Transcript Evaluations of Weight Loss Strategies to Improve Body

PCCHA 2014
Reaching New Heights in College Health
October 14, 2014
Colin K. Wills, B.Sc.
Joannie Dobbs, PhD CND
Human Nutrition, Food & Animal Sciences

Increasing body weight of Americans (College Students)
◦ Increased weight during Freshman year in college
 5 lbs. to 15 lbs.

Health Conditions related to excess weight
Gropper SS, et al. Journal of American College Health. 2009:58:3
Gropper SS, et al. Appl. Physiol. Nutr. Metab. 2012: 37: 1118–1123

Nurse

Nutritionist /
Dietitian

Health Educator

Physical Trainer

Psychology

Medical Doctor
‣ Common Opponent
∘ Over-FAT
VS.
• Related Health Factor
• Hypertension
• Dyslipidemia
• Stroke
• Cardiovascular Disease
• Diabetes
• Metabolic Syndrome
• Some Cancers
http://www.cdc.gov/obesity/data/adult.html
Flegal K, et al. JAMA. 2012;307(5):491-497.
U.S. Department of Health and Human Services. Office of the
Surgeon General, January 2010.
1)
Identify factors helpful in making healthful and
appropriate weight loss recommendations

2)
3)
4)
BMI vs. Body Fat
Discuss research related to weight loss strategies
most appropriate for long term weight / fat loss
Compare BMI and Body Composition as related to
protein intake
Describe appropriate diet recommendations for
weight loss
Understanding the Role of Body
1)
Composition
2)
◦
Health
◦
Weight loss
BMI not equal to Body Fat

It is assumed that BMI reflects body fat

Is that Correct?
 CDC - National Health and Nutrition Examination Survey (NHANES)
 1999-2004
• (Bio-electrical Impedance Analysis)
 Gender (n = 2286)
 Female (n) = 1059
 Male (n) = 1227
 College Aged ( 18-35 years)
 24-hr Diet Recall
 JMP Pro 11; SAS
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx
BMI Groups
Category
Assumptions
< 18.5
Underweight
Under-FAT
18.5 - < 25
Normal
LEAN
25 - < 30
Overweight
Over-FAT
30 - < 35
Obese
Over-FAT
35 - < 40
Obese I
Over-FAT
> 40
Morbid Obesity
Over-FAT
Institute of Medicine. DRI intakes for Energy, Carbohydrate, Fiber, Fat,
Protein and Amino Acids. 2005.
Body fat percentages for males and females and their classification
Females
Males
Rating
8-15%
5-10%
Athletic
16-23%
11-14%
Good
24-30%
15-20%
Acceptable
31-36%
21-24%
Overweight
>37
> 24
Obese
Jeukendrup A, et al. Sport Nutrition, Second Edition. 2010
Female
BMI Groups
Male
(Acceptable < 30%)
(Acceptable < 20%)
Body Fat
N
Min %
Max %
N
Min %
Max %
<18.5
49
19.5
42.6
39
6.1
31.4
18.5 - < 25
482
9.4
49.2
542
2.1
37.6
25 - < 30
233
16.8
52.7
414
2.7
43.5
30 - < 35
159
25.5
56.1
168
4.6
45.1
35 - < 40
79
27.7
56.5
45
14
47.7
> 40
57
25.6
60.2
19
22.6
51.5
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx
BMI Groups
Category
Over-FAT vs.
Normal / LEAN
< 18.5
Underweight
Under-FAT
Over-FAT*
18.5 - < 25
Normal
LEAN
Over-FAT*
25 - < 30
Overweight
Over-FAT*
LEAN
> 30
Obese
Over-FAT*
LEAN
*weight/fat modification would be beneficial
Normal BMI
but High %BF
Normal
BMI & %BF
High BMI
& %BF
High BMI but
Normal %BF
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx
Normal BMI
but High %BF
Normal
BMI & %BF
High BMI
& %BF
High BMI but
Normal %BF
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx
Energy
Intake
Protein
FAT
=
Energy
Expenditure
Physical
Activity
Basal Energy
Expenditure
Carbohydrate
Alcohol
Thermic Effect
of Food
Energy
Intake
>
Energy
Expenditure
‣ Example
∘ 50 kcal
extra a day
∘ ~5 lbs. in
a year
Energy
Intake
<
Energy
Expenditure

AHA Observed Average

DRI 2005 Energy
Calorie Intake
Recommended
◦ Female
◦ Female = 5’4, 56 kg (123.2 lbs.)
 1500 / day
◦ Male
 1500-1800 / day
 2403 kcal / day
◦ Male = 5’9, 70 kg (154 lbs.)
 3067 kcal / day
* AHA = American Heart Association
** DRI = Dietary Reference Intake
Jensen, MD, et al. Circulation. 2014;129:S102-S138
Institute of Medicine. DRI intakes for Energy,
Carbohydrate, Fiber, Fat, Protein and Amino Acids. 2005.
N Intake
(1.1 g pro/kg)
(1.3 g pro/kg)
Elwyn DH, et al. Crit Care Med.1980;8:9-20

Decrease BMI
Approaches to calorie reduction
1)
◦
Food diary vs. Counting calories
◦
Eat more; fiber, whole grain, lean meat, skimmed
dairy
◦
Drink more water
Kushner, RF. American Medical Association. Chicago, Il; 2003

Decrease BMI
Approaches to calorie reduction
1)
◦
Dietary Substitutions (fat-free/ low-fat vs. regular)
◦
Consistent eating schedule (routine meal times)
◦
Portion Control
◦
Awareness of triggers to eating

American Heart Association
o
High-carbohydrate
o
Low-Fat
o
Low-Protein
◦ Previous strategies
 Decrease BMI & lower body fat
 Rapid weight loss
◦ Loss of Fat Free Mass
 Decrease Immune function
 Increase loss of protein from bone
 Lower metabolism
 Lower calorie requirement
Sets up the
individual for
rebound
weight gain
Guthrie HA, et al. Human Nutrition. Mosby-Year Book.1995.
1)
Increase lean muscle mass
◦ Improve immune function and health
2)
Increase metabolism
 Energy needs
◦ Subsequently decrease body fat
3)
Increase stores of protein as muscle
◦ Slowing the rate of physiological change
Inevitable Factors
Changeable Factors
‣ Gender

Physical Activity
‣ Age

Energy balance
‣ Ethnicity

Essential Nutrients
◦ Adequate Dietary Protein
Devkota S, et al. Curr Opin Clin Nutr Metab Care.2010;
13:403-407.
Brown LD. Journal of Endocrinology. 2014; 221:R13-R29.
n=1059
(Pro g/kg B.Wt)
n=41
n=285
n=343
n=200
n=105
n=59
n=26
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx
n=1227
(Pro g/kg B.Wt)
n=40
n=209
n=327
n=306
n=166
n=105
n=74
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx
n=1059
n=275
n=249
n=457
n=37
n=41
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx
n=1227
n=342
n=290
n=485
n=44
n=66
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx

As Dietary Protein increases then BMI and % Body
Fat decreases (p<0.001)

~1.6 grams of protein/ kg bodyweight
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx

Muscle Mass = Adequate Protein
◦ Recommended Dietary Allowance (RDA)
 46 grams / day – Female 5’4”, 56 kg (123.3
lbs.)
 56 grams / day – Male 5’9”, 70 kg (154 lbs.)
◦ Dietary Reference Intake (DRI)
 0.8 grams / kg B.Wt / day
◦ NHANES
 1.6 g / kg B.Wt/ day
Institute of Medicine. DRI intakes for Energy, Carbohydrate,
Fiber, Fat, Protein and Amino Acids. 2005.
Evans et al. Nutrition & Metabolism 2012, 9:55
Dietary Protein Consumed As Related To Percent Body Fat
Above Or Below 30%
Female
Dietary Protein (gm)
/ Kg Bodyweight
N
< 30 % Body
Fat
> 30 % Body
Fat
0.0 – 0.79
326
8%
92%
0.8 - < 1.25
384
9%
91%
1.25 - < 1.6
159
25%
75%
1.6 - < 2
105
36%
64%
2 - < 2.5
59
28%
72%
2.5 - < 3
18
38%
62%
3+
8
60%
40%
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx
Dietary Protein Consumed As Related To Percent Body Fat
Above Or Below 20%
Male
(gm) Protein / Kg
Bodyweight
N
< 20 % Body
Fat
> 20 % Body
Fat
0.0 – 0.79
249
48%
52%
0.8 - < 1.25
375
56%
44%
1.25 - < 1.6
258
76%
24%
1.6 - < 2
166
80%
20%
2 - < 2.5
105
78%
22%
2.5 - < 3
51
70%
30%
3+
23
64%
36%
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx

Types of Diets
◦ PRO – Protein at 1.6 g/kg bodyweight
◦ CHO – Protein at 0.8 g/kg bodyweight
o
o
Individuals who completed the 12 mo. PRO (n = 41)
and CHO (n = 30) treatments regardless of
compliance.
-■
12 mo. - ■
Baseline
Individuals who successfully maintained a 10%
weight loss at 12 mo. (PRO, n = 20; CHO, n = 14)
Adapted from Layman DK, Evans E, et al. J Nutr. 2009:139;514-521
Evans E, et al. Nutrition & Metabolism. 2012:9;55.
Layman D, Evans E, et al. J Nutr.2005:135;1903-1910.
Ingestion of 90 grams of protein, distributed evenly at 3
meals

Ingestion of 90 grams of proteins unevenly distributed
throughout the day
During the meals vs. Unequal Protein distribution
◦ More likely to provide a greater 24 hour protein anabolic response
Adapted from Layman D. Nutrition & Metabolism. 2009;6-12.
Adapted from Paddon-Jones, Rassmussen, et al. Curr Opin Clin
Nutr Metab Care 2009, 12: 86–90.
Serving Recommendations by Body Weight - 20 y.o. Female
10
9
8
# Servings
7
100lb
120lb
140lb
160lb
180lb
200lb
6
5
4
220lb
3
2
1
0
Grains (oz)
Vegetables (C)
Fruits (C)
Dairy (C)
Protein (oz)
Oils (tsp)
Serving Recommendations by Body Weight - 20 y.o. Male
12
10
120lb
140lb
160lb
180lb
200lb
220lb
240lb
260lb
# Servings
8
6
4
2
0
Grains (oz)
Vegetables (C)
Fruits (C)
Dairy (C)
Protein (oz)
Oils (tsp)
Diet Types by Categories
Balanced
Liquid
Abs
Flat Belly
Macrobiotic
Traditional Asian
Martha's Vineyard
Acid Alkaline
Flexitarian
Mayo Clinic
Vegan
Lemonade
Anti-Inflammatory
Gluten-Free
Mediterranean
Vegetarian
Purium
Biggest Loser
Glycemic-Index
Nutri-system
Volumetrics
DASH
Jenny Craig
Slim-Fast
Zone
Engine 2
Low FODMAP
Spark Solution
Low-Calorie
Low-Fat
Low
Carbohydrate
High Protein
Miscellaneous
Cookie
Macrobiotic
Atkins
Atkins
Grapefruit
Medifast
Ornish
Eco-Atkins
Dukan
Mark Bittman's VB6
Nutrisystem
TLC
Dukan
LEARN
Power Protein
Raw Food
Vegetarian
Medifast
Medifast
Blood Type
Slim-Fast
Vegan
Paleo
Paleo
Skinny Bitch
South Beach
South Beach
The Fast
Johnston BC, et al. JAMA. 2014;312(9):923-933.
http://health.usnews.com/best-diet
http://www.webmd.com/diet
A large scientific panel of scientists
2-year review
16,000 studies on diet and obesity.
Using Dietary Recommendations to MAINTAIN a
healthy weight should NOT be used to get obese
people to a healthy weight.
Average Protein per Typical Food Serving
Food Sources
NLEA
Serving
Size (g)
NLEA
Volume per
Serving
Energy
(kcal)
Protein (g)
Kcal/ g
protein
Fish / Chicken
/ Beef
85
~ 3 oz. ckd
170
8
2% Cottage
Cheese
110
~ 0.5 oz. cup
100
8
Cheese
30
1 thin slice
110
16
90
~ 0.5 oz.
cup
120
16
130
~ 0.5 oz. cup
150
20
140
30
0.6 -1 cup
~ 3.5 Tbsp.
160
190
32
36
Legumes /
Beans
Beans Processed
Grains
Nuts
http://www.fda.gov/iceci/inspections/inspectionguides/ucm074948.htm
1. Know Their Body Fat
2. Their Weight Goal
3. Eating Style (? Dietary Sources: Iron, Zinc, Protein)
4. Their Daily Calories (Goal or Actual)

Do they use an App
5. Supplement Use (Protein/Multi/Other)
6. Dieting Frequency & Largest Weight Loss
7. # Hours Exercise and Sleep per 24 hours


This book is
translated into as
many languages as
the Bible
Promotes Blood
Donations to Lose
Weight and Other
Unhealthy Weight
Loss Practices
1)
Overall Health of Individual
a)
Fat Loss not Weight Loss
b)
Build Lean Muscle Tissue as Improving Immune
function (1.6 gm protein / kg B.wt)
c)
Weight Resistance Exercise
d)
Total Energy Deficit: No more than 500 kcal
per day (Dietary and/or Physical Activity)
e)
Ensuring all Essential Nutrients
This work is supported in part by USDA Smith Lever
Funding for Project 289H.

Thank you for your time and attention.

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
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
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
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
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
Flegal, K. M., et al. (2012). "Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999-2010." Jama-Journal of the
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
Gropper, S. S., et al. (2012). "Weight and Body Composition Changes during the First Three Years of College." Journal of obesity 2012: 634048-634048.

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
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
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
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
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
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
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
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
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
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
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
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
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
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
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

http://www.cdc.gov/obesity/data/adult.html
http://www.cdc.gov/nchs/nhanes/search/nhanes.aspx

http://health.usnews.com/best-diet


http://www.webmd.com/diet
http://www.fda.gov/iceci/inspections/inspectionguides/ucm074948.htm