OBESITY AND HEALTH
Updated: Feb 10
We're back!
And boy do we have some things in store for you!
Those whom know me will know by now that I am passionate about Health & Fitness. As someone whom has formerly battled against being overweight I am also just as personally driven & focused on getting clients sustainable results!
In my latest article I take a closer look at our nation's growing epidemic & a glimpse of some of the current research we have on the subject of Obesity.
Did you know according to the latest Report of the Chief Health Officer for Queensland:
"QUEENSLAND’S obesity crisis shows no signs of waning as new data reveals that close to 70 per cent of the population in some regional areas are either obese or overweight..."
"Two in three adults are now obese as well as one in three kids..."
In order to understand our growing problem, we must further explore and distinguish what Obesity is.
So without further ado, let's dive right in!
ON OBESITY.
Obesity simply put is a multi-factorial condition where body fat and gross weight has accumulated to the extent of impacting overall health.
It involves certain environmental and behavioral conditions to be perfectly met to produce an over-production of gross weight.
Gross Weight is the accumulation of weight mass you carry and can consist of:
⚠️ Muscle
⚠️ Fat
⚠️ Tissue
⚠️ Water
⚠️ Hair
⚠️ Skin
⚠️ Nails
⚠️ Food
⚠️ Hydration
⚠️ Clothing
Basically, anything that is within you, made of by you, consumed or added on can be defined as gross weight mass. The removal of any of the above mentioned weight variables will result in Weight loss.
Obesity is often attributed as a disorder of energy balance management. It most commonly arises from consuming an exponential amount of calories in excess over a prolonged period of time.
Part of the exponential energy balance is required to maintain life, organ functionality and perform physical work.
While the Thermodynamic 'Calorie Balance' model of energy balance is a useful framework for investigating obesity, it does not provide a causal explanation for why some people are predisposed to obesity or what to do about it.
To put things practically, changing one's body composition can be as simple as understanding the concept of Energy In = Energy Out. However managing obesity can be complex as it's largely dependent on one's individual situation.
Over time individuals will almost always encounter both psychological and physiological adaptations to weight loss resistance.
Given the current epidemic however, it has also become overwhelmingly difficult to ignore the long term success rate from dieting for most individuals.
WHAT IS THE LONG TERM SUCCESS RATE?
Individuals whom undergo weight loss are generally successful in the first instance. On average losing around 5-6kg per dieting attempt[76]. However on the context of long term dieting the statistics are quite poor.
To be frank, it is shockingly very low. So low in fact that only 5% of individuals whom diet are successful long term[34].
To put it simply:
6 out of 7 individuals will lose a significant amount of weight in their lifetime...
However, almost 80% of the same individuals will relapse to their beginning weight[29].
In 2 years this goes up to 85%[34].
In 3 years up to 95%[35].
Finally if that's not enough, almost 75% of the same individuals will gain MORE weight on top of their starting weight[36,77].
Obese individuals are generally a lot better off before dieting as research shows it is almost impossible to keep it off for good!
This leads us to the most obvious question: How do we get it off for good?
OBESITY AND BODY IMAGE.
Your body image is how you think and feel about your body. It involves your own perception, imagination and emotions. It doesn't necessarily always reflect what you see in the mirror but can also be influenced by what others see or what you think others see.
As a species we are generally a lot more motivated to do something about our weight on the context of sex appeal. A majority of weight management success stories centralize around individuals trying to look 'pleasing to the eye' more-so than complying with instructions of an allied health practitioner or physician.
Leading many individuals to start out and try many different diets that simply do not work for the long term.[18]
Coupled with the health risks when obesity becomes extreme i.e. visceral body fat overly-distributed in large areas, most individuals generally care more about their appearance than the health risks.
In turn, this can further result in an individual's weight range aka 'setpoint' fluctuating excessively for prolonged periods after constant dieting.[19]
Generally speaking most Diets are started due to poor body image, rather than an individual wanting to be within a healthy weight range. According to Dieting statistics Australia:
"Over 2.3 million Australians (13%) aged 15 years and over reported that they were on a diet to lose weight or for some other health reason. This included 15% of females and 11% of males."[23]
Poor body image and dieting can also be linked to eating disorders i.e. anorexia, nervosa, bulimia, binging and other mental health issues such as depression or anxiety. Constant dieting can also greatly enhance and further lead to physical illness and depression[20].
^one of the many reasons why it’s important to always maintain healthy eating behaviors where possible.
ON STRESS.
It is believed that much of the weight accumulation associated with obesity is environmental. Furthermore the behavioral response from environmental conditions is also an association and overall determinant.
If there is one thing we as a society experience too much of in this day and age, it is stress. Whether it's working a 9-5 job, going to school, raising a family or external relationships.
We will all deal with some form of stress on a daily basis.
Part of our natural biological stress response is the internal onset release of Cortisol and Epinephrine. To put it simply, these stress hormones help us become more resistant to stress in the short term.
Whilst encountering stress is a healthy component of becoming more resilient, there must always be a recovery period to become stronger.
Without a recovery period from chronic stress, we become susceptible of entering a state of constant exhaustion aka metabolic fatigue.
As the years roll by stress accumulates to the point of us numbing it's effects in our lives.
Here's the problem,
The psychological component of 'weight stigma' becomes a lot more complex to manage once an individual becomes significantly overweight and/or obese.[21]
In other words you are at a mental disadvantage before you even start managing your weight.
Chronically elevated cortisol (stress) levels is known to hinder our metabolic efficiency. In short, if we're grossly overweight and in a constant state of 'stress', you are more than likely already in metabolic fatigue.
In extreme circumstances, stress can contribute heavily to metabolic syndrome on a otherwise already healthy sedentary individual[70].
One's overall ability to lose body fat when dieting is greatly reduced with increased propensity to over consume high calorie foods[71].
Individuals whom spend a prolonged period of time in any one location are more likely to graze and/or snack more often.[27]
This may be of great concern for many stay-at-home/part-time working mums as according to research, kids with Healthy and Active Moms are up to 75% less likely to become Obese.[28]
OBESITY AND NUTRITION.
There are many popular diets that are advertised in today’s media that claim to be quick fixes for excess weight loss. Coupled with the never-ending emergence of FAD Diets, Weight Loss programs, supplements, ethics all adding to the mass confusion.
Most individuals are on the constant search for a ‘quick fix’ to manage their weight accumulation. This almost always stems from a lack of education and/or perceived lack lack of time to maintain a healthy lifestyle and diet.
The truth of the matter is that scientifically, nutrition's energy balance has not changed much at all.
According to the Government endorsed National Dietary guidelines by the National Health and Medical Research council (NHMRC), Australians should eat and enjoy a wide variety of Nutritious foods from the 5 groups per day every day including:
‐ 5 servings of Fruit & Vegetables
‐ Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties i.e. bread, cereals, rice,pasta, noodles, polenta, couscous, oats, quinoa and barley
‐ Lean meats and poultry i.e. Fish, Eggs, Tofu, nuts, seeds, legumes, beans
‐ Dairy i.e. Milk, Yoghurt, Cheese and/or their alternatives, mostly reduced fat
‐ Drink plenty of water
- Limit intake of processed food, soft drink and alcohol
The guidelines also recommend Australians keep physically active. Currently only 29% of the general population engage in weekly exercise activity to maintain muscle strength and stay within a healthy weight range.
Obesity is largely blamed on the combination of larger meal sizes, fast food consumption, sugar and a sedentary lifestyle of inactivity [10]. Whilst Nutritional Quality is important to improving one's Health, eating 'healthy' does not always equate to weight loss or successful weight management.
Why?
What the current evidence shows, when you look more closely at it, is that the different kinds of macronutrient proportions does not seem to confer to any long term advantage in weight control to individuals whom adhere strictly to them.
It is believed some of the prevalence to obesity lie's within one's macronutrient distribution. If we consider the thermic effect of nutrients where energy output is 2-3% for Lipids/Fats, 6-8% for Carbohydrates and 20-30% for Proteins[39]. The overall efficiency of nutrient utilization and distribution is more often than not mis-calculated or unaccounted for in most obese individuals.
In this case most obese individuals continue to maintain their weight within a narrow range aka 'set point' alongside their ^current macronutrient distribution. According to research a higher prevalence for overweight & obese individuals is to under report their overall energy (calorie) consumption and eating habits[82].
Further to the argument, a large body of studies have been put forward to further suggest that the problem isn't necessarily the food quality or macro distribution, rather the overall food quantity.
In accordance to the Department of Health and Human Services and the Calorie Thermodynamic model:
“...Does it matter what types of foods the calories come from? When it comes to calories and managing your weight, the answer is no. A calorie is a calorie."[11]
This is evident whether one follows low fat, low carb, carnivore, vegan, raw, keto etc.
But what about High/Low Carb Vs High/Low Fat?
Individuals whom consume a diet rich or low in either dietary fats or carbohydrates does NOT seem to impact or favor weight loss/health markers provided Protein, Calories and Fibre are accounted for! [2-9,38-68,72]
^The rise in evidence supporting an energy balanced model may be an ideal starting point for most individuals whom are looking to implement weight management and improve overall Health.
OBESITY AND HOLIDAYS.
Going by current research, individuals whom successfully lost weight from dieting are prone to significantly greater hunger levels than individuals whom don't lose weight[78,79].
It's believed the increase in hunger is at least 3 times higher alongside the corresponding weight loss acting as a strong determinant and predictor for weight regain[80].
The process of Losing Weight for an upcoming holiday followed by post festive weight gain has become part of the everyday Australian cycle.
However on the context on the rise of Obesity this is another further cause of a significantly larger problem as we are slowly putting on weight every holiday season[73,74].
WHY? To put things simply, holidays and festive seasons are times where we consume more than we are normally accustomed to: More festive foods = more Calories. Less activity = Less Energy Expenditure. More Calorie intake + Less Activity = Weight storage.
It's also uncommon for festivities to stretch out over multiple feeding days! For the everyday hard working Australian looking forward to some quality time off this is a perfectly natural part of one's cycle. On the context of Obesity however, gaining bodyfat every holiday season may not be for everyone. More-so for individuals whom attempt multiple yearly bouts of weight loss only to successfully increase their net weight by 0.5kg on average.
We know Obesity (Weight gain) is multi-factorial and stems from Psychological, Tradition, Culture, Physiological & Environmental factors.
The key in prevented weight gain over any holiday or Festive period stems from the behavioral word: prevention.
This includes everything from regular weighing, self-monitoring, food weighing to Weight management discussion alongside physical activity greatly assists expending excess calories from festive foods and drinks[75].
Behavioral interventions are great practical tools according to research and an important factor in successful weight management.
AFFECTS OF WEIGHT LOSS AND HEALTH?
In QLD currently about one-third of adults and two-thirds of children are still in the non-obese healthy weight range.
Leaving the remaining two in three adults and one in three children now susceptible to:
🚫 adverse health risk
🚫 reduced life expectancy
🚫 increased risk of chronic illness and disease.
For most relatively underweight individuals, the amount of body fat correlated with longevity increases with age. In short, our health benefits from higher body fat levels as we age...up to a point!
The good news for the non-obese individual with moderately managed amounts of body fat tend to outlive either extremely lean or extremely obese personas.[16] Higher levels of body fat also seems to correlate with higher rates of survival and longevity from serious injury or illness[17].
However:
“To the best of our knowledge, no randomized controlled trials, research and case studies have been conducted or presented to assess and support the health benefits associated from Obesity."
"This is an area that deserves attention for the general QLD population to be informed of the many potential obesity related health risks AND the many health benefits associated from Weight Loss alone."
There just isn't simply any data in favour of supporting obesity.
According to the overwhelming research, we can now deduce the various Weight loss benefits for individuals whom are either in the overweight or obese category including:
✅ Increased Life Longevity [15]
✅ Decreased risk of Cardiovascular Disease [12]
✅ Decreased risk of some cancers [14]
✅ Decreased risk of Type 2 Diabetes [13]
✅ Improved Quality of Life [15]
✅ Decreased inflammation[81]
✅ Looking and Feeling Great! [15]
Furthermore, if one can sustain the degree of overall weight lost:
Most of the health benefits can be obtained from Weight loss alone[37,63].
Unfortunately, the health risks alone still does not eliminate the likelihood of the problem increasing nor the ongoing impact on the public health system.
WHAT DOES THE RESEARCH SAY?
⚠️ Within 1 year of Weight lost, 80% of individuals relapse to their pre-diet weight. At 2 years it's 85%, at 3-4 years 95%[29]. We can summarize that rapid weight loss does NOT equate to long term success.🏃
⚠️ Losing weight slows down your metabolism and impacts how much fat you burn. Cutting out whole food groups, nutrients and calories increases the likelihood of binging.[30]
⚠️ Your chances of putting the weight back on plus more dramatically increase^ if 'how you lose the weight' is not done correctly.[19,33]
⚠️ Extreme bouts of constant dieting show an association with long term persistence of hormonal disruption, in-balance and regulation in Females.[31] impaired testosterone production, elevated cortisol levels and HPA axis dysfunction [32] to name a few...
^due to the aforementioned rise in evidence, it is always best to not store the excess in the first place as research shows once we've gained the weight over time, it is almost impossible to get rid of for good![22]
LOOKING AHEAD?
We all know of loved ones whom struggle daily from the multi-factorial conditions of being overweight or obese...
We also know only a select few of individuals are able to completely turn it around and make the lifestyle change successfully...
If you like the majority of the general population are constantly trying to Lose the weight:
Stop!🚫
If how you set about achieving weight management becomes more punishment than nourishment, you likely wont succeed!
If you are relying on willpower alone without any diet strategy or food re-education, you probably also wont succeed!
Successful Weight management needs to be part and parcel in order to successfully lead a healthy and active lifestyle.
The key to weight management also includes good 'housekeeping' strategy, habits and positive internal and external relations!
1. The first step in solving any problem is recognizing there is one.🤔
- we didn't get here overnight.
- nor will we get rid of it in a day.
- keep in mind the way in which you diet matters.
2. Learn the relationship of what a Habit and choice really are:💁
'a habit is something you do that you don't know you're doing'.
'a choice is something that you have control over'.
Not knowing a habit is a choice takes away the power to change, nothing changes.
Knowing a habit is a choice gives you the power to change and re-wire old habits into new ones.
3. Pick a dietary lifestyle that is sustainable long term.👍
In truth whilst most diets have the premise of getting you results, a successful diet is one you can stick to long term.
Make the right choice for YOU!
WHAT'S NEXT? 👇
If you're looking to become more effective at Weight Management & make better educated choices:
Grab your copy of my '5 Steps for Success' ebook and start setting yourself up for success today!
References:
1. The Health of Queenslanders 2018 - Full Report of the Chief Health Officer Queensland - Queensland Health:https://www.health.qld.gov.au/__data/assets/pdf_file/0032/732794/cho-report-2018-full.pdf
2. Gardner CD, et al. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial . JAMA. (2018)
https://www.ncbi.nlm.nih.gov/pubmed/29466592
3. Weststrate, JA et al 1990, Alcohol and its acute effects on resting metabolic rate and diet-induced thermogenesis. Br J Nutr. Sep;64(2):413-25. https://www.ncbi.nlm.nih.gov/pubmed/2121268
4. Layman DK, Evans E, Baum JI, Seyler J, Erickson DJ, Boileau RA. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. J Nutr. 2005 Aug;135(8):1903-10.
https://www.ncbi.nlm.nih.gov/pubmed/16046715
5. Feinman RD, Fine EJ. Thermodynamics and metabolic advantage of weight loss diets. Metab Syn Relat Dis. 2003. 1:209-219.
https://www.ncbi.nlm.nih.gov/pubmed/18370664
6. Brehm BJ, Seeley RJ, Daniels SR, D'Alessio DA. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. 2003 Apr;88(4):1617-23. https://www.ncbi.nlm.nih.gov/pubmed/12679447
7. Layman DK, Evans E, Baum JI, Seyler J, Erickson DJ, Boileau RA. Dietary protein and exercise have additive effects on body composition during weight loss in adult women. J Nutr. 2005 Aug;135(8):1903-10.
https://www.ncbi.nlm.nih.gov/pubmed/16046715
8. Feinman RD, Fine EJ. Thermodynamics and metabolic advantage of weight loss diets. Metab Syn Relat Dis. 2003. 1:209-219.
https://www.ncbi.nlm.nih.gov/pubmed/18370664
9. The American Journal of Clinical Nutrition, Volume 83, Issue 5, 1 May 2006, Pages 1055–1061, https://doi.org/10.1093/ajcn/83.5.1055
10. "Gene-Diet Interaction and Precision Nutrition in Obesity.", Int J Mol Sci. 2017 Apr 7;18(4). pii: E787. doi: 10.3390/ijms18040787.
https://www.ncbi.nlm.nih.gov/pubmed/28387720
11. U.S. Department of Health and Human Services. (2005). Chapter 5. A Calorie Is a Calorie, or Is It? Retrieved July 9, 2012, from U.S. Department of Health and Human Services:
http://www.health.gov/dietaryguidelines/dga2005/healthieryou/html/chapter5.html
12. 1 (2015, November 4). Effects on cardiovascular risk factors of weight losses ... - NCBI - NIH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987606/
13. 2 (2014, February 18). The importance of weight management in type 2 diabetes ... - NCBI - NIH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238418/
14. 3 (2017, September 6). Intentional weight loss and cancer risk - NCBI - NIH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669836/
15. 4 (2017, November 15). Effects of weight loss interventions for adults who are ... - NCBI - NIH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5682593/
16. Childers, D. K., & Allison, D. B. (2010, August). The ‘obesity paradox’: a parsimonious explanation for relations among obesity,mortality rate and aging? International Journal of Obesity, 34, 1231-1238.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3186057/
17. Bessesen, D. H. (2008, June). Update on Obesity. J Clin Endocrinol Metab, 93(6), 2027–2034. https://www.ncbi.nlm.nih.gov/pubmed/18539769
18. Keys, A., Brozek, J., Henschel, A. Et. al. (1950). The Biology of Human Starvation. University of Minnesota Press,Minneapolis.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1526048/
19. Sims, E.A.H., and Horton, E.S. : Endocrine and Metabolic adaptation to obesity and starvation. Amer. J. Clin. Nutr.,21:1455-1470, 1968.
https://www.ncbi.nlm.nih.gov/pubmed/4881681
20. "The association between diet quality, dietary patterns and depression in adults: a systematic review", BMC Psychiatry. 2013 Jun 27;13:175. doi: 10.1186/1471-244X-13-175. https://www.ncbi.nlm.nih.gov/pubmed/23802679
21. "Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review", J Adv Nurs. 2018 May;74(5):1030-1042. doi: 10.1111/jan.13511. Epub 2017 Dec 8. https://www.ncbi.nlm.nih.gov/pubmed/29171076
22. Sims, E.A.H., and Horton, E.S. : Endocrine and Metabolic adaptation to obesity and starvation. Amer. J. Clin. Nutr.,21:1455-1470, 1968.
https://www.ncbi.nlm.nih.gov/pubmed/4881681
23. Australian Health Survey: Nutrition First Results - Food and Nutrients, 2011-12
24. Nutrient Reference Values for Australia and New Zealand - Dietary Guidelines for Australian Adults (2013) - National Health and Medical Research Council. Dietary Guidelines for Children and Adolescents in Australia (2013) - National Health and Medical Research Council
25. Australian Bureau of Statistics (ABS). (2014). Australian historical population statistics 2014. (Cat no. 3105.64.001). Canberra: ABS.
26. ABS. (2017). 2016 Census of population and housing: General community profile, Australia (Cat no. 2001.0). Canberra: ABS. www.censusdata.abs.gov.au/census_services/getproduct/census/2016/communityprofile/036?opendocument
27. "Environmental and lifestyle influences on obesity.", J La State Med Soc. 2005 Jan;157 Spec No 1:S19-27. https://www.ncbi.nlm.nih.gov/pubmed/15751906
28. Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health: "Growing Up Today Study (GUTS).": https://web.sph.harvard.edu/mch-data-connect/results/growing-up-today-study-guts/
29. "Biology's response to dieting: the impetus for weight regain. - NCBI - NIH." 15 Jun. 2011, https://www.ncbi.nlm.nih.gov/pubmed/21677272.
30. Haase AM, Prapavessis H, Owens RG. Perfectionism, social physique anxiety and disordered eating: A comparison of male and female elite athletes. Psychology of sport and Exercise. 2002 Jul 1;3(3):209-22.
31. Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. Long-term persistence of hormonal adaptations to weight loss. New England Journal of Medicine. 2011 Oct 27;365(17):1597-604.
https://www.ncbi.nlm.nih.gov/pubmed/22029981
32. Healy ML, Gibney J, Pentecost C, Wheeler MJ, Sonksen PH. Endocrine profiles in 693 elite athletes in the postcompetition setting. Clinical endocrinology. 2014 Aug 1;81(2):294-305. https://www.ncbi.nlm.nih.gov/pubmed/24593684
33. Obes Rev. 2015 Feb;16 Suppl 1:25-35. doi: 10.1111/obr.12253. "How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery..." https://www.ncbi.nlm.nih.gov/pubmed/25614201
34. "Long-term efficacy of dietary treatment of obesity: a systematic review ...." https://www.ncbi.nlm.nih.gov/pubmed/12119984
35. Obes Rev. 2000 Oct;1(2):113-9. "[The mediocre results of dieting]. - NCBI." https://www.ncbi.nlm.nih.gov/pubmed/23859104
36. Proc Nutr Soc. 2012 Aug;71(3):379-89. doi: 10.1017/S0029665112000225. Epub 2012 Apr 5. "How dieting makes some fatter: from a perspective of human ... - NCBI.", https://www.ncbi.nlm.nih.gov/pubmed/22475574
37. Annu Rev Nutr. 2015;35:475-516. doi: 10.1146/annurev-nutr-071714-034434. Epub 2015 May 13. "Health Benefits of Long-Term Weight-Loss Maintenance." https://www.ncbi.nlm.nih.gov/pubmed/25974699
38. Hu, T.; Mills, K.T.; Yao, L.; Demanelis, K.; Eloustaz, M.; Yancy, W.S., Jr.; Kelly, T.N.; He, J.; Bazzano, L.A. Effectsof low-carbohydrate diets versus low-fat diets on metabolic risk factors: A meta-analysis of randomizedcontrolled clinical trials. Am. J. Epidemiol. 2012, 176 (Suppl. 7), S44–S54.
https://www.ncbi.nlm.nih.gov/pubmed/23035144
39. Jequier, E. Pathways to obesity. Int. J. Obes. Relat. Metab. Disord. 2002, 26 (Suppl. 2), S12–S17. https://www.nature.com/articles/0802123
40. Layman DK, Boileau RA, Erickson DJ, et al. .A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. J Nutr 2003;133:411–7.
https://www.ncbi.nlm.nih.gov/pubmed/12566476
41. Halton TL, Hu FB. The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review. J Am Coll Nutr 2004;23:373–85. https://www.ncbi.nlm.nih.gov/pubmed/15466943
42. Layman DK, Baum JI. Dietary protein impact on glycemic control during weight loss. J Nutr 2004;134:968S–73S. https://www.ncbi.nlm.nih.gov/pubmed/15051856
43. Skov AR, Toubro S, Ronn B, Holm L, Astrup A. Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes Relat Metab Disord 1999;23:528–36.
https://www.ncbi.nlm.nih.gov/pubmed/10375057
44. Due A, Toubro S, Skov AR, Astrup A. Effect of normal-fat diets, either medium or high in protein, on body weight in overweight subjects: a randomised 1-year trial. Int J Obes Relat Metab Disord 2004;28:1283–90.
https://www.ncbi.nlm.nih.gov/pubmed/15303109
45. Astrup A. The satiating power of protein—a key to obesity prevention? Am J Clin Nutr 2005;82:1–2. https://www.ncbi.nlm.nih.gov/pubmed/16002791
46. Raben A, Agerholm-Larsen L, Flint A, Holst JJ, Astrup A. Meals with similar energy densities but rich in protein, fat, carbohydrate, or alcohol have different effects on energy expenditure and substrate metabolism but not on appetite and energy intake. Am J Clin Nutr 2003;77:91–100.
https://www.ncbi.nlm.nih.gov/pubmed/12499328
47. Parker B, Noakes M, Luscombe N, Clifton P. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care 2002;25:425–30.
https://www.ncbi.nlm.nih.gov/pubmed/11874925
48. Clifton P. The science behind weight loss diets—a brief review. Aust Fam Physician 2006;35:580–2. https://www.ncbi.nlm.nih.gov/pubmed/16894429
49. Boaz, M.; Raz, O. Low Fat vs. Low Carbohydrate Diet Strategies for Weight Reduction: A Meta-Analysis.J. Obes. Weight Loss Ther. 2015, 5. https://www.ncbi.nlm.nih.gov/pubmed/16476868
50. Hall, K.D. A review of the carbohydrate-insulin model of obesity. Eur. J. Clin. Nutr. 2017, 71, 323–326. https://www.ncbi.nlm.nih.gov/pubmed/28074888
51. Sievenpiper JL1, de Souza RJ, Mirrahimi A, Yu ME, Carleton AJ, Beyene J, Chiavaroli L, Di Buono M, Jenkins AL, Leiter LA, Wolever TM, Kendall CW, Jenkins DJ. Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis. Ann Intern Med. 2012 Feb 21;156(4):291-304.
https://www.ncbi.nlm.nih.gov/pubmed/22351714
52. Korsmo-Haugen H-K, Brurberg KG,Mann J, Aas A-M. Carbohydrate quantity in the dietary man-agement of type 2 diabetes: A systematic review and meta-analysis.Diabetes Obes Metab. 2019;21:15–27. https://doi.org/10.1111/dom.13499
53. The American Journal of Clinical Nutrition, Volume 95, Issue 3, 1 March 2012, Pages 614–625, Effects of 4 weight-loss diets differing in fat, protein, and carbohydrate on fat mass, lean mass, visceral adipose tissue, and hepatic fat: results from the POUNDS LOST trial, https://doi.org/10.3945/ajcn.111.026328
54. The American Journal of Clinical Nutrition, Effect on body composition and other parameters in obese young men of carbohydrate level of reduction diet. Volume 24, Issue 3, 1 March 1971, Pages 290–296, https://doi.org/10.1093/ajcn/24.3.290
55. Obesity Energetics: Body Weight Regulation and the Effects of Diet CompositionKevin D. Hall and Juen Guo,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568065/pdf/nihms851543.pdf
56. Energy expenditure and body composition changes after an isocaloricketogenic diet in overweight and obese men1,2 National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD;4Pennington Biomedical Research Center, Baton Rouge, LA;5ColumbiaUniversity, New York, NY; and6The Translational Research Institute for Metabolism and Diabetes, Orlando, FL,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962163/pdf/ajcn133561.pdf
57. Cell Metab. 2015 September 1; 22(3): 427–436. doi:10.1016/j.cmet.2015.07.021, Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603544/pdf/nihms716061.pdf
58. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. Kimber L. Stanhope, ... , Lars Berglund, Peter J. HavelJ Clin Invest. 2009;119(5):1322-1334. https://doi.org/10.1172/JCI37385
59. J Nutr. 2004 Jan;134(1):135-42.Some dietary fibers increase elimination of orally administered polychlorinated biphenyls but not that of retinol in mice. https://www.ncbi.nlm.nih.gov/pubmed/14704306
60. J Nutr. 1999 Apr;129(4):896-902. Increased fecal bile acid excretion and changes in the circulating bile acid pool are involved in the hypocholesterolemic and gallstone-preventive actions of psyllium in hamsters.
https://www.ncbi.nlm.nih.gov/pubmed/10203567
61. Lancet. 2019 Feb 2;393(10170):434-445. doi: 10.1016/S0140-6736(18)31809-9. Epub 2019 Jan 10. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. https://www.ncbi.nlm.nih.gov/pubmed/30638909
62. Crit Rev Clin Lab Sci. 2016;53(1):52-67. doi: 10.3109/10408363.2015.1084990. Epub 2015 Sep 17.Sugar consumption, metabolic disease and obesity: The state of the controversy. https://www.ncbi.nlm.nih.gov/pubmed/26376619
63. Asian Pac J Cancer Prev. 2014;15(14):5959-64.Dietary carbohydrate, fiber and sugar and risk of breast cancer according to menopausal status in Malaysia. https://www.ncbi.nlm.nih.gov/pubmed/25081729
64. Int J Obes Relat Metab Disord. 2000 Oct;24(10):1310-8.Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. The Carbohydrate Ratio Management in European National diets. https://www.ncbi.nlm.nih.gov/pubmed/11093293
65. J Nutr. 2005 Oct;135(10):2387-91.Reduced glycemic index and glycemic load diets do not increase the effects of energy restriction on weight loss and insulin sensitivity in obese men and women. https://www.ncbi.nlm.nih.gov/pubmed/16177201
66. Am J Clin Nutr. 1997 Apr;65(4):908-15.Metabolic and behavioral effects of a high-sucrose diet during weight loss. https://www.ncbi.nlm.nih.gov/pubmed/9094871
67. Int J Obes (Lond). 2014 Dec;38(12):1511-7. doi: 10.1038/ijo.2014.52. Epub 2014 Mar 28.Weight loss maintenance in overweight subjects on ad libitum diets with high or low protein content and glycemic index: the DIOGENES trial 12-month results. https://www.ncbi.nlm.nih.gov/pubmed/24675714
68. The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on weight loss and related parametersJoshua Lowndes, Diana Kawiecki, Sabrina Pardo, Von Nguyen, Kathleen J Melanson, Zhiping Yu and James M RippeEmail authorNutrition Journal201211:5
https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-11-55
69. Yancy, W. S., Olsen, M. K., Guyton, J. R., Bakst, R. P., & Westman, E. C. (2004). A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Annals of internal medicine, 140(10), 769-777.
https://www.ncbi.nlm.nih.gov/pubmed/15148063
70. Front Neuroendocrinol. 2018 Jan;48:50-57. doi: 10.1016/j.yfrne.2017.10.005. Epub 2017 Oct 16. Fat-brain connections: Adipocyte glucocorticoid control of stress and metabolism. https://www.ncbi.nlm.nih.gov/pubmed/29042142 71. PLoS One. 2019 Jan 25;14(1):e0210726. doi: 10.1371/journal.pone.0210726. eCollection 2019. Lifestyle factors and visceral adipose tissue: Results from the PREDIMED-PLUS study. https://www.ncbi.nlm.nih.gov/pubmed/30682078
72. Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force C.F. Kirkpatrick et. Al (2019) DOI: https://doi.org/10.1016/j.jacl.2019.08.003
73. J Obes. 2017;2017:2085136. doi: 10.1155/2017/2085136. Epub 2017 Jul 4.Effect of the Holiday Season on Weight Gain: A Narrative Review. https://www.ncbi.nlm.nih.gov/pubmed/28744374 74. Physiol Behav. 2014 Jul;134:66-9. doi: 10.1016/j.physbeh.2014.03.018. Epub 2014 Mar 21.The effect of holiday weight gain on body weight. https://www.ncbi.nlm.nih.gov/pubmed/24662697 75. BMJ. 2018 Dec 10;363:k4867. doi: 10.1136/bmj.k4867. Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period: randomised controlled trial. https://www.ncbi.nlm.nih.gov/pubmed/30530821
76. (n.d.). Weight loss attempts in adults: goals, duration, and rate of ... - NCBI - NIH. RetrievedJuly 10, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694328/
77. 6. (n.d.). Weight regain in U.S. adults who experienced substantial ... - NCBI. Retrieved July 10,2019, from https://www.ncbi.nlm.nih.gov/pubmed/17572309
78. (n.d.). How strongly does appetite counter weight loss ... - NCBI - NIH. Retrieved July 17, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5108589/ 79. (n.d.). Successful and unsuccessful weight-loss maintainers ... - NCBI. Retrieved July 17, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033771/ 80. (n.d.). How Strongly Does Appetite Counter Weight Loss ... - NCBI - NIH. Retrieved July 17, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/27804272
81. Responses of inflammatory markers to a low-fat, high-carbohydrate diet: effects of energy intake https://academic.oup.com/ajcn/article/83/4/774/4649123
82. Prevalence and Characteristics of Misreporting of Energy Intake in US Adults: NHANES 2003-2012. https://pubmed.ncbi.nlm.nih.gov/26299892/
