Appetite: Journal for Intake Research, 1982,3, 61-68

Dietary Intake in Obese Women

WERA KULESZA National Food and Nutrition Institute, Warsaw

Dietary intake was evaluated in 100 obese and 50 lean women using the method of diet recording. In the dynamic phase of obesity the daily intake offood was about 2000 Kj (480 kcal) higher than in women with static obesity. No difference was found in the energy intake between women with static obesity and the control women. In the group of obese women proteins, carbohydrates and fats covered 15·7,44'0 and 40· 3% of the energy intake. In the control group these values were 16'0,46'0 and 38'0%, respectively.

In both groups the intake of vegetable oils was very low. Meal regularity was much higher in the group of lean women.

One of the causes, of great interest, shown in the problem of obesity is the fact that it increases the risk of developing diseases leading to general deterioration in health and reduction in lifespan, especially diabetes, liver cirrhosis and cholelithiasis. Moderate obesity increases mortality by 42% independently of sex. High-grade obesity increases it by 79% in males and 61% in females (Taton, 1975). Obesity is associated, not infrequently, with hyperiipoproteinaemia and impaired glucose tolerance (Chotkowska, Mirkiewicz, Chabros & Naruszewicz, 1980). These disturbances regress when a low-calorie diet is introduced and, because of that, it is considered that prevention of obesity plays an important role in prevention of atherosclerosis and adult-type diabetes. It is generally accepted that high energy intake and low energy expenditure are important factors in the development of obesity. Body weight is reduced as a result of decreased energy intake and increased energy expenditure (Bia-l'kowska, Szostak, Chotkowska, Szczyg-l'owa & Mvdrzejewski, 1977; Bia!kowska, Szostak, Nekanda-Trepka, Szczyglowa & Cybulska, 1978).

However, the relationship between body weight and energy intake and expenditure has not been fully clarified. Durnin, Lonergan, Good and Ewan (1974) reported lower energy intake by obese girls than thin girls. Similar observation concerning obese boys was reported by Stefanik, Heald and Mayer (1959). It should be stressed that energy expenditure by obese subjects was also lower in this study. Beaudoin and Mayer (1953) did not observe any differences in energy intake between obese and non-obese women. Also persistence of high body weight despite low energy intake has been reported (Ashworth, 1968). Miller and Mumford (1967) and Miller and Parsonage (1975) on the basis of observations of obese women, stated that certain subjects require a relatively low energy intake for maintaining a stable body weight and fail to lose weight on low­calorie diet and, conversely, in certain individuals high-grade overfeeding fails to produce weight gain.

Requests for reprints should be sent to Wera Kulesza, National Institute of Food and Nutrition, 61/63 Powsiriska Str.. Warsaw. Poland 02-903.

0195-6663/82/010061 +08 $03'00/0 © 1982 Academic Press Inc. (London) Limited

62 W. KULESZA

These unexplained problems make it difficult to present a well-founded view on the role of nutrition in the aetiology of obesity and point to the necessity of evaluating the diets of obese individuals.

METHODS

The reported investigations were carried out on 100 women living in Warsaw who were referred for treatment of obesity to the Food and Nutrition Institute. Their mean age was 44± 12·9 years, their mean height was 160±5cm and mean weight 91·3 ± 16·6 kg. They were employed as clerks doing light sedentary work. In most of them, obesity developed after the age of 20 years, mostly after pregnancy and lactation. In several cases the onset of obesity was in childhood.

The diagnosis of obesity was made when the body weight exceeded by at least 15% the expected weight. Dynamic phase of obesity was diagnosed by the criterion of a weight gain of at least 10% in the last year. The dynamic phase was thus identified in 39 cases and the static phase in 61 cases. No patient classified into the static phase had kept to a low-calorie diet in the previous year.

The control group comprised 50 adult women with normal body weight who, like the obese women, worked as clerks performing light sedentary work and lived in Warsaw. The mean age of these women was 38± 12·2 years, mean height was 160 ± 5 cm and mean weight was 56-4 ± 6· 3 kg.

It was established in preliminary history-taking that these patients and controls had not changed their dietary habits in the year previous to admission for treatment at the Institute. In the more distant past some obese patients had tried to observe calorie­restricted diet by avoiding sugar, sweets and other high-energy foodstuffs. However. these attempts had been made irregularly and never under physician's control.

In all women general medical examination excluded organic diseases which could have had on effect on their nutrition.

The expected body weight was determined according to the tables of Lindberg. Natvig, Rygh & Svensen (1956). The index of relative body weight was calculated in percent according to the formula: relative body weight index={present weight in kg/expected weight in kg) x 100.

For dietary assessment, the survey, the methods of dietary history and 24-h recall as cross-check were used (Kulesza & Narojek, 1976; Narojek & Kulesza, 1974). The dietary history assessed the frequency of intake of basic food products during the last four weeks. Twenty-four-hour recall recorded intake of meals, food products, beverages and snack-meals during the previous day. Photographs of meals and food products typical for Polish diet were used during the interview to help patients to determine the size of food portions. The computer program to convert reports to nutrient intakes was based on food composition data published by National Food and Nutrition Institute (Szczygiel', Klimczak, Piekarska & Muszkatowa, 1972).

The results were subjected to statistical analysis using students t-test, chi-square test and U-test.

RESULTS

The intake of selected food products in the average diet ration of the women studied is shown in Table 1. The contributions of these products to energy requirements is presented in Figure 1. Attention is called to a relatively low amount of food of plant

DIETARY INTAKE IN OBESE WOMEN 63

TABLE 1 Average consumption of foodstuffs (g/day) in obese and lean women

Foodstuffs Obese Lean

Bread 160±91 170± 75 Milk 250± 199 270±203 Cottage cheese 60±98 60±85 Cheese 15 ± 18 20±24 Meat 100±118 105± 36 Poultry 40±70 30±37 Fish 30±37 15 ± 11 Pork products 55±43 35±45 Eggs 20±21 20± 15 Butter 20±22 30± 18 Margarine 10± 19 Oils 3±6 4±7 Potatoes 200± 157 160± 86 Vegetables 170± 164 130± 127 Fruits 260±306 220± 152 Sugar 30±37 35± 31 Sweets 5± 15 1O±23

origin (cereals, potatoes, vegetables, fruit) and a high percent proportion of products of animal origin, especially meat, in the daily energy intake. The differences in the composition of the diet between obese and lean women were small. Higher consumption of fruits, vegetables and fish and lower consumption of sweets by obese patients was observed. Our investigation provides no means of identifying the cause of these differences, however, one may suppose that obese patients have been influenced by ideas about slimming given occasionally by the mass media.

The estimated intake of energy and nutrients in the studied groups of women is presented in Tables 2 and 3. It is worth stressing that the intake ofenergy and nutrients was higher in the dynamic phase of obesity than in the static phase. No significant difference in energy intake was observed between women with static obesity and the lean women.

c <1> U

tv (L

Obese Lean

1·7 10·4

8·0 7·4

11'9

15·9

FIGURE 1. Percent proportion of energy obtained from certain groups of food products in the average daily food ration in obese and lean women in relation to the recommended ration* [at C level for sedentary women (Szczygiel, 1970)]. Bread, 821; milk and dairy products, 0; meat and meat products,.; butter and margarine,~; potatoes,~; vegetables and fruit, E&l; sugar and sweets, 0; other products, [1].

64 W. KULESZA

TABLE 2 Daily intake of energy and nutrients in the usual food ration of obese and lean women

Obese Lean p

Energy (kJ) 8· 790 ± 3· 350 8·370± 1'940 >0·05 (kcal) 2·100± 826 2·000±487

Protein (g) 82-4± 30·7 79'9±25-4 >0·05 (15'7) (16'0)

Fats (g) 94·0±49·1 84·8±26·0 >0·05 (40'3) (38'0)

Carbohydrates (g) 231±98 230±68 >0·05 (44'0) (46'0)

Note: Values in parentheses represent the percentage of total energy.

TABLE 3 Daily intake of energy and nutrients in the usualfood ration of women in the dynamic and

static phase of obesity

Dynamic phase Static phase p

Energy (kJ) 10·020 ± 2·950 8'01O± 3-550 <0·05 (kcal) 2·395 ±705 1·915±848

Protein (g) 88-4±24'5 78·5 ± 33'7 >0·05 (14'8) (16-4)

Fats (g) 106'6±43'9 86'0±50'8 <0·05 (40'1) (40,5)

Carbohydrates (g) 270± 102 206± 88 <0·05 (45'1) (43'1)

Note: Values in parentheses represent the percentage of total energy intake.

The proportion of fats was high and that of carbohydrates was low in the daily intake ofenergy in all groups studied. Figure 2 shows that both obese and lean women had a much greater intake offat and lower intake of carbohydrates than recommended.

The intakes of mineral components, vitamins and fibre (Table 4) were as a rule similar to the recommended intakes. Only the intake of vitamin C after subtraction of its loss due to culinary processing was below the recommended level.

The frequency of meals was found to be irregular in the group of obese women. About 70% of them took only two or three meals daily, while over 80% ofIean women had four daily meals. Breakfast and supper were the meals dropped most frequently by obese women. This small number of meals in the group of obese women caused long intervals between meals (Figure 3).

c

~ Q

:i .c ~

.~ "' "0

>-c

{3 '!! "0

:i c z .-

DIETARY INTAKE IN OBESE WOMEN

100

80

60

40>-

20

Obese Diotary goals'

Lean

65

FIGURE 2. Nutrient distribution in average daily food intake of obese and non-obese women with reference to "Dietary Goals"* (*V.S. Government Printing Office, 1973). Carbohydrates, ~; protein, 0; fats, ~.

TABLE 4 D(/ily int(/ke of miner(/Is, ritol11ins (/ml fiber in usu(/I diet of obese (/nd le(/n women

Recommended" Nutrients (mg) Obese Lean p daily intake

Calcium 707±320 755± 384 >0·05 800 Phosphorus 1·166±392 1'157±377 >0'05 800 Iron 15·85 ± 7·11 13-38±4·39 <0'05 12 Thiamineb 1-40±0·62 1'25 ± 0·51 >0·05 1·2

(1'26) (1-13) Riboftavinb 1·70± 0·69 1·62±0·62 >0·05 1·2

(1'62) (1'54) Niacinb 16·23±7·14 14'63± 5·03 >0'05 13

(15-43) (13'90) Ascorbic acidb 77±40 63±34 <0'05 70

(38) (31) Fiber 5·34±2·25 4-46± 1·89 <0·05 5-7

a Recommended dietary intake for sedentary women (Szczygiel, 1970). b In parentheses: the intake of nutrients after subtraction of estimated loss in culinary

processes: 5% for vit. B2 and vit. PP; 10% for vit. BI , and 50% for vit. C.

l "' 80 4 5 0 Q)

E c 60 Q) Q)

~ OJ .c 40 "' "0 ;:: Q) 20

" Obese Lean

FIGURE 3. Evaluation of the regularity of meals in obese and lean women. (1) Breaks between meals of less than 4 h; (2) breaks between morning meals of greater than 5 h; (3) meals mainly consumed in the afternoon, at intervals ofless than 3 h; (4) only two meals consumed; (5) long breaks between meals in the afternoon; (6) long break in the night time of over 15 h.

66 W. KULESZA

DISCl!SSIO:-J

Our results are similar to those reported by Maxfield and Konishi (1966), McCarthy (1966), and Osancova and Hejda (1973). These authors also found no differences in the levels of energy and nutrient intakes in the groups of obese and lean women compared.

In our patients, the higher energy intake in the dynamic phase than in the static phase of obesity could account for the gain in the dynamic phase. Absence of this difference between the group with static obesity and the control group is consistent with maintenance of a steady body weight in the static phase of obesity. These observations further support the view that energy intake above the required level plays an important role in the development of obesity. Nevertheless, the value of our results is decreased somewhat by the fact that the energy expenditure of these women was not evaluated. However, the similarity of the work done by these women, similar age and the same place of residence suggest that the energy expenditure could have been similar in obese and lean women.

The striking difference between obese and lean women in the regularity of meals deserves attention. Obese women took fewer meals during the day, and~in view ofa similar energy value of the daily diet in both groups~it must be assumed that the energy intake per meal was higher in the obese group. This could of course relate to the observations that administration of the same amount of food in a lower number of meals is associated with greater body weight (Fabry, Fodor, Heil, Braun & Zvolankova, 1964; Fabry, Hejda, Cerny, Osancova, Pechar & Zvolankova, 1966; Finkelstein & Fryer, 1971; Metzner, Lamphiear, Wheeler & Larkin, 1977; Ries, 1973; Young, Scanlon, Topping, Simko & Lutwak, 1971). These observations can be explained, in part, by the results of certain experiments which showed that limitation of the number of meals increases glucose absorption and fat absorption from the digestive tract, enhances lipogenesis and glucose synthesis, decreases glucose tolerance and raises the blood insulin level (Debry, 1978).

In the group of obese women as well as in that oflean women, the diet contained a high proportion of food products of animal origin and low proportion of vegetable products, as a result of this the total consumption of fats was higher and that of carbohydrates lower than the recommended ones. Meat accounted for a high proportion of consumed fat, while vegetable oils played a very small role in the diet of this population. The ratio of polyunsaturated to saturated fatty acids in the diet was not determined in this work, but the composition of the consumed fats indicates that this ratio was very small. Similar results were obtained by us in investigations of the diet of men in Warsaw in whom the mean fat consumption accounted for 40% of the daily energy intake (Kulesza, Rywik, Narojek & Szostak, 1979). The high consumption of animal fat and low intake of vegetable rich in fibre is currently considered an incorrect pattern of diet contributing to the development of atherosclerosis (Kritchevsky, 1976).

The faulty dietary habits demonstrated in this study of women with obesity is yet another confirmat.ion of the necessity of multidirectional actions for rationalization of the nutrition of the population. It seems that health advantages of obesity prevention and reduction of overweight are widely recognized now. However, popular ideas on the methods of preventing or treating obesity are often wrong. Advice to obese people given by mass media usually are not exact enough and often can be misleading. Also, advice given to patients by their doctors should be of higher quality, as patients need instructions on the regularity and frequency of meals, quality and quantity of food

DIETARY INTAKE IN OBESE WOMEN 67

products, and a way of life involving special attention to energy expenditure, and not merely a simple recommendation of low-calorie diet. The aid of a dietitian may be of considerable value.

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68 W. KULESZA

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Received 28 July, 1981