Weight Management & Satiety

Obesity is a multi-factorial and complex health issue. Current guidance for weight management encourages physical activity along with consuming an overall healthy eating pattern which includes whole grains, fruits, vegetables, lean proteins, low-fat and fat-free dairy products. A growing body of research suggests that dietary protein, specifically, can help promote satiety, facilitating weight loss when consumed as part of reduced energy diets.

Several clinical trials have specifically assessed the effects of high-quality protein from eggs on satiety and weight loss. For example:

  • In a study in overweight adults, calorie-restricted diets that included either eggs or a bagel for breakfast were compared; the people who consumed eggs for breakfast lowered their body mass index by 61%, lost 65% more weight, and reported feeling more energetic than those who ate a bagel for breakfast.
  • Men who consumed an egg breakfast versus a bagel breakfast showed that appetite hormones were suppressed following eggs at breakfast, as was energy intake over the course of the day.
  • A study of overweight premenopausal women that evaluated satiety responses to eating a turkey sausage and egg breakfast sandwich versus a low-protein pancake breakfast showed better appetite control and few calories consumed at lunch following the egg-based breakfast.
  • In a 3-month trial among subjects with type 2 diabetes, those who consumed 2 eggs per day for 6 days a week reported less hunger and greater satiety than those who consumed less than 2 eggs per week.

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Primary Prevention is a Critical Component in Preventing Pediatric Obesity

Female doctor examining child with stethoscope

Newly updated pediatric report includes specific food recommendations as part of obesity prevention.

In July 2015, the American Academy of Pediatrics published an update to their 2003 clinical report on prevention of pediatric obesity (Daniels, 2015). Obesity prevention is a public health priority because obesity is the most prevalent chronic health condition in pediatrics. Moreover, the report noted:

Although treatment of obesity in the pediatric age group, as well as secondary and tertiary prevention, will remain a key component of a comprehensive strategy to address this public health problem, the results of treatment remain modest, and primary prevention is recognized as a critical part of a sustainable solution

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Experts still searching for solutions to obesity crisis

Featured article in the Fall 2015 Issue of Nutrition Close-Up; written by David Madsen

Overweight and obesity (OW/OB) now present a major global health problem and challenge–a “pandemic.”1-4  The CDC estimates that 35% of adults in the U.S. are OW or OB,5 while 17% of children are affected.6 The global picture is similar: 37% for adults (mean, both genders); for children and 13% and 23% in developing and developed countries, respectively.2

The problem, of course, has multiple causes and multiple consequences, all of them negative. The health burdens are alarming: in 2010 OW/OB was estimated to have caused 3.4 million deaths globally, 3.9% years of life lost, and 3.8% of Disability-Adjusted-Life-Years (DALY – a measure of quality of life).2  The financial costs are staggering;  the estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars.5

The causes of OW/OB continue to be heatedly debated at all levels and in many ways. Some of the more prominent proposed and purported causes include: sugared foods and beverages, processed foods, sedentary lifestyles, altered intestinal flora, environmental toxins, genes, caloric imbalance, and declining rates of breastfeeding (“breastfeeding protects against obesity,” some say). The sum total of these may be referred to as our “obesogenic environment.”7

  • Those in the field have called for urgent action and leadership, expressing such notable concerns as: “There are no exemplary populations in which the obesity epidemic has been reversed by public health measures.”3
  • “Little progress has been made beyond acknowledging that there is a worldwide problem with far-reaching consequences for health and wellbeing.”8

This all sounds dire. What is being done in response, and to what extent?  International organizations have issued recommendations for policies to turn things around.

  • The World Health Organization has published a Global Action Plan.4
  • Lobstein et al.9 recommend policies to promote healthy growth and household nutrition security, more physical activity, consumption of nutrient-dense foods, and to restrict marketing to children.

 

 

  • Swinburn et al.10 proposed that an improved food environment requires strengthened “accountability systems.” The authors go on further to suggest, “several non-regulatory mechanisms (e.g., quasiregulatory, political, market-based, and public and private communications) are underutilized; these mechanisms will help strength the difficult step of holding private sector to account for performance.
  • Gortmaker et al.1 assess that “the empirical evidence base for effective interventions is limited but growing.” The authors call for involvement of all sectors: government, international organizations, private sector, and civil society. Their  proposed policies include improving the food environment and the built environment, securing more funds for prevention and monitoring, and embedding actions into both health and non-health sectors.

In order to implement policies, what specific programs should be implemented at the local and national levels?  Mayne et al.11 reviewed  more than 1,000 abstracts and 115 papers, arriving at 37 papers as part of their systematic review of studies of the impact of policy and built environment changes on obesity-related outcomes in what they termed “natural experiments.”  Measures included nutrition and diet (intake), physical activity, and effects on BMI or weight.

Results were instructive. For nutrition-related outcomes, improvements in the food environment were positive (bans/restrictions on certain foods; altering purchase/payment rules for food stamps). On the other hand, menu labeling with health information, or new supermarkets, were ineffective.  Regarding physical activity, positive impacts were seen with improvements in transportation infrastructure (promotion of cycling, walking). Only one of three studies that directly measured impact on BMI or weight produced a positive effect.

Mayne et al.11 devoted ample discussion to evaluate the quality of reviewed research and how it might be improved. The study designs varied greatly in strength and quality. One serious limitation of most of the studies is that they measured process outcomes, but did not assess ultimate effects on obesity or BMI.

The above deal with higher-level policies.  There are numerous proposals for preventing or treating OW/OB: -“wonder” products, elaborate diet plans, physical activity promotions, and environmental modifications among them. Some are undoubtedly ineffective, while others may be worthwhile, if we’re willing to make the effort.  Roberto et al.12 note that while personal responsibility is basic and critical in the current setting, it is difficult and wearying to fight an unhelpful (obesogenic) environment.

I am heartened by many examples of local and community efforts to address OW/OB. Of great interest is a recent report13 on an elementary school district in California that has shown a 5% decrease in overweight children since 2010. A collaboration of policy makers, parents and educators devised a comprehensive health and wellness program to increase physical activity (throughout the school day) and add more fruits and vegetables to lunch menus, leading to tangible results that went well beyond school hours.

A final thought is that in addition to assuming more personal responsibility for our health, and participating in well-coordinated community efforts such as they did in California, we should also become involved in broader policy efforts at the local, state and national levels by communicating and counseling elected policy makers.

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 David Madsen, PhD, has worked in the nutrition, food and pharmaceutical industries for more than three decades, and occasionally writes on topics of interest in those areas.

 

References

  1. Gortmaker SL, Swinburn BA, Levy D, Carter R, Mabry PL, Finegood DT, Huang T, Marsh T, Moodie ML.  Changing the future of obesity: science, policy, and action.  Lancet. 2011;378:838-47.
  1. Ng M, Fleming T, Robinson M et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766-81.
  2. Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011; 378: 804–14.
  3. WHO. Global Action Plan for the Prevention and Control of Noncommunicable diseases 2013–2020. Geneva: World Health Organization, 2013.
  4. CDCa. http://www.cdc.gov/obesity/data/adult.html
  5. CDCb. http://www.cdc.gov/obesity/data/childhood.html
  6. Lake A, Townshend T.  Obesogenic environments: exploring the built and food environments.  J R Soc Promot Health. 2006;126:262-7.
  7. Kleinert S, Horton R. Rethinking and reframing obesity. Lancet. 2015;385:2326-8.
  8. Lobstein T, Jackson-Leach R, Moodie ML, Hall KD, Gortmaker SL, Swinburn BA, James WP, Wang Y, McPherson K. Child and adolescent obesity: part of a bigger picture. Lancet. 2015;385:2510-20.
  9. Swinburn, B. Kraak V, Rutter H, et al.  Strengthening of accountability systems to create healthy food environments and reduce global obesity.  Lancet. 2015;385:2534-45.
  10. Mayne SL, Auchincloss AH, Michael YL. Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments. Obes Rev. 2015;16:362-75.
  11. Roberto CA, Swinburn B, Hawkes C et al. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking.  Lancet. 2015; 385:2400-9.
  12. http://www.utsandiego.com/news/2015/may/06/childhood-obesity-rates-down-in-chula-vista/

 

Key Messages

  • An estimated 35% of adults and 17% of children in the U.S. are overweight or obese, which accounted for obesity-related medical costs of approximately $147 billion in just one year.
  • A thorough review of recently enacted programs designed to reverse obesity trends showed that restricting or banning certain foods can be effective; while adding health information to menus, or opening a new supermarket in the community, proved ineffective.
  • Assuming personal responsibility for weight management is basic and critical, but difficult and challenging in America where high-calorie foods are widely available and heavily marketed.

When It Comes To Health, Diet Patterns Matter More Than How Many Eggs You Eat

citrus patterns

Associations between egg consumption and cardiovascular risk factors depends on the other foods and beverages consumed.

Researchers compared cardiovascular risk among adult egg eaters to those who did not report eating an egg or egg dish during their 24-hour food recall in the 2001-2008 U.S. National Health and Nutrition Examination Survey (NHANES) (Nicklas, 2014). Egg eaters were additionally sub-grouped based on overall diet patterns characterized using percent energy intake from food groups, resulting in a total of 8 diet patterns (i.e., no egg diet pattern and 7 diet patterns among egg eaters).

Continue reading “When It Comes To Health, Diet Patterns Matter More Than How Many Eggs You Eat”

Higher Protein Diets Associated with Cardiometabolic Advantages

Woman measuring her waist

Men and women with greater dietary protein intakes were more likely to have lower body mass index and waist circumference, and higher HDL-cholesterol.

A cross-sectional study of over 23,000 adults from the NHANES, 2001-2010, examined usual protein intakes [expressed as g/kg body weight (BW) per day], and trends for associations with cardiometabolic risk factors including blood pressure, glucose, insulin, cholesterol, and triglycerides stratified by weight status using cut-points of >18.5, >25 and >30 kg/m2 for normal weight, overweight, and obese, respectively [Pasaikos, 2015]. Subjects were separated into deciles of usual protein intake, which ranged from 0.69 g/kg BW in the lowest decile to 1.51 g/kg BW in the highest decile.

Analyses indicated that a higher protein intake (g/kg BW) was associated with a lower body mass index (BMI) and lower waist circumference in the total population, with a more pronounced effect in overweight and obese than in normal weight individuals. Further, there was a positive association between protein intake and HDL-cholesterol in all weight classifications, which persisted after adjustment for multiple variables including energy and macronutrient intake. There were no other associations identified between protein intake and other cardiometabolic risk factors.

The authors noted a “robust association between dietary protein and HDL cholesterol”. Results showed that

“HDL cholesterol concentrations for those who consumed ~1.5 g protein/kg BW were ~15% higher than those who consumed protein at or below the RDA, particularly in overweight individuals.”

In summary, the authors stated that this study

“demonstrates the health-related benefits associated with habitual consumption of dietary protein beyond the RDA. The levels of protein routinely consumed in deciles 6 through 10 (~1.0-1.5 g/kg BW), that were associated with lower waist circumference, BMI, and higher HDL cholesterol are consistent with nationally recognized recommendations (based on nitrogen and skeletal muscle retention) for physically active adults…military personnel…older adults…and individuals attempting weight loss…all of which are higher than the current RDA.”

 

Reference Citation

Pasiakos, SM, HR Lieberman, and VL Fulgoni. “Higher-protein diets are associated with higher HDL cholesterol and lower BMI and waist circumference in US Adults.” J Nutrition 2015; Mar;145(3):605-14.

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