DIET THE OTHER FOUR LETTER WORD...NEW PODCAST!

        I know you have all been waiting for it, here is my synopsis for the recent nutritional seminar I gave last night on the evidence behind weight loss. Actually, I attempted to give it last night until some ice and several inches of snow derailed my plan. 
    The focus on the talk is a January 2016 consensus statement from the Academy of Nutrition and Dietetics (1). I also included results from other reviews so please see the references below. The podcast is located at the very bottom of the blog so please listen and would love any feedback. 

      It is going to be hard to cover everything but here goes...Increased food intake can be caused by a multitude of factors. One way to look at those factors is to separate them into interval and external factors. The internal factors can be physiologic or based upon a response from the body or hedonistic which might also come from the body but is more more cerebral in nature. One of the recommendations from AND or the Academy of Nutrition and Dietetics is the goal for a 3-10% baseline weight reduction in those needing to lose weight. The lower recommendation of 3% has been shown to improve blood pressure, lipid profiles, and diabetic factors in some populations still make this an important number even if smaller. The 5-10% is the more effective and harder to achieve guideline but does show significant health benefits as shown by the paper. This is translated to a 500-1000 calorie deficit per day resulting in a loss of 1-2 lbs per week. 
        The most surprising part of this paper is that the evidence does not support one macronutrient ie low carb versus high protein versus DASH versus Mediterranean over another. The most significant factor of the diet is if there is caloric restriction ie a 500-1000 calorie deficit built in to the diet. Not that these diets are all equal since some are associated with better blood pressure profiles ie DASH or lipid ie Mediterranean but for weight loss; caloric deficit is most important. 
        Other factors that have been shown to be be effective in weight loss include reducing or eliminating sugar sweetened beverages, portion control/ premade meals/ meal replacements, and consuming more calories earlier in the day. Now don't shoot the messenger with this one. Increased fruit and vegetable intake have not been show to result in significant weight loss in obese patients based on the paper as well as meal frequency/timing or breakfast consumption. To play devil's advocate; I would honestly need to review the papers discussed in this statement to really believe the fruit and vegetable statement.

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       The paper then focuses on recommendations for physical activity. Besides the guidelines for 30 min of moderate activity on most days of the week or 150 min/week, the focus on physical activity has been shown to improve weight loss when combined with caloric restriction and improve weight maintenance. The other important side of this story. If we up the activity level to >250 min per week; it was more likely that weight maintenance would be achieved. These are some pretty high recommendations meaning that there would need to be some pretty big life changes occurring to produce these results. There wasn't a real explanation of level of physical activity and it's comparison ie high vs low vs moderate such as aerobic activity versus high intensity training. 

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      The best part of this paper is the additional discussion of behavioral interventions. This is a team effort and having a multidisciplinary approach is more effective. Particular behavioral interventions studied included: cognitive behavioral therapy, motivational interviewing, and acceptance and commitment therapy. I will not go into these individually but you can review my podcast for examples of the first two. Additional behavioral interventions include: self monitoring such as self weighing, problem solving help, contingency management, relapse prevention, slowed eating, social support, stimulus reduction, and stress management.
   An additional interesting aspect is how technology comes into play with therapy...not just behavioral. Apparently face to face interventions are more effective than computer based interventions. The paper notes that with the smart phone and new and upcoming apps; many possibly successful options are out there that have not been researched. The paper also discussed how community based programs such as weight watchers, gym based, and church based programs have been shown to be effective at weight loss. Additional discussion is covered in the podcast so please see that for more information. 

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     The last couple of things I will note include supplements, medications, and surgical interventions just for completeness sake. To be brief,  supplements are just no effective and are harmful at times. Medications have a role with some patients and the studied medications included: orlistat, lorcaserin, and pheneramine/topiramate. The surgical options include: laparoscopic gastric banding, gastric bypass, and sleeve gastrectomy. Again, please see my podcast for a deeper review of these topics. This podcast/lecture was not intended to focus on these topics since they are only briefly reviewed in the paper and require a discussion in of themselves. Other things I would have liked to see the paper discuss include water consumption as well as sleep activity however they were not discussed and do seem to have significant effects on weight loss. Thanks for following!