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Deciphering Diets: From Atkins to Zone

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Deciphering Diets: From Atkins to Zone presented by: Paula Ackerman, MS, RD, CDE 2011 Lots of controversy re: GI Glycemic Load = GI X grams carb per serving divided ... – PowerPoint PPT presentation

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Title: Deciphering Diets: From Atkins to Zone


1
Deciphering Diets From Atkins to Zone
  • presented by
  • Paula Ackerman,
  • MS, RD, CDE
  • 2011

2
The Stress Diet
  • Breakfast
  • 1 grapefruit
  • 1 slice WW toast
  • 1 cup skim milk
  • Lunch
  • 3 oz steamed chicken
  • 1 cup spinach
  • 1 cup herbal tea
  • 1 Hersheys kiss
  • Afternoon Snack
  • The rest of the Hersheys kisses in the bag
  • 1 tub ice cream with hot fudge topping
  • Dinner
  • 4 glasses of wine
  • 2 loaves garlic bread
  • 1 family size supreme pizza
  • 3 Snickers bars
  • Evening Snack
  • 1 whole Sara Lee cheesecake (eaten directly
    from the freezer)

3
Losing Weight
  • 2011 Food Health Survey
    (International Food Information Council
    Foundation)
  • 43 report they are actively trying to lose
    weight (down from 54 in 2008)
  • Only 54 are dieting and exercising
  • Success?? the average dieter regains
  • 66 after 1 years
  • 98 after 5 years

4
Losing Weight
  • 2011 Calorie Control Council Survey
  • 54 report they are trying to lose weight
  • 86 are cutting back on sugar
  • 85 are cutting portions
  • 78 are drinking low-cal or sugar-free beverages
  • 73 are combining calorie reduction and physical
    activity
  • 17 are skipping meals
  • 13 are using diet pills
  • 7 are using online diet programs

5
Best Diets (US News 2011)
  • Rated by panel of health experts
  • Top-rated
  • easy to follow
  • Nutritious
  • Safe
  • effective for weight loss (short and long term)
  • effective against diabetes and heart disease
  • http//health.usnews.com/best-diet/

6
Top Diets Overall(US News 2011)
  • Dietary Approaches to Stop Hypertension (DASH)
  • Mediterranean
  • Therapeutic Lifestyle Changes (TLC)
  • Weight Watchers
  • Mayo Clinic
  • Volumetrics
  • 7-10 Jenny Craig, Ornish, Vegetarian, Slim Fast
  • 11-20 Nutrisystem, Vegan, South Beach,
    Eco-Atkins, Zone, Glycemic Index, Medifast, Raw
    Food, Atkins, Paleo

7
Top Diets Overall(US News 2012)
  • Dietary Approaches to Stop Hypertension
  • (DASH)
  • Therapeutic Lifestyle Changes (TLC)
  • Mayo Clinic
  • Mediterranean
  • Weight Watchers
  • 6. Volumetrics
  • 7-10 Jenny Craig, Biggest Loser, Ornish,
    Vegetarian
  • 11-20 Slim-Fast, Flat Belly, Nutrisystem, Abs
    Diet, South Beach, Vegan, Eco-Atkins, Glycemic
    Index, Zone, Macrobiotic Diet

8
Top Diets Weight Loss(US News 2011 and 2012)
  • 2011
  • Weight Watchers
  • Jenny Craig
  • Raw Food Diet
  • Volumetrics
  • Slim-Fast
  • Vegan
  • 2012
  • Weight Watchers
  • Biggest Loser
  • Jenny Craig
  • Raw Food Diet
  • Volumetrics
  • Atkins
  • Slim-Fast
  • Vegan

9
Dietary Approaches to Stop HTN (DASH)
  • 459 adults with sbp lt 160
    dbp of 80-95 BMI lt 35
  • 27 had HTN 49 women 60 African Amer.
  • 1/3 with income lt 30,000 per year
  • 3 meal plans
  • Typical American diet (control gp)
  • Typical American diet more fruits/veges
  • DASH

10
DASH Eating Plan Goals
  • Total fat no more than 27 total calories
  • Saturated fat 6 calories or less
  • Dietary cholesterol 150 mg or less
  • Protein 18 total calories
  • High fiber 30 g or more
  • Magnesium 500 mg or more
  • Calcium 590 mg per 1000 calories
  • Potassium 4700 mg or more
  • Sodium 2300 mg or less

11
DASH Eating Plan
1600 cal 2000 cal 3100 cal
Grains 6/day 7-8/day 12-13/day
Vegetables 3-4/day 4-5/day 6/day
Fruits 4/day 4-5/day 6/day
Dairy 2-3/day 2-3/day 3-4/day
Lean protein 3-6 oz/day 6 oz/day 6-9 oz/day
Nuts/seeds/dried beans 3/wk 4-5/wk 1/day
Fats/oils 2/day 2-3/day 4/day
Sweets 0 5/wk 2/day
12
DASH Results
  • At end of the study (8 weeks)
  • Changes occurred within 2 weeks
  • DASH more effective in those with HTN and
    minority groups (comparable to first line
    anti-HTN therapy)

Drop in sbp vs control Drop in dbp vs control
Fruits/Veges 2.8 mmHg 1.1 mmHg
DASH 5.5 mmHg 3.0 mmHg
13
What percent of Americans follow a DASH like Diet?
  • A. 19.4
  • B. 26.7
  • C. 38.6
  • D. 45.1

14
Dietary Habits of US
  • NHANES data 1988 - 2004 5,000 with HTN
  • Scored points based on 9 goals of DASH
  • 1 point for each goal met
  • ½ point given if were close to goal.
  • DASH followers 4.5 points or more (out of 9)
  • Results
  • 1988-1994 26.7 were DASH Diet followers
  • 1999-2004 19.4 were DASH Diet followers

Mellon PB et al. Deteriorating dietary habits
among adults with hypertension. Archives of
Internal Medicine. 2008168308-314.
15
DASH Wt Mgt
  • 144 with HTN assigned to 3 groups
  • Usual care
  • DASH alone
  • DASH exercise behavior modification
  • Results (American College of Cardiology 58th
    Annual Scientific Session 2009)

Sbp drop Dbp drop Wt
Usual Care 1 mmHg 6 mmHg 2 lb gain
DASH Alone 5 mmHg 9 mmHg 0.6 lb loss
DASH Wt Mgt 14 mmHg 11 mmHg 19 lb loss
16
DASH-Sodium
  • 412 adults with pre or stage 1 HTN 57 African
    Amer
  • Vollmer WM, et al. Annals of Internal Medicine,
    Vol 135, No 12, Dec 2001, 1019-1028
  • Followed 1 of 3 sodium levels for 1 mo. Results
  • DASH/1500 mg Na vs Control/3300 mg Na
  • 11.5 lower sbp (those with HTN) 7.1 lower sbp
    (no HTN)
  • 1 year f/u study Ard JA, et al. American Journal
    of HTN, Vol 17, Issue 12, Dec 2004, 1156-1162
  • Fruit/vege
  • DASH increased
  • no change in control
  • Sodium
  • both groups increased

3300 ? 2400 mg Na 2400 ? 1500 mg Na
Control ? 2.1 mmHg sbp ? 1.1 mmHg dbp ? 4.6 mmHg sbp ? 2.4 mmHg dbp
DASH ? 1.3 mmHg sbp ? 2.5 mmHg dbp ? 1.7 mmHg sbp ? 1.0 mmHg dbp
sbp rise dbp rise
Control 5.33 mmHg 3.2 mmHg
DASH 3.12 mmHg 0.79 mmHg
17
TLC Diet
  • Created by NIH Natl Cholesterol Education
    Program and endorsed by AHA
  • Focus to lower cholesterol (8-10 in 6 weeks)
  • Calories
  • Chol lowering only 2500 (men) 1800 (women)
  • Wt loss 1600 (men) 1200 (women)
  • Total fat 25-35 total calories
  • Saturated fat lt 7 total calories and lt 200
    mg dietary cholesterol
  • Protein 15 total calories
  • Carb 50-60 total calories
  • lt 2300 mg sodium
  • 40-50 g dietary fiber
  • If cholesterol hasnt dropped 8-10 after 6
    weeks,
  • add 2 g plant stanols or sterols and 10-25 g
    soluble fiber

18
TLC Diet
  • Pros
  • Definite CV benefits (? LDL chol)
  • Not a fad diet government endorsed
  • Meets needs nutritionally, but NCEP RD recommends
    a MVI
  • No health risks
  • Promotes exercise
  • Online manual Your Guide to Lowering Your
    Cholesterol with TLC
  • Cons
  • On your own
  • Time consuming
  • Must read nutrition labels
  • Few resources, no recipes

19
Mayo Clinic Diet
  • Focus lose 6-10 pounds in 2 weeks and continue
    losing weekly until you hit your goal
  • 2 Parts
  • 1. Lose It
  • add healthy bfast, lots fruits/veges, whole
    grains, healthy fats, at least 30 min activity qd
  • Ban eating while watching TV, sugar (except
    fruit), snacking (except fruits/veges), eating
    too much meat and full fat dairy and eating out
  • Food, activity and goal diaries
  • 2. Live It
  • calculate how many calories to eat, but focus on
    servings (not calories)
  • 1400 calories 4 servings fruits/veges 5
    servings carbs 4 of dairy/protein and 3 of fats

20
Mayo Clinic Diet
  • Pros
  • Nutritionally sound
  • You shape your diet
  • Promotes 60 minutes activity daily
  • Cons
  • You have to buy the book (26) and follow the
    rules
  • Time consuming
  • Limitations of foods in part 1

21
Mediterranean Diet
  • Developed in 1993 by Oldways, Harvard School of
    Public Health and the European Office of the
    World Health Org
  • Focus
  • 50 carb 10-35 protein, 20-35 fat
  • High in plant foods (produce), nuts/seeds,

    legumes, minimally processed foods

    fresh/locally grown foods, whole grains,
    olive oil, fish at
    least twice a week,
    herbs and
    spices
  • Moderate intake of poultry, cheese, yogurt,
    eggs (up to
    7/wk), occasional red wine
  • Low in red meat (12-16 oz per month),
    sugar and
    saturated fat
  • http//oldwayspt.org/mediterranean-diet-pyramid

22
Mediterranean Diet
  • Pros
  • Definite CV benefits (? bp and LDL chol)
  • Filling (high in fiber) and tasty (recipes
    provided)
  • Requires exercise
  • No supplements recommended
  • Cons
  • ( some of the ingredients can be pricey)
  • On your own
  • Time consuming (meal prep)

23
Weight Watchers
  • 45 years www.weightwatchers.com
  • Options
  • In person meetings or online follow-up
  • Points Plus Program (Nov 2010)
  • Allowed so many points daily
  • Adjusted points for food composition not just
    calories
  • Fruits and vegetables (except fruit juice, dried
    fruit and starchy vege) are 0 points
  • Recommends MVI
  • Costs
  • In person Varies depending on location
  • 39.95 monthly pass to unlimited meetings
  • Online 29.95 (sign up fee)
  • 18.95 (1 month) or 56.85 (3
    months)

24
Weight Watchers
  • Pros
  • Eat what you want
  • No foods restricted
  • No health risks
  • Promotes exercise allows for extra food points
  • Great support
  • Online and in-person resources
  • Cons
  • Time consuming (point tallying)

25
Volumetrics Diet
  • Created by Penn State nutrition professor Barbara
    Rolls
  • Focus lose 1-2 pounds a week approach to eating
    vs a structured diet
  • Calculate energy density focus on foods with
    high water content intended to promote satiety
  • Very low-density non-starchy fruits/veges,
    non-fat milk, broth based soups, sweet potato
  • Low-density starchy fruits/veges, whole grains,
    low-fat meat, legumes, chili, spaghetti
  • Medium-density (watch portions) meat, cheese,
    pizza, FF, salad dressing, bread, pretzels, ice
    cream, cake
  • High-density (keep to a minimum) crackers,
    chips, chocolate, cookies, nuts, butter, oil,
    white potato

26
Caloric Density
  • Divide calories by weight in grams
  • Examples fruits, veggies, broth based soups,
    lean proteins, whole grains

Caloric Density
Very Low Caloric Density lt 0.6
Low Caloric Density 0.6 1.5
Medium Caloric Density 1.6 4
High Caloric Density gt 4
27
Volumetrics Diet
  • Pros
  • CV benefits
  • Filling
  • Nothing is off limits
  • Guides available
  • The Volumetrics Eating Plan
  • The Volumetrics Weight Control Plan
  • Promotes 30 minutes most days a week
  • Cons
  • You have to buy the books (15.95 and 13)
  • Time consuming (meal prep)
  • Not for you if you dont like fruits, veges and
    soup

28
Jenny Craig
  • www.jennycraig.com
  • Options
  • Personalized (in person or online/phone) meal and
    exercise plan weekly 11 counseling sessions
  • Plans for Men, Silver, Type 2, Teens (13-17 yo)
  • Nutritionally
  • 1200-2300 calories
  • Start 3 Jenny meals 1 snack 2-3 servings
    fruits/veges and non-fat dairy
  • When halfway to goal cook own meals twice a
    week (using Jenny recipes)
  • When at goal 4 wks transition to make all your
    meals
  • Higher in sodium less whole grains (vs
    Nutrisystem)

29
Jenny Craig
  • Pros
  • No guesswork no health risks
  • Incorporates Volumetrics approach
  • Prepackaged meals, delivered to home
  • Good tasting (similar to Lean Cuisine/Healthy
    Choice)
  • Good support offered (7-15 min weekly)
  • Allows 250 extra calories for exercise
  • Cons
  • Consultants are not nutrition professionals
  • Home cooked restaurant meals off limits
  • Requires supplements
  • Cost reg fee 400 (get ½ back if 5 lbs of goal
    in 1 yr)
  • 39.99 (3 day sample kit)
  • 500-650 per month shipping

30
  • www.nutrisystem.com
  • Calorie restricted, meal replacement wt loss
    program (6 meals daily), focused on glycemic
    index, home delivered
  • Basic no refrigeration required gt130 items
    customizable
  • Select frozen gt 150 items cannot customize
  • Diabetic basic or select low-GI foods access
    to counselors and dietitians.
  • Calories and Sodium (average)

Bfast Lunch Dinner Snack Daily Total
Basic/ Select 160-163 calories 178-187 calories 235-242 calories 141-146 calories 1012-1014 calories
Sodium 194-216 473-476 623-630 142-151 1738-1793 mg
31
  • Cons
  • Requires MVI and Omega 3 fatty acid for senior
    plan
  • No home cooking or dining out
  • Cost (cheaper than Jenny Craig)

Plans Cost
Nutrisystem Basic 4 week (mens, womens, vegetarian, diabetes) 233.28 (1st month) 352.23 (month to month) 199.99 (weekends off)
Nutrisystem Select 4 week 259.95 (1st month) 430.05 (month to month) 249.99 (weekends off)
Basic 2 week 183.59
Basic 1 week 98.27
A la carte offerings various
32
Slim-Fast
  • Focus
  • Restricting calories and portions
  • Slim-Fast shakes/bars will replace bfast,lunch
    and snacks 500 calorie meal daily
  • 1200 calories, minimal meal prep
  • 24 fat (6 sat fat), 58 carb, 22 protein
  • Encourages activity and 6-8 cups water Exercise
    30 minutes per day.
  • Weigh every morning.
  • Best for those who need to lose 20 lbs (should
    take 8-10 weeks)


33
Slim Fast
  • Pros
  • Convenient minimal meal prep
  • No health risks
  • FREE online registration recipes, tools
  • Cons
  • Self-directed, no support
  • Limited food choices
  • Difficult to stick with long-term
  • Cost 24 pack shakes (35)
  • 24 snack bars (17)


34
Meal Replacements
  • Examples
  • Shakes, bars
  • Look for
  • Calories 200-300
  • Total fat lt 10 g
  • Saturated fat lt 2 g
  • Sodium lt 480 mg
  • Carb 25-45 g
  • Fiber at least 3 g
  • Protein 5-15 g

35
Raw Food Diet
  • Focus
  • Raw food is packed with natural enzymes and
    nutrients to help body reach optimal health
  • Raw food has not been cooked, processed,
    microwaved, irradiated, genetically engineered or
    exposed to pesticides or herbicides. All of
    those remove most of the vitamins in food
  • Nutritionally
  • Variations exist few follow 100 raw food diet)
  • Most are vegetarian, but some eat raw milk or
    meats
  • Lots of raw fruits/veges, nuts/seeds
  • No processed, refined foods
  • May benefit from supplement

36
Raw Food Diet
  • Pros
  • Nearly guaranteed wt loss (if follow rules)
  • Most who follow it eat ½ of the amount of food
    eaten on a cooked food diet.
  • Filling
  • Cons
  • Restrictive difficult to follow
  • Lots of rules
  • Very time consuming (meal prep and equipment use)
  • Equipment required (blenders300-600,
    dehydrator...200, food processorup to 700)
  • Concern with food poisoning
  • organic foods, equipment

37
Vegan Diet
  • Focus
  • Follow this diet to reduce your risk of heart
    disease, diabetes and cancer
  • Nutritionally
  • Prevalent in fruits, veges, leafy greens, whole
    grains, nuts, seeds, legumes and soy
  • No meat, fish, poultry, dairy, eggs, lard,
    margarine made with whey and anything with
    gelatin
  • Calories 1600-2000
  • Fat 33 of total calories (lt7 sat fat)
  • Carb 57 of total calories (43 g fiber)
  • Protein 13 total calories
  • Low sodium

38
Vegan Diet
  • Pros
  • Positive CV benefits
  • Health and environmental benefits.
  • Filling high in fiber
  • Supplement not recommended
  • Cons
  • Restrictive
  • Very time consuming (meal prep)
  • Difficult to follow
  • Moderately pricey

39
Very Low Calorie Diets
Medically supervised programs that uses
commercially prepared formulas (totaling 800
calories a day) that replace all usual food
intake for several weeks or months.
40
  • Since 1980 www.medifast1.com
  • 5 in 1 Plan 5 meal replacements 1 lean
    green meal
  • Lean
  • Leanest 7 oz cooked protein (gt 98 lean) 2
    healthy fats
  • Leaner 6 oz cooked protein (95-97 lean) 1
    healthy fat
  • Lean 5 oz cooked protein (85-94 lean) and no
    healthy fats
  • Green
  • Low carb 1 c lettuce/raw spinach, ½ c celery,
    radishes
  • Moderate carb ½ c asparagus, cabbage,
    cauliflower, summer squash
  • High carb ½ c broccoli, green/wax beans,
    peppers, tomatoes
  • Healthy Fat 1 tsp canola/olive oil 5-10 black
    olives 2 Tbsp salad dressing (lt 6 carb 5 g
    fat) 1 tsp trans-fat free margarine
  • 11/day for replacements only

41
  • Transition
  • http//www.medifastmedia.com/med/docs/quick_start_
    guide.pdf

Wk Calorie Target Medifast Meals Lean Green Meals
1 850-1050 5 1 2 servings (1 c) of your favorite vege
2 900-1150 4 1 Above 2 med fruit or 1 c cut up fruit or berries
3 1000-1300 4 1 Above 1 c low-fat or fat-free dairy
4 1100-1550 3 1 Above 4-6 oz lean meat and 1 serving whole grain
42
  • Since 1974 www.optifast.com
  • 12 weeks of meal replacements (MR) 2 cups
    low-starch, green veges 2 liters water qd
  • Full 5 shakes or MR daily (800 calories)
  • Partial 3-4 shakes/MR small meals (950-1000
    calories)
  • 13-18 weeks Transition
  • 2 optifast shakes/MR and 1 low cal meal (300-350
    cal) 2 c green vege, 2 fruit (50-70 cal and
    10-15 g carb) 1 dairy (1 c low-fat milk. 1
    oz low-fat cheese, 6 oz low-fat yogurt)
  • 19-22 weeks Maintenance
  • As above with 1 shake/MR and 2 low cal meals
  • Cost varies MD fees
  • 229 (84 shakes) at Amazon (1144.80 for 12
    weeks)

43
Very Low Calorie Diets
  • Pros
  • Effective at producing short-term wt loss in
    moderate to extremely obese (BMI gt 30)
  • Cons
  • Not tested in those over age 50
  • Cost
  • Lacks nutritionally need supplements
  • Primarily lose water and lean body mass
  • Side effects
  • Difficult long-term compliance

44
Novelty Diets
  • Grapefruit Diet
  • Hollywood 48 Hour Miracle Diet
  • Cabbage Soup Diet
  • 3 Day Diet
  • Fit for Life
  • Eat Right for your
    Blood Type Diet

45
Novelty Diets
  • Usually not scientifically based
  • Usually lacks nutritionally
  • May eliminate whole food groups
  • Most promote calorie reduction
  • Placebo effect

46
Internet Based Diets
  • Anyone can create a diet website
  • Beware of health fraud 7 Red Flag Claims
  • Lose wt without diet or exercise
  • Eat ALL you want and still lose wt
  • Never have to diet again
  • Product blocks absorption of fat, calories, carbs
  • Safely lose more than 3 lbs per week
  • This product works for everyone
  • Lose wt by wearing something/rubbing a cream

47
High Protein, Low Carb Diets
48
Low Carb Diet Claims
  • Carbs causes cravings and increases insulin
  • Refined carbs are addictive and evil
  • Ketosis offers a metabolic advantage
  • Severely restrict carbs, body is forced to burn
    fat deposits for energy ? lose wt stabilize BG
  • Calories dont count
  • Some promote any type of fat
  • Many promote supplement use

49
What we know
  • No consensus on what low carb is
  • Most Americans
  • cannot identify foods that are primarily carb
  • believe they can lose wt by cutting carbs alone
    and not calories
  • These diets restrict healthful foods that provide
    essential nutrients and fiber.
  • 20 years of research has shown that a diet high
    in fruits and vegetables can prevent disease
    (CVD, DM, CVA, certain cancers)

50
What we know
  • Rapid wt loss is due to loss of water, glycogen
    and lean tissue. Ketosis produces metabolic
    dehydration.
  • Carb and protein is stored with water (each gram
    glycogen is stored with 4 grams water)
  • When these stores are used, we lose water
  • Composition of Weight Loss During Short-Term
    Weight Reduction. Journal of Clinical
    Investigation. Vol. 55. Sept 1976. Pgs 722-730.

fat loss water loss
Balanced, low-cal diet 60 40
Low carb, high protein 35 65
51
What we know
  • Weight loss due to
  • Calorie restriction
  • Research shows those on low carb diets
    consume up to 1000 less calories a day
  • Increased satiety
  • Increased structure
  • No evidence that low carb diets are more
    effective in producing long-term weight loss
    compared to healthy eating and physical activity

52
  • Review of 107 research studies on various
    low-carb, high protein, wt loss diets concluded
  • Weight loss on these diets is not due to any
    special effect of restricting carbohydrate,
    rather weight loss depended on the extent to
    which dieters caloric intake fell and how long
    they continued their regimens

Bravata DM et al. Efficacy and safety of
low-carbohydrate diets a systemic review.
JAMA, 20032891837-1850.
53
Research (low carb vs low cal)
Study Time N Diet Wt Loss (6 mo) Wt loss (1 yr)
Samaha (DM and AA) 6 mo 132 carb (1630) cal (1576) 4.5 1.5
Stern (f/u to Samaha) 1 yr carb (1462) cal (1822) 3.9 2.3
Brehm 6 mo 53 carb (1300) cal (1247) 9 4
Yancy (?chol) 6 mo 120 carb cal 13 6.5
Foster 1 yr 63 carb cal 9.5 5 4.25 2.5
54
What we know
  • These diets are difficult to stick with
    long-term
  • The brain and central nervous system need and
    prefer glucose as a source of energy
  • We need 130 grams of carb a day for our brain to
    function
  • Typical male 200-300 g carb/day
  • Typical female 180-230 g carb/day

55
Health Concerns of Low Carb Diets
  • Colon Cancer
  • Heart Disease
  • Impaired kidney
    function
  • Osteoporosis
  • Kidney stones
  • Yancy WS et al. A low-carbohydrate, ketogenic
    diet versus a low-fat diet to treat obesity and
    hyperlipidemia. Ann Int Med 2004140769-777
  • Constipation 68
  • Headache 60
  • Bad breath 38
  • Muscle cramps 35
  • Diarrhea 23
  • General weakness 25

56
Other Side effects of Low Carb Diets
  • Heartburn
  • Elevated homocysteine
  • Nutrient deficiencies B Vit, C, E, Ca, Mg, K
  • Acidosis (insomnia, migraines, hard/dry
    stools, teeth insensitivity)
  • Lack of energy
  • Difficulty concentrating

57
Atkins Diet
  • www.atkins.com
  • Claims Severely restrict carbs, body is forced
    to burn fat deposits for energy ? lose wt and
    stabilize BG
  • 4 step program
  • Phase 1 (Induction/first 2 wks) - 20 g carb/day
  • Phase 2 (Wt loss) increase to 25 g carb/day and
    increase 5 g carb/wk until you stop losing wt.
  • Phase 3 (Pre-maintenance) increase 10 g carb/wk
    as long as you keep wt off
  • Phase 4 (Lifetime maintenance) reintroduce
    carbs until you reach the carb ceiling (50 g for
    most 100 g for aggressive exercisers)

58
(No Transcript)
59
Atkins Diet
  • Pros
  • Best for those desiring short-term, quick wt
    loss for those with no pre-existing
    conditions
  • Thrill of eating forbidden foods
  • Cons
  • Not for those with pre-existing conditions (heart
    disease, diabetes, liver disease, kidney disease,
    gout, gallbladder disease)
  • Requires counting carbs/figuring out how much
    carb to eat (after induction phase)
  • Most extend the induction phase
  • Boredom
  • Promotes supplements

60
Protein Power Life Plan(Michael Eades, MD, Mary
Eades, MD)
  • www.proteinpower.com
  • Claims
  • Eating carbs causes cravings refined carbs are
    evil
  • Eliminate grains and legumes (they contain
    lectins, which when fermented damage the body and
    may be responsible for auto-immune diseases)
  • Promote benefits of sunlight and supplements
    (up to 8 per day) featured product on web
    (Pentabosol..the original diet aid) is 64.95.
  • If dont eat enough protein, wont lose as much wt

61
Protein Power Life Plan(Michael Eades, MD, Mary
Eades, MD)
  • Meal plan
  • Intervention 20-40 g carb/day
  • Transition 55 g carb/day
  • Maintenance up to 130 g carb/day
  • Amt of protein needed is based on lean body mass
    (lbm) and activity level
  • Sedentary (no physical activity) 0.5 g
    protein/lb lbm
  • Moderately active (20-30 min activity 2-3
    times/wk) 0.6 g/lb lbm
  • Active (30 min activity 3-5 times/wk) 0.7
    g/lb lbm
  • Very active (active for 1 hrs at least 5
    times/wk) 0.8 g/lb lbm
  • Athlete (trains twice a day for 1 hrs) 1
    g/lb lbm

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The South Beach Diet(Arthur Agatston, MD)
  • www.southbeachdiet.com
  • Healthier version of Atkins 3 meals and 3
    snacks, encourages healthy fats and limits
    saturated fats
  • Phase 1 (2 wks) lose 13 lbs in 14 days lean
    protein, fat-free/low-fat dairy (milk/yogurt lt 2
    c qd), 1 serv beans or low starch vege, sm amts
    nuts. No fruits or alcohol
  • Phase 2 gradually reintroduce carbs lose 1-2
    lbs per week. Stay here until wt loss achieved.
    Less structure
  • Phase 3 (maintenance) stay away from high carb,
    refined or processed foods.
  • Cheating is why people gain weight

63
The Hamptons Diet (Fred Pescatore,MD)
www.hamptondiet.com
  • Combo of low carb Mediterranean diets
  • Eat more vegetables, fish, whole grains and
    omega-3 fatty acids.
  • Consume monounsaturated fats primarily.
    Best is
    Australian macadamia nut oil
  • Encourages organic foods and discourages
    all highly processed
    foods
  • Moderate alcohol consumption
  • No induction phase
  • Restricts total carb intake according to weight
    loss or maintenance phase, with no truly
    forbidden foods

64
The Carbohydrate Addicts Lifespan
Program(Richard and Rachael Heller)
  • www.carbohydrateaddicts.com
  • Claims
  • 75 of overwt people are addicted to carbs
  • Eating too many carbs ? insulin production, which
    triggers hunger and drives carb addiction (wt
    gain and out of control eating) Insulin makes
    you fat
  • Meal plan
  • 2 no carb meals followed by the reward meal
    (1/3 protein, 1/3 carb and 1/3 non-starchy vege)
  • Can have seconds, but must have same 1/3-1/3-1/3
    meal and have to eat in a 1 hour time limit

65
The Carbohydrate Addicts Lifespan Program
  • Also have line of books for kids, carb gram
    counters, carb addicts cookbook
  • Pros
  • Best for those with trouble controlling carb
    cravings or those who cannot eliminate carbs from
    their diet
  • Cons
  • Difficult to stick with long-term
  • Not for those with pre-existing conditions (heart
    disease, diabetes, kidney disease)

66
The Zone (Barry Sears, PhD) www.zonediet.com
  • Claims
  • Eating more protein and low GI vegetables
    help you lose wt and stay healthy
  • Extra carbs (esp high GI carbs), not extra
    calories, make people gain weight
  • Carbs take you out of the Zone are stored as
    fat
  • Best for
  • Those who want more carb than Atkins allows or
    who dont mind lack of variety with meals
  • Not for
  • Anyone not a fan of veges (get up to 3½
    cups/meal)

67
The Zone
  • Rigid Rules
  • 1-2-3- Method 1 g fat for every 2 g protein and
    3 g carb
  • Eat every 4-6 hours after meal or 2-2½ hrs after
    snacks whether hungry or not 64 oz water qd
  • If not hungry, youre in the Zone
  • Meals 1/3 plate (3-4 oz) protein, 2/3 plate
    (2-3 cups) fruits and veges (low carb)
  • Snacks are 1 oz protein, 1-2 cups low carb vege
    and fat.
  • Menus not appealing.

68
The g.i. Diet(Rick Gallop) www.gidiet.com
  • Simplified version of the Zone
  • Focuses on the glycemic index (GI)
    with a street light approach to
    eating
  • Phase 1 eat green light, low GI foods (lean
    meat, no-fat dairy, whole wheat products, low-GI
    fruits and veges) and rid of red light, high GI
    foods (sugar drinks, high carb foods, high-fat
    dairy and meat)
  • Meals should be 50 fruits and veges 25 low-GI
    grains fats kept to a minimum lean protein
  • Phase 2 after reaching target BMI, add yellow
    light foods (most nuts, higher-GI fruits/veges,
    low-fat dairy)

69
Sugar Busters(HL Steward, MC Bethea, L Balart,
SS Andrews)
  • Claims
  • Sugar and other high GI foods make you fat
  • Simplicity dont need to count calories, weigh
    foods or calculate carbs
  • Physical activity is a waste of time
  • Pros
  • Good for those who want to cut back on processed
    foods and eat more plant foods. (high in fiber)
  • Cons
  • Overreliance on Glycemic Index contraindications
    between text and food lists

70
Sugar Busters
  • Meal plan
  • Must eliminate processed foods, sugar, soft
    drinks, corn, watermelon. Good food and bad food
    charts, based on GI
  • Drink alcohol with protein to eliminate its harm.
  • 6 small meals/day (to ? insulin secretion).
  • No second helpings. No eating after 8 pm (to
    prevent increased cholesterol production).
  • Fruits 30 minutes before meals or 2 hours after
    meals (to avoid indigestion).
  • Drink fluids between meals only.

71
Top Selling Diet Books (2011)
  • The Amen Solution
  • The Carb Lovers Diet
  • Cinch! Conquer cravings, Drop Pounds and Lose
    Weight
  • Crazy, Sexy Diet
  • Lean Belly Prescription
  • New Abs Diet
  • New Sonoma Diet
  • Now Eat This Diet
  • Self-Compassion Diet
  • Veganist

72
Top 10 Diet Books
  • The Amen Solution
  • by David Amen, MD (neuroscientist, psychiatrist,
    brain imaging expert)
  • Claim build meal plan based on individual brain
    type (compulsive overeater impulsive overeater
    impulsive-compulsive overeater sad/emotional
    eater anxious overeater). Lean proteins early
    in the day, low GI foods, high fiber carbs,
    healthy fats, brain supplements and journaling
  • Veganist
  • by Kathy Freston
  • Claim Whole grains, beans, vegetables, fruits,
    and meat alternatives

73
Top 10 Diet Books
  • Carb lovers Diet
  • by Ellen Kunes and Frances Largeman-Roth, RD
    (both of Health magazine)
  • Claim Meal plan focused on resistant starchy
    foods. Cold foods thought to boost metabolism and
    suppress appetite (burn more fat, eat less
    calories)
  • Cinch!
  • by Cynthia Sass, MPH, RD
  • Claim 30 day regimen
  • 5 Fast Forward Days diet of spinach, almonds,
    raspberries, eggs and yogurt
  • 25 days of 4 healthy meals/day

74
Top 10 Diet Books
  • Crazy, Sexy Diet
  • by Kris Carr,

    motivational speaker, wellness coach
  • Claim vegetarian diet with a focus on balancing
    the bodys pH
  • Lean Belly Prescription
  • By Travis Stork, MD
  • Focus pick 3 to lean 3 significant changes to
    diet (cut out soda, switch to whole grains)

75
Top 10 Diet Books
  • New Abs Diet
  • by David Zinczenki (Author of Eat This, Not
    That),
  • Claim focuses on basal metabolism burning
    calories when not exercising how what you eat.
  • The New Sonoma Diet
  • By Connie Gutterson, RD, PhD
  • Focus 12 Diet Power Foods (beans, almonds,
    olive oil). 3 Stages/Waves
  • 1. Limit refined flour and sugar. No wine 2.
    Wine allowed. More fruits/veges 3.
    Maintenance

76
Top 10 Diet Books
  • Now Eat This Diet
  • by Rocco Dispirito (celebrity chef, triathlete)
  • Claim 6 meals daily 1200-1400 calories (women)
    and 1400-1600 calories (men)
  • Self-Compassion Diet
  • By Jean Fain, LICSW, MSW
    psychotherapist
  • Focus 4 weight loss routes self compassion,
    hypnosis, mindfulness and social support

77
Fat Restricted Diets
  • Dean Ornish and Pritikin
  • Very low fat (10 of calories)
  • High fiber
  • Few processed foods (lt 2 grams fat per serving)
  • 30 minutes daily activity
  • Ornish vegetarian (beans, legumes, whole
    grains, fruits, veggies, nonfat-dairy)
  • Pritikin choose foods low in caloric density

78
Sizing Up Diets
  • Is it safe? Practical? Nutritionally sound?
  • Does it sound too good to be true?
  • Does it promise rapid weight loss? Promote
    supplements?
  • Does it take into consideration special
    occasions, eating out or feeding other family
    members?
  • Does the plan include physical activity?
    Wt maintenance program?
  • Does it urge you to check with your doctor first
    (if you need to lose more than 20
    lbs)?
  • Reliable info your local dietitian
    (www.eatright.org)

79
National Weight Control Registry (NWCR)
  • (800) 606-NWCR (6927) www.nwcr.ws
  • Founded in 1993.
  • Long-term database of more than 3000 persons who
    have maintained at least a 30 lb weight
    loss for one year or longer.
  • Members have lost an average of 66 lbs and kept
    it off for 5½ years
  • In in 8 kept it off for gt 10 yrs

80
Habits of Successful Weight Loss
  • National Wt Control Reistry
  • Track food intake
  • Count calories or fat grams or use commercial wt
    loss program
  • Low cal, low fat diet
  • Calories/day Women 1300 Men 1700
  • lt 30 calories from fat
  • Eat breakfast regularly
  • Dine out 3 times/week (fast food lt once per week)
  • Walk 1 hour daily
  • Watch lt 10 hours TV weekly
  • Weigh themselves at least once/week

81
Habits of Successful Weight Loss
  • Consumer Reports survey (Jan 09, N21,632)
  • 3 categories identified
  • Always thin (never overwt)
  • Successful losers (once overwt and now 10
    lighter and kept wt off for at least 3 years)
  • Failed dieters (overwt and would like to lose,
    but close to heaviest wt)
  • Habits of always thin or successful losers
  • Watch portions limit fat lt 33 total
    calories eat 5 or more servings of fruits and
    veges daily choose whole grains over refined
    eat at home and exercise regularly

82
7 Predictors of Weight Regain
  • 1. Less regular physical activity (not meeting
    public health recommendations)
  • 2. Sedentary lifestyle more TV or screen time
    (gt 4 hours per day vs 0-1
    hours)
  • 3. Mexican American ethnicity (vs Caucasians)
  • 4. Loss of gt 20 of their weight (vs losing
    10-15)
  • 5. How long it was since they lost their wt
  • Maintaining loss for 2 yrs cuts risk of regain
    by 50
  • 6. Eating more fat
  • 7. Less monitoring (wt, food intake, activity)

83
5 minute Obesity Consult
  • What do you drink?
  • Limit sugar beverages
  • Evaluate after meal grazing
  • 3 meals a day, low cal dense snacks
  • How often do you eat fast food/on the go?
  • Decrease frequency/portions
  • What do you do for activity?
  • Less TV/videos more activity plenty of sleep

84
Keys to Successful Weight Mgt
  • Set a realistic goals (wt, bp, BG, chol)
  • Weight loss readiness test www.diabetesinmichiga
    n.org
  • Be active (60 minutes per day)
  • Add weight/strength training
  • Lose muscle mass when diet without activity
  • Stress management
  • Motivation/Support
  • Monitor (wt, eating, activity)

85
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86
Food Record Keeping
  • Kaiser Permanente Center for
    Health Research
  • 1700 obese/overweight adults with goal of losing
    9 lbs in 6 month
  • Those keeping daily food records 6 days a week
    lost 18 lbs (vs 9 lb loss in those not keeping
    records)
  • Most effective use of records is when someone
    else looks at them.
  • Helps us become more aware of our habits
  • American Journal of Preventative Medicine, Aug
    2008

87
Slow Down
  • Takes brain 20 minutes to register fullness
  • We consume more calories
    when we eat too quickly
  • Tips
  • Dont eat while doing other things
  • Take smaller bites
  • Chew food thoroughly
  • In between bites, put utensils down, drink water
  • Pause between bites

88
Liquids vs solids
  • Review of 42 studies (Physiol Behav. 199659179)
  • When eat 100 calories solid food eat 65
    calories less at next meal
  • When eat 100 calories semisolid food eat 21
    less calories at next meal
  • When drink 100 calories of liquid dont cut
    calories at next meal
  • Slim Fast bars vs drinks
  • Grehlin (hunger hormone) decreased with bar, but
    not with shake

89
Keys to Success
  • Healthy eating
  • Drink plenty of water (1 oz for every 4 lbs wt)
  • Choose high nutrition, low density foods
  • Eat plenty of fiber
  • Portion control

19-50 yrs Men/women 38 g/day
19-50 yrs Men/women 25 g/day
gt 50 yrs Men 30 g/day
gt 50 yrs Women 21 g/day
90
Portion Control
  • Larger plates more food
  • We eat 92 food on our plate
  • Eating on 10 plate could
    save 22 calories
  • If typical meal has 800 calories, could save 18
    lbs/yr for the average adult
  • Small plate movement (launched Jan 09)
  • www.smallplatemovement.org
  • Targets restaurants and families
  • Goal eat off 10 plate for largest meal daily

91
Keys to Success
  • Eat breakfast daily
  • Heavy in whole grains, lean protein and fruits
  • Bowl steel cut oatmeal with fruit and nuts
  • 6-8 oz yogurt with berries and sunflower seeds
  • 2 Whole grain toast or 1english muffin with
    peanut butter
  • Low fat omelet with 2 whole grain toast and fruit
  • Smoothie (low-fat/fat-free milk, yogurt, fruit ,
    ground flax)
  • Whole grain, high fiber cereal with milk and
    fruit
  • Cereal goals
  • Fiber at least 3 grams/serving
  • Fat lt 3 grams/serving
  • Sodium lt 240 mg/serving
  • Sugar lt 8 grams/serving

92
Calorie Savings (per month)
Calories lost
Drink 16 oz skim milk vs 2 milk daily 2400
Eliminate one slice of bread per day. 3000
Use skim milk and artificial sweetener in your coffee vs cream and sugar 3600
Use a vinegar based salad dressing vs a cream based one 1280
Reduce your alcohol intake by one drink/wk 500
Replace 1 sugar based drink with water 6000
Instead of french fries 3 times/wk, have a small baked potato with a little salt and pepper. 1900
93
Summary
  • Eat less
  • Move more
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