Obesity update needed in Masters Course at National Lipid Association.

PROPOSED EDITORIAL

by Brian Scott Edwards MD

American Board of Obesity certified

NLA board certified

Fellow NLA

Obesity not well covered by NLA

May 2016 New Orleans

I listened to a talk on nutrition  at the National Lipid Association Masters Course.

Unfortunately no distinction is made for insulin resistant  patients who would probably benefit from low carbohydrate high fat diet.  The American Diabetic Association does approve of LCHF as a possible weight loss diet. 

Saturated fat again is said to universally raise LDLc.  No mention of LDLp or apoB effect but they did say don't replace SF's with refined carbohydrates.   They also pointed out that  monkeys don't do well on Olive oil.

My main concern is that this update on Minnesota trial was never discussed.
 Buried files found on Minnesota trial.

Moving on to the coverage of Obesity.
  Any diet to lose weight is fine. 

The challenge is to maintain weight loss. 
 There were slides for this but basically the speaker only said maintaining weight loss is very difficult and then was vague about the reasons. 

I suggest the following needs to be incorporated into the teaching program at the very least for balance. 

Reduced obese failure to maintain weight loss explained here on HBO WEIGHT LOSS NATION 1 min video has been validated in recent New York Times article by Gina Kolata here:

Biggest Loser has 800 calories BMR decrease lower than expected with energy gap

Low Leptin in reduced obese tells brain it is starving.
 This is the salient point of why reduced obese regain despite diet and exercise. 
  Guidelines state 1 hour a day exercise will maintain weight loss.
 The National Weight Control Registry (NWCR) people do this with 1200 to 1500 calorie diet.
It is possible.

However,
 The Great Starvation Experiment by Ancel Keys  drove 32 men crazy with starvation over 24 weeks on 1550 calories/day  and one hour walking a day which  is what guidelines expect reduced obese to do for the rest of their lives just to maintain their weight loss.

Patients are told it's diet and exercise and will power that will maintain their weight loss and the evidence is with the 10,000 people in NCWR who have done it.

Reduced obese have to do Ancel Keys Starvation diet it for the rest of their lives.
NOT possible for most people as in LOOK AHEAD who failed under the best of circumstances.

In LOOK AHEAD trial the difference with control group was 2.5% weight loss. 
50% NWCR people do it completely on their own.  Amazing group of people.
Look how well the Control Group in LOOK AHEAD did without help

Treated group in LOOK AHEAD:
39% maintained greater than 10% weight loss for 8 years. 
Untreated Control Group in LOOK AHEAD:
24% of the control group lost more than 10% of weight after 8 years.

 How to tell the brain it is not starving in the Reduced Obese group. ?
The Chronic Disease of Obesity needs lifelong drugs.
4 new diet medications


My suggestion for future speakers on Nutrition and Obesity at NLA is to read two recent reviews by

Ochner and Greenway