weight management in health and disease session 3 … · nmdw221 weight management in health and...

NMDW221Weight Management in Health and Disease

www.endeavour.edu.au

Session 3

Biology of Obesity Part II

Nutritional Medicine Department

© Endeavour College of Natural Health www.endeavour.edu.au 2

Biology of Obesity Part II

o Metabolic fuels and obesity

o Carbohydrates

o Proteins

o Lipids

Metabolic fuels and obesity



o A healthy body weight results from a balance between

energy intake and energy expenditure

o An excess of energy from any of the macronutrients

outside of the Acceptable Macronutrient Distribution

Ranges (AMDR) will contribute to an energy imbalance

and weight gain (Australian Dietary Guidelines, (2013), p.14)



o All macronutrients provide energy and contribute to

dietary energy intake.

o Carbohydrates provides 16.7KJ per gram

o Protein provides 16.7KJ per gram

o Fat provides 37.7KJ per gram

o Alcohol provides 29.3KJ per gram (Although not a

macronutrient, alcohol provides a significant amount of

energy, and will contribute to weight gain if consumed

regularly) (Nutrient Reference Values, 2013)



o Acceptable Macronutrient Distribution Ranges (AMDR)

provide macronutrient percentage guidelines and are

associated with reduced risk of chronic diseases

including obesity

o The AMDR recommends total energy intake should be

obtained from the following macronutrients in the

recommended percentages

• 45-65% from carbohydrates

• 20-35% from fat

• 15-25% from protein (Australian Dietary Guidelines, 2013, p.16 )


Metabolic fuels and obesity o Energy intake outside of these reference ranges

increases the risk of chronic diseases including

overweight and obesity

o Alcohol also contributes to energy intake and should

contribute to no more than 5% of total energy intake

due to its lack of nutritional value, negative effect on

health and high energy density

(Australian Dietary Guidelines, 2013, p.16 )



o Energy intake increased in Australian adults by 3-4%

between 1983 and 1995

o This is equivalent to approximately 350KJ per day

o Energy intake also increased in Australian children and

adolescents with an 11% increase for 10-15 year old

girls, and a 15% increase for 10-15 year old boys

o This is equivalent to an extra 900KJ for girls, and

1400KJ for boys per day over the last decade o (Australian Dietary Guidelines, 2013, p.15)

o


Metabolic fuels and obesity o The increase in energy intake during this

time was mainly as a result of an increased

intake of cereal based foods, confectionary

and sugar sweetened beverages

o In 1995, 36% of adults total energy intake

came from energy dense and nutrient poor

food sources

o In children 41% of energy dense and

nutrient poor food sources contributed total

energy intake

(Australian Dietary Guidelines, 2013, p.15)https://en.wikipedia.org/wiki/File:Jim

my_gill_-_confectionary_stand_b.jpg


Metabolic fuels and obesity o These changes in energy intake along with a reduction in

physical activity have resulted in a significant increase in

obesity rates in adults and children since 1980 (Australian Dietary

Guidelines, 2013, p.22)

o The Most recent 2011-2012 Australian Health Survey

identified Australian adults are obtaining their total energy

intake coming from the following proportion of

macronutrients

• 45% from carbohydrates

• 31% from fat

• 18% from protein (Australian Health Survey, 2012)

http://medicalxpress.com/news/2015-05-tight-family-

lessen-impact-food.html



o Data from the most recent 2011-

2012 National Health Survey also

indicated that Australian adults

obtain more than one third (35%) of

total energy intake from

discretionary foods (Australian Bureau of

Statistics, 2012)

o Discretionary foods are nutrient

poor, high in energy, added sugar,

and are closely linked with the

development of obesity and poor

health (Eat for Health, 2013)

http://www.fda.gov/ForConsumers/Consum

erUpdates/ucm387164.htm

Carbohydrates


Carbohydrates

• Carbohydrates provide an important source of energy in the

diet supplying approximately 45% of energy in developed

countries and 85% in developing countries

• Carbohydrates are divided into complex carbohydrates

(starches and non starch polysaccharides) and refined

carbohydrates (simple sugars)

• Complex carbohydrates are also known as starch, or non

starch polysaccharides (dietary fibre) and include whole grains,

vegetables, legumes and fruit (Stylianopoulos, 2013)


Complex Carbohydrateso Complex carbohydrates provide a

number of nutrients including

protein, fibre, iron, B vitamins,

vitamin E, zinc, magnesium,

selenium and phosphorus (Stylianopoulos, 2013)

o These nutrients are vital for

supporting health and reducing

the risk of chronic disease (Nutrient

Reference Values, 2013; Stylianopoulos, 2013)

o When assessing carbohydrate

intake its very important to focus

on the quality of carbohydrates in

the diet (Stylianopoulos, 2013)

http://www.webmd.com/diabetes/insulin-16/slideshow-

counting-carbs

o Diets rich in fruit, vegetables,

whole grains and legumes

support health, reduce the

risk of disease and help to

manage body composition (Australian Dietary Guidelines, 2013, p.20)


Starch

o Starch is found in wheat, maize, oats, rye, root vegetables,

legumes and vegetables.

o Once again the focus is on improving the quality of

carbohydrates in the diet

o Refined starch present in white pasta, white bread, highly

processed cereal products, and potatoes are the most popular

types of starch containing foods incorporated into the Western

diet, and are often high in energy and low in nutritional value

o In contrast, whole grains contain starch but are also packed full

of other nutrients including fibre, B vitamins, magnesium,

chromium etc. (Stylianopoulos, 2013; Australian Dietary Guidelines, 2013, p.44)


Dietary fibre

o Non starch polysaccharides are also known

as dietary fibre and is high in whole grains,

vegetables, fruit and legumes (Stylianopoulos,

2013)

o Dietary fibre is very important for improving

satiety, lowering the glycaemic index of the

meal and for supporting digestive health

o Dietary fibre can help to manage weight by

improving satiety and reducing overeating.

Diets high in fibre are also often lower in

energy density resulting in a lower total

energy intake (Nutrient Reference Values, 2014)

o There is no RDI for dietary

fibre however an Adequate

Intake (AI) has been set at

25gm/day for women, and

30gm/day for men between

19-30 years old (Nutrient

Reference Values, 2014)

http://www.heart.org/HEARTORG/HealthyLiving/Health

yEating/HealthyDietGoals/Whole-Grains-and-

Fiber_UCM_303249_Article.jsp#.VyLuRE1f2Uk


Refined carbohydrates o Refined carbohydrates or simple sugars consist of

monosaccharides and disaccharides

o Sucrose is a disaccharide derived from sugar cane or sugar

beet and is added to food products to improve the viscosity,

sweetness and flavour. (Nutrient Reference Values, 2014; National Health and

Medical Research Council, 2015)

o Refined cereal products, flavoured dairy products, sugar

sweetened beverages, confectionary, baked goods, spreads,

desserts and many other food products contain added sugars (Nutrient Reference Values, 2014; National Health and Medical Research Council, 2015)

o These foods are energy dense (high in KJ) contain little

nutritional value, and if eaten in excess will contribute to weight

gain (Eat for Health, 2013; Nutrient Reference Values, 2014; National Health and

Medical Research Council, 2015)


Added sugars

o For the first time, revised Australian Dietary Guidelines

released in 2013, recommend to limit the amount of foods

containing added sugars in the diet including soft drinks, sports

drinks, fruit drinks, cordials, confectionary, cakes, biscuits etc(Eat for Health, 2015)

o There is strong evidence linking consumption of sugar

sweetened beverages (SSB) to the rise in obesity rates in

adults and children (National Health and Medical Research Council, 2015)

o Too much added sugar in the diet can lead to weight gain and

as a result increase the risk of developing type two diabetes (National Health and Medical Research Council, 2015)


Naturally occurring sugar o In contrast, lactose and fructose are also sugars, however

when naturally occurring, these sugars are found in dairy,

whole fruit, vegetables and legumes and contain vital nutrients

o Wholefoods containing naturally occurring sugars are nutrient

dense, contain a variety of nutrients essential for supporting

health, and have less of an effect on insulin than foods

containing added sugars (mainly due to the fibre content)

o To prevent weight gain foods high in added sugars should be

limited and is possible avoided (National Health and Medical Research

Council, 2015)


Toxic Sugar

o Watch the 2013 report on Catalyst “Toxic sugar” discussing the

detrimental effects sugar has health and obesity

http://www.abc.net.au/catalyst/stories/3821440.htm



Excess carbohydrates

o Once ingested, carbohydrates are broken down and signal the

release of insulin from the pancreas. Insulin takes glucose up from

the blood stream and uses it for energy. Any excess glucose which

is not utilised or stored as glycogen will be stored as triglycerides

in adipose tissue and contribute to weight gain (Stylianopoulos, 2013;

Tortora & Grabowski, 2003, p. 910)

o Insulin also impairs lipolysis (the breakdown of fat) and

encourages lipogenesis (fat storage) which contributes to weight

gain (Stylianopoulos, 2013; Tortora & Grabowski, 2003, p. 930)

o Therefore a diet high in refined carbohydrates will contribute to

weight gain and obesity (Stylianopoulos, 2013)


Fructose

o A diet high in fructose encourages the deposition of visceral fat

especially around the abdomen by increasing lipogenesis (Bray, 2007,

p. 885)

o Visceral fat disrupts normal metabolic functioning, increases insulin

resistance, causes liver damage and increases inflammation (Bray,

2007, p. 885)

http://www.iherb.com/now-

foods-real-food-fructose-3-lbs-

1361-g/7762


High fructose corn syrup

o Foods high in added fructose are those made using sucrose and

high fructose corn syrup (HFCS), and include food products such

as sugar sweetened beverages, confectionary and many other

processed foods commonly consumed in the Western diet (Bray,

2007, p.885; Caballero, 2013; Kopelman et al., 2010, p.144)

o The increased consumption of SSB and HFCS over the past 30

years has coincided with the increase in obesity rates during this

time (Bray, 2007, p.885; Caballero, 2013; Lakhan & Kirchgessner, 2013, p.5; National Health

and Medical Research Council, 2013, p.20)

http://news.wisc.edu/newsphotos/SCD-1_gene.html


Fructose

o Fructose when consumed in excess also disrupts satiety cues by

impairing leptin and the normal “switching off” of ghrelin (hunger

hormone) resulting in an increase in appetite (Lakhan & Kirchgessner, 2013,

p.5)

o Fructose found in whole fruit and whole vegetables does not have

the same effect on appetite and metabolic functioning as foods

containing added fructose due to the fibre content found in these

foods (Bray, 2007, p.885)

o Fructose is metabolised by the liver and when consumed in excess

causes damage to the liver (Bray, 2007, p.885; Caballero, 2013)


Class activity

• Come up with a list of common foods consumed in

the Australian diet which are high in refined

carbohydrates?

• Then come up with a list of foods to replace these

with which contain greater nutritional value?


Class activity

o View the following 2015 report

from Lateline discussing the

impact a high sugar and

refined carbohydrate diet has

on obesity and the obesity

epidemic

o www.abc.net.au/lateline/conten

t/2015/s4225649.htm(Lateline, 2015)

http://www.abc.net.au/lateline/content/2015/s4225649.htm

Proteins


Protein

o In contrast to carbohydrates, protein produces a moderate

insulin response

o Protein contains 17KJ per gram and has a much higher

thermogenic response than fat and carbohydrates (Nutrient

Reference Values, 2014)

o The thermic effect of food (TEF) accounts for approximately

10% of your total energy expenditure and is the energy

required for digestion, absorption, transport and storage of

nutrients. The thermogenic effect of:-

• Glucose is 5-10%

• Fat 3-5%

• Protein 20-30%

(Burke & Deakin, 2010, p.103)


Proteino As a result, protein has a greater effect on

the thermic effect of food and total energy

expenditure than carbohydrates and fat (Burke & Deakin, 2010, p.103)

o Foods containing good quality protein

including lean red meat, fish eggs, poultry,

nuts and seeds, legumes, whole grains

and dairy which all help to promote satiety

and reduce appetite (Nutrient Reference Values,

2014)

o Encouraging the patient to consume a

variety of plant and animal based protein

rich foods will help to support health and

promote a healthy body composition

https://en.wikipedia.org/wiki/Egg_(food)

Question: How many grams of

protein does the average egg

have?


Protein

o Foods high in protein but which are also highly processed are

high in energy, low in nutritional value and will contribute to

weight gain (fast food/take away)

o Once again the focus is on improving the quality and variety of

protein rich foods in the diet and ensuring that the diet is

balanced and nutrient dense

o Protein requirements vary depending on the individuals weight,

activity levels and life stage (infant, child, adolescent, adult,

pregnancy) and can be determined by undertaking a simple

calculation (Nutrient Reference Values, 2013)


Protein RDI

o The RDI for women between 19-70 years old is 0.75gm/kg/day

o The RDI for women > 70 years old is 0.94gm/kg/day

o The RDI for men between 19-70 years old is 0.84gm/kg/day

o The RDI for men > 70 years old is 1.07gm/kg/day (National Health and Medical Research Council, 2015)

Question: Why do you think protein requirements increase as

men and women age?


Protein for Athletes

o Protein requirements are slightly higher for athletes, and for people

participating in higher levels of physical activity.

o Moderate intensity endurance athletes exercising 4-5 times a week

for 45-60 minutes = 1.2g/kg/day of protein

o Recreational endurance athletes exercising 4-5 times a week for 30

minutes at <55% V02peak = 0.8-1.0g/kg/day of protein

(Burke and Deakin 2010, p.80)


Protein for Athletes

o Elite male endurance athletes = 1.6g/kg/day

o Football and power sports = 1.4-1.7g/kg/day

o Resistance athletes (early stage) = 1.5-1.7g/kg/day

o Resistance athletes (steady state) = 1.0-1.2g/kg/day

o Female athletes = up to10-20% lower than make athletes

(Burke and Deakin 2010, p.80)

http://gognarly.com/tips-on-eating-right-for-new-endurance-athletes-trying-to-

lose-weight-pt-1/


Protein

o Protein is cleaved in the digestive tract, broken down into

amino acids, and either used to maintain bodily processes,

converted to ketones, or converted into triglycerides (Groff et al,

2005, p.207 Tortora & Grabowski 2003, p.925)

o When carbohydrate intake is insufficient, protein and fat can be

utilized as a fuel source, and converted into ketones to be used

as energy (Tortora & Grabowski 2003, p.929)


Protein and lean muscle mass

o Ensuring adequate protein

in the diet also helps to

maintain lean muscle mass

which is essential for

supporting and maintaining

a healthy metabolism

o The more lean muscle

mass you have the more

energy the body expends

at rest which is very

important when trying to

lose weight or modify body

composition (Kopelman et al

2010, p.117)

http://www.menshealth.com/weight-

loss/worlds-best-protein-sources

http://thescrutinizer.net/creatine-

lean-muscle-mass/


Class activity

o Come up with three dietary strategies to increase a patient’s

intake of good quality lean protein?

o Come up with 1x breakfast, 1 x lunch, 1 x dinner and 1 x snack

suggestion high in protein and present this to the class


Fat

o Fat contains 37 KJ per gram and is the most energy dense of

all of the macronutrients

o Because of the increased energy density of fat, and unlimited

storage capacity of adipocytes, fat it is readily stored

o As a result, adipocytes expand and contribute to an increase in

adipose tissue which accelerates obesity

(National Health and Medical Research Council, 2015, National Health and Medical Research

Council 2013, p.68)


Unsaturated Fatso The types of dietary fat are very important

to consider when assessing a person’s

diet, as unsaturated fats including

monounsaturated and polyunsaturated fats

are beneficial to health and help to support

and maintain health

o Monunsaturated fats are found in plant

based oils including olive oil, nuts, seeds,

soybeans, avocadoes and plant based oils

o Polyunsaturated fats are found in deep sea

oily fish, chia seeds, flaxseeds, walnuts,

soybeans and green leafy vegetables

(Melanson et al., 2009, pp.234-235; National Health and

Medical Research Council, 2015; National Health and Medical

Research Council, 2013, p.68 )

http://www.health.harvard.edu/stayin

g-healthy/the-truth-about-fats-bad-

and-good


Saturated Fatso In contrast, foods high in saturated

fats should be limited as they are

high in energy, often low in

nutritional value, and are

associated with an increased risk of

cardiovascular disease (CVD)

o Foods high in saturated fats include

- butter, cream, coconut oil, palm

oil, biscuits, cakes, pastries,

desserts, confectionary, processed

meats, fried foods, chips, savoury

snacks, red meat, full fat dairy etc(Melanson et al., 2009, pp.234-235; National Health

and Medical Research Council, 2015; National Health

and Medical Research Council, 2013, p.68)

http://www.health.harvard.edu/staying-healthy/the-truth-

about-fats-bad-and-good


Function of Fat

• Fat is important for maintaining a number of bodily functions

including:

– Triglycerides- protection, insulation, energy storage

– Phospholipids- important part of cell membranes

– Steroids- cholesterol synthesis, synthesis of bile salts,

adrenocorticoid hormones, sex hormones

– Eicosanoids- involved in blood clotting, immune function, smooth

muscle contraction, inflammation etc

– Fat soluble vitamins- A,D,E,K

– Synthesis of lipoproteins- carrier proteins for cholesterol

– Fatty acids- Used to synthesize ATP (Tortora & Grabowski, 2003, p.45)


Fat

• Unlike carbohydrates and protein, fat generates the lowest

insulin response

• Out of all of the macronutrients, fat has the lowest effect on

lipogenesis (fat storage)

• The body can utilize fats as a fuel source when carbohydrate

intake is inadequate

• This can be achieved by converting fatty acids into ketones via

a pathway known as gluconeogenesis

(Tortora & Grabowski, 2003, p.929; Watkins, 2013)


Low fat revolution

o Dietary fat has been demonised since the 1980’s after an

American scientist Ancel Keys showed a correlation

between high fat diets and high cholesterol in the 1940’s

o Based on these findings it was assumed that a diet low in

fat reduced the risks of CVD

o The American government incorporated the inclusion of low

fat foods into the American dietary guidelines as a result of

these findings, which led to the development of the low fat

craze in the 1980’s, and to the manufacturing and demand

for low fat food products (Melanson et al., 2009, p.229)


Low fat revolution o The removal of fat from foods

resulted in manufacturers

replacing the fat with sugar to

improve the palatability and

taste

o The low fat revolution resulted

in people consuming low fat

food products which were high

in sugar, KJ’s and low in

nutritional value

o The low fat revolution

coincided with the increase in

obesity rates despite a

reduction in dietary fat intake (Kopelman et al., 2010, p.279; Melanson et

al., 2009, p.229)

Low fat Vaalia = 24.3g of

sugar per a 150g serve /

2g of fat

http://shop.coles.com.au/online/national/vaalia-

yoghurt-low-fat-passionfruit-4-pack


The shift – Fat and energy balance

o In recent years and with emerging evidence, the World

Health Organization has shifted its emphasis from reducing

dietary fat to the importance of maintaining energy balance

in order to maintain a healthy weight

o The Australian Dietary Guidelines reflect this in the most

recent 2013 Australian dietary guidelines and also

encourage people to reduce the intake of foods high in

added sugars

(National Health and Medical Research Council, 2013, p.19)


Fat and energy balance

o The Nutrient Reference Values and the Australian Dietary

Guidelines recommend that dietary fat should be consumed

in the following percentages in order to maintain health and

reduce the risk of heart disease

• Total fat 20-35% of total energy intake

• Total saturated fats and trans fats no more than 10% of total

energy intake

• 4-10% of energy should come from linoleic acid (omega 6

PUFA) and 0.4-1% of total energy from alpha-linolenic acid

(omega 3 PUFA)

(National Health and Medical Research Council, 2013, p.20)


“Harvard metastudy says

saturated fats are harmful”

o Listen to the following podcast on the health report about saturated

fat. “Harvard metastudy says saturated fats are harmful”

o http://mpegmedia.abc.net.au/rn/podcast/2015/10/hrt_20151005_17

30.mp3

(Health report, 2015)

http://mpegmedia.abc.net.au/rn/podcast/2015/10/hrt_20151005_1730.mp3


References o Australian Broadcasting Corporation. (2013). Catalyst: Toxic sugar?. Retrieved from


o Australian Bureau of Statistics. (2012). Australian Health Survey key findings. Retrieved from

http://www.abs.gov.au/ausstats/[email protected]/Lookup/4364.0.55.009main+features12011-12

o Bray, G. A. (2007). How bad is fructose?. The American Journal of Clinical Nutrition, 86(4), 895-

896. Retrieved from http://www.ebscohost.com

o Burke, L., & Deakin, V. (2010). Clinical Sports Nutrition (4th ed.). North Ryde, NSW: McGraw-

Hill.

o Caballero, B. (2013). Sucrose: Dietary sucrose and disease. In P. Allen (Eds.). Encyclopedia of

human nutrition. Oxford, England: Elsevier Science & Technology. Retrieved

from http://www.credoreference.com

o Gropper, S., Smith, J., & Groff, J. (2005). Advanced nutrition and human metabolism (4th ed.).

Belmont, CA: Thomson Wadworth


References o Kopelman, P. G., Caterson, I. D., & Dietz, W. H. (Eds.) (2010). Clinical obesity in adults and

children (3rd ed.). Oxford, England: Wiley- Blackwell.

o La Berge, A. F. (2008). How the ideology of low fat conquered America. Journal of The History

of Medicine And Allied Sciences, 63(2), 139-177. doi: 10.1093/jhmas/jrn001

o Lateline. (2015). Cardiologist says sugar and carbs are the main cause of rising obesity rates

[Video file]. Retrieved from www.abc.net.au/lateline/content/2015/s4225649.htm

o Lakhan, S. E., & Kirchgessner, A. (2013). The emerging role of dietary fructose in obesity and

cognitive decline. Nutrition Journal, 12, 114. doi: 10.1186/1475-2891-12-114.

o Melanson, E. L., Astrup, A., & Donahoo, W. T. (2009). The relationship between dietary fat and

fatty acid intake and body weight, diabetes, and the metabolic syndrome. Annals of

Nutrition & Metabolism, 55(1-3), 229-243. doi: 10.1159/000229004

o National Health and Medical Research Council. (2013). Australian Dietary Guidelines. Retrieved

from

https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n55_australian_die

tary_guidelines.pdf


References

o National Health and Medical Research Council. (2015a). Sugars. Retrieved from

https://www.eatforhealth.gov.au/food-essentials/fat-salt-sugars-and-alcohol/sugars

o National Health and Medical Research Council. (2015b). Nutrient Reference Values: Fats: Total

fat and fatty acids. Retrieved from https://www.nrv.gov.au/nutrients/fats-total-fat-fatty-

acids

o National Health and Medical Research Council. (2015c). Nutrient Reference Values: Protein.

Retrieved from https://www.nrv.gov.au/nutrients/protein

o Prentice, A. (2014). Encyclopedia of human nutrition (3rd ed.). Boston, MA: Credo Reference.

o Samaha, F. F., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., … Stern, L.

(2003). A low-carbohydrate as compared with a low-fat diet in severe obesity. The New

England Journal of Medicine, 348(21), 2074-2081. Retrieved from

http://www.ebscohost.com


References

o Stylianopoulos, C. (2013). Carbohydrates: Requirements and dietary importance. [Online]. In P

Allen (ed.). Encyclopedia of human nutrition. Oxford, United Kingdom: Elsevier Science

& Technology. Retrieved from http://www.ebscohost.com

o Swan, N. (2015). Harvard metastudy says saturated fats are harmful [Audio podcast]. Retrieved

from http://www.abc.net.au/radionational/programs/healthreport/harvard-metastudy-

saturated-fats/6828854

o Tortora G., & Grabowski, S. (2003). Principles of Anatomy and Physiology (10th ed.). Milton,

QLD: John Wiley & Sons, Inc.

o Watkins, P. (2013). Fatty acids: Metabolism. [Online]. In P. Allen (ed.). Encyclopedia of human

nutrition. Oxford, England: Elsevier Science & Technology. Retrieved from

http://www.credoreference.com

weight management in health and disease session 3 … · nmdw221 weight management in health and...

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