Popular Weight Loss Diet Fads and Obesity
Guidelines: Is there an Ideal Diet for Weight
Reduction?
Geeta Sikand, MA, RDN,FAND,CDE,CLS,FNLA
Associate Clinical Professor: Cardiology
Director of Nutrition
UC Irvine Preventive Cardiology Program
University of California, Irvine
Disclosure of Affiliations and
Significant Relationships
 None
University of California Irvine
Comprehensive Lifestyle Management
Program: Bimonthly visits
Cardiologist
Registered
Dietitian
Nutritionist
(RDN)
32 Weeks UC Irvine
Preventive Cardiology
Lifestyle-Intervention
Program
Exercise
Physiologist
Dieting on the Rise
 The dieting industry is a $61 billion dollar industry
Money Spent on the Diet Industry (Billions)
$70.0
$60.0
$50.0
$40.0
$30.0
$20.0
$10.0
$0.0
Marketdata Enterprises, Inc., 2011
Money Spent on the Diet Industry
(Billions)
Objectives
 Enumerate top 10 fad diets and the current
ACC/AHA/TOS guidelines for weight reduction &
weight maintenance.
 Identify three components of a comprehensive
lifestyle management program for weight
reduction.
 List three nutrition resources for weight
management
And what does fad dieting mean?
New Oxford’s American Dictionary
 Dieting “restrict oneself to small
amounts or special kinds of food in
order to lose weight”
 Fad“an intense and widely shared
enthusiasm for something, especially one
that is short-lived; a craze.
http://www.oxforddictionaries.com/definition/english/fad
Top 10 Fad Diets
10. Cut out wheat to slim down.
9. Get thin and healthy by controlling your body’s pH balance.
8. Probiotics diet
7. Raw foods will cleanse you.
6. Sugar Consumption is a Drug Habit you have to kick.
5. Superfoods will save you from everything.
4. Juices will cleanse you and shrink your waistline like magic.
3. Paleo diets make us healthy as cave people.
2. Go vegan and go ultra low fat.
1. Grains are killing your brain.
http://io9.com/10-types-of-diet-books-that-prove-you-cant-eat-anything1654378939
Meta-Analysis
Weight Loss Programs
 Search of 6 electronic databases
 Looked at wt loss at 6 and 12 months
 Largest wt loss assoc with
 Low-carb diet: 8.73 kg @ 6 mo; 7.25 kg @ 1 yr
 Low-fat diet: 7.99 kg @ 6 mo; 7.27 kg @ 1 yr
 Between 6-12 months, behavior support and
exercise were positively assoc with wt loss
Johnston et al. Comparison of Weight Loss Among Named Diet Programs
in Overweight and Obese Adults A Meta-analysis. JAMA 2014
Two year follow up of patients treated with a
very-low calorie diet (VLCD) and exercise
30 obese women on a VLCD 600-800 kcal/day for
4 months: exercise versus non-exercise groups.
Average weight loss = 40 lbs
At 2 years follow up:
Exercise group: re-gained 50%
Non-exercise group: re-gained 100 %
Conclusion: Weight maintenance is the “Achilles
heel” of VLCD diets.
G Sikand, J P Foreyt, A Kondo, P Jones, A Gotto
J Am Diet Assoc April 1988
What we know
 Rapid wt loss is due to loss of water, glycogen
and lean tissue. Ketosis produces metabolic
dehydration.
% fat loss
Balanced, low-cal diet
60%
Low carb, high protein
35%
% water loss
40%
65%
 Carb and protein is stored with water (each gram
glycogen is stored with 4 grams water)
 When these stores are used, we lose water

Composition of Weight Loss During Short-Term Weight Reduction. Journal of Clinical
Investigation. Vol. 55. Sept 1976. Pgs 722-730.
Fad Diets May Contribute to…
- Weight cycling
Kruger et al, 2004;
Strohacker &
McFarlin, 2010
- Increased risk for osteoporosis
Bacon et al, 2004;
Van Loan & Keim,
2000
- Increased chronic psychological stress & cortisol production
- Increased anxiety about weight
Tomiyama et al,
2010
- Eating disorder behaviors
Daníelsdóttir et al,
2007
- Weight gain
Neumark-Sztainer et
al, 2006
- Stigmatization and discrimination against fat individuals
Davison et al, 2003;
Holms, 2007
Puhl, 2008
Best Diets (US News 2014)
 Rated by panel of health experts
 Top-rated:
 easy to follow
 nutritious
 safe
 effective for weight loss (short and long term)
 effective against diabetes and heart disease
 http://health.usnews.com/best-diet/
Top 12 Diets (US News 2014)
Weight Loss
Diabetes
Weight Watchers
DASH
Biggest Loser
Jenny Craig
Raw Food Diet
Volumetrics
Biggest Loser
Engine 2
Flexitarian
Mayo Clinic
Ornish
Vegan
POUNDS LOST Study tested 4 diets
811 obese adults for 6 months
1. Low-fat, average protein, high carb: 20 % fat, 15 %
protein, 65 % carb
2. Low-fat, high protein, moderate carb: 20 % fat, 25 %
protein, 55 % carb
3. High-fat, average protein, low carb: 40 % fat, 15 %
protein, 45 % carb
4. High-fat, high-protein, very low carb: 40 % fat, 25 %
protein, 35 % carb
Sacks et al 2009
POUNDS LOST Study
Sacks et al 2009
 Average weight loss: 13 lbs (6 mo) in all 4 diet groups
with variability (20 lbs to weight gain).
 Maintained 9 lbs at 2 yrs, reduced waist by 1 to 3”
 Craving, fullness, hunger, diet satisfaction: similar all four
diets.
 Predictors of success in all study groups: Attendance at
their RD visits and group sessions, keeping a food diary
Maintenance of Weight Loss
Key Concerns
NIH Report Jan 2015 Obesity
 “Weight regain after weight loss: significant problem in
obesity treatment – both body and mind conspire against
individual efforts to maintain weight loss.”
 “Genetic and behavioral differences in individuals. We
need to individualize interventions or target specific
populations with evidence-based strategies.”
“Innovative Research to Improve Maintenance of Weight Loss”
MacLean, co-chair NIH working group
Daily Weighing Improves Weight Loss and
Adoption of Weight Control Behaviors
 47 adults: Daily weighers lost significantly more
weight (mean difference=–6.1 kg; 95% CI –10.2
to –2.1; P=0.004).
 Total number of weight control behaviors
adopted greater in daily weighers (17.6±7.6 vs
11.2±6.4; P=0.004), produced greater weight
loss versus weighing most days.
Steinberg DM et al ANDJRNL.org Feb 12 2015
Self-Determination Theory (SDT) Meta analysis:
184 Studies
Conclusion

Most important factor that emerged
“Patients’ perception of effectiveness in their
own ability to change their undesirable health
behaviors is critical to their ability to actually
make that change.”
Ng et al Perspectives on Psychological Science July 2012
Empower with Motivational Interviewing
 Overweight and obese people come to us with
so much emotional damage and baggage.
 Motivational Interviewing: tool that empowers
them and nurtures their often-fragile self esteem
helping them make wise food and activity
choices.
Motivational Interviewing in Health Care: Helping Patients Change
Behavior by Rollnick et al 2008 The Guilford Press
……
2013 AHA/ACC/TOS Guidelines Focus
5 Critical Questions (CQ)
 CQ 1. Is weight loss good for your patient?
 CQ 2. How do you identify who is at risk sufficiently to
mandate weight loss efforts?
 CQ 3. What is the efficacy of the different dietary
intervention strategies to promote weight loss?
 CQ 4. What is the efficacy of a comprehensive approach
(diet, physical activity and behavior therapy) to achieving
and maintaining weight loss?
 CQ 5. What are the benefits and risks of bariatric
surgery?
Grade
A
B
Strength of Recommendation
Strong recommendation: There is high certainty based on
evidence that the net benefit is substantial.
Moderate recommendation: There is moderate to high certainty based
on evidence that the net benefit is moderate to substantial
C
Weak recommendation: There is at least moderate certainty based on
D
Recommendation against: There is at least moderate certainty based
evidence that there is a small net benefit.
on evidence that it has no net benefit or that risks/harms outweigh benefits.
Expert opinion (“There is insufficient evidence or evidence is unclear or
conflicting, but this is what the Panel recommends.”)
E
Net benefit is unclear. Balance of benefits and harms cannot be determined because of no evidence,
insufficient evidence, unclear evidence, or conflicting evidence, but the Panel thought it was
important to provide clinical guidance and make a recommendation. Further research is
recommended in this area.
No recommendation for or against (“There is insufficient evidence
or evidence is unclear or conflicting.”) Net benefit is unclear. Balance of benefits and harms
N
cannot be determined because of no evidence, insufficient evidence, unclear evidence, or conflicting
evidence, and the Panel thought no recommendation should be made. Further research is
recommended in this area.
Executive Summary Highlights
Identifying who is at risk?
 Use BMI as a screening method, not a diagnostic tool.
 BMI classifications of >25 kg/m2 = ‘overweight.'
 But not all people with excess weight per BMI need to
lose weight.
 Achieving ideal BMI is not necessary and may not be
possible for some people. Even 5% of weight loss could
be beneficial.
2013 AHA/ACC/TOS Obesity Guidelines
http://onlinelibrary.wiley.com/enhanced/doi/10.1002/oby.20821/
Table 11. Definition of Overweight and Obesity
ACC/AHA/TOS BMI cut points
Classification of Overweight & Obesity
Classification
BMI, kg/m2
Classification
BMI (kg/m2)
Underweight
Less than 18.5
Normal
Overweight
Obesity
Class I
Class II
Class III (extreme obesity)
18.5–24.9
25.0–29.9
30.0–34.9
35.0–39.9
40 or greater
Executive Summary
Evidence statements graded “high”
 The greater the individual’s BMI, the greater the risk of
CVD and T2DM. Even modest weight loss (3-5% of
body weight) can result in clinically meaningful benefits
for TG, HbA1c and development of T2DM.
 Six months or more of lifestyle counseling with a
nutritional professional e.g. RDN produces the most
successful outcomes.
 Advise overweight & obese patients who have lost
weight to participate in a long term (>1 year)
comprehensive weight maintenance program.

2013 AHA/ACC/TOS Obesity Guidelines
Executive Summary
Which diet is most effective for weight loss?
•
Research shows: no one diet is superior for
weight loss.
•
A negative energy balance must be present to
produce weight loss.
•
15 dietary regimens were equally effective in
inducing weight loss as long as they were
calorie-restricted.
2013 AHA/ACC/TOS Obesity Guidelines
Executive Summary
Weight Reduction: Best Meal Plan?

“A variety of dietary approaches can produce weight loss
in overweight and obese adults…if reduction in dietary
energy intake is achieved.”
 Low fat
 Higher protein
 Low carbohydrate (30 g to 130 g)
 Adopting new dietary patterns such as DASH, Mediterranean or
Vegetarian
 At least 14 visits over 6 months with a Registered Dietitian
Nutritionist (RDN) for behavior modification and
personalized meal planning.
2013 AHA/ACC/TOS Obesity Guidelines
Executive Summary
Most effective approach to lose weight?
A comprehensive lifestyle management program:
 A reduced calorie diet.
 Increased physical activity
 Behavior changes that make it easier to eat
fewer calories and become more active.
 At least 14 visits over 6 months with a trained
interventionist e.g. RD
2013 AHA/ACC/TOS Obesity Guidelines
Executive Summary
How can weight loss be maintained?
 Following weight loss, patients should continue
regular contact (at least once a month) with a
trained interventionist e.g. RD for monitoring.
 High physical activity (200 to 300 minutes per
week),
 Consume a reduced calorie diet
 Monitor their body weight regularly.
 Continued participation in the same behaviors
that produced weight loss will prevent regain.
2013 AHA/ACC/TOS Obesity Guidelines
Summary
2013 ACC/AHA/TOS Obesity Guidelines
 A comprehensive lifestyle management program
is the gold standard.
 Underscored “one size fits all” diet approach be
avoided to achieve long term success.
 Refer to a registered dietitian nutritionist (RDN)
to tailor weight loss program to patients’
individual preference and needs.
 Achieving ideal BMI is not necessary and may
not be possible for some people. Even 5% of
weight loss could be beneficial.
Nutrition Resources
 USDA: menu plans
http://www.cnpp.usda.gov/usdafoodplanscostoff
ood.htm
 To find a RD (RDN) in your area:
www.eatright.org
 Virtual Nutritionist: Personalize your experience
by creating your profile, and get a meal plan
tailored for you.
https://www.supertracker.usda.gov/default
Thank you