Another Nail in the Low-Fat Coffin

Hot off the presses.

322 obese folks randomized to one of 3 diets for 2 years: Low-fat, Mediterranean or Low-Carb.

An amazing 84.6% adherence rate at 2 years!

The results?

Not spectacular in terms of actual amount of weight loss but significant in terms of who lost what.

3.3kg in 2 years for study completers in the low-fat group.

4.6kg in 2 years for study completers in the Mediterranean group

5.5kg in 2 years for study completers in the low-carb group.

Metabolic parameters were also better in the Mediterranean and low-carb groups versus low fat for cholesterol numbers, fasting insulin and glycemic control.

Bottom line?

Blindly low-fat diets do not appear to be as effective for weight loss OR for health as other dietary approaches.

National eating guidelines and guidelines from medical organizations need to start changing their recommendations and letting go of an outdated and now unsupported approach for the blanket reduction in dietary fat as either a means to improve health or weight loss.

It's my opinion that blindly low-fat diets, whether for weight-loss or for health, are dead horses as far as the evidence is concerned.

How much ya wanna bet people keep beating them?

Surprise! Protein's more filling!

Ok, maybe it's not a surprise, but today at least, it's sure going to be news (and perhaps I'll be the first to break the embargo at 12:01AM - thanks Blogger for allowing scheduled posts!).

It's going to be on radio, print and television - the results of the first prong of the DiOGenes study. DiOGenes is a multi-pronged study spearheaded over in Europe and today's spear has to do with trying to answer the question, "What's the best diet to help maintain weight loss?".

This study was an enormous undertaking as it looked at whole families, in 8 different European countries for between 6 and 12 months and randomized their dietary intakes to compare weight gain with diets high or normal in protein and high or low in glycaemic index carbohydrates.

In total, the study aimed

"to recruit a total of around 850 obese/overweight parents (BMI>28) from the 8 participating centres, corresponding to 450 families with an estimated 450-1050 children, where at least one child in each family is overweight."

Mandatory too was an 8 week run-in weight loss phase where adult family members were required to lose 8% of their body weight before their family was admitted into the study.

The results weren't particularly surprising. Dietary protein helped maintain weight loss while GI index did not.

I think the most important part of the whole paper was a quote in the introduction that does a great job explaining why the world's getting so big so fast,

"Given our genetic background, it is essentially infeasible for humans to self-regulate food intake under current environmental circumstances."

What this basically states is that in 2008, the default is weight gain, and I can't agree more. People haven't changed in the past 100 years, but our environment sure has and the reason we're gaining weight so quickly now is that since weight gain is the default, that means by definition maintenance of a healthy body weight in our current environment has actually become a skill. And just like other skills (martial arts for instance), just because your minds' eye might know what it looks like to do a jumping, spinning hook kick, it doesn't mean you can simply jump up and do one.

To extrapolate a martial arts analogy to healthy weight think of it this way: Just because your minds' eye might know what a healthy lifestyle looks like, to expect yourself, without instruction, to be able to simply jump up and happily live with one is often too much to ask (people do it unhappily all the time - that's called dieting).

Not surprisingly this study was funded by Big Food and here's one time where I think it's a great partnership. Here's an opportunity for Big Food to help by using their study to help pave the way to the creation of new food products that may be useful in preventing weight gain/regain.

Hurray for Big Food!

(there's something I don't say very often)

[BTW, I'll likely have a 5-10 second sound bite on CTV's National News tonight in Avis Favaro's story on this study should any of my Canadian readers want to watch]

Subway's Jared Celebrates 10 Years of Weight Maintenance!

Congratulations go out to Subway's Jared for doing what the vast majority of those that lose weight don't do - keep it off.

According to an article in the Washington Post, Jared's Subway eureka moment came back when he weighed 425lbs and his college roommate at Indiana University made a tape recording of the sounds he made while sleeping (severe sleep apnea can sound quite dramatic and frightening). He reports trying a few other efforts before finally settling in on his now famous Subway diet which arose with him reading a nutrition facts panel while standing in line for a sub. The rest of course, is marketing history.

Jared's Subway diet amounted to roughly 1,500 Calories a day, low for the majority of men, combined with lots of walking.

Subway took notice after Jared was featured on multiple local media outlets and he has remained a spokesman for them every since.

He no longer formally counts Calories but certainly practices Calorie awareness and knows what portions work best in his own personal foodscape.

Jared's not alone in his weight maintenance success. The National Weight Control Registry (NWCR) now numbers well into the thousands and to be a registrant you've had to have lost over 30lbs and kept it off for over 1 year. The last time I saw Dr. Rena Wing (one of the registry's founders) speak, the average registrant had lost 66lbs and kept it off for 5.5 years.

So how do the registrants do it? The NWCR has a great facts page and here are some highlights,

Duration of successful weight loss has ranged from 1 year to 66 years!

Some have lost the weight rapidly, while others have lost weight very slowly--over as many as 14 years.

45% of registry participants lost the weight on their own and the other 55% lost weight with the help of some type of program.

98% of Registry participants report that they modified their food intake in some way to lose weight.

94% increased their physical activity, with the most frequently reported form of activity being walking.

78% eat breakfast every day.

62% watch less than 10 hours of TV per week.

90% exercise, on average, about 1 hour per day.

One thing's absolutely certain and during a working day you'll hear me say it at least 5 times a day,

"The more weight you'd like to permanently lose, the more of your lifestyle you'll need to permanently change"

which of course then leads me to the,

"Therefore if you don't like the life you're living while you're losing, you're much more likely to gain it back"

Jared has kept his weight off because he likes his new lifestyle.

Do you like yours?

Congratulations again Jared.

A Weight Loss Cult?

It's called the Weigh Down Workshop and since 1986 it has been held in over 30,000 locations around the world. Even more remarkable is the fact that out of this God based diet has grown an actual evangelical church.

I'll get back to the church in a moment, but first let me help you with the question, "How will God help me lose weight?"

Well according to the Weigh Down website,

"God is broken hearted over the fact that so many of His children have learned to run to the food instead of to Him for comfort, companionship, and acceptance."

"God does not care about what we eat, so we should no longer feel self-righteous about following any man-made rules. Instead, what God cares about is how much we eat; He cares very much about - and is displeased with - overindulgence."

"Typical diets have not worked because everyone is using man-made rules instead of God’s rules. God has never asked anyone to eat food off of a list, count fat exchanges, or take an appetite suppressant! Weigh Down doesn’t have any of those things. What we DO have is a future-a future to be filled and fulfilled. Hunger will be filled and appetites will be under control, given to God."

Ok, a little weird that these folks feel that God cares how much I eat, but to ask God to help them with weight loss, what's wrong with that?

Nothing.

Interestingly however, the Weigh Down Workshop actually spawned a church called the Remnant Fellowship (130 worldwide and growing) and on the Remnant Fellowship website they describe the role of the Weigh Down workshop as,

"The Weigh Down Workshop Productions creates the Bible material for its members and is the evangelistic arm to these Churches that are now scattered across the USA, Canada, Europe and Australia."

Now I'm no cult expert, but Rick Ross is and The Rick Ross Institute has a collection of articles regarding the Remanant Fellowship including some which detail how the church apparently teaches that over eaters court eternal damnation.

Oh, and did I mention that the Church was featured prominently in the beating death of an 8 year old by two of its members? Apparently the Church is a big fan of corporal punishment for children. They funded the defense of the two parishioners Joseph and Sonya Smith who were each given life plus 30 years for the death of their son who prosecutors said was kept locked in a wooden box and confined to a closet for hours at a time before he died in October 2003 from a blow to the head. The Church has stuck by the convicted parents and have set up a website to help pay for their appeal.

So let me get this straight, their version of God hates over eaters and damns them to an eternity burning in the fires hell but has a soft spot for child abuse?

I think I like my version better.

Atkins - the King of Diets?

The Journal of the American Medical Association released a study today entitled, "Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women. The A to Z Weight Loss Study: A Randomized Trial".

The media are going to have a field day talking about how this study proves that Atkins is the way to go.

I disagree.

Read the study and you'll learn some things.

Firstly you'll learn every participant in the study receieved 8 hours of lectures from registered dietitians on how to follow their respective diets - real world, people buy books, skim them and kind of follow them.

Next you'll learn that every participant receieved $150 for their efforts. Real world you don't get anything.

Lastly, and most importantly you'll learn that even on Atkins, the crowned king of diets in this study, the average person, in an entire year of effort, only lost 10lbs.

Does that make you want to rush out and cut your carbs?

Fact is most people quit Atkins because it's tough to live that way - it's tough to eat out and it's tough to cook for your family.

Best diet in the world for you involves two components: First, you have to eat fewer Calories than you burn, otherwise you won't lose weight. Second, you have to like what you're eating, otherwise you won't keep it off. On Atkins' it's the second part that's hard.

The reason why there are 194,218 diet books today on Amazon.com is that none of them have proven themselves to be remarkable at long term weight loss. If one had, there'd only be one diet book on Amazon.com and it's the one we'd all be using.

Bottom line - the only way I'd recommend Atkins is if you happened to love your life on the Atkins diet and felt that you could honestly and happily live that way forever. Otherwise, it's just another diet.

Dr. Dean Ornish Shills for McDonald's?

I never thought I'd see the name Dean Ornish linked with McDonald's, but then I guess I'd never looked.

Sure enough, if you wander around McDonald's website there's a page by Dr. Ornish with tips on heart health.

Dr. Ornish, founder of the Preventive Medicine Research Institute, has made a name for himself promoting lifestyle change in the treatment and prevention of cardiovascular disease. One of the basic tenets of Dr. Ornish's work is the adoption of a diet extremely low in saturated fat.

Why then would Dr. Ornish lend his name to McDonald's?

Dr. Ornish, on his own site, advocates for diets that contain less than 10% of daily Calories from fat.

He notes in a talk available here, that by helping corporations steer customers to healthier choices, he's making a positive difference. He specifically cites the salads at McDonald's as being very beneficial.

Looking at the salads at McDonald's, depending on how you order them, many have as much fat as a quarter pounder and almost as many Calories.

In fact, order chicken in any of your salads, including the Asian salad he notes in the aforementioned talk, and you'll likely reach your entire day's Dean Ornish limit for fat intake.

Dr. Ornish also reports working with ConAgra (Kentucky Fried Chicken) and Pepsi Co.

I don't understand how Dr. Ornish is comfortable working for these corporations when without a doubt, he counsels his own patients not to eat there.

My guess?

Big Food has big pockets.

World's First Calorie Burning Cola?

Celsius Cola - Raises your metabolism by 12% for 3 hours!

Sounds great right?

Umm, not so much to me.

Forget about whether or not the data supports the conclusion, let's work with it just like we did with the other so-called energy burning drink, "Enviga".

So a 12% increase in metabolism for 3 hours.

I burn 2,250 Calories per day or 93.75 Calories per hour.

12% more than 93.75 is an additional 11.75 Calories per hour.

11.75 Calories per hour x 3 hours = 33.75 additionally burned Calories.

But wait, the drink has 10 calories therefore it's only an additional 22.75 Calories.

But wait again, if I drank 355ml of ice water instead of Celsius I would burn 12 more Calories bringing the temperature of the ice water up from 0 degrees Celsius to 37 degrees Celsius, therefore now we're down to an additional 10.75 Calories.

If I drink one a day for a year I'll therefore burn an additional 3,923 Calories representing 1.1lbs, at a cost of $2 per bottle = $730.

That's $664/lb!

And I'm a fairly fit, somewhat young, 5'8" man who burns a fair number of Calories.

What if you burn less Calories than me?

Let's say instead you burn 1,500 Calories daily. Then your cost per lb of weight loss after all the calculations ends up being $14,600/lb and if you simply had a glass of ice water daily, you'd get virtually the same benefit as one Celsius drink daily.

How do I figure?

1,500 Calories / 24 hrs = 62.5 Calories per hour.

62.5 Calories/hr * 0.12 (12 % increase) * 3 hours = 22.5 Calories extra.

22.5 Calories extra - 10 Calories for the drink = 12.5 Calories extra.

12.5 Calories extra - 12 Calories raising the temperature of 355ml of ice water = 0.5 Calories extra.

0.5 additional Calories per day * 365 days per year = 182.5 Calories per year

182.5 Calories / 3,500 Calories per pound = 0.05lbs.

$730/0.05lbs = $14,600/lb

Makes me almost rather give my money to Aquamantra!

Seventeen Magazine makes me want to Vomit!

Ok, that's a bit of an exaggeration, but I do find the magazine to be rather repulsive.

But the question that researchers have asked and that the media has reported on is does reading magazines like Seventeen make young women vomit, practice other disordered eating behaviours or negatively affect their body images?

A study conducted by Dr. Patricia van den Berg looked at over 2,500 teenage girls and boys in Minnesota and followed them for 5 years. They followed their body image attitudes, whether or not they fasted, skipped meals, smoked, binged or used laxatives to help control their weight, and the frequency with which they read dieting articles in the lay press. What they were looking to see was whether or not reading the shlock dieting articles in magazines like Seventeen led to an increase in any or all of these behaviours or attitudes.

The authors concluded that indeed, among teenage girls (not boys), more frequent reading of diet articles led to increased frequency of unhealthy eating behaviours and unhealthy body images.

BUT, and this is a very big but, the researchers did NOT control for weight gain over the 5 years of this study and it's affect on these young women.

Teenage years are hard to say the least. Given societal role models for teenage girls, gaining weight would almost certainly lead many teenagers to look for help. Where would they look for help? Well they'd probably look at what they might well already have at hand - magazines, and the diet/weight loss articles therein.

Frankly the omission of a control for weight or BMI at the end of the study is a staggering one. I think it is extremely likely that those girls who may have gained more weight during the five years of the study would in turn be the ones to be more likely to read diet articles, be more likely to engage in unhealthy eating behaviors and have more difficulties with their body images.

I don't doubt that the fascinating pieces like the one in the issue above entitled, "Is that my Butt?" can't help with a young woman's body image, but to blame the articles for triggering unhealthy eating behaviours and attitudes is not substantiated because weight gain was not taken into consideration during the study as a possible cause of trouble.

It's a matter of chicken and egg and in many cases I would venture, the weight comes first and may well inspire disordered eating even in the absence of reading dieting articles.

Heck, a large percentage of the adult population turns to unhealthy behaviours to lose weight and has poor body images, why should teenage girls be any different?

Why Do my Plates Keep Yelling at me?

Put this one on your do-not-buy list.

Dr Hryhory Chausovsky, a Ukrainian scientist from the University of Zaporizhia's Life Activities Laboratory has invented the irritating plate (he calls it a talking plate).

The plate is quite small, 15cm in diameter and it's hooked up to a small computer and has a built in scale.

If the plate decides you've put too much food on it, it yells at you,

"Stop right there",

"What about excess weight?"

"Where's your willpower?"

Chausovsky apparently hasn't met really anyone with a background in nutrition. The problem with his vision, as I'm sure many of you are aware, is that weight alone does not dictate the nutritional or caloric content of a food. I don't want my heaping plate of salad yelling at me and asking me about my willpower.

The plate reminds me of a common occurrence in many households - Food Cops.

He or she is the guy that watches you carefully while you eat and asks "helpful" questions like, "Are you supposed to eat that?" and "How much of that are you allowed?".

Food cops aren't helpful. Instead of helping they push our buttons - buttons that once pushed, often lead to angry eating.

If you've got a food cop at home feel free to forward this blog where they can read the only question they're is ever allowed to ask you, and they're only allowed to ask it once. The question is,

"Is there anything that I can do to help you honey?"

And if the answer's no, no more questions.

Low Carb Diets again Prove Safe

My patients will tell you, there's no particular diet that I believe to be better than another for weight management.

I only have two real rules regarding diets and weight management:

1. If you want to lose weight, you have to eat fewer calories than you burn.
2. If you want to keep it off, you have to actually like what you're eating.

I've often said that if anyone ever walked into my office and told me that they love low-carb diets, lose weight on them but don't stick to them because they're scared they're not healthy I'd simply tell them to get back to low-carbs and get out of my office.

Fact is low carb dieting has proven itself to be safe time and time again.

Well, it's time again, again.

Yesterday in the New England Journal of Medicine Thomas Halton and colleagues (including Walt Willett) published a 20 year retrospective study utilizing data from the 82,802 nurses in the Nurses Health Study who have completed their extensive dietary questionnaires, looking at the rate of development of heart disease as a function of low-carb dieting.

I'll just skip straight to their conclusion,

"Our findings suggest that diets lower in carbohydrate and higher in protein and fat are not associated with increased risk of coronary heart disease in women. When vegetable sources of fat and protein are chosen, these diets may moderately reduce the risk of coronary heart disease."

Frankly my only problem with low-carb diets is the fact that most people find them far too restrictive to stick to....and of course, if you don't like the way you lose the weight, it'll never stay off.

Are you Giving your Kids Chocolate Bars for Breakfast?

Would you feed your children chocolate bars for breakfast?

If you answered, "of course not" but give your children sugary cereals, you'd better get ready to revise your answer.

If you read food labels regularly, this might not be news, but if your child is eating a sugary cereal for breakfast, they're probably having as much or more sugar than they would if they ate a chocolate bar.

Some equivalents (based on a 50gm or 1.75oz serving):

Kellogg's Fruit Loops = 5.6 teaspoons sugar = Dark Chocolate Kit Kat Bar
Nestle Nesquick = 5.8 teaspoons sugar = Twix Bar
Post Sugar Crisps = 6.6 teaspoons sugar = Snickers Bar

Remember too that many kids will have more than one bowl.

So what should you do?

Try to give your kids cereals with 6-7 grams of fibre per serving, and unfortunately you have to be a bit cautious with the lower sugar cereals as well as often they may compensate with more carbohydrates and more calories.

Is it time yet to cut the sugary cereal out of the pantry?

French Women DO get fat!

You may have seen this book on the bookshelves. It's been a national best seller all over the world. Unfortunately it seems, the french women, aren't reading the book (or perhaps, like 98-99% of diet books, it fails in the most important part of weight management - sustainability).

A national survey conducted annually in France show that in fact overweight and obesity rates are rising rapidly. Currently 42% of France's population over the age of 15 is either overweight or obese.

It should be pretty telling to consumers. As of today, there are over 178,285 different diet books for sale on Amazon.com. If any single one of them was dramatically better than another, doctors offices worldwide would be prescribing it. In fact in the history of medicine, there has yet to be a study the definitively proves one diet is better than another for weight loss.

In my office at the Bariatric Medical Institute, there are no prescribed diets. Every person is an individual, with different cultural backgrounds and different dietary likes and dislikes.

Here are the only two criteria that matter for diet and weightloss:

1. You eat less calories than you burn (that will help you lose the weight)
2. You like what you're eating (that will help you keep it off)

Low fat? Low carb? Who cares?

Cover your ears medical organizations, low-fat is not the magic bullet for weight management. The low fat movement, born out of the simple fact that there are more calories per gram of fat than there are per gram of carbohydrate or protein, is dying a slow, painful death. Medical professionals and governments around the globe have latched onto the low fat approach as not only the healthiest way to live, but also as the only way to lose weight. It seems that finally, that tide is turning.

Two days ago the American Heart Association released their 2006 dietary recommendations and for the first time in over two decades, they focused on the currency of weight - calories, rather than just a blanket statement about the reduction of dietary fat (for full text visit the journal Circulation and read the 16 page scientific report of the AHA).

Another blow to the low-fat proponents came from this months issue of the journal Obesity where Rena Wing and Jim Hill have continued their exemplary reporting on what it takes to not only successfully lose weight, but more importantly keep it off. In 1994 Drs. Wing and Hill established the National Weight Control Registry in order to study people who had lost at least 30lbs and kept it off for at least 1 year (actually the average results are even better with the average registrant having lost 67lbs and kept it off for 5 or more years). What they found originally was that those folks who were successful did so with low-fat approaches. Of course the late 80s and early 90s were the low-fat diet years so it is not altogether surprising that the folks who enrolled in the registry had tried low-fat approaches. What had always frustrated me was that people often used the data from the registry to suggest that therefore low-fat was the only way to go. Well guess what, they're wrong - the registry is changing. In the article in Obesity, it turns out that those folks entering the registry in the late 90s and early 2000s in fact were much less likely to be on a low-fat diet.

Bottom line of course is it doesn't matter if it's low fat, high fat, low carb or high carb, if you're happy and it's less calories, it's good.