paul clayton fdin 28/6/07 - weight management -. paul clayton fdin 28/6/07 - weight management - -...
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Paul ClaytonFDIN 28/6/07
- Weight Management -
Paul ClaytonFDIN 28/6/07
- Weight Management -
- still waiting …
18971897
19191919
1952
1952
1952
2001
Ob / ob/ob normal
Reduced energy expenditureReduced energy expenditure
1600
1800
2000
2200
2400
2600
2800
60 65 70 75 80 85 90 95Year
kcal
per
day
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
1940 50 60 70 80
Positive Positive energyenergy balance balance
1600
1800
2000
2200
2400
2600
2800
60 65 70 75 80 85 90 95Year
kcal
per
day
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
1940 50 60 70 80
Obesogenic culture (AHA ’03)Obesogenic culture (AHA ’03)
Avge US adult sedentary 8 hours / day, < 2,000 steps / day (NYS Public Health Assocn ‘05)
Amish 16,000 steps /day: obesity 9% women, 0% men (Bassett et al ’04)
MRI
* 28 yr man
* Good diet
* Desk worker
Yellow = fat
TOFI – something to chew onTOFI – something to chew on
Thin Outside – Fat Inside
Dangers of inner fat (J Bell, Imp. College)
Inner fat prevalent when normal BMI maintained by diet: 45% women, 60% men
Lean people get CAD, NIDDM too
Exercise the only way to reduce inner fat
Unfitness more dangerous than fatness
Why is weight gain so easy?Why is weight gain so easy?
Multiple satiation mechanisms (enteroendocrine)Protein (Protein (’s, fish > whey > casein)’s, fish > whey > casein)Fat (FA’s esp LCP’s) Fat (FA’s esp LCP’s) Digestible carbs (glucose, CNS)Digestible carbs (glucose, CNS)Fermentable carbs (propionic acid, liver?)Fermentable carbs (propionic acid, liver?)Insufficient calorific throughputInsufficient calorific throughputSocial / stress over-rideSocial / stress over-rideHigh calorific density foods / ‘fast foods’High calorific density foods / ‘fast foods’
AHA 2002: ‘obesogenic culture’AHA 2002: ‘obesogenic culture’
Fewer bus-stops, remote parking
Exercise to be mandatory at all levels of educational system
No ‘junk foods’ to be sold / served in schools
Fat - but starvingFat - but starving
W.H.O. ‘02: ‘Globally, overweight greater health problem than underweight.’
W.H.O./F.A.O ’03: ‘Poor diet the major cause of degenerative disease’.
U.N. ’06: Overweight but malnourished40-60% hospital admissions malnourished (1-3)
25-30% malnourished in the community J Nutr Hlth Ageing 3:133-139, ‘99
> > 3.6 million malnourished in UK (BANT ’07)
Percentage of Population DepletedPercentage of Population DepletedIn Vitamins (USDA 1997)In Vitamins (USDA 1997)
C E A B1 B2 C E A B1 B2 NiacinNiacin Folate Folate B6 B12 B6 B12------------------------------------------------------------------------------------------------------------------------------------------37 68 55 32 31 27 34 54 1737 68 55 32 31 27 34 54 17
Vitamins
%
* Gregory et al 2000. National Diet and Nutrition Surveys, HMSO
Iron from all sources (including supplements)% of children of all ages with intakes below RNI and LRNI
84
57
14
28
39
59 60
96
43
93
16
40 1 1 3 3
44
2
48
0
10
20
30
40
50
60
70
80
90
100
<4 >4 Boys Girls Boys Girls Boys Girls Boys Girls
1.5 - 4.5 Age 4-6 Age 7-10 Age 11-14 Age 15-18
% < RNI
% < LRNI
* Gregory et al 2000. National Diet and Nutrition Surveys, HMSO
Vitamin A from food% of children of all ages with intakes below RNI and LRNI
0
10
20
30
40
50
60
70
80
<4 >4 Boys Girls Boys Girls Boys Girls Boys Girls
1.5 - 2.5 Age 4-6 Age 7-10 Age 11-14 Age 15-18
% < RNI
% < LRNI
RSM 2005: Pathogenic culture?RSM 2005: Pathogenic culture?
Type 2 diabetes
.
RSM 2005: Pathogenic culture?RSM 2005: Pathogenic culture?
Type 2 diabetes increased heart disease, stroke, cancers,
. kidney disease, blindness, Alzheimer’s
RSM 2005: Pathogenic culture?RSM 2005: Pathogenic culture?
Type 2 diabetes increased heart disease, stroke, cancers,
. kidney disease, blindness, Alzheimer’s
asthma, allergy food intolerance / eosinophilic GI disease
osteoporosis
lymphoma, leukaemia, melanoma, germ cell tumours in teens & young adults
ARMD ADD / ADHD / dysphasia / dyspraxia
Positive Positive energyenergy balance balance
1600
1800
2000
2200
2400
2600
2800
60 65 70 75 80 85 90 95Year
kcal
per
day
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
1940 50 60 70 80
Fat – but starvingFat – but starving
Do we really want to encourage people to eat less?
They can at least eat better:
Increased nutrient / calorie ratios
(functional foods, nutraceuticals, supplements)
OROR
Be more physically active so they can eat more?
Burn more calories without exercise? (thermogenic strategies)
Low fat / cholesterolLow fat / cholesterol
Reduced fat / cholesterol contentReduced fat / cholesterol absorption Olestra (sucrose esters)
"... will very probably increase the risks of cancer, heart disease, stroke and blindness." Willett & Stampfer, Harvard School of Public Health Reduced cholesterol absorption ANDReduced lipophile absorptionTake Control, Benecol etc (sterol/stannol esters)
Fat vs carb reductionFat vs carb reduction
Lose more calories by reducing fat
Health issues?
Reducing carbs loses fewer calories
But probably a healthier option
Projected benefits of reducing CHO by 30gProjected benefits of reducing CHO by 30g
1. Salmeron et al 1997ab; Meyer et al, 2000
30% 30% reduction in reduction in type-2 DMtype-2 DM
1
Projected benefits of reducing CHO by 30gProjected benefits of reducing CHO by 30g
1. Salmeron et al 1997ab; Meyer et al, 2000
2. Diabetes Control and Complications Trial, 1996
30% 30% reduction in reduction in type-2 DMtype-2 DM
1.0 % fall in 1.0 % fall in HbAHbA1c1c 25% 25%
reduction in reduction in retinopathyretinopathy
1
2
Projected benefits of reducing CHO by 30gProjected benefits of reducing CHO by 30g
1. Salmeron et al 1997ab; Meyer et al, 2000
2. Diabetes Control and Complications Trial, 1996
3. De Vegt et al 1999; Khaw et al, 2001
30% 30% reduction in reduction in type-2 DMtype-2 DM
1.0 % fall in 1.0 % fall in HbAHbA1c1c
25% 25%
reduction in reduction in retinopathyretinopathy
1
2
3>30% reduction >30% reduction
in CHDin CHD
Projected benefits of reducing CHO by 30gProjected benefits of reducing CHO by 30g
1.2% fall in1.2% fall in
HbAHbA1c1c
Potential appetite suppressorsPotential appetite suppressors
Pinoleic acid: 6 PUFA from Korean pine nut oil. (‘PinnoThin’, Lipid Nutrition Nl)PUFA’s in small bowel trigger cholecystokinin (CCK)PUFA’s at end of small bowel trigger Glucagon-like peptide 1 (GLP1)CCK and GLP1 influence meal terminationClinical trial ‘inconclusive’
Potrential appetite suppressorsPotrential appetite suppressors
Oleoylethanolamide Oleoylethanolamide (cannabinoid receptor blocker): (cannabinoid receptor blocker): cocoa, soybeans, hazelnuts, oatscocoa, soybeans, hazelnuts, oats
Fish & whey protein isolates (anti-stress)Fish & whey protein isolates (anti-stress)
PeptideA, LactiumPeptideA, Lactium
Caralluma fimbriataCaralluma fimbriata
Indian food plant – edible succulentIndian food plant – edible succulent1 g/day, 4 weeks, n=26: weight loss, no adx1 g/day, 4 weeks, n=26: weight loss, no adx
(Lawrence & Choudhary, 12(Lawrence & Choudhary, 12thth World Conf Anti-aging World Conf Anti-aging Medicine, ’04)Medicine, ’04)
1 g/day, 8 weeks, n=501 g/day, 8 weeks, n=50Appetite reduction, weight loss, no adx Appetite reduction, weight loss, no adx (Kuriyan et al, Appetite 48:338-44, ’07)(Kuriyan et al, Appetite 48:338-44, ’07)Some evidence of adipocte inhibitionSome evidence of adipocte inhibition
Pre-adipocyte
Immature adipocyte
Immature multilocular adipocyte
Mature unilocular adipocyte
Differentiation of pre-adipocyte into mature adipocyte
Metabolic shiftMetabolic shift
Capsiate: sweet red pepper CH-19 (1)
Up-regulates UCP 1, 2 (1) and 3 (2)
BUT, increases physical endurance (3)
Animal weight /fat loss data (4)
Clinical studies underway in Japan, USA
Anti-cancer effects (5, 6)
NIDDM, CAD? (7)
Metabolic shiftMetabolic shift
Adrenaline REsearch
Thermo-regulatory clothing
Thermal receptors at base of brain
Up-regulate brown adipose tissue
Up-regulate UCP 1 and 2
Appetite increase, weight loss
..dubious …..dubious …
USA: ‘Weight loss’ patches. Guarana, Garcinia, Menthol, Fucus Vesiculosus (kelp)
UK: hypnosis. ‘You don’t have to clear your plate’
Austria: caffeine-laced tights. ‘The caffeine is absorbed locally and breaks down cellulite’.
The BacklashThe Backlash
Fat Acceptance Movement ’86Fat Liberation ’88Fat Pride ‘89Fat Positive ‘93National Association to Advance Fat Acceptance Council on Size and Weight Discrimination International Society for Size Acceptance
Co-conspiratorsCo-conspirators
For every $ spent on food in the US, 48 cents is spent in fast food restaurants …
… which operate in a very competitive commercial environment …
… and are extremely sensitive to changing consumer demands
BK’s ‘Enormous Omelet Sandwich’BK’s ‘Enormous Omelet Sandwich’
730 calories, 70 g fat: $2.99730 calories, 70 g fat: $2.99
Hardee’s ‘Monster Thickburger’Hardee’s ‘Monster Thickburger’
1420 calories, 107 g fat: $5.491420 calories, 107 g fat: $5.49
Atkins and other low-GL dietsAtkins and other low-GL diets
Efficacy? (6 vs 12 months; 1 +ve vs 3 –ve)
High fat / protein, low fruit / veg diet increases risk of bowel & other cancer1 in 3 adults have renal impairment; worsened by high protein diet Knight et al ’03
low phytate diet Curran et al ‘04
Who has renal impairment? Overweight, IGT Overweight, IGT
Low cal-GL / high micronutrientLow cal-GL / high micronutrient
Low GL
5 – 9 portions fruit and vegetables
Vegetable >> animal protein
Increased intake of fermentable carbs
Limited amounts of fats and oils
V limited digestible carbs
Supplements
New Food PyramidNew Food Pyramid
Wide variety fruits / veg (not potatoes): 800g
Pulses, legumes, seeds, nuts, soy: 300g
Meat, dairy: 150g
Oils, fats: 25g
High GL
supplements
Cals/g 9
3
0.5
New Food PyramidNew Food Pyramid
Wide variety fruits / veg (not potatoes): 800g
Pulses, legumes, seeds, nuts, soy: 300g
Meat, dairy: 150g
Oils, fats: 25g
High GL
supplements
Cals/g 9
3
0.5
Total calories less than 2000 / dayTotal calories less than 2000 / day