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The skinny on high-protein, low-carbohydrate diets.

Short-term studies of high-protein, low-carbohydrate diets have shown weight loss and improvements in plasma lipid profiles. Studies of greater than 6 months' duration, however, have failed to show continued benefit of high-protein, low-carbohydrate diets on weight loss and cardiovascular risk factors compared with conventional diets. Without concurrent weight loss and caloric restriction, these diets offer no additional benefit to lipids or body weight over other weight-loss regimens. In fact, high-protein, low-carbohydrate diets may add additional risk to individuals with cardiovascular disease due to their high fat and cholesterol content combined with decreased intake of fruits, vegetables, whole grains, and other nutrients related to cardiovascular risk. In addition, high-protein, low-carbohydrate diets have been implicated in other risks, including impaired renal, bone, and gastrointestinal health.

Caloric Restriction↗

A review of current weight management: research and recommendations.

PURPOSE: To review current research and recommendations on weight loss and weight control and provide suggestions for health care providers who furnish weight management counseling. DATA SOURCES: Scientific publications, clinical guidelines, and government sources. CONCLUSIONS: Research reaffirms the long-held understanding that weight loss can be accomplished only through a reduction in the number of calories consumed and an increase in exercise. Weight maintenance requires life-long behavioral change combining moderate exercise, lower fat intake, increased fruit and vegetable consumption, as well as social support. Fad diets and medications are not the answer to long-term weight maintenance. IMPLICATIONS FOR PRACTICE: The essential components of a weight loss or weight management program include: calorie reduction of 300-500 calories per day, appropriate exercise, variety in food choices, increased consumption of grains, fruits, and vegetables, and reduction of fat to no more than 30% of daily calories. Clients should be referred to dietitian and exercise consultants as needed.

Body Mass Index↗

Malnutrition in infants receiving cult diets: a form of child abuse.

Severe nutritional disorders, including kwashiorkor, marasmus, and rickets, were seen in four children and were due to parental food faddism, which should perhaps be regarded as a form of child abuse. All disorders were corrected with more normal diets and vitamin supplements. In view of the potentially serious consequences of restricted diets being fed to children, families at risk should be identified and acceptable nutritional advice given. When children are found to be suffering from undernutrition due to parental food faddism a court order will normally be a necessary step in providing adequate treatment and supervision.

Child Abuse↗

Dietary intake and plasma lipid levels: lessons from a study of the diet of health conscious groups.

AIM: To re-examine the contentious relation between diet and plasma lipids within a population. DESIGN: Cross sectional sample from a large prospective cohort study of people eating different diets in Britain. Blood samples and diet records collected from subjects. SUBJECTS: Volunteers eating one of four distinct diets--namely, vegans, vegetarians, fish eaters who do not eat meat, and meat eaters. 52 Subjects selected from each group. METHODS: Examination of the relation between nutritional intake recorded in a four day dietary record and plasma lipid concentrations of subjects measured in blood samples collected previously. RESULTS: After controlling for age, sex, and body mass index, the correlation between plasma total cholesterol and the Keys score (which includes dietary cholesterol and saturated and polyunsaturated fat) was 0.37 (p less than 0.001). The mean saturated fat intake in all groups was low (6-14% of energy), but polyunsaturated fat intake was high, so mean total fat intake was generally above that recommended. A high dietary fibre intake was not associated with high carbohydrate intake. Plasma high density lipoprotein values were not associated with any measure of fat intake, but there was a significant correlation of 0.24 between high density lipoprotein values and alcohol intake. CONCLUSIONS: The nature rather than quantity of dietary fat is an important determinant of cholesterol concentrations. Health conscious individuals select a fat modified, rather than a low fat--high carbohydrate diet. National cholesterol lowering dietary advice should be reconsidered.

Adult↗

Competing dietary claims for weight loss: finding the forest through truculent trees.

In response to an accelerating obesity pandemic, competing weight-loss diets have propagated; those touting carbohydrate restriction are currently most in vogue. Evidence that sustainable weight loss is enhanced by means other than caloric restriction, however, is lacking. Whereas short-term weight loss is consistently achieved by any dietary approach to the restriction of choice and thereby calories, lasting weight control is not. Competing dietary claims imply that fundamental knowledge of dietary pattern and human health is lacking; an extensive literature belies this notion. The same dietary and lifestyle pattern conducive to health promotion is consistently associated with weight control. A bird's eye view of the literature on diet and weight reveals a forest otherwise difficult to discern through the trees. Competing diet claims are diverting attention and resources from what is actually and urgently needed: a dedicated and concerted effort to make the basic dietary pattern known to support both health and weight control more accessible to all.

Body Composition↗

Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association.

High-protein diets have recently been proposed as a "new" strategy for successful weight loss. However, variations of these diets have been popular since the 1960s. High-protein diets typically offer wide latitude in protein food choices, are restrictive in other food choices (mainly carbohydrates), and provide structured eating plans. They also often promote misconceptions about carbohydrates, insulin resistance, ketosis, and fat burning as mechanisms of action for weight loss. Although these diets may not be harmful for most healthy people for a short period of time, there are no long-term scientific studies to support their overall efficacy and safety. These diets are generally associated with higher intakes of total fat, saturated fat, and cholesterol because the protein is provided mainly by animal sources. In high-protein diets, weight loss is initially high due to fluid loss related to reduced carbohydrate intake, overall caloric restriction, and ketosis-induced appetite suppression. Beneficial effects on blood lipids and insulin resistance are due to the weight loss, not to the change in caloric composition. Promoters of high-protein diets promise successful results by encouraging high-protein food choices that are usually restricted in other diets, thus providing initial palatability, an attractive alternative to other weight-reduction diets that have not worked for a variety of reasons for most individuals. High-protein diets are not recommended because they restrict healthful foods that provide essential nutrients and do not provide the variety of foods needed to adequately meet nutritional needs. Individuals who follow these diets are therefore at risk for compromised vitamin and mineral intake, as well as potential cardiac, renal, bone, and liver abnormalities overall.

American Heart Association↗

Severe obesity: a growing health concern A.S.P.E.N. should not ignore.

The definition of malnutrition in the published standards of the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) is any derangement in the normal nutrition status and includes overnutrition, commonly referred to as obesity. The incidence of obesity is increasing and reaching epidemic proportions in the United States and even worldwide. This has significant financial impact as our society spends billions of dollars on fad diets, commercial weight-loss programs, nutrition and dietary supplements, prescription and over-the-counter medications, and health clubs. Another approximately dollars 100 billion are spent to treat the medical consequences of obesity. Currently, for those patients with intractable morbid obesity, defined as having a body mass index >40 kg/m2, surgery offers the only option for achieving meaningful and sustainable weight loss. The resultant weight loss dramatically improves health and decreases the cost of health care for these patients. Years of refinement in technology and the introduction of safer and less invasive procedures have dramatically reduced the short-term morbidities and long-term metabolic consequences of these procedures. This address will review the field of weight loss (bariatric) surgery and will offer a compelling request for A.S.P.E.N. to include obesity in its fabric.

Bariatrics↗

Perceptions and beliefs about body size, weight, and weight loss among obese African American women: a qualitative inquiry.

The purpose of this qualitative study was to explore perceptions and beliefs about body size, weight, and weight loss among obese African American women in order to form a design of weight loss intervention with this target population. Six focus groups were conducted at a community health clinic. Participants were predominantly middle-aged with a mean Body Mass Index of 40.3 +/- 9.2 kg/m(2). Findings suggest that participants (a) believe that people can be attractive and healthy at larger sizes; (b) still feel dissatisfied with their weight and self-conscious about their bodies; (c) emphasize eating behavior as the primary cause for weight gain; (d) view pregnancy, motherhood, and caregiving as major precursors to weight gain; (e) view health as the most important reason to lose weight; (f) have mixed experiences and expectations for social support for weight loss; and (g) prefer treatments that incorporate long-term lifestyle modification rather than fad diets or medication.

Adult↗

Ketosis leads to increased methylglyoxal production on the Atkins diet.

In the popular and widely used Atkins diet, the body burns fat as its main fuel. This process produces ketosis and hence increased levels of beta-hydroxybutyrate (BOB) acetoacetate (AcAc) and its by-products acetone and acetol. These products are potential precursors of the glycotoxin methylglyoxal. Since methylglyoxal and its byproducts are recognized as a significant cause of blood vessel and tissue damage, we measured methylglyoxal, acetone, and acetol in subjects on the Atkins diet. We found that by 14-28 days, methylghyoxal levels rose 1.67-fold (P = 0.039) and acetol and acetone levels increased 2.7- and 6.12-fold, respectively (P = 0.012 and 0.028). Samples from subjects with ketosis showed even greater increases in methylglyoxal (2.12-fold), as well as acetol and acetone, which increased 4.19- and 7.9-fold, respectively; while no changes were seen in samples from noncompliant, nonketotic subjects. The increase in methylglyoxal implies that potential tissue and vascular damage can occur on the Atkins diet and should be considered when choosing a weight-loss program.

Adult↗

Peer, parent, and media influences on the development of weight concerns and frequent dieting among preadolescent and adolescent girls and boys.

OBJECTIVE: To assess prospectively the influence of peers, parents, and the media on the development of weight concerns and frequent dieting. DESIGN: Prospective cohort study. SETTING: Questionnaires mailed annually to participants throughout the United States. PARTICIPANTS: One-year follow-up of 6770 girls and 5287 boys who completed questionnaires in 1996 and 1997 and were between 9 and 14 years of age in 1996. MAIN OUTCOME MEASURE: Onset of high levels of concern with weight and dieting frequently to control weight. RESULTS: During 1 year of follow-up, 6% of girls and 2% of boys became highly concerned with weight and 2% of girls and 1% of boys became constant dieters. Peer influence was negligible. Independent of age and body mass index, both girls (odds ratio [OR]): 1.9; 95% confidence interval [CI]: 1.1-3.1) and boys (OR: 2.7; 95% CI: 1.1-6. 4) who were making a lot of effort to look like same-sex figures in the media were more likely than their peers to become very concerned with their weight. Moreover, both girls (OR: 2.3; 95% CI: 1.1-5.0) and boys (OR: 2.6; 95% CI: 1.1-6.0) who reported that their thinness/lack of fat was important to their father were more likely than their peers to become constant dieters. CONCLUSIONS: Our results suggest that parents and the media influence the development of weight concerns and weight control practices among preadolescents and adolescents. However, there are gender differences in the relative importance of these influences.

Adolescent↗