Weight Management: Popular
Approaches
Formula Diets and Meal
Replacements
• Meal formats and nutritional profiles vary
• Total calories range from 1000-1600 kcals
day with meal replacement drinks or bars
replacing two meals during weight loss or
one meal for weight maintenance
Formula Diets and Meal
Replacements
• There is evidence
that meal
replacements can
be as effective as
standard lowcalorie diets in
promoting weight
loss
Evaluation of Major Commercial Weight Loss
Programs
• Reviewed research regarding the efficacy of
commercial weight loss programs including
Weight Watchers, Jenny Craig, LA Weight
Loss, HMR, OPTIFAST, commercial
Internet programs (e-diets.com); Overeaters
Anonymous and Take Off Pounds Sensibly
(Tsai and Wadden, Ann Int Med 2005; 142:56-66)
Evaluation of Major Commercial Weight
Loss Programs
• Weight Watchers had the strongest studies
to support it
• Best study: participants lost 5% of their
initial body weight (about 10 pounds) and
kept off 3% (about 5 pounds) at 2 years
• No published high-quality studies of
Jenny Craig or LA Weight Loss
(Tsai and Wadden, Ann Int Med 2005; 142:56-66)
Evaluation of Major Commercial Weight
Loss Programs
• Studies of VLCDs were of limited quality
• Patients who stayed on the program lost 1520% of initial body weight in 6 months
• Many patients dropped out of these programs
• Those who completed the program regained
half of lost weight in 1-2 years after treatment
• Studies of internet-based programs of limited
quality and produced minimal weight loss
(Tsai and Wadden, Ann Int Med 2005; 142:56-66)
Atkins Diet Premise
• Stabilizes insulin production by limiting
carb intake. This forces the body from
glucosis into lipolysis, thus ketones are
burned as the primary energy source.
• This results in a metabolic advantage of low
carbohydrate: dieters can lose weight while
eating more calories
Atkins Diet: Induction Phase
• “Induction Phase”: 2 weeks, 20 g carb/day
• Eliminate fruit, bread, grains, starchy
vegetables, dairy products except cheese,
cream, butter
• 20 g carb: 3 cups salad greens, or 2 cups salad
plus 2/3 cups cooked vegetables such as
asparagus, summer squash, green beans
Atkins- Sample Menu Phase 1
• B: scrambled eggs and ham, butter,
decaffeinated coffee or tea
• L: Bacon cheeseburger, no bun, small
tossed salad, selzer water
• D: shrimp cocktail with mustard and mayo,
clear consomme, steak, roast, fish or fowl,
tossed salad, diet gelatin with whipped
cream, sf beverage
Atkins Phase 2: OWL
• “Ongoing weight loss phase” or “Owl.”
• Add carbohydrate at a rate of 5 grams a day
until weight loss stops
• This is the CCLL: critical carbohydrate level
for losing
• May be 45, or 33, or 19 grams/day
• Continue at this level until desired weight is
reached
Atkins: Sample menu OWL
• B: Western omelet, 3 ounces tomato juice, 2
carbo grams of bran crispbread, decaf
coffee or tea
• L: Chef’s salad with ham, cheese, chicken
and egg; zero carbohydrate or oil and
vinegar dressing, iced herbal tea
• D: Seafood salad, poached salmon, 2/3 cup
vegetable from permitted list, half cup of
strawberries in cream
South Beach Diet Premise
• “Addiction” to carbs is a psychological need for
comfort food and is likely a real, physiological
phenomenon
• Eating bad carbs leads to cravings for more
which is “ultimately responsible for our obesity
epidemic”
• States that Atkins may limit carbs too severely
• Stresses glycemic index as the biggest
determinant of a food’s potential impact on body
weight
South Beach Diet: Phase 1 (2 weeks)
• Carbs limited to low-carb vegetables, salads,
1% milk, fat-free buttermilk, nonfat yogurt.
• Proteins: unlimited lean meats, poultry, fish,
low fat cheese, tofu
• Nuts included, but limited
• “Good” fats including olive, canola oils
• Sugar-free hard candies, diet gelatin, sugar subs
• NO fatty meats, starchy vegetables like corn,
potatoes, carrots, fruits, grains, alcohol
South Beach: Sample Day Phase 1
• B: 6 oz tomato juice, 1/4-1/2 cup liquid egg
substitute, decaf coffee or tea, non-fat milk, sugar
substitute
• snack: 1-2 turkey roll ups
• L: SB chopped salad with tuna, sf gelatin
• snack: celery, 1 wedge Laughing Cow Light
Cheese
• D: baked chix breast, roasted eggplant and
peppers, salad, lo sugar dressing
• Dessert: Mocha Ricotta Creme
South Beach: Sample Day Phase 2
• B: 1 cup blueberries; 1 scrambled egg w/ salsa;
oatmeal mixed with 1 cup nonfat milk, sprinkled with
cinnamon and walnuts; coffee or tea
• Snack: 4 oz non-fat sugar-free yogurt
• L: Tuna salad w/ celery, mayo, tomato, onion in
whole wheat pita
• Snack: 1 part-skim mozzarella cheese stick
• D: Pan roasted steak and onions, South Beach salad,
steamed broccoli; chocolate-dipped strawberries
South Beach Diet: Phase 2
• Reintroduces most fruits, whole grains (sparingly)
including popcorn, legumes such as pinto beans,
starchy vegetables such as peas, carrots and sweet
potatoes, flavored nonfat yogurt, semisweet or
bittersweet chocolate, wine
• Still forbidden: white flour and products made
from it including breads, cookies, pasta; potatoes,
white rice, corn; fruits including bananas, canned
fruit, pineapple, raisins, watermelon
• Dieters stay in this phase until goal weight
achieved
South Beach: Sample Day Phase 2
• B: 1 cup blueberries; 1 scrambled egg w/ salsa;
oatmeal mixed with 1 cup nonfat milk, sprinkled with
cinnamon and walnuts; coffee or tea
• Snack: 4 oz non-fat sugar-free yogurt
• L: Tuna salad w/ celery, mayo, tomato, onion in
whole wheat pita
• Snack: 1 part-skim mozzarella cheese stick
• D: Pan roasted steak and onions, South Beach salad,
steamed broccoli; chocolate-dipped strawberries
South Beach Diet: Phase 3
• Maintenance- no foods are forbidden
• Continue to limit high carb, refined or
heavily processed foods.
• Return to earlier phase if weight gain occurs
South Beach vs Atkins Phase 1
•
•
•
•
Atkins
Proteins: All meats, poultry,
fish, shellfish, eggs, cheese are
unlimited
Fats: vegetable oils, butter,
mayonnaise, heavy cream,
bacon
Vegetables: 3 cups salad or 2
cups salad and 2/3 cup low carb
vegetables
NO: artificial sweeteners,
margarine, fruits, grains, breads,
starchy vegetables, dairy,
alcohol
•
•
•
•
•
South Beach
Proteins: Lean beef, pork,
skinless poultry, low fat cheese,
seafood, eggs
Fats: Canola and olive oil
Vegetables: salad greens, beans,
tomatoes, cabbage, summer
squash, broccoli, all low carb are
unlimited
Dairy: Fat free or 1% milk or
yogurt
NO: fatty meat, high fat cheese;
fruits, grains, breads, starchy
vegetables, butter, margarine,
alcohol
High Carbohydrate Low Fat
Diets
• The Pritikin Weight Loss Breakthrough
• Eat More, Weigh Less (Dean Ornish)
High Carb Low Fat Diets
• Rationale: diet is high in bulk and fiber, low
in calorie density producing early satiety
and weight loss
• Description: 50-75% carbohydrate calories,
relatively less meat, fish, fats and oils, more
grains, cereals, breads, fruits, vegetables
Sample Menu: High Carb Low Fat
• B: 1 cup blueberries; oatmeal mixed with 1 cup
nonfat milk, sprinkled with cinnamon and
walnuts; coffee or tea
• Snack: 4 oz non-fat sugar-free yogurt
• L: Vegetarian vegetable soup, fresh orange, nonfat
yogurt
• D: Grilled salmon with yogurt-dill sauce, bulgur
with raisins, steamed broccoli; strawberries over
angelfood cake
• Snack: air popped popcorn
Very Low Fat Diets
• <10% of calories from fat
• May be vegetarian
• Includes The Pritikin Program and Dean
Ornish’s Program for Reversing Heart
Disease
• Elimination of fat makes the diet less
energy dense
• May be difficult for some people to adhere
to
Research on Macronutrient Mix in
Weight Loss Diets
A Low- Carbohydrate, Ketogenic Diet versus a LowFat Diet To Treat Obesity and Hyperlipidemia
• Objective: Compare effects of a low-carb, ketogenic
diet with those of a low-fat, low chol, reduced calorie
diet
• Design: Randomized, controlled
• Subjects: 120 overweight, hyperlipidemic volunteers
• Intervention: Low carb diet (initially <20 g carb/day)
plus nutritional supplementation, exercise
recommendation, and group meetings or low-fat diet
(<30% energy from fat, <300 mg chol, deficit of 5001000 kcal/d) plus exercise recommendation and group
meetings
Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777
Low Carb vs Low Fat Diet
• Measurements: body weight, body composition, fasting
serum lipid levels and group meetings
• Results: 76% of the low-carb group and 57% of the lowfat group completed the study. At 24 weeks weight loss
was greater in the low-carb group (12.9%) than in the
low-fat group (6.7%)
• Pts in both groups lost more fat mass (-9.4 kg low carb, 4.8 kg low-fat) than fat free mass (-3.3 kg vs -2.4 kg)
• Low carb diet subjects had > decreases in serum
triglycerides (-74.2 mg.dL vs. -27.9 mg/dL)
Expected mean body weight over time, by diet group
Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777
Low Carb vs. Low Fat
• Low carb group had > increases in HDL-C (5.5
mg/dL vs. -1.6 mg/dL P<0.001)
• Changes in LDL-C were not significant
• Low carb group had greater participant retention and
greater weight loss over 24 weeks
• Minor adverse effects were more frequent in the lowcarb diet group
• Limitations: Effects of the low-carb diet and of the
nutritional supplements could not be separated.
Participants were healthy and were followed for only
24 weeks.
Yancy, W. S. et. al. Ann Intern Med 2004;140:769-777
Effects of Low-Carbohydrate vs Conventional
Weight Loss Diets in Severely Obese Adults: One
Year Follow Up of a Randomized Trial
• Objective: Review the 1-year outcomes of two
groups randomized to these diets
• 132 obese adults, BMI 35 or greater; 83% had
diabetes or metabolic syndrome
• Participants were counseled to either restrict carb
intake to < 30g/day or reduce calories by 500
cals/day with <30% of cals from fat
Stern, L. et. al. Ann Intern Med 2004;140:778-785
Comparison of mean weight loss in kg between participants on the
conventional diet and participants on the low-carbohydrate diet at
6 months (n = 118) and at 1 year (n = 126)
Stern, L. et. al. Ann Intern Med 2004;140:778-785
Low carb vs. conventional
1 year follow up
• By 1 year, mean weight change for persons on the low carb
diet was -5.1 +/- 8.7 kg compared with -3.1 +/- 8.4 kg for
persons on a conventional diet. Differences were not
significant (P= 0.20)
• Triglycerides decreased more on low carb diet, HDL levels
decreased less, HbA1c improved more
• Changes in other lipids (LDL, total-C) and insulin
sensitivity did not differ between groups
• Limitations: 34% drop out rate, suboptimal dietary
adherence; relatively small net weight loss in both groups
Stern, L. et. al. Ann Intern Med 2004;140:778-785
Low Carb vs. Conventional Diet
Outcomes
• Between 6 months and 1 year, persons in the low
carb group began to regain weight while persons
on the conventional diet continued to lose weight
• By 6 months, there was no significant difference
in weight loss between the two groups
• Intake data suggest that differences in weight
loss, where they exist, are the result of
differences in calorie intakes, not a metabolic
advantage of low carb
Atkins vs Zone vs Ornish vs Learn
• 311 overweight women ages 20 to 50 were
randomized to one of four diets
incrementally different in CHO
• Subjects were given books explaining the
diet and attended weekly instruction for
eight weeks; then remained on the diets for
another 10 months (total = 1 year)
Gardner CD, et al. JAMA 2007;297:969-977
Changes from baseline at 12 months
Outcome
Weight (kg)
LDL (mg/dL)
HDL (mg/dL)
Triglycerides
Systolic BP
Atkin
s
-4.7
0.8
4.9
-29.3
-7.6
Zon
e
-1.6
0.0
2.2
-4.2
-3.3
LEA
RN
-2.6
0.16
2.8
-14.6
-3.1
Gardner CD et al. JAMA 2007; 297:969-977.
Ornis
h
-2.2
-3.8
0.0
-14.9
-1.9