Help Your Patients Make Good on New Year's Resolutions to Lose Weight
January 1, 2006
Help Your Patients Make Good on New Year's Resolutions to Lose Weight
By Mary Hardy, MD Dr. Hardy is Associate Director, UCLA Center for Dietary Supplement Research: Botanicals, and Medical Director, Cedars-Sinai Integrative Medicine Program, Los Angeles, CA. Dr. Hardy is on the scientific advisory board for Pharmavite and Herablife.
Source: Nickols-Richardson SM, et al. Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs. high-carbohydrate/low-fat diet. J Am Diet Assoc 2005;105:1433-1437.
Abstract: The impact of a low-carbohydrate/high-protein diet compared with a high-carbohydrate/low-fat diet on ratings of hunger and cognitive eating restraint were examined. Overweight premenopausal women consumed a low-carbohydrate/high-protein (n = 13) or high-carbohydrate/low-fat (n = 15) diet for six weeks. Fasting body weight (BW) was measured and the eating inventory was completed at baseline, weeks 1-4, and week 6. All women experienced a reduction in BW (P < 0.01), although relative BW loss was greater in the low-carbohydrate/high-protein vs. high-carbohydrate/low-fat group at week 6 (P < 0.05). Based on Eating Inventory scores, self-rated hunger decreased (P < 0.03) in women in the low-carbohydrate/high-protein but not in the high-carbohydrate/low-fat group from baseline to week 6. In both groups, self-rated cognitive eating restraint increased (P < 0.01) from baseline to week 1 and remained constant to week 6. Both diet groups reported increased cognitive eating restraint, facilitating short-term weight loss; however, the decrease in hunger perception in the low-carbohydrate/high-protein group may have contributed to a greater percentage of BW loss.
Source: Lofgren I, et al. Weight loss associated with reduced intake of carbohydrate reduces the atherogenicity of LDL in premenopausal women. Metabolism 2005;54:1133-1141.
Abstract: The effect of a three-tier intervention including dietary modifications (i.e., moderate energy restriction, decreased carbohydrate, increased protein), increased physical activity, and the use of carnitine as a dietary supplement was evaluated on plasma lipids and the atherogenicity of low-density lipoprotein (LDL) particles in a population of overweight and obese premenopausal (aged 20-45 years) women. Carnitine or a placebo (cellulose) was randomly assigned to the participants using a double-blind design. Carnitine supplementation was postulated to enhance fat oxidation resulting in lower concentrations of plasma triglycerides. Seventy women completed the 10-week protocol, which followed a reduction in their energy intake by 15% and a macronutrient energy distribution of 30% protein, 30% fat, and 40% carbohydrate. In addition, subjects increased the number of steps taken per day by 4,500. As no differences were observed between the carnitine and placebo groups in all the measured parameters, all subjects were pooled together for statistical analysis. Participants decreased (P < 0.01) their caloric intake (between 4,132.8 and 7,770 kJ) and followed prescribed dietary modifications as assessed by dietary records. The average number of steps increased from 8,950 ± 3,432 to 12,764 ± 4,642 (P < 0.001). Body weight, plasma total cholesterol, LDL cholesterol, and triglycerides were decreased by 4.5%, 8.0%, 12.3%, and 19.2% (P < 0.0001), respectively, after the intervention. Likewise, apolipoproteins B and E decreased by 4.5% and 15% (P < 0.05) after 10 weeks. The LDL mean particle size was increased from 26.74 to 26.86 nm (P < 0.01), and the percent of the smaller LDL subfraction (P < 0.05) was decreased by 26.5% (P < 0.05) after 10 weeks. In addition, LDL lag time increased by 9.3% (P < 0.01), and LDL conjugated diene formation decreased by 23% (P < 0.01), indicating that the susceptibility of LDL to oxidation was decreased after the intervention. This study suggests that moderate weight loss (< 5% of body weight) associated with reduced caloric intake, lower dietary carbohydrate, and increased physical activity impacts the atherogenicity of LDL.
Comments
Start the new year off right! that should be your resolution with your patients this month. Many patients make resolutions to lose weight starting on New Year's Day. The worst of the holiday eating is behind you and there are six weeks until the next candy holiday, Valentine's Day, rears its head. Use this opportunity to discuss this crucial health issue with your patientsbut be prepared with some new ideas and the right information. Make it your resolution to record weight with each patient visit and use height to calculate body mass index (BMI).
However, I'd like you to consider another measurement that should become the next vital sign in the United Stateswaist circumference. According to Lofgren and colleagues, this simple measurement is a better predictor of coronary heart disease than BMI.1 Educate yourself about the myriad of dietary choices available for patients. The recent review by Tangney et al provides an excellent review of the literature on the results of a variety of different diets.2 It's a good place to start when choosing a diet style most likely to help your patients.
In this month's review, I would like to focus on one issue which has been controversial in popular weight loss dietsdoes the limiting of carbohydrates or the increase in protein provide any benefit beyond short-term weight loss? A small trial by Nickols-Richardson et al addresses the effect of high-protein content vs. high-carbohydrate content in controlling hunger and promoting weight loss.3 This small trial looked at the effect on premenopausal women of choosing either a high-carbohydrate/low-fat diet as recommended by the National Cholesterol Education Program (n = 13) vs. a high-protein/low-carbohydrate Atkins type diet (n = 15). The women were maintained on these two eating plans for six weeks. At the end of this intervention, the high-protein/low-carbohydrate group was consuming 61% of their energy from fat, an increase of 25% from baseline, but did manage to lose an average of 6 kg. The high-carbohydrate/low-fat group was eating 22% of their calories from fat, a decrease of 14% from baseline with a 4 kg weight loss.
Lipids were not recorded, but clear concerns exist about continuing such a high-fat intake over the long term. What was instructive in this trial and should be considered for all diet interventions was the effect that extra protein had on hunger. Both groups demonstrated better restraint in eating, without significant differences between groups as recorded on a standard measure of eating behavior, the Cognitive Eating Restraint and Hunger scale. However, mean self-reports of hunger scores in women on the high-protein/low-carbohydrate diet were significantly lower than those in the high-carbohydrate/low-fat group. This suggests that increased protein contributes to greater feelings of satiety and decreases in self-perceived hunger. Clearly, having greater control over hunger would be a benefit to a patient seriously trying to change her eating habits.
But is there a benefit to carbohydrate restriction in and of itself? Recent work by Lofgren and her group suggest that there is.4 She conducted a randomized clinical trial of 70 women, initially to study the effects of carnitine as a supplement to enhance weight loss. The diet recommended to all participants was designed to decrease total caloric intake by 15% and to provide macronutrients in the ratio of 30% protein, 30% fat, and 40% carbohydrate. All subjects also moderately increased the number of steps taken daily as recorded by pedometers. This modest restriction in energy and some reduction in carbohydrates led to a small weight loss of < 5% of body weight in all subjects. However, these modest changes were sufficient to cause a marked improvement in atherogenicity of plasma. The total cholesterol decreased by 8%, LDL cholesterol by 12%, and triglycerides by 19% (P < 0.0001). In addition, LDL particle size was improved and susceptibility to oxidation decreased. A regression analysis conducted by the authors, found that the reduction in carbohydrates was the major factor responsible for weight loss in this trial. For changes in cholesterol, a similar effect was found. This is an interesting finding and can explain the fact, observed by many of us in practice, that patients adherent to a high-carbohydrate but low-fat diet were not as successful as either they or we would have wished.
How do these two articles help us help our patients? It is clear from recent studies that the Atkins diet improves short-term weight loss but concerns regarding high-fat content remain. Two suggestions from Atkins would be helpful for a wide variety of dieters. First, increase protein to increase satiety and control hunger and decrease carbohydrates to improve lipid parameters. It seems that the marketplace of popular diet interventions has replicated the tale of the blind men and the elephant. Each had a piece of the true elephant, but none saw the elephant in its entirety. We should help our patients deal with this hard issue by discussing it sensitively at all medical visits, by measuring all relevant parameters to give more markers than just weight to show success, and by taking the best ideas from many different diet styles to design the right intervention for our patients. Here's to a healthier New Year for us and our patients!
References
1. Lofgren I, et al. Waist circumference is a better predictor than body mass index of coronary heart disease risk in overweight premenopausal women. J Nutr 2004;134:1071-1076.
2. Tangney CC, et al. A review: Which dietary plan is best for your patients seeking weight loss and sustained weight management? Dis Mon 2005;51:284-316.
3. Nickols-Richardson SM, et al. Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet. J Am Diet Assoc 2005;105:1433-1437.
4. Lofgren I, et al. Weight loss associated with reduced intake of carbohydrate reduces the atherogenicity of LDL in premenopausal women. Metabolism 2005;54:1133-1141.
Hardy M. Help your patients make good on New Year's resolutions to lose weight. Altern Ther Women's Health 2006;8(1):4-5.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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