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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Mythbusters: The Truth About Eggs

Wouldn’t it be fun to do the TV show Mythbusters but focused on Nutrition??

A recent “Eat this Not That” posting from Men’s Health looked at the Egg/Cholesterol myth. Kudos to them for busting the myth (you cannot eat eggs because of the cholesterol). As we say “An Egg a Day is OK!!” There are a multitude of studies showing this same message, but unfortunately consumers and even health professionals are still hesitant to eat eggs. So here’s to hoping these mythbusting messages continue to spread!

Here is an example of a study showing this message:

A study published in Medical Science Monitor including 9,500 people demonstrates that eating one or two eggs a day does not increase the risk of heart disease or stroke among healthy adults. The study notes that eating eggs may actually be associated with a decrease in blood pressure. Qureshi A, et al. “Regular egg consumption does not increase the risk of stroke or cardiovascular diseases. Medical Science Monitor. 2007; 13(1):CR1-8.”

Another parallel message to think about is the additional benefits an egg can offer. In the article they also mention weight management. Satiety/weight management is an area that is being actively researched. Other benefits from the varying 13 essential vitamins and minerals include muscle strength, healthy pregnancy, brain function and more.

Check out the information on “An Egg A Day” to share with patients and fellow health professionals. Also, we will be launching a new cholesterol specific section on our website in the future, so check back.

A new look at middle aged weight gain

Books about middle age weight gain or abdominal fat accumulation, as it’s known in professional circles, are flying off the shelves as a record number of the US population enters their golden years. This generation, brought up on the fat phobic diet that made fat intake of any kind an inexcusable excess, is now seeing the result of this mistaken dietary guidance. By avoiding the demonized macronutrient (fat) in an effort to avoid heart disease in later life, today’s baby boomers may have set themselves up for sarcopenia or age related muscle loss and the dangerous abdominal fat accumulation, a contributor to heart disease. How is this possible? The answer lies in the unintended consequence of reducing protein intake while avoiding fat.

During the years 1970-2000, Americans were advised to lower their fat intake which resulted in reducing intake of foods high in protein like beef, pork, eggs, milk and butter. The assumption had been and still remains, that Americans consume a surplus of protein and protein recommendation need only keep Americans from negative protein balance. Optimal protein intake for supporting health was not a goal. However, recent research is beginning to accumulate which indicates a role of protein, in particular the level of specific branch chain amino acids (BCAA) in proteins, that is associated with a lower prevalence of obesity and overweight in middle age adults.

A recent study published in Journal Nutrition1, looked at the association between BCAA intake and the risk of overweight/obesity status in a cohort of 4429 Asian and Western adults. The study was a part of a larger International Study of Macro-/Micronutrients and Blood Pressure Study (INTERMAP) which did not include any intervention in the methodology other than recording dietary recall and 24 hr. urinary measurement. Results confirm the hypothesis that across an international population, dietary intake of branch chain amino acid intake was inversely associated with prevalence of overweight status amongst healthy middle age adults and with the prevalence of obesity in Western adults. These results confirm earlier animal studies that have found higher leucine intake (BCAA) associated with lower body weight and fat mass gain.

1 Qin, LQ et al. J. Nutr. 141:249-254, 2011

Source: U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 24. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl

The Global Obesity Pandemic: Shaped by Global Drivers and Local Environments

Below are highlights from the article.  We as health professionals already know many of these. I think the approach of looking at obesity in the large picture rather than pieces is long overdue. There have been many “smaller scale strategies” and some of those have been successful in targeted areas.  I think the approach of looking at obesity in the large picture rather than pieces is long overdue.  What does this really mean though?

We’ve all seen the numbers and generally are aware of the history of obesity.  Obesity began in most high income countries in the 1970-80’s, but now most middle and low income countries also have obesity.  Three years ago, in 2008, it was estimated that 1.46 million adults globally were overweight and 502 million were obese.  Children were estimated at 170 million as overweight or obese.  Other trends within obesity are prevalent as well, but these numbers tell the story.

A Hoad, Somerford and Katzenellenbogen article (Aust NZ J Public Health) drives home that obesity has overtaken tobacco as the largest preventable cause of disease burden in some regions.

What are some key indicators in this report?

  • Economic Effects
    • Sufficient wealth-this has been an enabler for obesity.  This however, is not always indicative as shown in the Pacific Island nations and others.
    • Some countries are faced with a substantial burden of undernutrition also has an emerging burden of overnurition and related diseases to both forms of malnutrition.
    • Obesity is the result of people responding to the obesogenic environment and the obesogenic environments arise because governments and business are responding the economic and politic environments.
    • Drivers of the obesity epidemic
      • Several studies have shown that technological changes have created cheaper and more available food calories and have driven forces towards overconsumption.
      • The “built environment” Changes in our overall habits- less physical activity (driving instead of walking) as well as increased of the food supply starting in the 70’s.  Interestingly enough if everyone was following the fruit and vegetable recommendations of the dietary guidelines, there would not be enough fruits and vegetables for everyone.  What does this say about the oversupply of food? 
      • Cultural preferences such as (body size) can have a significant effect in different regions. 
      • Marketing-On the marketing question-Is the market failing children”?  You decide
      • Genetics- an article by Bray GA states genetics loads the guns but the environment pulls the trigger.
      • Approaches and implications to address obesity
        • The figure below shows a framework to categorize determinants and solutions of obesity.
        • Sustainability and affordability remain to challenges for programs.
        • The major strategies available to directly affect behaviors aim to increase motivation to make healthy choices and include social marketing health education and promotion programs.
        • Realistically policy interventions can be directed at the environment (rather than the individual).
        • The article suggests the solution to obesity should be developed on a global level.


Stay tuned for reviews of the next articles in the series.

Increased Dietary Protein & Breakfast Consumption-Effects on Appetite, Satiety, and Reward-driven Eating Behavior

Hi Readers –  I’m honored to let you know that Dr. Heather Leidy is blogging today regarding research .

– Mitch

Two key forces exist which act against our desire to be healthy and manage body weight.  First, we have internal ‘physiological’ signals which respond to energy restriction, dieting, and weight loss and lead to increased hunger and reductions in fullness (satiety).   Many individuals respond to these signals and eat in excess, leading to the prevention of sustained weight loss and/or obesity.  We are also constantly bombarded by the modern food environment containing food-centered advertisements and easy access to highly palatable, energy dense, sugar-laden snacks.  This type of environment shifts our eating away from physiological need towards reward-driven over-eating.

To add to the problem, many Americans follow unhealthy dietary practices further intensifying these behaviors.  One in particular is the now-common habit of skipping breakfast which is strongly associated with over-eating/snacking (especially in the evening), weight gain, and obesity.  Fortunately, there are several dietary strategies that have been implemented to target and prevent both types of eating behavior.  These include increased dietary protein and breakfast consumption.

We’ve published several articles focusing on the beneficial effects of a modest increase in protein intake (1-4).   Through these studies, we found that an increase in protein consumption from 15% of daily intake to 25-30% of intake leads to improvements in appetite control and satiety(1-4).  In fact, a higher protein diet, containing lean meat and eggs, leads to increased fullness throughout the day and reduced desire to eat and preoccupation with thoughts of food throughout the evening hours compared to a normal protein diet—even during weight loss(1,3).   It is quite clear that a diet containing an increase in dietary protein, still well-within the dietary guidelines, is beneficial for appetite control.

Based on this data as well as the negative outcomes associated with breakfast skipping, we are now focusing on the daily addition of a protein-rich breakfast in those who skip the morning meal.  We recently report that  skipping breakfast leads to greater hunger and reduced satiety (i.e., fullness) throughout the morning hours, leading to a greater amount of food consumed at lunch time compared to a normal protein breakfast5.  We also found that eating a higher protein breakfast (38% of the meal as high quality dairy and egg protein, 49 g) leads to even greater benefits by further reducing appetite and subsequent food intake.

In our most recent study6, we focused on whether breakfast would actually alter food-related brain activation known to stimulate reward-driven eating behavior.  In this study, ‘breakfast skippers’ consumed meals containing either normal quantities of protein or higher protein (i.e., 40% of the meal as dairy and egg protein).  Compared to breakfast skipping, the consumption of both types of breakfast meals led to reductions in brain activation patterns in regions controlling appetite, motivation to eat, and food reward.  The higher protein breakfast led to even greater reductions in these activations compared to the normal protein breakfast.  These data suggest that incorporating a healthy breakfast containing protein-rich foods may be a simple dietary strategy to improve appetite control and prevent over-eating.


1Leidy HJ, et al.  2007  Higher protein intake preserves lean mass & satiety with weight loss in pre-obese & obese women.  Obesity 15:421-429.

2Leidy HJ, et al.   2007 Effects of acute & chronic protein intake on metabolism, appetite & ghrelin during weight loss. Obesity.  15:1215-25.

3Leidy HJ, et al.  2011 The effects of consuming frequent, higher protein meals on appetite and satiety during weight loss in overweight/obese men.  Obesity; 19 (4):  818-824.

4Leidy HJ, et al.  2010 The influence of higher protein intake and greater eating frequency on appetite control in overweight and obese men.  Obesity;  18(9):  1725-1732.

5Leidy HJ & Racki EM.  2010  The addition of a protein-rich breakfast and its effects on acute appetite control and food intake in `breakfast-skipping’ adolescents.  International Journal of Obesity.  34(7):  1125-1133.

6Leidy HJ, et al. 2011 Neural responses to visual food stimuli after normal vs. higher protein breakfast in breakfast-skipping teens-a pilot fMRI study.  Obesity; EPUB ahead of Print.  doi:10.1038/oby.2011.108

Childhood Nutrition Myths and Facts

Hi Readers –  As you may have noticed, we have changed our blog name to Nutrition Unscrambled. Enjoy!

I was recently made aware of a blog called Raise Healthy Eaters. The site looks very good, and it offers a number of excellent tips on healthy eating for kids. A recent post discussed various nutritional myths, many of which were aimed at the micronutrient needs of children.

If you’re interested in learning more about healthy eating for children, this blog is worth checking out. And while we’re on the topic of healthy eating for children, a couple of recent studies you should be aware of are:

Krebs NF, Gao D, Gralla J, et al. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. J Pediatr 2010.

The study demonstrated that severely obese adolescents who followed a high-protein, low-carbohydrate diet had significantly lower body mass index (BMI) after 13 weeks and were also able to maintain weight loss after six months versus those who followed a low-fat diet. The obese adolescents who followed the high-protein, low-carbohydrate diet also experienced greater fat mass loss and reductions in triglyceride levels.

 Leidy HJ, Racki EM. The addition of a protein-rich breakfast and its effect on acute appetite control and food intake in ‘breakfast skipping’ adolescents. Int J Obs 2010.

These researchers examined the impact of a protein-rich breakfast on adolescents who traditionally skipped breakfast. When the study participants ate a protein-rich breakfast the researchers observed that the teens were less hungry and ate approximately 130 fewer calories at lunch.

It continues to amaze me that nearly one in three American children are overweight or obese,  which increases their risk for developing chronic diseases such as diabetes, high blood pressure, heart disease and cancer. More and more research is suggesting that the high carbohydrate eating practices that have been so prevalent in the U.S. for many years may be exacerbating the problem. Newer studies suggesting the benefits of higher protein/lower carb diets, such as those cited above are provocative, and worth considering.