principles of energy balance and weight control pdf

Principles Of Energy Balance And Weight Control Pdf

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KYLE J. Patient Information Handout. Related Editorial.

Finding a Balance

Metrics details. Reducing dietary energy density has proven to be an effective strategy to reduce energy intakes and promote weight control. This effect appears most robust when a low energy dense preload is consumed before meals. Yet, much discussion continues regarding the optimal form of a preload. The purpose of the present study was to compare effects of a solid grapefruit , liquid grapefruit juice and water preload consumed prior to breakfast, lunch and dinner in the context of caloric restriction.

Eighty-five obese adults BMI Preloads were matched for weight, calories, water content, and energy density. Weekly measures included blood pressure, weight, anthropometry and hour dietary intakes. Resting energy expenditure, body composition, physical performance and cardiometabolic risk biomarkers were assessed. The total amount grams of food consumed did not change over time.

Subjects experienced 7. However, differences were not statistically significant among groups. These data indicate that incorporating consumption of a low energy dense dietary preload in a caloric restricted diet is a highly effective weight loss strategy. But, the form of the preload did not have differential effects on energy balance, weight loss or body composition. It is notable that subjects in GF and GFJ preload groups experienced significantly greater benefits in lipid profiles. As the clinical and economic burden of obesity grows [ 1 ], practical interventions for weight management offer considerable therapeutic and cost containment advantages.

Dietary strategies range from restricting calories, manipulating macronutrient composition or enhancing single nutrients, to altering energy density. Accumulating evidence indicate that reducing dietary energy density kilocalories per gram of food increases satiety and decreases energy intake [ 2 — 4 ]. While some studies indicate that solids have greater effects on reducing food and energy intake [ 7 , 8 ], others demonstrate that liquids can be as effective [ 5 ].

Thus, the evidence on the optimal form of a preload, i. While it appears that the water content of the item predominately determines its energy density and effects on intakes [ 11 ], few studies have been conducted with foods that have naturally high water contents - like fruit.

Fruit is also informative because it is readily available in solid, semi-solid and liquid forms. A series of experiments demonstrated significantly less hunger and greater satiety after consuming whole apple, orange and grape compared to apple, orange and grape juice [ 12 ].

Further, when matched by energy density, whole apple reduced lunch meal energy intakes more than apple sauce and juice [ 13 ]. Yet, all three forms reduced lunch meal energy intakes compared to no preload. Notably, the above studies were conducted with healthy normal-weight adults. When lean and obese adults were included, the three forms of apple elicited different appetite ratings, but energy intakes did not differ [ 14 ].

The present study was designed to compare the effects of consuming solid and liquid forms of a fruit preload on energy balance, body weight and composition, and cardiometabolic risk factors in free-living obese adults who were prescribed caloric restriction.

Moreover, consumption of GF and GFJ has been widely publicized in the lay media as an effective strategy for achieving weight loss for over four decades [ 15 ]. To rigorously compare preload forms, we matched GF and GFJ preloads by weight, calories, water content, and energy density.

In addition, GF and GFJ preloads were compared to a water preload matched by weight as water has no calories or energy density. Since dietary fiber content should reduce energy intake by slowing gastric emptying and inducing early satiety [ 16 ], we hypothesized that subjects consuming GF preloads would experience greater weight loss due to the potential combined effects of low energy density and higher fiber content.

We further hypothesized that subjects consuming the GFJ preload would experience greater reductions in cardiometabolic risk due to the potential combined effects of low energy density with higher bioflavonoid content, which is associated with influencing lipoprotein dynamics [ 17 ]. Adults aged 21 to 50 years who responded to print and electronic advertisements were screened by telephone to exclude diabetes, cardiovascular, liver or kidney disease; medications for estrogen replacement, thyroid disease, depression, gastrointestinal disorders; medications metabolized by the cytochrome P CYP 3A4 enzyme [ 18 ]; orexigenic agents; and food allergies or medically restricted diets.

National Institutes of Health ClinicalTrials. The study opened for accrual in March and enrollment closed in January One hundred seventeen individuals were scheduled for further eligibility assessment by Registered Dietitians RD trained in anthropometry [ 19 ] and the U.

Department of Agriculture multi-pass hour diet recall methodology [ 20 ]. Written informed consent was obtained at the enrollment visit Figure 1. Flow diagram of study subjects from eligibility criteria screening to study completion. At the enrollment visit, RDs obtained demographic information and diet, weight and gastrointestinal health history.

Subjects were included if BMI was Ninety-five subjects who met eligibility were enrolled and instructed to maintain stable body weight by consuming their habitual diet until the first clinic visit. They were trained to use two-dimensional food portion estimation posters 2D Food Portion Visual, Nutrition Consulting Enterprises, Framingham, MA and measuring utensils to quantify dietary intakes.

Between enrollment and the first clinic visit, RDs conducted unannounced telephone-administered diet recalls to capture hour intakes on two nonconsecutive weekdays and one weekend day determined by a computer-generated randomization scheme. At the first clinic visit, subjects were prescribed a diet plan providing a Meal plans and sample menus were designed by distributing calorie and macronutrient prescription into 3 meals and 3 snacks daily using Exchange Lists [ 26 ]. The number of servings for each food group complied with the Dietary Guidelines for Americans , Since meal plans included 3 fruit servings daily, subjects agreed to avoid consuming GF or GFJ during the next two weeks.

Subjects also avoided taking dietary supplements throughout the study. Before scheduling individual counseling sessions for the end of study weeks 1 and 2, RDs demonstrated how to complete daily diet, exchange list and pedometer logs. Of the 95 enrolled subjects, 85 submitted logs indicating meal plan compliance during the 2-week caloric restriction phase.

These 85 were randomized in an open-label, parallel-arm design to one of three preload conditions for the next 12 weeks. They were trained to cut, peel and portion GF to exclude only the rind.

Subjects were instructed to consume preloads entirely starting 20 minutes before meals [ 27 ]. At weekly clinic visits, RDs collected empty GF, GFJ and water containers, obtained weight and blood pressure, reviewed logs and counseled subjects to facilitate diet adherence, and distributed preload supplies. They were instructed to avoid alcohol and excessive caffeine intake the day before the CRC, and fast from pm until arrival at am.

After weight and vital signs were obtained, visual analog scales VAS were administered for subjects to rate hunger, thirst, satiety amount that could be consumed , appetite desire for food and fullness by marking "x" on a mm line anchored with extremes such as "nothing at all" and "an extremely large amount" [ 28 ].

For measurement of resting energy expenditure REE , subjects laid supine, room lights were dimmed, and subjects were habituated to breathing under the canopy in thermoneutral conditions.

Dual energy x-ray absorptiometry DEXA was performed by a certified densitometrist using a Prodigy whole body scanner software version 4. Lastly, subjects performed a timed meter walk to assess exercise capacity [ 30 ]. Standard assays at the Vanderbilt Department of Pathology Clinical Laboratory were performed for lipid profile triglyceride and total, LDL and HDL-cholesterol by selective enzymatic hydrolysis, liver function tests ALT, AST and alkaline phosphatase by colormetric rate determination, serum glucose by colorimetric timed endpoint method, and insulin by chemiluminescent immunoassay.

Sample size was determined a priori using nQuery Advisor version 6. A sequence of random numbers without replacement was generated by computer algorithm to assign subjects to preload group [ 33 ]. After entering recall data, RDs compared subjects' food logs to recall data to identify omissions in recalled intakes. Recipes were created for items not present in NDS-R using the gram weight of food ingredients consumed. Energy and nutrient intakes from all preloads, meals and snacks in each hour period were combined to calculate total daily intakes.

Baseline descriptive characteristics for the sample were tested using Chi-square test of independence for categorical variables and one-way ANOVA for continuous variables. Chi-square tests of independence and Student's t- tests were used to compare dropouts to completers.

Data were analyzed according to the intention-to-treat principle with last observation carried forward. Differential changes in outcome variables among the preload groups were tested using analysis of covariance ANCOVA with baseline values included as the covariate to control for possible baseline differences in outcome variables. Relationships between changes post-intervention minus baseline in any two outcome variables were assessed using Spearman's correlation coefficients.

Data were analyzed using SPSS software version Sixty-four women and 21 men completed the caloric restriction phase and were randomly assigned to GF, GFJ or water preloads. At baseline, there were no statistically significant differences according to preload assignment for age, gender, BMI, race, education or disordered eating scores Table 2 ; subjects' average age was Subjects had an average weight loss of 0.

The rate of weight loss increased significantly by Adjusted for baseline weight, total weight loss was not statistically different by group. As average weight loss across groups was 7. Although there were statistically significant within-group decreases for waist circumference and percentage body, trunk, android and gynoid fat, there were no statistically significant differences among groups after adjusting for baseline values.

Likewise, there were no statistically significant differences among groups in the change in the proportion of fat to lean mass. There were no statistically significant differences among groups at baseline or study completion for respiratory quotient, substrate oxidation rates, REE or REE adjusted for fat-free mass. Baseline habitual and prescribed As displayed in Figure 2 , there were no significant changes over time in the average amount grams of total food consumed daily.

However, when preloads were combined with caloric restriction, average dietary energy density decreased by After adjustment for baseline values, the differences among groups in dietary energy density and total energy intakes were not statistically significant.

Likewise, there were no significant differences among groups at baseline or over the course of the study for total fluid intakes or macronutrient intakes as percentages of energy. Total dietary fiber intake was significantly increased in the GF group by 3. The mean changes in total and LDL cholesterol did not differ significantly from baseline. In contrast, within-group triglyceride levels decreased significantly, but these changes did not differ by group when adjusted for baseline values. There was a mean increase in HDL-C from baseline by 6.

There were no significant changes from baseline detected in blood pressure, fasting glucose, insulin and HOMA scores, perhaps a reflection of baseline and study completion values that were within normal ranges. This study is one of few randomized trials comparing the effects of consuming low energy dense preloads as part of a dietary weight loss intervention in free-living obese adults. Thus, any differential responses to the preload strategy would result from the higher fiber content of GF or higher bioflavonoid content of GFJ.

Interestingly, reduced energy intakes were not associated with higher VAS ratings of hunger, indicating that subjects remained satiated [ 35 ]. If the amount grams of food consumed is a determinant of hunger [ 36 ], the lack of perceived hunger may be explained by the consistent amount of food consumed throughout the study.

It is intriguing that subjects not only adjusted the total amount of their food intakes to incorporate the amount of the preloads, but also compensated for the energy content of the preloads by decreasing energy intakes from meals and snacks to achieve an overall reduction in total energy intakes.

The reduction in dietary energy density and energy intakes achieved represents an 8. This finding is consistent with other community-based interventions in which consumption of a low energy dense diet has led to substantial reductions in energy intakes and body weight [ 37 — 40 ].

Counseling for Physical Activity in Overweight and Obese Patients

A healthy lifestyle includes good nutrition and adequate physical activity. If your body weight has not changed for several months, the calories you consume from food and the calories you burn from physical activity are balanced. If you need to gain or lose weight, consider changing your dietary pattern and physical activity level to achieve your goal. Counting calories all the time is not necessary, but in the beginning, it may help to determine how many calories are in the foods and drinks you consume regularly. See MyPlate Plan external icon to determine how many calories a day you need to maintain your current weight based on your age, sex, height, weight, and physical activity level.

How to lose weight is one of the most pressing health questions for many people. People gain weight by consuming more energy than they burn, so consuming fewer calories , or energy, can help. However, other factors play a role, such as genetic factors, metabolism, hormones, the type of food you eat, your body type, and lifestyle. This article will look at the reasons to lose weight, the most effective methods and medical interventions. Health experts around the world now see obesity as an an epidemic. Some are evidence-based, safe and effective, but others are not.

Consume more than the body burns, weight goes up. Less, weight goes down. But what about the type of calories: Does it matter whether they come from specific nutrients-fat, protein, or carbohydrate? Specific foods-whole grains or potato chips? And what about when or where people consume their calories: Does eating breakfast make it easier to control weight? Does eating at fast-food restaurants make it harder?

How can I lose weight?

If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Low levels may contribute to an increased risk for insulin resistance and diabetes. Obesity is associated with leptin resistance. Forgot Password?

When it comes to losing weight, the details don't matter much. It's the principles that count. Every legitimate nutrition expert, whether a popular diet guru or a representative of the medical nutrition establishment, agrees that there are some fundamental principles of healthy weight loss that apply to everyone. And nobody achieves permanent weight loss and optimal health without obeying these principles, consciously or unconsciously.

Metrics details. Reducing dietary energy density has proven to be an effective strategy to reduce energy intakes and promote weight control. This effect appears most robust when a low energy dense preload is consumed before meals. Yet, much discussion continues regarding the optimal form of a preload. The purpose of the present study was to compare effects of a solid grapefruit , liquid grapefruit juice and water preload consumed prior to breakfast, lunch and dinner in the context of caloric restriction.

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