Lean ChoicesLean ChoicesIntroductionIntroduction

Warren R. Peters MD. MPHWarren R. Peters MD. MPH

Jeanne M. Peters RN.Jeanne M. Peters RN.

GeneticGenetic

Brain ChemistryBrain Chemistry

MetabolismMetabolism

EnvironmentalEnvironmental Cultural and Cultural and PsychosocialPsychosocial

A Complex Medical ProblemA Complex Medical Problem

PHILOSOPHIES OF OBESITY PHILOSOPHIES OF OBESITY THERAPYTHERAPY

““No one would get heavy for the fun of it. There No one would get heavy for the fun of it. There has to be a “reason” and it is our job to jointly has to be a “reason” and it is our job to jointly understand it.”understand it.”

““We all get heavy for different reasons. We all get heavy for different reasons. Therefore therapy must be individualized.”Therefore therapy must be individualized.”

““This is a chronic disease and can not be This is a chronic disease and can not be currently cured. Therefore we, the patient and currently cured. Therefore we, the patient and the provider will be treating this disease forever.”the provider will be treating this disease forever.”

““Obesity is not fair or democratic” Obesity is not fair or democratic”

POINTS OF POTENTIAL POINTS OF POTENTIAL INTERVENTIONINTERVENTION

Eat lessEat lessExercise more Exercise more – Frequently recommended and can be useful for some.Frequently recommended and can be useful for some.– Most patients that you see in your office will have already tried Most patients that you see in your office will have already tried

these two methods and failed.these two methods and failed.

Macronutrient manipulation Macronutrient manipulation Alter gastric emptyingAlter gastric emptyingAlter nutrient absorption or storageAlter nutrient absorption or storageAccelerate the metabolic rateAccelerate the metabolic rateLimit food choicesLimit food choicesAvoid meal skippingAvoid meal skippingChange brain chemistry – with psychology and/or drugsChange brain chemistry – with psychology and/or drugs

GLYCEMIC INDEX/LOADGLYCEMIC INDEX/LOAD

In vivo measurement of the relative effect of a In vivo measurement of the relative effect of a single food on blood sugar over time compared single food on blood sugar over time compared to sucrose. (some indexes used white bread as to sucrose. (some indexes used white bread as a reference)a reference)

Glycemic Load = Index X gms. of CHOGlycemic Load = Index X gms. of CHO

Illustration: Popcorn has a high index but a low Illustration: Popcorn has a high index but a low load due to the small amount of digestible CHOload due to the small amount of digestible CHO

““Glycemic index and obesity” Glycemic index and obesity” Am J Clin Nutr Am J Clin Nutr 2002;76 (suppl):281S-5S2002;76 (suppl):281S-5S

LOW GLYCEMIC FOODSLOW GLYCEMIC FOODS

May not be high fiber – pasta.May not be high fiber – pasta.High fiber may be high glycemic – millet, and High fiber may be high glycemic – millet, and puffed wheat.puffed wheat.Low glycemic foods increase satiety by delayed Low glycemic foods increase satiety by delayed gastric emptying. gastric emptying. Creates a reduction of insulin response – Creates a reduction of insulin response – therefore a decrease of sodium retention and a therefore a decrease of sodium retention and a decrease in appetite.decrease in appetite.Lipid oxidation is enhanced.Lipid oxidation is enhanced.Greater weight loss. Greater weight loss.

WEIGHT OF EVIDENCEWEIGHT OF EVIDENCE

““A reduced-glycemic load diet in the treatment of A reduced-glycemic load diet in the treatment of adolescent obesity. adolescent obesity. Arch Pediatr Adolesc Med. 2003 Aug: Arch Pediatr Adolesc Med. 2003 Aug: 157(8):725-7157(8):725-7

““Glycemic index and satiety”. Glycemic index and satiety”. Nutr Clin Care. 2003 Jan-Nutr Clin Care. 2003 Jan-Apr,6(1):20-6Apr,6(1):20-6

““The effect of high- and low-glycemic index energy The effect of high- and low-glycemic index energy restricted diets on plasma lipid and glucose profiles in restricted diets on plasma lipid and glucose profiles in type 2 diabetic subjects with varying glycemic control. type 2 diabetic subjects with varying glycemic control. J Am Coll Nutr. 2002apr;21(2):120-7.J Am Coll Nutr. 2002apr;21(2):120-7.

““High protein intake sustains weight maintenance after High protein intake sustains weight maintenance after body weight loss in humans.” (18 vs.15% of energy body weight loss in humans.” (18 vs.15% of energy intake resulted in 50% less weight gain) intake resulted in 50% less weight gain) Int J Obes Relat Int J Obes Relat Metab Disord. 2004 Jan;28(1):57-64.Metab Disord. 2004 Jan;28(1):57-64.

MEAL REPLACEMENTSMEAL REPLACEMENTS

““More people may be heavy because they skip More people may be heavy because they skip meals than are heavy because they over eat.”meals than are heavy because they over eat.”

A population of “hurry”. Single mom who works A population of “hurry”. Single mom who works full time, goes to school, and raises two kids.full time, goes to school, and raises two kids.

Eating becomes a nuisance. Eating becomes a nuisance.

Medical management – Optifast. Medical management – Optifast.

OTC – EAS, SlimFast, Atkins, even Dr. Phil. OTC – EAS, SlimFast, Atkins, even Dr. Phil.

MEAL REPLACEMENT MEAL REPLACEMENT EVIDENCEEVIDENCE

““Weight management using a meal Weight management using a meal replacement strategy: meta and pooling replacement strategy: meta and pooling analysis from six studies.” analysis from six studies.” Int J Obes Relat Metab Int J Obes Relat Metab Disord. 2003 May;27(5):537-49.Disord. 2003 May;27(5):537-49.

““A novel soy-based meal replacement A novel soy-based meal replacement formula for weight loss among obese formula for weight loss among obese individuals: a randomized controlled individuals: a randomized controlled clinical trial.” clinical trial.” Int J Clin Nutr. 2003 Apr;57(4):414-22Int J Clin Nutr. 2003 Apr;57(4):414-22

Useful for weight loss and weight Useful for weight loss and weight maintenance.maintenance.

MEAL REPLACEMENTMEAL REPLACEMENT

Meal Replacement for low-income patients. 6 Meal Replacement for low-income patients. 6 months, BMI- 40 to 37 months, BMI- 40 to 37 Int.J. Obes Relat Metab Disord. Int.J. Obes Relat Metab Disord. 2004 Dec;28(12):1575-9.2004 Dec;28(12):1575-9.

One-year combination trial with type 2 Diabetics – sibutramine, low calorie diet, once daily meal replacement compared to standard care. – 7.3 kg vs. 0.8 kg loss, – HgbA1 -0.6 vs 0.0– Diabetes Care.2003 Sep;26(9):2505-11

Lean Choices-Nutritional Lean Choices-Nutritional FoundationFoundation

Nutrient “malnutrition” in the face of too Nutrient “malnutrition” in the face of too many caloriesmany calories

Chromium deficiency – too much sugarChromium deficiency – too much sugar

Stress and B vitaminsStress and B vitamins

AntioxidantsAntioxidants

““Vitality Gold” and “Daily for Life”Vitality Gold” and “Daily for Life”

Lean Choices-ExerciseLean Choices-Exercise

Avoid muscle loss.Avoid muscle loss.

Walk (if possible)Walk (if possible)

Wait to exercise until you have lost 10-15#Wait to exercise until you have lost 10-15#

Upper body exerciseUpper body exercise

Discouraging information – 90 minutes per Discouraging information – 90 minutes per day for weight lossday for weight loss

Lean Choices-Meal ReplacementLean Choices-Meal Replacement

Balanced proteinBalanced protein

Low glycemic fruitLow glycemic fruit– BerriesBerries– PineapplePineapple

2% milk or “Silk” milk2% milk or “Silk” milk

Morning and eveningMorning and evening– 250-280 calories250-280 calories

““The Baggies”The Baggies”

10 carrots10 carrots– CrunchCrunch– Healthy carbohydrate for the brainHealthy carbohydrate for the brain– IndestructibleIndestructible

10 almonds10 almonds– Healthy fats for satisfactionHealthy fats for satisfaction– Omega-3 fatty acids for brain and artery functionOmega-3 fatty acids for brain and artery function

Portable-no refrigerationPortable-no refrigerationMid-morning, Mid-afternoonMid-morning, Mid-afternoon120 calories120 calories½ of Attain Bar alternative½ of Attain Bar alternative

Lean Choices-Lunch or DinnerLean Choices-Lunch or Dinner

3 oz. of high quality, low fat protein3 oz. of high quality, low fat proteinTwo vegetable servingsTwo vegetable servings– Green, red, Green, red, – Broccoli, squash, beans, tomatoes, “greens”Broccoli, squash, beans, tomatoes, “greens”

Grain servingGrain serving– Rye bread, pasta, sprouted wheat bread, sourdough Rye bread, pasta, sprouted wheat bread, sourdough

breadbread

Fat servingFat serving– Dressing or butterDressing or butter

Calories – 500-600 caloriesCalories – 500-600 calories

The CostThe Cost

Your commitmentYour commitmentFree 12 week programFree 12 week programOne time, life long membership with Melaleuca-One time, life long membership with Melaleuca-the wellness company - $29.00the wellness company - $29.00Products – Products – – Plan #1 $175/mo ($6.25/day) Plan #1 $175/mo ($6.25/day) – Plan #2 $205/mo ($7.25/day)Plan #2 $205/mo ($7.25/day)– Subtracted from your grocery billSubtracted from your grocery bill– Plan #2 for individuals with hypertension, diabetes, or Plan #2 for individuals with hypertension, diabetes, or

high cholesterolhigh cholesterol