Nutrition

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Nutrition

• Class 3 and 4
• Exercise, Diet, and Weight Management
• Instructor Samantha Rubin, MS, RD, CDE

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The Calorie Balance

• Kcal in vs Kcal out
• Kcal in Kcal out weight gain
• Kcal in Kcal out weight maintenance
• Kcal in

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CALORIES CALORIES CALORIESThe Bottomline!

• Calories in
• Beverages
• Food
• Fat- 9 kcal/gm
• Protein- 4 kcal/gm
• Carbs- 4 kcal/gm
• Alcohol-7 kcal/gm
• Choose lower calorie foods
• Portion Sizes

• Calories out
• RMR
• Activity
• Exercise
• Eat more often, at least every 4 ½ to 5 hours
• 58 of Americans do not eat breakfast

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The Calorie Balance

• 1 pound body fat 3500 calories
• Realistic goal 1-2 pounds per week
• To do need to take in 500-1000 calories less per
  day, than what is being used
• Average American consumes 2900 calories per day

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Realistic Weight Loss Goals

• Should be 1-2 pounds per week.
• Studies show that weight loss that occurs above
  this tends to be gained back easier
• Slow weight loss tends to be the result of
  lifestyle changes from reduction of energy intake
  and increased energy output.
• Weight loss greater than 1-2 pounds per week is
  more a result of water and protein loss.

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Not Easy To Lose

• Consistency! Need to maintain 500-1000 kcal
  deficit daily for the 1-2 pound weight loss per
  week.
• Expectations often higher 1-2 pounds for all of
  the hard work doesnt seem worthwhile.
• 1 pound per week 50 pounds in a year
• BMI greater than 30, the initial goal 10
• Health benefits and good start!

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Yet Easy to Gain

• 8 extra calories per day (more in than out) over
  30 years can result in a 10 kg (22 ) weight gain
• creeping obesity
• 5 more calories in than out over 1 year could
  result in a 5 kg (11) weight gain
• take in 2100 and expend 2000- easy to do!

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Adipose Tissue

• Adipocytes
• Lean adult- approximately 35 billion
• Extreme obese adult- 4xs- 125 billion
• Triglycerides
• Bodys major fuel reserve
• Contained in adipocyte
• Obese- may contain 2xs as much TG
• Hypercellular obesity- greater
• Hypertrophic obesity- greater size
• Average 70 kg man has 120,000 calories of stored
  adipose tissue (fat)!

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What is lost?

• When lose weight with mild kcal deficit, the
  weight loss is
• 75-85 fat
• 15-25 fat free mass
• When reduce kcal intake drastically, more of the
  weight loss is fat free mass.
• Create energy deficit 3500 kcal, in reality lose
  1 lb because of oxidizing lean tissue and water
  losses.

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What is lost?

• Most, if not all, of the loss of fat is caused by
  a decrease size of fat cells
• decreased lipid content
• may be factor in regain
• Large long-term fat loss can decrease number of
  fat cells.
• Glycogen- energy source in muscle tissue.
• 1 gm of glycogen stored with 2 gm of water.
• Lose weight faster when losing lean tissue versus
  adiipose tissue

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Back to Calories In vs Calories Out

• Need to create kcal deficit of 500 to 1000 kcal
  per day
• general recommendation for achieving this
  combination of diet and exercise
• Many ways to determine how many kcal needed per
  day to create this deficit.
• General recommendation
• Women- 1200 to 1500 kcal/day
• Men- 1500 to 1800 kcal/day
• 20 to 25 kcal per kg

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Calorie Needs

• Harris Benedict formula- takes height, weight,
  and age into account- add an activity factor and
  subtract for weight loss tends to over-calculate
  needs by 5.
• RDAs
• Males after age 51 drops to 2,300 calories

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Calorie Needs

• 9-10 calories/pound sedentary
• 12-13 calories/pound light activity
• 14-20 calories/pound moderate to heavy activity
• May want to decrease 100 calories after the age
  of 30 and 100 calories after for every 10 years.
• Oliver equation women- 795 7.18 x wt (kg) for
  men- 879 10.2 x wt (kg)

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RMR

• Stands for resting metabolic rate- this is the
  average energy metabolism of a person resting in
  a comfortable environment does not include
  physical activity but does include thermic effect
  of food.
• Higher for men, decreases with age, and is
  affected by body composition, weight, diet,
  temperature, hormones, drugs, stress and
  exercise.
• For every 1 degree increase in body temp there is
  a 7 increase in metabolic rate.

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Direct Calorimetry

• Best way to measure energy needs both rest and
  total energy expenditure
• Metabolic cart- indirect measurement, based on
  weight, height, age
• Bodygem- measure volume of oxygen consumed

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RMR

• So do obese individuals have a lower RMR? Studies
  show this is not the case, they have the same
  RMR. BUT studies show they have a lower total
  energy expenditure, most likely due to not as
  much physical activity.

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Weight Loss

• So does cutting calories and weight loss result
  in a decrease in RMR?
• Does exercise seem to prevent this? YES!

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Thermic Effect

• Thermic Effect of food
• Protein cost 25 of its energy content to
  digest, absorb, metabolize, store
• Carbs 10
• Fats 3
• TEF mixed meal is 8.
• 1 decrease in TEF would result in 2.6 wt gain
  per year, change from a high carb to high fat
  diet, even if same calories, will gain weight.

• Thermic Effect of exercise
• Seems that exercise tends to raise the RMR for
  many hours after exercise
• May be as long as 12 hours
• Effect is proportional to the intensity and
  duration of exercise.

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Fun Fact

• Organs make up 75 of resting metabolic rate,
  resting skeletal muscles make up 20 of RMR,
  adipose tissue accounts for only 5 of RMR.

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Calories In Detail

• Calorie- energy content of food is measured in
  kilocalories
• definition amount of heat required to raise the
  temperature of 1 kg of water 1 degree Celsius
  from 14.5 to 15.5 degrees Celsius
• 3 types carbohydrates, protein, fat
  (macronutrients)
• foods made up of different combos of the
  different types of kcal
• fat- concentrated source kcal
• high fat foods, high kcal foods
• Diets vary in the types of kcal they emphasize
  or exclude
• Dieters love diets when they allow unlimited
  eating of at least certain foods/food groups and
  do not appear to limit calorie intake.

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Food Groups- Type of Kcal

• Starches- mainly carbohydrate, little protein, no
  fat
• 15 grams C, 3 grams P, 0 grams F, 80 kcal
• Meats- no carbohydrates, protein, varying fat
• 0 grams C, 7 grams P, 3 - 8 grams F, 55-100 kcal
• Dairy- carbohydrates, protein, varying fat
• 12 grams C, 8 grams P, 0 - 8 grams F, 90-150 kcal
• Vegetables- carbohydrates, little protein, no fat
• 5 grams C, 2 grams P, 0 grams F, 25 kcal
• Fruits- carbohydrates, no protein, no fat
• 15 grams C, 0 grams P, 0 grams F, 60 kcal
• Fats- no carbohydrates, no protein, fat
• 0 grams C, 0 grams P, 5 grams F, 45 kcal

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New RDIs

• 45-64 of calories from carbohydrates
• 20-35 of calories from fat
• 10-35 of calories from protein
• 130 gm of carbohydrates per day- this is what the
  brain requires for glucose
• 0.8 kg/gm of protein
• 38 gm fiber for men, and 25 gm for women, after
  age of 50, then 30 gm men and 21 gm for women.

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American Diabetes Association

• Carbohydrates 45-65
• Fat 20-35
• Protein 15-20

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Putting it into practical terms
How do you apply the recommendations for
macronutrient composition? Millions of people
are asking, So what should I eat? Common
teaching tool is the Food Guide Pyramid.
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Food Guide Pyramid

• 6 serving of grains- for weight loss this is
  appropriate
• 2-3 fruits
• 2-3 milk
• 6-7 oz protein
• Limit fats
• Vegetables

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Food Guide Pyramid

• Problems include
• All fats lumped together
• Potatoes as vegetables
• Dried beans as meat
• Too much emphasis on total carbs instead of
  healthier carbs
• Quantities/servings
• Being evaluated by the USDA, expect to hear by
  2005 if any changes

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5 A Day
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Australian Food Guide
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Effect of Varying Macronutrient Compositions on
Food Intake and Body Weight

• Diets and weight loss plans vary in the types
  of kcal they emphasize and exclude.
• High protein, high fat, low carbohydrate
• Low fat, high carbohydrate
• 40/30/30
• Focus on fiber
• Research studies have been done to determine
  effectiveness of the different approaches.

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High Protein/Fat, Low Carbohydrates

• Emerged 50s-60s many versions
• Atkins currently
• Based on premise carbohydrate/sugar, low satiety
  value, create artificial appetite
• Can promote weight loss for some individuals
• self limiting- energy deficit created
• fat higher satiety value?
• more palatable enhanced long term compliance?
• water loss w/ loss lean body mass
• Hard to follow long term
• stepping stone?
• Not adequate from nutrition standpoint
• fiber, fat (type of fat), vitamins/minerals

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Theories how fat causes obesity

• Fat causes people to overeat
• fat increases palatability
• Energy dense
• small quantities yet lots of kcal
• Obese individual insensitive to satiety value of
  fat?
• Body has little ability to increase fat oxidation
  to compensate leading to storage of excess diet
  fat as body fat

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Diet Composition and Wt.

• Has been suggested low fat, regardless kcal,
  weight loss
• Result- increased intake low fat/fat free foods
• Over the last decade, Americans cut their fat
  intake from 36 to 34 of calories, but energy
  intake increased 100 to 300 calories
• Overweight increased 8 over the same time period

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Modified High Protein, High Fat, Low Carbohydrate

• Many versions
• 40/30/30
• South Beach Diet
• The Zone
• Can be effective
• decreases starches- often area of diet where
  excess kcal come from
• decreases sweets/simple sugars
• Metabolic Syndrome- studies suggest this can be
  more effective for weight loss than low fat
• Nutritionally adequate- higher fiber starches,
  lean proteins, heart healthy fats

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High Fiber

• Theory high fiber- slows gastric emptying and
  intestinal motility- feel full faster and longer
• More chewing, takes longer to eat
• On its own small effect.
• When used as part of an overall diet low in kcal,
  increased effect.
• Diets low in dietary fiber may be associated with
  higher body weights.

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Energy Density- the Key?

• High fat- high energy density
• If there is a tendency to maintain the volume of
  food consumed at a constant level, high fat diet
  diets- elevated energy intake
• When subjects were fed diets w/ increasing levels
  of fat and energy density, ate same amount so
  kcal increased with increasing fat.
• Maybe obese compensate poorly for changes in
  energy density?
• Difficult to decrease energy density or fat
  content without increasing fiber.

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Volumetrics

• Larger portions result in people eating more
• Telling people to eat less, wont necessary solve
  the problem.
• Individuals learn portion sizes
• Potential solution lower density foods
• Ex. Raisins, 100 calorie for ¼ cup, but grapes
  100 calorie for 1 2/3 cup.
• Safe to say diet low density, high fiber, low
  kcal good for weight loss

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3 Apples a Day Diet

• Golds Gym in California
• Premise is to start each meal with one small
  apple.
• Why would this help you lose weight?

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Problems with Nutrition Research

• Has been shown that food intake is underreported
• self reports of food intake become less accurate
  as dietary intake increases
• obese especially prone
• Obese individuals tend to overestimate their
  activity level

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Survey Studies

• Study people in their natural environment
• NHANES, Nurses Health Study
• Survey studies suggest
• Relationship between dietary fat and obesity
  independent of energy intake
• underreporting?
• Overall, high fat, low carbohydrate, low fiber,
  and high sugar diet is associated with excessive
  energy intake
• Indicate that obese individuals have a preference
  for high fat foods but is this due to training
  the taste buds?
• Large clinical sample- fat major nutrient source
  in top 10 favorite foods

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Intervention Studies

• Procedure
• baseline intake determined
• intervention group instructed on how to modify
  diet or exercise
• evaluate compliance and efficacy compare the
  changes in weight between two groups
• ex Womens Health Trial
• Suggest obese, low fat diet, no conscious kcal
  restriction, modest weight loss restrict fat and
  kcal may be more effective
• Enhanced weight loss maintained?

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Laboratory Studies

• Dietary manipulations are highly controlled food
  intake accurately measured
• Energy content fat/carbohydrate metabolically
  equivalent?
• Thermic effect of food
• cost deposition dietary fat into body fat- 3
• dietary carbohydrates 23
• In rats, same kcal, lower fat, greater loss
  adipose tissue
• In humans, to date fat to carb ratio does not
  affect body composition.

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Type of calories vs amount

• It has been put forward by some in the popular
  press that in weight reduction, the type of
  calories an individual eats is more important
  than the total amount of calories eaten
• As far as research, there is little indication
  that the macronutrient composition of a
  nutritionally adequate weight reduction diet is
  important- most important is total energy is
  reduced.

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Using the research...

• Energy (calorie) reduction can best be achieved
  by
• Reducing fat intake
• Increasing high-fiber, low energy-dense foods
• Reducing intake of high energy-dense foods
• Reducing alcohol consumption

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In practical terms...

• Eat small quantities every 4 to 5 hours.
• Make vegetables the bulk of the meal.
• Decrease portion sizes of meats and starches.
• Water is the most important beverage for weight
  loss. Calorie free, caffeine free beverages.
• Fruits for snacks and dessert.
• Limit fried foods.
• Work on eating more slowly
• Consistency!

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How to spot a Quack Diet

• 54 million Americans are on a diet.
• Remember 85 of Americans do not receive advice
  about how to lose weight from a health
  professional
• 35 billion spent annually on weight loss
  products and services
• Many Quack diets!

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Quack Diets

• claim or imply a large or quick weight loss of
  more then 1-2 pounds/week.
• promote magical or miracle foods
• no foods can undo the long-term effects of
  overeating and not exercising or melt away fat
• restrict or eliminate certain foods, recommend
  certain foods in large quantities, insist on
  eating specific food combinations, or offer
  rigid, inflexible menus
• imply that weight can be lost and maintained
  without exercise and other lifestyle changes

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Quack Diets

• rely heavily on undocumented case histories,
  testimonials, and anecdotes but have no
  scientific research to back claims
• contradict what most trusted health professional
  group say, or make promises that sound too good
  to be true

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Quack Diets

• ASK
• Does it promise success for everyone rather than
  tailoring its program to individual needs?
• Does it require a severe calorie limitation? Less
  than 1200?
• Does it rely heavily on meal substitutes?
• Are there supplements involved?
• If the answer is yes, watch out!

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Healthy Nutrition Changes versus Quack Diets

• Behavior therapy- basic learning principles that
  can help you overcome barriers to changing your
  eating and exercise habits
• can set weight loss goals
• how are you going to reach them?
• Weight loss plan is made up of nutrition and
  exercise goals.
• Individuals often try to lose weight and fail.
• Lack of willpower?
• Problem with their plan?
• We need to help our clients/patients develop
  their plan.

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How to develop Nutrition Goals

• Goals need to be
• short-term
• specific
• realistic/attainable
• forgiving
• Look at current intake and identify problem
  areas.
• The goal should be a solution to a specific
  problem area.
• One goal should address one problem.
• Not realistic to attempt more than three goals at
  one time.
• Rome wasnt built in one day.

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Good Goals?

• I will lose 50 pounds.
• I will eat less.
• I will eat more fruit and vegetables.
• I wont eat fast food anymore.
• I will drink 64 ounces of water every day,
  without fail.

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Good Goals?

• I will lose one to two pounds per week by
  working on nutrition and exercise changes.
• I will decrease my portions of starches by
  half.
• I will increase my fruit by one piece per day.
• I will make vegetables the bulk of my evening
  meal.
• I will decrease my fast food to one time per
  week.
• I will increase my water intake by eight ounces
  each week until I reach 64 ounces per day.

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Conclusions

• Weight loss is calories in versus calories out.
• Quack diets are not the way to promote weight
  loss.
• Specific nutrition changes are the way to promote
  weight loss.
• Healthy nutrition goals can help your
  clients/patients make nutrition changes.
• Understanding the above will make you successful
  in helping your clients/patients manage their
  weight.