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30 Billion
dollars!
http://www.youtube.com/watch?v=98_5OgZieUA
1990 1999
2008
No Data < 10 % 10 %– 14 % 15 %– 19 %
20 %– 24 % 25 %– 29 % ≥ 30 %
Source: CDC Behavioral Risk Factor Surveillance System
“With rising rates of obesity, new
and questionable diets appearing
on the market almost everyday,
and the current trend toward
marketing huge portions, is it
possible to control one’s weight
with a nutritionally sound,
emotionally healthy, common-
sense-based approach?”
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/media_10819_ENU-
HTML.htm.
The Source of Information
Media
47% Magazines
34% Television
29% Books
28% Newspaper
Nutrition information and physicians
21% Internet
19% Product labels
18% Friends and family
13% Dietetic professionals
Carbohydrates cause
weight gain
Myth
C a lo rie s ca u se w e ig h t g a in
If yo u co n su m e m o re ca lo rie s th a n yo u
exp e n d yo u w illb e g in to g a in w e ig h t
Occasionally following a
fad diet is a safe way to
quickly lose weight
Myth
M a n y cre a to rs o f th e se fa d d ie ts d o n o t
h a ve scie n tific b a ckg ro u n d
S o m e fa d d ie ts ca n b e h a rm fu lto th o se w ith
ce rta in h e a lth p ro b le m s
-
Fad Diet Myths
Why do people buy into these
myths?
- All people have to eat
- We live in a society focused on being thin
- Celebrity role models
- People may have a false sense of security
about their health
-
All of these popular high-protein/low-carbohydrate
diet books have reached The New York Times
bestseller status.
-Amazon.com
High-protein/Low-carbohydrate
Diets
What makes these diets so appealing?
uPromises of rapid weight loss
uEasy to follow plans
uDiets include many palatable foods
uPhysical activity not required
High-protein/Low-carbohydrate
Diets
Rapid weight-loss:
Many low-CHO diets report greater, and more
rapid weight-loss when compared to other higher
CHO diets.
The reality:
This is short term (<6 months). After 12
months, this weight-loss dissipates, and total
weight-loss is no more than traditional higher
Po ssib le m eCHO
ch a ndiets.
ism s: Nordmann AJ et al. (2006) Arch Intern Med 166:
D iu re285–29.
sis
M o b ilza tio n o f g lyco g e n sto re s
C ircu la tin g ke to n e b o d ie s
S a tia tin g e ffe cts o f p ro te in
U se o f p ro te in m o re e n e rg e tica lly co stly
N o t e n o u g h e vid e n ce
Atkins Diet
T h e Pre m ise :
S e ve re re strictio n o f d ie ta ry
ca rb o h yd ra te (< 2 0 % o f d a ily ca lo ric
in ta ke ), w ith its re su ltin g ke to sis,
p ro m o te s lip id oxid a tio n , sa tie ty , a n d
in cre a se d e n e rg y exp e n d itu re , fa cto rs
th a t sh o u ld p ro m o te n e g a tive e n e rg y
b a la n ce a n d w e ig h t lo ss
C a rb o h yd ra te in ta ke cre a te s:
H ig h b lo o d su g a r
In su lin re sista n ce
In cre a se d b o d y fa t
A tkin s R , D r. A tkin s’ N e w D ie t R e vo lu tio n .
1992.
High-protein/Low-carbohydrate
Diets
Atkins Diet
The good:
Initial rapid weight loss can be motivating.
The bad:
Long-term CVD risks need to be better
studied
Nutrient deficiencies
T h e g o o d : D o e sn ’ t le a ve o u t a n y fo o d
g ro u p s
T h e b a d : T h e first p h a se is m u ch like
th e A tkin s d ie t, ve ry re strictive o n
CHO.
High-protein/Low-carbohydrate
Diets
What are Meal Replacements?
Beverages, prepackaged or frozen entrees,
and meal or snack bars that are designed
to take the place of one or two meals
Contain a known energy and macronutrient
content
Objective is to attain a 500 to 1,000 kcal/day
energy deficit
The Slimfast diet plan is an example
Meal Replacements
Convenient
Good for portion and calorie control
In some cases can improve a person’s
nutritional status
How effective are meal
replacements?
Several studies have shown a greater weight
loss efficacy with structured meal replacement
plans than compared to reduced calorie diet
treatments
In a randomized controlled trial by Rothacker in
2001 a meal replacement diet was compared
to a low-fat diet
After one year, the meal replacement group
maintained their initial weight loss, while the
other group regained most of the initial weight
loss back
J Am Diet Assoc 2001; 101(3): 345-347
Meal Replacements
May not be a long-term solution
Encourages “eating on the run”
Concerns of nutritional inadequacies
May still feel hungry or may not be satisfying
Does not teach good eating habits or
choices
What ADA says about meal
replacements
Advise on how to optimize the overall
nutrient content
Must be careful selection of the conventional
foods that make up the non-meal
replacement portion of the diet plan
Detox Diets
What is a Detox Diet
Popular Detox Diets
oThe Master Cleanse, also known
as “The Lemonade Diet”
oThe Juice Diet
oThe Water Fast
http://vids.myspace.com/index.cfm?fuseaction=vids.individual&videoid=6518245
o
Pro’s of Detox Diets
Beneficial in treating the side
effects of chronic diseases
Stepwise detox program used to
eliminate bad eating habits, and
reduce smoking and drinking
addictions
Detoxing used as a “motivational
tool”
Con’s of Detoxing
Lack of scientific research
supporting detox diets
Nutrient deficiencies and electrolyte
imbalances
Detoxing is extremely dangerous
for certain groups of people
Negative physical effects
How Dietitians Feel About
Detoxing
Stress the importance of being under the
supervision of a dietitian while detoxing
Feel that more research needs to be
done: which toxins are being removed
from the body?
Believe in using detox diets to motivate
people to lose weight and live healthier
lifestyles
Important for patients to remember that
it is what they eat after the cleanse is
complete
“The best diet is one you can stick too”
- Michael Dansinger
- Director of Diabetes, New
England Medical Center,
Boston
Healthy Weight Loss and
Management
More than just a number on a scale!!
Can be complex
Nutritional intake
Physical Activity
Psychological Status
Social and Cognitive Function
Emotional factors
Food access
Environment and Environmental triggers
Functional capacity for food preperation
Nutrition Care Process
Assessment, Diagnosis, Intervention, Monitoring and Evaluation
Ready…set…go!
Team
Realistic goals and expectation
Realistic expectations about time to achieve
goals
Emphasize health rather than cosmetic goals
Portion control
Portion distortion
Eat more low energy dense foods
Know what’s in the foods your eating
Don’t skip breakfast
Triggers
Physical Activity
30 -60 minutes moderate-vigerous activity most days of the week
Food Guide Pyramids
Variety, Proportionality, and Moderation
RD’s rely on this everyday
Low fat
Fat is the most energy dense macronutrient but
is known to have a weak effect on both
satisfaction and making you feel full
Instead of all fats being bad…eat healthy fats.
Instead of focusing only on complex carbs…limit
sugar and emphasize benefits of whole grains.
2005 first to emphasize physical activity.
Mypyramid.gov
Interactive website with educational modules
Follow up
Monitor
Evaluate
Modify plans to…
Prevent weight gain
Long term weight management
“Slow and steady wins the race!”
ADA National Nutrition Month 07’
References
1. American Dietetic Association. Position of the American Dietetic
Association: Food and nutrition misinformation. J Am Diet
Assoc.2006;106:602.
2. American Dietetic Association. Nutrition: Fact vs. Fiction. 2009.
Available at:
http://www.eatright.org/ada/files/Nutrition_Fact_vs_Fiction.pdf.
Accessed September 26, 2009.
3. Starkey J, Dombrowski J, Ryan T. Quick Fixes Aren’t the Answer for
Healthful Weight Control: Learn to Spot Fads and Steer Clear –
Then Seek Proven, Long-Term Solutions. 2007. Available at:
http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/media_10819_ENU_HTM
, 2009.
4. American Dietetic Association. Position of the American Dietetic
Association: Weight management. J Am Diet Assoc.
2002;102:1150.
5. American Dietetic Association. Position of the American Dietetic
Association: Weight management. J Am Diet Assoc.
2009;109:335,331.
6. Atkins R 1992 Dr. Atkins’ new diet revolution. New York: Avon Books.
7. Levine M.J., Jones J.M., Lineback D.R.Low-Carbohydrate Diets:
Assessing the Science and Knowledge Gaps, Summary of an ILSI
North America Workshop (2006) Journal of the American Dietetic
Association, 106 (12), pp. 2086-2094
References:
1. M. Miller, V. Beach, J.D. Sorkin, C. Mangano, C. Dobmeier, D.
Novacic, J. Rhyne and R.A. Vogel, Comparative effects of three
popular diets on lipids, endothelial function, and C-reactive
protein during weight maintenance, J Am Diet Assoc 109
(2009), pp. 713–717.
2. Jackson, D. The Skinny on Meal Replacements for Weight
Management. Today’s Dietitian. July 2004;23-24
3. Sherer, E. Examining the most popular weight loss diets: How
effective are they? JAAPA. November 2008;31-34.
4. Spring Cleansing: Assessing the Risks and Benefits of DetoxDiets.
Today’s Dietitian. 2008; 34-38
5. PiccoM. Nutrition and Healthy Eating: Do detox diets offer any
health benefits? MayoClinic.com. 2008:1. Available at
http://www.mayoclinic.com/health/detox-diets/AN01334.
Accessed September 29, 2009.