Great Diets For Weight Reduction

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Das ist ein Vortrag, den Dr. Clarence P. Davis im Jahre 2007 im Rahmen eines Anti-Aging Kongresses in Paris gehalten hat. Er beinhaltet theoretisches Basis- und Hintergrundswissen zu den verschiedenen Diaettypen, sowie einige praktische Beispiele aus dem aerztlichen Alltag. Der Vortrag ist auf einem hohen Niveau und richtet sich ausschliesslich an professionelle Leser mit fundierten Vorkenntnissen.

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Great Diets For Weight Reduction

  1. 1.
  2. 2. Great Diets for Weight Reduction<br />Dr. Clarence P. Davis<br />Bergstrasse 8<br />CH-8702 Zollikon<br />
  3. 3. Diet and/or behavior modification:<br />Long-term results<br />-5<br />0<br />-5<br />WEight change (kg)<br />VLCD<br />Modified diet + behavior modification<br />VLCD + behavior modification<br />-10<br />-15<br />-20<br />1<br />2<br />3<br />4<br />5<br />Years after intervention<br />Intervention<br />(adapdet from Wadden TA. Ann Intern Med 1993; 119:688-93)<br />
  4. 4. Behavior modification<br />2<br />[months]<br />0<br />6<br />18<br />0<br />Standard behavioral<br />-2<br />Treatment (SBT)<br />SBT + structered<br />-4<br />meal plans<br />-6<br />SBT + fat reduction<br />SBT + caloric<br />-8<br />restriction<br />-10<br />SBT + walking<br />program 3d/week<br />-12<br />-14<br />[weight loss % of initial weight]<br />-16<br />[Sherwood et al. Int J Obes 1999;23:485-93<br />
  5. 5. Focus of every overweight therapy<br />should lie on a<br />LIVELONG<br />continuing<br />weight reduction<br />
  6. 6. activity<br />milleniumscenturies decades<br />energy density<br />
  7. 7. Cause: Genetics versus Environment<br />OBESITY<br />Catherine Christie, PhD, RD, LD/N, 2003<br />
  8. 8. Population percentage<br /> with BMI &gt; 30kg/m2<br />Prof. P James, et al., IOTF Unpublished Data.<br />Obesity Rates Could Double in 25 Years<br />
  9. 9. BIG EATER<br />
  10. 10. Definition: BIG EATER<br />Has no or only short lasting feeling of satiety<br />Eats at least once a day more than a normal restaurant size serving<br />Usually not more than 4 meals per day<br />No feelings of discomfort even after very opulent meals.<br />
  11. 11. BBC 2003<br />&apos;Big portions&apos; health warning<br />http://news.bbc.co.uk/1/hi/health/3112718.stm<br />Hamburgers are 112% bigger than they were 20 years ago<br />BBC 2003:<br />Fast food &apos;as addictive as heroin&apos;<br />http://news.bbc.co.uk/1/hi/health/2707143.stm<br />BBC 2002<br />Snack food sales rocket<br />http://news.bbc.co.uk/1/hi/uk/2262816.stm<br /> BBC 2003<br />Court dismisses <br />McDonald&apos;s obesity case<br />http://news.bbc.co.uk/1/hi/world/americas/2685707.stm<br />BB2 2002<br />Junk food battle hits <br />US schools<br />http://news.bbc.co.uk/1/hi/world/americas/2016819.stm<br />NEWS Tbo 2004:<br />Fast Food As Health Food?<br />http://news.tbo.com/news/MGALX4Y1WPD.html<br />
  12. 12. Increased Portion Sizes<br />Catherine Christie, PhD, RD, LD/N, 2003<br />
  13. 13. Comparison of Energy Densities<br />Nielsen SJ et al JAMA. 2003 Jan 22-29;289(4):450-3 <br />
  14. 14. Comparison of Energy Densities<br />Prentice AM et al Obes Rev. 2003 Nov;4(4):187-94<br />
  15. 15. Changes in body weight, fat mass and fat-free mass in overweight people during intervention with sucrose vs. artificial sweeteners. <br />10 week-followup<br />● sucrose; mean BMI 28.0; n=21 <br />∆ artificial sweetners; mean BMI 27.6; n=20<br />Over study period, significant differences between changes in:<br />body weight- P &lt; 0.001<br />fat mass- P &lt; 0.05<br />At different time points:<br />* P &lt; 0.05<br />** P &lt; 0.001<br />*** P &lt; 0.0001<br />Mean±SEM<br />Raben A, et al. Am J Clin Nutr 2002;76:721-9.<br />
  16. 16. „Energy-density“of typical fast-food<br />145% more energy per meal compared with a traditional African diet<br />A.M. Prentice et al. Obes Rev. 2003;4:187-194<br />
  17. 17. Summary:Energy density<br />Energy content of fast food is <br /> +145% higher of Gambian traditional food<br />Energy density correlates best with fat content<br />No adaptation process<br /> PASSIVE over-consumption<br />Results in:<br />Higher fat intake<br />Weight gain<br />
  18. 18. Case 1<br />Male, 56 y<br />Sales representative <br />„lots of business lunches“<br />BW: 93.4; FM: 26.1 kg (28%); LBM: 67.3 kg <br />BMI: 32.3<br />~ 1000 km of cycling every month<br />Actual Medication:<br /><ul><li>Diamicron (Gliclazidum): 0-0-1
  19. 19. Glucophage 1000 (Metformin): 1-0-0
  20. 20. Selipran (Pravastatin): ½-0-½</li></li></ul><li>Case 1<br />Therapy:<br />Ketogenic diet (1200 kcal/d) for 6 wk<br />200 g of meat/fish/poultry/(tofu)<br />Vegetable side dish<br />salad<br />Slight reduction of endurance activities<br />Adaptation of diabetic medication according to blood glucose<br />
  21. 21. WM male 56 years<br />
  22. 22. Ketogenic Diet<br />Definition:<br /><ul><li>The KD is both a high-fat/low-non-fat diet, and a diet that is calorie-restricted
  23. 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”</li></ul>Side effects<br /><ul><li>Usually none to only slight side effects if carried out properly
  24. 24. hyperuricemia
  25. 25. gout
  26. 26. gallstones</li></ul>Indication<br /><ul><li>Weight reduction under medical supervision and normal metabolic status
  27. 27. age < 60 y
  28. 28. BMI ≥ 30 kg/m2</li></li></ul><li>Ketogenic Diet<br /><ul><li>Contraindications:
  29. 29. Absolute:
  30. 30. Low serum potassium
  31. 31. Hyperuricemia
  32. 32. Any form of renal dysfunction
  33. 33. Nephrolithiasis
  34. 34. Instable angina
  35. 35. Myocardial infarction within the last 6 months
  36. 36. Epilepsy
  37. 37. Pregnancy and lactation
  38. 38. Malignancies
  39. 39. Relative
  40. 40. certain professions
  41. 41. Drivers
  42. 42. Pilots
  43. 43. etc.
  44. 44. Eating disorders</li></li></ul><li>Ketogenic Diet: Procedure<br />Thorough clinical examination:<br /><ul><li>Exclusion of contraindications</li></ul>Evaluation of protein need<br /><ul><li>Rule of thumb: per 10 kg of target weight 10 g of protein (may be increased)</li></ul>Patient instruction<br /><ul><li>Basic principles
  45. 45. Permitted and not permitted food
  46. 46. Preparation techniques (fat- and CHO-restricted cooking)
  47. 47. Possibly self control with ketone sticks
  48. 48. Slow resumption of CHO after diet</li></ul>Regular weight control in your office<br />Transition phase<br />
  49. 49. Ketogenic Diet: food choice <br />Protein need based on target weight:<br /><ul><li>10 g of biological valuable protein per 10 kg of target weight
  50. 50. Dairy products
  51. 51. 300 ml: skim milk, buttermilk, whey protein drinks
  52. 52. 2 x 180 yogurt (preferentially skim milk yogurt)
  53. 53. 100 g cottage cheese, tofu
  54. 54. 50 g of 50% fat cheese
  55. 55. Eggs
  56. 56. 1 egg
  57. 57. Fish
  58. 58. 60 g of fish (any kind, preferentially lean types) or canned fish in water
  59. 59. Meat
  60. 60. 50 g of lean meat (pork, beef, veal, horse, poultry, venison)
  61. 61. 30 g of dried meat</li></li></ul><li>Ketogenic Diet: food choice<br />In 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.<br /><ul><li>Vegetable group 1 (1 serving = 200 g)
  62. 62. Eggplant, artichoke, broccoli, cauliflower, cucumber, salt cucumber, pepperoni, cabbage (all types), mushrooms, radish, spinach, asparagus, tomato, chicory, onions, zucchini, celery, fennel
  63. 63. Vegetable group 2 (1 serving = 150 g)
  64. 64. Green beans, green lattice, dandelion, carrots, pumpkin</li></ul>One green salad per main course is extra<br />
  65. 65. Herniated disc impedes physical activity<br />Severe illness of close family member<br />WM male 56 years<br />
  66. 66. FAT EATER<br />
  67. 67. Nutritional Fat<br />Typical nutrition composition<br />Recommended nutrition composition<br />Protein<br />Protein<br />15-20%<br />15-20%<br />CHO<br />CHO<br />40-50%<br />Fat 40%<br />Fat 30%<br />45-55%<br />
  68. 68. Case 2<br />Femal, 58 y<br />Yoga instructor <br />„can’t move my body properly anymore“<br />BW: 86.9; FM: 38.2 kg (44%); LBM: 48.7 kg<br />BMI: 31.9<br />~ apart from Yoga no other physical activity<br />Actual Medication:<br /><ul><li>HRT</li></li></ul><li>Case 2<br />
  69. 69. Low-fat Diet<br />Definition:<br /><ul><li>Any diet with a restriction of fat may be called a low-fat diet.
  70. 70. Mostly a low-fat diet will also have some sort of fat-modification.</li></ul>Side effects<br /><ul><li>Usually none if fat restriction is not absolute</li></ul>Indication<br /><ul><li>A modified composition of fat should be part of every healthy nutrition. It may play a special role in
  71. 71. Cardiovascular disease (Mediterranean diet, PUFA-rich diets, DASH-diet, etc) for the prevention/therapy of dyslipidemia, and the primary and secondary prevention of arteriosclerosis</li></ul>Contraindications:<br /><ul><li>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 maintained</li></li></ul><li>Low-fat Diet: Procedure<br />Thorough clinical examination:<br /><ul><li>Evaluation of cardiovascular risk factors
  72. 72. Blood lipids
  73. 73. Blood pressure</li></ul>Diet modification<br /><ul><li>Reduction of fat below 30% of total energy intake (max. 60-70 g fat/d)
  74. 74. Distribution of fat-types: SFA:MUFA:PUFA=<1:1-1.5:<1
  75. 75. Cholesterol < 300 mg/d
  76. 76. Avoid/reduce trans fatty acids
  77. 77. Increase of fibers to ≥ 30 g/d
  78. 78. Diet should be high in CHO (~ 55-60% of total energy intake)
  79. 79. Avoid alcohol or strict alcohol reduction</li></ul>Regular weight control in your office<br />Well suited as lifelong diet<br />
  80. 80. Low-fat Diet: food choice <br /><ul><li>Ask your dietitian!</li></li></ul><li>„Fat-Quiz“<br />Recognize and estimate hidden fat!<br />Would you have know it?<br />
  81. 81. 9 g of fat<br />0,7 g of fat<br />
  82. 82. 1 handful = 50 g<br />1 handful = 40 g<br />12 g of fat<br />1,3 g of fat<br />
  83. 83. 1 handful = 20 g<br />1 handful = 40 g<br />2 g of fat<br />7 g of fat<br />
  84. 84. 1 plate<br />1 Pizza<br />10 g of fat<br />32 g of fat<br />
  85. 85. 1 serving = 180 g<br />1 seving (side dish) = 60 g<br />0,4 g of fat<br />32 g of fat<br />
  86. 86. 1 sausage = 110 g<br />1 chicken breast = 150 g<br />26 g of fat<br />2,4 g of fat<br />
  87. 87. Active center lipase<br />CHONH<br />OH<br />Xenical®<br />H2NCO<br />OH<br />Stable Xenical-complex blocks fat digestion<br />Low-fat Diet: medical treatment<br />
  88. 88. 42<br />Xenical prevents the absorption of up to 30% of dietary fat...<br />
  89. 89. 30% of <br />triglycerides <br />pass <br />undigested and are excreted.<br />…which pass through the body undigested and are excreted.<br />
  90. 90. Placebo + diet<br />Xenical + diet<br />Weight loss (%)<br />p&lt;0.001<br />12<br />p&lt;0.001<br />p&lt;0.001<br />10.2%<br />9.7%<br />10<br />8.8%<br />8<br />6.6%<br />6.1%<br />5.8%<br />6<br />4<br />2<br />0<br />Sjöström<br />Rössner<br />Davidson<br />Consistent weight loss in clinical trials<br />Sjöström L et al Lancet. 1998 Jul 18;352(9123):167-72Rössner S et al Obes Res. 2000 Jan;8(1):49-61<br />Davidson MH et al JAMA. 1999 Jan 20;281(3):235-42<br />
  91. 91. 0<br />Placebo<br />Xenical® 60mg<br />Xenical® 120mg<br />-2<br />*p&lt;0.01<br />-4<br />Veränderung Körpergewicht (%)<br />-6<br />-8<br />-10<br />60<br />70<br />80<br />90<br />104<br />-4<br />0<br />10<br />20<br />30<br />40<br />52<br />Xenical: Long-term weight reduction<br />Sjöström L et al Lancet. 1998 Jul 18;352(9123):167-72<br />
  92. 92. Placebo + lifestyle modification<br />Xenical + lifestyle modification<br />(kg)<br />0<br />–3<br />–4,1 kg<br />–6<br />–6,9 kg<br />–9<br />p&lt;0.001 vs. Placebo<br />–12<br />0<br />52<br />104<br />156<br />208<br />Woche<br />Xenical: XENDOS-results<br />Torgerson JS et al Diabetes Care. 2004 Jan;27(1):155-61 <br />
  93. 93. Low-fat Diet<br />

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