Assessment no

Obesity: A Very Individual Conundrum
Lorraine Nicolle
July 2006
What’s going on with obesity? We
him/her there in the first place. This is expect an obese person to become slim without first understanding the Figure 1: The hub of the nutritional therapist’s approach is ‘getting to know the individual’. Hormones
Blood sugar
is ‘insulin resistance’. And if that wasn’t bad enough, Brain chemicals
first nutrients to be depleted by dieting18. the specific proportions of fatty acids in the individual’s circulation Joined-up patient care
The NT does not expect her approach to work in isolation. Psychological support33,34
and behavioural intervention, such as stress management and regular exercise8,35,
are equally as important and the NT will refer the client to appropriate specialists in
these areas.
The Bedrock of the Protocol:
A Low Energy, Low Glycaemic, Wholefood Eating Plan

A low glycaemic index (GI) diet comprises foods that have minimal effects on blood
sugar and insulin levels. This controls appetite, promotes weight loss36,37,38 and
reduces the risk of diabetes and heart disease13,39, to which obese people are prone.
Even greater weight loss may occur if the diet is adapted to consist almost entirely of
low energy, nutrient-dense foods40.
Such a diet would include fresh fruit and vegetables, fish, eggs, poultry, pulses,
beans, seeds and small amounts of whole grains and unprocessed olive and seed
oils. Sugar, refined and processed foods, saturated, hydrogenated and trans-fats,
tea, coffee, alcohol and carbohydrate-only meals are kept to the absolute minimum.
Meals are small, but regular. Separate studies have also found dietary fibre41, a high
protein-to-carbohydrate ratio42 and high protein breakfasts43 (all elements of a low-GI
diet), to be helpful.
The nutritional protocol
diet (see box). This is then tailored to the individual by adding specific nutrient interventions to address any Ultimately, there is no miracle cure for
obesity. But if just a small part of the individual to feel deprived. The NT


References

1. Brochu M, Poehlman ET, Ades PA (2000). Obesity, body fat distribution and coronary artery disease. Journal of Cardiopulmonary Rehabilitation. 20:96-108. 2. Kershaw EE and Flier JS (2004). Adipose tissue as an endocrine organ. The Journal of Clinical Endocrinology and Metabolism. 89(6):2548-2556. 3. Bergstrom A, Pisani P, Tenet V, Wok A, Adami HO (2001). Overweight as an avoidable cause of cancer. International Journal of Cancer. 9(3):421-30. 4. Bray GA (2002). The underlying basis for obesity: relationship to cancer. The Journal of Nutrition. 132(11 Suppl):3451S-5S. 5. Bloom S (2005). Appetite, the gut and obesity. Physiology News. 59:27-8. 6. House of Commons Health Committee (2004). Obesity: Third report of session 2003- 04. Volume 1. The Stationery Office Ltd. 7. National Audit Office (2001). Tackling Obesity in England. Report by the Comptroller and Auditor General. The Stationery Office Ltd. 8. Prentice AM and Jebb SA (1995). Obesity in Britain: Gluttony or Sloth? BMJ. 9. Prentice AM, Black AE, Murgatroyd PR, Goldberg GR, Coward WA (1989). Metabolism or appetite? Questions of energy balance with particular reference to obesity. Journal of Human Nutrition and Dietetics. 2:95-104. 10. Lichtman SW, Pisarska K. Berman ER, Pestone M, Dowling M, Offenbacher E (1992). Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. New England Journal of Medicine. 327:1893-8. 11. Quistorff B and Grunnett N (2003). Transformation of sugar and other carbohydrates into fat in humans. Ugeskrift for Laeger. 165(15):1551-2. 12. Gunczler P and Lanes R (2006). Relationship between different fasting-based insulin sensitivity indices in obese children and adolescents. Journal of Pediatric Endocrinology and Metabolism. 19(3):259-65. 13. Ludwig DS (2003). Novel treatments for obesity. Asia Pacific Journal of Clinical 14. Livesey G (2005). Low-glycaemic diets and health: implications for obesity. Proceedings of the Nutrition Society. 64(1):105-13. 15. Pawlak DB, Kushner JA, Ludwig DS (2004). Effects of dietary glycaemic index on adiposity, glucose homeostasis and plasma lipids in animal. The Lancet. 364(9436):778-85. 16. Roche HM (1999). Unsaturated fatty acids. Proceedings of the Nutrition Society. 17. Lovejoy JC (1999). Dietary fatty acids and insulin resistance. Current Atherosclerosis 18. Anderson IM, Parry-Billings M, Newsholme EA, Fairburn CG and Cowen PJ (1990). Dieting reduces plasma tryptophan and alters brain 5HTP function in women. Psychological Medicine. 20:785-791. 19. Wurtman RJ and Wurtman JJ (1996). Brain serotonin, carbohydrate-craving, obesity and depression. Advances in Experimental Medicine and Biology. 398:35-41. 20. Bralley JA and Lord RS (2002). Organic Acids in Urine in Laboratory Evaluations in Molecular Medicine: Nutrients, Toxicants and Cell Regulators. USA: Institute for Advances in Molecular Medicine. 21. Cangiano C, Ceci F, Cascino A (1992). Eating behaviour and adherence to dietary prescriptions in obese adult subjects treated with 5-hydroxytryptophan. American Journal of Clinical Nutrition. 56:863-7. 22. Cangiano C, LAvano A, Del Ben M (1998). Effects of oral 5-hydroxytryptophan on energy intake and macronutrient selection in non-insulin dependent diabetic patients. International Journal of Obesity Related Metabolism Disorders. 22:648-54. 23. Salarkia N, Hedayati M, Mirmiran P, Kimiagar M, Azizi F (2003). Evaluation of the impact of an iodine supplementation programme on severely iodine-deficient schoolchildren with hypothyroidism. Public Health Nutrition. 6(6):529-33. 24. Chanoine JP (2003). Selenium and thyroid function in infants, children and adolescents. Biofactors. 19(3-4):137-43. 25. Redmond GP (2004). Thyroid dysfunction and women’s reproductive health. Thyroid. 26. Bentley GR, Gann PH, Hodges KR, Chatterton RT (1999). Salivary estradiol and progesterone levels in conception and nonconception cycles in women: evaluation of a new assay for salivary estradiol. Fertility and Sterility. 71(5):863-8. 27. Aardal E, Holm AC (1995). Cortisol in saliva--reference ranges and relation to cortisol in serum. European Journal of Clinical Chemistry and Clinical Biochemistry. 33(12):927-32 28. Bhathena SJ and Velasquez MT (2002). Beneficial role of dietary phytoestrogens in obesity and diabetes. American Journal of Clinical Nutrition. 76(6):1191-201. 29. Randolph TG (1947). Masked food allergy as a factor in the development and persistence of obesity. Journal of Laboratory and Clinical Medicine. 32:1547. 30. Yamamoto T (2003). Brain Mechanisms of sweetness and palatability of sugars. Nutrition Reviews. 61(5 Pt 2):S5-9. 31. Pelchat ML (2002). Of human bondage: food craving, obsession, compulsion and addiction. Physiology and Behaviour. 76(3):347-52. 32. Bruinsma K and Taren DL (2000). Dieting, essential fatty acid intake and depression. 33. Greenwald A (2006). Current nutritional treatments of obesity. Advances in Psychosomatic Medicine. 27:24-41. 34. Molinari E, Bariffi N, Croci M, Marchi S, PEtroni ML (2005). Binge Eating Disorder: comparison of different therapeutic strategies. Eating and Weight Disorders. 10(3):154-61. 35. Murgatroyd PR, Goldberg GR, Leahy FE (1999). Effects of inactivity and diet composition on human energy balance. International Journal of Obesity and Related Metabolic Disorders. 12:1269-75. 36. Ebbeling CB, Ludwig DS (2001). Treating obesity in youth: should dietary glycemic load be a consideration?’ Advances in Pediatrics. 48:179-212. 37. Brand-Miller JC, Holt SH, PAwlack DB, McMillan J (2002). Glycemic Index and obesity. American Journal of Clinical Nutrition. 76(1):281S-5S 38. Willett WC (2002). Dietary fat plays a major role in obesity: no. Obesity Reviews. 39. Frost G, Leeds AA, Dore CJ, Madeiros S, Brading S, Dornhorst A (1999). Glycaemic index as a determinant of serum HDL-cholesterol concentration. The Lancet. 353(9258):1045-8. 40. Ello-Martin JA, Ledikwe JH, Rolls BJ (2005). The influence of food portion size and density on energy intake: implications for weight management. American Journal of Clinical Nutrition. 82(1Suppl):236S-241S. 41. Bergmann JF, Chassany O, Petit A, Triki R, Caulin C, Segrestaa JM (1992). Correlation between echographic gastric emptying and appetite: influence of psyllium. Gut. 33:1,042-3. 42. Westphal SA, Gannon MC, Nuttall FQ (1990). Metabolic response to glucose ingested with various amounts of protein. American Journal of Clinical Nutrition. 52(2):267-272. 43. Wyatt HR, Grunwald OK, Mosca CL, Klem ML, Wing RR, Hill JO (2002). Long-term weight loss and breakfast in subjects in the National Weight Control Registry. Obesity Research. 10:78-82. 44. Miller WC (1999). How effective are traditional dietary and exercise interventions for weight loss? Medicine and Science in Sports and Exercise. 31:1129-34. 45. Ayyad C and Andersen T (1999). Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obesity Reviews. 1(2):113.

Source: http://www.lorrainenicollenutrition.co.uk/pdfs/ObesityArticle-LorraineNicolle.pdf