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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Protein Continues To Be a Priority at the Food & Nutrition Conference & Expo

The Academy of Nutrition and Dietetics’ Food & Nutrition Conference & Expo (FNCE) is the world’s largest gathering of credentialed nutrition professionals, Registered Dietitian Nutritionists (RDNs), and is also known to draw nutrition science researchers, policy makers, health-care providers and industry leaders for a four day conference addressing the latest food and nutrition information, research and trends. This year ENC traveled to Houston, TX to share the latest on egg nutrition research at the educational exhibit hall and Weight Management Dietetic Practice Group educational breakfast session.

Tia Rains, PhD, Senior Director of Nutrition Research & Communications at ENC and Heather Leidy, PhD, Assistant Professor in the Department of Nutrition & Exercise Physiology at the University of Missouri presented, Changing Paradigms on Weight Management and Macronutrient Intake . Visit ENC.org to download the full presentation, including practical meal plans to put the research into practice. Insights of the presentation included:

  • “Fat Phobia” may have contributed to the doubling of obesity rates since the 1970s as intake of grains, fruit juices, sodas and snacks increased while consumption of red meat, dairy and eggs decreased.1
  • Many people think adults eat more protein than they need. However, recommendations for protein are based on the structural and functional properties of amino acids, determined by nitrogen balance studies. This means that the requirement is based on preventing loss of lean body mass in healthy individuals.  No other functional measures of protein status have been considered in establishing the RDA and no health benefits of protein have been considered either.2
  • Emerging benefits of increased dietary protein include: Improved lipid profile, blood glucose modulation, improved retention of muscle (elderly), increased satiety, improved body composition and weight management.3-9
  • A diet rich in protein is a viable strategy to prevent and/or treat obesity based on studies showing increased appetite control and satiety reduced reward-driven eating behavior .3-9
    • 25-30% of daily energy intake (24-30 grams per eating occasion) is optimal to elicit the above responses.

The Egg Nutrition Center educational exhibit also drew crowds as we shared the latest researcheducational materials and ENC offerings for health professionals such as, continuing education credits through webinars and materials.

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How do you build your breakfasts to include 25-30 grams of protein?

If you would like more breakfast examples, join Egg Nutrition Center and Produce for Better Health Foundation for a webinar Building a Better Breakfast with High-Quality Protein and Produce presented by Neva Cochran on Wednesday, November 20th 2 pm ET. Register here.

References:

1Flegal, K M, et al.  Prevalence of obesity and trends in the distribution of body mass index among U.S. adults, 1999-2010. Journal of the American Medical Association. 2012; 307(5), 491-497

2Layman, D. Dietary guidelines should reflect new understanding about adult protein needs. Nutrition & Metabolism 2009; 6(12), www.nutritionandmetabolism.com/content/6/1/12

3Leidy, HJ.  Beneficial effects of a higher-protein breakfast on the appetitive, hormonal and neural signals controlling energy intake regulation in overweight/obese “breakfast skipping” late-adolescent girls. Am J Clin Nutr . 2007; 97(4): 677-688

4Leidy, HJ, et al. Effects of acute and chronic protein intake on metabolism, appetite, and ghrelin during weight loss. Obesity. 2007; 15(5): 1215-25

5Leidy, HJ, et al.  The influence of higher protein intake and greater eating frequency on appetite  control in overweight and obese men. Obesity. 2010; 18(9): 1725-32

6Modified from: Fulgoni VL. Current protein intake in America: Analysis of the National Health and Nutrition Examination Survey 2003-2004 AJCN; 2008; 87(supp):1554S-78

7Wycherley TP, et al. Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials. AJCN. 2012; 96(6): 1281-98

8Skov et al. Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obesity. 1999; 23(5): 528-536

9Symons et al.  Aging does not impair the anabolic response to a protein-rich meal.  AJCN. 2007; 86(2): 451-456.

Setting Standards for the Science of Satiety

It’s well known that around the world, obesity rates are higher than they were in previous decades. 

The pharmaceutical, fitness, food, and supplement industries have responded, commercializing a number of products and services to support weight loss efforts.  Satiety, in particular, has been a target across all of these industries.  Hunger and preoccupations with food are often cited as barriers to maintaining a weight loss diet.  Given the potential for satiety to favorably affect obesity, several regulatory agencies and scientific organizations have established guidelines and position statements to standardize the study and communication of satiety enhancement.

One of the first groups to proactively address satiety was the International Life Sciences Institute (ILSI) Europe.  In 2008, they formed the Eating Behaviour and Energy Balance Task Force, a group of scientific experts charged with generating “a wider understanding of satiety benefits and claims and the appropriate methods for their substantiation”.  The efforts of the Task Force have resulted in five publications, including recommendations on standardized satiety methodology, consumer interpretation of satiety benefits, and biomarkers of appetite regulation.1-5

Most recently, the Task Force published proceedings of a one-day workshop held November 27, 2012 in Brussels, Belgium.5  One of the key outputs from the meeting was the recognition that there is a need for more longer-term studies on the efficacy of satiety enhancement for weight loss.  To date, the over-whelming majority of satiety studies have been in an acute setting, usually only over a few hours.  It is not known whether all satiety-enhancing foods/beverages will sustain their benefit over longer periods of time.

Another key output was agreement among the experts that the benefits of satiety extend beyond just weight loss.  For example, cognitive performance has been shown to be tightly associated with feelings of hunger and satiety in both children and adults.  Similar findings have been reported for mood.

Clearly, this is an area that continues to evolve and has the potential to benefit many.  The Egg Nutrition Center has invested in this area for several years given the satiating properties of eggs.6-8  The majority of the research suggests that higher protein meals tend to be more satiating than high carbohydrate meals, particularly when the protein is consumed at the breakfast meal.  These data corroborate findings of other studies, which have been conducted over the course of a day, a few days and, in some cases, for several weeks.

1Bilman EM, Kleef Ev, Mela DJ, et al. Consumer understanding, interpretation and perceived levels of personal responsibility in relation to satiety-related claims. Appetite. 2012;59:912-20.
2Blundell J, de Graaf C, Hulshof T, et al. Appetite control: methodological aspects of the evaluation of foods. Obes Rev. 2010;11:251-70.
3Delzenne N, Blundell J, Brouns F, et al. Gastrointestinal targets of appetite regulation in humans.Obes Rev. 2010;11:234-50.
4Hetherington MM, Cunningham K, Dye L, et al. Potential benefits of satiety to the consumer: scientific considerations. Nutr Res Rev. 2013;26:22-38.
5Griffioen-Roose S, Wanders A, Banati D. Satiety and appetite control claims: Getting it right for consumers. Nutr Bull. 2013;38:373-77.
6Vander Wal JS, Marth JM, Khosla P, et al. Short-term effect of eggs on satiety in overweight and obese subjects. J Am Coll Nutr. 2005;24:510-5.
7Leidy HJ, Ortinau LC, Douglas SM, Hoertel HA. Beneficial effects of a higher-protein breakfast on the appetitive, hormonal, and neural signals controlling energy intake regulation in overweight/obese, “breakfast-skipping,” late-adolescent girls. Am J Clin Nutr. 2013;97:677-88.
8Ratliff J, Leite JO, de Ogburn R, et al. Consuming eggs for breakfast influences plasma glucose and ghrelin, while reducing energy intake during the next 24 hours in adult men. Nutr Res. 2010;30:96-103.

What Should We Eat & When We Should Eat It

What should we eat and when we should eat it?

These are questions on the minds of almost every health-conscious and weight-conscious consumer. Recent research seems to be providing some answers, or at least providing us with some interesting food-for-thought. A just-completed study done in Israel, for example, indicates that eating the largest meal of the day at breakfast not only helps obese subjects maintain lower blood glucose, insulin, and triglyceride levels than their counterparts who eat their largest meal at the dinner hour, it also helps with weight loss. In this study the group that ate the larger breakfast lost an impressive 17 pounds after 12 weeks on a 1400 kcal/d diet, versus a 7 pound weight loss for the large dinner group.

Other recent studies indicate that subjects who eat higher protein breakfasts tend to be more satisfied and eat fewer calories over the course of the day. Taken together these studies have led many researchers and nutritionists to re-consider the long held belief that carbohydrates should be the main staple of our diets, at all meals. More and more studies suggest that carbs, while indispensable for athletes or active people who burn what they consume, should be ramped down in the average American diet. And substituting protein for the carbs we remove from the diet may aid the cause, by promoting satiety and the constant desire to eat more throughout the day.

Market research data suggests that consumers are getting the message. A recent article in Business Week indicates that breakfast cereal sales for most of the large manufactures are in decline. Analysts point to changing consumer behaviors, including a growing reluctance to eat simple carbs, and a rising concern about a gluten allergy. And though diet fads of this nature often come and go, the growing body of literature pointing to the importance of breakfast in general, and high protein breakfasts in particular, may mean this is a trend that’s here to stay.

Skipping Breakfast: Is When You Eat as Important as What You Eat?

There has been quite a bit of buzz recently over a study out of Harvard1 looking at the relationships between eating patterns and coronary heart disease (CHD) risk.  Researchers analyzed data from the Health Professionals Follow-up Study, one of the largest prospective cohort studies (51,529 male health professionals) initiated back in 1986 when these men were between 40 and 75 years of age.  Participants have been evaluated at regular intervals since then, resulting in a plethora of data on disease incidence, dietary habits, and mortality. From these data, researchers analyzed associations between eating habits, specifically if and when meals were consumed, and development of CHD.

There were several interesting findings from this analysis. For example, men who ate late at night had a 55% higher risk of CHD than men who did not eat late at night. Further, there was no difference in CHD risk in men who ate 1 to 2 times a day versus men who ate ≥6 times a day. But the media focused on only one finding, that skipping breakfast was associated with a 27% greater risk of CHD. And the resultant headlines used more riveting language such as, “skipping breakfast causes heart attacks”.

But a closer look at the data suggests that it may not be a very simple relationship. In fact, it’s never quite so simple when it comes to these prospective cohort studies.  For example, men who did not report eating breakfast were more likely to exhibit unfavorable diet and lifestyle habits, such as smoking, being less physically active, and drinking more alcohol. Although these factors were included and adjusted for in the statistical models, there may be other potentially important lifestyle factors which were not assessed or assessed inadequately that may influence the relationship between breakfast eating and CHD risk.

Men who did not report eating breakfast were also more likely, albeit slightly, to have high cholesterol, high blood pressure, and a higher body mass index.  Once these conditions were accounted for in the statistical models, there was no longer an association between skipping breakfast and incident CHD.  How strong is the relationship between breakfast eating and risk of heart disease when you can completely attenuate the effect by adjusting for known mediators of CHD?

That’s not to say that this isn’t an important piece of the puzzle for understanding the impact of eating behaviors on disease risk.  In fact, this new observational evidence dovetails nicely with findings from randomized, controlled trials showing favorable effects of breakfast eating on CHD risk factors2,3. Plus, eating breakfast, particularly one rich in nutrient-dense food choices, has been shown to impart other benefits, as reviewed in this recent blog. However like all observational evidence, results are merely associations and should be interpreted in this context before jumping to conclusions about breakfast skipping causing heart attacks.

1. Cahill LE, Chiuve SE, Mekary RA, Jensen MK, Flint AJ, Hu FB, Rimm EB. Prospective Study of Breakfast Eating and Incident Coronary Heart Disease in a Cohort of Male US Health Professionals. Circulation. 2013;128:337-43.

2. Farshchi HR, Taylor MA, Macdonald IA. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. Am J Clin Nutr. 2005;81:388-96.

3. Astbury NM, Taylor MA, Macdonald IA. Breakfast consumption affects appetite, energy intake, and the metabolic and endocrine responses to foods consumed later in the day in male habitual breakfast eaters. J Nutr. 2011;141:1381-9.

More Data in Support of a Higher Protein Diet

In recent years, more and more research has demonstrated the benefits of higher protein diets. The growing body of literature is driving many to rethink  the conventional nutrition dogma that has been  prevalent for the past fifty years or so–a  high carbohydrate, low fat, moderate protein diet is the best way to ward off disease and to promote good health.

A study recently published in the Journal of Nutrition adds to the protein story1. The study, a part of the larger DiOGenes project designed to investigate the potential of dietary protein to prevent weight gain in European subjects, looked at the impact of higher protein diets in children (ages 5-18) of overweight and obese parents2. It has been shown that children of obese parents are more than twice as likely as children of normal-weight parents to become obese, and to develop the co-morbidities associated with obesity.

In this study, families were randomized to 1 of 5 diets consisting of a combination of higher and lower protein foods, and higher and lower glycemic index foods. Diet, body composition, blood pressure, and various serum cardiovascular markers were measured in 253 children at baseline, and at one and six months following diet intervention. Among other things, children in the higher protein group demonstrated a smaller waist circumference and lower serum LDL cholesterol levels compared to the lower protein group at 6 months. In a separate analysis, high protein subjects had reduced waist circumference, and lower blood pressure and serum insulin than did subjects in the lower protein group.  Taken together, these results suggest that increased protein intake may improve markers associated with body composition and cardiovascular disease risk in high-risk children.

This study was unique in that it is one of the first randomized control trials to demonstrate the benefits of higher protein diets in children of overweight/obese parents. Most prior studies of this nature have relied on epidemiological data. Research on the health impact of macronutrients undoubtedly will continue, but more and more it appears that there may be an alternate dietary approach to the high carbohydrate, low fat and protein paradigm.

1. Damsgaard CT, Papadaki A, Jensen SM, Ritz C, Dalskov SM, Hlavaty P, Saris WH, Martinez JA, Handjieva-Darlenska T, Andersen MR, Stender S, Larsen TM, Astrup A, Mølgaard C, Michaelsen KF; Diogenes. Higher protein diets consumed ad libitum improve cardiovascular risk markers in children of overweight parents from eight European countries. J Nurt 2013;143(6):810-7.

2. Gögebakan O, Kohl A, Osterhoff MA, van Baak MA, Jebb SA, Papadaki A, Martinez JA, Handjieva-Darlenska T, Hlavaty P, Weickert MO, Holst C, Saris WH, Astrup A,Pfeiffer AF; DiOGenes. Effects of weight loss and long-term weight maintenance with diets varying in protein and glycemic index on cardiovascular risk factors:the diet, obesity, and genes (DiOGenes) study: a randomized, controlled trial. Circulation 2011;124(25):2829-38.