changing my weight destiny - ywmconvention.com · erica & justin sonnenburg, phd’stracey...
TRANSCRIPT
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Christopher Gardner, PhD Rehnborg Farquhar Professor of Medicine
Stanford Prevention Research Center Stanford University
Changing my Weight Destiny: Can I Choose a Diet
that Better Matches my Biology?
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Outline Ø Background and Context Ø DietFits: Design & Methods
Ø Preliminary Results
Ø Preliminary Conclusions
Ø Future Directions
Ø Take Home Points
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Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults
The Evidence Report. National Institutes of Health. Obesity Research 1998;6(Suppl)2:51S-209S.
≥55% energy from carbohydrate
≤30% energy from fat
and approximately 15% energy from protein
Carb Fat Protein >55%
<30%
~15%
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All of the following are associated with weight loss AHA-style Step 1 Higher protein Higher protein Zone-type Lacto–ovo–vegetarian–style Low calorie Low carbohydrate Low fat Low fat vegan-style Lower fat, high-dairy Low–glycemic–load Macronutrient targeted diets Mediterranean style Moderate protein
With prescribed energy restriction, or Without formal prescribed energy restriction, but with a realized energy deficit.
…if reduction in dietary energy intake is achieved:
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Acceptable macronutrient distribution ranges (AMDR)
Percentages of daily calories from carbohydrate, fat and protein sufficient to provide adequate total energy intake and nutrients while reducing the risk of chronic disease.
45-65% Carbohydrate
20-35% Fat
10-35% Protein
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Carbs 45 60 45 55 65
Fats 35 20 25 30 25
Protein 20 20 30 15 10
Let’s call it Std American Diet (SAD) Low Fat / High Carb High Protein Food Pyramid / My Plate Hi Carb / Low Fat / Low Pro
Possible Combinations
Acceptable macronutrient distribution ranges (AMDR)
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Carbs ~15 ~40 ~30 40
~75
Fats ~50 ~40 ~40 30
~10
Protein ~35 ~20 ~30 30
~15
Let’s call it Atkins Diet Mediterranean Diet Paleo Diet Zone Diet Ornish Very Low Fat Diet
= Outside AMDR
Outside the range of AMDR
Possible Combinations
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-9 -8 -7 -6 -5 -4 -3 -2 -1 0
Base- line
8 weeks
6 months 1 year
Atkins
Zone Ornish
Percent weight change across time, by group
LEARN Weight change as % of baseline
Gardner, JAMA 2007;297:969-77
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12-month net weight change (kg): Individual results
-30 -25 -20 -15 -10 -5 0 5 10 15 20
-30 -25 -20 -15 -10 -5 0 5 10 15 20
-30 -25 -20 -15 -10 -5 0 5 10 15 20
-30 -25 -20 -15 -10 -5 0 5 10 15 20
Gardner, JAMA 2007;297:969-77
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12-month net weight change (kg): Individual results
-30 -25 -20 -15 -10 -5 0 5 10 15 20
-30 -25 -20 -15 -10 -5 0 5 10 15 20
-30 -25 -20 -15 -10 -5 0 5 10 15 20
-30 -25 -20 -15 -10 -5 0 5 10 15 20
Gardner, JAMA 2007;297:969-77
~65 lb RANGE of weight change
WITHIN each diet group.
From losing 45-55 lbs to gaining 10-15 lbs
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Dansinger et al., Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction: A Randomized Trial. JAMA, 2005; 293:43-53
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Outline Ø Background and Context
Ø DIETFITS: Design & Methods
Ø Preliminary Results
Ø Preliminary Conclusions
Ø Future Directions
Ø Take Home Points
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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Do Genotype Patterns Predict Weight Loss Success for Low Carb vs. Low Fat Diets?
R01 DK091831 (2013-17), Nutrition Science Initiative (NuSI)
Christopher Gardner, PhD Professor of Medicine, Nutrition Scientist
DIETFITS Study
Diet Intervention Examining The Factors Interacting with Treatment Success
Healthy Low-Fat vs. Healthy Low-Carb
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Reframe the Question What is the “best diet”?
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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What is the “best diet”?
Which diet is best
for whom?
Reframe the Question
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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Main Hypothesis
12-month weight loss success WITHIN diet groups for both a Healthy Low-Fat & Healthy Low-Carb diet,
will differ by Genotype and Insulin Resistance
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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Do Genotype Patterns Predict Weight Loss Success for Low Carb vs. Low Fat Diets? NIH, Nutrition Science Initiative, and donors
n=609 BMI 28-40 kg/m2
non-diabetic generally healthy adults 18-50 yrs (57% women)
Low Carbohydrate (n=305) .
Low Fat (n=304) Months 0 12 3 6
INTERVENTION: 22 group classes, 15-22 participants/group
XXXXXXXX X X X X X X X X X X X X X X
WEIGHT (1° outcome) X X X XBlood (DNA, lipids, glucose, insulin, OGTT, cytokines) X X X X
X X X XDiet Assessment (NDS-R)
Psychosocial (Questionnaires) X X X XDEXA, REE (Metabolic cart) X X X
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Healthy Low-Fat vs. Healthy Low-Carb
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Outline Ø Background and Context
Ø DIETFITS: Design & Methods
Ø Preliminary Results Ø Preliminary Conclusions
Ø Future Directions
Ø Take Home Points
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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Macronutrient Distribution K
cals
0
500
1,000
1,500
2,000
2,500
Protein
Fat
Carb
22%
53%
24%
Low Fat
26%
23%
49%
Low Carb
21%
51%
26%
Low Fat
24%
27%
47%
Low Carb
21%
48%
29%
Low Fat
23%
30%
45%
Low Carb
Baseline 3-months 6-months 12-months
18%
45%
35%
Low Fat
45%
36%
Low Carb
17%
36%
45%
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-35 -30 -25 -20 -15 -10
-5 0 5
10 15
-35 -30 -25 -20 -15 -10
-5 0 5
10 15
WeightC
hange(kg)
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
0
0RangeofWeightLossinBOTHgroups
Fromlosing~30kg(65lbs)togaining~10kg(~20lbs)
~40kg(85lb)rangeofresponsetothesamedietaryinstrucJon!!!
12-monthWeightChange(kg)(Eachbarrepresentsoneindividual)
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-35 -30 -25 -20 -15 -10
-5 0 5
10 15
-35 -30 -25 -20 -15 -10
-5 0 5
10 15
WeightC
hange(kg)
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
12-monthWeightChange(kg)(Eachbarrepresentsoneindividual)0
0
>6,500 lbs lost
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0
-10
-20
-30
10
kg
Low-Fat Low-Carb
Lowest Tertile
Middle Tertile
Highest Tertile
Lowest Tertile
Middle Tertile
Highest Tertile
Most Middle
Least Least
Most
Hypothesized DIET X INSULIN Difference:
Middle
Mean ± sem
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0
-10
-20
-30
10
kg
Hypothesized DIET X GENOTYPE Difference:
Low-Fat Low-Carb
Matched
More
Mis- Matched
Less
Matched
More
Mis- Matched
Less
Low-Fat Genotype
Low-Carb Genotype
Mean ± sem
Low-Fat Genotype
Low-Carb Genotype
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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Other Health Factors Healthy Low-Fat
Lower LDL-C Healthy Low-Carb Lower Triglycerides
Higher HDL-C
Similar Improvement (both diets) Glucose Insulin
Metabolic Syndrome Body Composition
Resting Energy Expenditure DIETFITS
Hlthy Low-Fat vs Hlthy Low-Carb
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DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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-70-60-50-40-30-20-100102030
ChangeinLeanandFatMass(lbs)at12Months
ChangeinTotalLean(lbs)-12M ChangeinTotalFat(lbs)-12M
HealthyLow-Fat HealthyLow-Carb
Poun
ds
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Outline Ø Background and Context
Ø DIETFITS: Design & Methods
Ø Preliminary Results
Ø Preliminary Conclusions
Ø Future Directions
Ø Take Home Points DIETFITS
Hlthy Low-Fat vs Hlthy Low-Carb
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Genome 3-SNP Multilocus Genotype
Pattern Not Helpful
Possibly an
alternate Genetic Risk
Score??
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Metabolism
INS-30 - Not Helpful
Possibly an alternate parameter related to glucose-insulin dynamics?
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Microbiome
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Outline Ø Background and Context
Ø Design & Methods
Ø Preliminary Results
Ø Preliminary Conclusions
Ø Future Directions
Ø Take Home Points
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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Healthy Low-Fat vs. Healthy Low-Carb
QUALITY ??
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“...the study helped me change my
relationshipwith food.”
Quote from a highly successful participant
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All of the following are associated with weight loss AHA-style Step 1 Higher protein Higher protein Zone-type Lacto–ovo–vegetarian–style Low calorie Low carbohydrate Low fat Low fat vegan-style Lower fat, high-dairy Low–glycemic–load Macronutrient targeted diets Mediterranean style Moderate protein
With prescribed energy restriction, or Without formal prescribed energy restriction, but with a realized energy deficit.
…if reduction in dietary energy intake is achieved:
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Some participants possibly should have been screened for, and helped
with, emotional & psychological challenges
Emily Amundson Masters Student
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
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DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
Genetic Risk Score
UK Biobank Axiom® Array
Liana Del Gobbo PhD
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John Trepanowski
Glucose & Insulin Dynamics
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Healthy Low-Fat vs. Healthy Low-Carb
Michelle Hauser
Jennifer Hartle
Sarah Farzinkhou
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Lucia Aronica
Epigenetics
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Microbiome
Erica&JusJnSonnenburg
PhDJulieParsonnet
MD
ErinAveryMS
LisaOffringaPhD
Cohort2–723samplesCohort3–538samples
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Outline Ø Background and Context
Ø Design & Methods
Ø Preliminary Results
Ø Preliminary Conclusions
Ø Future Directions
Ø Take Home Points DIETFITS
Hlthy Low-Fat vs Hlthy Low-Carb
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Diets
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Veggies
![Page 49: Changing my Weight Destiny - ywmconvention.com · Erica & Justin Sonnenburg, PhD’sTracey McLaughlin Julie Parsonnet, MD MD, MPH ... Antonella Dewell Rise Cherin Joe Rigdon Emily](https://reader036.vdocument.in/reader036/viewer/2022062908/5ac3b7227f8b9a12608c3f90/html5/thumbnails/49.jpg)
Added Sugars
![Page 50: Changing my Weight Destiny - ywmconvention.com · Erica & Justin Sonnenburg, PhD’sTracey McLaughlin Julie Parsonnet, MD MD, MPH ... Antonella Dewell Rise Cherin Joe Rigdon Emily](https://reader036.vdocument.in/reader036/viewer/2022062908/5ac3b7227f8b9a12608c3f90/html5/thumbnails/50.jpg)
White Wheat Flour
![Page 51: Changing my Weight Destiny - ywmconvention.com · Erica & Justin Sonnenburg, PhD’sTracey McLaughlin Julie Parsonnet, MD MD, MPH ... Antonella Dewell Rise Cherin Joe Rigdon Emily](https://reader036.vdocument.in/reader036/viewer/2022062908/5ac3b7227f8b9a12608c3f90/html5/thumbnails/51.jpg)
Veggies
Added Sugars
White Wheat Flour
![Page 52: Changing my Weight Destiny - ywmconvention.com · Erica & Justin Sonnenburg, PhD’sTracey McLaughlin Julie Parsonnet, MD MD, MPH ... Antonella Dewell Rise Cherin Joe Rigdon Emily](https://reader036.vdocument.in/reader036/viewer/2022062908/5ac3b7227f8b9a12608c3f90/html5/thumbnails/52.jpg)
Improved relationship with food(i.e., don’t eat in car, cook more, eat meals with family)
Address emotional and psychological
issues related to food
Achieve calorie restriction without prescribing it (satiety)
Take Home Points
![Page 53: Changing my Weight Destiny - ywmconvention.com · Erica & Justin Sonnenburg, PhD’sTracey McLaughlin Julie Parsonnet, MD MD, MPH ... Antonella Dewell Rise Cherin Joe Rigdon Emily](https://reader036.vdocument.in/reader036/viewer/2022062908/5ac3b7227f8b9a12608c3f90/html5/thumbnails/53.jpg)
Abby King, PhD John Ioannidis, MD, DSc Manisha Desai, PhD
Erica & Justin Sonnenburg, PhD’s
Julie Parsonnet, MD Tracey McLaughlin MD, MPH Robert Haile
DrPH Megan Hitchins
PhD
Holden Maecker PhD Mark Davis
MD, PhD Kari Nadeau MD, PhD
Tim Assimes MD, PhD Josh Knowles
MD, PhD Erik Ingelsson MD, PhD
![Page 54: Changing my Weight Destiny - ywmconvention.com · Erica & Justin Sonnenburg, PhD’sTracey McLaughlin Julie Parsonnet, MD MD, MPH ... Antonella Dewell Rise Cherin Joe Rigdon Emily](https://reader036.vdocument.in/reader036/viewer/2022062908/5ac3b7227f8b9a12608c3f90/html5/thumbnails/54.jpg)
Valerie Alaimo
Josephine Hau
Sue Kirkpatrick
Sarah Farzinkhou
Dalia Perelman Jae Berman
Mollie Shimer Diane Demis
Lisa Offringa Katherine Dotter Jennifer Hartle Erin Avery
Alana Koehler Jennifer Robinson
Mandy Murphy
Sarah Mummah
Michelle Hauser
Antonella Dewell
Rise Cherin
Joe Rigdon
Emily Amundson
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Thank you - Stay Tuned
DIETFITS Hlthy Low-Fat vs Hlthy Low-Carb
Questions ??