Exercise and Diet for Weight Control. Obesity Trends Among U.S. Adults between 1985 and 2006 Source of the data: Source of the data: The data shown

Exercise and Exercise and Diet for Weight Diet for Weight ControlControl

Obesity Obesity TrendsTrends Among Among U.S. Adults between 1985 U.S. Adults between 1985 and 2006and 2006

Obesity Obesity TrendsTrends Among Among U.S. Adults between 1985 U.S. Adults between 1985 and 2006and 2006

Source of the data:Source of the data: The data shown in these maps were collected The data shown in these maps were collected

through CDC’s Behavioral Risk Factor through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state Surveillance System (BRFSS). Each year, state health departments use standard procedures health departments use standard procedures to collect data through a series of monthly to collect data through a series of monthly telephone interviews with U.S. adults.telephone interviews with U.S. adults.

Prevalence estimates generated for the maps Prevalence estimates generated for the maps may vary slightly from those generated for may vary slightly from those generated for the states by BRFSS the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.different analytic methods are used.

Source of the data:Source of the data: The data shown in these maps were collected The data shown in these maps were collected

through CDC’s Behavioral Risk Factor through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state Surveillance System (BRFSS). Each year, state health departments use standard procedures health departments use standard procedures to collect data through a series of monthly to collect data through a series of monthly telephone interviews with U.S. adults.telephone interviews with U.S. adults.

Prevalence estimates generated for the maps Prevalence estimates generated for the maps may vary slightly from those generated for may vary slightly from those generated for the states by BRFSS the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.different analytic methods are used.

• In 1990, among states participating in the In 1990, among states participating in the Behavioral Risk Factor Surveillance System, 10 Behavioral Risk Factor Surveillance System, 10 states had a prevalence of obesity less than 10% states had a prevalence of obesity less than 10% and no states had prevalence equal to or greater and no states had prevalence equal to or greater than 15%. than 15%.

By 1998, no state had prevalence less than 10%, By 1998, no state had prevalence less than 10%, seven states had a prevalence of obesity between seven states had a prevalence of obesity between 20-24%, and no state had prevalence equal to or 20-24%, and no state had prevalence equal to or greater than 25%.greater than 25%.

In 2006, only four states had a prevalence of In 2006, only four states had a prevalence of obesity less than 20%. Twenty-two states had a obesity less than 20%. Twenty-two states had a prevalence equal or greater than 25%; Two of prevalence equal or greater than 25%; Two of these states (Mississippi and West Virginia) had a these states (Mississippi and West Virginia) had a prevalence of obesity equal to or greater than prevalence of obesity equal to or greater than 30%.30%.

• In 1990, among states participating in the In 1990, among states participating in the Behavioral Risk Factor Surveillance System, 10 Behavioral Risk Factor Surveillance System, 10 states had a prevalence of obesity less than 10% states had a prevalence of obesity less than 10% and no states had prevalence equal to or greater and no states had prevalence equal to or greater than 15%. than 15%.

By 1998, no state had prevalence less than 10%, By 1998, no state had prevalence less than 10%, seven states had a prevalence of obesity between seven states had a prevalence of obesity between 20-24%, and no state had prevalence equal to or 20-24%, and no state had prevalence equal to or greater than 25%.greater than 25%.

In 2006, only four states had a prevalence of In 2006, only four states had a prevalence of obesity less than 20%. Twenty-two states had a obesity less than 20%. Twenty-two states had a prevalence equal or greater than 25%; Two of prevalence equal or greater than 25%; Two of these states (Mississippi and West Virginia) had a these states (Mississippi and West Virginia) had a prevalence of obesity equal to or greater than prevalence of obesity equal to or greater than 30%.30%.

Obesity Trends* Among U.S. Obesity Trends* Among U.S. AdultsAdultsBRFSS, 1988BRFSS, 1988(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%


No Data <10% 10%–14%


No Data <10% 10%–14%


No Data <10% 10%–14% 15%–19%


No Data <10% 10%–14% 15%–19%


No Data <10% 10%–14% 15%–19%


No Data <10% 10%–14% 15%–19%


No Data <10% 10%–14% 15%–19%


No Data <10% 10%–14% 15%–19%


No Data <10% 10%–14% 15%–19% ≥20%


No Data <10% 10%–14% 15%–19% ≥20%


No Data <10% 10%–14% 15%–19% ≥20%


No Data <10% 10%–14% 15%–19% ≥20%


No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


No Data <10% 10%–14% 15%–19% 20%–24% ≥25%


No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%


No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Percentage of obesityPercentage of obesity(>30 lbs overweight)(>30 lbs overweight)

0

5

10

15

20

25

30

35

40

1960-62 1976-80 1988-94 1998-00 2008

%%

1996 Cost of Overweight 1996 Cost of Overweight and Obesity in U.S.*and Obesity in U.S.*

Total cost: $99.2 billionTotal cost: $99.2 billion Direct cost: $51.6 billion (5.7 Direct cost: $51.6 billion (5.7

percent of the U.S. health percent of the U.S. health expenditure)expenditure)

Indirect cost: $47.6 billion Indirect cost: $47.6 billion (comparable to the economic costs (comparable to the economic costs of cigarette smoking) of cigarette smoking)

NIH Publication No. 96-4158 July 1996NIH Publication No. 96-4158 July 1996

The Costs: 2000The Costs: 2000

Cost of obesity in U.S. : Cost of obesity in U.S. : $117 Billion $117 Billion (>17% increase from 1996) (>17% increase from 1996)

9.4 percent of the national health 9.4 percent of the national health care expenditures in the United care expenditures in the United States are directly related to States are directly related to obesity and physical inactivityobesity and physical inactivity

Annual Deaths Attributable to Annual Deaths Attributable to Obesity in the United StatesObesity in the United StatesAllison, et al, Allison, et al, JAMAJAMA 282: 1530- 282: 1530-1538, 19991538, 1999

Estimate of Estimate of 418,154418,154 deaths each deaths each year attributable to obesityyear attributable to obesity

““Aside from mortality rate, obesity Aside from mortality rate, obesity substantially increases morbidity and substantially increases morbidity and impairs quality of life. In essence, the impairs quality of life. In essence, the health impact of obesity far exceeds health impact of obesity far exceeds

what we have presented herein.”what we have presented herein.”

FrenchFrench Paradox? Paradox?

Americans spend $33 billion annually on Americans spend $33 billion annually on weight-loss products and servicesweight-loss products and services

The potential savings if all inactive The potential savings if all inactive American adults became physically American adults became physically active could be $76.6 billion in 2000 active could be $76.6 billion in 2000 dollarsdollars

BMRBMR

ArousalArousal

Sleeping MR

Physical Activity

Thermic effect of foodThermic effect of foodComponents of Daily Energy

Expenditure

Components of Daily Energy

Expenditure

Components of Daily Energy Components of Daily Energy ExpenditureExpenditure

Resting Metabolic RateResting Metabolic Rate– Body Composition -- Fat Free Mass is the Body Composition -- Fat Free Mass is the

most important determinantmost important determinant– Energy balance -- Hypocaloric diet reduces Energy balance -- Hypocaloric diet reduces

metabolic ratemetabolic rate Thermic Effect of FeedingThermic Effect of Feeding

– Fat is far less thermogenic than carbohydrateFat is far less thermogenic than carbohydrate– Protein is more thermogenic than Protein is more thermogenic than

carbohydratecarbohydrate Physical ActivityPhysical Activity

– Voluntary (walking, running, etc.)Voluntary (walking, running, etc.)– Involuntary (fidgeting)Involuntary (fidgeting)

Thermic Effect of FoodThermic Effect of Food

Induced ObesityInduced Obesity

5 times as many 5 times as many kcal to produce kcal to produce the same weight the same weight gain with mixed gain with mixed compared to a compared to a high fat diethigh fat diet

Cumulative Excess (kcal/M2)

20,000 60,000 100,000 140,000

Weight Gain (kg)

5

10

15 FAT MIXED

Lipogenesis from a Lipogenesis from a large amount of sugarlarge amount of sugar

Consumption of Consumption of 500 g (2,000 500 g (2,000 kcal) of glucose.kcal) of glucose.

Only 5 g (45 kcal) Only 5 g (45 kcal) of lipid madeof lipid made

Metabolic fate:Metabolic fate:– OxidationOxidation– Glycogen storageGlycogen storage

050100150

200250300

350400450

500

Glucose Lipogenesis

LeanObese

Acheson, et al. Am J Clin Nutr. 45: Acheson, et al. Am J Clin Nutr. 45: 78-85, 198778-85, 1987

Dietary intake, oxidation and Dietary intake, oxidation and storage of macronutrientsstorage of macronutrients

0

500

1000

1500

2000

2500

3000

3500

Intake Oxidation Intake Oxidation

LipidProteinCHO

Lipid Lipid StoraStoragege

Eucaloric (no Eucaloric (no weight gain or weight gain or

loss)loss)

HypercaloricHypercaloricJequier, Regulation of body weight Jequier, Regulation of body weight in humans, in humans, Phys. Rev.Phys. Rev. 79: 1999 79: 1999

De novo lipogenesis during controlled De novo lipogenesis during controlled overfeeding with sucrose or glucose in overfeeding with sucrose or glucose in lean and obese womenlean and obese womenMcDevitt et al, McDevitt et al, Am. J. Clin. Nutr.Am. J. Clin. Nutr. 74, 74, 737, 2001737, 2001

De novo lipogenesis measure during 96 h of De novo lipogenesis measure during 96 h of overfeeding by 50% with sucrose or glucoseoverfeeding by 50% with sucrose or glucose

Subjects -- 13 womenSubjects -- 13 women– 5 obese -- 81 ± 4.5 kg, 31 ± 4 BMI, 44.8 5 obese -- 81 ± 4.5 kg, 31 ± 4 BMI, 44.8 ± 4.6% fat± 4.6% fat

– 8 lean -- 65.6 ± 6 kg, 25.1 ± 1 BMI, 35.1 8 lean -- 65.6 ± 6 kg, 25.1 ± 1 BMI, 35.1 ± 5.6% fat± 5.6% fat

DietDiet– Control -- Eucaloric providing 48% CHO, Control -- Eucaloric providing 48% CHO, 40% fat, 8% protein40% fat, 8% protein

– Overfeeding -- 50% more energy than Overfeeding -- 50% more energy than requirement 27.3% CHO (sugar) and 22.7% requirement 27.3% CHO (sugar) and 22.7% fatfat

Energy, Fat, Carbohydrate, and Protein Energy, Fat, Carbohydrate, and Protein Balance with OverfeedingBalance with Overfeeding

Contribution Contribution of lipogenesis of lipogenesis to fat balanceto fat balance

Quantitative Quantitative assessment of assessment of lipogenesis with lipogenesis with overfeedingoverfeedingControl OF gluc OF sucr

CHO intake Lean Obese

231 ± 12250 ± 13

360 ± 17389 ± 21

360 ± 17389 ± 21

VLDL (g/d) Lean Obese

1.17 ± 0.51.98 ± 0.5

3.23 ± 1.93.60 ± 0.9

3.59 ± 1.94.40 ± 1.18

ConclusionsConclusions

No significant difference between No significant difference between lean and obeselean and obese

““Quantitatively, absolute Quantitatively, absolute amounts of fat synthesized from amounts of fat synthesized from carbohydrate did not represent a carbohydrate did not represent a significant contribution to overall significant contribution to overall fat stores after 96 h of excess fat stores after 96 h of excess carbohydrate intake.”carbohydrate intake.”

Dietary Fat is less Dietary Fat is less thermogenic than dietary thermogenic than dietary carbohydrate of equal carbohydrate of equal energy intakeenergy intake

•Fat eaten in excess of the Fat eaten in excess of the amount oxidized is stored amount oxidized is stored as fatas fat

•CHO excess is mostly CHO excess is mostly oxidizedoxidized

Storage of CHO as fat is Storage of CHO as fat is inefficientinefficient

24% of ingested kcal to 24% of ingested kcal to store CHO as fatstore CHO as fat

3% of ingested kcal to 3% of ingested kcal to store fat as fatstore fat as fat

Does Exercise Contribute to Does Exercise Contribute to Weight Loss?Weight Loss?

Aerobic exercise combined with Aerobic exercise combined with energy restriction did not energy restriction did not preserve fat free mass or preserve fat free mass or result in any greater weight result in any greater weight loss than diet alone. loss than diet alone. – Heymsfield, S., Rate of weight Heymsfield, S., Rate of weight loss during underfeeding: relation loss during underfeeding: relation to level of physical activity to level of physical activity Am. Am. J. Clin. NutrJ. Clin. Nutr., 1989,38:215-223.., 1989,38:215-223.

Exercise and Weight Exercise and Weight LossLoss

Most studies examining the Most studies examining the combination of aerobic combination of aerobic exercise and weight loss are exercise and weight loss are short-termshort-term..– Out of shape, overweight Out of shape, overweight individuals will not spend many individuals will not spend many kcals performing exercisekcals performing exercise

– 3 months is inadequate to improve 3 months is inadequate to improve aerobic capacity sufficiently for aerobic capacity sufficiently for exercise to contribute exercise to contribute significantly to daily energy significantly to daily energy balance.balance.

RMRTEMEEPATraining

25%

10%10%65%65%

14%

10%10%

6%6%

71%71%

Effect of Endurance Training on Total Energy Expenditure in the Elderly

Effect of Endurance Training on Total Energy Expenditure in the Elderly

Pre-Training TEE = 2408 kcal/dayPre-Training TEE = 2408 kcal/day

During Training TEE = 2474 kcal/dayDuring Training TEE = 2474 kcal/day

from: Goran & Poehlman Am. J. Physiol. 263: E950, 1992from: Goran & Poehlman Am. J. Physiol. 263: E950, 1992

Pre-Training Post-Training0

50

100

150

200

Strength ExerciseOther EERMR

kJ/kgBW•d

kJ/kgBW•d-

1-1

125±3125±3141±6*141±6*

Effects of 12 wks of resistance training Effects of 12 wks of resistance training on energy needson energy needs

Long-Bout ExerciseLong-Bout Exercise– n = 49, instructed to exercise 5d/wk; 20 n = 49, instructed to exercise 5d/wk; 20

min/d during weeks 1 - 4, 30 min/d weeks 5 - min/d during weeks 1 - 4, 30 min/d weeks 5 - 8, and 40 min/d for duration of study8, and 40 min/d for duration of study

Short-Bout ExerciseShort-Bout Exercise– n = 51, instructed to exercise 5d/wk; n = 51, instructed to exercise 5d/wk;

progressed from 20 min/d to 40 min/d, progressed from 20 min/d to 40 min/d, performed in multiple 10 minute bouts performed in multiple 10 minute bouts throughout day throughout day

Short-Bout Plus Exercise Short-Bout Plus Exercise EquipmentEquipment– n = 48, same instructions as short-bout, n = 48, same instructions as short-bout,

provided motorized treadmills during studyprovided motorized treadmills during studyJackicic, et al,Jackicic, et al, JAMA JAMA, 282: 1554-1560, 1999., 282: 1554-1560, 1999.

1812600-12

-10

-8

-6

-4

-2

0

2

SBLBSBEQ

****

MonthsMonths

Change in Body Weight, kg

Change in Body Weight, kg

Jackicic, et al,Jackicic, et al, JAMA JAMA, 282: 1554-1560, 1999., 282: 1554-1560, 1999.

1812600-16

-14

-12

-10

-8

-6

-4

-2

0<150 min/wk150 min/wk200 min/wk

““. . dietary modification combined with exercise . . dietary modification combined with exercise performed in short bouts does not improve performed in short bouts does not improve long-term weight loss compared with exercise long-term weight loss compared with exercise performed in longer bouts. However, the additionperformed in longer bouts. However, the additionof a home treadmill to the multiple short-boutof a home treadmill to the multiple short-boutexercise intervention minimized reductionsexercise intervention minimized reductionsin long-term exercise participation and improved in long-term exercise participation and improved long-term weight loss.”long-term weight loss.”

Jackicic, et al,Jackicic, et al, JAMA JAMA, 282: 1554-1560, 1999., 282: 1554-1560, 1999.

Copyright restrictions may apply.

Jakicic, J. M. et al. JAMA 2003;290:1323-1330.

Percentage Change in Weight Based on Exercise Duration (N = 196)

Long term participation in a Long term participation in a regular aerobic exercise program regular aerobic exercise program enhances weight lossenhances weight loss

Greatest value of participation is in Greatest value of participation is in maintenance of the weight lossmaintenance of the weight loss– Total number of kcal spent per day in Total number of kcal spent per day in

exercise is the most important exercise is the most important determiner of successdeterminer of success

– Intensity appears to be less importantIntensity appears to be less important

Intensity of exerciseIntensity of exercise

Does intensity of exercise Does intensity of exercise determine the rate of fat loss?determine the rate of fat loss?

Study of Ballor et al controlled Study of Ballor et al controlled kcals spent performing exercise kcals spent performing exercise of different intensities.of different intensities.

High Low-10

0

10

20

30

40

Pre

Post

Difference

% FAT

Ballor, et al, Am. J. Clin. Nutr.,51: 142-146, 1990. (25 min/day) (50 min/day)

Mike Huckabee, Mike Huckabee, Governor of ArkansasGovernor of Arkansas

Body FatBody Fat Waist/hipWaist/hip InactivityInactivity

Insulin Action Insulin Action

Insulin Secretion Insulin Secretion Fasting GlucoseFasting GlucoseGlucose ToleranceGlucose Tolerance

Hypertension, Type 2 Diabetes, Hypertension, Type 2 Diabetes, Atherosclerosis, PeripheralAtherosclerosis, Peripheral

Vascular Disease, Cataracts, Nephropathy, Vascular Disease, Cataracts, Nephropathy, NeuropathyNeuropathy

Exercise, Diet, and Exercise, Diet, and Glucose MetabolismGlucose Metabolism

Effects of aerobic exercise, Effects of aerobic exercise, with no change in body weightwith no change in body weight

Effects of a high carbohydrate Effects of a high carbohydrate diet and exercise, with no diet and exercise, with no change in body weightchange in body weight

Effects of high carbohydrate, Effects of high carbohydrate, ad libitumad libitum diet with and diet with and without aerobic exercisewithout aerobic exercise

Intensity: 70% VOIntensity: 70% VO2max2max; Frequency: 4 ; Frequency: 4 days/wkdays/wk

Duration: 3 monthsDuration: 3 months

200100080

100

120

140

160

180

200

220

PRE-TRAININGPOST-TRAININGNORMAL GTT

**

Glu

cose

(m

g/d

l)

Time (minutes)

Three months regular aerobic exercise Three months regular aerobic exercise improved oral glucose tolerance in improved oral glucose tolerance in subjects who had impaired glucose subjects who had impaired glucose

tolerancetolerance

Exercise without Exercise without weight loss:weight loss:

Modest improvement in oral glucose Modest improvement in oral glucose tolerancetolerance

10% increase in insulin sensitivity10% increase in insulin sensitivity 60% increase in muscle glucose 60% increase in muscle glucose

transporter-- GLUT-4transporter-- GLUT-4 NO change in body compositionNO change in body composition No change in triglycerides, HDL or total No change in triglycerides, HDL or total

cholesterolcholesterol

Typical, Typical, ad libitumad libitum dietdiet

CHO

Fat

Protein

Ethanol

48.748.735.2

15.15.77

High carbohydrate, low High carbohydrate, low fat dietfat diet

CHOFatProtein

606020

2020

High carbohydrate low fat High carbohydrate low fat dietdietAd Libitum Ad Libitum (Arch. Int. Med. 164: 210-(Arch. Int. Med. 164: 210-217, 2004)217, 2004)

When consumed When consumed ad libitumad libitum will will produce weight loss and improved produce weight loss and improved oral glucose tolerance in older oral glucose tolerance in older subjects with impaired GT.subjects with impaired GT.

Groups:Groups:– Control (40% fat, 40% CHO, 20% Pro), no Control (40% fat, 40% CHO, 20% Pro), no

exex– HICHO (20% fat, 60% CHO, 20% Pro), no exHICHO (20% fat, 60% CHO, 20% Pro), no ex– HICHO, exercise: 3 days/wk, 75% max, 45 HICHO, exercise: 3 days/wk, 75% max, 45

min/daymin/day

Total energy intake (food Total energy intake (food weigh-back), kcal/dweigh-back), kcal/d

0

500

1000

1500

2000

2500

3000

Baseline 6 weeks 12 weeks

Control

Lofat sed

Lofat ex

kcal/dkcal/d

No differences from No differences from baselinebaseline

-6

-4

-2

0

2

4

6

Mixed ComplexCHO

SimpleCHO

HI-CHO/EX

High carbohydrate, High carbohydrate, ad libitumad libitum diet diet with or without with or without aerobic exercise aerobic exercise compared to compared to “typical” American “typical” American diet (40% kcal from diet (40% kcal from fat)fat) **

##

# p = 0.07# p = 0.07

*p < 0.05*p < 0.05

Change in weight

Change in weight

##

Resting Metabolic Resting Metabolic RateRate

500

600

700

800

900

1000

1100

1200

1300

1400

Control Hi CHO Hi CHOEX

Pre

Postkcal/d

kcal/d

No change in RMR after three No change in RMR after three monthsmonths

Respiratory Exchange Respiratory Exchange RatioRatiouse of fat & carbohydrateuse of fat & carbohydrate

0.7

0.75

0.8

0.85

0.9

0.95

1

Control Hi CHO Hi CHOEX

Pre

Post

No change in fasting RER after 3 No change in fasting RER after 3 monthsmonths

Bo

dy

Fat

(%

)

20

25

30

35

40

45

Mixed HI-CHO HI-CHO/EX

PrePost

* interaction (P < 0.05) *

*

Pea

k A

ero

bic

Cap

acit

y (L

/min

)

0.5

0.8

1.0

1.3

1.5

1.8

2.0


PrePost


Aerobic CapacityAerobic Capacity

Glucose DisposalG

luco

se D

isp

osa

l (

mg

/kg

bo

dy

mas

s/m

in)

0

1

2

3

4

5


PrePost


*

“. . .whether low-fat diets have an important long-term effect on body weight remains an open question.”

“Consumption of foods with a low glycemic index (irrespective of fat intake) does appear to reduce the incidence of of adult onset diabetes, but the effects on long-term weight control remain to be documented.”

W. Willett, Am. J. Clin. Nutr., 68, 1998

Glycemic Index:Glycemic Index:

““. . our results demonstrate a remarkable degree of consistency . . our results demonstrate a remarkable degree of consistency in finding a lack of association of glycemic index, glycemic load, in finding a lack of association of glycemic index, glycemic load, and carbohydrate intake with measure of insulin sensitivity, and carbohydrate intake with measure of insulin sensitivity, insulin secretion, and adiposity.”insulin secretion, and adiposity.” (Liese et al, Measures of insulin (Liese et al, Measures of insulin sensitivity, secretion, and adiposity in the insulin resistance sensitivity, secretion, and adiposity in the insulin resistance atherosclerosis study, atherosclerosis study, Diabetes CareDiabetes Care 28: 2832-8, 2005) 28: 2832-8, 2005)

Reduction in dietary fat and increase in CHO intake resulted in a Reduction in dietary fat and increase in CHO intake resulted in a significant loss of body weight with no significant effect on lipids. significant loss of body weight with no significant effect on lipids. “Neither type of carbohydrate (simple vs. complex) revealed “Neither type of carbohydrate (simple vs. complex) revealed significant differences in body weight loss or blood lipids.”significant differences in body weight loss or blood lipids.” (Saris (Saris et al, Randomized controlled trial of changes in dietary et al, Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study, body weight and blood lipids: the CARMEN study, Int. J. of Int. J. of ObesityObesity, 24: 1310-8, 2000), 24: 1310-8, 2000)

Low-fat dietary pattern and weight change over 7 years: Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial, the Women's Health Initiative Dietary Modification Trial, JAMAJAMA 295: 39-49, 2006 295: 39-49, 2006

48,835 postmenopausal women48,835 postmenopausal women– 29,294 decrease fat, increase fruit and grain 29,294 decrease fat, increase fruit and grain

intake (no kcal restriction goal)intake (no kcal restriction goal)– 19,541 control group (diet-related information)19,541 control group (diet-related information)

OutcomeOutcome– Women in intervention group lost an average Women in intervention group lost an average

of 2.2 kg (P<0.001) and maintained lower of 2.2 kg (P<0.001) and maintained lower weight compared to control for 7.5 years.weight compared to control for 7.5 years.

““Weight loss was greatest among Weight loss was greatest among women in either group who decreased women in either group who decreased

their % energy from fat”their % energy from fat”

Restaurant Hall of Shame (Center for Science in the Public Interest)

Each of these foods has more than 1,000 calories and one to four day's worth of saturated fat

Kcal Fat g Saturated Fat g

Cheese fries with ranch dressing 3,010 217 91Movie theater popcorn with "butter” topping (large) 1,640 126 73Prime rib, untrimmed (16 oz.) 1,280 94 52Fettuccine Alfredo 1,500 97 48Stuffed potato skins with sour cream 1,260 95 48Fudge brownie sundae 1,130 57 30Cheesecake Factory Carrot Cake (1 slice) 1,560 84 23Pizzeria Uno Chicago Classic (1/2 pizza) 1,500 74 30

Rice (8 cups) 1,600 1 0

Soy burger (30) 1,500 33 6

Monster ThickburgerMonster Thickburger

1,420 kcal1,420 kcal– 107 g fat107 g fat

2, 1/3 lbs of beef2, 1/3 lbs of beef 4 strips of bacon4 strips of bacon 3 slices of cheese3 slices of cheese Mayo and Mayo and

buttered rollsbuttered rolls

CVD Death Rates by CVD Death Rates by FitnessFitness7,080 women & 25,340 7,080 women & 25,340 menmen

0

2

4

6

8

10

12

14

16

18

Women Men

Low

Mod

High

Adjusted for age, exam year, and Adjusted for age, exam year, and other risk factors, Blair, et al other risk factors, Blair, et al JAMA, 276, 205, 1996JAMA, 276, 205, 1996

Adjusted RR for All-Cause Adjusted RR for All-Cause Mortality by Fitness and BMI, Mortality by Fitness and BMI, ACLS WomenACLS Women

0

0.5

1

1.5

2

2.5

3

3.5

4

Normal Wt. Overweight Obese

Fit

UnfitAdj for Adj for age, exam age, exam year, year, smoking smoking and health and health statusstatus

Farrell et al Obes. Res. 10:417, Farrell et al Obes. Res. 10:417, 20022002

OptionsOptions

DietDiet– Hypocaloric -- Balanced Calorie Deficit Hypocaloric -- Balanced Calorie Deficit

DietDiet– Low Fat -- < 20% Fat, ad libitum CHOLow Fat -- < 20% Fat, ad libitum CHO

ExerciseExercise– Aerobic -- Accumulate 40 min/day, 4 Aerobic -- Accumulate 40 min/day, 4

days/wk, intermittent or long boutdays/wk, intermittent or long bout– Progressive resistance training -- High Progressive resistance training -- High

intensity, upper and lower body, at least intensity, upper and lower body, at least 2 x week2 x week

AtkinsAtkins

CHO restriction: Naturesis (diuresis)CHO restriction: Naturesis (diuresis) Ketosis: Appetite SuppressionKetosis: Appetite Suppression What happens after weight loss?What happens after weight loss?

– Water weight gain, increased appetiteWater weight gain, increased appetite

Body Weight Body Weight RegulationRegulationGenderGender

Metabolic differencesMetabolic differences Differences in fat distributionDifferences in fat distribution Body image differencesBody image differences

Weight ControlWeight ControlOther questions:Other questions:

New TrendsNew TrendsGlycemic Index?Glycemic Index?

ExperiencesExperiences Exercise and complianceExercise and compliance Aging and menopauseAging and menopause

Contact InformationContact Information

• For information about this specific presentation please For information about this specific presentation please contact William Evans, PhD at evanswilliamjcontact William Evans, PhD at [email protected]@uams.edu

• For any questions about the monthly GRECC Audio For any questions about the monthly GRECC Audio Conference Series please contact Tim Foley at Conference Series please contact Tim Foley at [email protected] or call (734) [email protected] or call (734) 222-4328

• For the link to the evaluation form for this conference that For the link to the evaluation form for this conference that will confer CE credit please go to will confer CE credit please go to http://vaww.sites.lrn.va.gov/vacatalog/cu_detaihttp://vaww.sites.lrn.va.gov/vacatalog/cu_detail.asp?id=24489l.asp?id=24489 and click the “Handout: Registration and click the “Handout: Registration and Evaluation” linkand Evaluation” link

Documents

Exercise and Diet for Weight Control. Obesity Trends Among U.S. Adults between 1985 and 2006 Source of the data: Source of the data: The data shown