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| Celebrities are given a great deal of viability when promoting diets, even if they have no idea what is going on. One of the more recent cases of this is seen within GOOP-- a company created by actress Gwyneth Paltrow that gives health and lifestyle advice to other individuals. | Celebrities are given a great deal of viability when promoting diets, even if they have no idea what is going on. One of the more recent cases of this is seen within GOOP-- a company created by actress Gwyneth Paltrow that gives health and lifestyle advice to other individuals. | ||
| - | Dr. Timothy Caulfield is a professor and public health at the University of Alberta. He is also the director of their Health Law Institute. Dr. Caulfield set out to examine the diets and their discrepancies set out by Paltrow in his book called “Is Gwyneth Paltrow wrong about everything?” The diet Paltrow promotes the most is called “The Clean Cleanse.” The program claims the human body accumulates toxins from the air around us and the food we eat over time, and therefore we need to rid our body of these toxins in some ways. Although quite the appealing idea, this concept of toxin build up in our bodies is not scientifically proven.<sup>[36]</sup> Our bodies are constantly detoxifying through sweating and urinating, and no diet can somehow change this process. Another avid point made by the cleanse team is that these toxins lead to “fatigue” of our adrenal gland, which lead to “sky high adrenals” which stress our bodies and cause us to put on weight. Once again, there is no scientific basis to this claim. Studies do show that eating healthier is associated with better affect and lower depression (ie. higher fruit and vegetable diets). There is no tie however to our adrenal glands being stressed and that causing us to gain weight. The program generally lasts 21 days, and from experience Dr. Caulfield has claimed he did in fact lose weight, but not from “detoxification” but more simply from a lack of calories being consumed over the period of time, not from a magical diet that cuts out wheat and sugars (as the Clean Cleanse does). | + | Dr. Timothy Caulfield is a professor and public health at the University of Alberta. He is also the director of their Health Law Institute. Dr. Caulfield set out to examine the diets and their discrepancies set out by Paltrow in his book called “Is Gwyneth Paltrow wrong about everything?” The diet Paltrow promotes the most is called “The Clean Cleanse.” The program claims the human body accumulates toxins from the air around us and the food we eat over time, and therefore we need to rid our body of these toxins in some ways. Although quite the appealing idea, this concept of toxin build up in our bodies is not scientifically proven.<sup>[36]</sup> Our bodies are constantly detoxifying through sweating and urinating, and no diet can somehow change this process. Another avid point made by the cleanse team is that these toxins lead to “fatigue” of our adrenal gland, which leads to “sky high adrenals” which stress our bodies and cause us to put on weight. Once again, there is no scientific basis to this claim. Studies do show that eating healthier is associated with better effect and lower depression (ie. higher fruit and vegetable diets). There is no tie however to our adrenal glands being stressed and that causing us to gain weight. The program generally lasts 21 days, and from experience Dr. Caulfield has claimed he did, in fact, lose weight, but not from “detoxification” but more simply from a lack of calories being consumed over the period of time, not from a magical diet that cuts out wheat and sugars (as the Clean Cleanse does). |
| http://blog.cleanprogram.com/elimination-diet | http://blog.cleanprogram.com/elimination-diet | ||
| This is a link to the program diet. There is no rhyme or reason to any of these foods being validated on the program list, but people lose weight and therefore the program continues to grow. | This is a link to the program diet. There is no rhyme or reason to any of these foods being validated on the program list, but people lose weight and therefore the program continues to grow. | ||
| - | The unfortunate reality of these crash diets is that only 5% of individuals will actually keep the weight off for any extended period of time. This is why a continuation of healthy eating and living is the truly only effective way to lose weight and maintain it. | + | The unfortunate reality of these crash diets is that only 5% of individuals will actually keep the weight off for an extended period of time. This is why a continuation of healthy eating and living is the truly only effective way to lose weight and maintain it. |
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| <box 20% round right | > {{ :diet.png?200|}} </box| Figure 8: https://d2ebzu6go672f3.cloudfront.net/media/content/images/p6_HeartFood_N1801_ts516546584.jpg > | <box 20% round right | > {{ :diet.png?200|}} </box| Figure 8: https://d2ebzu6go672f3.cloudfront.net/media/content/images/p6_HeartFood_N1801_ts516546584.jpg > | ||
| - | The main component to the treatment of obesity is to have healthier modifications to the individuals diet. The goal for dietary therapy as well as each of the other lifestyle changes is to have the energy intake be lower than the energy expenditure, essentially having a negative energy balance.<sup>[38]</sup> | + | The main component to the treatment of obesity is to have healthier modifications to the individual's diet. The goal for dietary therapy as well as each of the other lifestyle changes is to have the energy intake be lower than the energy expenditure, essentially having a negative energy balance.<sup>[38]</sup> |
| - | There are many types of diets prescribed to obese individuals, the main ones that are studied are the low-fat diet, very low-fat diet, high protein diet and low carbohydrate diet. The low-fat diet restricts individuals to consume 20-35% of their dietary calories in fats.<sup>[38]</sup> These diets are the most studied of all dietary approaches to weight loss and have shown a significant weight decrease in individuals following this diet. The very low-fat diet restricts individuals to consume less than or equal to 20% of their dietary calories from fats.<sup>[38]</sup> These diets are primarily plant based, studies have shown that participants following the Ornish diet (a very low-fat diet) experienced significant weight loss and improvements in CVD risk factors.<sup>[38]</sup> | + | There are many types of diets prescribed to obese individuals, the main ones that are studied are the low-fat diet, very low-fat diet, high protein diet and low carbohydrate diet. The low-fat diet restricts individuals to consume 20-35% of their dietary calories in fats.<sup>[38]</sup> These diets are the most studied of all dietary approaches to weight loss and have shown a significant weight decrease in individuals following this diet. The very low-fat diet restricts individuals to consume less than or equal to 20% of their dietary calories from fats.<sup>[38]</sup> These diets are primarily plant-based, studies have shown that participants following the Ornish diet (a very low-fat diet) experienced significant weight loss and improvements in CVD risk factors.<sup>[38]</sup> |
| The high protein diet is when the intake of dietary protein is higher than 25% of the individuals daily calories. Studies have proven the efficacy of both weight loss and improvements in body composition with this diet.<sup>[38]</sup> Individuals following a high protein diet, decrease their waist circumference, waist to hip ratio and intra-abdominal adipose tissue.<sup>[38]</sup> This diet is of great interest due to the fact that certain chronic diseases are associated with these body composition.<sup>[38]</sup> | The high protein diet is when the intake of dietary protein is higher than 25% of the individuals daily calories. Studies have proven the efficacy of both weight loss and improvements in body composition with this diet.<sup>[38]</sup> Individuals following a high protein diet, decrease their waist circumference, waist to hip ratio and intra-abdominal adipose tissue.<sup>[38]</sup> This diet is of great interest due to the fact that certain chronic diseases are associated with these body composition.<sup>[38]</sup> | ||
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| The first component to the weight loss therapy is to treat obesity by increasing the levels of the obese individual’s physical activity.<sup>[39]</sup> The goal for any weight loss program is to have a negative energy balance at the end of the day, so the individual should aim to increase their energy expenditure and physical activity is an excellent way to do so.<sup>[39]</sup> Physical activity is linked to increased weight loss and weight management.<sup>[39]</sup> | The first component to the weight loss therapy is to treat obesity by increasing the levels of the obese individual’s physical activity.<sup>[39]</sup> The goal for any weight loss program is to have a negative energy balance at the end of the day, so the individual should aim to increase their energy expenditure and physical activity is an excellent way to do so.<sup>[39]</sup> Physical activity is linked to increased weight loss and weight management.<sup>[39]</sup> | ||
| - | It is important to take note that not every exercise routine responds the same way to each individual, one type may be more effective at reducing weight for some individuals than others. There are a variety of different exercise routines which can involve running, walking, rowing, free weights or a combination of any of these.<sup>[39]</sup> It is very difficult for obese individuals to lose weight due to all of the variables associated with their weight gain and because of this it can be just as much of a mental battle as a physical one, so it is recommended that the individuals acquire a trainer that can help them with their exercise regime as well as help set realistic goals throughout the process. A meta-analysis done by Shaw et al., 2006 showed that exercise is an excellent weight loss intervention and the effects are improved with the combination of dietary modifications as well.<sup>[39]</sup> They also found that exercise was able to alleviate secondary symptoms associated with obesity like cardio vascular disease, blood pressure.<sup>[39]</sup> | + | It is important to take note that not every exercise routine responds the same way to each individual, one type may be more effective at reducing weight for some individuals than others. There are a variety of different exercise routines which can involve running, walking, rowing, free weights or a combination of any of these.<sup>[39]</sup> It is very difficult for obese individuals to lose weight due to all of the variables associated with their weight gain and because of this it can be just as much of a mental battle as a physical one, so it is recommended that the individuals acquire a trainer that can help them with their exercise regime as well as help set realistic goals throughout the process. A meta-analysis was done by Shaw et al., 2006 showed that exercise is an excellent weight loss intervention and the effects are improved with the combination of dietary modifications as well.<sup>[39]</sup> They also found that exercise was able to alleviate secondary symptoms associated with obesity like cardiovascular disease, blood pressure.<sup>[39]</sup> |
| === Behavioural Modifications === | === Behavioural Modifications === | ||
| <box 20% round right | > {{ :screen_shot_2018-02-02_at_6.26.10_pm.png?200|}} </box| Figure 9: Illustration of Cognitive Behavioural Therapy http://stewartoncbt.co.uk/wp-content/uploads/2011/12/cbt.jpg > | <box 20% round right | > {{ :screen_shot_2018-02-02_at_6.26.10_pm.png?200|}} </box| Figure 9: Illustration of Cognitive Behavioural Therapy http://stewartoncbt.co.uk/wp-content/uploads/2011/12/cbt.jpg > | ||
| - | Behavioural therapy has recently started to become added into the therapies alongside the exercise and dietary modifications. This is because obesity is thought to be a result of maladaptive eating patterns and exercise habits and that these behaviours can be modified with specific interventions which will lead to weight loss.<sup>[40]</sup> The main goal for behavioural therapy is to help individuals with obesity develop skills that can help them achieve and maintain a healthier body weight. Cognitive behavioral therapy has become popular over the past two decades.<sup>[40]</sup> | + | Behavioural therapy has recently started to become added into the therapies alongside the exercise and dietary modifications. This is because obesity is thought to be a result of maladaptive eating patterns and exercise habits and that these behaviours can be modified with specific interventions which will lead to weight loss.<sup>[40]</sup> The main goal for behavioural therapy is to help individuals with obesity develop skills that can help them achieve and maintain a healthier body weight. Cognitive behavioural therapy has become popular over the past two decades.<sup>[40]</sup> |
| A few of the common components used in behavioural therapy are:<sup>[40]</sup> | A few of the common components used in behavioural therapy are:<sup>[40]</sup> | ||
| · Self-monitoring: this includes keeping a daily food log of all of the meals the individual has had throughout the day. | · Self-monitoring: this includes keeping a daily food log of all of the meals the individual has had throughout the day. | ||
| - | · Stimulus control: the purpose for this component is to alter the environment for the individual in order to avoid over eating. This is to basically eliminate energy dense foods from the home and replace it with nutrient dense foods. | + | · Stimulus control: the purpose for this component is to alter the environment for the individual in order to avoid overeating. This is to basically eliminate energy-dense foods from the home and replace it with nutrient-dense foods. |
| · Goal setting: setting realistic goals for both the short and long term. | · Goal setting: setting realistic goals for both the short and long term. | ||
| · Behavioural contracting: reinforcing of good behaviours. | · Behavioural contracting: reinforcing of good behaviours. | ||
| - | · Social support: it has been shown that behavioural modifications have become more sustainable in the long term with social support. Receiving encouragement from family and friends can be effective with losing more weight. | + | · Social support: it has been shown that behavioural modifications have become more sustainable in the long term with social support. Receiving encouragement from family and friends can be effective in losing more weight. |
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| Another line of treatment for obesity is to use medication in combination with the lifestyle changes mentioned above. Two popular obesity medications are in the classes of lipase inhibitors and appetite suppressants. | Another line of treatment for obesity is to use medication in combination with the lifestyle changes mentioned above. Two popular obesity medications are in the classes of lipase inhibitors and appetite suppressants. | ||
| - | Lipase inhibitors function to prevent the absorption of fats from the individuals diet therefore reducing caloric intake. Orlistat is a common lipase inhibitor used to combat obesity, it is a derivative of lipstatin which is a natural inhibitor of pancreatic lipases.<sup>[41]</sup> Orlistat has been proven with definitive results to work with weight loss. A study showed that when prescribed orlistat combined with lifestyle changes individuals lost been 3% and 9% of their initial weight within one year compared to a control group who only underwent lifestyle changes.<sup>[42]</sup> | + | Lipase inhibitors function to prevent the absorption of fats from the individual's diet, therefore, reducing caloric intake. Orlistat is a common lipase inhibitor used to combat obesity, it is a derivative of lipstatin which is a natural inhibitor of pancreatic lipases.<sup>[41]</sup> Orlistat has been proven with definitive results to work with weight loss. A study showed that when prescribed orlistat combined with lifestyle changes individuals lost been 3% and 9% of their initial weight within one year compared to a control group who only underwent lifestyle changes.<sup>[42]</sup> |
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| === Bariatric Surgery === | === Bariatric Surgery === | ||
| - | Bariatric surgery is a weight loss procedure which aims to decrease the size of the obese individuals stomach by either a gastric band or the removal of a portion of the stomach.<sup>[44]</sup> It is not recommended for individuals below a BMI of 40 to undergo bariatric surgery. Post-surgery patients are only able to have a clear liquid diet which is continued until the gastro intestinal tract is healed.<sup>[44]</sup> Once that stage is complete a blended diet where foods high in protein are recommended alongside soft meals. Finally, once recovery is complete the patient is able to eat all types of foods again, but they are restricting from over eating due to the surgery. If they over eat they will reach the capacity of their stomach which will cause discomfort.<sup>[44]</sup> | + | Bariatric surgery is a weight loss procedure which aims to decrease the size of the obese individual's stomach by either a gastric band or the removal of a portion of the stomach.<sup>[44]</sup> It is not recommended for individuals below a BMI of 40 to undergo bariatric surgery. Post-surgery patients are only able to have a clear liquid diet which is continued until the gastrointestinal tract is healed.<sup>[44]</sup> Once that stage is complete a blended diet where foods high in protein are recommended alongside soft meals. Finally, once recovery is complete the patient is able to eat all types of foods again, but they are restricted from overeating due to the surgery. If they over eat they will reach the capacity of their stomach which will cause discomfort.<sup>[44]</sup> |
| <box 45% round | > {{ :bariatric_surgery.png?500|}} </box| Figure 10: Different Types of Bartric Surgery Procedures. http://asamed.net/wp-content/uploads/2017/02/bariatric-surgeries-2.jpg > | <box 45% round | > {{ :bariatric_surgery.png?500|}} </box| Figure 10: Different Types of Bartric Surgery Procedures. http://asamed.net/wp-content/uploads/2017/02/bariatric-surgeries-2.jpg > | ||
| - | Studies have proven the effectiveness of this procedure in causing significant weight loss in the long term as well as secondary effects like recovery from diabetes, CVD and reduction in mortality.<sup>[45]</sup> There is great debate at the moment whether individuals with type 2 diabetes shoul be given bariatric surgery because of the success it has with diabetes remission; more research needs to be done on the topic with the focus group as well as the proper timing for the most effective treatment.<sup>[45]</sup> | + | Studies have proven the effectiveness of this procedure in causing significant weight loss in the long term as well as secondary effects like recovery from diabetes, CVD and reduction in mortality.<sup>[45]</sup> There is great debate at the moment whether individuals with type 2 diabetes should be given bariatric surgery because of the success it has with diabetes remission; more research needs to be done on the topic with the focus group as well as the proper timing for the most effective treatment.<sup>[45]</sup> |
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| Gene therapy is a hot topic in the science community at the moment, and advances in this technology and the understanding of the molecular basis for obesity have allowed for researchers to design therapies to tackle this disease. The main goal for gene therapy is to increase gene products in favour of fat loss and energy expenditure.<sup>[46]</sup> | Gene therapy is a hot topic in the science community at the moment, and advances in this technology and the understanding of the molecular basis for obesity have allowed for researchers to design therapies to tackle this disease. The main goal for gene therapy is to increase gene products in favour of fat loss and energy expenditure.<sup>[46]</sup> | ||
| - | The most studied gene directly linked to obesity is leptin, which plays a role in appetite and energy expenditure. It is thought that obese individuals have a mutation within this gene. A defect in the ob gene coding for leptin has been linked to sever obesity.<sup>[46]</sup> It was found that mice who homozygous for this defect in the leptin gene ate excessively and developed obesity. Researchers found that the delivery of leptin into the brain though a recombinant virus into mice was able to generate long term beneficial effects with body weight.<sup>[46]</sup> Another study aimed to show that leptin sensitivity was also crucial with the weight loss with mice, because HFD mice were unresponsive with the treatment but when they were delivered leptin receptor gene reduction in body weight was seen.<sup>[46]</sup> | + | The most studied gene directly linked to obesity is leptin, which plays a role in appetite and energy expenditure. It is thought that obese individuals have a mutation within this gene. A defect in the ob gene coding for leptin has been linked to severe obesity.<sup>[46]</sup> It was found that mice who homozygous for this defect in the leptin gene ate excessively and developed obesity. Researchers found that the delivery of leptin into the brain through a recombinant virus into mice was able to generate long-term beneficial effects with body weight.<sup>[46]</sup> Another study aimed to show that leptin sensitivity was also crucial with the weight loss with mice because HFD mice were unresponsive with the treatment but when they were delivered leptin receptor gene reduction in body weight was seen.<sup>[46]</sup> |
