Category Archives: Weight Loss

What’s the Best Type of Exercise to Reduce Obesity?

Steve Parker MD
Resistance training on left; treadmill on right can be high intensity

From Obesity Reviews:

Current international guidelines recommend people living with obesity should be prescribed a minimum of 300 min of moderately intense activity per week for weight loss. However, the most efficacious exercise prescription to improve anthropometry [measurements and proportions of the body], cardiorespiratory fitness (CRF) and metabolic health in this population remains unknown. Thus, this network meta‐analysis was conducted to assess and rank comparative efficacy of different exercise interventions on anthropometry, CRF and other metabolic risk factors.

* * *

Results reveal that while any type of exercise intervention is more effective than control [no particular exercise, if any], weight loss induced is modest. Interventions that combine high‐intensity aerobic and high‐load resistance training exert beneficial effects that are superior to any other exercise modality at decreasing abdominal adiposity, improving lean body mass and increasing cardiorespiratory fitness. Clinicians should consider this evidence when prescribing exercise for adults living with obesity, to ensure optimal effectiveness.

Source: What exercise prescription is optimal to improve body composition and cardiorespiratory fitness in adults living with obesity? A network meta‐analysis – O’Donoghue – – Obesity Reviews – Wiley Online Library

So, “combine high‐intensity aerobic and high‐load resistance training” to reduce body fat and increase fitness.

Steve Parker, M.D.

 

Ketogenic Diet More Effective Than Low-Fat for Obesity and Diabetes

One of many ketogenic salads

From The Journal of Nutrition:

For >50 y, dietary guidelines in the United States have focused on reducing intakes of saturated and total fat. However, rates of obesity and diabetes rose markedly throughout this period, with potentially catastrophic implications for public health and the economy. Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Source: Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed | The Journal of Nutrition | Oxford Academic

     Steve Parker, M.D.

PS: A ketogenic diet is one of the options in The Advanced Mediterranean Diet, 2nd edition.

Despite Pasta, You Can Still Lose Weight With a Mediterranean Diet

spaghetti squash, spaghetti
Spaghetti squash is an alternative to pasta

The title above sums it up. If you’re eating pasta frequently and trying to lose weight, you do have to be careful not to over-eat. In other words, you generally have to restrict calories. In the study at hand, I don’t know how many daily calories were allowed since I haven’t read the full report. Here’s the abstract:

Background & aims

The effect of pasta consumption within a low-energy [read: calorie-restricted] Mediterranean diet on body weight regulation has been scarcely explored. This paper investigates the effect of two Mediterranean diets, which differed for lower or higher pasta intake, on body weight change in individuals with obesity.

Methods & Results

Forty-nine volunteers finished a quasi-experimental 6-month two–parallel group dietary intervention. Participants were assigned to a low-energy high pasta (HP) or to a low-energy low Pasta (LP) group on the basis of their pasta intake (HP ≥ 5 or LP ≤ 3 times/week). Anthropometrics, blood pressure and heart rate were measured every month. Weight maintenance was checked at month 12. Body composition (bioelectrical impedance analysis, BIA), food intake (24-h recall plus a 7-day carbohydrate record) and the perceived quality of life (36-item short-form health survey, SF-36) were assessed at baseline, 3 and 6 months. Blood samples were collected at baseline and month 6 to assess glucose and lipid metabolism. After 6-month intervention, body weight reduction was −10 ± 8% and −7 ± 4% in HP and LP diet, respectively, and it remained similar at month 12. Both dietary interventions improved anthropometric parameters, body composition, glucose and lipid metabolism, but no significant differences were observed between treatment groups. No differences were observed for blood pressure and heart rate between treatments and among times. HP diet significantly improved perception of quality of life for the physical component.

Conclusions

Independent of pasta consumption frequency, low-energy Mediterranean diets were successful in improving anthropometrics, physiological parameters and dietary habits after a 6-month weight-loss intervention.

Source: Body weight of individuals with obesity decreases after a 6-month high pasta or low pasta Mediterranean diet weight-loss intervention – Nutrition, Metabolism and Cardiovascular Diseases

Steve Parker, M.D.

No Big Difference Among Popular Diets

The french fries and 40 diet

From MedPage Today:

When it comes to choosing among popular diets, patients might as well choose the one they like. The diets all result in modest weight loss and their differences generally disappear at 12 months, scientists said.

The meta-analysis of 121 randomized clinical trials comparing 14 popular diets found that the top three in terms of mean weight loss and blood pressure reductions at 6 months were Atkins (5.5 kg, 5.1 mm Hg systolic); Zone (4.1 kg, 3.5 mm Hg); and DASH (3.6 kg, 4.7 mm Hg), reported Bradley Johnston, PhD, of McMaster University in Hamilton, Ontario, and colleagues.

However, as shown in the study online in The BMJ, the other popular diets were associated with some degree of weight loss and blood pressure improvement at 6 months, on the order of 2-3 kg for body weight and 3-4 mm Hg for systolic blood pressure.

By 12 months, the effects had diminished to the degree that the differences between diets were negligible, the team said.

None of the popular diets were associated with significant reductions in lipids, with the notable exception of the Mediterranean diet, for which there was a mean 4.59 mg/dL reduction in low-density lipoprotein (LDL) cholesterol at 6 months. The Mediterranean diet was also notable in that this effect did not diminish at 12 months, the researchers said.

Source: Study: No Big Difference Among Popular Diets | MedPage Today

Diets don’t work if you don’t follow them. Compliance drops off dramatically after 6-12 months. People go back to their old ways of eating and regain the last weight.

Steve Parker, M.D.

PS: The Advanced Mediterranean Diet is not popular. But if you don’t follow it, you’ll gain back the lost weight.

Anna Lee’s 10 Tips for Weight Loss

She’s smart and “on the money.” The only additional advice I’d give is to do resistance training, aka weight training.

More about Anna Lee’s transformation:

Improve Weight Loss on a Mediterranean Diet By Restricting Breakfast Carbohydrates

Steve Parker MD, Advanced Mediterranean DIet

Naturally low-carb Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil

Reducing carbohydrate content of breakfast improved weight loss on a calorie-restricted Mediterranean diet. Both diets in the study at hand were calorie restricted Mediterranean diets but only one of them restricted carbs at breakfast. Unfortunately the abstract does not mention the degree of calorie restriction nor the the AM carb restriction.

From the abstract of the study at hand:

Methods

Seventy overweight/obese individuals were randomized to two hypocaloric dietary regimens: one Mediterranean diet (Med-D) and one morning carbohydrate-restriction diet (MCR-D). Participants assigned to the MCR-D were permitted to consume a breakfast low in carbohydrate content, whereas typical Mediterranean morning meals were allowed in the Med-D group. Both diets were identical from midday on. Participants were followed over a period of 2 mo.

Results

Individuals in both groups achieved significant reductions in body weight, body mass index, waist circumference, and body fat mass. These reductions were more pronounced in the MCR-D than in the Med-D group (all P < 0.001). More participants in the MCR-D group achieved loss of 5% to 10% of body weight by the end of the first month, as well as 5% to 10% and >10% of body weight by the end of the second month (all P < 0.001). All participants achieved loss of ≥5% baseline body weight by the end of the intervention. Both groups achieved similar reductions in fasting serum glucose, glycated hemoglobin, and serum triacylglycerols as well as improvement in insulin sensitivity. Individuals in the Med-D group showed reductions in total and low-density lipoprotein cholesterol, whereas no such effect was observed in the MCR-D group.

Conclusions

Integration of morning carbohydrate restriction into a Mediterranean-type hypocaloric diet resulted in greater weight loss while retaining metabolic benefits in glycemia-related parameters.

Source: Carbohydrate restriction in the morning increases weight loss effect of a hypocaloric Mediterranean type diet: a randomized, parallel group dietary intervention in overweight and obese subjects – ScienceDirect

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Mediterranean Diet Ranked as Best Overall of 2020

Santorini, Greek seaside

Not surprising!

Every year, the U.S. News and World Report puts together a panel of experts to rank various diets.

From MedScape:

For the third year in a row, the Mediterranean diet has been named the best diet overall in the U.S. News & World Report annual rankings.

In 2018, the Mediterranean diet shared top honors with the DASH (Dietary Approaches to Stop Hypertension) diet. Both focus on fruits, vegetables, and whole grains. The ketogenic diet, one of the most popular, again fared well in the annual survey, but only in the fast weight loss category. Overall, it was not rated highly.

Angela Haupt, managing editor of health for the publication, says this year’s list has ”no surprises,” as it includes many diets that have been named outstanding before. Trendy diets typically won’t be found on its list, she says, explaining that its experts look for plans that have solid research and staying power.

Source: Mediterranean Diet Repeats as Best Overall of 2020

Click for the traditional Mediterranean diet.

Steve Parker, M.D.

Click pic to purchase book at Amazon.com. E-book versions are also at Smashwords.com.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

Ketogenic Diet: Evidence for Optimism From Dr David Ludwig

Sous vide chicken and sautéed sugar snap peas. This meal is allowed on a ketogenic diet.

From The Journal of Nutrition:

Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Source: Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

PS: If you have the 2nd edition of The Advanced Mediterranean Diet, you already have the Ketogenic Mediterranean Diet.

Click pic to purchase book at Amazon.com. E-book versions are also at Smashwords.com.

Now That You’ve Blown Your New Years’ Weight Loss Resolution, What’s Next?

That excess weight can shorten your life

If you’re down at least 4–5 pounds (2.5 kg) since Jan. 1, that’s great. Keep it up. But most folks did well for a couple weeks and started gaining the weight back. Don’t be too hard on yourself. Weight management is not a walk in the park. You probably weren’t adequately prepared for the challenge.

Longterm success requires careful forethought. That’s why I’ve written this eight-part series.

Questions beg for answers.  For example . . .

Which of the myriad weight-loss programs will I follow?  Can I design my own program?  Should I use a diet book?  Sign up for Nutri-System, Weight Watchers, or Jenny Craig?  Should I stop wasting my time dieting and go directly to bariatric surgery?  Can I simply cut back on sodas and chips?  What should I eat?  What should I not eat?  Do I need to start exercising?  What kind?  How much?  Do I need to join a gym?  What methods are proven to increase my odds of success?  How much weight should I lose?  Should I use weight-loss pills or supplements?  Which ones?  What’s the easiest, most effective way to lose weight?  Is there a program that doesn’t require willpower?  Now, what were those “top 10 super-power foods” that melt away the fat?  Am I ready to get serious and stick with it this time?

This series will answer many of these questions and get you teed up for success.  Teed up like a golfer ready to hit his first shot on hole #1 of an 18-hole course.  Take 10 minutes to read the following articles.  The time invested will pay dividends for years.

C’mon now. Let’s be realistic.

Part 1:  Motivation

Immediate, short-term motivation to lose weight may stem from an upcoming high school reunion, swimsuit season, or a wedding. You want to look your best. Maybe you want to attract a mate or keep one interested. Perhaps a boyfriend, co-worker, or relative said something mean about your weight. These motivators may work, but only temporarily. Basing a lifestyle change on them is like building on shifting sands. You need a firmer foundation for a lasting structure. Without a lifestyle change, you are unlikely to vanquish a chronic overweight problem.  Proper long-term motivation may grow from:

  • the discovery that you feel great and have more energy when you are lighter and eating sensibly
  • the sense of accomplishment from steady progress
  • the acknowledgment that you have free will and are responsible for your weight and many aspects    of your health
  • the inspiration from seeing others take charge of their lives successfully
  • the admission that you have some guilt and shame about being fat, and that you like yourself more when you’re not fat  [I’m not laying shame or guilt on you; many of us do it to ourselves.]
  • the awareness of overweight-related adverse health effects and their improvement with even modest weight loss.

Appropriate motivation will support the commitment and willpower that will be needed soon.

PS: I’m thinking of how Dave Ramsay, when he’s counseling people who have gotten way overhead in debt, tells them they have to get mad at the debt.  Then they can attack it.  Maybe you have to get mad at your fat.  It’s your enemy, dragging you down, trying to kill you.  Now attack it!

Part 2:  The Energy Balance Equation

An old joke from my medical school days asks, “How many psychiatrists does it take to change a light bulb?”  Only one, but the light bulb must want to change.

How many weight-loss programs does it take before you lose that weight for good?  Only one, but…

Where does the fat go when you lose weight dieting?  Metabolic reactions convert it to energy, water, and carbon dioxide, which weigh less than fat.  Most of your energy supply is used to fuel basic life-maintaining physiologic processes at rest, referred to as resting or basal metabolism.  Basal metabolic rate (BMR) is expressed as calories per kilogram of body weight per hour.  Even at rest, a kilogram of muscle is much more metabolically active than a kilogram of fat tissue.  So muscular lean people sitting quietly in a room are burning more calories than are fat people of the same weight sitting in the same room.

The major determinants of BMR are age, sex, and the body’s relative proportions of muscle and fat.  Heredity plays a lesser role.

Energy not used for basal metabolism is either stored as fat or converted by the muscles to physical activity.  Most of us use about 70 percent of our energy supply for basal metabolism and 30 percent for physical activity.  Those who exercise regularly and vigorously may expend 40–60 percent of their calorie intake doing physical activity.  Excess energy not used in resting metabolism or physical activity is stored as fat.

If you want to lose excess weight and keep it off, you must learn the following equation:

The energy you eat,

          minus the energy you burn in metabolism and activity,

               determines your change in body fat.  [read more]

Cute mouse, but a slave to instincts.

Part 3:  Free Will

The only way to lose excess fat weight is to cut down on the calories you take in, increase your physical activity, or do both.

Oh, sure.  You could get a leg amputated, develop hyperthyroidism or out-of-control diabetes, or have liposuction or bariatric surgery.  But you get my drift.

Although the exercise portion of the energy balance equation is somewhat optional, you must reduce food intake to lose a significant amount of weight.  Once you reach your goal weight you will be able to return to nearly your current calorie consumption, and even higher consumption if you have increased your muscle mass and continue to be active.

Are you be able to reduce calorie intake and increase your physical activity temporarily? It comes down to whether we have free will.  Free will is the power, attributed especially to humans, of making free choices that are unconstrained by external circumstances or by an agency such as divine will.

Will is the mental faculty by which one chooses or decides upon a course of action; volition.

Willpower is the strength of will to carry out one’s decisions, wishes, or plans.

If we don’t have free will, you’re wasting time trying to lose weight through dieting; nothing will get your weight problem under control.  Even liposuction and weight-reduction stomach surgery will fail in time if you are fated to be fat.  The existence of free will is . . . [read more]

Part 4:  Starting New Habits

You already have a number of good habits that support your health and make your life more enjoyable, productive, and efficient.  For example, you brush your teeth and bathe regularly, put away clean clothes in particular spots, pay bills on time, get up and go to work every day, wear your seat belt, put your keys or purse in one place when you get home, balance your checkbook periodically.

At one point, these habits took much more effort than they do now.  But you decided they were the right thing to do, made them a priority, practiced them at first, made a conscious effort to perform them on schedule, and repeated them over time.  All this required discipline.  That’s how good habits become part of your lifestyle, part of you.  Over time, your habits require much less effort and hardly any thought.  You just do it.

Your decision to lose fat permanently means that you must establish some new habits, such as regular exercise and reasonable food restriction.  You’ve already demonstrated that you have self-discipline.  The application of that discipline to new behaviors will support your commitment and willpower.

Exercise isn’t very important for weight loss, but critical for preventing weight regain.

Part 5:  Supportive Social System

Success at any major endeavor is easier when you have a supportive social system.  And make no mistake: losing a significant amount of weight and keeping it off long-term is a major endeavor.

As an example of a supportive social system, consider childhood education.  A network of actors play supportive roles.  Parents provide transportation, school supplies, a home study area, help with homework, etc.  Siblings leave the child alone so he can do his homework, and older ones set an example.  Neighbors may participate in carpooling.  Taxpayers provide money for public schools.  Teachers do their part.  The school board oversees the curriculum, supervises teachers, and does long-range planning.

Success is more likely when all the actors work together for their common goal: education of the child.  Similarly, your starring role in a weight-loss program may win an Academy Award if you have a strong cast of supporting actors.  Your mate, friends, co-workers, and relatives may be helpers or hindrances.  It will help if they . . . [read more]

Part 6:  Weight Goals

Despite all the chatter about how to lose weight, few talk about how much should be lost.

"This can't be right!"

Down 4 pounds in 6 months. I’ll take it!

If you are overweight, deciding how much weight you should lose is not as simple as it seems at first blush.  I rarely have to tell a patient she’s overweight. She knows it and has an intuitive sense of whether it’s mild, moderate, or severe in degree.  She’s much less clear about how much weight she should lose.  If it’s any consolation, clinicians in the field aren’t always sure either.

Five weight standards have been in common usage over the last quarter-century . . . [read more]

Part 7:  Creative Visualization

How will your life be different after you make a commitment and have the willpower to lose weight permanently?

Odds are, you will be more physically active than you are now.  Exercise will be a habit, four to seven days per week.  Not necessarily vigorous exercise, perhaps just walking for 30 or 45 minutes.  It won’t be a chore.  It will be pleasant, if not fun.  The exercise will make you more energetic, help you sleep better, and improve your self-esteem.

After you achieve your goal weight, you’ll be able to cut back on exercise to three or four days per week, if you want.  If you enjoy eating as much as I do, you may want to keep very active physically so that you can eat more.  I must tell you that I rarely see anyone lose a major amount of weight and keep it off without . . . [read more]

Part 8:  Choosing A Program

I listed most of your weight-loss program options in the introductory comments to this series.  Now it’s time to make a choice.  And it’s not easy sorting through all the options.

Straight away, I must tell you that women over 300 pounds (136 kg) and men over 350 pounds (159 kg) rarely have permanent success with self-help methods such as diet books, meal replacement programs, diet pills or supplements, and meal-delivery systems.  People at those high weights who have tried and failed multiple different weight-loss methods should seriously consider bariatric surgery.

I respect your intelligence and desire to do your “due diligence” and weigh all your options: diet books, diet pills and supplements, bariatric surgery, meal replacement products (e.g., SlimFast), portion-control meal providers (e.g., NutriSystem), Weight Watchers, fad diets, no-diet diets, “just cutting back,” etc.  You have to make the choice; I can’t make it for you.  Here are some well-respected sources of advice to review before you choose . . . [read more]

Last modification date:  November 1, 2017

High Protein Diet Could Help Prevent Weight Regain

Filet mignon and sautéed asparagus

Weight loss can change your metabolism in such a way that promotes regain of lost weight. For successful weight-losers with prediabetes, a higher protein diet could help with prevention of regain. How much higher protein? 25% versus the usual 15% of calories from fat.

This is important research since most people who lose fat weight gain it back, typically 6–12 months later.

For the boring details, keep reading.

ABSTRACT

Background

Weight loss has been associated with adaptations in energy expenditure. Identifying factors that counteract these adaptations are important for long-term weight loss and weight maintenance.

Objective

The aim of this study was to investigate whether increased protein/carbohydrate ratio would reduce adaptive thermogenesis (AT) and the expected positive energy balance (EB) during weight maintenance after weight loss in participants with prediabetes in the postobese state.

Methods

In 38 participants, the effects of 2 diets differing in protein/carbohydrate ratio on energy expenditure and respiratory quotient (RQ) were assessed during 48-h respiration chamber measurements ∼34 mo after weight loss. Participants consumed a high-protein (HP) diet (n = 20; 13 women/7 men; age: 64.0 ± 6.2 y; BMI: 28.9 ± 4.0 kg/m 2) with 25:45:30% or a moderate-protein (MP) diet (n = 18; 9 women/9 men; age: 65.1 ± 5.8 y; BMI: 29.0 ± 3.8 kg/m 2) with 15:55:30% of energy from protein:carbohydrate:fat. Predicted resting energy expenditure (REEp) was calculated based on fat-free mass and fat mass. AT was assessed by subtracting measured resting energy expenditure (REE) from REEp. The main outcomes included differences in components of energy expenditure, substrate oxidation, and AT between groups.

Results

EB (MP = 0.2 ± 0.9 MJ/d; HP = −0.5 ± 0.9 MJ/d) and RQ (MP = 0.84 ± 0.02; HP = 0.82 ± 0.02) were reduced and REE (MP: 7.3 ± 0.2 MJ/d compared with HP: 7.8 ± 0.2 MJ/d) was increased in the HP group compared with the MP group (P < 0.05). REE was not different from REEp in the HP group, whereas REE was lower than REEp in the MP group (P < 0.05). Furthermore, EB was positively related to AT (rs = 0.74; P < 0.001) and RQ (rs = 0.47; P < 0.01) in the whole group of participants.

Conclusions

In conclusion, an HP diet compared with an MP diet led to a negative EB and counteracted AT ∼34 mo after weight loss, in participants with prediabetes in the postobese state. These results indicate the relevance of compliance to an increased protein/carbohydrate ratio for long-term weight maintenance after weight loss. The trial was registered at clinicaltrials.gov as NCT01777893.

Source: High Compared with Moderate Protein Intake Reduces Adaptive Thermogenesis and Induces a Negative Energy Balance during Long-term Weight-Loss Maintenance in Participants with Prediabetes in the Postobese State: A PREVIEW Study | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

PS: I didn’t read the whole study. I leave that to you.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.