie_calculator.htm (internal use only)
BMI
31.5
BMI
31.4

CONCEPT #7:
Gaining muscle is likely to
happen when someone is
LOSING weight
(calorie deficit)
and
working out
FACT:
During weight loss it is very UNLIKELY that
people will gain muscle. Usually 10-20% of
weight loss will come from lean tissue.
However, it is possible to gain some
muscle tissue during weight loss,
but even then it is
in the range of 1-5 lbs

Muscle Changes During Weight Loss
Overwhelming evidence points to the fact that it is much more likely that muscle
mass will be LOST while dieting. However, major determining factors are;
degree of calorie deficit, protein intake, exercise or not, type of exercise, age, gender,
and degree of excess bodyfat.
For MOST people losing weight, the ability to maintain their current level of muscle
tissue is more realistic and should be the focus during weight loss and
people losing weight should be aware of this reality.

CONCEPT #8:
A great way to increase
your metabolic rate is to
gain some muscle
FACT:
A POUND of skeletal muscle
only burns about 5-10 calories a day.
Therefore, for most people, the difference
from a change in muscle tissue will
NOT have a meaningful effect on
overall metabolic rate, i.e.,
calories burned in a day

Skeletal Muscle and Metabolic Rate
Every 10-kg difference in lean mass translates to a difference in energy expenditure of ≈ 100 kcal/d, assuming a
constant rate of protein turnover. (p.477)
At rest, skeletal muscle consumes 54.4 kJ/kg (13.0 kcal/kg) per day. This is larger than adipose tissue (fat) at
18.8 kJ/kg (4.5 kcal/kg), and bone at 9.6 kJ/kg (2.3 kcal/kg). (p.E132)
For each kilogram of FFM, an average 17.5 and 20.9 kcal/d was expended in the sleeping and basal states,
respectively, whereas 26.5 kcal/d was expended when the subjects were fed and able to move (24EE). After
correcting for the effect of activity, an estimated 20.5 kcal/d were accounted for by each kilogram of FFM, which
did not differ from that measured for BMR (20.9 kcal/kg FFM * d). (p.1575)
5 calories
6 calories
10 calories

CONCEPT #9:
Muscle weighs more
than fat
FACT:
5lbs of muscle and 5lbs of fat weigh the same.
However, muscle and fat have different
weight densities.
Muscle is about
18% smaller than fat

CONCEPT #10:
To lose weight, creating a
calorie deficit is the most
important determinant of
weight loss
FACT:
A calorie deficit is THE biological factor that
determines if weight loss will happen. It is
likely obvious, but it often gets lost in the
many other nutritional and exercise
aspects that are related to
weight loss.

Calories are King
Conclusions
Reduced-calorie diets result in clinically meaningful weight loss regardless
of which macronutrients they emphasize. (p.859)

Calories are King
All 4 diets resulted in modest statistically significant
weight loss at one year, with no statistically
significant differences between diets…all diets
achieved modest, although statistically significant,
improvements in several cardiac risk factors at one
year…In the long run, however, sustained adherence
to a diet rather than diet type was the key predictor
of weight loss and cardiac risk factor reduction in
our study. (pp.48-52)

Calories are King
• 5 obese patients in a hospital metabolic ward
• Fed liquid diets for ≥10 weeks
• 800-1200 calories/day (tailored per patient) to induce rapid weight loss
• Every 3-4 weeks diet composition changed
• protein (ranging from 14 percent to 36 percent of calories)
• fat (12 percent to 83 percent)
• carbohydrate (3 percent to 64 percent).
• All patients lost weight at a constant rate, regardless of diet composition
Authors concluded:
It is therefore obvious that the significant factor responsible for weight loss is reduction
of calories, irrespective of the composition of the diet.
We conclude that a calorie is a calorie. (p.904S)

Calories are King, but…
• Modify appetite and
cravings
• Modify adherence
during weight loss
• Modify maintenance of
weight lost
• Modify biometric
changes
• Modify the type of
tissue lost
• Modify the ability to
increase lean tissue
Macro Intake
Differences &
Sources
Can

Calories are King,
but how many?
From the NIH (National Institute of Health)
Practical Guide to the Identification, Evaluation and
Treatment of Overweight and Obesity in Adults
Caloric intake should be
reduced by 500 to 1,000
calories a day from the current
[maintenance] level (p.2)

CONCEPT #11:
If your calorie intake is
very low it will likely
inhibit weight loss, often
referred to as
“starvation mode”
FACT:
As typically stated, the starvation mode is a myth.
There are metabolic adaptions to reduced calorie
intakes, such as adaptive thermogenesis, but the
adaptation is relatively small. To function the
body has to use a good amount of calories
regardless of intake. Everyone who eats a
low amount of calories, consistently,
will always lose weight

No “starvation mode”
A 27 year old man weighing 456lbs started a
medically supervised fast which lasted 382
days (1 year, 2 weeks, and 4 days). This was
a true fast, meaning there were NO calories
ingested and only non-calorie beverages and
a few vitamin and mineral supplements were
prescribed. During this time he lost 276lbs,
which means he averaged about a
5lb loss per week

No “starvation mode”
But there is real starvation
and this is what it looks like
(p.1350) Kalm, L. & Semba, R. (2005). They starved so that others could be feed better:
Remembering Ancel Keys and the Minnesota Experiment. J Nutrition

CONCEPT #12:
Short sleep duration is
likely an important factor
in weight gain & the
ability to lose weight
FACT:
The epidemiological research has shown a clear and
negative relationship between short sleep durations
and higher bodyweights.
The intervention studies have largely supported
this association. Therefore, getting the
proper amount of sleep is likely to
help with bodyweight problems.

Sleep and Weight
Short sleep duration and obesity
are common occurrence in today’s
society. An extensive literature from
cross-sectional and longitudinal
epidemiological studies shows a
relationship between short sleep
and prevalence of obesity and
weight gain. However, causality
cannot be inferred from such
studies. Clinical intervention
studies have examined whether
reducing sleep in normal sleepers,
typically sleeping 7-9 h/night, can
affect energy intake, energy
expenditure, and endocrine
regulators of energy balance…
Most studies support the notion
that restricting sleep increases
food intake, but the effects on
energy expenditure are mixed.
(p.73)

Sleep and Weight
“Based on a review of the
literature, we conclude that
sleep loss represents an
important risk factor for
weight gain, insulin
resistance, type 2 diabetes
and dyslipidaemia.
Therefore, an adequate
sleep pattern is fundamental
for the nutritional balance of
the body and should be
encouraged by
professionals in the area.”
(p.195)

CONCEPT #13:
Drinking 2 cups of water
(fluid) before a meal will
typically cause a
decrease in food
intake for
that meal
FACT:
The current research shows that drinking
about 16 ounces of water about 30 min. before
meals can decrease calorie intake in older
adults. The best evidence supports the
benefits of replacing sugar-based
beverages with water as a helpful
weight management
strategy

Water Intake and WT Loss
Consumed 16 fl oz
(500ml) of bottled water
prior to each of the three
daily meals. Intervention
was 12 weeks long.
Both groups lost weight.
Water group lost about
4.5lbs more weight than
the control group, which
equates to about 1/3
pound per week
“Increasing daily water consumption is widely recognized as a weight loss strategy in the general public, yet
there is surprisingly little data supporting this practice” (p.1)
“To our knowledge, this is the first randomized controlled trial investigating the influence of increased water
consumption on weight loss” (p.7, emphasis added)

Water Intake and WT Loss
The effects of consuming water
with meals rather than drinking
no beverage or various other
beverages remains under-
studied… The literature for these
comparisons is sparse and
somewhat inconclusive… studies
suggested a potentially important
role for water in reducing energy
intakes, and by this means a role
in obesity prevention. A need for
randomized-controlled trials
exists. (p.505)

CONCEPT #14:
Sugar
is
addictive
FACT:
Currently there is no good evidence that
sugar, by itself, is addictive to humans
There is some good evidence that certain
FOODS, which are a COMBINATION of
nutrients and flavors, particularly
sugar, fat, and salt can
have addictive like
properties

“Conclusion: There is
no support from the
human literature for
the hypothesis that
sucrose may be
physically addictive or
that addiction to sugar
plays a role in eating
disorders.”
Sugar is NOT addictive

CONCEPT #15:
As we get older our
metabolism slows down
substantially
FACT:
Basal Metabolic Rate (BMR) and Total Energy
Expenditure (TEE) tend to decrease with aging.
The decrease in BMR is relatively small.
BMR decreases by about
2% for women and 2.9% for men
each decade after 20.

BMR Does NOT Decrease Significantly With Age
Taken together, these
observations indicate
that BMR is indeed lower
in the elderly compared
with young adults…but
the difference is so
small…that it can be
considered insignificant
(p.658,emphasis added)

CONCEPT #16:
Eating high volume/high fiber based
foods such as non-starchy veggies
and fruits can help increase the
satiation of a
meal and lead to
eating less calories
at that meal
FACT:
In general, high intakes of low-energy-dense foods
can help reduce total calorie intake. High intakes of
these foods during a hypocaloric diet can increase
feelings of fullness at a meal even though there
are less calories which can help with dietary
adherence. This effect tends to come from
eating the low-energy-dense foods
15 to120 minutes before
the meal

Eat Lots of Low-Energy-Dense Foods
Energy density is the relationship of calories to the weight of food
(# of calories per gram of food).
Several studies have demonstrated
that eating low-energy-dense foods
(such as fruits, vegetables, and soups)
maintains satiety while reducing
energy intake. In a clinical trial, advising
individuals to eat portions of low-energy-
dense foods was a more successful
weight loss strategy than fat reduction
coupled with restriction of portion sizes.
Eating satisfying portions of low-energy-
dense foods can help to enhance satiety
and control hunger while restricting
energy intake for weight management.
(p.236S)

Soups
The findings from this study confirm
previous reports that consuming soup as
a preload can significantly reduce
subsequent entrée intake, as well as total
energy intake at the meal. The present
study expanded upon prior investigations
to show that varying the form and
viscosity of soup, by changing the way in
which identical ingredients were blended,
did not significantly affect energy intake or
satiety. Therefore, consuming a preload of
low-energy-dense soup, in
a variety of forms, is one strategy that can
be used to moderate energy intake in
adults. (p.633, emphasis added)

CONCEPT #17:
Self-monitoring
(keeping track of certain
behaviors/metrics)
is likely a helpful
tool for losing
weight
FACT:
There is pretty good evidence that frequent
monitoring of behaviors and metrics
(diet, exercise, and weight)
will increases positive outcomes,
both short-term and long-term.

Self-Monitoring
Overall “A significant association between self monitoring
and weight loss was consistently found; however, the level
of evidence was weak because of methodological
limitations” (p.92)

Self-Monitoring of Body Weight
Multiple reviews of the
research in this area have
come to similar
conclusions, which are:
Checking weight
frequently, daily to weekly
can help with weight loss
and help with maintaining
the weight loss
Frequent weighing is
unlikely to cause negative
psychological outcomes

Self-Monitoring of Exercise/Activity
When it comes to exercise, self-monitoring can
help with the development of a consistent
exercise habit. This can be done through
recording amount of exercise/steps/etc, wearing
a pedometer or other exercise tracking device
such as a FitBit.

CONCEPT #18:
If a person is able to
walk for 30 minutes for
5 days a week, they
would likely lose one
pound a week
FACT:
While exercise confers many health
benefits, it causes minimal weight loss
when used alone and contributes little
when paired with dietary calorie
restriction in weight loss trials

Exercise for Weight Loss

Exercise & Calorie Burning
Walking @ 3mph 5 Times/Week for 30
Minutes
Calories Burned
= 905
Weight Lost
=¼ Pound
Exercise for 30 Minutes Calories Burned
(250 lbs person)
# of Sessions
to Lose 1 lb
Walking @ 3mph 181 19
Waling @ 4mph 300 12
Cycling @ 12mph (5 minute mile pace) 400 9
Jogging @ 5mph (12 minute mile pace) 733 5
* While these calorie numbers are accurate, they do not account for the increased food
(calorie) consumption often seen in those who are exercising and not carefully
monitoring their food intake. In other words, regardless of these figures, many people
would fail to lose weight at these exercise frequencies and intensities if their diet/calorie
intake is not controlled

Why Exercise?
• Delays all-cause mortality
• Decreases risk of CHD, stroke, type 2 DI, some cancers
• Lowers blood pressure
• Improves lipoprotein profile, c-reactive protein and other CHD
biomarkers
• Enhances insulin sensitivity/blood sugar regulation
• Preserves bone mass
• Preserves muscle mass
• Reduces risk of falling in older adults
• Prevention and improvement of depression and anxiety
• Enhances: feelings of “energy”, well-being, quality of life, cognitive
function
*adapted from: Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal,
and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. (Garber et al, 2011)
…. But NOT for Weight Loss 

CONCEPT #19:
Meal replacements are
not a helpful strategy for
losing weight
FACT:
In general, utilizing a variety of different types of
quick and convenient “meal replacements” can be a
helpful tool for losing weight and maintaining the
weight lost.

Meal Replacements
“Meal replacements provide portion- and calorie-
controlled servings, which can facilitate weight
loss by reducing the consumption of inappropriate
foods. Additionally, meal replacements increase
the reliability of estimated energy intake, decrease
food options, and provide structure to meal plans,
each of which increase compliance with a
treatment program” (p.27)
“Substituting one or two daily meals or snacks with meal replacements is a
successful weight loss and weight maintenance strategy” (p.335)*
“Conclusion: The first systematic evaluation of randomized controlled trials utilizing PMR [partial meal replacement]
plans for weight management suggest that these types of interventions can safely and effectively produce sustainable
weight loss and improve weight-related risk factors of disease” (p.537)

What are “Meal Replacements”?
“Presently, there are no standard definitions of “meal
replacement” or PMR plans. The term meal replacement,
as applied in the scientific literature, encompasses
a wide range of food products, including beverages, prepackaged
shelf-stable and frozen entrees, and meal snack
bars. These foods can be used as the sole energy
source for a meal or in combination with other foods.
Meal replacements can be purchased at medically supervised
weight-loss clinics, commercial weight-loss centers,
over the counter, on the Internet, and through
independent direct sales distributors. The majority of
meal replacement products are vitamin-mineral fortified, designed
to replace 1 or 2 regular meals daily while providing
advice for a nutritionally balanced low-fat, low energy
meal plan.” (Li et al, p.23-24)

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References
Fundamental principle #1, Simple:
• Hall. K. et al (2012). Energy balance and its components: implications for body weight regulation. Am J Clin Nutr; 95: 989-994.
• Schoeller, D. (2009). The energy balance equation: looking back and looking forward are two very different views. Nutrition
Reviews; 67(5): 249-254.
Fundamental principle #2, Complexity:
• Power, ML. & Schulkin, J. (2009). The evolution of obesity. John Hopkins University Press. Baltimore, Maryland
• Ulijaszek, SJ. & Lofink, H. (2006). Obesity in biocultural perspective. Annu Rev Anthropol; 35: 337-360.
• Zheng, H. & Berthoud, H. (2008). Neural systems controlling the drive to eat: Mind versus metabolism. Physiology; 23: 75-83
Fundamental principle #3, Finite resources:
• Pereto Principle; http://www.bsu.edu/libraries/ahafner/awh-th-math-pareto.html, http://blogs.hbr.org/2012/05/the-unimportance-
of-practicall/, http://en.wikipedia.org/wiki/Pareto_principle
Evidence based practice references
• Guyatt, G. et al . (2008). GRADE: what is “quality of evidence” and why it is important to clinicians? BMJ; 336; 995-998
• McKeon, P et al (2006). Hierarchy of research design in evidence-based sports medicine. Athletic Therapy Today; 11(4)
• Shlonsky, A & Gibbs, L. (2004). Will the real evidence-based practice please stand up? Teaching the process of evidence-based
practice to the helping professionals. Brief treatment and crisis intervention; 4(2)
#1-A pound of body fat contains 3,500 calories:
• http://www.health.gov/dietaryguidelines/dga2005/healthieryou/html/chapter5.html
• Kershaw, R. & Flier, J. (2004). Adipose tissue as an endocrine gland. J Clin Endocrinol Metal; 89(6):2548-56.
• Wishnofsky, M. (1958). Caloric equivalents of gained or lost weight. Am J Clin Nutr; 6(5): 542-546.
• Hamdy, O. et al (2006). Metabolic Obesity: The Paradox Between Visceral and Subcutaneous Fat. Current Diabetes Review; 2(4):
1-7
• Waki, H. & Tontonoz, P. (2007). Endocrine functions of adipose tissue. Annu Rev Pathol Mech Dis; 2: 31-56.
#2-Eating more often and metabolic rate:
• Bellisle, F et al (1997). Meal frequency and energy balance. Br J Nutr; 77 (suppl 1): S57-S70.
• Cameron, J. et al (2010). Increased meal frequency does not promote greater weight loss in subjects who were prescribed an 8-
week equi-energetic energy-restricted diet. Br J Nutr; 103: 1098-1101.
• Leidy, H. & Campbell, W. (2011). The effect of eating frequency on appetite control and food intake: Brief synopsis of controlled
feeding studies. J Nutr; 141: 154S-157S.

References – cont.
#3-Skipping a meal, metabolic rate and its effects on subsequent energy intake:
• Leidy, H & Campbell, W. (2011). The effect of eating frequency on appetite control and food intake: Brief synopsis of controlled feeding studies. J
Nutr; 141: 154S-157S.
• Levitsky, D. & DeRosimo, L (2010). One day of food restriction does not result in an increase in subsequent daily food intake in humans.
Physiology & Behavior; 99: 495-499.
• Mattson, M. (2005). The need for controlled studies of the effects of meal frequency on health. Lancet; 365: 1978-1980.
• Palmer, M. et al (2009). Association between eating frequency, weight, and health. Nutr Reviews; 67(7): 379-390.
• Parks, E. & McCrory, M. (2005). When to eat and how often? Am J Clin Nutr; 81: 3-4.
• Saris, WHM. (1995). Effects of energy restriction and exercise on the sympathetic nervous system. Inter J Obese Relat Metab Disord; Suppl 7:
S17-S23.
• Taylor, MA & Garrow, JS (2001). Compared to nibbling, neither gorging nor a morning fast affect short term energy balance in obese patients in
a chamber calorimeter. Inter J Obesity; 25: 519-528.
• Webber, J. & Macdonald, I.A. (1994). The cardiovascular, metabolic and hormonal changes accompanying acute starvation in men and women.
Br J Nutr; 71: 437-447.
#4-Eating relatively higher amounts of protein:
• Carbone, J. et al (2012). Skeletal muscle responses to negative energy balance: Effects of dietary protein. Adv Nutr; 3: 119-126.
• Bosse, J & Dixon, B. (2012). Dietary protein in weight management: a review proposing protein spread and change theories. Nutrition &
Metabolism; 9:81.
• Westerterp-Plantenga. M. et al (2012). Dietary protein – its role in satiety, energetics, weight loss and health. Br J Nutr; 108: S105-S112.
• Layman, D. (2009). Dietary guidelines should reflect new understandings about adult protein needs. Nutrition & Metabolsim; 6:12.
• Layman, D. et al (2008). Protein in optimal health: heart disease and type 2 diabetes. Am J Clin Nutr; 87 (suppl): 1571S-1575S.
• Protein content of selected foods retrieved from http://nutritiondata.self.com/
• http://www.quorn.us/products/61/grounds
#5-There are no fattening foods:
• Park, M. (2010). Twinkie diet helps nutrition professor lose 27 pounds. Retrieved from
http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/
• 20 potatoes a day. Retrieved from http://www.20potatoesaday.com/index.html
• Also see references for #10 Calorie Deficit
• Lowndes, J. et al (2012). The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on weight loss and
related parameters. Nutr J; 11:55.
• Surwit, R. et al (1997). Metabolic and behavioral effects of a high-sucrose diet during weight loss. Am J Clin Nutr; 65: 908-915.
• West JA & de Looy AE. (2001). Weight loss in overweight subjects following low-sucrose or sucrose-containing diets. Int J Obes Relat Metab
Disord; 25(8):1122-8.

#6-Your Basal Metabolic Rate is the MAIN determinant of Total Energy Expenditure:
• MacLean, P. (2011). Biology’s response to dieting: the impetus for weight regain. Am J Physiol Regul Comp Physiol; 301: R581-
R600.
• Hall. K. et al (2012). Energy balance and its components: implications for body weight regulation. Am J Clin Nutr; 95: 989-994
• Levine, JA. (2007). Nonexercise activity thermogenesis – liberating the life-force. J Intern Med; 262: 273-287.
• Weijs, P. (2008). Validity of predictive equations for resting energy expenditure iin US and Dutch overweight and obese class I and
II adults aged 18-65 y. Am J Clin Nutr; 88: 959-970.
• WebMD metabolic calculator. Retrieved from http://www.webmd.com/diet/healthtool-metabolism-calculator
#7-Gaining muscle is likely to happen when someone is LOSING weight and working out:
• Chaston, TB. Et al (2007). Changes in fat free mass during significant weight loss: a systematic review. Inter J Obesity; 31: 743-
750.
• Stiegler, P. & Cunliffe, A. (2006). The role of diet and exercise for the maintenance of fat free mass and resting metabolic rate
during weight loss. Sports Med; 36(3): 239-262.
• Weinheimer, E. et al (2010). A systematic review of the separate and combined effects of energy restriction and exercise on fat free
mass in middle aged and older adults: implications for sarcopenic obesity. Nutr Reviews; 68(7): 375-388.
#8-A great way to increase your metabolic rate is to gain some muscle:
• Heymsfield, S. et al (2002). Body-size dependence of resting energy expenditure can be attributed to nonenergetic homogeneity of
fat-free mass. Am J Physiol Endocrinol Metab; 282: E132-E138.
• Ravussin, E. et al (1986). Determinants of 24-hour energy expenditure in man. J Clinical Investigations; 78: 1568-1578.
• Wolfe,R. (2006). The underappreciated role of muscle in health and disease. Am J Clin Nutr; 84:475–82.
#9-Muscle weighs more than fat:
• Muscle, retrieved from http://en.wikipedia.org/wiki/Muscle

#10-To lose weight, creating a calorie deficit is the most important determinant of weight loss:
• Alhassan, S. et al (2008). Dietary adherence and weight loss success among overweight women: results from the A TO Z weight
loss study. International Journal of Obesity; 32, 985–991
• Brehm, B. & D’Alessio, D. (2008). Weight loss and metabolic benefits with diets varying fat and carbohydrate content: seperating
the wheat from the chaff. Nature Clinical Practice; 4(3): 140-146.
• Buchholz, A. & Schoeller, D. (2004). Is a calorie a calorie. Am J Clin Nutr; 79(suppl); 899S-906S.
• Das, S. et al (2007). Long-term effects of 2 energy restricted diets differing in glycemic load on dietary adherence, body
composition, and metabolism: a 1-y randomized controlled trial. Am J Clin Nutr; 85: 1023-1030.
• Foreyt, JP. et al (2009). Weight-reducing diets: Are there any differences? Nutrition Reviews; 67(suppl 1): S99-S101.
• Hite, A. et al (2011). Low-Carbohydrate Diet Review: Shifting the Paradigm. Nutr Clin Pract; 26(3): 300-308
• Martin, CK. et al (2011). Change in food cravings, food preferences, and appetite during a low carbohydrate and low fat diet.
Obesity; 19(10): 1963-1970.
• Sacks, F. et al (2009). Comparison of weight loss diets with different compositions of fat, protein, and carbohydrates. NEJM; 360:
859-873.
• Wycherley, TP. Et al (2012). Comparison of the effects of 52 weeks weight loss with either a high-protein or high-carbohydrate diet
on body composition and cardiometabolic risk factors in overweight and obese males. Nutrition and Diabetes; 2: e40.
• http://www.pbs.org/wgbh/nova/body/is-a-calorie-a-calorie.html
• http://www.foodpolitics.com/2012/08/low-carb-or-low-fat-do-calories-count/
• http://hip.stanford.edu/online-resources/Documents/Is%20a%20calorie%20always%20a%20calorie%20-
%20Gardner%208Oct%202012%20HIP%20Webinar.pdf
#11-If your calorie intake is very low it will likely inhibit weight loss, often referred to as “starvation mode”:
• Stewart, W.K. & Fleming, L.W. (1973). Features of a successful therapeutic fast of 382 days duration. Postgraduate Medical J; 49:
203-209.
• Heymsfield, S. et al (1995). The calorie: myth, measurement, and reality. Am J Clin Nutr; 62(suppl): 1034S-1041S.
• Lichtman, S. et al (1992). Discrepency between self-reported and actual caloric intake and exercise in obese subjects. New Eng J
Med; 327: 1893-1898.
• de Boer, J. et al (1986). Adaptation of energy metabolism of overweight women to low-energy intake, studied with whole-body
calorimeters. Am J Clin Nutr; 44: 585-595.
• Robinson, D. (2012).Starvation mode: fact or fiction? Retrieved from http://www.beyonddiets.com/beyonddiets-
blog/2012/3/9/starvation-mode-fact-or-fiction.html

#12-Sleep duration can have a significant impact on appetite regulating hormones:
• Cripim, C.A. et al (2007). The influence of sleep and sleep loss upon food intake and metabolism. Nutr Research Rev; 20:
195-212.
• Patel, S. & Hu, F. (2008). Short sleep duration and weight gain: a systematic review. Obesity; 16(3): 643-653.
• Sleep Foundation (n.d.) How much sleep do we need? Retrieved from http://www.sleepfoundation.org/article/how-sleep-
works/how-much-sleep-do-we-really-need
• St-Onge, MP. (2013). The role of sleep duration in the regulation of energy balance: Effects on energy intakes and
expenditure. J Clin Sleep Med; 9(1): 73-80.
• Breus, M. (n.d.). Sleep Habits: More Important Than You Think. Retrieved from http://www.webmd.com/sleep-
disorders/features/important-sleep-habits
• Taheri, S. (2007). The Interactions Between Sleep, Metabolism, and Obesity. INT J SLEEP WAKEFULNESS; 1(1): 20-29.
#13-Drinking 2 cups of water (fluid) before a meal will typically cause a decrease in food intake for that meal:
• Daniels, M. & Popkin, B. (2010). The impact of water intake on energy intake and weight status: a systematic review. Nutr
Rev; 68(9): 505-521.
• Dennis, E. et al (2010). Water consumption increases weight loss during a hypocaloric diet intervention in middle-aged and
older adults. Obesity; 18(2): 300-307.
• Stookey, J. et al (2008). Drinking water associated with weight loss in overweight dieting women independent of diet and
activity. Obesity; 16: 2481-2488.

14-Sugar is addictive:
• Benton, D. (2010). The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical Nutrition; 29: 288-303.
• Kessler, D. (2009). The end of overeating. Taking control of the insatiable American appetite. New York. Rodale Books.
• Rogers, P. & Smit, H. (2000). Food craving and food “addiction”: A critical review of the evidence from a biopsychosocial
perspective. Pharmacol Biocehm Behav; 66(1): 3-14.
• Ziauddeen, H. et al (2012). Obesity and the brain: how convincing is the addiction model? Nature Reviews; 13: 279-286.
#15-As we get older our metabolism slows down substantially:
• Roberts, S. & Rosenberg, I. (2006). Nutrition and aging: Changes in the regulation of energy metabolism with aging. Physiology
Review; 86: 651-667.
#16-Eating high volume/high fiber based foods such as non-starchy veggies , fruits and soups can help increase the satiation of a meal
and lead to eating less calories at that meal:
• Flood, JE. & Rolls, BJ. (2007). Soup preloads in a variety of forms reduce meal energy intake. Appetite; 49(3):626-34.
• Flood-Obbagy, JE. & Rolls, BJ. (2009). The effect of fruit in different forms on energy intake and satiety at a meal. Appetite; 52(2):
416-422.
• What is energy density? http://www.nutrition.org.uk/healthyliving/fuller/what-is-energy-density
• Almiron-Roig, E. et al (2013). Factors that determine energy compensation: a systematic review of preload studies. Nutrition
Reviews; 71(7): 458-473.
• CDC (n.d.). Low-energy-dense foods and weight management: cutting calories while controlling hunger. Retrieved from
http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/r2p_energy_density.pdf
• Ello-Martin, J. et al (2005). The influence of food portion size and energy density on energy intake: implications for weight
management. Am J Clin Nutr; 82(suppl): 236S-241S.
• Rolls, B. et al (2005). Provisions of foods differing in energy density affects long-term weight loss. Obesity Research; 13(6): 1052-
1060.
• Rolls, BJ. et al (2005). Changing the energy density of the diet as a strategy for weight management. J Am Diet Assoc; 105: S98-
S103.

#17-: Self-monitoring
• Burke, L. et al. (2011). Self-monitoring in weight loss: A systematic review of the literature. J Am Diet Assoc; 111(2): 92-102.
• Zheng, Y. et aal. (2015). Self-weighing in weight management: A systematic literature review. Obesity; 23(2): 256-265.
• Pacanowski, C. et al (2014). Daily self-weighing to control bodyweight in adults: A critical review of the literature. SAGE Open: 1-
16
• VanWormer, J. et al. (2008). The impact of regular self-weighing on weight management: A systematic literature review. Inter J
Behavioral Nutr Physical Activity; 5:54.
#18: Exercise and weight
• Garber, CE. Et al (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and
maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing
exercise. Med Sci Sports Exerc; 43(7):1334-59
• Donnelly, J. Et al (2009). American College of Sports Medicine Position Stand. Appropriate physical activity intervention
strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc; 41(2):459-71
• King, NA. Et al (2008). Individual variability following 12 weeks of supervised exercise: identification and characterization of
compensation for exercise-induced weight loss. Int J Obes; 32(1):177-84.
• Miller, WC. Et al (1997). A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise
intervention. Int J Obes Relat Metab Disord; 21(10):941-7.
• Shaw, K. Et al (2006). Exercise for ovwerweight or obesity. Cochrane Database of Systematic Reviews; 4(CD003817).
• Wu, T. Et al (2009). Long-term effectiveness of diet-plus-exercise interventions vs. diet-only interventions for weight loss: a meta-
analysis. Obes Rev; 10(3):313-23
#19: Meal replacements

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